1
|
Illés Á, Dobó B, Borics F, Tóthfalusi D, Pinczés LI, Miltényi Z. The Effect of Diagnostic and Therapeutic Changes on the Survival of Hodgkin's Lymphoma Patients (1980-2019). MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1272. [PMID: 39202553 PMCID: PMC11356088 DOI: 10.3390/medicina60081272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Revised: 07/28/2024] [Accepted: 08/03/2024] [Indexed: 09/03/2024]
Abstract
Background and Objectives: The overall- and progression-free survival rates of Hodgkin's lymphoma patients have improved. Our goal was to examine the changes in our treatment results and their causes depending on the daily diagnostic and therapeutic practice. Materials and Methods: We analysed data of 776 classical Hodgkin lymphoma patients treated between 1980 and 2019. Patient data were investigated in ten-year periods (first period: 1980-1989, second period: 1990-1999, third period: 2000-2009, and fourth period: 2010-2019). Results: Radiotherapy alone as a first-line treatment was used progressively less often, and in the 4th period it was no longer used before or without chemotherapy. The use of combined chemo- and radiotherapy decreased in the last period, and the number of those patients who received only chemotherapy increased significantly. The 10-year overall survival improved significantly from 1990 to 1999 compared to 2010 to 2019 (74.9% vs. 86.9%). About 30% of patients relapsed after or were refractory to first-line therapy in each period. The incidence of relapse in the last period did not increase after two years, but there was no significant difference between the periods. Conclusions: Overall survival rates of HL patients have improved significantly in recent decades, which is due to improved diagnostic methods and modern therapies. Progression-free survival is unchanged; one-third of patients relapse or are refractory to first-line treatment within the first two years. Early recognition of R/R patients, the early application of newer and already available innovative therapies, and the finding of additional new and effective therapies are of particular importance.
Collapse
Affiliation(s)
- Árpád Illés
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (B.D.); (F.B.); (D.T.); (Z.M.)
- Doctoral School of Clinical Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Boglárka Dobó
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (B.D.); (F.B.); (D.T.); (Z.M.)
- Doctoral School of Clinical Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Fanni Borics
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (B.D.); (F.B.); (D.T.); (Z.M.)
- Doctoral School of Clinical Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Dávid Tóthfalusi
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (B.D.); (F.B.); (D.T.); (Z.M.)
- Doctoral School of Clinical Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - László Imre Pinczés
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (B.D.); (F.B.); (D.T.); (Z.M.)
- Doctoral School of Clinical Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Zsófia Miltényi
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (B.D.); (F.B.); (D.T.); (Z.M.)
- Doctoral School of Clinical Medicine, University of Debrecen, 4032 Debrecen, Hungary
| |
Collapse
|
2
|
Gates P, Green HJ, Gough K, Dhillon H, Vardy JL, Dickinson M, Guarnera J, Krishnasamy M, Livingston PM, White V, Ugalde A, Caeyenberghs K. Web-based cognitive rehabilitation intervention for cancer-related cognitive impairment following chemotherapy for aggressive lymphoma: protocol for a randomised pilot trial. BMJ Open 2024; 14:e081084. [PMID: 38653511 PMCID: PMC11043699 DOI: 10.1136/bmjopen-2023-081084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/02/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION Cancer-related cognitive impairment is common among people diagnosed with and treated for cancer. This can be a distressing and disabling side effect for impacted individuals. Interventions to mitigate cognitive dysfunction are available, but, to date, most have been trialled in samples that are largely or exclusively composed of people with solid tumours. Intervention strategies to support cognitive functioning are needed, but there is a paucity of research in this area. The main aim of this study is to test the feasibility and acceptability of methods and procedures intended for use in a definitive trial of a web-based cognitive rehabilitation programme, Responding to Cognitive Concerns (eReCog), in people who have received chemotherapy for aggressive lymphoma. METHODS AND ANALYSIS The proposed study is a single-site, parallel-group, pilot randomised controlled trial, with one baseline and one follow-up (or postintervention) assessment. 38 people from the target population with low perceived cognitive function based on the Cognitive Change Screen will be recruited from a specialist cancer centre between July 2023 and June 2024. After baseline assessment, participants will be randomised one-to-one to receive usual care only (a factsheet about changes in memory and thinking for people with cancer) or eReCog plus usual care. The 4-week eReCog intervention consists of four online modules offering psychoeducation on cognitive impairment associated with cancer and its treatment, skills training for improving memory, and attention and relaxation training. Study outcomes will include the feasibility of recruitment and retention at follow-up assessment (primary outcomes), as well as adherence to, usability of and intrinsic motivation to engage with eReCog, and compliance with study measures. The potential efficacy of eReCog will also be evaluated. ETHICS AND DISSEMINATION Ethical approval was granted by the Peter MacCallum Cancer Centre Human Research Ethics Committee in Victoria, Australia (HREC/97384/PMCC). Study findings will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry, ACTRN12623000705684.
