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Gaps in Follow-up Care in Young Survivors of Hodgkin Lymphoma

Surabhi Dangi-Garimella, PhD
Less than 50% of patients diagnosed with Hodgkin lymphoma between 15 and 39 years of age received recommended care within the first year after their treatment, a Kaiser Permanente study has found.
Less than 50% of patients diagnosed with Hodgkin lymphoma between 15 and 39 years of age received recommended care within the first year after their treatment, according to a study presented at the American Society of Clinical Oncology (ASCO)’s 2016 Cancer Survivorship Symposium.

“Patients treated for Hodgkin lymphoma are at high risk for recurrence and relapse, as well as serious long-term and late effects,” said lead study author Erin E. Hahn, PhD, MPH, a research scientist at Kaiser Permanente Southern California, Department of Research and Evaluation. “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.”

Hahn’s research group identified 354 patients with Hodgkin lymphoma, ages 15 to 39 years, who were diagnosed between 2000 and 2010. Patients were followed for an average of 6 years post-treatment. The authors discovered that while recommended oncology visits were conducted almost 96% of the time in the first 5-years post-diagnosis, only 70% of patients received NCCN-recommended laboratory testing, and a little over 66% received a recommended CT scan within 12 months post-treatment.

There was also overuse and underuse of imaging observed among these patients. Forty seven percent of patients received a non-recommended scan in year 2 and 35% in year 3, while 33% of patients received a non-recommended PET scan. Nearly 50% of patients received recommended care within the first 12 months, with those diagnosed later, between 2006 and 2010, more likely to receive recommended care within the first 12 months.

The study was one amongst those included in ASCO’s presscast earlier this week. Merry-Jennifer Markham, MD, ASCO spokesperson and moderator of the presscast said, “While it’s great news that so many young adult survivors are receiving critical aspects of their post-treatment care, this study helps us understand where there is more work to be done. 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.”

While this study was limited to patients in California, the authors hope to expand the cohort to include other Kaiser Permanente regions. 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.

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