Outcome Disparities Persist in Young Patients With Hodgkin Lymphoma

Older age and non-White race/ethnicity may predict worse survival in children, adolescents and young adults with Hodgkin lymphoma regardless of treatment, study findings demonstrate.

In particular, this represents a disparity among a patient population younger than 40 years.

“Hodgkin lymphoma is an ideal paradigm within which to study outcome disparities, primarily because it is so amenable to cure,” Dr. Justine M. Kahn, an assistant professor of pediatrics in the division of pediatric hematology/oncology/stem cell transplantation at Columbia University Irving Medical Center in New York, told CURE®. “When we talk about overall survival (length of time that a patient with cancer is still alive) in Hodgkin lymphoma being near 95% at five or even 10 years, … in doing so, we may miss the patients or groups of patients who actually aren’t achieving such high survival rates. We think it is really important to break down these large populations and to identify the subgroups who may not be doing as well in order to focus efforts on improving their outcomes.”

Previous analyses of adolescent and young adult cancer outcomes determined that Black and Hispanic race/ethnicity, public or no health insurance and low neighborhood socioeconomic status predicted worse survival and overall survival related to Hodgkin lymphoma. Researchers could not assess whether differences in therapy led to these disparities because treatment data were unavailable. Kahn and her team aimed to focus on this aspect to learn more about this specific patient population.

“For this study, we sought to examine survival outcomes in one of our most treatable malignancies while controlling for detailed treatment regimens,” Kahn said. “This is something that is quite unique to our work, as generally the only other way to control for therapy is to use either clinical trials data (which may not be representative of “real-world” care) or to use linked administrative data.”

To do so, researchers analyzed data from 4,807 patients (33% aged 21 years and younger; 48% White; 51% men) younger than 40 years with Hodgkin lymphoma such as individual treatment information. Most patients within this group (95%) were alive after a median follow-up of 4.4 years.

Rates of patients who received chemotherapy differed by age. Seventy percent of patients age 22 to 39 received doxorubicin, vinblastine, bleomycin and dacarbazine compared with 41% in those younger than 22 years. Worse survival outcomes occurred more often in patients who were older and those who were Black or Hispanic. Black patients younger than 21 years had a 3.3-fold increased risk for death.

“The level of detail that we were able to get from text mining was exceptional, and this allowed us to say, ‘Look, non-White and (adolescent and young adult) patients are still having worse survival outcomes even after adjusting for any differences in therapy. Something beyond treatment is contributing,” Kahn explained.

Although researchers were able to obtain insightful information from this study, more research is needed in this area.

“It is my feeling that more research is needed to understand care inequities and disparities over the full cancer continuum,” Kahn said. “We need research to identify barriers to early diagnosis and then prospective studies (those that follow patients with similar disease types but different characteristics over time to assess for a particular outcome) powered to understand disease and patient-related predictors of poor outcomes. Finally, we need to understand and improve access to long-term survivorship care because in diseases like Hodgkin lymphoma, focused survivorship care is key to maintaining optimal long-term outcomes.”

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