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. 2014 Mar;19(3):283-90.
doi: 10.1634/theoncologist.2013-0343. Epub 2014 Feb 25.

Effect of place of residence and treatment on survival outcomes in patients with diffuse large B-cell lymphoma in British Columbia

Benny Lee  1 , Ozge Goktepe, Kevin Hay, Joseph M Connors, Laurie H Sehn, Kerry J Savage, Tamara Shenkier, Richard Klasa, Alina Gerrie, Diego Villa
Affiliations

Effect of place of residence and treatment on survival outcomes in patients with diffuse large B-cell lymphoma in British Columbia

Benny Lee et al. Oncologist. 2014 Mar.

Abstract

Background: We examined the relationship between location of residence at the time of diagnosis of diffuse large B-cell lymphoma (DLBCL) and health outcomes in a geographically large Canadian province with publicly funded, universally available medical care.

Patients and methods: The British Columbia Cancer Registry was used to identify all patients 18-80 years of age diagnosed with DLBCL between January 2003 and December 2008. Home and treatment center postal codes were used to determine urban versus rural status and driving distance to access treatment.

Results: We identified 1,357 patients. The median age was 64 years (range: 18-80 years), 59% were male, 50% were stage III/IV, 84% received chemotherapy with curative intent, and 32% received radiotherapy. There were 186 (14%) who resided in rural areas, 141 (10%) in small urban areas, 183 (14%) in medium urban areas, and 847 (62%) in large urban areas. Patient and treatment characteristics were similar regardless of location. Five-year overall survival (OS) was 62% for patients in rural areas, 44% in small urban areas, 53% in medium urban areas, and 60% in large urban areas (p = .018). In multivariate analysis, there was no difference in OS between rural and large urban area patients (hazard ratio [HR]: 1.0; 95% confidence interval [CI]: 0.7-1.4), although patients in small urban areas (HR: 1.4; 95% CI: 1.0-2.0) and medium urban areas (HR: 1.4; 95% CI: 1.0-1.9) had worse OS than those in large urban areas.

Conclusion: Place of residence at diagnosis is associated with survival of patients with DLBCL in British Columbia, Canada. Rural patients have similar survival to those in large urban areas, whereas patients living in small and medium urban areas experience worse outcomes.

Keywords: Access to care; Cancer care quality; Disparities; Lymphoma.

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Conflict of interest statement

Disclosures of potential conflicts of interest may be found at the end of this article.

Figures

Figure 1.
Figure 1.
Map of British Columbia showing the geographic distribution of rural, small urban, medium urban, and large urban areas by local health authorities. The four BC Cancer Agency centers—Vancouver Island, Vancouver, Southern Interior, and Fraser Valley—are represented by asterisks, and cities are represented by circles on the map. Two additional BC Cancer Agency centers, Abbotsford and Center for the North, opened after the study period. Abbreviations: AC, Abbotsford; CN, Center for the North; FV, Fraser Valley; SI, Southern Interior; V, Vancouver; VI, Vancouver Island.
Figure 2.
Figure 2.
Overall survival.
Figure 3.
Figure 3.
Disease-specific survival.
See this image and copyright information in PMC

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