Hematologist/oncologist disease-specific expertise and survival: lessons from chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL).
BACKGROUND
The impact of physicians' disease-specific expertise on patient outcome is unknown. Although previous studies suggest a survival advantage for cancer patients cared for at high-volume centers, these observations may simply reflect referral bias or better access to advanced technologies, clinical trials, and multidisciplinary support at large centers.


METHODS
We evaluated time to first treatment (TTFT) and overall survival (OS) of patients with newly diagnosed chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL) at a single academic center based on whether they were cared for by a hematologist/oncologist who subspecializes in CLL (CLL hematologist) or a hematologist/oncologist with expertise in other areas (non-CLL hematologist).


RESULTS
Among 1309 newly diagnosed patients with CLL cared for between 1999 and 2009, 773(59%) were cared for by CLL hematologists and 536 were cared for by non-CLL hematologists. Among early-stage patients (Rai 0-I), median TTFT (9.2 vs 6.1 years; P < .001) and OS (10.5 years vs 8.8 years; P < .001) were longer for patients cared for by CLL hematologists. For all patients, OS was superior for patients cared for by CLL hematologists (10.5 years vs 8.4 years; P = .001). Physician's disease-specific expertise remained an independent predictor of OS after adjusting for age, sex, stage, and lymphocyte count at diagnosis. Patients seen by a CLL hematologist were also more likely to participate in clinical trials (48% vs 16%; P < .001).


CONCLUSIONS
Physician disease-specific expertise appears to influence outcome in patients with CLL. To the greatest extent possible, patients should be cared for by a hematologist/oncologist expert in the care of their specific malignancy. When not possible, practice guidelines developed by disease-specific experts should be followed.
Mayo Clinic, Rochester, Minnesota 55902, USA. shanafelt.tait@mayo.edu
Tait D
TD
Shanafelt
Neil E
NE
Kay
Kari G
KG
Rabe
David J
DJ
Inwards
Clive S
CS
Zent
Jose F
JF
Leis
Susan M
SM
Schwager
Carrie A
CA
Thompson
Deborah A
DA
Bowen
Thomas E
TE
Witzig
Susan L
SL
Slager
Timothy G
TG
Call
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D019992:Databases as Topic; D005260:Female; D006405:Hematology; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D011379:Prognosis