Healthcare usage among Hodgkin lymphoma survivors

Survivors of Hodgkin lymphoma (HL) sometimes experience late treatment effects. These include secondary lung cancer, secondary breast cancer and cardiovascular diseases. 

Formerly, the standard HL chemotherapy was MOPP (mechlorethamine, vincristine, procarbazine, prednisone). The former standard radiation therapy included higher doses over larger body areas. Standard chemotherapies have changed in recent years. One combination is ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine). Another is BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone). Radiation therapy is now focused on a more targeted region. These therapies have increased the numbers of long-term survivors. The impact of contemporary therapies on survivor healthcare usage is currently unknown.

This study examined the healthcare usage of 1017 relapse-free HL survivors. All survivors were treated with contemporary therapies. The patients had to be surviving at least one year post-diagnosis. The study also examined 4031 patients without HL. The information was collected from a Swedish nationwide register.  The rates of non-primary outpatient visits (NPOPVs) measured. NPOPVs were all unscheduled visits to specialist centers. Inpatient (hospital) bed days (IPBDs) were also evaluated. The average follow-up period was eight years (maximum: 14 years).

 HL survivors had 80% increase in the rate of NPOPVs. This persisted up to ten years post-diagnosis. HL survivors also had a 3.6-fold increase in the rate of IPBDs. This persisted up to four years.

40% of those with Stage III / Stage IV disease had at least one IPBD, compared to 32% of those with Stage I / Stage II. Patients requiring 6-8 chemotherapy courses also had higher rates of NPOPVs and IPBDs than patients with fewer chemotherapy courses.

Reasons for the increased visits included acute myeloid leukemia, other cancers (including skin, lung, and brain tumors), infections, and depression.

The authors concluded that HL survivors had increased healthcare usage up to ten years after treatment. Those requiring 6-8 chemotherapy courses had especially high rates.

Longer follow-up periods are needed.

Consult your doctor regarding post-treatement screening options.