Hodgkin's disease: a population-adjusted clinical epidemiology study (PACE) of management at presentation. Northern Region Lymphoma Group.
Between January 1991 and December 1993, all newly-diagnosed patients with Hodgkin's disease in the Northern Health Region (population 3.08 million) were entered into a prospective population-based (PACE) study to assess the accuracy of staging at diagnosis, and to evaluate treatment and outcome. On histological review, 202 patients were confirmed to have Hodgkin's disease, an incidence of 2.2 per 100,000 per annum. Radiological review revealed that only 12% of patients were staged to recognized guidelines. In early-stage disease, treatment outcome was comparable to published results in Stage IA disease, but disappointing for Stage IIA. This was partly due to inadequate or inaccurate staging. In-built audit in the process was followed by the introduction and implementation of improved guidelines. Of younger patients (15-55 years) with 'poor-risk disease', 75% of the eligible population were entered into the appropriate randomized controlled trial. This intensive treatment has led to improved survival in this group over that which might be expected on four-drug therapy. The results of the randomized trial are not discussed as it is currently ongoing. This combined research/audit programme has resulted in greater standardization of care across a whole region, and confirms that the PACE (population-adjusted clinical epidemiology) approach facilitates the flow of information from research into practice and vice versa.
Taylor
P R
PR
Department of Haematology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Angus
B
B
Owen
J P
JP
Proctor
S J
SJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D001853:Bone Marrow / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D015994:Incidence; D008297:Male; D008485:Medical Audit / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D011379:Prognosis; D011446:Prospective Studies; D012306:Risk; D015996:Survival Rate