title: Impact of delays in definitive treatment on overall survival: a National Cancer Database study of patients with Hodgkin lymphoma.
abstract: The purpose of this large observational study was to examine outcomes in patients with Hodgkin lymphoma (HL) by timing to definitive chemotherapy (TTC) using standard and propensity score (PS)-adjusted Cox proportional hazards models. From 1998-2011, 56,457 patients with stage I-IV HL were studied, with a median follow-up of 6.0 years (median age=39). Median TTC was 26 days from diagnosis. The cohort of "early" (<60 days from diagnosis) TTC patients included 45,307 (80.3%) patients and "late" (≥60 days) TTC was 11,150 (19.7%). Patients were more likely to experience early TTC if they were of a younger age, at an advanced stage, with "B" symptoms, favorably insured, favorable socioeconomic status, and treated at comprehensive cancer center (all p<0.05). Ten-year overall survival for patients with early TTC was 73.2% vs. 70.0% for those with late TTC (HR=0.87; 95%CI, 0.83-0.92, p<0.0001). After PS-matching for co-variates, early TTC was not associated with overall survival (HR=0.96; 95%CI, 0.85-1.08, p=0.51). This represents the only study to evaluate overall survival by time to definitive treatment for HL.
authors.affiliation: a Mount Sinai Beth Israel Medical Center & Mount Sinai St. Luke's-Roosevelt Hospitals, Mount Sinai Health System , Department of Radiation Oncology , New York .
authors.forename: Rahul R
authors.initials: RR
authors.lastname: Parikh
authors.affiliation: b Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center , Division of Hematology-Oncology , New York .
authors.forename: Michael L
authors.initials: ML
authors.lastname: Grossbard
authors.affiliation: c Moffitt Cancer Center and Research Institute , Department of Radiation Oncology , Tampa , FL , and.
authors.forename: Louis B
authors.initials: LB
authors.lastname: Harrison
authors.affiliation: d Memorial Sloan-Kettering Cancer Center , Department of Radiation Oncology , New York , NY , USA.
authors.forename: Joachim
authors.initials: J
authors.lastname: Yahalom
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011159:Population Surveillance; D016016:Proportional Hazards Models; D012307:Risk Factors; D012959:Socioeconomic Factors; D061665:Time-to-Treatment; D014481:United States / Q000453:epidemiology
keywords: Chemotherapy; Hodgkin Lymphoma; National Cancer Database; disparities in care; overall survival