Increased healthcare use up to 10 years among relapse‐free Hodgkin lymphoma survivors in the era of intensified chemotherapy and limited radiotherapy

Abstract

With today's excellent cure rates for Hodgkin lymphoma (HL), the number of long-term survivors is increasing. This study aims to provide a global assessment of late adverse effects for working-age HL survivors treated with contemporary protocols (combination chemotherapy and limited radiotherapy). From Swedish nationwide registers we identified 1017 HL survivors diagnosed in 2000-2009, aged 18-60 years (median 32) and surviving at least one year post-diagnosis, and 4031 age-, sex-, and calendar-year-matched population comparators. Incidence rate ratios (IRR) and 95% confidence intervals (95%CI) for outpatient visits and inpatient bed-days after the first year up to 14 years post-diagnosis (through 2013) were estimated across treatment subgroups, considering relapse-free time and using negative binomial regression. Scheduled outpatient visits for HL were excluded. The rate of outpatient visits was nearly double (IRR = 1.8, 95%CI: 1.6-2.0) that among comparators and higher rates persisted up to 10 years post-diagnosis. The rate of inpatient bed-days among relapse-free survivors was more than three-fold (IRR = 3.6, 95%CI: 2.7-4.7) that of comparators and the increase persisted up to four years post-diagnosis. Patients requiring 6-8 chemotherapy courses had higher rates of outpatient visits (IRR = 1.4, 95%CI: 1.1-1.7) and bed-days (IRR = 4.7, 95%CI: 2.9-7.8) than patients treated with 2-4 courses + radiotherapy. Previously seldom reported reasons for the excess healthcare use included chest pain, keratitis, asthma, diabetes mellitus, and depression. Contemporary treatment, chemotherapy in particular, was associated with excess healthcare use among HL survivors during the first decade postdiagnosis. The reasons for healthcare visits reflected a wide range of disorders, indicating the need of broad individualized care in addition to specific screening programs.

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

“…10,12,26,33,34 Our finding that the excess hospital use among survivors is mainly driven by the relapsing individuals is in line with a few other previous investigations. 26,35,36 Results similar to the present study were recently reported in a Danish population-based study of 1768 5-year survivors of HL, diagnosed at ages 15-39 years in the period 1943-2004. 37 That study overlapped with the present investigation for the subset of 15-24-year-old Danish patients diagnosed between 1990 and 2004, who survived their disease by 5 years or more, but included neither children, nor outpatient data or clinical information, such as disease stage, and further, only approximated relapse-status.…”

Genomic chaos in peripheral blood lymphocytes of Hodgkin's lymphoma patients one year after ABVD chemotherapy/radiotherapy

“…For example, unbalanced chromosomal abnormalities may result in the deletion of tumor suppressor genes or inactivation of genes involved in DNA repair. In addition, balanced exchanges could allow the survival of carrier cells by affecting the function of genes important for preventing cancer development, modifying the expression of oncogenes, or tumor suppressor genes, and thus, permitting the occurrence of SMN in these patients (Glimelius et al, ).…”

No excess long‐term mortality in stage I‐IIA Hodgkin lymphoma patients treated with ABVD and limited field radiotherapy

“…Despite showing high survival rates for relapse-free individuals and less fatal treatment toxicity, our data still motivate follow-up (Glimelius et al, 2017). Fatal late effects may develop beyond two decades of follow-up.…”