Collapse
Affiliation(s)
- Priscilla Gates
- Cognitive Neuroscience Unit, Deakin University, Burwood, Victoria, Australia
- Health Services Research, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia
| | - Heather J Green
- Faculty of Health, Griffith University, Gold Coast, Queensland, Australia
| | - Karla Gough
- Health Services Research, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia
- Department of Nursing, The University of Melbourne, Melbourne, Victoria, Australia
| | - Haryana Dhillon
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Janette L Vardy
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Concord Cancer Centre, Concord, New South Wales, Australia
| | - Michael Dickinson
- Clinical Haematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jade Guarnera
- Cognitive Neuroscience Unit, Deakin University, Burwood, Victoria, Australia
| | - Meinir Krishnasamy
- Health Services Research, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia
- Department of Nursing, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Victoria White
- Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Anna Ugalde
- Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Karen Caeyenberghs
- Cognitive Neuroscience Unit, Deakin University, Burwood, Victoria, Australia
| |
Collapse
|
3
|
Fiaccadori V, Neven A, Fortpied C, Aurer I, Andre M, Federico M, Counsell N, Phillips EH, Clifton-Hadley L, Barrington SF, Illidge T, Radford J, Raemaekers JMM. Relapse patterns in early-PET negative, limited-stage Hodgkin lymphoma (HL) after ABVD with or without radiotherapy-a joint analysis of EORTC/LYSA/FIL H10 and NCRI RAPID trials. Br J Haematol 2023; 200:731-739. [PMID: 36541117 DOI: 10.1111/bjh.18594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/08/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022]
Abstract
In the H10 and RAPID randomised trials, chemotherapy+radiotherapy (combined modalities treatment, CMT) was compared with chemotherapy (C) in limited-stage Hodgkin lymphoma (HL), with negative early positron emission tomography (ePETneg). We analysed patterns of relapses in the H10 trial, validated findings in the RAPID trial and performed a combined analysis stratified by trial. The impact of radiotherapy (RT) on risk of relapse was studied using adjusted Cox models, with time-varying effects. In H10, 1,059 ePETneg patients were included (465 European Organisation for Research and Treatment of Cancer (EORTC) favourable [F], 594 unfavourable [U]). Among the F patients, 2/227 (1%) relapsed after CMT, 30/238 (13%) after C: of these relapses, 21/30 (70%) occurred in less than 2 years and 25/30 (83%) affected originally involved areas. Among the U group, 16/292 (5%) relapsed after CMT: 8/16 (50%) in less than 2 years, 11/16 (69%) in originally involved areas. After C 30/302 (10%) relapsed: 27/30 (90%) in less than 2 years, and 26/30 (87%) in originally involved areas. Similar results were observed in 419 ePETneg RAPID patients (241 F, 128 U, 50 unclassified): among F patients, 6/118 (5%) relapsed after CMT; 13/123 (11%) after C: 11/13 (85%) in less than 2 years and 11/13 (85%) affecting originally involved areas. In U patients, 3/65 (5%) relapsed after CMT and 5/63 (8%) after C. In both trials, omitting RT in ePETneg HL resulted in more early relapses, mainly affecting originally involved areas. RT significantly reduced risk of early relapses in the combined stratified analysis.
Collapse
Affiliation(s)
- Valeria Fiaccadori
- University College London Hospital, London, UK.,European Organisation for Research and Treatment of Cancer, Brussels, Belgium.,Cancer Institute, University College London, London, UK
| | - Anouk Neven
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium.,Luxembourg Institute of Health, Competence Center for Methodology and Statistics, Strassen, Luxembourg
| | - Catherine Fortpied
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Igor Aurer
- Division of Hematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marc Andre
- Department of Hematology, CHU UCL Namur, Yvoir, Belgium
| | | | - Nicholas Counsell
- Cancer Research UK and University College London Cancer Trials Centre, Cancer Institute, University College London, London, UK
| | - Elizabeth H Phillips
- Division of Cancer Sciences, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK.,The Christie NHS Foundation Trust, Manchester, UK
| | - Laura Clifton-Hadley
- Cancer Research UK and University College London Cancer Trials Centre, Cancer Institute, University College London, London, UK
| | - Sally F Barrington
- King's College London and Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, UK
| | - Timothy Illidge
- Division of Cancer Sciences, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK.,The Christie NHS Foundation Trust, Manchester, UK
| | - John Radford
- Division of Cancer Sciences, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK.,The Christie NHS Foundation Trust, Manchester, UK
| | | |
Collapse
|
4
|
Gates P, Krishnasamy M, Wilson C, Hawkes EA, Doré V, Perchyonok Y, Rowe CC, Walker AK, Vardy JL, de Ruiter MB, Cushion T, Dhillon HM, Gough K. Cancer-related cognitive impairment in patients with newly diagnosed aggressive lymphoma undergoing standard chemotherapy: a longitudinal feasibility study. Support Care Cancer 2022; 30:7731-7743. [PMID: 35699780 PMCID: PMC9385796 DOI: 10.1007/s00520-022-07153-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 05/13/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Cancer-related cognitive impairment (CRCI) is a recognised adverse consequence of cancer and its treatment. This study assessed the feasibility of collecting longitudinal data on cognition in patients with newly diagnosed, aggressive lymphoma undergoing standard therapy with curative intent via self-report, neuropsychological assessment, peripheral markers of inflammation, and neuroimaging. An exploration and description of patterns of cancer-related cognitive impairment over the course of treatment and recovery was also undertaken and will be reported separately. METHODS Eligible participants completed repeated measures of cognition including self-report and neuropsychological assessment, and correlates of cognition including blood cell-based inflammatory markers, and neuroimaging at three pre-specified timepoints, time 1 (T1) - pre-treatment (treatment naïve), time 2 (T2) - mid-treatment, and time 3 (T3) - 6 to 8 weeks post-completion of treatment. RESULTS 30/33 eligible patients (91%, 95% CI: 76%, 97%) were recruited over 10 months. The recruitment rate was 3 patients/month (95% CI: 2.0, 4.3 patients/month). Reasons for declining included feeling overwhelmed and rapid treatment commencement. Mean age was 57 years (SD = 17 years) and 16/30 (53%) were male. Most patients (20/30, 67%) had diffuse large B cell lymphoma or Hodgkin lymphoma (4/30, 13%). The neuroimaging sub-study was optional, 11/30 participants (37%) were eligible to take part, and all agreed. The remaining 19 participants were ineligible as their diagnostic PET/CT scan was completed prior. Retention and compliance with all assessments were 89 to 100% at all timepoints. Only one participant was withdrawn due to disease progression. CONCLUSIONS Findings from this study including excellent recruitment, retention, and compliance rates demonstrate it is feasible to longitudinally assess cognition in people with newly diagnosed aggressive lymphoma during their initial treatment and recovery to inform the development of future research to improve patient experiences and cognitive outcomes. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12619001649101.
