Most nurses will likely encounter a Hodgkin lymphoma (HL) survivor at some point, but will they know what to assess for?

‘Hodgkin’s is the good one to get.’

When I was going to graduate school, I worked part-time for a hematologist who mostly treated people with leukemias and lymphomas. Many of them had Hodgkin lymphoma (though we called it Hodgkin’s disease then). I administered chemotherapy, did a lot of patient teaching and a lot of listening and answering questions for this largely young group of patients. Most were close to my own age; it was easy to relate to their shock at finding out they had a life-threatening disease and that the treatment would not be easy.

I especially recall two young women—one had gone to her physician for a pre-marriage physical; the other went for a check-up because she felt she wasn’t “bouncing back” from the birth of her daughter three months previously. They were distraught at the diagnosis, and as they went through chemotherapy, they were often depressed over the side effects from the drugs: hair loss, GI upset, and fatigue.

But both of them did well. I remember the physician telling them his standard line, “If you had to get cancer, Hodgkin’s is the good one to get,” since it was often curable when caught early. At the end of treatment, they thought they were home free. Unfortunately, we didn’t know to tell them about long-term sequelae from the treatments they received. People hadn’t yet lived “long-term.”

What we didn’t yet know about long-term treatment effects.

In this month’s clinical CE article, “Caring for Survivors of Hodgkin Lymphoma,” authors Xin Lin and Stacie Corcoran describe what these two women may have later faced. While treatments for HL have become more targeted as awareness of their long-term effects has increased and techniques have been refined, high-dose radiation and highly toxic chemotherapy agents administered as long as 40 years previously have been linked to subsequent breast and lung cancers, pulmonary disease, endocrine dysfunction including thyroid and pregnancy complications, and cardiovascular disease. In fact, according to the authors, “cardiovascular disease secondary to cancer treatment is the leading noncancer-related cause of death among HL survivors.” 

Nurses will encounter HL survivors outside of oncology settings.

With many of these problems showing up years after treatment, it’s the non-oncology nurse or physician who will likely encounter HL survivors presenting with these problems in the ER, clinic, or primary care practice. In this comprehensive article, the authors “review the most commonly encountered late adverse effects of treatment and discuss current recommendations for survivor surveillance and screening.” There’s also a list of resources for both clinicians and survivors, as well as screening guidelines for follow-up.

This article won the Nurse Faculty Scholar/AJN Mentored Writing award for 2018. You can submit for the 2019 award until April 1. The article is free; you can also earn CE credit. And listen to a ‘Behind the Article’ podcast with the authors to hear about their personal experiences in working with HL survivors.