Irish Hospitals Meet Proposed International Guidelines For Non-Hodgkin Lymphoma Management, But Areas For Improvement Remain

High-grade non-Hodgkin lymphoma is an aggressive condition that requires equally aggressive management. Due to the possibility of curative treatment if the disease is effectively managed, rapid diagnosis, precise staging, and swift commencement of treatment are crucial. In Ireland there is little reliable data on how closely guidelines in non-Hodgkin lymphoma treatment are followed. In order to obtain better data, we replicated a recent study carried out in the Netherlands by Wennekes and colleagues (J Clin Oncol 2011 April 10;29(11): 1436-1444).

This study was carried out in two hospitals in Cork, Ireland. Ethical approval was obtained from the Cork Research Ethics Committee. We used the National Cancer Registry of Ireland and records of the Citywide Lymphoma Conference to identify high-grade non-Hodgkin lymphoma patients treated at the participating centers. 125 patient records were identified. This was similar to the sample size used by Wennekes. The quality markers used in the Dutch study were chosen as data points. This set was then slightly modified to account for local guideline differences. Data was obtained through a systematic, retrospective chart review.

When analyzing the data, 90% adherence was set as a target. This was in keeping with previous research. Of our 22 quality markers, 11 reached the target level. Diagnosis and staging markers were generally well adhered to. 93% of non-CNS lymphoma patients received an RCHOP or DA-EPOCH-R regimen, 92.8% of patients were diagnosed with an appropriate biopsy, and 92% received a histological diagnosis before treatment was commenced. Scores regarding treatment were close to the target level. 83.5% of patients began chemotherapy within four weeks of diagnosis, and 74.1% of patients received a histological diagnosis within three weeks of presentation. Lower adherence was noted in areas relating to the communication of results. Use of the Cheson criteria to report radiological response was very limited. 12.8% of PET reports and 5% of CT reports used the Cheson criteria. In addition, the patient’s Ann Arbor staging was rarely included on CT and PET reports – 0% and 2.4% respectively.

This is the first replication of the Dutch study on non-Hodgkin lymphoma management. Irish hospitals are meeting non-Hodgkin lymphoma management guidelines in 11 of 22 areas. Adherence for the remaining areas ranges from 83.5% to 0%. Further studies in different Irish centers will provide important data to increase the external validity of this study.

No relevant conflicts of interest to declare.