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. 2019 Dec 10;3(4):bjgpopen19X101668.
doi: 10.3399/bjgpopen19X101668. Online ahead of print.

Hodgkin Lymphoma Detection and Survival: Findings From the Haematological Malignancy Research Network

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Free PMC article

Hodgkin Lymphoma Detection and Survival: Findings From the Haematological Malignancy Research Network

Maxine Je Lamb et al. BJGP Open. .
Free PMC article

Abstract

Background: Hodgkin lymphoma is usually detected in primary care with early signs and symptoms, and is highly treatable with standardised chemotherapy. However, late presentation is associated with poorer outcomes.

Aim: To investigate the relationship between markers of advanced disease, emergency admission, and survival following a diagnosis of classical Hodgkin lymphoma (CHL).

Design & setting: The study was set within a sociodemographically representative UK population-based patient cohort of ~4 million, within which all patients were tracked through their care pathways, and linked to national data obtained from Hospital Episode Statistics (HES) and deaths.

Method: All 971 patients with CHL newly diagnosed between 1 September 2004-31 August 2015 were followed until 18th December 2018.

Results: The median diagnostic age was 41.5 years (range 0-96 years), 55.2% of the patients were male, 31.2% had stage IV disease, 43.0% had a moderate-high or high risk prognostic score, and 18.7% were admitted via the emergency route prior to diagnosis. The relationship between age and emergency admission was U-shaped: more likely in patients aged <25 years and ≥70 years. Compared to patients admitted via other routes, those presenting as an emergency had more advanced disease and poorer 3-year survival (relative survival 68.4% [95% confidence interval {CI} = 60.3 to 75.2] versus 89.8% [95% CI = 87.0 to 92.0], respectively [P<0.01]). However, after adjusting for clinically important prognostic factors, no difference in survival remained.

Conclusion: These findings suggest that CHL survival as a whole could be increased by around 4% if the cancer in patients who presented as an emergency had been detected at the same point as in other patients.

Keywords: cancer staging; data collection; delayed diagnosis; prognosis; real-world data; routes to diagnosis.

Figures

Figure 1.
Figure 1.. Patients with classical Hodgkin lymphoma distributed by demographic and clinical prognostic characteristics, with ORs (95% CIs) for diagnosis following emergency admission presented for all patients and those treated with curative intent (data from HMRN diagnoses 2004–2015). IPS = International Prognostic Score
Figure 2.
Figure 2.. Classical Hodgkin lymphoma overall survival (OS) and relative survival (RS) curves for all patients (A) and those treated with curative intent (B), stratified by emergency admission status and age (data from Haematological Malignancy Research Network diagnoses 2004–2015)
Figure 3.
Figure 3.. Classical Hodgkin lymphoma survival curves for all patients (A) and those treated with curative intent (B). Overall survival in non-emergency versus emergency admission with 95% CIs (A1, B1) and non-emergency versus emergency adjusted for prognostic factors (A2, B2).a (data from HMRN diagnoses 2004–2015)
aSurvival adjusted for age, performance status (ECOG), B symptoms (yes/no), disease stage, specific components of IPS (albumin, haemoglobin, and lymphocyte count), and treatment with curative intent (yes/no) (A2 only). Survival curves are weighted so that the patient mix with respect to ECOG status, B symptoms, disease stage, and specific components of IPS among those presenting as an emergency is similar to those who presented via other routes. ECOG = Eastern Oncology Cooperative Group. IPS = International Prognostic Score

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