Journal article
Disparity in Utilization of Multiagent Therapy for Acute Promyelocytic Leukemia in the United States
Clinical lymphoma, myeloma and leukemia, Vol.22(5), pp.319-325
05/2022
DOI: 10.1016/j.clml.2021.10.010
PMID: 34852977
Abstract
Despite high rate of cure in acute promyelocytic leukemia (APL) in clinical trials, outcomes in real-world practice are dismal. We utilized National Cancer Database (NCDB) to explore utilization of multiagent therapy in APL and identify any disparities in treatment in real-world practices.
NCDB categorizes use of systemic chemotherapy into single agent versus multiagent therapy. Some patients received hormonal therapy, immunotherapy, and unknown therapy; details of these treatments could not be ascertained. We therefore used multiple logistic regression analysis to evaluate effects of covariates on the probability of multiagent therapy use in 6678 patients.
Compared to patients >60 years, patients aged 0 to 18 years (hazard ratio[HR] 3.2, 95% confidence interval [CI] 1.8-5.5, P< .0001), 19 to 40 years (HR 1.6, 95% CI 1.03-2.54, P= .03), and 41 to 60 years (HR 1.6, 95% CI 1.3-1.9, P< .0001) were more likely to receive multiagent therapy. Patients with Charlson comorbidity index (CCI) of 0 (HR 1.6, 95% CI 1.2-2.3, P= .001) and CCI of 1 (HR 1.4, 95% CI 1.0-1.9, P= .04) had a higher likelihood of receiving multiagent therapy than patients with CCI ≥ 3. Patients treated at academic cancer centers, compared to those treated at community cancer center (HR 0.5, 95% CI 0.3-0.7, P= .001), comprehensive community cancer center (HR 0.7, 95% CI 0.6-0.8, P< .0001), and integrated network cancer center (HR 0.8, 95% CI 0.6-0.9, P= .02) were more likely to be treated with multiagent therapy. Compared to the patients with private insurance, those with Medicaid had increased likelihood (HR 1.2, 95% CI 1.0-1.4, P= .04) whereas uninsured patients had a lower likelihood of receiving multiagent therapy (HR 0.6, 95% CI 0.5-0.8, P= .0005).
To our knowledge, this study is the first and the largest scale analysis of treatment practices in APL in real-world practices. Our findings highlight significant disparities in treatment of APL based on age, insurance, and health-system factors.
We explored the utilization of multiagent therapy in acute promyelocytic leukemia(APL) and identified disparities in treatment of APL in real-world practices. Older patients and those with multiple comorbidities or without insurance, and patients treated at nonacademic centers, and uninsured patients had less likelihood of receiving multiagent therapy. Suboptimal treatment possibly led by these disparities may have contributed to inferior survival outside of clinical trials.
Details
- Title: Subtitle
- Disparity in Utilization of Multiagent Therapy for Acute Promyelocytic Leukemia in the United States
- Creators
- Prajwal Dhakal - University of IowaElizabeth Lyden - University of Nebraska Medical CenterUtsav Joshi - Rochester General HospitalAvantika Pyakuryal - Pokhara UniversityKrishna Gundabolu - University of Nebraska Medical CenterAmer M. Zeidan - Yale Cancer CenterKah Poh Loh - University of Rochester Medical CenterAlfred L. Fisher - University of Nebraska Medical CenterVijaya Raj Bhatt - University of Nebraska Medical Center
- Resource Type
- Journal article
- Publication Details
- Clinical lymphoma, myeloma and leukemia, Vol.22(5), pp.319-325
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.clml.2021.10.010
- PMID
- 34852977
- ISSN
- 2152-2650
- eISSN
- 2152-2669
- Language
- English
- Date published
- 05/2022
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
- Record Identifier
- 9984361565302771
Metrics
8 Record Views