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AYA survivors of Hodgkin’s lymphoma underutilize recommended follow-up care
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Fewer than half of adolescent and young adult survivors of Hodgkin’s lymphoma received all recommended care in their first year after treatment, according to research presented at the Cancer Survivorship Symposium.
However, nearly all survivors attended recommended oncology appointments and 70% of survivors received recommended laboratory tests within their first 5 years after treatment.
“Patients treated for Hodgkin’s lymphoma are at high risk for recurrence and relapse, as well as serious long-term and late effects,” Erin E. Hahn, PhD, MPH, research scientist at Kaiser Permanente Southern California in Pasadena, California, said in a press release. “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.”
Organizations such as the National Comprehensive Cancer Network (NCCN) have issued guidelines for after-treatment care of adolescent and young adult (AYA) survivors of Hodgkin’s lymphoma. However, guideline adherence has not been studied.
Thus, Hahn and colleagues sought to identify AYA survivors within an integrated health care system with the intent of examining their utilization of post-treatment services.
The researchers identified individuals aged 15 to 39 years who received a Hodgkin’s lymphoma diagnosis between 2000 and 2010. The investigators identified the use of NCCN-recommended services — including oncology visits, scheduled labs and CT scans in the first year after treatment — as well as the use of non-recommended services, such as PET scans and CT scans after the first year.
The study included data from 354 survivors of Hodgkin’s lymphoma (mean age at diagnosis, 26 years; 59% diagnosed at stage II).
Ninety-six percent of survivors attended all recommended oncology visits within the first 5 years, and 70% received all recommended labs. Further, two-thirds received a recommended CT scan within the first 12 months after treatment.
However, 47% received a non-recommended CT scan in year 2, and 35% received a scan in year 3. Thirty-three percent of patients received a non-recommended PET scan.
Overall, researchers observed that only 48% of survivors received all recommended care within the first year after treatment.
In a multivariate analysis, patients diagnosed between 2000 and 2005 appeared less likely to receive all recommended treatment than those diagnosed between 2006 and 2010 (OR = .007; P < .0001).
“Ultimately, we want to make sure that these patients receive optimal care so that they can achieve optimal health outcomes,” Hahn said during a press conference. “We have the opportunity to improve longer-term use of services. There is a need to improve care delivery, and our next steps are to think about designing and implementing systematic programs to address these needs.” – by Cameron Kelsall
Reference:
Hahn EE, et al. Abstract 107. Presented at: Cancer Survivorship Symposium; Jan. 15-16, 2016; San Francisco.
Disclosure: Kaiser Permanente Southern California funded this study. All researchers report employment with Kaiser Permanente Southern California.
Perspective
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Merry-Jennifer Markham, MD, FACP
Survivorship care is really crucial in the adolescent and young adult (AYA) population of Hodgkin’s lymphoma survivors, because most of them have long lives ahead of them.
We have national guidelines in place to determine screening for recurrence, screening for late treatment effects and methods to maintain health. Despite these guidelines, the study of Hahn and colleagues demonstrates that fewer than half of AYA survivors are receiving the critical components of survivorship care.
Clearly, we have some opportunities ahead of us to improve adherence to posttreatment guidelines. Hopefully as a result, we will be able to improve outcomes for all.
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