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Prevalence of function‐limiting late effects in Hodgkin lymphoma survivors
Author(s) -
Enam Nabela,
Chou Kathy,
Stubblefield Michael D.
Publication year - 2022
Publication title -
pmandr
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.617
H-Index - 66
eISSN - 1934-1563
pISSN - 1934-1482
DOI - 10.1002/pmrj.12662
Subject(s) - medicine , lymphedema , physical therapy , radiation therapy , late effect , dysphagia , cancer , breast cancer , surgery
Background Hodgkin lymphoma (HL) is highly curable, but survivors often develop function‐limiting impairments. Screening guidelines for neuromuscular and musculoskeletal late effects are not as well recognized across medical disciplines. Early identification and management of functional late effects are instrumental in improving the longitudinal care of HL survivors. Objective To define the prevalence of neuromuscular, musculoskeletal, visceral, oncologic, and other late effects affecting function and quality of life (QOL) in HL survivors. Design A retrospective cohort analysis. Setting Outpatient cancer rehabilitation clinic. Participants One hundred HL survivors. Interventions Not applicable. Main Outcome Measures Prevalence of neuromuscular, musculoskeletal, visceral, oncologic, and other late effects contributing to functional impairment and disability in HL survivors. Results Among the 100 HL survivors, 43% received chemotherapy, 94% radiation therapy, and 38% a combination of chemo‐radiation for their initial cancer treatment. Nearly all HL survivors were diagnosed with myelopathy (83%), radiculoplexopathy (93%), mononeuropathy (95%), and localized myopathy (93%). Musculoskeletal sequelae included dropped head syndrome (83%), cervicalgia (79%), shoulder girdle dysfunction (73%), and dysphagia (42%). Visceral disorders included cardiovascular (70%), pulmonary (44%), endocrine (63%), gastrointestinal (29%), and genitourinary (11%) dysfunction. Lymphedema affected 21% of survivors and 30% had a history of a secondary malignancy. Pain (71%), fatigue (45%), and dyspnea (43%) were major function‐limiting impairments. Nearly all (95%) of survivors were referred to at least one therapy discipline including physical therapy, occupational therapy, speech and language pathology, and/or lymphedema therapy. Conclusion Neuromuscular, musculoskeletal, visceral, oncologic, and other late effects are extremely common in HL survivors seeking physiatric evaluation. Multiple function‐limiting disorders can coexist in HL survivors with the potential to severely compromise function and QOL. Safe and effective rehabilitation may depend on the physiatrist's ability to identify, evaluate, and manage the multitude of complex and often interrelated functional late effects seen in HL survivors.