BONE-MARROW EXAMINATION IN NEWLY-DIAGNOSED HODGKINS-DISEASE - CURRENTPRACTICE IN THE UNITED-KINGDOM

In the UK Hodgkin's disease is usually treated by either clinical onco logists or haematologists. A national study of the performance of bone marrow examination in newly diagnosed Hodgkin's disease was undertake n to establish current practice. A total of 620 questionnaires were de spatched, and replies were received from 60% of consultants (45% of cl inical oncologists and 70% of haematologists). Bone marrow examination was performed in all new cases significantly more often by haematolog ists than by clinical oncologists (74% vs 40%, P<0.001). Among haemato logists, there was no correlation between the number of new patients s een annually and practice, however clinical oncologists were even less likely to perform routine bone marrow biopsies if they saw more than ten patients per year (P<0.02). Where bone marrow examination was perf ormed selectively, the most common criteria used were peripheral blood cytopenia and advanced-stage disease. These criteria were applied in the same way by both clinical oncologists and haematologists. Bone mar row biopsy, an invasive and often painful procedure, is currently perf ormed more frequently in Hodgkin's disease than can be recommended on the basis of recent studies in the literature and associated guideline s. There is a significant difference in practice between clinical onco logists and haematologists, and this raise's the wider issue of the in fluence of hospital specialisation on patient management.