SP6: Survey Health Care

Introduction: The aim of this prospective, population based observational study was to survey the medical care and treatment results of lymphoma patients (HL and NHL) and to compare those participating in a clinical trial with the others.

Methods: Data on patient characteristics, type of treating institution, diagnostic measures, type of treatment and treatment results were collected.

Results: The lymphoma project evaluated 453 patients, including 49 Hodgkin's lymphomas, 266 non-Hodgkin's-lymphomas, 94 chronic lymphatic leukaemias and 40 multiple myelomas, 4 unknown lymphoma type. 146 patients participate in clinical trials, 275 participate not, unclear for 32 cases.
Between the first visit to a doctor and diagnosis of lymphoma, 58% of patients were diagnosed within the first two months (but only 38% MM-patients). Until the final diagnosis, 77% of patients had seen between 2 and 5 physicians.
83% of the patients were treated by haemato-oncological specialists, 2%, by internists, 3% by other physicians, unknown for 12%.
For 345 (76%) cases, first line treatment was documented. 39% of HL patients received chemotherapy, 59% received combined chemo-radiotherapy, 2% only radiation. 48/46% of NHL (Low grade/high grade) patients were treated with chemotherapy, 9/26% combined chemo-radiotherapy, 14/6%, only radiation, 16/20% immune therapy. 59% of CLL patients were managed with a watch and wait strategy. Chemotherapy was administered in 41% of all cases. The treatment strategy depended on the type of lymphoma but was generally independent of age, sex and survey region. However, immune therapy was administered more frequently in university hospitals, and older patients more often received chemotherapy alone without additional radiotherapy.
First-line treatments outside of clinical trials were reviewed by external experts. Assessment was anonymous, based upon details of the received treatment, taking lymphoma type and stage, risk factors, age and concurrent diseases into consideration. The experts have so far reviewed 144 patients. They declared 110 first-line treatments to be appropriate. 34 patients received inappropriate therapy: 10 cases were treated more intensively than standard, 7 cases were treated less intensively than standard. In 10 cases an uncommon strategy was chosen, in 7 cases no assessment was possible.

Conclusion: Sufficient data was collected to allow description and evaluation of the state of care and treatment outside of clinical trials.

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