Disparities Persist in the Long Term for 5-Year AYA Survivors of Hodgkin Lymphoma

Decades after adolescents and young adults (AYAs) survive Hodgkin lymphoma (HL), racial, ethnic, and socioeconomic status (SES) disparities continue to exist, according to a study published in Cancer Epidemiology, Biomarkers & Prevention.

Previous studies have focused on early survival, but this new study looked at 5-year survivors with an extended follow-up for up to 30 years. The overall cancer incidence in AYAs is increasing, but so are the cure rates, and there is growing research on the long-term mortality outcomes among these survivors.

“As the AYA cancer survivor population continues to grow, more data are needed on long-term outcomes, specifically factors associated with inferior long-term survival,” the authors explained.

They characterized long-term mortality patterns using data from the Surveillance, Epidemiology, and End Results (SEER) database from 1975 to 2011. The analysis included 15,899 patients with HL who survived 5 years after their initial diagnosis.

The median age of diagnosis was 27 years and the follow-up after 5-year survival was 9.4 years. The overall mortality rate was 11%, but the rate varied widely depending on when an individual received their diagnosis: 30% in the 1980s, 13% in the 1990s, and 5% in the 2000s.

Half of the cohort was female, 10% was Black, 12% was Hispanic, 4% were non-Hispanic Asian or Pacific Islander, and 74% were non-Hispanic White. Non-Hispanic Black survivors had worse long-term survival compared with non-Hispanic White survivors. Their survival rate was 66% that of non-Hispanic Whites.

While all groups saw an improvement in survival from the 1980s to the 2000s, non-Hispanic Whites who received their diagnosis in the 2000s had survival times almost 3 times as long as those who received their diagnosis in the 1980s. In comparison, non-Hispanic Blacks and Hispanics with a diagnosis in the 2000s had survivals times that were nearly twice the survival time as those with a diagnosis in the 1980s.

“Structural racism is also likely to be contributing to the persistent racial/ethnic disparities seen in the current study, particularly as it relates to health care access and SES disparities,” the authors wrote.

As SES declined, so did survival time. Each additional unit increase on the count of socioeconomic deprivation index, in which a higher value indicates lower SES, was associated with an 8% reduction in survival time. However, only survivors who received a diagnosis in the 1980s had a difference in long-term survival by SES level. There were no significant differences for survivors who received diagnoses in the 1990s or 2000s.

The researchers also found:

• Each additional year of age at diagnosis was associated with a 4% reduction in survival time.
• Rurality had no significant impact on long-term survival.
• Female survivors had a significantly longer survival time. Males only had a survival rate that was 68% of females’ survival time.
• Survival for both female and male survivors improved over time.
• High stage at diagnosis was associated with worse long-term survival.

The authors noted treatment-related modifications have benefited the overall HL population and led to improved outcomes, but there needs to be a better understanding of why racial, ethnic, SES, and sex disparities persist in the long term.

“With improved cure rates for AYAs with HL, additional attention is needed to improve long-term outcomes for specific high-risk populations,” they wrote.

Reference

Berkman AM, Andersen CR, Puthenpura V, et al. Impact of race, ethnicity, and socioeconomic status over time on long-term survival of adolescent and young adult Hodgkin lymphoma survivors. Cancer Epidemiol Biomarkers Prev. Published online July 8, 2021. doi:10.1158/1055-9965.EPI-21-0103