Disparities in AYA Hodgkin Lymphoma Persist into Survivorship

Racial, socioeconomic, and sex-based disparities presented among adolescent and young adult (AYA) patients with Hodgkin lymphoma (HL) persisted into survivorship, according to results of a recent study.

Looking at 15,899 five-year survivors with a median follow-up of 14.4 years, data showed that non-Hispanic Black patients had worse survival outcomes compared with non-Hispanic white survivors (P = 0.002). Additionally, worse survival was seen in male survivors, those at an older age at diagnosis, those diagnosed at higher stages, and those living in areas of higher socioeconomic deprivation.

“Importantly, the current study did not find any evidence of disparities in long-term survival in AYA HL survivors changing over time,” the study researchers wrote. “This is an expected finding in age and stage at diagnosis disparities. However, it is a discouraging trend, particularly in race/ethnicity disparities, although this is consistent with recent data showing stable to worsening race/ethnicity disparities over time in five-year survival among AYA patients with cancer.”

The researchers used data from the Surveillance, Epidemiology, and End Results (SEER) registry to identify survivors of HL diagnosed between the ages of 15 and 39 years who were still alive five years after diagnosis. Half of the patients were female; 10% were Black, 12% Hispanic, and 4% were non-Hispanic Asian or Pacific Islander.

In addition to the worse survival seen for non-Hispanic Black survivors, Hispanic survivors also had worse long-term survival compared with non-Hispanic white survivors, although it was not statistically significant. Specifically, non-Hispanic Black survival was 66% that of non-Hispanic white patients and survival of Hispanic patients was 78% that of non-Hispanic white.

Length of survival also decreased as the county socioeconomic deprivation index (SES) increased, an indication of higher levels of deprivation. Each additional unit increase on this index was associated with an 8% reduction in survival time.

Age at diagnosis also impacted survival. Each additional year of age at diagnosis was associated with a 4% reduction in survival time. There were also association between sex and survival, with male survivors having 68% the survival time of females.

“Treatment-related modifications that have been implemented in the overall HL population, including decreasing utilization of mediastinal radiation and limiting exposure to toxic agents such as bleomycin, will likely continue to lead to improved long-term outcomes for AYAs; however, further studies are needed to understand why racial, ethnic, SES, and sex disparities persist years after cancer treatment has been completed,” the researchers concluded.