Collapse
Affiliation(s)
- Priscilla Gates
- Department of Clinical Haematology, Austin Health, Melbourne, Victoria, Australia.
- Department of Nursing, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Meinir Krishnasamy
- Department of Nursing, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Academic Nursing Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Research and Education Nursing, Victorian Comprehensive Cancer Centre Alliance, Melbourne, Victoria, Australia
| | - Carlene Wilson
- Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Victoria, Australia
- School of Psychology and Public Health, LaTrobe University, Melbourne, Victoria, Australia
| | - Eliza A Hawkes
- Department of Clinical Haematology, Austin Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Olivia Newton-John Cancer Research Institute (ONJCRI), Austin Health, Melbourne, Victoria, Australia
| | - Vincent Doré
- Department Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia
- The Australian E-Health Research Centre, CSIRO Health & Biosecurity, Melbourne, Victoria, Australia
| | - Yuliya Perchyonok
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department Radiology, Austin Health, Melbourne, Victoria, Australia
| | - Christopher C Rowe
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia
| | - Adam K Walker
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Janette L Vardy
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Concord Cancer Centre, Concord Repatriation and General Hospital, Concord, New South Wales, Australia
| | | | - Tania Cushion
- Department of Clinical Haematology, Austin Health, Melbourne, Victoria, Australia
| | - Haryana M Dhillon
- Faculty of Science, School of Psychology, Centre for Medical Psychology& Evidence-Based Decision-Making, The University of Sydney, Sydney, New South Wales, Australia
| | - Karla Gough
- Department of Nursing, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| |
Collapse
|
5
|
Lu Z, Teng Y, Ning X, Wang H, Feng W, Ou C. Long-term risk of cardiovascular disease mortality among classic Hodgkin lymphoma survivors. Cancer 2022; 128:3330-3339. [PMID: 35872619 DOI: 10.1002/cncr.34375] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/25/2022] [Accepted: 06/09/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The temporal trend of cardiovascular disease (CVD) mortality in patients with classic Hodgkin lymphoma (cHL) throughout follow-up remains unclear. This study aimed to assess this temporal trend in patients with cHL. METHODS This multicenter cohort included 15,889 patients with cHL diagnosed between 1983 and 2015, covering all ages. The proportional mortality ratio, cumulative incidence of cause-specific mortality accounting for competing risk, standard mortality ratio, and absolute excess risk were analyzed. RESULTS Among patients in stage I and stage II cHL, the proportional mortality ratio for CVD exceeded that for cHL, after approximately 60 or 120 months of follow-up, respectively. For almost all the patients with stage I or stage II disease, the cumulative incidence of CVD mortality exceeded that of cHL and other neoplasms over time. In recent decades, the risk of cHL mortality declined sharply, but the risk of CVD mortality among patients with cHL declined quite slowly or even remained unchanged among some populations. Patients with stage I or stage II disease experienced a higher risk of CVD mortality than the general population in almost all follow-up intervals. The absolute excess CVD risk among patients in stage I reached 48.5. CONCLUSIONS The risk of CVD mortality exceeded that of cHL and other neoplasms and became the leading cause of death over time, among patients with stage I or stage II disease. More effective measures should be taken to reduce the risk of CVD mortality. LAY SUMMARY Among patients with stage I and stage II classic Hodgkin lymphoma (cHL), the proportional mortality ratio of cardiovascular disease (CVD) exceeded that of cHL after approximately 60 or 120 months of follow-up, respectively. For almost all the patients with stage I or stage II disease, the cumulative incidence of CVD mortality exceeded that of cHL and other neoplasms over time. In the past several decades, the risk of cHL mortality declined sharply, but the risk of CVD mortality among patients with cHL declined quite slowly or even unchanged among some populations. CVD exceeded cHL and has become the leading cause of death over time.
