The care center influences the management of lymphoma patients in a universal health care system: an observational cohort study

Abstract

BackgroundHealthcare providers-related disparities in adherence to the treatment plan among lymphoma patients are found even in a universal healthcare system, but the mechanism remains unclear. We investigated the association between the type of care center and the relative dose intensity and determined whether it persists after adjustment for patients’ recruitment differences.MethodsProspective observational cohort study of 294 patients treated with standard protocols for diffuse large B-cell lymphoma (DLBCL) in teaching or community public hospitals or in private centers in the French Midi-Pyrénées region from 2006–2013. To test our assumptions, we used multinomial and mixed-effect logistic models progressively adjusted for patients’ biomedical characteristics, socio-spatial characteristics and treatment-related toxicity events.ResultsPatients treated using standard protocols in the teaching hospital had more advanced stage and poorer initial prognosis without limitation regarding the distance from the residence to the care center. Patients’ recruitment profile across the different types of care center failed to explain the difference in relative dose intensity. Low relative dose intensity was less often observed in teaching hospital than elsewhere.ConclusionWe showed that even in a universal healthcare system, disparities in the management of DLBCL patients’ do exist according to the types of care center. A main issue may be to find and diffuse the reasons of this benefit in cancer management in the teaching hospital to the other centers.

The Use of Optimal Treatment for DLBCL Is Improving in All Age Groups and Is a Key Factor in Overall Survival, but Non-Clinical Factors Influence Treatment

“…However, we did not demonstrate a difference in treatment by residential location, suggesting that some patients residing in non-metropolitan locations may seek treatment in metropolitan centers. This observation is in keeping with other studies suggesting patients treated in community hospitals in less urbanized areas hospitals received lower intensity chemotherapy and less radiotherapy than those treated in university hospitals [4,23]. In Australia, patients living in rural areas are reported to be less likely to receive chemotherapy for advanced stage colorectal cancer [24] however no similar studies in lymphoma have been published to date.…”

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?

“… 37 , 46 More recently, Lamy et al . 47 suggested that even in a universal health care system, disparities in the management of DLBCL patients still exist depending on the type of care center, even after adjustment for differences between patients.…”

Lisocabtagene Maraleucel (Breyanzi)

“…EORTC QLQ-C30 is 1 of the most commonly used PRO measures in oncology clinical trials. 22 It is a multi-dimensional, cancer-specific, evaluative measure of HRQoL. It consists of 30 questions that are scored to create 5 multiitem functional scales, 3 multi-item symptom scales, 6 single-item symptom scales, and a 2-item quality of life (QoL) scale, and uses a 1-week recall period in assessing function and symptoms.…”