Socioeconomic inequality and short-term outcome in Hodgkin's lymphoma.
Socioeconomic status (SES) is a determinant of outcome in various types of cancer. The aim of this study is to analyze the impact of the SES in Hodgkin's lymphoma (HL). From 2001 to 2005, 194 consecutive patients were prospectively followed in 5 institutions. Patients answered a questionnaire with a set of items used to determine the SES, and were then divided in 2 groups according to their SES score. There were 151 patients (78%) with a higher SES and 43 patients (22%) with a lower SES. The complete remission (CR) rate was 82%. Patients with a higher SES had a higher CR rate than those with a lower SES (85 vs. 72%, crude odds ratio = 2.27, p = 0.046). A lower SES and the performance status >1 were independently associated with a trend towards a lower CR, even when controlled for the other covariables of interest. Ten patients (5%) died during treatment. Death during treatment was associated with a lower SES (16 vs. 2%, p = 0.001), a performance status >1 (p < 0.0001), a lower lymphocyte count (p = 0.012) and weakly with a lower albumin level (p = 0.065). With a median follow-up of 1.7 years, a higher SES was associated with a better 2-year overall survival (93 vs. 79%, p = 0.01). In underprivileged countries, patients with a lower SES require a more careful monitoring during treatment, possibly with specific support measures. Regimens more intense than doxorubicin, bleomycin, vinblastine and dacarbazine could pose a prohibitive risk of complications in this group of patients. (c) 2006 Wiley-Liss, Inc.
Soares
Andrea
A
Hematology and Pathology Services, University Hospital, Federal University of Rio de Janeiro, Brazil.
Biasoli
Irene
I
Scheliga
Adriana
A
Luiz
Ronir Raggio
RR
Costa
Mário Alberto
MA
Land
Marcelo
M
Romano
Sérgio
S
Morais
José Carlos
JC
Spector
Nelson
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility / Q000191:economics*; D006689:Hodgkin Disease / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012923:Social Class; D012959:Socioeconomic Factors; D015996:Survival Rate; D016896:Treatment Outcome