Lower socioeconomic status is independently associated with shorter survival in Hodgkin Lymphoma patients - an analysis from the Brazilian Hodgkin Lymphoma Registry

5 years ago

Lower socioeconomic status is independently associated with shorter survival in Hodgkin Lymphoma patients - an analysis from the Brazilian Hodgkin Lymphoma Registry

Carmino de Souza, Gilberto de Freitas Colli, Fernanda Franceschi, José Carlos Morais, Rafael Gaiolla, Cristiane Milito, Giovana Steffenello, Otávio Baiocchi, Andrea Soares, Cristiana Solza, Nelson Castro, Ronir Raggio Luiz, Carla Boquimpani, Caroline Bonamin Sola, Nelma Clementino, Nelson Spector, Talita Silveira, Monica Praxedes, Guilherme Fleury Perini, Belinda Pinto Simões, Marcia Delamain, Carlos Sérgio Chiattone, Jacques Tabacof, Irene Biasoli, Kátia Pagnano, James Farley

Socioeconomic status (SES) is a well-known determinant of outcomes in cancer. The purpose of this study was to analyze the impact of the SES on the outcomes of Hodgkin lymphoma (HL) patients from the Brazilian Prospective HL Registry. SES stratification was done using an individual asset/education-based household index. A total of 624 classical HL patients with diagnosis from January/2009 to December/2014, and treated with ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine), were analyzed. The median follow-up was 35.6 months, and 33% were classified as lower SES. The 3-year progression- free survival (PFS) in higher and lower SES were 78% and 64% (p<0.0001), respectively. The 3-year overall survival (OS) in higher and lower SES were 94% and 82% (p<0.0001), respectively. Lower SES patients were more likely to be ≥ 60 years (16% vs 8%, p=0.003), and to present higher risk International Prognostic score (IPS) (44% vs 31%, p=0.004) and advanced disease (71% vs 58%, p=0.003). After adjustments for potential confounders, lower SES remained independently associated with poorer survival (HR = 3.12 [1.86-5.22] for OS and HR = 1.66 [1.19-2.32] for PFS). The fatality ratio during treatment was 7.5% and 1.3% for lower and higher SES (p=0.0001). Infections and treatment toxicity accounted for 81% of these deaths. SES is an independent factor associated with shorter survival in HL in Brazil. Potential underlying mechanisms associated with the impact of SES are delayed diagnosis and poorer education. Educational and socio-economic support interventions must be tested in this vulnerable population. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1002/ijc.31096