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Flow-sorting and Exome Sequencing of the Reed-Sternberg Cells of Classical Hodgkin Lymphoma
Published on: June 10, 2017
Clinical Outcomes and Patterns of Care Among Patients With Newly Diagnosed Classical Hodgkin Lymphoma in a Safety-Net
Trung Minh Nguyen1, Jason Lu2, Danielle Guffey3
1Department of Medicine, Baylor College of Medicine, Houston, TX.
Insights
Uninsured patients with classical Hodgkin lymphoma (cHL) in a safety-net system showed similar outcomes to insured patients. Advanced stage and HIV were linked to survival differences, not lack of insurance.
Area of Science:
- Oncology
- Public Health
- Hematology
Background:
- Limited data exists on outcomes for uninsured patients with classical Hodgkin lymphoma (cHL).
- Social determinants of health significantly impact cancer care and patient outcomes.
- Safety-net hospitals serve vulnerable populations, necessitating research into their specific health challenges.
Purpose of the Study:
- To evaluate treatment patterns and outcomes for uninsured patients with cHL.
- To identify factors influencing survival in a safety-net hospital setting.
- To assess the impact of social determinants of health on cHL patient care.
Main Methods:
- Retrospective cohort study of 231 adult patients with newly diagnosed cHL.
- Data collected from January 2011 to December 2021 at a large safety-net hospital system.
- Analysis included survival rates, response to treatment, and factors associated with overall survival (OS).
Main Results:
- 82% of patients were uninsured, and 87% lived in socioeconomically deprived areas.
- Complete response rate was 67%, with 5-year OS of 79.6%.
- Factors associated with inferior OS included older age, poor performance status, elevated creatinine, and low albumin.
Conclusions:
- Uninsurance was not associated with worse outcomes in this cHL cohort within a safety-net system.
- Survival differences may be attributed to a higher prevalence of advanced-stage disease, higher-risk disease, and HIV co-infection.
- Financial assistance and access to advanced therapies in safety-net settings can mitigate disparities in cHL outcomes.
Background:
There is limited data on outcomes and patterns of care for patients with classical Hodgkin lymphoma (cHL) who are uninsured or have adverse social determinants of health.
Methods:
We conducted a retrospective cohort study of patients with newly diagnosed cHL treated in a large safety-net hospital system between January 2011 and December 2021.
Results:
Of the 231 patients aged ≥18 years diagnosed with cHL at Harris Health, Houston, TX, the median age was 39 years, 82% were uninsured, and 87% lived in a neighborhood with an Area Deprivation Index below the national median. Most (73%) had stage III/IV disease; 19% had a history of HIV. The median diagnosis-to-treatment interval was 24 days. The median follow-up interval was 72.3 months. Among 217 evaluable patients, 67% achieved a complete response, and 7% had a partial response. Twenty-two (61%) of 36 eligible patients underwent hematopoietic stem cell transplantation. At 5 years, event-free and overall survival (OS) rates were 62.7% and 79.6%, respectively. Factors associated with OS in multivariable analysis included age (hazard ratio [HR] 1.34 per 10-year increase, P = .007), Eastern Cooperative Oncology Group performance status (HR 2.35 for 2-4 vs. 0-1, P = .026), serum creatinine (HR 2.94 per mg/dL increase, P = .006), and serum albumin (HR 0.59 per g/dL increase, P = .014).
Conclusion:
In this health system with financial assistance and access to cell therapies, uninsurance was not associated with inferior outcomes. Small survival differences may be due to a greater proportion of patients with advanced-stage, higher-risk, and HIV-associated disease.
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