Need and Use of Healthcare Services in Survivors of Hodgkin Lymphoma.

PURPOSE: Hodgkin lymphoma (HL) is the commonest cancer in adolescents and young adults (AYAs), aged 15-29 years. While the survival rate is high, many survivors experience adverse late effects of therapy. Yet, this age group in general makes limited use of health services. This study sought to determine whether the need for health services by HL survivors was mismatched to their health service utilization, as hypothesized a priori. METHODS: A population-based cohort of survivors (N = 43) younger than 39 years of age was sent a mailed survey for self-assessment of need, as expressed in health-related quality of life (HRQOL), and utilization of health services by validated instruments; the Health Utilities Index and Health and Social Service Utilization Survey, respectively. Survivors who were AYAs at diagnosis were compared to children and older adults. RESULTS: AYAs had the lowest mean HRQOL score (0.79 on a scale of 0.00-1.00) compared to children (0.86) and older adults (0.94)-clinically meaningful differences. The difference in the single attribute score for cognition reached statistical significance (0.89 vs. 0.99 vs. 1.00, p = 0.02). AYAs also had lower mean overall annual costs for health services (CAN$601) than children (CAN$753) and older adults (CAN$936) did. CONCLUSIONS: Survivors of HL who were AYAs at diagnosis had a mismatch between high need for and low utilization of health services. Providers of healthcare to this population should be made aware of this discrepancy, and the survivors should be encouraged to seek the health services they need.

An evaluation of age-related differences in quality of life preferences in patients with non-Hodgkin's lymphoma.

Health related quality of life is an important outcome measure. With aging, patients may experience changes in physical, socioeconomic and psychological functioning. This pilot study examined whether age influences the level of importance that patients with non-Hodgkin's lymphoma assign to questions addressing aspects of traditional quality of life domains. A questionnaire assessing six domains (physical, appearance, toxicity, social, financial, psychological) with 29 items was given to 76 outpatients with non-Hodgkin's lymphoma. Each question asked how important the content of the item was to the individual. Mean item scores were compared between patients aged < 65 and > 65 years. Reliability ranged from 0.57 (social domain) to 0.83 (physical domain). Test-retest reliability for the entire questionnaire was 0.63. Although there was a suggestion that older patients scored the items relating to faith, appearance to others, intimacy and toxicity trade-offs differently than younger patients, when accounting for multiple comparisons in this study, no apparent differences were seen in any of the items between age groups. It appears that in this group of patients with lymphoma, age does not obviously influence the preferences of patients for items contained in quality of life assessment.

Cost-effectiveness of a transplantation strategy compared to melphalan and prednisone in younger patients with multiple myeloma.

High dose chemotherapy with autologous stem cell transplantation (ASCT) improves outcomes in patients 65 years of age or less with multiple myeloma. Survival and costs in a cohort of 16 patients who received melphalan and prednisone as part of a clinical trial were compared with those of 36 patients referred to our centre for consideration of ASCT. In the transplant group, survival and costs were extrapolated to match the period of observation in the melphalan and prednisone group. Patient-specific and average costs were calculated from the perspective of the Ontario Ministry of Health. Costs and survival were varied by 50% in the sensitivity analysis. Transplantation improved life expectancy by 19.3 months with a cost difference of 30,517 Canadian dollars. The incremental cost-effectiveness of transplantation compared with melphalan and prednisone was 25,710 Canadian dollars per life-year gained when additional pamidronate and follow-up costs were considered. Discounting costs and survival at 3 and 5% did not result in important differences. The sensitivity analysis resulted in best and worse case scenarios for transplantation compared with melphalan and prednisone of 13,049 dollars and 63,954 dollars per life-year gained respectively. In comparison with melphalan and prednisone, ASCT appears to be cost-effective in patients 65 years old or younger with myeloma.