The Use of Optimal Treatment for DLBCL Is Improving in All Age Groups and Is a Key Factor in Overall Survival, but Non-Clinical Factors Influence Treatment

Nicole Wong Doo^{1

2

3}, Victoria M White^{4

5}, Kara Martin⁶, Julie K Bassett⁶, H Miles Prince^{7

8}, Simon J Harrison^{7

8}, Michael Jefford^{8

9}, Ingrid Winship^{10

11}, Jeremy L Millar^{12

13}, Roger L Milne^{6

14

15}, John F Seymour^{7

8}, Graham G Giles^{6

14

15}

Affiliations

¹ Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria 3004, Australia. nicole.wongdoo@health.nsw.gov.au.
² Concord Repatriation General Hospital, Sydney Medical School, University of Sydney, Sydney, NSW 2139, Australia. nicole.wongdoo@health.nsw.gov.au.
³ Concord Clinical School, University of Sydney, Concord, NSW 2139, Australia. nicole.wongdoo@health.nsw.gov.au.
⁴ School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria 3220, Australia.
⁵ Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria 3004, Australia.
⁶ Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria 3004, Australia.
⁷ Department of Haematology, Peter MacCallum Cancer Centre & Royal Melbourne Hospital, Melbourne, Victoria 3000, Australia.
⁸ Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria 3010, Australia.
⁹ Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia.
¹⁰ Genomic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia.
¹¹ Department of Medicine, The University of Melbourne, Parkville, Victoria 3010, Australia.
¹² Alfred Health Radiation Oncology, Alfred and LaTrobe Regional Hospital, Melbourne, Victoria 3004, Australia.
¹³ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia.
¹⁴ Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3010, Australia.
¹⁵ Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria 3800, Australia.

PMID: 31269764
PMCID: PMC6678990
DOI: 10.3390/cancers11070928

The Use of Optimal Treatment for DLBCL Is Improving in All Age Groups and Is a Key Factor in Overall Survival, but Non-Clinical Factors Influence Treatment

Nicole Wong Doo et al. Cancers (Basel). 2019.

. 2019 Jul 2;11(7):928.

doi: 10.3390/cancers11070928.

Authors

Affiliations

¹ Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria 3004, Australia. nicole.wongdoo@health.nsw.gov.au.
² Concord Repatriation General Hospital, Sydney Medical School, University of Sydney, Sydney, NSW 2139, Australia. nicole.wongdoo@health.nsw.gov.au.
³ Concord Clinical School, University of Sydney, Concord, NSW 2139, Australia. nicole.wongdoo@health.nsw.gov.au.
⁴ School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria 3220, Australia.
⁵ Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria 3004, Australia.
⁶ Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria 3004, Australia.
⁷ Department of Haematology, Peter MacCallum Cancer Centre & Royal Melbourne Hospital, Melbourne, Victoria 3000, Australia.
⁸ Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria 3010, Australia.
⁹ Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia.
¹⁰ Genomic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia.
¹¹ Department of Medicine, The University of Melbourne, Parkville, Victoria 3010, Australia.
¹² Alfred Health Radiation Oncology, Alfred and LaTrobe Regional Hospital, Melbourne, Victoria 3004, Australia.
¹³ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia.
¹⁴ Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3010, Australia.
¹⁵ Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria 3800, Australia.

PMID: 31269764
PMCID: PMC6678990
DOI: 10.3390/cancers11070928

Abstract

Introduction: Diffuse large B cell lymphoma (DLBCL) is an aggressive form of non-Hodgkin lymphoma for which a cure is usually the therapeutic goal of optimal treatment. Using a large population-based cohort we sought to examine the factors associated with optimal DLBCL treatment and survival.

Methods: DLBCL cases were identified through the population-based Victorian Cancer Registry, capturing new diagnoses for two time periods: 2008-2009 and 2012-2013. Treatment was pre-emptively classified as 'optimal' or 'suboptimal', according to compliance with current treatment guidelines. Univariable and multivariable logistic regression models were fitted to determine factors associated with treatment and survival.

