Impact of age and socioeconomic status on treatment and survival from aggressive lymphoma: a UK population-based study of diffuse large B-cell lymphoma.
OBJECTIVE
To examine the influence of patient's age and socio-economic status on treatment and outcome in diffuse large B-cell lymphoma (DLBCL); an aggressive curable cancer, with an incidence rate that increases markedly with age but varies little with socio-economic status.


METHODS
Set within a representative UK population of around 4 million, data are from an established patient cohort. This report includes all patients (≥ 18 years) newly diagnosed with DLBCL 2004-2012, with follow-up to February 2015.


RESULTS
Of the 2137 patients (median age 70.2 years) diagnosed with denovo DLBCL, 1709 (80%) were treated curatively/intensively and 1161(54.3%) died during follow-up. Five-year overall and relative survival (RS) estimates were 46.2% (95% CI 44.0-48.4%) and 54.6% (52.1%-57.0%) respectively for all patients, and 58.5% (56.1-60.9%) and 67.0% (64.3-69.6%) for intensively treated patients. 96.3% of patients <55 years (366/380) and 96.4% of those with the best performance status (543/563) were treated curatively: 5-year RSs being 77.9% (73.1-82%) and 87.1% (82.5-90.6%) respectively. At the other end of the age/fitness spectrum, 33.3% of those ≥ 85 years (66/198) and 41.1% with the worst performance (94/225) were treated curatively: the corresponding 5-year RSs being 50.5% (27.1-69.0%) and 22.9% (14.0-33.2%). The proportion of patients whose cancer was fully staged fell with increasing age and worsening performance status. No socio-economic variations with treatment, stage at presentation or outcome were detected.


CONCLUSIONS
Performance status is more discriminatory of survival than chronological age, with fitter patients benefiting from treatment across all ages. Socio-economic factors are not predictive of outcome in patients with DLBCL in the UK.
Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, YO10 5DD, UK. Electronic address: alex.smth@ecsg.york.ac.uk.
Alexandra
A
Smith
Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, YO10 5DD, UK.
Simon
S
Crouch
Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, YO10 5DD, UK.
Debra
D
Howell
St James's Institute of Oncology, Leeds Teaching Hospitals NHS Trust, LS9 7TF, UK.
Cathy
C
Burton
Queens Centre for Oncology, Castle Hill Hospital, HU16 5JQ, UK.
Russell
R
Patmore
Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, YO10 5DD, UK.
Eve
E
Roman
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D006304:Health Status; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012107:Research Design; D012923:Social Class
Age; Chemotherapy; Diffuse large B-cell lymphoma; Inequality; Non-Hodgkin lymphoma; Socio economic status