Introduction: Socioeconomic status (SES) is a well-known determinant of outcomes in cancer. We have previously reported that Hodgkin’s lymphoma (HL) patients (pts) with a lower SES had inferior survival in a different cohort from Rio de Janeiro.
Methods: SES stratification was done using an asset/education-based household index widely used in publicity and political polls in Brazil.
Results: 624 classical HL pts with diagnosis until December 31 2014, ≥ 13 y-old and HIV-, treated with ABVD, were analysed. The median follow-up was 35.6 months for all pts, 67% (390/578) were classified as higher SES and 33% (188/578) as lower SES. The 3-y PFS in higher and lower SES were 78% and 64% (p<0.0001), respectively. The 3-year OS in higher and lower SES were 94% and 82% (p<0.0001), respectively.
Lower SES pts were more likely to be ≥ 60 years (16% vs 8%, p=0.003), to have a poor performance status (20% vs 10%, p=0.001) and high risk IPS (44% vs 31%, p=0.004), to present with advanced disease (71% vs 58%, p=0.003) and to have histopathology other than nodular sclerosis (31% vs 19%, p=0.002). Also, time to diagnosis > 4 months was more frequent in lower SES pts (69% vs 53%, p=0.0001). After adjustments for potential confounders (age, PS, advanced disease, IPS, histopathology and time to diagnosis), lower SES remained associated with poorer survival (HR = 3.15 [1.8-5.2] for OS and HR = 1.67 [1.2-2.31] for PFS).
Twenty-one patients died during treatment, accounting for a death rate of 7.5% and 1.3% for lower and higher SES (p=0.0001). Infections and treatment toxicity accounted for 81% of deaths during treatment. No differences were found according to the distance and travel time from residence to hospital, or to availability of someone to transport pts to hospital in an emergency. Independent factors associated with death during treatment were: age ≥60 year, poor PS, advanced disease, lower SES and low educational level.
Deaths after the conclusion of treatment occurred in 48 patients, mostly due to progressive disease. However, follow-up is still short for analysis of long-term outcomes.
Conclusions: SES is an independent factor associated with shorter survival in Brazil. Along with age, advanced disease, and poor PS, SES and educational level allow the identification of vulnerable patients who might benefit from a program of intensive medical and social supervision, or from management modifications to reduce serious infections and drug toxicity during treatment.