Inequalities identified in treatment and survival in non-Hodgkin’s lymphoma

A new NCRI-led study finds that private health insurance influences treatment and survival in non-Hodgkin's Lymphoma (NHL).

Non-Hodgkin’s Lymphoma is a group of similar types of cancer that start in the lymph nodes and lymphatic system. Incidence of NHL has increased rapidly in many countries since the early 1970s. While there have been improvements in survival over the last 30 years, there are still differences in outcomes. For example, studies have shown poorer survival may be related to age, sex, marital status, ethnicity, relative poverty and area of residence. Such factors may impact on access to health services for NHL patients.

The aim of the newly published study was to investigate a range of factors (e.g. age, sex, health insurance status, deprivation, cancer stage) that impact on treatment and survival in NHL patients.

The research was part funded by the Irish Cancer Society, a collaborative effort involving researchers from the NCR, Brazilian National Cancer Institute, the Health & Wellbeing Directoriate Health Intelligence Unit, HSE, Newcastle University and the University of Salerno, Italy. 2793 cases of NHL diagnosed in Ireland between 2004 and 2008 were included in the study.

The study found that patients with more aggressive forms of NHL, other health conditions (co-morbidities) and those from more deprived areas were more likely to present as emergency admissions to hospitals.

Having a more aggressive lymphoma, increasing age, having co-morbidities, treatment in a high caseload hospital and being diagnosed at a late stage (Stage III/IV) negatively impacted on survival. Patients with no private health insurance had poorer survival outcomes.

The higher rate of emergency presentation, and consequent poorer survival, of uninsured patients, suggests that they face barriers to early presentation. Social, educational and cultural factors may also discourage disadvantaged patients from presenting with early symptoms of NHL. Non-insured patients, who present later and have more emergency admissions would benefit from better access to diagnostic services.

The study was recently published in the journal PLOS ONE.

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