Hodgkin lymphoma detection and survival: findings from the Haematological Malignancy Research Network.

Maxine Je Lamb,Cathy Burton,Debra A Howell,Alexandra G Smith,Russell Patmore,Eve Roman,Eleanor Kane,Timothy Bagguley

doi:10.3399/bjgpopen19x101668

Abstract

BackgroundHodgkin lymphoma is usually detected in primary care with early signs and symptoms, and is highly treatable with standardised chemotherapy. However, late presentation is associated with poorer outcomes.AimTo investigate the relationship between markers of advanced disease, emergency admission, and survival following a diagnosis of classical Hodgkin lymphoma (CHL).Design & settingThe study was set within a sociodemographically representative UK population-based patient cohort of ~4 million, within which all patients were tracked through their care pathways, and linked to national data obtained from Hospital Episode Statistics (HES) and deaths.MethodAll 971 patients with CHL newly diagnosed between 1 September 2004–31 August 2015 were followed until 18th December 2018.ResultsThe median diagnostic age was 41.5 years (range 0–96 years), 55.2% of the patients were male, 31.2% had stage IV disease, 43.0% had a moderate–high or high risk prognostic score, and 18.7% were admitted via the emergency route prior to diagnosis. The relationship between age and emergency admission was U-shaped: more likely in patients aged <25 years and ≥70 years. Compared to patients admitted via other routes, those presenting as an emergency had more advanced disease and poorer 3-year survival (relative survival 68.4% [95% confidence interval {CI} = 60.3 to 75.2] versus 89.8% [95% CI = 87.0 to 92.0], respectively [P<0.01]). However, after adjusting for clinically important prognostic factors, no difference in survival remained.ConclusionThese findings suggest that CHL survival as a whole could be increased by around 4% if the cancer in patients who presented as an emergency had been detected at the same point as in other patients.

Highlights

The relationship between late diagnosis and poor outcome is recognised for many cancers, with delay often resulting in more advanced disease, worse survival, increased risk of complications, and impaired quality of life.[1,2,3] over recent decades the UK Department of Health has introduced a series of interventions aimed at facilitating earlier diagnosis
Compared to patients admitted via other routes, those presenting as an emergency had more advanced disease and poorer 3-year survival
These findings suggest that classical Hodgkin lymphoma (CHL) survival as a whole could be increased by around 4% if the cancer in patients who presented as an emergency had been detected at the same point as in other patients

Summary

Introduction

Diagnosis is of particular interest in the context of CHL, since it typically presents with early signs and symptoms and is highly treatable with standardised chemotherapy; the 5-y ear survival is around 85%,7–9 decreasing to around 70% in those diagnosed at an advanced stage.[7] By contrast, the clinical course of the rarer NLPHL is generally indolent, immediate treatment is not always required, and relative survival approaches that of the general population.[9,10,11,12].

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