By Peter Martin, MD
More bad news for smokers: A recent study published in the Journal of Clinical Oncology reports an association between cigarette smoking and Hodgkin lymphoma. The investigators evaluated 17 large cohort studies, involving over one million individuals and 285 cases of Hodgkin lymphoma. They found that current smokers had a 39% higher risk developing Hodgkin lymphoma. Among men, individuals older than 30 or 40 years old, those that smoked more than 20 cigarettes per day, and those that smoked for more than 20 years, the risk was even higher.
The good news is that former smokers did not have an increased risk of Hodgkin lymphoma, but this may have been due to inconsistencies regarding the way “former smoker” was defined in the cohort studies.
The authors conclude, “The health implications of tobacco smoke are vast, having an impact on almost every organ system. Smoking cessation will have a positive impact on public health and should be advised globally.”
By Peter Martin, MD
Post-traumatic stress disorder (PTSD) is a chronic condition characterized by anxiety and re-experiencing of a particularly stressful psychological trauma. Typically, we associate PTSD with events like wars or serious accidents. There is increasing data, however, that survivors of serious medical illness can also be affected by symptoms of PTSD. Long-term results of a study designed to evaluate PTSD in survivors of non-Hodgkin lymphoma (NHL) were recently reported in the Journal of Clinical Oncology.
The investigators administered surveys to 886 individuals with a history of NHL. They found that 39% of patients experienced PTSD symptoms with 8% meeting diagnostic criteria for PTSD. In a follow up study performed five years later, 566 of the original group of patients responded to a second survey. The investigators found that roughly one-third of patients experienced persisting or worsening PTSD symptoms. Only 12% of patients had symptoms that resolved over the course of the study. People most likely to experience persistent or worsening symptoms of PTSD were those with a lower annual income and those that reported a negative impact from the cancer (e.g., appearance concerns, body changes, life interferences, worry).
These results are particularly concerning for two reasons. First, the assumption that cancer-related anxiety will improve over time appears to be flawed. Second, as the population of patients with cancer ages, and as cancer care becomes more expensive, we are likely to see an increase in persistent PTSD symptoms. Clearly, we need to find ways to improve the initial cancer experience and to intervene earlier in patients at risk of persistent PTSD symptoms. The statement “survivorship begins at diagnosis” appears to be truer than ever.
By Peter Martin, MD
Investigators at Fred Hutchinson Cancer Research Center in Seattle recently reported the results of retrospective study of 118 patients with mantle cell lymphoma. After receiving a variety of first-line chemotherapy regimens, including R-HyperCVAD and R-CHOP, 85 patients underwent consolidation with autologous stem cell transplantation. Initially, it appeared that patients who received an aggressive induction regimen, like R-HyperCVAD, had a better outcome following stem cell transplantation. Interestingly, after controlling for other prognostic factors, like age, LDH, White Blood Cell count, and performance status, it became apparent that choice of induction chemotherapy had little effect on outcome after transplant. In other words, patients that had a better baseline prognosis were more likely to be treated with aggressive first-line regimens, which gave the appearance that the more aggressive regimens were responsible for better outcomes. Click here to read the abstract.
This study is important because it helps us to contextualize the results of many of the phase 2 studies that have been published on mantle cell lymphoma. It is possible that the results of phase 2 studies appear to be more or less impressive than standard therapies because there is no comparison group; i.e., it is the baseline prognostic factors of the patients that explain the results rather than the treatment regimen being tested. Retrospective studies, such as the study from Seattle, are also prone to bias because it is difficult to control for everything, particularly prognostic factors that we don’t yet know about. That is why randomized studies comparing at least two regimens are of critical importance. Only randomized studies can distinguish the between the good and bad effects of two or more regimens. Continue reading “Lymphoma in the News: Choice of Pre-Transplant Chemotherapy Regimen May Not Be As Important As Other Factors in Mantle Cell Lymphoma”