Childhood cancer and its treatment come at a risk of late effects for survivors. In fact, the evidence shows that two of every three childhood cancer survivors are at increased risk of at least one late effect due to their cancer or its treatment, including heart disease, second cancers and cognitive challenges.  

A recent study published in JAMA (The Journal of the American Medical Association) looks at the treatment of Hodgkin lymphoma in children and the resulting risk of cardiac disease to survivors.  

POGO Medical Director, Dr. David Hodgson, is the lead author of the study titled Late Cardiac Toxic Effects and Treatment Protocols for Hodgkin Lymphoma in Children. 

“Cardiac disease as a late effect of treating Hodgkin lymphoma is a serious risk that is well documented,” he says. “One of the challenges of improving treatment is that we don’t want to wait for over 20 years to observe the late effects of treatments we’re currently giving today. The goal of this study was to estimate the risk of late effects of current treatment to better understand how to advise current patients and families, and also explore what changes to treatment would have the greatest benefit to reduce these risks.” 

Understanding the extent to which treatment can be modified for improved health outcomes is critical for several reasons. 

• Reducing treatment intensity is a trade-off against the risk of relapse. 
• Understanding which components of treatment can be adjusted, and to what extent, can lead to better decisions about treatment modifications. 
• Care for survivors is based on their treatment exposure making the burden of follow-up care an important consideration. 

The study evaluated the treatment of 2,563 patients with Hodgkin lymphoma treated in four consecutive Children’s Oncology Group clinical trials between 2002 and 2022. Patients were treated with different doses of radiation therapy and doxorubicin chemotherapy – both of which are known to increase the risk of cardiac late effects.  Based on the doses of these treatments, the 30-year cumulative incidence of severe or life-threatening heart disease was estimated to decrease from 10% in the first trial to 6% in the last trial. The findings were favourable, suggesting that evolutions in treating Hodgkin lymphoma will lead to a net reduction in late cardiac disease. Moreover, findings suggest that for adolescent and young adult patients, increasing the use of “cardioprotective” medications during treatment would be one of the best ways to reduce this risk further, without compromising cure rates. 

“While there is still work to be done to monitor the long-term gains in reducing cardiac toxic effects, this is encouraging news that bodes well for the quality of life of childhood cancer survivors,” says Dr. Hodgson. “And, as with every study, we need to ensure that the guidelines for follow-up care of survivors, particularly in POGO AfterCare Clinics, are updated to reflect the latest evidence.” 

Read the study here.