Long-term survivors of pediatric Hodgkin lymphoma (HL) have a high rate of chronic health problems. However, the relationship between neurocognitive and psychosocial morbidity was not well understood. A total of 1,760 HL survivors and 3,180 siblings (mean age, 33.2+8.5 years; time since diagnosis, 23.6+4.7 years; 52.1% female) completed cross-sectional questionnaires evaluating a neurocognitive function, emotional distress, quality of life, social achievement, smoking, and physical activity. Medical data were used to extract treatment exposures. The National Cancer Institute’s Common Terminology Criteria for Adverse Events version 4.3 was used to assess chronic health issues (1=mild, 2=moderate, 3 = severe/disabling, and 4 = life-threatening). Adjusted for age, gender, and race, multivariable analyses calculated the relative risk (RR) of impairment in survivors vs. siblings and the risk of impairment linked with demographic, clinical, treatment, and grade 2 or higher chronic health issues in survivors. 

Survivors had a 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 than siblings (eg, physical function, 11.2% vs 3.0%). Smoking was linked with an increased risk of impairment in task efficiency (RR, 1.56; 95% 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, 2.43; 95% CI, 1.51-3.93). (RR, 2.73; 95% CI, 1.85-4.04). Meeting the Centers for Disease Control and Prevention’s exercise standards was linked to a decreased 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), melancholy (RR, 0.66; 95% CI, 0.48-0.92), and numerous quality of life categories. Cardiovascular and neurologic disorders were linked to impairment in almost every category. Survivors of HL were at an increased risk of neurocognitive and psychosocial impairment, and the risk was linked to modifiable characteristics that can be targeted for treatments to enhance long-term functional outcomes.