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. 2012 Apr 1;118(7):1827-37.
doi: 10.1002/cncr.26474. Epub 2011 Aug 26.

Hematologist/oncologist disease-specific expertise and survival: lessons from chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL)

Tait D Shanafelt  1 , Neil E Kay, Kari G Rabe, David J Inwards, Clive S Zent, Jose F Leis, Susan M Schwager, Carrie A Thompson, Deborah A Bowen, Thomas E Witzig, Susan L Slager, Timothy G Call
Affiliations

Hematologist/oncologist disease-specific expertise and survival: lessons from chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL)

Tait D Shanafelt et al. Cancer. .

Abstract

Background: The impact of physicians' disease-specific expertise on patient outcome is unknown. Although previous studies suggest a survival advantage for cancer patients cared for at high-volume centers, these observations may simply reflect referral bias or better access to advanced technologies, clinical trials, and multidisciplinary support at large centers.

Methods: We evaluated time to first treatment (TTFT) and overall survival (OS) of patients with newly diagnosed chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL) at a single academic center based on whether they were cared for by a hematologist/oncologist who subspecializes in CLL (CLL hematologist) or a hematologist/oncologist with expertise in other areas (non-CLL hematologist).

Results: Among 1309 newly diagnosed patients with CLL cared for between 1999 and 2009, 773(59%) were cared for by CLL hematologists and 536 were cared for by non-CLL hematologists. Among early-stage patients (Rai 0-I), median TTFT (9.2 vs 6.1 years; P < .001) and OS (10.5 years vs 8.8 years; P < .001) were longer for patients cared for by CLL hematologists. For all patients, OS was superior for patients cared for by CLL hematologists (10.5 years vs 8.4 years; P = .001). Physician's disease-specific expertise remained an independent predictor of OS after adjusting for age, sex, stage, and lymphocyte count at diagnosis. Patients seen by a CLL hematologist were also more likely to participate in clinical trials (48% vs 16%; P < .001).

Conclusions: Physician disease-specific expertise appears to influence outcome in patients with CLL. To the greatest extent possible, patients should be cared for by a hematologist/oncologist expert in the care of their specific malignancy. When not possible, practice guidelines developed by disease-specific experts should be followed.

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Conflict of interest statement

AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

Employment or Leadership Position: None

Consultant or Advisory Role: None

Stock Ownership: None

Honoraria: None

Research Funding: None

Expert Testimony: None

Other Remuneration: None

Figures

Figure 1
Figure 1
TTFT and Survival of Intermediate Risk CLL (Rai stage I-II) as Compared to SLL patients without cytopenia
Figure 2
Figure 2
TTFT and OS Among Rai Stage 0-I Patients
Figure 2
Figure 2
TTFT and OS Among Rai Stage 0-I Patients
Figure 2
Figure 2
TTFT and OS Among Rai Stage 0-I Patients
Figure 3
Figure 3
Survival All Patients
Figure 3
Figure 3
Survival All Patients
See this image and copyright information in PMC

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