Improving Resident Use of Mental Health Resources: It's Time for an Opt-Out Strategy to Address Physician Burnout and Depression (Commentary)

摘要

Introduction. BEACOPPescalated is the German Hodgkin Study Group (GHSG) standard for advanced Hodgkin Lymphoma (HL). Bleomycin and vincristine cause significant acute and long-term toxicities and are fre- quently discontinued during the course of therapy. However, the impact of bleomycin and vincristine dose reductions on outcome and tolerabili- ty of BEACOPP chemotherapy has never been systematically assessed. Therefore, we performed a retrospective analysis in patients treated with- in the GHSG HD12 (8xBEACOPPescalated versus 4xBEACOPPescalated plus 4xBEACOPPbaseline) and HD15 (8xBEACOPPescalated versus 6xBEACOPPescalated versus 8xBEACOPP14) trials for advanced stages. Methods. Characteristics and outcomes of patients with the full number of chemotherapy cycles from the intention-to-treat sets of the final analy- ses of HD12 and HD15 were analyzed with respect to bleomycin and vin- cristine dose reductions. Progression-free survival (PFS) and overall sur- vival (OS) from end of chemotherapy were estimated according to the Kaplan-Meier method and compared between groups using the log-rank test. Results. 3309 (89.4%) of patients received the full number of planned cycles and had complete chemotherapy documentation available. Bleomycin was discontinued in 10.5%, vincristine in 21.7% of cases. All other substances had discontinuation rates not exceeding 1.5%. 157 (4.7%) of patients received ≤4 cycles of bleomycin and 218 (6.6%) of patients received ≤3 cycles of vincristine, these were deemed sufficient numbers for comparisons to patients with >4 cycles of bleomycin (3152 patients [95.3%]) and >3 cycles of vincristine (3091 patients [93.4%]). After a median follow-up of 59 months, there was no significant PFS or OS difference in patients with ≤4 or >4 cycles of bleomycin (6-year PFS- difference 0.3% [95%CI -5.7 to 6.2%]; 6-year OS-difference 0.4% [95%CI -3.7 to 4.5%]; Figure 1A). Similarly, there was no significant PFS or OS difference in patients with ≤3 or >3 cycles of vincristine (6-year PFS- difference -1.6% [95%CI -6.4 to 3.2%]; 6-year OS-difference 1.9% [95%CI -2.5% to 6.3%]; Figure 1B). Detailed analyses and comparisons of patient characteristics, dose delivery of chemotherapy and toxicity will be presented. Conclusion. Bleomycin and vincristine may have a limited role in the BEACOPP regimen and discontinuation in the event of drug-specific side effects seems to be safe.