Contact With The General Practitioner Among Non-Hodgkin Lymphoma Survivors Diagnosed at Young Age (18-35): A Cohort Study in Norway.

Background: Cancer is the most common cause of disease-related death in children, adolescents, and young adults in high-income countries. In Norway, leukemia, non-Hodgkin lymphoma and cancer in the central nervous system are the most common cancers among children. These represent nearly 60% of all cancer cases in boys and girls. Hodgkin’s lymphoma accounts for about 10% of all lymphomas and the remaining 90% are referred to as non-Hodgkin lymphoma (NHL). Objective: The main objective of this study was to investigate late effects of cancer among survivors of NHL diagnosed at the age 18-35 years in Norway. Methods: Nationwide longitudinal register-based study investigating General practitioners (GPs) consultations among adolescents, and young adults (AYAs) diagnosed with NHL at the age of 18-35 years in Norway. All GP consultations were identified from the national GP claims register for 2006- 2017. We compared diseases and complaints for which NHL cases and AYAs without cancer in the same age contacted their GP using logistic regression models. The follow-up period was divided into three periods according to GP consultations presented in the first year, 2-5 years, 6-10 years after the cancer diagnosis. Results: A total of 2,224,484 AYA were included in the study whereas 275 were survivors of NHL. Compared with AYAs without cancer, NHL survivors had significantly more overall GP visits 6 years postdiagnosis for symptoms and complains related to blood and immune system OR=1.64 95% CI:1.59-1.69, digestive system OR=1.09 95% CI:1.04-1.14, neurological system OR=1.06 95% CI:1.02-1.11, respiratory system OR=1.09 95% CI:1.05- 1.13), skin OR=1.10 95% CI1.06-1.14, urological system OR=3.86 95% CI:3.09-4.81, and general and unspecified symptoms OR=1.10 95% CI 1.06-1.13. These health problems were statistically significant in mature B cell lymphoma, mature T-cell and NK-cell lymphomas, and NHL NOS (not otherwise specified). Conclusion: Compared with AYAs without cancer, NHL survivors have an increased contacts with the GP for health problems for up to 10 years post-diagnosis. Our results indicate the need of follow-up programs for possible late effects of cancer treatment