A population-based study of follow-up care for Hodgkin lymphoma survivors: opportunities to improve surveillance for relapse and late effects

Abstract

Background: The majority of Hodgkin lymphoma (HL) patients are cured, and post-treatment visits are a major component of their management. Little is known about the quality of follow-up care received by these survivors.

Methods: All patients who were diagnosed with HL in Ontario from 1992 through 2000 were identified from a population-based cancer registry. Individual-level linkage with physician claims was used to examine the follow-up care received by 2071 1-year survivors for up to 15 years after their HL diagnosis. Physician visits, imaging studies, and the use of routine and HL-specific cancer screening tests were evaluated.

Results: Most patients had visits with both a primary care provider and an oncologist in Years 2 through 5 after their HL diagnosis. In Year 5 after HL diagnosis, 31.8% of patients had at least 1 computed tomography (CT) scan, and 62.9% had a chest x-ray. There were 5352 CT scans performed in Years 2 through 5, and 125 patients subsequently received chemotherapy within 6 months of a CT. Among the survivors who met age criteria for routine screening, 62.5% had no evidence of colorectal cancer screening during Years 2 through 15, 32.3% had no evidence of breast cancer screening, and 19.9% had no evidence of cervical cancer screening. Among young women potentially at high risk of breast cancer because of radiation therapy, 87.1% had not received the recommended breast cancer screening.

Conclusions: Radiologic surveillance of HL survivors rarely led to salvage therapy. Despite frequent physician contact, many survivors did not receive established cancer screening interventions, and the recommended early initiation of breast cancer screening among young women at high risk was not widely used.