The Bottom Line:
Chronic lymphocytic leukemia (CLL) patients treated at academic centers live lived longer than those treated at non-academic centers, but the data was confounded by significant demographic and socioeconomic variation between CLL patients treated at Academic Centers and Non-Academic Centers.
By whom and where were the research and presentation done:
Dr. Victoria Vardell and her colleagues at the Huntsman Cancer Institute in Salt Lake City, Utah, presented the results at the American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago in 2022.
Methods and Participants:
The National Cancer Database was used to identify CLL patients diagnosed from 2004-2018.
- 98,186 patients were studied.
- 33.3% or 1 in 3 were treated at Academic Centers.
- Patients treated at Academic Centers were younger than those treated at Non-Academic Centers (median age 67 vs. 71 years).
- Academic Centers were more likely to treat Black and other minority patients, with Black patients representing 9.7% vs. 6.3% of Academic Centers vs. Non-Academic Center patients.
- Academic Centers were more likely than Non-Academic Centers to treat privately insured (39.1% vs. 30.3%) but also to see more uninsured (3.2% vs.2.0%) and patients on Medicaid (4.1% vs. 2.9%).
- Academic Centers cared for more patients from the highest quartiles of income (OR 1.46) and education (OR 1.12) when compared to the lowest quartiles (p<0.001).
- Academic Centers were more likely to manage patients with active observation or watch and wait versus Non-Academic Centers (53.7% vs. 45%, p<0.001).
- With a median follow-up of 4.3 years, the median overall survival (OS) at Academic Centers was significantly improved when compared to Non- Academic Centers, with a median OS of 11.0 years (CI 10.5-11.3) vs. 8.2 years (CI 8.1-8.3), respectively (p<0.001).
The survival benefit was maintained at both 5 years (73% vs. 66%) and 10 years (53% vs. 43%) (both p<0.001).
- On multivariate analysis adjusted for age and comorbidity, management of CLL patients at Academic Centers was an independent factor for improved OS (HR 0.87, CI 0.85-0.89, p<0.001).
Conclusions and Comments:
This was a large study of patients, and there was a significant demographic and socioeconomic variation between CLL patients treated at Academic Centers and Non- Academic Centers. The improved OS benefit of CLL patients managed at Academic Centers suggests possible differences in treatment, including the higher percentage of patients managed by active observation. Perhaps better clinical trial availability and supportive care management are factors too.
This documented survival advantage in receiving expert care is not news. Ten years ago, Dr. Shanafelt reported a similar survival advantage in seeing a CLL expert. CLL Society is committed to closing this gap so that survival odds are not influenced by geography, insurance, or economic status, and all patients, regardless, can access an expert and, through our educational services, become their own best advocate.
Links and resources:
The ASCO 2022 abstract that gives more detailed statistics can be found here: Survival outcomes in patients with chronic lymphocytic leukemia treated at academic centers.
We also provide a link to our free Second Opinion program, Ask the Expert, which provides free access to a CLL to anyone in the USA who might otherwise not have such access.
We also share a link to help you build your CLL team.
Our motto is Smart Patients Get Smart Care, and one of the smartest things you can do is get expert care.
Stay strong. We are all in this together.
Brian Koffman MDCM (retired) MS Ed (he, him, his)
Co-Founder, Executive VP, and Chief Medical Officer, CLL Society, Inc.