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PubMed This is a summary of 19 peer-reviewed journal articles Updated
Oncology

Life After Treatment: Your Path Forward

At a Glance

After classic Hodgkin lymphoma treatment, survivors need lifelong monitoring for late effects like heart disease, thyroid issues, and secondary cancers. A Survivorship Care Plan is essential, though routine PET scans are not recommended due to radiation risks and false positives.

Completing treatment for classic Hodgkin Lymphoma (cHL) is a major milestone, but it is also the beginning of a new phase of care. Because cHL has such high cure rates, many survivors live for decades after treatment [1]. This long-term success makes it vital to monitor for late effects—health issues that can appear years or even decades after your last dose of medicine [2][3].

Monitoring for Late Effects

Historical treatments were very effective but often carried risks that modern, risk-adapted therapies try to minimize [4]. Regardless of when you were treated, several areas require lifelong attention:

  • Secondary Malignancies: Survivors are at a higher risk of developing a second, different cancer later in life [3][5].
    • Breast Cancer Risk: For those who received radiation to the chest, the risk of breast cancer increases over time. Screening (typically with both mammography and MRI) should begin 8 to 10 years after radiation treatment, but usually not before age 25 [6][7].
    • Lung and Colorectal Cancer: Monitoring for other cancers is also essential, especially for those who have a history of smoking [8][9].
  • Cardiovascular Health: Treatments like chest radiation and certain chemotherapies (specifically anthracyclines like doxorubicin/Adriamycin) can affect the heart [10][11]. Long-term follow-up often includes regular heart health assessments to check for coronary artery disease or valve issues [12][5].
  • Thyroid Function: If you received radiation to the neck or upper chest, your thyroid may eventually become underactive (hypothyroidism) [6]. Doctors monitor this with a simple blood test for thyroid-stimulating hormone (TSH) [6].

Why “More Scans” Aren’t Always Better

It is natural to feel anxious about the cancer returning, a feeling often called “scanxiety.” However, for survivors who are in remission and have no symptoms, routine surveillance PET/CT scans are not recommended [13].

There are three main reasons for this:

  1. They don’t improve survival: Research shows that routine scans do not help survivors live longer compared to regular physical exams and symptom monitoring [13].
  2. Radiation exposure: PET/CT scans use radiation. Adding “extra” radiation to a survivor’s body can slightly increase the risk of future cancers [14][15].
  3. False positives: Scans often find small, harmless spots (like inflammation or scar tissue) that look like cancer. This leads to unnecessary biopsies, procedures, and significant emotional stress [16][17].

Taking Control of Your Long-Term Health

The most powerful tools you have as a survivor are a healthy lifestyle and a proactive medical partnership [10].

  • Stay Active: Regular physical activity can significantly lower the risk of heart disease, even in those who had chest radiation [12][10].
  • Quit Smoking: If you smoke, quitting is the single most important thing you can do to lower your risk of secondary lung cancer and heart issues [8][18].
  • Know Your History: Ensure you have a Survivorship Care Plan—a document that lists your exact chemotherapy drugs, radiation doses, and the specific screenings you need based on those treatments [3][5].

By focusing on these proactive steps, you can move forward with confidence, knowing you are doing everything possible to protect the cure you worked so hard to achieve [19].

Common questions in this guide

Why are routine PET/CT scans not recommended after Hodgkin lymphoma treatment?
Routine surveillance PET/CT scans are not recommended if you are in remission and have no symptoms because they do not improve survival rates. They also expose you to additional radiation and frequently cause false positives, which can lead to unnecessary procedures and anxiety.
What are the long-term heart risks after classic Hodgkin lymphoma treatment?
Treatments like chest radiation and certain chemotherapies, such as anthracyclines, can impact cardiovascular health years later. Your doctor may recommend regular heart health assessments to monitor for conditions like coronary artery disease or heart valve issues.
Will I need special breast cancer screening if I had chest radiation?
Yes, if you received chest radiation, your risk of breast cancer increases over time. Screening, typically with both a mammogram and a breast MRI, is usually recommended to begin 8 to 10 years after your radiation treatment, but generally not before age 25.
How does classic Hodgkin lymphoma treatment affect my thyroid?
Radiation to the neck or upper chest can cause your thyroid gland to become underactive over time, a condition known as hypothyroidism. Doctors monitor this with a simple annual blood test that measures your thyroid-stimulating hormone (TSH) levels.
What is a Survivorship Care Plan?
A Survivorship Care Plan is a personalized document provided by your oncology team that summarizes your exact treatments, including chemotherapy drugs and radiation doses. It outlines the specific medical screenings and follow-up care you will need for the rest of your life.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Given my specific radiation dose and location, when should I begin annual breast cancer screening (if applicable)?
  2. 2.How often should we check my thyroid-stimulating hormone (TSH) levels to monitor for thyroid dysfunction?
  3. 3.What specific cardiovascular tests, such as an echocardiogram or stress test, do I need based on my exposure to anthracyclines and chest radiation?
  4. 4.If I feel a new lump or have a concern, what is the process for getting a diagnostic scan instead of a 'routine' surveillance scan?
  5. 5.Are there specific vaccinations or lifestyle modifications you recommend to protect my health long-term?

Questions For You

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References

References (19)
  1. 1

    PET-adapted approaches to primary therapy for advanced Hodgkin lymphoma.

    Lang N, Crump M

    Therapeutic advances in hematology 2020; (11()):2040620720914490 doi:10.1177/2040620720914490.

    PMID: 32537115
  2. 2

    [Hodgkin's lymphoma and radiotherapy].

