Summary of follow-up recommendations for long-term HL survivors according to NCCN and COG
| Treatment exposures . | NCCN guidelines for monitoring for late effects after 5 y in HL survivors . | Selected COG follow-up guidelines (relevant to HL survivors) . |
|---|---|---|
| Neck irradiation | Thyroid function: yearly TSH | Thyroid function: yearly TSH, free T4 |
| Thyroid nodule/cancer screening: yearly thyroid examination | ||
| Carotid artery disease screening: consider carotid ultrasound at 10-y intervals after treatment completion | Carotid artery disease screening: yearly examination for diminished carotid pulses, carotid bruits, and abnormal neurologic examination | |
| Dental health: dental examination and cleaning every 6 mo; supportive care with saliva substitutes, moistening agents, and sialogogues (pilocarpine); regular dental care including fluoride applications | ||
| Skin cancer screening: yearly dermatologic examination of irradiated fields | ||
| Chest irradiation | Cardiac risk factor screening: annual lipids, annual blood pressure, aggressive management of cardiovascular risk factors, consider stress test/echocardiogram at 10-y intervals after treatment completion | Cardiac risk factor screening: fasting glucose and lipid profile every 2 y; if abnormal, refer for ongoing management |
| Cardiac screening: baseline electrocardiogram (include evaluation of QTc interval) at entry into long-term follow-up, repeat as clinically indicated; baseline echocardiogram at entry into long-term follow-up, then periodically based on age at treatment, radiation dose, and cumulative anthracycline dose | ||
| Breast cancer screening: initiate annual breast cancer screening 8-10 y after treatment or at age 40, whichever comes first, if chest or axillary irradiation; MRI in addition to mammography for women who received chest irradiation between ages 10 and 30 | Breast cancer screening: yearly breast self-examination beginning at puberty until age 25, then every 6 mo; yearly mammogram and breast MRI beginning 8 y after radiation or at age 25, whichever occurs last | |
| Lung cancer screening: consider chest imaging for patients at increased risk for lung cancer | Lung cancer screening: imaging and surgery and/or oncology consultation as clinically indicated | |
| Pulmonary function screening: baseline chest x-ray and pulmonary function tests (including DLCO and spirometry) at entry into long-term follow-up, repeat as clinically indicated in patients with abnormal results or progressive pulmonary dysfunction | ||
| Skin cancer screening: yearly dermatologic examination of irradiated fields | ||
| Splenic irradiation or splenectomy | Infection prevention/management: pneumococcal, meningococcal, and Haemophilus influenzae revaccinations every 5-7 y | Infection prevention/management: blood culture when febrile temperature ≥101°F; immunization with pneumococcal, meningococcal, and H. influenzae vaccines; pneumococcal booster in patients ≥10 y old at ≥ 5 y after previous dose |
| Skin cancer screening: yearly dermatologic examination of irradiated fields | ||
| Abdominal/pelvic irradiation | Colorectal cancer screening: colonoscopy every 5 y (minimum) beginning at 10 y after radiation or at age 35 y, whichever occurs last, more frequently if indicated based on colonoscopy results | |
| Reproductive health evaluation: baseline FSH, LH, estradiol at age 13 and as clinically indicated in patients with delayed puberty, irregular menses, primary or secondary amenorrhea, and/or clinical signs and symptoms of estrogen deficiency; baseline FSH, LH and testosterone at age 14 and as clinically indicated in patients with delayed puberty or clinical signs and symptoms of testosterone deficiency | ||
| Skin cancer screening: yearly dermatologic examination of irradiated fields | ||
| Alkylating chemotherapy | Reproductive health evaluation: baseline FSH, LH, estradiol at age 13 and as clinically indicated in patients with delayed puberty, irregular menses, primary or secondary amenorrhea, and/or clinical signs and symptoms of estrogen deficiency; baseline FSH, LH and testosterone at age 14 and as clinically indicated in patients with delayed puberty or clinical signs and symptoms of testosterone deficiency | |
| Anthracyclines | Cardiac screening: baseline electrocardiogram (include evaluation of QTc interval) at entry into long-term follow-up, repeat as clinically indicated; baseline echocardiogram or MUGA scan at entry into long-term follow-up, then periodically based on age at treatment, radiation dose, and cumulative anthracycline dose | |
| Bleomycin | Pulmonary function screening: baseline chest x-ray and pulmonary function tests (including DLCO and spirometry) at entry into long-term follow-up, repeat as clinically indicated in patients with abnormal results or progressive pulmonary dysfunction |
