The impact of survivorship care on burden of disease among Hodgkin lymphoma survivors

BACKGROUND: Hodgkin lymphoma (HL) survivors are at increased risk of late adverse events, eg cardiovascular diseases (CVD), breast cancer (bc), hypothyroidism and severe infections. At Dutch BETER clinics, HL survivors are regularly screened for (risk factors for) these adverse events. The impact of survivorship care on burden of disease from adverse outcomes has rarely been evaluated. METHODS: In a nationwide retrospective cohort study, we compared HL survivors invited for BETER care in 2013 to 2016 (intervention group) with matched survivors who were eligible for such care, but were not invited until 2019 to 2024 (comparison group). Incidence and mortality rates for CVD, bc, hypothyroidism and severe infections were collected from general practitioners and nationwide registries. Disability-adjusted life years (DALYs) attributable to late adverse events were compared using multivariable regression models. RESULTS: At study start, survivors in the intervention group (n = 491) and comparison group (n = 373) had a median age of 46 years; median time since HL diagnosis was 15 to 18 years. After 8.5 years (median), there were no significant differences in DALYs attributable to CVD, bc, hypothyroidism and severe infections between the groups. In both groups, approximately one third of survivors acquired DALYs attributable to adverse events. Adherence to recommended screening diagnostics was high, but cardiovascular risk management and vaccination rates were suboptimal. CONCLUSION: After 8.5 years of follow-up, survivorship care for HL survivors was not associated with lower disease burden. Better care coordination, amendment of the cardiovascular risk management guidelines and greater survivor involvement may improve long-term effectiveness of measures to prevent late adverse events.