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. 2021 Oct;125(9):1299-1307.
doi: 10.1038/s41416-021-01523-6. Epub 2021 Aug 13.

Investigating the inequalities in route to diagnosis amongst patients with diffuse large B-cell or follicular lymphoma in England

Matthew J Smith  1 , Miguel Angel Luque Fernandez  2   3 , Aurélien Belot  2 , Matteo Quartagno  4 , Audrey Bonaventure  5 , Sara Benitez Majano  2 , Bernard Rachet  2 , Edmund Njeru Njagi  2
Affiliations

Investigating the inequalities in route to diagnosis amongst patients with diffuse large B-cell or follicular lymphoma in England

Matthew J Smith et al. Br J Cancer. 2021 Oct.

Abstract

Introduction: Diagnostic delay is associated with lower chances of cancer survival. Underlying comorbidities are known to affect the timely diagnosis of cancer. Diffuse large B-cell (DLBCL) and follicular lymphomas (FL) are primarily diagnosed amongst older patients, who are more likely to have comorbidities. Characteristics of clinical commissioning groups (CCG) are also known to impact diagnostic delay. We assess the association between comorbidities and diagnostic delay amongst patients with DLBCL or FL in England during 2005-2013.

Methods: Multivariable generalised linear mixed-effect models were used to assess the main association. Empirical Bayes estimates of the random effects were used to explore between-cluster variation. The latent normal joint modelling multiple imputation approach was used to account for partially observed variables.

Results: We included 30,078 and 15,551 patients diagnosed with DLBCL or FL, respectively. Amongst patients from the same CCG, having multimorbidity was strongly associated with the emergency route to diagnosis (DLBCL: odds ratio 1.56, CI 1.40-1.73; FL: odds ratio 1.80, CI 1.45-2.23). Amongst DLBCL patients, the diagnostic delay was possibly correlated with CCGs that had higher population densities.

Conclusions: Underlying comorbidity is associated with diagnostic delay amongst patients with DLBCL or FL. Results suggest a possible correlation between CCGs with higher population densities and diagnostic delay of aggressive lymphomas.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Variance of diagnostic delay of diffuse large B-cell lymphoma amongst clinical commissioning groups.
Empirical Bayes estimates of the random effects from the model for the route to diagnosis, by each Clinical Commissioning Group, amongst patients (n = 30,078) diagnosed with diffuse large B-cell lymphoma in England during 2005–2013.
Fig. 2
Fig. 2. Variance of diagnostic delay of follicular lymphomas amongst clinincal commissioning groups.
Empirical Bayes estimates of the random effects from the model for the route to diagnosis, by each Clinical Commissioning Group amongst patients (n = 15,551) diagnosed with follicular lymphoma in England during 2005–2013.
See this image and copyright information in PMC

References

    1. Shankland KR, Armitage JO, Hancock BW. Non-Hodgkin lymphoma. Lancet. 2012;380:848–57. doi: 10.1016/S0140-6736(12)60605-9. - DOI - PubMed
    1. Haematological Malignancy Research Network. Incidence of non-Hodgkin lymphoma. 2016. Date accessed: 2020-07-20. https://hmrn.org/statistics/incidence.
    1. Rachet B, Mitry E, Shah A, Cooper N, Coleman MP. Survival from non-Hodgkin lymphoma in England and Wales up to 2001. Br J Cancer. 2008;99:S104–6. doi: 10.1038/sj.bjc.6604605. - DOI - PMC - PubMed
    1. Exarchakou A, Rachet B, Belot A, Maringe C, Coleman MP. Impact of national cancer policies on cancer survival trends and socioeconomic inequalities in England, 1996-2013: population based study. BMJ. 2018;360:k764–k764. doi: 10.1136/bmj.k764. - DOI - PMC - PubMed
    1. Allemani C, Matsuda T, Di Carlo V, Harewood R, Matz M, Nikšić M, et al. Global surveillance of trends in cancer survival 2000–14 (CONCORD-3): analysis of individual records for 37,513,025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet. 2018;391:1023–75. doi: 10.1016/S0140-6736(17)33326-3. - DOI - PMC - PubMed

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