Department of Epidemiology and Cancer Control.
Department of Biostatistics, and.
Blood. 2022 May 19;139(20):3073-3086. doi: 10.1182/blood.2021013167.
Long-term survivors of childhood Hodgkin lymphoma (HL) experience a high burden of chronic health morbidities. Correlates of neurocognitive and psychosocial morbidity have not been well established. A total of 1760 survivors of HL (mean ± SD age, 37.5 ± 6.0 years; time since diagnosis, 23.6 ± 4.7 years; 52.1% female) and 3180 siblings (mean age, 33.2 ± 8.5 years; 54.5% female) completed cross-sectional surveys assessing neurocognitive function, emotional distress, quality of life, social attainment, smoking, and physical activity. Treatment exposures were abstracted from medical records. Chronic health conditions were graded according to the National Cancer Institute's Common Terminology Criteria for Adverse Events version 4.3 (1 = mild, 2 = moderate, 3 = severe/disabling, and 4 = life-threatening). Multivariable analyses, adjusted for age, sex, and race, estimated relative risk (RR) of impairment in survivors vs siblings and, among survivors, risk of impairment associated with demographic, clinical, treatment, and grade 2 or higher chronic health conditions. Compared with siblings, survivors had significantly higher risk (all, P < .05) of neurocognitive impairment (eg, memory, 8.1% vs 5.7%), anxiety (7.0% vs 5.4%), depression (9.1% vs 7%), unemployment (9.6% vs 4.4%), and impaired physical/mental quality of life (eg, physical function, 11.2% vs 3.0%). Smoking was associated with a higher risk of impairment in task efficiency (RR, 1.56; 95% confidence interval [CI], 1.02-2.39), emotional regulation (RR, 1.84; 95% CI, 1.35-2.49), anxiety (RR, 2.43; 95% CI, 1.51-3.93), and depression (RR, 2.73; 95% CI, 1.85-4.04). Meeting the exercise guidelines of the Centers for Disease Control and Prevention was associated with a lower risk of impairment in task efficiency (RR, 0.70; 95% CI, 0.52-0.95), organization (RR, 0.60; 95% CI, 0.45-0.80), depression (RR, 0.66; 95% CI, 0.48-0.92), and multiple quality of life domains. Cardiovascular and neurologic conditions were associated with impairment in nearly all domains. Survivors of HL are at elevated risk for neurocognitive and psychosocial impairment, and risk is associated with modifiable factors that provide targets for interventions to improve long-term functional outcomes.
儿童期霍奇金淋巴瘤（HL）的长期幸存者患有多种慢性健康疾病，负担沉重。尚未明确与神经认知和社会心理发病相关的因素。共纳入 1760 例 HL 幸存者（平均年龄 ± SD，37.5 ± 6.0 岁；诊断后时间 ± SD，23.6 ± 4.7 年；52.1%为女性）和 3180 名同胞（平均年龄 ± SD，33.2 ± 8.5 岁；54.5%为女性）完成了横断面调查，评估了神经认知功能、情绪困扰、生活质量、社会成就、吸烟和身体活动。从病历中提取治疗暴露情况。根据国家癌症研究所的不良事件通用术语标准 4.3 版（1=轻度、2=中度、3=重度/致残、4=危及生命）对慢性健康状况进行分级。多变量分析调整了年龄、性别和种族，估计了幸存者与同胞相比的认知障碍风险（RR），以及在幸存者中，与人口统计学、临床、治疗以及 2 级或更高级别的慢性健康状况相关的认知障碍风险。与同胞相比，幸存者的神经认知障碍（如记忆障碍，8.1%比 5.7%）、焦虑（7.0%比 5.4%）、抑郁（9.1%比 7%）、失业（9.6%比 4.4%）和生活质量受损（如身体功能，11.2%比 3.0%）的风险显著更高（均 P <.05）。吸烟与任务效率（RR，1.56；95%置信区间[CI]，1.02-2.39）、情绪调节（RR，1.84；95%CI，1.35-2.49）、焦虑（RR，2.43；95%CI，1.51-3.93）和抑郁（RR，2.73；95%CI，1.85-4.04）障碍的风险增加有关。符合疾病控制与预防中心的运动指南与任务效率（RR，0.70；95%CI，0.52-0.95）、组织（RR，0.60；95%CI，0.45-0.80）、抑郁（RR，0.66；95%CI，0.48-0.92）和多个生活质量领域障碍的风险降低有关。心血管和神经疾病与几乎所有领域的障碍都有关。HL 幸存者的神经认知和社会心理障碍风险增加，并且风险与可改变的因素有关，这些因素为改善长期功能结局提供了干预目标。
