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

• Main Authors: Maxine JE Lamb, Eve Roman, Debra A Howell, Eleanor Kane, Timothy Bagguley, Cathy Burton, Russell Patmore, Alexandra G Smith
• Format: Article
• Language: English
• Published: Royal College of General Practitioners 2019-12-01
• Series: BJGP Open
• Subjects: cancer staging; data collection; delayed diagnosis; prognosis; real-world data; routes to diagnosis
• Online Access: https://bjgpopen.org/content/3/4/bjgpopen19X101668

Background: Hodgkin 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. Aim: To investigate the relationship between markers of advanced disease, emergency admission, and survival following a diagnosis of classical Hodgkin lymphoma (CHL). Design & setting: The 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. Method: All 971 patients with CHL newly diagnosed between 1 September 2004–31 August 2015 were followed until 18th December 2018. Results: The 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. Conclusion: These 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.