How do other serious health conditions affect diagnosis and treatment for older patients with Hodgkin lymphoma?

This study examined older patients with Hodgkin lymphoma (HL) to understand how other serious health conditions affect their diagnosis and treatment. The authors found that patients with more serious illnesses were more likely to be diagnosed with advanced HL and had limited treatment options.

Treatment options for patients with HL are based on factors such as age, HL stage, and the presence of other illnesses. Between 15% to 30% of patients with HL are 65 years or older. Older patients often develop serious side effects to treatment. One reason for this is that older patients are more likely to have other health conditions. It is unclear how the presence of other serious illnesses affects older patients’ diagnosis and treatment.

Data from 76 patients with HL aged 65 or older was examined. 41 patients (54%) also had another serious health condition. The most common serious illnesses were heart conditions (5 patients) and lung conditions (15 patients).

More patients that had other serious illnesses (90%) were diagnosed with advanced (stage III or IV) HL than patients that did not (60%). The International Prognostic Score (IPS) is a prediction of life expectancy for patients with HL. 51% of patients with other serious illnesses, and 26% of patients who did not, had poorer IPS scores (above 3).

Overall, 78% of patients received ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine) chemotherapy, a standard treatment for HL. The other patients received COPP (cyclophosphamide, oncovin, procarbazine, and prednisone). 32% of patients with other serious illnesses were given COPP treatment compared to 6% of patients who did not have other serious illnesses.

Of those that received ABVD, 72% survived after 3 years with another serious illness compared to 93% of those that did not have another serious illness.

After 3 years, 46% of patients with another serious illness and 88% of patients without had survived.  Patients who did not have another serious illness had a 2.34 times higher chance of survival. Patients who received ABVD had a 2.99 times higher chance of survival.

The authors concluded that the presence of other serious illnesses made a poor diagnosis more likely and affected treatment options for older patients.

This study would benefit from confirming results in more patients. More analysis of different serious illnesses and their contribution to HL diagnosis and treatment is needed.