Survivorship Symposium 2016: Study Finds That Less Than Half of Survivors of Hodgkin Lymphoma Received All Recommended Follow-up Care


Key Points

  • Less than half (48%) of adolescent and young adult survivors of Hodgkin lymphoma received recommended follow-up care within the first 12 months post-treatment.
  • Within the first 5 years after completing treatment, 96% of survivors had at least one visit per year with an oncologist, and 70% received the recommended laboratory testing. Services that were commonly lacking included psychosocial counseling and appropriate vaccines.
  • These results will inform the development of effective programs to meet survivors’ needs.

According to the American Cancer Society’s 2014 Cancer Facts & Figures, Hodgkin lymphoma is diagnosed in about 800 adolescents and young adults each year. And while standard treatments for the cancer, including chemotherapy and radiation, are very effective in improving survival, survivors remain at high risk for long-term and late effects of treatment, including heart and thyroid problems, lung disease, second cancers, infertility, and psychosocial problems.

A study investigating adherence to the National Comprehensive Cancer Network (NCCN) post-treatment guidelines for adolescent and young adult survivors of Hodgkin lymphoma has found that less than half (48%) of patients received recommended care within the first 12 months post-treatment. However, nearly all survivors (96%) had recommended oncology visits, and 70% received the recommended laboratory testing within the first 5 years. These results, according to the study authors, will inform the development of effective programs to meet survivors’ needs.

The study (Abstract 107) results were presented at the 2016 Cancer Survivorship Symposium, cosponsored by ASCO, the American College of Physicians, and the American Academy of Family Physicians, January 15 to 16 in San Francisco, California.

Study Methodology

The researchers identified 354 patients, ages 15 to 39, diagnosed with classical Hodgkin lymphoma between 2000 and 2010 from an integrated health-care system. The researchers identified use of NCCN recommended services, such as oncology visits, laboratory tests, and computed tomography (CT) scans, and nonrecommended services, such as positron-emission tomography (PET) and CT imaging after the first year. Multivariate logistic regression was used to identify associations between receipt of recommended services within the first 12 months post-treatment (oncology visits, labs, CT) and patient (gender, race/ethnicity) and cancer characteristics (stage, diagnosis age, diagnosis year).

Study Results

The researchers found that nearly all the survivors had the recommended oncology visits within the first 5 years (96%); and 70% received recommended labs. Two-thirds received a recommended CT scan within 12 months post-treatment. However, 47% received a nonrecommended CT in year 2 and 35% in year 3, and 33% received nonrecommended surveillance PET scans. Overall, 48% received all recommended care within the first 12 months. Diagnosis year was significant in regression, with those diagnosed between 2000 and 2005 less likely to receive recommended care than those diagnosed between 2006 and 2010 (OR = 0.007, P < .0001).

Next Steps

“This study really shows that there is a need to improve care delivery for these patients and our next steps are to think about designing and implementing systematic programs to address these things,” said Erin E. Hahn, PhD, MPH, a research scientist in the Department of Research and Evaluation at Kaiser Permanente Southern California and lead author of this study, during a press briefing announcing the study results.

In her summary of Dr. Hahn’s study results, Merry-Jennifer Markham, MD, FACP, ASCO spokesperson and moderator of the press briefing, agreed that more has to be done to improve adherence to post-treatment guidelines.

“Survivorship care is really crucial in the adolescent and young adult population of Hodgkin lymphoma survivors because many of them, most of them, in fact, will have long lives ahead of them. We have national guidelines that exist to provide recommendations on screening for recurrence, screening for late treatment effects, and methods to maintain health,” said Dr. Markham. “However, despite these guidelines, Dr. Hahn’s study illustrates that less than half of these young adult Hodgkin lymphoma survivors are receiving some critical components of survivorship care. So clearly we have some opportunities ahead of us to improve adherence to post-treatment guidelines and, hopefully, as a result [improved] survivorship outcomes for all.”

Funding for this study was provided by the Department of Research and Evaluation, Kaiser Permanente Southern California.

All the study authors, Erin E. Hahn, PhD, MPH; Yi-Lin Wu, MS; Jazmine Garcia Delgadillo, MPH; and Corrine E. Munoz-Plaza, MPH, are employees of Kaiser Permanente.


The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.