title: The impact of health care settings on survival time of patients with chronic myeloid leukemia.
abstract: With the introduction of tyrosine kinase inhibitors, the treatment of chronic myeloid leukemia (CML) patients has migrated extensively to municipal hospitals (MHs) and office-based physicians (OBPs). Thus, we wanted to check whether the health care setting has an impact on outcome. Based on 1491 patients of the German CML Study IV, we compared the outcomes of patients from teaching hospitals (THs) with those from MHs and OBPs. Adjusting for age, European Treatment and Outcome Study (EUTOS) score, Karnofsky performance status, year of diagnosis, and experience with CML, a significant survival advantage for TH patients (hazard ratio: 0.632 respectively 0.609) was found. In particular, when treated in THs, patients with blast crisis showed a superior outcome (2-year survival rate: 47.7% vs 22.3% vs 25.0%). Because the impact of the health care setting on the outcome of CML patients has not been reported before, these findings need confirmation by other study groups. This trial was registered at www.clinicaltrials.gov as #NCT00055874.
authors.affiliation: Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität, München, Germany; and.
authors.forename: Michael
authors.initials: M
authors.lastname: Lauseker
authors.forename: Joerg
authors.initials: J
authors.lastname: Hasford
authors.forename: Markus
authors.initials: M
authors.lastname: Pfirrmann
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Hehlmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000706:statistics & numerical data; D005858:Germany / Q000453:epidemiology; D006268:Health Facilities / Q000706:statistics & numerical data*; D006773:Hospitals, Municipal / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000401:mortality*; D008875:Middle Aged; D010824:Physicians' Offices / Q000706:statistics & numerical data; D015996:Survival Rate; D013997:Time Factors; D055815:Young Adult