Collapse
Affiliation(s)
- Zhenxing Lu
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China.,Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Yintong Teng
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China.,Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Xiaodong Ning
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Guangzhou, China.,Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Guangzhou, China
| | - Hao Wang
- Department of Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Weijing Feng
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Lab of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Caiwen Ou
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Second Clinical Medical College of Southern Medical University, Southern Medical University, Guangzhou, China
| |
Collapse
|
6
|
de Armas S, Huertas-Ayala C, Chan RY, Chi YY, Huh WW, Termuhlen A, Gaynon PS, Kovach AE, Doan A. Survival of pediatric Hodgkin lymphoma patients treated with doxorubicin, bleomycin, vincristine, etoposide, prednisone, and cyclophosphamide (ABVE-PC) versus doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) at a single institution. Pediatr Blood Cancer 2022; 69:e29601. [PMID: 35187850 DOI: 10.1002/pbc.29601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Adriamycin, bleomycin, vinblastine, dacarbazine (ABVD), the de facto standard of care in adult-onset Hodgkin lymphoma (HL), has not been directly compared to doxorubicin, bleomycin, vincristine, etoposide, prednisone, and cyclophosphamide (ABVE-PC), a pediatric-aimed regimen designed to reduce late effects. We aimed to describe the single-institution experience of using both regimens in patients with pediatric HL. METHODS This retrospective cohort study evaluated a total of 224 patients diagnosed with HL between 1999 and 2018 at Children's Hospital Los Angeles (CHLA), of which 93 patients were eligible having received ABVD (n = 46) or ABVE-PC (n = 47) chemotherapy as their initial treatment. Descriptive analyses were performed using the Student's t-test or Fisher's exact test. Survival analysis used the Kaplan-Meier method. Events included death, relapse, and secondary malignancy. We also describe the use of radiation therapy, pulmonary toxicity, and cardiomyopathy determined by shortening fraction <29%. Analyses followed an intention-to-treat principle. RESULTS There was no difference in baseline characteristics between the patients receiving ABVE-PC or ABVD in regard for stage, risk group, or prognostic variables, such as the presence or absence of "B" symptoms, bulky disease, and extra-nodal involvement. A greater proportion of patients treated with ABVE-PC received consolidating external beam radiation treatment (XRT) either by randomization or by response compared to ABVD (59.6% vs. 32.6%, respectively, p = .01). While not statistically significant, response to therapy, assessed by positron emission tomography/computerized tomography (PET/CT) where available, mirrored the use for radiation (rapid response 58.3% vs. 90.0%, n = 34, p = .11). The median dose of anthracycline (doxorubicin) was the same in patients receiving ABVE-PC versus ABVD (200 vs. 200 mg/m2 , interquartile range 200-250 vs. 200-300 mg/m2 , p = .002). There was no difference in event-free survival (p = .63) or overall survival (p = .37) with a median follow-up length of 3.9 years. CONCLUSIONS ABVD and ABVE-PC achieved similar survival outcomes in our single-institution cohort.
Collapse
Affiliation(s)
| | | | - Randall Y Chan
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.,Department of Pediatrics, Los Angeles County+University of Southern California Medical Center, Los Angeles, California, USA
| | - Yueh-Yun Chi
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Winston W Huh
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.,Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Amanda Termuhlen
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Paul S Gaynon
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.,Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Alexandra E Kovach
- Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.,Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Andrew Doan
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.,Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| |
Collapse
|
7
|
Iorio GC, Salvestrini V, Borghetti P, De Felice F, Greco C, Nardone V, Fiorentino A, Gregucci F, Desideri I. The impact of modern radiotherapy on radiation-induced late sequelae: Focus on early-stage mediastinal classical Hodgkin Lymphoma. A critical review by the Young Group of the Italian Association of Radiotherapy and Clinical Oncology (AIRO). Crit Rev Oncol Hematol 2021; 161:103326. [PMID: 33862247 DOI: 10.1016/j.critrevonc.2021.103326] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/07/2021] [Accepted: 03/26/2021] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION The historically feared radiation-induced secondary cancers and cardiac toxicities observed among mediastinal classical Hodgkin Lymphoma (cHL) patients may still negatively burden the benefit of radiotherapy among long-term survivors. Modern radiotherapy (RT) delivery techniques, including intensity-modulated RT (IMRT) and deep inspiration breath-hold (DIBH) solutions, are drastically changing this scenario. Results of a literature overview are reported and discussed in this paper. MATERIALS AND METHODS Key references were derived from a PubMed query. Hand searching and clinicaltrials.gov were also used. RESULTS This paper contains a narrative report and a critical discussion of organs-at-risk dose-volume metrics linked with radiation-induced toxicities in cHL patients. CONCLUSIONS The scenario of early-stage cHL presents long-life expectancies, thus the goal of treatment should aim at maintaining high cure rates and limiting the onset of late complications. Further evaluations of dosimetric measures and clinical outcomes are warranted to identify patients at higher risk to target treatment tailoring.
Collapse
Affiliation(s)
| | - Viola Salvestrini
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Paolo Borghetti
- Department of Radiation Oncology, University and Spedali Civili, Brescia, Italy
| | - Francesca De Felice
- Department of Radiation Oncology, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Carlo Greco
- Department of Radiation Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Valerio Nardone
- Department of Radiation Oncology, Ospedale del Mare, Viale della Metamorfosi, Naples, Italy
| | - Alba Fiorentino
- Department of Radiation Oncology, General Regional Hospital "F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Fabiana Gregucci
- Department of Radiation Oncology, General Regional Hospital "F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Isacco Desideri
- Department of Radiation Oncology, University of Florence, Florence, Italy
| |
Collapse
|
8
|
Gates P, Gough K, Dhillon H, Wilson C, Hawkes E, Dore V, Perchyonok Y, Rowe CC, Walker AK, Vardy JL, de Ruiter M, Krishnasamy M. Longitudinal exploration of cancer-related cognitive impairment in patients with newly diagnosed aggressive lymphoma: protocol for a feasibility study. BMJ Open 2020; 10:e038312. [PMID: 32994248 PMCID: PMC7526311 DOI: 10.1136/bmjopen-2020-038312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/11/2020] [Accepted: 08/06/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Cancer-related cognitive impairment (CRCI) is a distressing and disabling side-effect of cancer treatments affecting up to 75% of patients. For some patients, their cognitive impairment may be transient, but for a subgroup, these symptoms can be long-standing and have a major impact on the quality of life. This paper describes the protocol for a study: (1) to assess the feasibility of collecting longitudinal data on cognition via self-report, neuropsychological testing, peripheral markers of inflammation and neuroimaging and (2) to explore and describe patterns of cancer-related cognitive impairment over the course of treatment and recovery in patients with newly diagnosed, aggressive lymphoma undergoing standard therapy with curative intent. METHODS AND ANALYSIS This is a prospective, longitudinal, feasibility study in which 30 newly diagnosed, treatment-naive patients with aggressive lymphoma will be recruited over a 12-month period. Patients will complete comprehensive assessments at three time points: baseline (time 1, pre-treatment) and two post-baseline follow-up assessments (time 2, mid-treatment and time 3, 6-8 weeks post-treatment completion). All patients will be assessed for self-reported cognitive difficulties and objective cognitive function using Stroop Colour and Word, Trail Making Test Part A and B, Hopkins Verbal Learning Test-Revised, Controlled Oral Word Association and Digit Span. Blood cell-based inflammatory markers and neuroimaging including a positron emission tomography (PET) with 18F-labelled fluoro-2-deoxyglucose (18F-FDG) and CT (18F-FDG-PET/CT) and a MRI will explore potential inflammatory and neuroanatomical or functional mechanisms and biomarkers related to CRCI. The primary intent of analysis will be to assess the feasibility of collecting longitudinal data on cognition using subjective reports and objective tasks from patients during treatment and recovery for lymphoma. These data will inform the design of a larger-scale investigation into the patterns of cognitive change over the course of treatment and recovery, adding to an underexplored area of cancer survivorship research. ETHICS AND DISSEMINATION Ethical approval has been granted by Austin Health Human Rights Ethics Committee (HREC) in Victoria Australia. Peer reviewed publications and conference presentations will report the findings of this novel study. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12619001649101).
