Post-treatment care for young Hodgkin lymphoma survivors

12 Jan 2016

Researchers have identified gaps in receipt of recommended post-treatment care for adolescent and young-adult Hodgkin lymphoma survivors.

Hodgkin lymphoma is one of the leading diagnoses for adolescent and young-adults, accounting for 12% of all new adolescent and young-adult cancer diagnoses. Standard treatments for the disease, which involve chemotherapy and radiation, are very effective, enabling the majority of patients to survive past five years.

However, survivors remain at high risk for long-term and late effects of treatment, such as heart and thyroid problems, lung disease, second cancers, infertility, and psychosocial problems. The onset of late effects varies, with complications emerging as late as 10 years after treatment, in some cases.

“Survivorship care is especially important for adolescents and young adults, who still have long lives ahead of them after completing treatment. This study highlights that, despite the existence of post-treatment guidelines for this population of survivors, there are opportunities for improvement to increase adherence and improve survivorship outcomes.” said Merry-Jennifer Markham, MD.

Nearly all survivors had recommended oncology visits

This study assessed adherence to the National Comprehensive Cancer Network (NCCN) post-treatment guidelines among 354 Hodgkin lymphoma survivors, diagnosed between the ages of 15-39 years. The patients were identified from the  Kaiser Permanente Southern California integrated health care system and were diagnosed, treated, and followed within the system. The average follow-up time was six years.

The analysis of the results showed that within the first five years after completing treatment:

  • 96% of survivors had at least one visit per year with an oncologist
  • 70% received the recommended laboratory testing
  • Overall, 48% of survivors received all recommended care within the first 12 months
  • Services that were commonly lacking included psychosocial counselling and appropriate vaccines
  • The patients diagnosed in more recent years (2006-2010) were more likely to receive recommended post-treatment care than those diagnosed between 2000 and 2005.

CareAcross-girl-beach

The researchers also found overuse and underuse of imaging to screen for recurrences and new cancers. While two-thirds of survivors received a recommended CT scan in the first 12 months post-treatment, nearly half also received non-recommended CT scans in year two.

In addition, a third of survivors received non-recommended surveillance PET scans. Lead study author, Erin E. Hahn, PhD, MPH, a research scientist at Kaiser Permanente Southern California, Department of Research and Evaluation, stressed that the researchers were unable to determine clinical indications of these imaging tests.

“We need a systematic way to deliver post-treatment care”

“Patients treated for Hodgkin lymphoma are at high risk for recurrence and relapse, as well as serious long-term and late effects,” said Dr. Hahn. “We need a systematic way to deliver post-treatment care, including screening for late effects of treatment. Studies like this will help inform the design of survivorship care programs that address all our patients’ needs.”

While this study was limited to patients in California, the authors hope to expand the cohort to include other Kaiser Permanente regions. Dr. Hahn’s research team plans to conduct a more detailed analysis of this dataset, as well as conduct a follow-up study with a larger group of patients to look at use of longer-term recommended services.

Source: eCancer News
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