The Effect of Specialized Cancer Treatment Centers on Treatment Efficacy in Hodgkin’s Lymphoma

Klimm, Beate; Brillant, Corinne; Skoetz, Nicole; Müller, Horst; Engert, Andreas; Borchmann, Peter

doi:10.3238/arztebl.2012.0893

Cited by 9 publications

(7 citation statements)

References 23 publications

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“…This finding is in line with previous studies (Stark et al, 2002;Engert et al, 2005;Bjorkholm et al, 2011;Evens et al, 2012;Klimm et al, 2012;Thyss et al, 2014). Although in the current study we included patients from the cancer registry with the same age range as trial patients (i.e.…”

Section: Discussionsupporting

confidence: 89%

Survival differences between patients with Hodgkin lymphoma treated inside and outside clinical trials. A study based on the EORTC‐Netherlands Cancer Registry linked data with 20 years of follow‐up

et al. 2016

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SummaryThe survival of patients diagnosed with Hodgkin lymphoma (HL) has improved from 70% to 90% in clinical trials. However, population-based data has shown lower survival. In this study, clinical trial data were linked with cancer registry to identify trial and non-trial participants and differences in overall survival and associated factors were assessed. In 1986-2004, 27% of HL patients aged 15-70 years participated in clinical trials. Compared to non-trial participants, trial participants were younger (median age, 31 vs. 34 years), had staging registered more accurately and had an 8% higher 20-year survival rate (73% vs. 65%). After adjusting for baseline differences, no differences in survival (hazard ratio = 0Á96, 95% confidence interval 0Á82-1Á12), or in subgroup analysis according to stage, remained. Over time, increased administration of chemotherapy in combination with radiotherapy, together with the decreased use of radiotherapy alone was observed among the trial population. This trend was later followed in nontrial participants, coinciding with a similar 'take-up' in survival. The observed superior survival among patients with HL treated in clinical trials can be largely explained by the differences in baseline characteristics, particularly younger age. High trial participation rate and centralized expertise facilitates the implementation of trial findings to real-world practice.Keywords: overall survival, hodgkin lymphoma, clinical trials, populationbased cancer registry, deterministic data linkage. Between 1964 and, the Lymphoma Group of the European Organisation for Research and Treatment of Cancer (EORTC) has conducted a series of phase III randomized clinical trials (RCTs) aiming to improve the efficacy of treatment in Hodgkin Lymphoma (HL), while minimizing longterm treatment-related toxicities. These subsequent trials have successfully improved the 10-year relative survival (RS) of HL patients, diagnosed between 1964 and 2004, with early stage disease from 72% to 93% and with advanced staged disease from 63% to 78% (Favier et al, 2009). However, compared to the high survival rate observed in the most recent clinical trials, that of the general patient population seems to be lower. In the Netherlands, for instance, for patients diagnosed with HL between 1989 and 2000, the 5-year RS was 78% in the general patient population (including trial participants), which is much lower than the 5-year RS seen in patients entered in clinical trials (87%). With longer follow-up, the survival gap between these two patient research paper ª

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Section: Discussionsupporting

confidence: 89%

Survival differences between patients with Hodgkin lymphoma treated inside and outside clinical trials. A study based on the EORTC‐Netherlands Cancer Registry linked data with 20 years of follow‐up

et al. 2016

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“…Interestingly, centre type did not affect the risk of incorrect TGA. This is in accordance with a previous analysis by the GHSG that found no difference in the treatment outcome with regard to centre type or size (Klimm et al , ). The GHSG quality control programme as well as prompt consulting by study physicians via telephone in case of uncertainties prior to enrolment may contribute to this observation.…”

Section: Discussionsupporting

confidence: 93%

Impact of centralized diagnostic review on quality of initial staging in Hodgkin lymphoma: experience of the German Hodgkin Study Group

et al. 2015

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SummaryAccurate clinical staging is crucial for adequate risk-adapted treatment in Hodgkin lymphoma (HL) to prevent patients from under-or over-treatment. Within the latest German Hodgkin Study Group trial generation, diagnostic findings such as histopathology, computerized tomography imaging and clinical risk factors were re-evaluated by expert panels. Here, we retrospectively analysed 5965 patients and identified 399 in who major discordant findings changed their first-line treatment allocation. Histopathology review did not confirm the initial diagnosis of HL in 87 patients. Treatment allocation was revised in 312 of the remaining 5878 patients: 176 were assigned to a higher and 128 to a lower risk group, respectively; the correct treatment group remained unclear in 8 patients. Cases of revised treatment allocation accounted for 9Á8%, 6Á0%, 0Á8%, and 14Á8% of patients initially assigned to the HD13, HD14, HD15 trials and stage IA lymphocyte-predominant HL project, respectively. Most revisions were due to wrong application of clinical stage (20Á5% of 312 patients with revised treatment group), histological subtype (9Á0%) or the risk factors ≥3 involved areas (46Á8%) or large mediastinal mass (9Á3%). In conclusion, centralized review by experienced experts changed risk-adapted first-line treatment in a relevant proportion of HL patients. Quality control measures clearly improve the accuracy of treatment and should be implemented in clinical practice.

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“…Considering breast cancer, however, they reported a significantly better survival for TH patients. In Germany, Klimm et al 6 analyzed center effects in the treatment of Hodgkin lymphoma but found no influence of the type of hospital or of the treatment experience.…”

Section: Resultsmentioning

confidence: 99%

The impact of health care settings on survival time of patients with chronic myeloid leukemia

Lauseker

Hasford

Pfirrmann

et al. 2014

Blood

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The Effect of Specialized Cancer Treatment Centers on Treatment Efficacy in Hodgkin’s Lymphoma

Cited by 9 publications

References 23 publications

Survival differences between patients with Hodgkin lymphoma treated inside and outside clinical trials. A study based on the EORTC‐Netherlands Cancer Registry linked data with 20 years of follow‐up

Survival differences between patients with Hodgkin lymphoma treated inside and outside clinical trials. A study based on the EORTC‐Netherlands Cancer Registry linked data with 20 years of follow‐up

Impact of centralized diagnostic review on quality of initial staging in Hodgkin lymphoma: experience of the German Hodgkin Study Group

The impact of health care settings on survival time of patients with chronic myeloid leukemia

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