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Poor, minority AYAs less likely to survive Hodgkin’s lymphoma
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Adolescents and young adults aged 15 to 39 years with Hodgkin’s lymphoma appeared more likely to die if they were black, Hispanic or lived in a poor neighborhood, according to the results of a population-based analysis conducted in California.
Treatment advances for Hodgkin’s lymphoma — one of the more common cancers in adolescents and young adults (AYAs) — have resulted in substantial improvements in survival for many patients, according to study background. However, data have indicated these survival gains may not exist uniformly across the AYA population.
Theresa H.M. Keegan, PhD, MS
“Identifying and reducing barriers to recommended treatment and surveillance in these adolescents and young adults at much higher risk of mortality is essential to ameliorating these survival disparities,” Theresa H.M. Keegan, PhD, MS, associate professor in the division of hematology and oncology at University of California Davis Comprehensive Cancer Center in Sacramento, said in a press release.
The investigators used the California Cancer Registry to evaluate data from 9,353 patients who were aged 15 to 39 years at the time of their Hodgkin’s lymphoma diagnosis, which occurred between 1988 and 2011.
Overall, 32% of the population was followed for 15 years or more, with a mean follow-up of 11 years. Most of this cohort was non-Hispanic white (63%) and 24% were Hispanic.
A greater proportion of black (40%) and Hispanic (37%) AYAs were diagnosed at an advanced stage than white patients (31%) and Asian/Pacific Islanders (34%). Further, 73% of black and Hispanic patients resided in the lowest three categories of neighborhood socioeconomic status compared with 47% of white and Asian/Pacific Islander patients.
Having public or no insurance also was more common among black patients (35%) and Hispanic patients (39%) compared with white patients (17%) and Asian/Pacific Islanders (16%).
As of December 2012, 13% of the patients had died, 72% of whom died of cancer.
Overall, the risk for Hodgkin’s lymphoma death appeared greater among black AYAs (HR = 1.62; 95% CI, 1.24-2.11) and Hispanic patients (HR = 1.35; 95% CI, 1.12-1.64) compared with white patients.
Further, AYAs living in the lower socioeconomic status neighborhoods experienced a 52% to 77% increased risk for Hodgkin’s lymphoma mortality compared with those living in the highest quintile (lowest quintile, HR = 1.77; 95% CI, 1.34-2.33).
When researchers conducted separate analyses for disease stage, results showed black patients appeared more likely to experience Hodgkin’s lymphoma-specific death than white patients among those with early-stage (HR = 1.68; 95% CI, 1.14-2.49) and late-stage (HR = 1.68; 95% CI, 1.17-2.41) disease.
Similarly, Hispanic patients had a worse Hodgkin’s lymphoma-specific survival than white patients with late-stage disease (HR = 1.58; 95% CI, 1.22-2.04).
Greater mortality risks also existed among patients with early-stage disease from poorer neighborhoods (HR = 2.06; 95% CI, 1.59-2.68), as well as among patients diagnosed between 2000 and 2011 who had public health insurance or were uninsured (HR = 2.08; 95% CI, 1.52-2.84).
Limitations of this study included that the researchers did not having specific details about treatment following the first course and that health insurance status was not available for patients at the time of diagnosis prior to 2001. Additionally, changes in health insurance status for patients after their initial treatment were unavailable.
“With uninsurance rates historically peaking in adolescence and young adulthood, [these] patients may be particularly vulnerable to failing to receive cancer survivor-focused medical care,” Keegan and colleagues concluded. “The Affordable Care Act has the potential to influence both access to insurance and use of necessary health care for adolescents and young adults and should be evaluated in future studies.” – by Anthony SanFilippo
Disclosure: Keegan reports no relevant financial disclosures. One other researcher reports receiving a research grant from Genentech.
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