Top Line: What are the mental health consequences of Hodgkin lymphoma?
The Study: Several trials have evaluated de-escalation of HL treatment by omitting radiation therapy. While survival outcomes are similar, the risk of recurrence is significantly higher even among the most favorable early stage patients when radiation is omitted. But that hasn’t softened continued calls for replacing this regimen with more chemo at the expense of more recurrences. The argument goes that these recurrences can be salvaged with more intensive treatment that often includes hematopoietic stem cell transplant (HSCT). Here is a novel look at mental health outcomes for 795 patients treated for Hodgkin lymphoma in a Utah cancer registry matched with 3575 patients in a Utah population database. Sadly, patients with a former Hodgkin lymphoma diagnosis were more likely to have a subsequent mental health disorder including anxiety, depression, substance abuse, and even suicide. Furthermore, those diagnosed with a mental health disorder had worse overall survival. The risk of death at 10 years was twice as high for those with mental health disorders (30%) than those without (16%). Was this a direct effect of the mental health disorder, or were patients with worse disease outcomes having related mental health disorders? The only treatment-related factor that was associated with developing a mental health disorder was HSCT. The authors postulate that the use of HSCT in the relapsed and refractory setting may suggest that not only the intensity of treatment but the burden of disease relapse may play an important role in developing mental health disorders. In other words, it is important to consider the long-term mental health consequences of disease relapse in HL.
TBL: Survivors of HL have a high risk of developing mental health disorders, and the risk appears to be greatest among those who experience relapse and require intensive salvage therapy. | Tao, Cancer 2022