Collapse
Affiliation(s)
- Priscilla Gates
- Department of Clinical Haematology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Victoria, Australia
- Department of Nursing, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Karla Gough
- Department of Nursing, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Cancer Experiences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Haryana Dhillon
- Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Carlene Wilson
- Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Victoria, Australia
- School of Psychology and Public Health, LaTrobe University, Melbourne, Victoria, Australia
| | - Eliza Hawkes
- Department of Clinical Haematology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Vincent Dore
- Biomedical Imaging, Health & Biosecurity Flagship, The Australian e-Health Research Centre, CSIRO Health & Biosecurity, Melbourne, Victoria, Australia
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia
| | - Yuliya Perchyonok
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Radiology, Austin Health, Melbourne, Victoria, Australia
| | - Christopher C Rowe
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia
| | - Adam K Walker
- Laboratory of ImmunoPsychiatry, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Janette L Vardy
- Concord Cancer Centre, Concord Repatriation and General Hospital, Concord, New South Wales, Australia
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Michiel de Ruiter
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Meinir Krishnasamy
- Cancer Nursing Research Group, Department of Nursing/Centre for Cancer Research, School of Health Sciences/University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Academic Nursing Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Research and Education Nursing, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| |
Collapse
|
9
|
Trachtenberg E, Gurion R, Mashiach T, Tadmor T, Kedmi M, Dann EJ. Recognizing severe fatigue and decline in quality of life in Hodgkin lymphoma survivors. Leuk Lymphoma 2019; 60:3449-3454. [PMID: 31331223 DOI: 10.1080/10428194.2019.1641803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Hodgkin lymphoma (HL) is common in young adults and considered curable in most patients. Young HL survivors (HLS) are at risk of long-term adverse effects. Our study aimed to assess various fatigue and quality of life (QoL) complaints, and their correlations with treatment. Self-reported questionnaires assessing fatigue (MFI-20) and QoL-related issues (EORTC-QOL-C-30) were used to examine HLS aged 18-65 who completed first-line chemotherapy ± radiotherapy (RT) and were in complete remission for at least six months post-therapy. The cohort included 120 HLS (median age 32 years), assessed between 6 months and 15 years post-treatment. About 28% presented with severe fatigue and severely reduced QoL. Higher fatigue levels were associated with four cycles of the ABVD + RT. Young HLS experience high levels of persistent physical fatigue, emotional distress, and cognitive decline that are insufficiently investigated. Assessment of these complaints is essential and further investigation may provide tailored solutions for a better QoL for HLS.
Collapse
Affiliation(s)
- Estherina Trachtenberg
- The Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Psychology Department, Anglia Ruskin University, Cambridge, UK
| | - Ronit Gurion
- Davidoff Cancer Center, Rabin Medical Center, Institute of Hematology, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tatiana Mashiach
- Quality Assurance Unit, Rambam Health Care Campus, Haifa, Israel
| | - Tamar Tadmor
- The Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Bnai Zion Medical Center, Hematology Unit, Haifa, Israel
| | - Meirav Kedmi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Eldad J Dann
- The Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| |
Collapse
|
10
|
Lee SF, Ng TY, Spika D. Prognostic value of lymphocyte-monocyte ratio at diagnosis in Hodgkin lymphoma: a meta-analysis. BMC Cancer 2019; 19:338. [PMID: 30971203 PMCID: PMC6458704 DOI: 10.1186/s12885-019-5552-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 03/28/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Prognoses of most adult Hodgkin lymphoma (HL) patients are excellent; most of them can achieve permanent remission that can be considered cured. However, many are under-treated or over-treated by standard modern therapies. An accurate determination of prognosis may allow clinicians to design personalised treatment according to individual risk of disease progression and survival. Lymphocyte monocyte ratio (LMR) at diagnosis has been investigated as a prognostic biomarker in patients with HL. Our objective with this meta-analysis was to explore the prognostic value of the LMR at diagnosis in adult HL, by investigating the association between LMR and survival outcomes. METHODS PUBMED and EMBASE were searched for relevant articles. Survival outcomes that we investigated included overall survival (OS), progression-free survival (PFS), event-free survival (EFS), lymphoma-specific survival (LSS), and time to progression (TTP). No restriction to the language, date, study country, or sample size was applied. Final search of databases was performed on 2 April 2018. We performed random-effects meta-analysis to aggregate and summarise the results from included studies, where four or more studies on a particular outcome were available. RESULTS A total of eight studies (all retrospective cohort studies) involving 3319 HL patients were selected for analysis. All studies except one reported the effect of LMR on OS; five reported on PFS, three reported on TTP and LSS, respectively, and one reported on EFS. The pooled estimates showed low LMR was associated with poor OS (hazard ratio [HR] 2.67, 95% CI 1.67, 4.26) and PFS (HR 2.19, 95% CI 1.46, 3.29). Subgroup analyses of OS stratified by LMR cut-off values and sample sizes both indicated that low baseline LMR was associated with poorer prognosis. CONCLUSIONS Low LMR at diagnosis was associated with poor OS and PFS in HL. LMR is easy and cheap to determine and has a potential role in daily clinical management. More studies are needed to validate this biomarker and explore its interaction with known prognostic factors.
