Timeliness and quality of diagnostic care for medicare recipients with chronic lymphocytic leukemia

Abstract

BACKGROUND: Little is known about the patterns of care relating to the diagnosis of chronic lymphocytic leukemia (CLL), including the use of modern diagnostic techniques such as flow cytometry. METHODS: The authors used the SEER‐Medicare database to identify subjects diagnosed with CLL from 1992 to 2002 and defined diagnostic delay as present when the number of days between the first claim for a CLL‐associated sign or symptom and SEER diagnosis date met or exceeded the median for the sample. The authors then used logistic regression to estimate the likelihood of delay and Cox regression to examine survival. RESULTS: For the 5086 patients analyzed, the median time between sign or symptom and CLL diagnosis was 63 days (interquartile range [IQR] = 0‐251). Predictors of delay included age ≥75 (OR 1.45 [1.27‐1.65]), female gender (OR 1.22 [1.07‐1.39]), urban residence (OR 1.46 [1.19 to 1.79]), ≥1 comorbidities (OR 2.83 [2.45‐3.28]) and care in a teaching hospital (OR 1.20 [1.05‐1.38]). Delayed diagnosis was not associated with survival (HR 1.11 [0.99‐1.25]), but receipt of flow cytometry within thirty days before or after diagnosis was (HR 0.84 [0.76‐0.91]). CONCLUSIONS: Sociodemographic characteristics affect diagnostic delay for CLL, although delay does not seem to impact mortality. In contrast, receipt of flow cytometry near the time of diagnosis is associated with improved survival. Cancer 2011. © 2010 American Cancer Society.

Symptoms of adult chronic and acute leukaemia before diagnosis: large primary care case-control studies using electronic records

“…[9][10][11] Similarly, chest pain was found to be associated with AL only. 9 Bruising, previously reported in AML patients, was found in both CL and AL, but twice as often in AL.…”

“…9 Another study of over 5000 CLL patients reported infection in 32%, fatigue in 17%, and lymphadenopathy in 7%, with splenomegaly and excessive sweating being much rarer. 10 For CML, fatigue has been reported in nearly 34%, with bleeding and weight loss in 21% and 20%, respectively. 11 Infection, headache, cough, malaise, and nausea were rarer, reported in 7% of cases.…”

Telomere length and telomerase levels delineate subgroups of B-cell chronic lymphocytic leukemia with different biological characteristics and clinical outcomes

“…1 A comprehensive prognostic characterization of patients with B-CLL and identification of reliable prognostic markers is essential for tailoring therapeutic strategies. 2 Specific molecular alterations in gene expression and protein activity are thought to underlie the variability in disease outcome. [3][4][5] Among molecular indicators, the presence or absence of somatic mutations in the immunoglobulin heavy-chain variable gene (IGVH) appears to be the best prognostic discriminator, with the unmutated IGVH profile (<2% difference from germ-line) being associated with an aggressive clinical course.…”

Essays on Private Health Insurance in Public Programs

“…The median time between the start of symptoms and diagnosis for lung cancer patients is 180 days, with 25 percent of lung cancer patients being diagnosed more than 300 days after their first sign of symptoms (Koo, Zhou, and Lyratzopoulos, 2015). Similarly, 25 percent of patients with chronic lymphocytic leukemia are diagnosed 251 days or more after their first sign of symptoms (Friese et al, 2011) and about 20 percent of colorectal cancer patients are diagnosed 8 months or more after their first sign of symptoms (Pruitt et al, 2013). Long diagnosis delays have also been documented for breast, ovarian, prostate, and other cancers (Allgar and Neal, 2005).…”

“…Thus, people who were diagnosed with cancer should not have been able to predict the timing of their diagnosis three or more calendar years before being diagnosed. The diagnosis delay literature (Koo, Zhou, and Lyratzopoulos, 2015;Friese et al, 2011;Pruitt et al, 2013;Allgar and Neal, 2005) suggests that very few patients experience cancer symptoms more than one year in advance. To the extent this is true, β −2 acts as a placebo parameter and should be estimated as zero.…”