HODGKINS-DISEASE - A POPULATION-ADJUSTED CLINICAL EPIDEMIOLOGY STUDY (PACE) OF MANAGEMENT AT PRESENTATION

Between January 1991 and December 1993, all newly-diagnosed patients w ith Hodgkin's disease in the Northern Health Region (population 3.08 m illion) were entered into a prospective population-based (PACE) study to assess the accuracy of staging at diagnosis, and to evaluate treatm ent and outcome. On histological review, 202 patients were confirmed t o have Hodgkin's disease, an incidence of 2.2 per 100 000 per annum. R adiological review revealed that only 12% of patients were staged to r ecognized guidelines. In early-stage disease, treatment outcome was co mparable to published results in Stage IA disease, but disappointing f or Stage IIA. This was partly due to inadequate or inaccurate staging. In-built audit in the process was followed by the introduction and im plementation 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 trea tment has led to improved survival in this group over that which might be expected on four-drug therapy. The results of the randomized trial ape 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 clini cal epidemiology) approach facilitates the flow of information from re search into practice and vice versa.