Study Identifies Disparity in Survival of AYA Hodgkin Lymphoma

Mortality in adolescent and young adult (AYA) Hodgkin lymphoma patients is significantly affected by ethnic and socioeconomic factors, as well as insurance status, according to a new study published in Cancer Epidemiology, Biomarkers & Prevention.

The collaborative study, led by authors at the University of California Davis Comprehensive Cancer Center, gathered data for 9353 AYA patients with Hodgkin lymphoma from the California Cancer Registry. These patients were between 15 and 39 years of age when diagnosed during the period between 1988 and 2011. The primary variables impacting survival that were analyzed were sociodemographic characteristics [race/ethnicity, neighborhood socioeconomic status (SES), and health insurance], initial combined-modality treatment, and subsequent cancers on survival.

“Hodgkin lymphoma is thought of as a curable cancer. However, the impressive survival gains have not been shared uniformly across the AYA population,” said lead author Theresa H.M. Keegan, PhD, MS, in an associated press release.

The study found that Hodgkin lymphoma—specific survival was worse for Black AYA patients diagnosed at both early stage [hazard ratio (HR), 1.68; 95% CI; 1.14-2.49) and late stage disease (HR, 1.68; 95% CI, 1.17-2.41), compared with White AYA patients. Also, Hispanic AYA patients diagnosed at late-stage had worse survival compared with White AYA patients (HR, 1.58; 95% CI, 1.22-2.04). Further, AYA patients diagnosed at an early stage did much worse if they lived in lower SES neighborhoods (HR, 2.06; 95% CI, 1.59-2.68), the study found.

Insurance status was another determinant of survival, according to the authors. Survival in AYA patients who were newly diagnosed with Hodgkin lymphoma was worse if they were uninsured or if they were covered by public health insurance (HR, 2.08; 95% CI, 1.52-2.84).

According to Keegan, some patients who may have initially been declared cancer-free may not have continued medical care, leaving them susceptible to secondary cancers or other complications and late effects. “Identifying and reducing barriers to recommended treatment and surveillance in these AYAs at much higher risk of mortality is essential to ameliorating these survival disparities,” she added.

Study limitations included lack of information on follow-up treatment, lack of insurance information on patients diagnosed prior to 2001, and lack of information on changes in insurance status if it occurred after their initial treatment.