    Datsenko PV, Panshin GA

    Voprosy onkologii 2015; (61(1)):45-51.

    PMID: 26016145
  3. 3

    Long-Term Follow-Up of Classical Hodgkin Lymphoma and Diffuse Large B-Cell Lymphoma Survivors: Aims and Methodological Approach for Fondazione Italiana Linfomi Systematic Reviews.

    Gerardi C, Allocati E, Minoia C, et al.

    Cancers 2021; (13(12)) doi:10.3390/cancers13122976.

    PMID: 34198635
  4. 4

    Frontline Therapy for Classical Hodgkin Lymphoma by Stage and Prognostic Factors.

    Allen PB, Gordon LI

    Clinical Medicine Insights. Oncology 2017; (11()):1179554917731072 doi:10.1177/1179554917731072.

    PMID: 28989291
  5. 5

    Long-term risk of cardiovascular disease mortality among classic Hodgkin lymphoma survivors.

    Lu Z, Teng Y, Ning X, et al.

    Cancer 2022; (128(18)):3330-3339 doi:10.1002/cncr.34375.

    PMID: 35872619
  6. 6

    Best practice & research clinical haematology: Screening for breast cancer in hodgkin lymphoma survivors.

    Wong SM

    Best practice & research. Clinical haematology 2023; (36(4)):101525 doi:10.1016/j.beha.2023.101525.

    PMID: 38092481
  7. 7

    Clinicopathologic features of breast cancers diagnosed in women treated with prior radiation therapy for Hodgkin lymphoma: Results from a population-based cohort.

    Wong SM, Ajjamada L, Weiss AC, et al.

    Cancer 2022; (128(7)):1365-1372 doi:10.1002/cncr.34065.

    PMID: 34919263
  8. 8

    Quitting smoking after a cancer diagnosis is associated with high-risk neutrophil-to-lymphocyte ratio among tobacco use-related cancer survivors.

    Lu Y, Kwong K, Wells J, et al.

    Scientific reports 2023; (13(1)):2745 doi:10.1038/s41598-023-27624-1.

    PMID: 36797297
  9. 9

    Risk of Subsequent Primary Cancers Among Adult-Onset 5-Year Cancer Survivors in South Korea: Retrospective Cohort Study.

    Choi YY, Lee M, Kim EH, et al.

    JMIR public health and surveillance 2024; (10()):e48380 doi:10.2196/48380.

    PMID: 38717807
  10. 10

    Long-term risk of second malignancy and cardiovascular disease after Hodgkin lymphoma treatment.

    van Leeuwen FE, Ng AK

    Hematology. American Society of Hematology. Education Program 2016; (2016(1)):323-330 doi:10.1182/asheducation-2016.1.323.

    PMID: 27913498
  11. 11

    Long-Term Cause-Specific Mortality in Hodgkin Lymphoma Patients.

    de Vries S, Schaapveld M, Janus CPM, et al.

    Journal of the National Cancer Institute 2021; (113(6)):760-769 doi:10.1093/jnci/djaa194.

    PMID: 33351090
  12. 12

    Radiation Dose-Response Relationship for Risk of Coronary Heart Disease in Survivors of Hodgkin Lymphoma.

    van Nimwegen FA, Schaapveld M, Cutter DJ, et al.

    Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2016; (34(3)):235-43 doi:10.1200/JCO.2015.63.4444.

    PMID: 26573075
  13. 13

    Improvements in Imaging of Hodgkin Lymphoma: Positron Emission Tomography.

    Hutchings M

    Cancer journal (Sudbury, Mass.) 2018; (24(5)):215-222 doi:10.1097/PPO.0000000000000336.

    PMID: 30247256
  14. 14

    How I Follow Hodgkin Lymphoma in First Complete (Metabolic) Remission?

    Milunović V

    Medicina (Kaunas, Lithuania) 2024; (60(2)) doi:10.3390/medicina60020344.

    PMID: 38399631
  15. 15

    Bone damage and health-related quality of life in Hodgkin lymphoma survivors: closing the gaps.

    Mancuso S, Mattana M, Giammancheri F, et al.

    Frontiers in oncology 2024; (14()):1201595 doi:10.3389/fonc.2024.1201595.

    PMID: 38406804
  16. 16

    Concurrent pembrolizumab with AVD for untreated classic Hodgkin lymphoma.

    Lynch RC, Ujjani CS, Poh C, et al.

    Blood 2023; (141(21)):2576-2586 doi:10.1182/blood.2022019254.

    PMID: 36913694
  17. 17

    Mind the Pitfall: Solitary Nodular Fasciitis Mimicking Extra-Nodal Manifestation of Hodgkin Lymphoma on [18F]FDG PET/CT.

    Markandu S, Blickle A, Burgard C, et al.

    Diagnostics (Basel, Switzerland) 2024; (14(8)) doi:10.3390/diagnostics14080783.

    PMID: 38667429
  18. 18

    Smoking Behaviors in Survivors of Smoking-Related and Non-Smoking-Related Cancers.

    Gritz ER, Talluri R, Fokom Domgue J, et al.

    JAMA network open 2020; (3(7)):e209072 doi:10.1001/jamanetworkopen.2020.9072.

    PMID: 32614423
  19. 19

    Accelerated atherosclerosis, hyperlipoproteinemia and insulin resistance in long-term survivors of Hodgkin lymphoma during childhood and adolescence.

    Cepelova M, Kruseova J, Luks A, et al.

    Neoplasma 2019; (66(6)):978-987.

    PMID: 31305124

This page provides general survivorship information for classic Hodgkin lymphoma. Always consult your oncology team to discuss your specific Survivorship Care Plan and recommended screening schedule.

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