title: Impact of a federal program on response rate & survival, in a cohort of patients with diffuse large B-cell lymphoma. Analysis in a single national reference institution in México.
abstract: The actual standard of care of diffuse large B-cell lymphoma (DLBCL) includes rituximab in combination with chemotherapy, with response rates up to 76%. However, this treatment may not be accessible to many patients, particularly in developing countries, where most of the treatment must be paid from the pocket of patients or their families. In México, since 2011 a federal program has fully covered this treatment of patients with DLBCL. At the Instituto Nacional de Cancerología (INCan) in Mexico City, 214 new cases with this disease were treated without cost with the standard of care in 20 months. The mean age at diagnosis was 56.7 ± 15.9 (22-91). This series of cases was compared with a retrospective analysis of cases with DLBCL attended at the INCan between 2006-2009. A total of 264 cases were retrospectively analyzed. No differences were found in demographic and clinical characteristics at time of diagnosis. However a clear positive impact was found in the group that received full treatment thanks to this new social coverage by this new social security program. The follow-up and completion of treatment was 99 %. In contrast; from 264 in the retrospective group (79%) were treated, but only 29 (10.9%) were able to receive an optimal treatment, including rituximab. These differences in treatments had a clearly impact on the response rate: 66.8 vs. 50.7% global response (full treatment vs. retrospective group, respectively). These results demonstrate the importance of social programs that may accessible standard treatment options in countries with limited resources.
authors.affiliation: Investigación Clínica. Instituto Nacional de Cancerología.
authors.forename: Myrna
authors.initials: M
authors.lastname: Candelaria
authors.forename: Juan
authors.initials: J
authors.lastname: Labardini-Mendez
authors.forename: Ana F
authors.initials: AF
authors.lastname: Ramírez-Ibarguen
authors.forename: Alejandro
authors.initials: A
authors.lastname: Avilés-Salas
authors.forename: Enrique
authors.initials: E
authors.lastname: Estrada-Lobato
authors.forename: Abelardo
authors.initials: A
authors.lastname: Meneses-García
authors.forename: Alejandro
authors.initials: A
authors.lastname: Mohar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy / Q000191:economics / Q000473:pathology*; D008297:Male; D008800:Mexico; D008875:Middle Aged; D009313:National Health Programs; D012189:Retrospective Studies; D000069283:Rituximab; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab