FACTORS RELATED TO NON-HODGKIN?S LYMPHOMA LONG-TIME TO TREATMENT INITIATION AND IMPACT ON SURVIVAL IN A POPULATION-BASED STUDY IN FRANCE: IS THERE A ROLE OF SOCIOECONOMIC STATUS?
(Abstract release date: 05/19/16)
EHA Library. Le Guyader-Peyrou S. 06/09/16; 134585; PB1685
Dr. Sandra Le Guyader-Peyrou
Contributions
Contributions
Abstract
Abstract: PB1685
Type: Publication Only
Background
Diffuse large B cell lymphoma (DLBCL) is one of the most frequent non-Hodgkin’s lymphoma histological subtype for which care management is well codified and remaining still an aggressive disease potentially curable with a combination of anthracycline-based chemotherapy. In this context, time to treatment initiation (TTI) could be having an impact on the patient’s survival.
Aims
The aim of this study was to identify the socioeconomic and medical factors predicting a long TTI and determine the impact of a long delay on overall (OS) and relative (RS) survival (excess mortality due to lymphoma) for DLBCL patients.
Methods
We performed a population-based 'high-resolution' study including all patients diagnosed with DLBCL in three registry-areas in France (Gironde, Côte d'Or and Basse-Normandie) between 2002-2008. Medical and socioeconomic factors (GP’s density, rural area, distance to the nearest reference centre, index deprivation) were collected. TTI was the delay in days between diagnosis and treatment initiation. A long TTI was considered for 75th percentile and very long TTI for the 90th percentile. Three multivariate analysis logistic regressions were performed for the first aim using median, 75th and 90th percentiles TTI as dependant variables.For each patient, the follow-up period continued from the date of diagnosis to the death or until June, 30, 2013. For survival outcome we fitted a multivariate cox model for OS and an Esteve model for RS (3 and 5 years). Net survival (NS) using Pohar Perme unbiaised method was also calculated for 1, 3 and 5 years.
Results
We included 1084 DLBCL patients (median age 71(9-99) years) and sex ratio H/F 1.12.The median TTI was 27 days, interquartile (15-42); The long TTI was 42 days and a very long TTI was considered >63 days. Each dependant variable has been analysed in details. Among these variables in multivariate logistic regression, adjusted on age and sex, we first confirmed that elevated serum lactate dehydrogenase and disseminated stage of disease were independently associated with a TTI>63 days (OR: 0.37 IC 95%: 0.22-0.63 and OR: 0.59 IC 95%: 0.37-0.93, respectively). The registry areas and outpatient diagnosis were both independently associated with a long TTI (OR: 1.89 IC 95%: 1.38-2.60 for patients of north of France; OR: 1.55 IC 95%: 1.01-2.39 for outpatients). In contrast, the socioeconomic status (European Deprivation Index) was not associated with the delay of treatment initiation.Median of follow up was 5 years. For the respective long TTI groups, 5 years OS estimates were 55% and 60.5%; 5 years NS estimates were 62.3% and 67.7%.We found no association between a TTI>63 days and overall survival or relative survival.
Conclusion
This study shows that medical factors such as LDH and stage of disease influence a longer delay of treatment. To be diagnosed in the same place of care management that treated seems to be also a factor of earlier treatment. Socioeconomic status is not associated with TTI whatever the delay. Finally, our results emphasize disparities according to France area.This retrospective cohort suggest that time to treatment initiation don’t may influence outcomes.
Session topic: E-poster
Keyword(s): DLBCL
Type: Publication Only
Background
Diffuse large B cell lymphoma (DLBCL) is one of the most frequent non-Hodgkin’s lymphoma histological subtype for which care management is well codified and remaining still an aggressive disease potentially curable with a combination of anthracycline-based chemotherapy. In this context, time to treatment initiation (TTI) could be having an impact on the patient’s survival.
Aims
The aim of this study was to identify the socioeconomic and medical factors predicting a long TTI and determine the impact of a long delay on overall (OS) and relative (RS) survival (excess mortality due to lymphoma) for DLBCL patients.
Methods
We performed a population-based 'high-resolution' study including all patients diagnosed with DLBCL in three registry-areas in France (Gironde, Côte d'Or and Basse-Normandie) between 2002-2008. Medical and socioeconomic factors (GP’s density, rural area, distance to the nearest reference centre, index deprivation) were collected. TTI was the delay in days between diagnosis and treatment initiation. A long TTI was considered for 75th percentile and very long TTI for the 90th percentile. Three multivariate analysis logistic regressions were performed for the first aim using median, 75th and 90th percentiles TTI as dependant variables.For each patient, the follow-up period continued from the date of diagnosis to the death or until June, 30, 2013. For survival outcome we fitted a multivariate cox model for OS and an Esteve model for RS (3 and 5 years). Net survival (NS) using Pohar Perme unbiaised method was also calculated for 1, 3 and 5 years.
Results
We included 1084 DLBCL patients (median age 71(9-99) years) and sex ratio H/F 1.12.The median TTI was 27 days, interquartile (15-42); The long TTI was 42 days and a very long TTI was considered >63 days. Each dependant variable has been analysed in details. Among these variables in multivariate logistic regression, adjusted on age and sex, we first confirmed that elevated serum lactate dehydrogenase and disseminated stage of disease were independently associated with a TTI>63 days (OR: 0.37 IC 95%: 0.22-0.63 and OR: 0.59 IC 95%: 0.37-0.93, respectively). The registry areas and outpatient diagnosis were both independently associated with a long TTI (OR: 1.89 IC 95%: 1.38-2.60 for patients of north of France; OR: 1.55 IC 95%: 1.01-2.39 for outpatients). In contrast, the socioeconomic status (European Deprivation Index) was not associated with the delay of treatment initiation.Median of follow up was 5 years. For the respective long TTI groups, 5 years OS estimates were 55% and 60.5%; 5 years NS estimates were 62.3% and 67.7%.We found no association between a TTI>63 days and overall survival or relative survival.
Conclusion
This study shows that medical factors such as LDH and stage of disease influence a longer delay of treatment. To be diagnosed in the same place of care management that treated seems to be also a factor of earlier treatment. Socioeconomic status is not associated with TTI whatever the delay. Finally, our results emphasize disparities according to France area.This retrospective cohort suggest that time to treatment initiation don’t may influence outcomes.
Session topic: E-poster
Keyword(s): DLBCL
Abstract: PB1685
Type: Publication Only
Background
Diffuse large B cell lymphoma (DLBCL) is one of the most frequent non-Hodgkin’s lymphoma histological subtype for which care management is well codified and remaining still an aggressive disease potentially curable with a combination of anthracycline-based chemotherapy. In this context, time to treatment initiation (TTI) could be having an impact on the patient’s survival.
Aims
The aim of this study was to identify the socioeconomic and medical factors predicting a long TTI and determine the impact of a long delay on overall (OS) and relative (RS) survival (excess mortality due to lymphoma) for DLBCL patients.
Methods
We performed a population-based 'high-resolution' study including all patients diagnosed with DLBCL in three registry-areas in France (Gironde, Côte d'Or and Basse-Normandie) between 2002-2008. Medical and socioeconomic factors (GP’s density, rural area, distance to the nearest reference centre, index deprivation) were collected. TTI was the delay in days between diagnosis and treatment initiation. A long TTI was considered for 75th percentile and very long TTI for the 90th percentile. Three multivariate analysis logistic regressions were performed for the first aim using median, 75th and 90th percentiles TTI as dependant variables.For each patient, the follow-up period continued from the date of diagnosis to the death or until June, 30, 2013. For survival outcome we fitted a multivariate cox model for OS and an Esteve model for RS (3 and 5 years). Net survival (NS) using Pohar Perme unbiaised method was also calculated for 1, 3 and 5 years.
Results
We included 1084 DLBCL patients (median age 71(9-99) years) and sex ratio H/F 1.12.The median TTI was 27 days, interquartile (15-42); The long TTI was 42 days and a very long TTI was considered >63 days. Each dependant variable has been analysed in details. Among these variables in multivariate logistic regression, adjusted on age and sex, we first confirmed that elevated serum lactate dehydrogenase and disseminated stage of disease were independently associated with a TTI>63 days (OR: 0.37 IC 95%: 0.22-0.63 and OR: 0.59 IC 95%: 0.37-0.93, respectively). The registry areas and outpatient diagnosis were both independently associated with a long TTI (OR: 1.89 IC 95%: 1.38-2.60 for patients of north of France; OR: 1.55 IC 95%: 1.01-2.39 for outpatients). In contrast, the socioeconomic status (European Deprivation Index) was not associated with the delay of treatment initiation.Median of follow up was 5 years. For the respective long TTI groups, 5 years OS estimates were 55% and 60.5%; 5 years NS estimates were 62.3% and 67.7%.We found no association between a TTI>63 days and overall survival or relative survival.
Conclusion
This study shows that medical factors such as LDH and stage of disease influence a longer delay of treatment. To be diagnosed in the same place of care management that treated seems to be also a factor of earlier treatment. Socioeconomic status is not associated with TTI whatever the delay. Finally, our results emphasize disparities according to France area.This retrospective cohort suggest that time to treatment initiation don’t may influence outcomes.
Session topic: E-poster
Keyword(s): DLBCL
Type: Publication Only
Background
Diffuse large B cell lymphoma (DLBCL) is one of the most frequent non-Hodgkin’s lymphoma histological subtype for which care management is well codified and remaining still an aggressive disease potentially curable with a combination of anthracycline-based chemotherapy. In this context, time to treatment initiation (TTI) could be having an impact on the patient’s survival.
Aims
The aim of this study was to identify the socioeconomic and medical factors predicting a long TTI and determine the impact of a long delay on overall (OS) and relative (RS) survival (excess mortality due to lymphoma) for DLBCL patients.
Methods
We performed a population-based 'high-resolution' study including all patients diagnosed with DLBCL in three registry-areas in France (Gironde, Côte d'Or and Basse-Normandie) between 2002-2008. Medical and socioeconomic factors (GP’s density, rural area, distance to the nearest reference centre, index deprivation) were collected. TTI was the delay in days between diagnosis and treatment initiation. A long TTI was considered for 75th percentile and very long TTI for the 90th percentile. Three multivariate analysis logistic regressions were performed for the first aim using median, 75th and 90th percentiles TTI as dependant variables.For each patient, the follow-up period continued from the date of diagnosis to the death or until June, 30, 2013. For survival outcome we fitted a multivariate cox model for OS and an Esteve model for RS (3 and 5 years). Net survival (NS) using Pohar Perme unbiaised method was also calculated for 1, 3 and 5 years.
Results
We included 1084 DLBCL patients (median age 71(9-99) years) and sex ratio H/F 1.12.The median TTI was 27 days, interquartile (15-42); The long TTI was 42 days and a very long TTI was considered >63 days. Each dependant variable has been analysed in details. Among these variables in multivariate logistic regression, adjusted on age and sex, we first confirmed that elevated serum lactate dehydrogenase and disseminated stage of disease were independently associated with a TTI>63 days (OR: 0.37 IC 95%: 0.22-0.63 and OR: 0.59 IC 95%: 0.37-0.93, respectively). The registry areas and outpatient diagnosis were both independently associated with a long TTI (OR: 1.89 IC 95%: 1.38-2.60 for patients of north of France; OR: 1.55 IC 95%: 1.01-2.39 for outpatients). In contrast, the socioeconomic status (European Deprivation Index) was not associated with the delay of treatment initiation.Median of follow up was 5 years. For the respective long TTI groups, 5 years OS estimates were 55% and 60.5%; 5 years NS estimates were 62.3% and 67.7%.We found no association between a TTI>63 days and overall survival or relative survival.
Conclusion
This study shows that medical factors such as LDH and stage of disease influence a longer delay of treatment. To be diagnosed in the same place of care management that treated seems to be also a factor of earlier treatment. Socioeconomic status is not associated with TTI whatever the delay. Finally, our results emphasize disparities according to France area.This retrospective cohort suggest that time to treatment initiation don’t may influence outcomes.
Session topic: E-poster
Keyword(s): DLBCL
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