Results: Altogether, 1442 DLBCL cases were included. Based on multivariable analysis, delivery of optimal treatment was less likely for those aged ≥80 years (p < 0.001), women (p = 0.012), those with medical comorbidity (p < 0.001), those treated in a non-metropolitan hospital (p = 0.02) and those who were ex-smokers (p = 0.02). Delivery of optimal treatment increased between 2008-2009 and the 2012-2013 (from 60% to 79%, p < 0.001). Delivery of optimal treatment was independently associated with a lower risk of death (hazard ratio (HR) = 0.60 (95% confidence interval (CI) 0.45-0.81), p = 0.001).

Conclusion: Delivery of optimal treatment for DLBCL is associated with hospital location and category, highlighting possible demographic variation in treatment patterns. Together with an increase in the proportion of patients receiving optimal treatment in the more recent time period, this suggests that treatment decisions in DLBCL may be subject to non-clinical influences, which may have implications when evaluating equity of treatment access. The positive association with survival emphasizes the importance of delivering optimal treatment in DLBCL.

Keywords: cancer survival; chemotherapy; diffuse large B cell lymphoma; epidemiologic studies; patterns of care.

PubMed Disclaimer

Conflict of interest statement

J.F.S. (Abbvie: Research funding, honoraria, Advisory Board, Speakers Bureau, Acerta: honoraria, Advisory Board, Celgene: Research funding, honoraria, Advisory Board, Speakers Bureau, Genentech: honoraria, Advisory Board, Gilead: honoraria, Advisory Board, Janssen: Research funding, honoraria, Advisory Board, Roche: Research funding, honoraria, Advisory Board, Speakers Bureau, Sunesis: honoraria, Advisory Board, Takeda: honoraria, Advisory Board). There are no other conflicts of interest. M.J. (Roche, travel support 2018).

References

1. Tilly H., Gomes da Silva M., Vitolo U., Vitolo U., Jack A., Meignan M., Lopez-Guillermo A., Walewski J., André M., Johnson P.W., et al. Diffuse large B-cell lymphoma (DLBCL): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann. Oncol. 2015;26:116–125. doi: 10.1093/annonc/mdv304. - DOI - PubMed
1. Vose J.M., Link B.K., Grossbard M.L., Czuczman M., Grillo-Lopez A., Gilman P., Lowe A., Kunkel L.A., Fisher R.I. Phase II study of rituximab in combination with chop chemotherapy in patients with previously untreated, aggressive non-Hodgkin’s lymphoma. J. Clin. Oncol. 2001;19:389–397. doi: 10.1200/JCO.2001.19.2.389. - DOI - PubMed
1. Wang M., Burau K.D., Fang S., Wang H., Du X.L. Ethnic variations in diagnosis, treatment, socioeconomic status, and survival in a large population-based cohort of elderly patients with non-Hodgkin lymphoma. Cancer. 2008;113:3231–3241. doi: 10.1002/cncr.23914. - DOI - PMC - PubMed
1. Lee B., Goktepe O., Hay K., Connors J.M., Sehn L.H., Savage K.J., Shenkier T., Klasa R., Gerrie A., Villa D. Effect of place of residence and treatment on survival outcomes in patients with diffuse large B-cell lymphoma in British Columbia. Oncologist. 2014;19:283–290. doi: 10.1634/theoncologist.2013-0343. - DOI - PMC - PubMed
1. Kent E.E., Morris R.A., Largent J.A., Ziogas A., Sender L.S., Anton-Culver H. Socioeconomic Impacts on Survival Differ by Race/Ethnicity among Adolescents and Young Adults with Non-Hodgkin’s Lymphoma. J. Cancer Epidemiol. 2010;2010:824691. doi: 10.1155/2010/824691. - DOI - PMC - PubMed

Grants and funding

#EOI09_36/Victorian Cancer Agency

LinkOut - more resources

Full Text Sources

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

The Use of Optimal Treatment for DLBCL Is Improving in All Age Groups and Is a Key Factor in Overall Survival, but Non-Clinical Factors Influence Treatment

Affiliations

The Use of Optimal Treatment for DLBCL Is Improving in All Age Groups and Is a Key Factor in Overall Survival, but Non-Clinical Factors Influence Treatment

Authors

Affiliations

Abstract

Conflict of interest statement

References

Grants and funding

LinkOut - more resources

Full Text Sources