title: Effect of place of residence and treatment on survival outcomes in patients with diffuse large B-cell lymphoma in British Columbia.
abstract: BACKGROUND
  We examined the relationship between location of residence at the time of diagnosis of diffuse large B-cell lymphoma (DLBCL) and health outcomes in a geographically large Canadian province with publicly funded, universally available medical care.
  
  
  METHODS
  The British Columbia Cancer Registry was used to identify all patients 18-80 years of age diagnosed with DLBCL between January 2003 and December 2008. Home and treatment center postal codes were used to determine urban versus rural status and driving distance to access treatment.
  
  
  RESULTS
  We identified 1,357 patients. The median age was 64 years (range: 18-80 years), 59% were male, 50% were stage III/IV, 84% received chemotherapy with curative intent, and 32% received radiotherapy. There were 186 (14%) who resided in rural areas, 141 (10%) in small urban areas, 183 (14%) in medium urban areas, and 847 (62%) in large urban areas. Patient and treatment characteristics were similar regardless of location. Five-year overall survival (OS) was 62% for patients in rural areas, 44% in small urban areas, 53% in medium urban areas, and 60% in large urban areas (p = .018). In multivariate analysis, there was no difference in OS between rural and large urban area patients (hazard ratio [HR]: 1.0; 95% confidence interval [CI]: 0.7-1.4), although patients in small urban areas (HR: 1.4; 95% CI: 1.0-2.0) and medium urban areas (HR: 1.4; 95% CI: 1.0-1.9) had worse OS than those in large urban areas.
  
  
  CONCLUSIONS
  Place of residence at diagnosis is associated with survival of patients with DLBCL in British Columbia, Canada. Rural patients have similar survival to those in large urban areas, whereas patients living in small and medium urban areas experience worse outcomes.
authors.affiliation: Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Leukemia/Bone Marrow Transplantation Program of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Benny
authors.initials: B
authors.lastname: Lee
authors.forename: Ozge
authors.initials: O
authors.lastname: Goktepe
authors.forename: Kevin
authors.initials: K
authors.lastname: Hay
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Connors
authors.forename: Laurie H
authors.initials: LH
authors.lastname: Sehn
authors.forename: Kerry J
authors.initials: KJ
authors.lastname: Savage
authors.forename: Tamara
authors.initials: T
authors.lastname: Shenkier
authors.forename: Richard
authors.initials: R
authors.lastname: Klasa
authors.forename: Alina
authors.initials: A
authors.lastname: Gerrie
authors.forename: Diego
authors.initials: D
authors.lastname: Villa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001955:British Columbia / Q000453:epidemiology; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
keywords: Access to care; Cancer care quality; Disparities; Lymphoma