TITLE:
The Unmet Need in Chronic Lymphocytic Leukemia: Impact of Comorbidity Burden on Treatment Patterns and Outcomes in Elderly Patients
AUTHORS:
Sacha Satram-Hoang, Carolina Reyes, Khang Q. Hoang, Faiyaz Momin, Sandra Skettino
KEYWORDS:
Chronic Lymphocytic Leukemia; Elderly Patients; Comorbidities; Treatment; Survival
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.4 No.8,
October
25,
2013
ABSTRACT: Introduction: Chronic lymphocytic
leukemia (CLL) is a disease of the elderly. Elderly patients often have
increased comorbidity burden and loss of organ reserve that may impact their
ability to tolerate cancer therapy. We described realworld characteristics of
typical CLL patients and identified factors predictive of receiving treatment. Methods: A retrospective cohort analysis of 8343 first primary CLL patients
was performed using the linked Surveillance, Epidemiology, and End
Results-Medicare database. Patients were diagnosed from 1/1/1998 to 12/31/2007,
>66 years, and continuously enrolled in Medicare Parts A and B in the year
prior to diagnosis. Comorbidity was examined using the National Cancer
Institute comorbidity index and the Cumulative Illness Rating Scale. Cox and
Logistic regression modeling assessed patient characteristics predictive of
receiving treatment within the first year after diagnosis. Results: Median follow-up time from diagnosis was 782 days. During
the study time period, there were 3366 (40%) treated patients and 4977 (60%)
untreated. Even among those diagnosed with advanced stage (n = 4213), 57% were
not treated. Treated patients were younger at diagnosis compared to untreated
(76 vs. 79; p 80 years, females, and with early stage disease; and
significantly decreased with increasing comorbidity burden. Conclusions: Age, gender, comorbidity
and stage were predictive of receiving treatment. Among patients with advanced
stage, 57% were not being treated possibly due to older age and/or higher comorbidity
burden.