QJM, Vol 91, Issue 2 131-139, Copyright © 1998 by Oxford University Press
PR Taylor, B Angus, JP Owen and SJ Proctor
Between January 1991 and December 1993, all newly-diagnosed patients with
Hodgkin's disease in the Northern Health Region (population 3.08 million)
were entered into a prospective population-based (PACE) study to assess the
accuracy of staging at diagnosis, and to evaluate treatment and outcome. On
histological review, 202 patients were confirmed to have Hodgkin's disease,
an incidence of 2.2 per 100,000 per annum. Radiological review revealed
that only 12% of patients were staged to recognized guidelines. In
early-stage disease, treatment outcome was comparable to published results
in Stage IA disease, but disappointing for Stage IIA. This was partly due
to inadequate or inaccurate staging. In-built audit in the process was
followed by the introduction and implementation of improved guidelines. Of
younger patients (15-55 years) with 'poor-risk disease', 75% of the
eligible population were entered into the appropriate randomized controlled
trial. This intensive treatment has led to improved survival in this group
over that which might be expected on four-drug therapy. The results of the
randomized trial are not discussed as it is currently ongoing. This
combined research/audit programme has resulted in greater standardization
of care across a whole region, and confirms that the PACE
(population-adjusted clinical epidemiology) approach facilitates the flow
of information from research into practice and vice versa.
ORIGINAL PAPERS
Hodgkin's disease: a population-adjusted clinical epidemiology study (PACE) of management at presentation. Northern Region Lymphoma Group
Department of Haematology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
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