Excess Health-Care Use in “Cured” Hodgkin Lymphoma Patients

For patients with Hodgkin lymphoma (HL) who have lived relapse-free for at least one year, health-care use remains substantially higher – and, in some cases, excessive – compared with individuals without HL, according to a study by Ingrid Glimelius, MD, PhD, and co-authors from the Karolinska Institute in Stockholm.

The researchers assessed late adverse effects in a population of 1,017 HL patients diagnosed between 2000 and 2009 who were enrolled in Swedish national registries. All patients were treated with combination chemotherapy and limited radiotherapy and had survived at least one year post-diagnosis. The authors then compared the rates of health-care resource use (defined as outpatient visits and inpatient bed-days, but excluding scheduled outpatient visits for HL) between HL survivors and 4,031 age-, sex-, and calendar year-matched counterparts.

The rate of outpatient visits among HL patients was almost double that of matched controls (IRR=1.8; 95% CI 1.6-2.0). These higher rates persisted for up to 10 years after diagnosis, the authors noted. The rate of inpatient bed-days was also substantially higher among HL patients – more than triple that of comparators (IRR=3.6; 95% CI 2.7-4.7) – and this increase persisted for up to four years after diagnosis.

Patients who received six to eight courses of chemotherapy also were more likely to have subsequent greater use of health-care resources than patients who received two to four courses (IRR=1.4 [95% CI 1.1-1.7] for outpatient visits and 4.7 [95% CI 2.9-7.8] for inpatient bed-days).

“The reasons for excess health-care visits reflected a wide range of disorders,” the authors reported, including chest pain, keratitis, asthma, diabetes mellitus, and depression. This finding “indicates the need of broad individualized care in addition to specific screening programs,” they concluded.

Source: Glimelius I, Eloranta S, Ekberg S. et al. Increased healthcare use up to 10 years among relapse-free Hodgkin lymphoma survivors in the era of intensified chemotherapy and limited radiotherapy. Am J Hematol. 2017; 92:251-8.