Keegan Theresa H M, Li Qian, Steele Amy, Alvarez Elysia M, Brunson Ann, Flowers Christopher R, Glaser Sally L, Wun Ted
Center for Oncology Hematology Outcomes Research and Training (COHORT) and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA, USA.
Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA, USA.
Cancer Causes Control. 2018 Jun;29(6):551-561. doi: 10.1007/s10552-018-1025-0. Epub 2018 Apr 13.
Hodgkin lymphoma (HL) survivors experience high risks of second cancers and cardiovascular disease, but no studies have considered whether the occurrence of these and other medical conditions differ by sociodemographic factors in adolescent and young adult (AYA) survivors.
Data for 5,085 patients aged 15-39 when diagnosed with HL during 1996-2012 and surviving ≥ 2 years were obtained from the California Cancer Registry and linked to hospitalization data. We examined the impact of race/ethnicity, neighborhood socioeconomic status (SES), and health insurance on the occurrence of medical conditions (≥ 2 years after diagnosis) and the impact of medical conditions on survival using multivariable Cox proportional hazards regression.
Twenty-six percent of AYAs experienced at least one medical condition and 15% had ≥ 2 medical conditions after treatment for HL. In multivariable analyses, Black HL survivors had a higher likelihood (vs. non-Hispanic Whites) of endocrine [hazard ratio (HR) = 1.37, 95% confidence interval (CI) 1.05-1.78] and circulatory system diseases (HR = 1.58, CI 1.17-2.14); Hispanics had a higher likelihood of endocrine diseases [HR = 1.24 (1.04-1.48)]. AYAs with public or no insurance (vs. private/military) had higher likelihood of circulatory system diseases, respiratory system diseases, chronic kidney disease/renal failure, liver disease, and endocrine diseases. AYAs residing in low SES neighborhoods (vs. high) had higher likelihood of respiratory system and endocrine diseases. AYAs with these medical conditions or second cancers had an over twofold increased risk of death.
Strategies to improve health care utilization for surveillance and secondary prevention among AYA HL survivors at increased risk of medical conditions may improve outcomes.
霍奇金淋巴瘤（HL）幸存者患第二种癌症和心血管疾病的风险很高，但尚无研究考虑这些疾病及其他医疗状况的发生在青少年及青年成人（AYA）幸存者中是否因社会人口学因素而异。
从加利福尼亚癌症登记处获取了1996 - 2012年期间确诊为HL且存活≥2年的5085例年龄在15 - 39岁患者的数据，并将其与住院数据相关联。我们使用多变量Cox比例风险回归分析了种族/族裔、邻里社会经济地位（SES）和健康保险对医疗状况发生情况（诊断后≥2年）的影响，以及医疗状况对生存的影响。
26%的AYA在接受HL治疗后经历了至少一种医疗状况，15%有≥2种医疗状况。在多变量分析中，黑人HL幸存者患内分泌疾病[风险比（HR）= 1.37，95%置信区间（CI）1.05 - 1.78]和循环系统疾病（HR = 1.58，CI 1.17 - 2.14）的可能性高于非西班牙裔白人；西班牙裔患内分泌疾病的可能性更高[HR = 1.24（1.04 - 1.48）]。有公共保险或无保险的AYA（与私人/军事保险相比）患循环系统疾病、呼吸系统疾病、慢性肾病/肾衰竭、肝病和内分泌疾病的可能性更高。居住在低SES社区的AYA（与高SES社区相比）患呼吸系统和内分泌疾病的可能性更高。患有这些医疗状况或第二种癌症的AYA死亡风险增加了两倍多。
对于医疗状况风险增加的AYA HL幸存者，改善医疗保健利用以进行监测和二级预防的策略可能会改善结局。
