Disparities by race, age, and sex in the improvement of survival for lymphoma: Findings from a population - based study

Fahad Mukhtar 1 , Paolo Boffetta 2 , Bashir Dabo 1 , Jong Y. Park 3 , Chi TD Tran 4 ,

Thuan V. Tran 5,6 , Huong Thi-Thanh Tran 5,6 , Madison Whitney 1 , Harvey A. Risch 7 ,

Linh C. Le 4,8 , Wei Zheng 9 , Xiao-Ou Shu 9 , Hung N. Luu 9,10,11

1 Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL; 2 Tisch Cancer Institute, Icahn School of Medicine, Mount Sinai School of Medicine, New York, NY; 3 Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; 4 Vietnam Colorectal Cancer and Research Program, Vinmec Healthcare System, Hanoi, Vietnam; 5 Vietnam National Cancer Hospital, Hanoi, Vietnam; 6 Vietnam National Institute for Cancer Control, Hanoi, Vietnam; 7 Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT; 8 VinUniversity Project-Health Sciences, Hanoi, Vietnam; 9 Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN

10 Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA; 11 Currently at the Division of Cancer Control and Population Sciences, University of Pittsburgh Medical Center-Hillman Cancer Center, Pittsburgh, PA, USA.

OBJECTIVE:

To evaluate improvement in survival of lymphoma patients from 1990 to 2014, stratified by age, sex and race using Surveillance Epidemiology and End-Result Survey Program (SEER) data.

STUDY DESIGN AND SETTING:

We identified 113,788 incident lymphoma cases from nine SEER cancer registries were followed up for cause-specific mortality from lymphoma. Cox proportional hazard regression was used to estimate hazard ratios (HRs) and their respective 95% confidence interval (CIs) for various time periods within groups stratified by race, age and sex.

RESULTS:

Five-year survival for Hodgkin's lymphoma (HL) was 89% for patients 20-49 years of age. For this age group, compared to 1990-1994, survival significantly improved in 2000-2004 (HR = 0.65; 95% CI: 0.54-0.78), 2005-2009 (HR = 0.46, 95% CI: 0.38-0.57) and 2010-2014 (HR = 0.29, 95% CI: 0.20-0.41). Hodgkin's lymphoma patients aged 75-85 years had 5-year survival of 37% and in these patients, compared to 1990-1994, survival only improved from 2005 onward (HR = 0.67, 95% CI: 0.50-0.90). In patients with non-Hodgkin's Lymphoma (NHL), all age groups showed survival improvements between 1990-1994 period and 2010-2014 period. Improvements in HL and NHL survival were seen for all race categories and both genders.

CONCLUSION:

Survival among US lymphoma patients has improved substantially between 1990-1994 period and 2010-2014 period, though disease-specific mortality was still higher in older age groups.

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