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Survival of Patients With a Common Lymphoma Is Worse Among Those With Low Income

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Key Points

  • Patients with diffuse large B-cell lymphoma who live in low-socioeconomic-status neighborhoods have a 34% greater risk of dying from their cancer and other causes than patients living in high-socioeconomic-status neighborhoods.
  • Neighborhood socioeconomic status mortality disparities were more pronounced in younger patients, married patients, and patients treated after the introduction of rituximab as first-line chemotherapy for lymphoma.
  • Inadequate insurance coverage and high out-of-pocket costs for treatments may be associated with increased mortality after a diffuse large B-cell lymphoma diagnosis for patients living in low-socioeconomic-status neighborhoods.

Despite advances in the treatment of diffuse large B-cell lymphoma (the most common subtype of non-Hodgkin lymphoma), including the introduction of rituximab (Rituxan), diffuse large B-cell lymphoma patients living in low-socioeconomic-status neighborhoods have a 34% greater risk of dying from their cancer and other causes than patients living in high-socioeconomic-status neighborhoods, according to a study by researchers at the Cancer Prevention Institute of California. The study by Tao et al is published in Blood.

Study Methodology

The researchers examined the association between neighborhood socioeconomic status and overall and diffuse large B-cell lymphoma–specific mortality before (1988–2000) and after (2001–2009) the introduction of rituximab among the ethnically and socioeconomically diverse population in the California Cancer Registry. The study included 33,032 patients diagnosed with diffuse large B-cell lymphoma between 1988 and 2009. Information was collected about their age, sex, race/ethnicity, marital status, census-block group of residence at diagnosis, summary stage, presence of B symptoms, nodal status, treatment modalities within the first 12 months of diagnosis, vital status as of December 31, 2010, and underlying cause of death.

The mean age of the patients at diagnosis was 63.3 years and 63.6 years for patients diagnosed before and after 2000, respectively. Most patients were of non-Hispanic white race/ethnicity, but the proportion of nonwhite patients increased in the 2001 to 2009 diagnostic period.

Findings

Patients diagnosed between 2001 and 2009 vs between 1988 and 2000 had a significantly decreased overall and diffuse large B-cell lymphoma–specific mortality. However, patients living in lower-socioeconomic-status neighborhoods had a 34% (95% confidence interval [CI] = 27%–40%) and 24% (95% CI = 16%–32%) higher mortality rate from all causes and lymphoma, respectively, than patients living in higher-socioeconomic-status neighborhoods.

In addition, the magnitude of mortality disparities by neighborhood socioeconomic status was more striking in younger (< 65 years) than in older patients (≥ 65 years), in married than in unmarried patients, and after the introduction of rituximab.

“Low socioeconomic status individuals are less likely to have insurance coverage, or, even with coverage, are less likely to be able to pay high out-of-pocket costs for treatments. Because of insurance or other access factors, low socioeconomic status individuals may also be less likely to obtain high-quality treatment and follow-up care,” concluded the researchers.

Li Tao, MD, MS, PhD, of the Cancer Prevention Institute of California, is the corresponding author for the Blood article.

This study was supported by the California Department of Public Health and the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. The study authors reported no conflicts of interest.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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