Although most oncologists report giving significant consideration to National Comprehensive Cancer Network (NCCN) guidelines when treating stage III/IV classic Hodgkin lymphoma (cHL), they also report inconsistent adherence to positron emission tomography (PET)-adapted strategies described by the guidelines and have a limited consensus on the interpretation of interim PET/computed tomography (CT) scan results, according to research published in JCO Oncology Practice.

As part of the CONNECT study — the first real-world survey of physicians, patients, and caregivers about cHL to understand the treatment decision-making process, including the use and interpretation of and barriers to PET/CT imaging — researchers surveyed 301 US physicians self-identifying as oncologists, hematologists, or hematologists/oncologists with at least 2 years of practice experience who treated ≥1 adult with stage III/IV cHL in the frontline setting in the last year. The survey was administered between October 19, 2020 and November 16, 2020.

The participating physicians had been practicing for an average of 16 years. The survey revealed that 88% of physicians reported somewhat (23%) to significant (65%) consideration of NCCN guidelines when treating patients with cHL.

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It also showed 94% of physicians reported obtaining a PET/CT scan at diagnosis, and of those, 97% reported obtaining an interim PET/CT scan for stage III/IV cHL, with 65% obtaining an interim PET/CT scan after cycle 2 (guideline recommended at the time of the survey).

Of physicians who reported using a PET/CT scan, only 62% reported using the Deauville 5-point scale (5PS), as recommended in the NCCN guidelines, to review PET/CT results. The physicians showed variability on what they believed defined a positive Deauville 5PS score (, with a positive score defined as ≥3 by 44%, ≥4 by 37%, and ≥2 by 12%.

When asked about obtaining PET/CT scans, 55% of physicians reported difficulty, with 21% reporting that the greatest barrier to treating cHL was difficulty in obtaining a PET/CT scan. Those who reported difficulty in obtaining a PET/CT scan indicated that, on average, they were unable to get a PET/CT scan 20% of the time.

“These results suggest that there is an opportunity to educate oncologists and radiologists on the importance of consistently reporting PET/CT Deauville 5PS scores and the use of response-adapted imaging to optimize treatment modifications,” the study authors concluded in their report.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of authors’ disclosures. 


Parsons SK, Yu KS, Liu N, et al. Observations of oncologists on treatment selection with interim positron emission tomography-adapted approaches in classic Hodgkin lymphoma: The real-world CONNECT study. JCO Oncol Pract. Published online March 22, 2023. doi:10.1200/OP.22.00811