Collapse
Affiliation(s)
- Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, New Territory West Cluster, Hospital Authority, Tuen Mun, Hong Kong
- London School of Hygiene and Tropical Medicine, London, UK
| | - Ting Ying Ng
- Department of Clinical Oncology, Tuen Mun Hospital, New Territory West Cluster, Hospital Authority, Tuen Mun, Hong Kong
| | - Devon Spika
- Health Economics Unit, Department of Clinical Science (Malmö), Lund University, Lund, Sweden
- Department of Economics, School of Economics and Management, Lund University, Lund, Sweden
- London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
11
|
Totadri S, Radhakrishnan V, Ganesan TS, Ganesan P, Kannan K, Lakshmipathy KM, Selvaluxmy G, Sagar TG. Can Radiotherapy Be Omitted in Children With Hodgkin Lymphoma Who Achieve Metabolic Remission on Interim Positron Emission Tomography? Experience of a Tertiary Care Cancer Referral Center. J Glob Oncol 2018; 4:1-7. [PMID: 30241201 PMCID: PMC6180840 DOI: 10.1200/jgo.2017.009340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Treating pediatric Hodgkin lymphoma (HL) involves a delicate balance between cure and reducing late toxicity. Fluorodeoxyglucose positron emission tomography (PET) combined with computed tomography (CT) identifies patients with early response to chemotherapy, for whom radiotherapy may be avoided. The role of PET-CT in upfront risk stratification and response-adapted treatment is evaluated in this study. METHODS Patients with HL, who were younger than 18 years, were included. PET-CT was performed at baseline and after two cycles of chemotherapy. Patients were stratified into three risk groups: group 1 (stage I or II with no unfavorable features); group 2 (stage I or II with bulky disease/B symptoms); and group 3 (stage III/IV). A doxorubicin, bleomycin, vinblastine, dacarbazine-based regimen was used in early disease. A cyclophosphamide, vincristine, prednisolone, procarbazine, doxorubicin, bleomycin, vinblastine-based regimen was used in advanced disease. RESULTS Forty-nine patients were included. Fifteen (31%), seven (14%), and 27 (55%) patients were included in groups 1, 2, and 3, respectively. Among 36 patients who underwent staging by PET-CT at diagnosis, seven (19%) patients were upstaged and one (3%) patient was downstaged by PET compared with CT. On the basis of negative interim PET responses, 39 (80%) patients were treated without radiotherapy. The 3-year event-free survival for the entire cohort was 91% (± 5.2%) and overall survival was 100%. CONCLUSION PET-CT is an excellent stand-alone staging modality in HL. The omission of radiotherapy can be considered in patients who achieve metabolic remission on interim PET.
Collapse
|
12
|
Trachtenberg E, Mashiach T, Ben Hayun R, Tadmor T, Fisher T, Aharon-Peretz J, Dann EJ. Cognitive impairment in hodgkin lymphoma survivors. Br J Haematol 2018; 182:670-678. [PMID: 29974933 DOI: 10.1111/bjh.15448] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/17/2018] [Indexed: 12/25/2022]
Abstract
Cancer-related cognitive impairment (CRCI) is commonly reported post-chemotherapy in adults with solid tumours. Hodgkin lymphoma (HL) mostly affects young adults. Data regarding CRCI in HL survivors (HLS) are scarce. The current study aimed to objectively assess CRCI incidence and characteristics in HLS. HLS, who completed first-line (chemotherapy ± radiation) therapy and remained in complete remission for 6 months to 5 years from therapy end, were evaluated. Age- and education-matched healthy individuals served as controls (n = 14). Test results were compared to population norms and healthy controls. Study participants completed self-reported questionnaires evaluating fatigue, depression, anxiety, quality of life and cognitive function. Subjects underwent neurocognitive evaluation, assessing processing speed, memory, attention, executive functions and intelligence domains. The present study included 51 HLS with a median age of 28 years, mean education of 14·5 ± 2·5 years. Complaints related to cognitive deterioration and fatigue were significantly more severe and frequent in HLS compared to healthy controls. Objective neurocognitive evaluation demonstrated that 30% of HLS were impaired in ≥2 cognitive domains. In conclusion, the present study demonstrates that fatigue and cognitive impairment, predominantly in executive functions and memory, constitute frequent and alarming findings in HLS. These adverse effects can persist and exert an impact on all aspects of life.
