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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

1
Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC 3004, Australia
2
Concord Repatriation General Hospital, Sydney Medical School, University of Sydney, Sydney, NSW 2139, Australia
3
Concord Clinical School, University of Sydney, Concord, NSW 2139, Australia
4
School of Psychology, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia
5
Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, VIC 3004, Australia
6
Department of Haematology, Peter MacCallum Cancer Centre & Royal Melbourne Hospital, Melbourne, VIC 3000, Australia
7
Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC 3010, Australia
8
Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
9
Genomic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, VIC 3050, Australia
10
Department of Medicine, The University of Melbourne, Parkville, VIC 3010, Australia
11
Alfred Health Radiation Oncology, Alfred and LaTrobe Regional Hospital, Melbourne, VIC 3004, Australia
12
School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
13
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia
14
Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3800, Australia
*
Author to whom correspondence should be addressed.
Cancers 2019, 11(7), 928; https://doi.org/10.3390/cancers11070928
Received: 6 June 2019 / Revised: 17 June 2019 / Accepted: 28 June 2019 / Published: 2 July 2019
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PDF [266 KB, uploaded 3 July 2019]

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. View Full-Text
Keywords: diffuse large B cell lymphoma; chemotherapy; epidemiologic studies; patterns of care; cancer survival diffuse large B cell lymphoma; chemotherapy; epidemiologic studies; patterns of care; cancer survival
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

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Wong Doo, N.; White, V.M.; Martin, K.; Bassett, J.K.; Prince, H.M.; Harrison, S.J.; Jefford, M.; Winship, I.; Millar, J.L.; Milne, R.L.; Seymour, J.F.; Giles, G.G. 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. Cancers 2019, 11, 928.

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