Distribution of hospital care among pediatric and young adult Hodgkin lymphoma survivors—A population‐based cohort study from Sweden and Denmark

Abstract

The burden of late effects among Hodgkin lymphoma (HL) survivors treated according to contemporary protocols remains poorly characterized. We used nation‐wide registers to assess number of inpatient bed‐days and specialist outpatient visits among 1048 HL‐patients (<25 years, diagnosed 1990‐2010) and 5175 country‐, sex‐, and age‐matched comparators. We followed them for up to 24 years, with time‐dependent assessment of relapse status. International Classification of Diseases (ICD‐10) chapter‐specific hazard ratios (HRs) were assessed in Cox regression analyses, and nonparametric statistics described patterns of health‐care‐use. Relative to comparators, relapse‐free survivors were at increased risk of infections, diseases of the blood, endocrine, circulatory and respiratory systems, and unspecific symptoms, HRs ranging from 1.86 to 3.05. Relative to comparators, relapsed survivors had at statistically significantly increased risk of diseases reflecting practically all investigated disease‐chapters, HRs ranging from 1.60 to 18.7. Among relapse‐free survivors, 10% of the patients accounted for 80% of all hospital bed days, and 55% were never hospitalized during follow‐up. Among relapsed‐survivors , 10% of the patients accounted for 50% of the bed days, and only 24% were never hospitalized during follow‐up. In contrast, 10% of the comparators accounted for 90% of hospital bed days and 75% were never hospitalized. These findings challenge the impression of a uniformly distributed long‐term morbidity among all HL survivors and emphasize the need for early identification and attention to patients particularly susceptible to late effects, such as relapsed survivors.

Comparison of Hodgkin’s Lymphoma in Children and Adolescents. A Twenty Year Experience with MH’96 and LH2004 AIEOP (Italian Association of Pediatric Hematology and Oncology) Protocols

“…Given the very favorable survival rates achieved in the last decade in AYAs affected by HL, future studies should focus not only on treatment efficacy but also on identifying the best approaches, in terms of a better quality of life during therapy and reduced long-term negative side effects [ 53 , 54 , 55 , 56 ]. The choice of OS as the only parameter defining outcome excludes relapses or long-term harmful effects that profoundly affect the quality of life [ 57 ].…”

Pulmonary diseases in patients with classical Hodgkin lymphoma relative to a matched background population: A Danish national cohort study

“…In contrast to the prospective studies, several of the retrospective studies did not find an association between radiotherapy and pulmonary complications, but pulmonary function testing was not done in all survivors. 20,[24][25][26][27] Glimelius et al 44 examined the burden of late effects in 1048 young patients with HL (<25 years) and found higher risk of pulmonary complications when patients were treated with chemotherapy alone as compared to combined modality. The present study also found higher risk of pulmonary disease events with standalone chemotherapy.…”

“…In the Swedish study, 44 relapse treatment was the main driver of hospitalization for pulmonary complications with HR 12.7 for patients with relapse versus comparators. In this present study, relapse treatment caused some of the pulmonary events, but the risk was still substantially higher in patients when relapses were analysed as competing risks.…”