Collapse
Affiliation(s)
| | - Tatiana Mashiach
- Quality Assurance Unit, Rambam Health Care Campus, Haifa, Israel
| | - Rachel Ben Hayun
- Department of Cognitive Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Tamar Tadmor
- Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Haematology Unit, Bnai Zion Medical Centre, Haifa, Israel
| | - Tali Fisher
- Department of Cognitive Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Judith Aharon-Peretz
- Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Department of Cognitive Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Eldad J Dann
- Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Department of Haematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| |
Collapse
|
13
|
Wong OY, Yau V, Kang J, Glick D, Lindsay P, Le LW, Sun A, Bezjak A, Cho BCJ, Hope A, Giuliani M. Survival Impact of Cardiac Dose Following Lung Stereotactic Body Radiotherapy. Clin Lung Cancer 2017; 19:e241-e246. [PMID: 28941961 DOI: 10.1016/j.cllc.2017.08.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/09/2017] [Accepted: 08/18/2017] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The purpose of this study was to determine the impact of radiation dose to substructures of the heart in lung stereotactic body radiotherapy (SBRT) patients on non-cancer-related deaths. METHODS Patients treated with lung SBRT at a single institution from 2005 to 2013 were included. The heart and its substructures were contoured, and dose was calculated including mean, max, and max 10 cc dose. Clinical variables including stage, histology, age, gender, Charlson comorbidity index (CCI), preexisting cardiac disease, pulmonary function (forced expiratory volume in 1 second, diffusion capacity), and smoking status were explored for association with non-cancer-related deaths in univariable (UVA) and multivariable (MVA) analyses. Heart dosimetric parameters were correlated with the risk of radiation pneumonitis (RP) using UVA and MVA. RESULTS A total of 189 patients were included with median age of 76 years (range, 48-93 years). Of these patients, 45.5% were female, 27.5% were T2, 16.9% were current smokers, 64% had preexisting cardiac risk factors, and 34.5% had CCI score of ≥ 3. Mean lung dose ± SD was 456 ± 231 cGy. Heart max, mean, and 10 cc doses were 1867 ± 1712 cGy, 265 ± 269 cGy, and 1150 ± 1075 cGy, respectively. There were 14 (7.4%) ≥ Grade 2 RP and 3 (1.6%) were ≥ Grade 3. The median overall survival was 37.3 months (95% confidence interval, 29.8-45.3 months). On UVA, female gender (P < .01), higher Eastern Cooperative Oncology Group (P = .01), cardiac risk (P < .01), CCI (P < .01), and bilateral ventricles max dose (P = .02) were associated with non-cancer-related deaths; on MVA, bilateral ventricles max dose was significant (P = .05). No heart parameters were associated with RP. CONCLUSIONS Higher bilateral ventricles max dose is associated with poorer survival. Heart dose parameters should be considered when planning patients for SBRT.
Collapse
Affiliation(s)
- Olive Y Wong
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Vivian Yau
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Julie Kang
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Daniel Glick
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Patricia Lindsay
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Lisa W Le
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Alexander Sun
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Bezjak
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - B C John Cho
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Hope
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Meredith Giuliani
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
14
|
Rugbjerg K, Maraldo M, Aznar MC, Cutter DJ, Darby SC, Specht L, Olsen JH. Long-term hospitalisation rates among 5-year survivors of Hodgkin lymphoma in adolescence or young adulthood: A nationwide cohort study. Int J Cancer 2017; 140:2232-2245. [PMID: 28213927 PMCID: PMC5396317 DOI: 10.1002/ijc.30655] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 02/01/2017] [Accepted: 02/02/2017] [Indexed: 01/21/2023]
Abstract
In the present study, we report on the full range of physical diseases acquired by survivors of Hodgkin lymphoma diagnosed in adolescence or young adulthood. In a Danish nationwide population-based cohort study, 1,768 five-year survivors of Hodgkin lymphoma diagnosed at ages 15-39 years during 1943-2004 and 228,447 comparison subjects matched to survivors on age and year of birth were included. Hospital discharge diagnoses and bed-days during 1977-2010 were obtained from the Danish Patient Register for 145 specific disease categories gathered in 14 main diagnostic groups. The analysis was conducted separately on three subcohorts of survivors, that is, survivors diagnosed 1943-1976 for whom we had no information on rehospitalisation for Hodgkin lymphoma and survivors diagnosed 1977-2004, split into a subcohort with no expected relapses and a subcohort for whom a rehospitalisation for Hodgkin lymphoma indicated a relapse. The overall standardised hospitalisation rate ratios (RRs) were 2.0 [95% confidence interval (CI), 1.9-2.1], 1.5 (1.4-1.6) and 2.9 (2.6-3.1) respectively, and the corresponding RRs for bed-days were 3.5 (3.4-3.5), 1.8 (1.8-1.9) and 10.4 (10.3-10.6). Highest RRs were seen for nonmalignant haematological conditions (RR: 2.6; 3.1 and 9.7), malignant neoplasms (RR: 3.2; 2.5 and 4.7) and all infections combined (RR: 2.5; 2.2 and 5.3). Survivors of Hodgkin lymphoma in adolescence or young adulthood are at increased risk for a wide range of diseases that require hospitalisation. The risk depends on calendar period of treatment and on whether the survivors were rehospitalised for Hodgkin lymphoma, and thus likely had a relapse.
