Primary central nervous system lymphoma: a real-world comparison of therapy access and outcomes by hospital setting

Abstract

Background This study analyzes sociodemographic barriers for primary CNS lymphoma (PCNSL) treatment and outcomes at a public safety-net hospital versus a private tertiary academic institution. We hypothesized that these barriers would lead to access disparities and poorer outcomes in the safety-net population. Methods We reviewed records of PCNSL patients from 2007-2020 (n = 95) at a public safety-net hospital (n = 33) and a private academic center (n = 62) staffed by the same university. Demographics, treatment patterns, and outcomes were analyzed. Results Patients at the safety-net hospital were significantly younger, more commonly Black or Hispanic, and had a higher prevalence of HIV/AIDS. They were significantly less likely to receive induction chemotherapy (67% vs 86%, p = 0.003) or consolidation autologous stem cell transplantation (0% vs. 44%, p = 0.001), but received more whole-brain radiation therapy (35% vs 15%, p = 0.001). Younger age and receiving any consolidation therapy were associated with improved progression-free (PFS, p = 0.001) and overall survival (OS, p = 0.001). Hospital location had no statistical impact on PFS (p = 0.725) or OS (p = 0.226) on an age-adjusted analysis. Conclusions Our study shows significant differences in treatment patterns for PCNSL between a public safety-net hospital and an academic cancer center. A significant survival difference was not demonstrated, which is likely multifactorial, but likely was positively impacted by the shared multidisciplinary care delivery between the institutions. As personalized therapies for PCNSL are being developed, equitable access including clinical trials should be advocated for resource-limited settings.

Comparison of the outcomes of patients with primary central nervous system lymphoma between the neurosurgery and hematology/oncology departments based on the relative dose intensity of methotrexate

“…Some patients treated at our hematology/oncology department received BTK inhibitors as consolidation therapy, especially patients who could not continue receiving treatment with cytotoxic agents due to their frailty (13). Different treatment departments have different specialties, and different hospital settings have been reported to lead to different treatment patterns (24). In addition to differences in the RDI of MTX in induction therapy, differences in the treatment options available for consolidation therapy may affect the outcomes of PCNSL patients.…”

Diagnostics and treatment delay in primary central nervous system lymphoma: What the neurosurgeon should know

“…It is crucial that clinicians treating patients with PCNSL prior to histopathological diagnosis refrain from prescribing corticosteroids if possible [ 59 ]. Dexamethasone induces apoptosis of PCNSL cells and could lead to temporary disappearance, otherwise known as “vanished lymphoma”, which complicates histopathological diagnostics due to morphological changes and transient tumor mass reduction [ 27 , 49 ]. The administration of corticosteroids is associated with inconclusive biopsy by an odds ratio of 3.3 [ 59 ].…”

Disparities in Access to Radiotherapy Among Hispanic/Latinx Populations in the United States

“…Five articles were identified that addressed insurance barriers, and the type of treatment center that care was received at. 16,28,29,31,49 Authors identified that the Hispanic population was more commonly uninsured (4.4% vs. 1.4% for NHW patients, P < 0.0001), 28 that those with private insurance (vs. Medicare) had shorter time to treatment initiation, 16 that oncology patients at safety net hospitals were more often Hispanic (69% vs. 34% at private hospital, P < 0.001), 30,31 and that regardless of insurance status, Hispanic patients still receive RT less often than White patients (aOR 0.82, 95 CI 0.71-0.94). 29…”