|The following article features coverage from the American Society of Hematology 2019 Annual Meeting. Click here to read more of Oncology Nurse Advisor‘s conference coverage.|
A single-center oncology care program for people with de novo diffuse large B-cell lymphoma (DLBCL) that involved high utilization of oncology nurse navigators reported no differences in progression-free survival (PFS) and overall survival (OS) were observed between Caucasian and non-Caucasian patients. The findings from this study were presented at the 61st American Society of Hematology (ASH) Annual Meeting & Exposition, held in Orlando, Florida.
Previous population-based studies have shown that the survival of minority patients with DLBCL is lower compared with white patients with the disease. Questions remain regarding whether these differences are associated with disparities relating to oncology care access, driven by the underlying biology of the disease, or arise from a combination of these and other factors.
This retrospective study analyzed demographic and disease- and treatment-related characteristics, as well as clinical outcomes, of patients with de novo DLBCL, defined as DLBCL in the absence of proceeding diagnoses of either chronic lymphocytic lymphoma (CLL) or a low-grade B-cell lymphoma, who presented at the Levine Cancer Institute of Atrium Health located in Charlotte, North Carolina, between January 2016 and January 2019.
Of the 182 patients included in the study, 141 (77%) and 41 (23%) self-reported as Caucasian or non-Caucasian, with the latter group identifying as African-American (73%), Hispanic (15%), Asian (10%), and other (2%).
Demographic differences between the 2 study groups included a median age of 64 years in the Caucasian group vs 56 years in the non-Caucasian group (P =.007). In addition, the rates of patients with private insurance was lower in the non-Caucasian group (27% vs 33%), whereas those in the non-Caucasian group were more likely to be uninsured (7% vs 0%) (P =.014).
Notably, utilization rates of the services of a nurse navigator, described by Bei Hu, MD, of the Levine Cancer Institute in Charlotte, North Carolina, the presenting study author, as “an oncology nurse who guides a patient throughout their cancer care and identifies any barriers that would prevent the patient from going to their appointments or receiving their treatments,” were not significantly different when the Caucasian patients (86%) were compared with those in the non-Caucasian group (80%; P =.461).
Furthermore, no significant differences were observed with respect to Revised International Prognostic Index (R-IPI) score, type of frontline treatment, median number of treatments received, whether the patients were relapsed/refractory to front-line therapy, or the percentages of patients enrolled in clinical trials or treated with stem cell transplantation when the 2 groups were compared.
Two-year PFS was 60% and 63% in the Caucasian and non-Caucasian groups, respectively, and rates of 2-year OS were also similar in the 2 groups (74% in the Caucasian group; 81% in the non-Caucasian group).
In commenting on these results, Dr Bei stated that “the key finding from our study showed that Caucasians and non-Caucasians with DLBCL had similar outcomes for PFS and OS at the Levine Cancer Institute. Caucasians and non-Caucasians had similar rates of stem cell transplant for relapsed/refractory disease and a similar frequency of clinical trial enrollment.”
She further noted that “we think that high utilization of our nurse navigation program, equal access to standard of care treatments, clinical trials, and stem cell transplant may abrogate the outcomes seen in minorities in previously reported studies.”
Chen T, Boselli D, Bose R, et al. Minorities do not have worse outcomes for diffuse large B cell lymphoma (DLBCL) if optimally managed. Oral presentation at: 61st ASH Annual Meeting & Exposition; December 7-10, 2019; Orlando, FL. Abstract 425.