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. 2015 Dec;39(6):1103-12.
doi: 10.1016/j.canep.2015.08.015. Epub 2015 Sep 2.

Impact of age and socioeconomic status on treatment and survival from aggressive lymphoma: a UK population-based study of diffuse large B-cell lymphoma

Alexandra Smith  1 , Simon Crouch  2 , Debra Howell  2 , Cathy Burton  3 , Russell Patmore  4 , Eve Roman  2
Affiliations

Impact of age and socioeconomic status on treatment and survival from aggressive lymphoma: a UK population-based study of diffuse large B-cell lymphoma

Alexandra Smith et al. Cancer Epidemiol. 2015 Dec.

Abstract

Aim: To examine the influence of patient's age and socio-economic status on treatment and outcome in diffuse large B-cell lymphoma (DLBCL); an aggressive curable cancer, with an incidence rate that increases markedly with age but varies little with socio-economic status.

Methods: Set within a representative UK population of around 4 million, data are from an established patient cohort. This report includes all patients (≥ 18 years) newly diagnosed with DLBCL 2004-2012, with follow-up to February 2015.

Results: Of the 2137 patients (median age 70.2 years) diagnosed with denovo DLBCL, 1709 (80%) were treated curatively/intensively and 1161(54.3%) died during follow-up. Five-year overall and relative survival (RS) estimates were 46.2% (95% CI 44.0-48.4%) and 54.6% (52.1%-57.0%) respectively for all patients, and 58.5% (56.1-60.9%) and 67.0% (64.3-69.6%) for intensively treated patients. 96.3% of patients <55 years (366/380) and 96.4% of those with the best performance status (543/563) were treated curatively: 5-year RSs being 77.9% (73.1-82%) and 87.1% (82.5-90.6%) respectively. At the other end of the age/fitness spectrum, 33.3% of those ≥ 85 years (66/198) and 41.1% with the worst performance (94/225) were treated curatively: the corresponding 5-year RSs being 50.5% (27.1-69.0%) and 22.9% (14.0-33.2%). The proportion of patients whose cancer was fully staged fell with increasing age and worsening performance status. No socio-economic variations with treatment, stage at presentation or outcome were detected.

Conclusions: Performance status is more discriminatory of survival than chronological age, with fitter patients benefiting from treatment across all ages. Socio-economic factors are not predictive of outcome in patients with DLBCL in the UK.

Keywords: Age; Chemotherapy; Diffuse large B-cell lymphoma; Inequality; Non-Hodgkin lymphoma; Socio economic status.

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Figures

None
Supplementary Fig. S1 Cancer stage by A) age at diagnosis (years) B) performance status C) deprivation: HMRN patients (≥ 18 years) diagnosed with DLBCL 2004-12.
Fig. 1
Fig. 1
Overall and relative survival curves by age, performance status, stage and deprivation for all patients and chemotherapy treated patients: HMRN patients (≥ 18 years) diagnosed with DLBCL 2004–12 and followed until February 2015.
Fig. 2
Fig. 2
Jitter plot showing the patients distributed by performance status and age according to whether they received chemotherapy (green dots, with median ages marked with a green bar) or not (red triangles, with median ages marked with a red bar): HMRN patients (≥18 years) diagnosed with DLBCL 2004–12. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)
Fig. 3
Fig. 3
5-year relative survival estimates and 95% confidence intervals stratified by age and performance status for all patients and chemotherapy treated patients: HMRN patients (≥18 years) diagnosed with DLBCL 2004–12 and followed until February 2015.
See this image and copyright information in PMC

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