Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California.
Southern California Permanente Medical Group, Los Angeles, California.
Cancer. 2019 May 1;125(9):1558-1567. doi: 10.1002/cncr.31953. Epub 2019 Jan 8.
Hodgkin lymphoma (HL) is a leading cancer diagnosis for adolescents and young adults (AYAs), with an overall 5-year survival rate of >80%. However, to the authors' knowledge, little is known regarding posttreatment patterns of care. In the current study, the authors characterized the use of guideline-recommended services in a cohort of AYA survivors of HL in Kaiser Permanente Southern California.
Patients with HL who were diagnosed between ages 15 and 39 years between 2000 and 2010 were identified. The authors calculated the number of patients who received recommended short-term care within 2 years after treatment cessation for those who remained enrolled and alive from 2001 through 2015. Use of recommended late-effects screening for breast cancer and cardiovascular disease was examined. Logistic regression was used to evaluate the association between receipt of recommended care and patient, cancer, and treatment characteristics.
A total of 354 patients were identified, with a mean age at the time of diagnosis of 26 years (standard deviation, 6.9 years). Approximately 12% of patients had stage I disease, 59% had stage II disease, 17% had stage III disease, and 13% of patients had stage IV disease. Nearly all patients received chemotherapy (95%), 51% received radiotherapy, and 5% received care from a pediatric oncologist. Overall, approximately 49% of patients received recommended short-term care. Of those patients eligible for cardiovascular screening at 10 years posttreatment (60 patients), 53% received at least 1 screening. Of those patients eligible for breast cancer screening (21 patients), approximately 50% underwent at least 1 screening. Regression results indicated that those patients treated by a pediatric oncologist were >3 times as likely to receive recommended short-term care.
The results of the current study highlight gaps in the delivery of posttreatment care to AYA survivors of HL. By determining areas in need of improvement, these findings can guide the development of tailored interventions with which to improve care.
霍奇金淋巴瘤（HL）是青少年和年轻成年人（AYA）的主要癌症诊断，总体 5 年生存率>80%。然而，据作者所知，对于治疗后护理模式知之甚少。在目前的研究中，作者描述了在 Kaiser Permanente Southern California 的 HL AYA 幸存者队列中使用指南推荐服务的情况。
确定 2000 年至 2010 年间诊断为 15 至 39 岁的 HL 患者。作者计算了在 2001 年至 2015 年期间仍入组且存活的患者在治疗结束后 2 年内接受推荐的短期护理的患者人数。检查了乳腺癌和心血管疾病的推荐的晚期效应筛查的使用情况。使用逻辑回归评估接受推荐的护理与患者、癌症和治疗特征之间的关联。
共确定了 354 名患者，诊断时的平均年龄为 26 岁（标准差为 6.9 岁）。约 12%的患者患有 I 期疾病，59%的患者患有 II 期疾病，17%的患者患有 III 期疾病，13%的患者患有 IV 期疾病。几乎所有患者都接受了化疗（95%），51%接受了放疗，5%接受了儿科肿瘤学家的治疗。总体而言，约 49%的患者接受了推荐的短期护理。在接受治疗后 10 年有心血管筛查资格的 60 名患者中，53%接受了至少 1 次筛查。在有乳腺癌筛查资格的 21 名患者中，约 50%至少进行了 1 次筛查。回归结果表明，接受儿科肿瘤学家治疗的患者接受推荐的短期护理的可能性是未接受儿科肿瘤学家治疗的患者的 3 倍以上。
本研究的结果强调了 HL AYA 幸存者接受治疗后护理方面的差距。通过确定需要改进的领域，这些发现可以指导制定有针对性的干预措施，以改善护理。