Collapse
Affiliation(s)
- Kathrine Rugbjerg
- Department of Survivorship UnitDanish Cancer Society Research CenterStrandboulevarden 49Copenhagen2100Denmark
| | - Maja Maraldo
- Department of OncologyRigshospitalet, University of CopenhagenBlegdamsvej 9Copenhagen2100Denmark
| | - Marianne C. Aznar
- Department of OncologyRigshospitalet, University of CopenhagenBlegdamsvej 9Copenhagen2100Denmark
- Nuffield Department of Population HealthUniversity of OxfordRichard Doll Building, Old Road CampusOxfordOX3 7LFUnited Kingdom
| | - David J. Cutter
- Nuffield Department of Population HealthUniversity of OxfordRichard Doll Building, Old Road CampusOxfordOX3 7LFUnited Kingdom
- Department of Oncology, Oxford Cancer and Haematology CentreOxford University Hospitals NHS Foundation TrustOld RoadOxfordOX3 7LEUnited Kingdom
| | - Sarah C. Darby
- Nuffield Department of Population HealthUniversity of OxfordRichard Doll Building, Old Road CampusOxfordOX3 7LFUnited Kingdom
| | - Lena Specht
- Department of OncologyRigshospitalet, University of CopenhagenBlegdamsvej 9Copenhagen2100Denmark
- Department of HaematologyRigshospitalet, University of CopenhagenBlegdamsvej 9Copenhagen2100Denmark
| | - Jørgen H. Olsen
- Danish Cancer Society Research CenterStrandboulevarden 49Copenhagen2100Denmark
| |
Collapse
|
15
|
Glimelius I, Eloranta S, Ekberg S, Chang ET, Neovius M, Smedby KE. Increased healthcare use up to 10 years among relapse-free Hodgkin lymphoma survivors in the era of intensified chemotherapy and limited radiotherapy. Am J Hematol 2017; 92:251-258. [PMID: 28006849 DOI: 10.1002/ajh.24623] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 11/21/2016] [Accepted: 12/07/2016] [Indexed: 01/15/2023]
Abstract
With today's excellent cure rates for Hodgkin lymphoma (HL), the number of long-term survivors is increasing. This study aims to provide a global assessment of late adverse effects for working-age HL survivors treated with contemporary protocols (combination chemotherapy and limited radiotherapy). From Swedish nationwide registers we identified 1017 HL survivors diagnosed in 2000-2009, aged 18-60 years (median 32) and surviving at least one year post-diagnosis, and 4031 age-, sex-, and calendar-year-matched population comparators. Incidence rate ratios (IRR) and 95% confidence intervals (95%CI) for outpatient visits and inpatient bed-days after the first year up to 14 years post-diagnosis (through 2013) were estimated across treatment subgroups, considering relapse-free time and using negative binomial regression. Scheduled outpatient visits for HL were excluded. The rate of outpatient visits was nearly double (IRR = 1.8, 95%CI: 1.6-2.0) that among comparators and higher rates persisted up to 10 years post-diagnosis. The rate of inpatient bed-days among relapse-free survivors was more than three-fold (IRR = 3.6, 95%CI: 2.7-4.7) that of comparators and the increase persisted up to four years post-diagnosis. Patients requiring 6-8 chemotherapy courses had higher rates of outpatient visits (IRR = 1.4, 95%CI: 1.1-1.7) and bed-days (IRR = 4.7, 95%CI: 2.9-7.8) than patients treated with 2-4 courses + radiotherapy. Previously seldom reported reasons for the excess healthcare use included chest pain, keratitis, asthma, diabetes mellitus, and depression. Contemporary treatment, chemotherapy in particular, was associated with excess healthcare use among HL survivors during the first decade postdiagnosis. The reasons for healthcare visits reflected a wide range of disorders, indicating the need of broad individualized care in addition to specific screening programs.
Collapse
Affiliation(s)
- Ingrid Glimelius
- Department of MedicineClinical Epidemiology Unit, Karolinska Institutet and Karolinska University HospitalStockholm Sweden
- Department of Immunology, Genetics and Pathology, Clinical and Experimental OncologyUppsala University and Uppsala Akademiska Hospital Sweden
| | - Sandra Eloranta
- Department of MedicineClinical Epidemiology Unit, Karolinska Institutet and Karolinska University HospitalStockholm Sweden
| | - Sara Ekberg
- Department of MedicineClinical Epidemiology Unit, Karolinska Institutet and Karolinska University HospitalStockholm Sweden
| | - Ellen T. Chang
- Center for Epidemiology and Computational Biology, Health Sciences Practice, ExponentMenlo ParkCalifornia USA
- Division of Epidemiology, Department of Health Research and PolicyStanford University School of MedicineStanford California USA
| | - Martin Neovius
- Department of MedicineClinical Epidemiology Unit, Karolinska Institutet and Karolinska University HospitalStockholm Sweden
| | - Karin E. Smedby
- Department of MedicineClinical Epidemiology Unit, Karolinska Institutet and Karolinska University HospitalStockholm Sweden
- Department of MedicineKarolinska University Hospital and Karolinska InstitutetStockholm Sweden
- Division of HematologyKarolinska University Hospital and Karolinska InstitutetStockholm Sweden
| |
Collapse
|
16
|
Soumerai JD, Hellmann MD, Feng Y, Sohani AR, Toomey CE, Barnes JA, Takvorian RW, Neuberg D, Hochberg EP, Abramson JS. Treatment of primary mediastinal B-cell lymphoma with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone is associated with a high rate of primary refractory disease. Leuk Lymphoma 2013; 55:538-43. [DOI: 10.3109/10428194.2013.810738] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
17
|
Cooper RA, Straus DJ. Clinical guidelines, the politics of value, and the practice of medicine: physicians at the crossroads. J Oncol Pract 2012; 8:233-5. [PMID: 23180988 PMCID: PMC3396820 DOI: 10.1200/jop.2011.000500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2012] [Indexed: 11/20/2022] Open
Abstract
Best practice guidelines are being used to an increasing degree, not only by physicians to improve the level of care, but also by bureaucrats to constrain reimbursement and guide the pathways of care.
Collapse
Affiliation(s)
- Richard A Cooper
- Center for the Future of the Healthcare Workforce, New York Institute of Technology, New York, NY 10022, USA.
| | | |
Collapse
|