Higher Mortality Risk in Poor or Minority Adolescents and Young Adults vs White Patients With Hodgkin Lymphoma
Despite improvements in survival for adolescents and young adults diagnosed with Hodgkin lymphoma, the gains have not been shared uniformly across this patient population. A large population-based study by Keegan et al investigating the impact of race/ethnicity, socioeconomic status, influence of combined-modality treatment, and health insurance on survival among adolescents and young adults diagnosed with Hodgkin lymphoma found that black patients were 68% more likely to die than non-Hispanic white patients regardless of disease stage. Hispanic adolescents and young adults diagnosed at a late stage were 58% more likely than non-Hispanic white patients to die of their disease. There was not a significant disparity for Hispanic patients diagnosed at an early stage.
Identifying and reducing barriers to recommended treatment and surveillance in these patients at much higher risk of mortality are essential to improving survival disparities, concluded the study investigators. The study is published in Cancer Epidemiology, Biomarkers & Prevention.
Study Methodology
The researchers analyzed data obtained from the California Cancer Registry on 9,353 adolescent and young adult patients diagnosed with Hodgkin lymphoma between 1988 and 2011. The patients were between the ages of 15 to 39 when they were diagnosed. The researchers used multivariate Cox proportional hazards regression to examine the impact of sociodemographic characteristics, including race/ethnicity, neighborhood socioeconomic status, and health insurance; initial combined-modality treatment; and subsequent cancers on survival.
Study Findings
Over the 24-year study period, the researchers observed improvements in Hodgkin lymphoma–specific survival by diagnostic period and differences in survival by race/ethnicity, neighborhood socioeconomic status, and health insurance for a subset of more recently diagnosed patients (2001–2011). In multivariable analyses, Hodgkin lymphoma–specific survival was worse for blacks than whites with early-stage (hazard ratio [HR] = 1.68; 95% confidence interval [CI] = 1.14–2.49) and late-stage disease (HR = 1.68; 95% CI = 1.17–2.41) and for Hispanics than whites with late-stage disease (HR = 1.58; 95% CI = 1.22–2.04). Adolescents and young adults diagnosed with early-stage disease experienced worse survival if they also resided in lower socioeconomic status neighborhoods (HR = 2.06; 95% CI = 1.59–2.68). Furthermore, more recently diagnosed adolescents and young adults with public health insurance or who were uninsured experienced worse Hodgkin lymphoma–specific survival (HR = 2.08; 95% CI = 1.52–2.84).
Implications
Although the study authors noted that prior studies have also found these racial/ethnic and socioeconomic status survival disparities in this adolescent and young adult population of Hodgkin lymphoma patients, this study “extends these previous efforts by considering combined-modality treatment, subsequent primary cancers, and health insurance. With uninsurance rates historically peaking in adolescence and young adulthood, adolescent and young adult Hodgkin lymphoma patients may be particularly vulnerable to failing to receive cancer survivor–focused medical care. The ACA [Affordable Care Act] has the potential to influence both access to insurance and use of necessary health care for adolescents and young adults and should be evaluated in future studies. In addition, identifying and reducing barriers to recommended treatment and surveillance in these adolescents and young adults at higher risk of mortality are essential to ameliorating these survival disparities,” concluded the study authors.
Theresa H.M. Keegan, PhD, MS, of the Division of Hematology and Oncology at the University of California Davis Comprehensive Cancer Center, is the corresponding author of this study in Cancer Epidemiology, Biomarkers & Prevention.
Christina A. Clarke, PhD, MPH, reported receiving a commercial research grant from Genentech. No potential conflicts of interest were disclosed by the other study authors.
This study was funded by the Stanford Cancer Institute, the Cancer Prevention Institute of California, and the National Cancer Institute.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
