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February 13, 2000

Other Illnesses

Question from Gainesville, Florida, USA:

My brother was diagnosed with type 1 diabetes approximately 23 years ago. He has not taken very good care of his health over the years and he has had a great deal of complications (amputation of toes, and one foot; kidney failure, and subsequent transplant; heart problems, etc). He has recently been diagnosed with Hodgkin's disease (he has been taking non-rejection drugs for his kidney for about 3 years if there is any correlation). This cancer was found in both sides of his neck, and is quite visible. Is treatment for Hodgkin's complicated because of previously existing diabetes? Is the development of Hodgkin's common for those with type 1 diabetes? Is there anything particular to this type of situation we should be aware of when deciding whether to treat this type of cancer?

Answer:

There is indeed a clear link between Hodgkin’s Disease and a wide spectrum of autoimmune disorders. The specific association with diabetes is uncommon and then only with Type 1A diabetes.

The existence of diabetes will not directly affect the treatment of Hodgkin’s Disease by radiotherapy or chemotherapy; but diabetes control is likely to be exacerbated by any complications of therapy. The incidence of Hodgkin’s Disease is related to the underlying autoimmunity rather than to the long term complications of the diabetes. As regards your last question, I think that the most important consideration in deciding on treatment will be to balance the implications of yet more therapy against the burden of coping with the existing medical problems.

It would help for him to talk all this over with both the diabetes and oncology doctors and the Medical Social Workers on their teams.

DOB