Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

For patients with non-Hodgkins lymphoma receiving chemotherapy after surgery, what are the comparative risks and benefits of receiving additional chemotherapy cycles after tests show no remaining cancer? What is the optimum number of additional cycles, if any, to minimize risk and maximize benefit?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Compare different number of cycles of Chemotherapy given after tests show no evidence of cancer.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Adult patients with non-Hodgkins lymphoma (separated by stage), treated with surgery and subsequent chemotherapy.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Varying stages of the disease may show a different number of cycles to be optimum.

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Improvement of quality of life. Reduction in occurrence of leukemia in patients due to excessive chemotherapy, and reduction in re-occurrence of lymphoma due to insufficient chemotherapy cycles.

Describe any health-related risks, side effects, or harms that you are concerned about.

Risk of recurring cancer, risk of contracting leukemia, all risks associated with side effects of chemotherapy, including ability of patient to fight the cancer if and when it returns, as a function of the number of cycles undergone with the original treatment. Do additional cycles reduce the recurrence of the cancer? Do additional cycles reduce the patient's ability to return to remission multiple times?

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Cancer
• Depression and other mental health disorders
• Functional limitations and disability

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women
• Elderly
• Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

It is important to understand the value of each additional cycle of chemotherapy after remission is achieved in order to achieve optimum health for patients.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

My 53 yr old sister has non-Hodgkins Stage 2 lymphoma of the abdomen. After nearly dying, she underwent major surgery to remove the cancer, then a PET Scan to determine that there was cancer remaining on the margins of the surgery and two small additional nodules. After 4 cycles of chemotherapy, a CT Scan revealed no cancer. Her doctor wants 4 more cycles of chemotherapy. She has had 2, but is torn between the additional risk of Leukemia and wear and tear on her body for the additional 2 cycles, the financial burden, and what benefit those 2 cycles will have.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

It seems that the additional cycles are dependent upon the oncologists personal style: aggressive or conservative rather than solid evidence.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

It will help patients and oncologists to make good decisions, and to provide patient confidence in the regimen proscribed.

Describe the timeframe in which an answer to your question is needed.

ASAP to effect maximum good.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Reduce variations in treatment: onset of Leukemia and other side effects of chemotherapy and immediate recurrence of lymphoma.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

It will help patients and oncologists to make good decisions, and to provide patient confidence in the regimen proscribed.

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program

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