Patient-level Factors Associated With the Initial Management of Older Adults Diagnosed With Follicular Lymphoma: A Surveillance, Epidemiology, and End Results–Medicare Analysis
| Autor: | Sreevalsa Appukkuttan, Eberechukwu Onukwugha, Karen Keating, Madhuram Nagarajan, Jean A. Yared, Husam Albarmawi, Aakash Bipin Gandhi |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Cancer Research medicine.medical_specialty medicine.medical_treatment Medicare Logistic regression 03 medical and health sciences 0302 clinical medicine Chemoimmunotherapy Internal medicine Epidemiology Surveillance Epidemiology and End Results Humans Medicine Healthcare Disparities Lymphoma Follicular Aged Aged 80 and over business.industry Hematology Odds ratio Middle Aged medicine.disease Comorbidity United States Confidence interval Socioeconomic Factors Oncology 030220 oncology & carcinogenesis Female business Watchful waiting 030215 immunology |
| Zdroj: | Clinical Lymphoma Myeloma and Leukemia. 20:e184-e194 |
| ISSN: | 2152-2650 |
| Popis: | Introduction We evaluated patient-level factors associated with the initial management of older adults diagnosed with follicular lymphoma (FL). Materials and Methods Using linked Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) data; we identified 11,500 beneficiaries aged ≥ 66 years, diagnosed with FL between 2000 and 2013. A logistic regression model was used to estimate adjusted odds ratios (AORs) for factors associated with the receipt of active treatment versus watchful waiting (WW) as an initial management strategy. A multinomial logistic regression model was used to predict factors associated with receipt of specific active treatments, namely chemoimmunotherapy, rituximab monotherapy, chemotherapy, or radiation as compared with WW. Results Overall, the initial management strategies adopted were WW (49%), chemoimmunotherapy (25%), radiation (10%), rituximab monotherapy (9%), and chemotherapy (7%). In reference to WW, grade III FL (AOR, 2.21; 95% confidence interval [CI], 1.99-2.46), increasing disease stage (Stage IV AOR, 1.80; 95% CI, 1.62-2.00), and use of preventive services (AOR, 1.18; 95% CI, 1.07-1.30) were associated with increased odds of active treatment receipt. Age > 80 years (AOR, 0.79; 95% CI, 0.71-0.87), Non-Hispanic African-American race (AOR, 0.64; 95% CI, 0.50-0.80), and state buy-in coverage (AOR, 0.81; 95% CI, 0.70-0.94) were associated with decreased odds of active treatment receipt. In reference to WW, the multinomial logistic regression model displayed differences in the receipt of rituximab-based therapies by age and comorbidity burden. Non-Hispanic African-American race and state buy-in coverage were associated with decreased odds of receiving rituximab-based therapies. Conclusion The present analysis identifies disparities in the initial management of older adults with FL owing to race and socioeconomic status. Future research should examine implications for subsequent treatment and health outcomes. |
| Databáze: | OpenAIRE |
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