A longitudinal study of non-medical determinants of adherence to R-CHOP therapy for diffuse large B-cell lymphoma: implication for survival

Abstract

BackgroundAdherence to therapy has been established for years as a critical parameter for clinical benefit in medical oncology. This study aimed to assess, in the current practice, the influence of the socio-demographical characteristics and the place of treatment on treatment adherence and overall survival among diffuse large B-cell lymphoma patients.MethodsWe analysed data from 380 patients enrolled in a French multi-centre regional cohort, with diffuse large B-cell lymphoma receiving first-line treatment with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) or R-CHOP-like regimens. Direct examination of administrative and medical records yielded the date of death. We studied the influence of patients’ socio-demographic characteristics and place of treatment on the treatment adherence and overall survival, adjusted for baseline clinical characteristics. Treatment adherence was measured by the ratio between received and planned dose Intensity (DI), called relative DI (RDI) categorized in “lesser than 85%” and “at least 85%”.ResultsDuring the follow-up, among the final sample 70 patients had RDI lesser than 85% and 94 deceased. Multivariate models showed that advanced age, poor international prognosis index (IPI) and treatment with R-CHOP 14 favoured RDI lesser than 85%. The treatment in a public academic centre favoured RDI greater than or equal to 85%. Poor adherence to treatment was strongly associated with poor overall survival whereas being treated in private centres was linked to better overall survival, after adjusting for confounders. No socioeconomic gradient was found on both adherence to treatment and overall survival.ConclusionsThese results reinforce adherence to treatment as a critical parameter for clinical benefit among diffuse large B-cell lymphoma patients under R-CHOP. The place of treatment, but not the socioeconomic status of these patients, impacted both RDI and overall survival

Factors related to the relative survival of patients with diffuse large B-cell lymphoma in a population-based study in France: does socio-economic status have a role?

“…36,37 Only one study published in 2014 evaluated the role of SES in specific DLBCL survival. 23 In contrast to our results, the authors reported lower DLBCL survival in patients with a lower SES, with the association being more pronounced in the modern treatment era after the introduction of rituximab and in younger patients.…”

Randomized Phase III Trial of Ibrutinib and Rituximab Plus Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone in Non–Germinal Center B-Cell Diffuse Large B-Cell Lymphoma

“…5,6 Depending on local practice guidelines, R-CHOP is typically administered for six or eight cycles 5,6 ; treatment adherence is important for optimal outcomes. 7 Although R-CHOP cures approximately 60% of patients, 8 outcomes remain poor for those who do not achieve complete remission or develop disease relapse, 8 with a median overall survival (OS) of less than 1 year after progression during first-line treatment. 9 Despite the development and testing of innovative therapies, none has outperformed R-CHOP in almost two decades.…”

Using ecological socioeconomic position (SEP) measures to deal with sample bias introduced by incomplete individual-level measures: inequalities in breast cancer stage at diagnosis as an example

“…However, the indices were more efficient at measuring individual income than education or occupational category and are suitable for measuring deprivation but not affluence [17]. Despite these limitations, EDI was used in previous paper to study social inequalities in cancer risk [20], incidence [21], treatment [22, 23], characteristics [24] or outcome [25] confirming the relevance of such index. Since its development in 2012, almost forty papers using the European Deprivation Index (EDI) was published up to the first quarter of 2019.…”