Young, Poor African Americans and Hispanics Have Harder Time Beating Hodgkin Lymphoma

Insurance coverage, neighborhood socio-economic status (SES) and the types of treatment provided patients all played a role in survival, the study found.The research, led by Theresa Keegan, associate professor in the Division of Hematology and Oncology, found that while overall survival from Hodgkin lymphoma has improved over time, disparities in mortality persist for some racial/ethnic groups, regardless of when the disease is diagnosed. The study is published in today’s issue of Cancer, Epidemiology, Biomarkers & Prevention. “This study identifies vulnerable subgroups of young Hodgkin lymphoma patients at higher risk of dying from their disease and points to disparities in treatment delivery and follow-up care as likely contributing factors,” said Keegan, who conducted the research while at the Cancer Prevention Institute of California. “Identifying and reducing barriers to recommended treatment and follow-up care is critical to improving survival for all patients.” For this study, Keegan expanded on earlier work examining mortality among the young population diagnosed with Hodgkin lymphoma, which can be cured about 90 percent of the time when it is diagnosed in its earliest stages. The study tracked 9,353 patients ages 15-39 who were diagnosed with Hodgkin lymphoma between 1988 and 2011. Using California Cancer Registry data, they examined the impact on survival of socio-demographic characteristics such as race and ethnicity, neighborhood SES, health insurance, the types of treatment patients received and whether they were diagnosed with subsequent cancers.

While there were improvements in survival over time, the researchers found striking disparities in survival among different groups, as well. Among them:• Regardless of stage at diagnosis, African Americans were 68 percent more likely to die from the disease than non-Hispanic whites• Hispanics who were diagnosed at later stages of the disease were 58 percent more likely to die than non-Hispanic whites diagnosed at similar stages• African Americans, Hispanics, adolescent and young adults in lower SES neighborhoods and those with public or no insurance were more likely to receive chemotherapy alone as initial treatment vs. chemotherapy and radiation - disparities associated with higher mortality• AYA patients who were uninsured or had public health insurance were twice as likely to die from the disease, even when their disease was diagnosed at an early stage • As found in earlier studies, survival was significantly worse among adolescent and young adults who live in lower SES neighborhoods “Hodgkin lymphoma, a common cancer in adolescents and young adults, has been one of the great success stories in oncology,” said Dr. Sally L. Glaser, Director of the Greater Bay Area Cancer Registry at the Cancer Prevention Institute of California and the study’s senior author. “This paper is important in identifying patient groups who are not benefitting from these important and well-established medical opportunities.”

Keegan said the findings point to problems often associated with AYA cancer patients. For one, this age group historically is more often uninsured, and adolescent and young adults may be more likely to fail to receive medical care after diagnosis, making them more vulnerable to worse outcomes. Financial concerns, including lost wages, copayments, high deductibles, child care and transportation costs, could be burdensome and influence initial or subsequent care.

“Are they getting the surveillance to make sure that any complications or late effects of treatment are caught early?” she asked. “We need to understand the continuity of health insurance over time and other barriers to care.”

Keegan said implementation of the Affordable Care Act of 2010 and 2014 should improve adolescent and young adult cancer survivors’ access to health insurance, adding that studies should continue to monitor barriers to enrollment and care.

Keegan’s study was supported by the Stanford Cancer Institute, the Cancer Prevention Institute of California, the National Cancer Institute’s Surveillance, Epidemiology and Ed Results Program (HHSN261201000140C) and a National Cancer Institute Career Development Award (K07CA175063).

Other authors include: Mindy C. DeRouen, Christina A. Clarke, Debbie Goldberg and Sally L. Glaser of the Cancer Prevention Institute of California; Helen M. Parsons of the University of Texas Health Science Center; and Christopher R. Flowers of the Winship Cancer Institute at Emory University.