Emergency admission and survival from aggressive non-Hodgkin lymphoma: A report from the UK's population-based Haematological Malignancy Research Network

TY - JOUR

T1 - Emergency admission and survival from aggressive non-Hodgkin lymphoma

T2 - A report from the UK's population-based Haematological Malignancy Research Network

AU - Kane, Eleanor Victoria

AU - Howell, Debra

AU - Smith, Alexandra

AU - Crouch, Simon

AU - Burton, Cathy

AU - Roman, Eve

AU - Patmore, Russell

N1 - © 2017 The Author(s).

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Background Non-Hodgkin lymphoma (NHL) is often diagnosed after emergency presentation, a route associated with poor survival and an indicator of diagnostic delay. Accounting for around half of all NHLs, diffuse large B-cell lymphoma (DLBCL) is of particular interest since although it is potentially curable with standardised chemotherapy it can be challenging to identify at an early stage in the primary care setting. Patients and methods Set within a socio-demographically representative United Kingdom population of around 4 million people, data are from an established patient cohort. This report includes all patients (≥18 years) diagnosed with DLBCL 2004–2011 (n = 1660). Emergency admissions were identified via linkage to Hospital Episode Statistics using standard methods, and survival was examined using proportional hazards regression. Results Two out of every five patients were diagnosed following an emergency admission, and this was associated with advanced disease and poor survival (p < 0.001). Among the 80% of patients treated with curative chemotherapy, survival discrepancies emerged at the point of diagnosis; the adjusted hazard ratio (emergency versus non-emergency) at one month being 4.0 (95% confidence interval 1.9–8.2). No lasting impact was evident in patients who survived for 12 months or more. Conclusion Emergency presentation impacts negatively on DLBCL survival; patients presenting via this route have significantly poorer outcomes than patients with similar clinical characteristics who present via other routes.

AB - Background Non-Hodgkin lymphoma (NHL) is often diagnosed after emergency presentation, a route associated with poor survival and an indicator of diagnostic delay. Accounting for around half of all NHLs, diffuse large B-cell lymphoma (DLBCL) is of particular interest since although it is potentially curable with standardised chemotherapy it can be challenging to identify at an early stage in the primary care setting. Patients and methods Set within a socio-demographically representative United Kingdom population of around 4 million people, data are from an established patient cohort. This report includes all patients (≥18 years) diagnosed with DLBCL 2004–2011 (n = 1660). Emergency admissions were identified via linkage to Hospital Episode Statistics using standard methods, and survival was examined using proportional hazards regression. Results Two out of every five patients were diagnosed following an emergency admission, and this was associated with advanced disease and poor survival (p < 0.001). Among the 80% of patients treated with curative chemotherapy, survival discrepancies emerged at the point of diagnosis; the adjusted hazard ratio (emergency versus non-emergency) at one month being 4.0 (95% confidence interval 1.9–8.2). No lasting impact was evident in patients who survived for 12 months or more. Conclusion Emergency presentation impacts negatively on DLBCL survival; patients presenting via this route have significantly poorer outcomes than patients with similar clinical characteristics who present via other routes.

KW - Adolescent

KW - Adult

KW - Aged

KW - Antineoplastic Combined Chemotherapy Protocols/therapeutic use

KW - Child

KW - Child, Preschool

KW - Delayed Diagnosis

KW - Emergencies/epidemiology

KW - Emergency Service, Hospital/statistics & numerical data

KW - Emergency Treatment/mortality

KW - Female

KW - Humans

KW - Infant

KW - Infant, Newborn

KW - Lymphoma, Non-Hodgkin/drug therapy

KW - Male

KW - Middle Aged

KW - United Kingdom/epidemiology

KW - Young Adult

UR - http://www.scopus.com/inward/record.url?scp=85017365106&partnerID=8YFLogxK

U2 - 10.1016/j.ejca.2017.03.013

DO - 10.1016/j.ejca.2017.03.013

M3 - Article

C2 - 28412589

SN - 0959-8049

VL - 78

SP - 53

EP - 60

JO - European Journal of Cancer

JF - European Journal of Cancer

ER -