Demographic Factors Impacting Time to Diagnosis of Diffuse Large B-Cell Lymphoma

Abstract

Purpose: Diffuse large B-cell lymphoma (DLBCL) is the most common form of non-Hodgkin’s lymphoma, and patients are sometimes asymptomatic until the presentation of an oncological emergency, such as end organ complications, tumor lysis syndrome, or spinal cord compression. We aimed to investigate demographic and clinical factors associated with time from initial symptom onset until diagnosis of DLBCL. Methods: We performed a retrospective cohort study of 1076 patients with DLBCL diagnosed in the Montefiore Health System from 2005 to 2022. Logistic regression models, adjusted for race and preferred language, estimated the associations between demographic factors and increased time to diagnosis (TTD), defined as a time to diagnosis greater than the median for non-Hispanic White patients (58.5 days). Results: Within our cohort, 24.7% of patients were non-Hispanic White, 26.5% were non-Hispanic Black, and 39.86% were Hispanic. Median TTD was highest for Hispanic patients at 63 days (IQR 22–224) followed by non-Hispanic Whites at 58.5 (IQR 22–331) and 58 for non-Hispanic Black patients (IQR 17–237) (p = 0.03). Patients who had a preferred language of Spanish had increased odds of prolonged TTD in the multivariable model (adjusted OR = 2.06, 95% CI = 1.05–4.01, p = 0.03) compared to English speakers, as did patients with a preferred language of “other” (adjusted OR = 3.11, 95% CI = 1.01–9.59, p = 0.05.) Conclusions: Non-English-speaking patients experienced longer TTD of DLBCL compared to English speaking patients. Our results suggest that interventions increasing the availability of interpreter services, patient literature on preventative screenings in non-English languages, and increasing the number of healthcare workers with competency in common foreign languages, may potentially reduce TTD in non English speaking patients.