Adam Olszewski, MD, of The Cancer Center at Memorial Hospital is the lead author of a study showing that half of Americans with early-state Hodgkin lymphoma do not receive therapy recommended by guidelines which may affect their survival rate.
The study, conducted through Brown University, was recently published in the Journal of Clinical Oncology, one of the most prominent oncology journals in the U.S.
Hodgkin lymphoma is one of the most curable cancers affecting more than 9,000 Americans every year, accounting for 12 percent of all cancers among Americans aged 15 to 29. When diagnosed at an early stage, the disease can be cured in more than 90 percent of cases using a combination of chemotherapy and radiation, often termed “combined modality therapy” or CMT. However, survivors treated with extensive radiation in 1960s and 1970s are known to have a remarkably high risk of breast and lung cancers later in life. The awareness of this complication led some oncologists to omit radiation therapy and rely on chemotherapy alone.
Until now, there was no data about how patients with early-stage Hodgkin lymphoma are treated in the U.S. and how treatment choices affect survival.
Olszewski, an assistant professor of medicine at Alpert Medical School of Brown University, led a team that studied these issues using information from the National Cancer Data Base, which contains data on approximately 70 percent of newly diagnosed cancer cases in the U.S. and is a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society.
The team – which included Dr. Rajesh Shrestha and Dr. Jorge Castillo - looked at 20,600 cases of early-stage Hodgkin lymphoma reported between 2003 and 2011, treated with either CMT or chemotherapy alone. They discovered that although national guidelines uniformly recommended CMT throughout the past decade, only about half of patients received the full treatment, while the other half received chemotherapy without radiation. Moreover, the proportion of cases treated with CMT decreased steadily over the years, especially among younger adults. Certain groups had a particularly low chance of receiving CMT. These included younger women, older and sicker patients, African Americans, and patients without health insurance. Although 90 percent of all patients survived more than five years after their diagnosis, those who received CMT appeared to have a significantly better survival rate compared with those who omitted radiation. This advantage was present regardless of patients’ age, gender, race, or specific subtype of Hodgkin lymphoma.
Dr. Olszewski noted, that choosing the best cancer treatment is a complex process which is difficult to capture in large databases. The fact that the choice between CMT and chemotherapy alone is partly affected by patients’ race, health insurance or local treatment patterns underscores deficiencies of cancer care delivery in the US. According to the US Census, about 30% of Americans younger than 30 years were uninsured in 2011, and thus at risk of receiving suboptimal treatment for early-stage Hodgkin lymphoma.
Omitting radiation therapy in half of the patients, he added, may indicate that doctors are concerned about its long-term toxicity for their patients, even though radiation techniques in the 21st century are more advanced. The team of scientists said future clinical trials in Hodgkin lymphoma are needed and should focus on minimizing toxicities without compromising survival in order to meet the concerns of patients and physicians.
For additional information on this research study, contact Dr. Olszewski at (401) 729-2255 or firstname.lastname@example.org.
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