Original Paper Socio-medical Situation for Long-term Survivors of Hodgkin's Disease: a Survey of 459 Patients Treated at One Institution A.F. Abrahamsen, 1 J.H. Loge, 2 E. Hannisdal, 1 H. Holte 1 and S. Kvalùy 1 1 Department of Medical Oncology and Radiotherapy, The Norwegian Radium Hospital, Montebello, 0310 Oslo; and 2 Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway We present the socio-medical situation for 459 adult disease-free long-term survivors of Hodgkin's disease (HD) 3±23 years after ®rst line curative treatment. In 1994, 557 patients were sent a self-report questionnaire relating to their social status and 459 patients (82%) replied. Educational or professional plans were changed due to HD in 142 patients (32%). After 6, 12 and 18 months from start of treat- ment, 52, 82 and 95% of the patients, respectively, had returned to their job or education. The sum of full-time and part-time employment was in men 78% at diagnosis and 85% at follow-up, and in women 57% at diagnosis and 64% at follow-up. Only 2% of men and 3% of women did not have a job at follow- up in 1994. At diagnosis 2% of the patients were permanently disabled versus 19% at follow-up in 1994. Age > 40 years at diagnosis, increased the total score of psychological distress and fatigue and long- term disablement after ®rst line treatment were predictors for permanent disablement. Transient or permanent sexual problems were reported in 16% and 13%, respectively. MVPP (mustine, vinblastine, procarbazine and prednisone) or LVPP (chlorambucil, vinblastine, procarbazine and prednisone) chemotherapy was responsible for most cases of early menopause in women older than 30 years, and of infertility in both men and women. In summary, most long-term HD survivors had adapted well to their socio-medical situation except a high number of permanently disabled patients. By focusing more on factors predisposing for permanent disablement and early treatment for these, more patients may be helped to return to their job. # 1998 Elsevier Science Ltd. All rights reserved. Key words: Hodgkin's disease, employment problems, family problems, fertility Eur J Cancer, Vol. 34, No. 12, pp. 1865±1870, 1998 INTRODUCTION Hodgkin's disease (HD) often aVects young people. Long- term disease-free survival has increased considerably during the last 30 years, especially in young patients [1±3]. Never- theless, follow-up studies of successfully treated patients have shown that this therapeutic success has costs; it is accom- panied by a wide range of physical, psychological and social problems [4±18]. These problems have an in¯uence upon functioning and the feeling of well-being. Long-term quality of life in HD patients has been addressed in only a few studies from the U.S.A. [4, 11] and Europe [12±15]. Most work- related problems reported in long-term survivors of HD are health-related limitations in the types of work that they could do, as well as poorer performance [4, 6, 11, 12, 15]. In most studies, the percentage of employed individuals is comparable to that among healthy controls, but more survivors than controls worked part-time due to health problems. Late sex- ual problems of HD and its treatment include decreased interest in sex, decreased levels of sexual activity, increased incidence of ejaculatory dysfunction [4, 12] and fertility pro- blems [4, 12, 19±24]. More frequent separations and divorces in long-term survivors of HD are reported in some studies [4, 25], and less frequent in another study [12]. Most psychosocial studies in HD are based on selected or small samples. In Norway, the treatment of adult HD patients in the whole of Norway was centralised to The Nor- wegian Radium Hospital (NRH). Since 1985, patients from the Eastern and Southern parts of Norway have still been treated at NRH. The high number of unselected patients treated according to standardised protocols at one institution with close follow-up for many years yields an excellent sample European Journal of Cancer, Vol. 34, No. 12, pp. 1865±1870, 1998 # 1998 Elsevier Science Ltd. All rights reserved Pergamon Printed in Great Britain PII: S0959-8049(98)00269-X 0959-8049/98/$Ðsee front matter 1865 Correspondence to A.F. Abrahamsen. Received 27 Feb. 1998; revised 20 May 1998; accepted 18 Jun. 1998.