| Treatment exposures . | NCCN guidelines for monitoring for late effects after 5 y in HL survivors . | Selected COG follow-up guidelines (relevant to HL survivors) . |
|---|---|---|
| Neck irradiation | Thyroid function: yearly TSH | Thyroid function: yearly TSH, free T4 |
| Thyroid nodule/cancer screening: yearly thyroid examination | ||
| Carotid artery disease screening: consider carotid ultrasound at 10-y intervals after treatment completion | Carotid artery disease screening: yearly examination for diminished carotid pulses, carotid bruits, and abnormal neurologic examination | |
| Dental health: dental examination and cleaning every 6 mo; supportive care with saliva substitutes, moistening agents, and sialogogues (pilocarpine); regular dental care including fluoride applications | ||
| Skin cancer screening: yearly dermatologic examination of irradiated fields | ||
| Chest irradiation | Cardiac risk factor screening: annual lipids, annual blood pressure, aggressive management of cardiovascular risk factors, consider stress test/echocardiogram at 10-y intervals after treatment completion | Cardiac risk factor screening: fasting glucose and lipid profile every 2 y; if abnormal, refer for ongoing management |
| Cardiac screening: baseline electrocardiogram (include evaluation of QTc interval) at entry into long-term follow-up, repeat as clinically indicated; baseline echocardiogram at entry into long-term follow-up, then periodically based on age at treatment, radiation dose, and cumulative anthracycline dose | ||
| Breast cancer screening: initiate annual breast cancer screening 8-10 y after treatment or at age 40, whichever comes first, if chest or axillary irradiation; MRI in addition to mammography for women who received chest irradiation between ages 10 and 30 | Breast cancer screening: yearly breast self-examination beginning at puberty until age 25, then every 6 mo; yearly mammogram and breast MRI beginning 8 y after radiation or at age 25, whichever occurs last | |
| Lung cancer screening: consider chest imaging for patients at increased risk for lung cancer | Lung cancer screening: imaging and surgery and/or oncology consultation as clinically indicated | |
| Pulmonary function screening: baseline chest x-ray and pulmonary function tests (including DLCO and spirometry) at entry into long-term follow-up, repeat as clinically indicated in patients with abnormal results or progressive pulmonary dysfunction | ||
| Skin cancer screening: yearly dermatologic examination of irradiated fields | ||
| Splenic irradiation or splenectomy | Infection prevention/management: pneumococcal, meningococcal, and Haemophilus influenzae revaccinations every 5-7 y | Infection prevention/management: blood culture when febrile temperature ≥101°F; immunization with pneumococcal, meningococcal, and H. influenzae vaccines; pneumococcal booster in patients ≥10 y old at ≥ 5 y after previous dose |
| Skin cancer screening: yearly dermatologic examination of irradiated fields | ||
| Abdominal/pelvic irradiation | Colorectal cancer screening: colonoscopy every 5 y (minimum) beginning at 10 y after radiation or at age 35 y, whichever occurs last, more frequently if indicated based on colonoscopy results | |
| Reproductive health evaluation: baseline FSH, LH, estradiol at age 13 and as clinically indicated in patients with delayed puberty, irregular menses, primary or secondary amenorrhea, and/or clinical signs and symptoms of estrogen deficiency; baseline FSH, LH and testosterone at age 14 and as clinically indicated in patients with delayed puberty or clinical signs and symptoms of testosterone deficiency | ||
| Skin cancer screening: yearly dermatologic examination of irradiated fields | ||
| Alkylating chemotherapy | Reproductive health evaluation: baseline FSH, LH, estradiol at age 13 and as clinically indicated in patients with delayed puberty, irregular menses, primary or secondary amenorrhea, and/or clinical signs and symptoms of estrogen deficiency; baseline FSH, LH and testosterone at age 14 and as clinically indicated in patients with delayed puberty or clinical signs and symptoms of testosterone deficiency | |
| Anthracyclines | Cardiac screening: baseline electrocardiogram (include evaluation of QTc interval) at entry into long-term follow-up, repeat as clinically indicated; baseline echocardiogram or MUGA scan at entry into long-term follow-up, then periodically based on age at treatment, radiation dose, and cumulative anthracycline dose | |
| Bleomycin | Pulmonary function screening: baseline chest x-ray and pulmonary function tests (including DLCO and spirometry) at entry into long-term follow-up, repeat as clinically indicated in patients with abnormal results or progressive pulmonary dysfunction |
TSH indicates thyroid stimulating hormone; DLCO, diffusing capacity of the lungs for carbon monoxide; FSH, follicle-stimulating hormone; LH, luteinizing hormone; and MUGA, multigated acquisition.