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

Abstract

BackgroundNon-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 methodsSet 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.ResultsTwo 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.ConclusionEmergency 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.

Hodgkin lymphoma detection and survival: findings from the Haematological Malignancy Research Network

“…[20][21][22][23] Pre-diagnostic emergency admissions were identified in HES using 'Routes-to-Diagnosis' methods, which include: an emergency inpatient admission originating via Accident & Emergency attendance, GP, Bed Bureau transfer, or consultant outpatient clinic within 28 days of diagnosis. [24][25][26] The income domain of the Index of Multiple Deprivation (IMD), grouped into quintiles (with Q1 representing the most affluent fifth of the population), was used as a marker of socioeconomic status. 27…”

Pixantrone plus rituximab versus gemcitabine plus rituximab in patients with relapsed aggressive B‐cell non‐Hodgkin lymphoma not eligible for stem cell transplantation: a phase 3, randomized, multicentre trial (PIX306)

“…Non‐Hodgkin lymphoma (NHL) is one of the most frequently diagnosed haematological malignancies in Western countries (Ferlay et al , ; SEER, ). Diffuse large B‐cell lymphoma (DLBCL) represents approximately 50% of NHL cases (Kane et al , ) and follicular lymphoma (FL) 20% (Bierman, ). For the ~30–40% patients who relapse or the 10% who are refractory to initial therapy (Gisselbrecht & Van Den Neste, ), salvage therapy followed by a high‐dose myeloablative regimen and stem cell transplant (SCT) is potentially curative (Tilly et al , ; National Comprehensive Cancer Network, ).…”

‘Unpacking’ pathways to lymphoma and myeloma diagnosis: Do experiences align with the Model of Pathways to Treatment? Findings from a UK qualitative study with patients and relatives

“…This difficulty could occur despite the best efforts of patients and relatives (eg, re-presenting to GPs for reassessment), as well as actions taken by GPs themselves, such as requesting investigations (eg, blood tests and imaging, and colonoscopies/endoscopies due to anaemia), which were often normal. Our findings highlight some of the reasons for delays in help seeking, re-presentation and diagnosis,18–22 as well as potential explanations for the lack of urgent hospital referrals for suspected cancer and the high proportion of emergency presentations 17 24–26. Our results also explain why interventions such as education campaigns targeting the (very broad) symptoms of these diseases would probably lack impact.…”

“…Importantly, time to diagnosis can be prolonged and associated with multiple GP consultations before hospital referral,18–23 myeloma being one of very few cancers that has seen increases in time to diagnosis in recent years, despite policy initiatives 6. Emergency presentation is comparatively common in these cancers, a route linked to advanced disease, more complications and poorer survival than other pathways 24–26. Conversely, fewer 2-week wait referrals are made to secondary care and more routine GP referrals than for other malignancies, suggesting cancer is not suspected at the time of hospital referral.…”