title: Comparison of outcome of patients with CLL who are referred or nonreferred to a specialized CLL clinic: a Canadian population-based study.
abstract: Chronic lymphocytic leukemia and small lymphocytic lymphoma (CLL/SLL) patients in Manitoba are either referred to the CLL Clinic at CancerCare Manitoba (CCMB) or are followed by other hematologists and general practitioners. However, it has been unclear whether referral to the CLL clinic influences patient outcome. Overall survival (OS) was assessed for all CLL/SLL patients diagnosed in Manitoba between 2007 and 2011. Of 555 patients, 281 (51%) were referred to the CLL clinic. Patients seen in this clinic had a twofold increased OS compared to patients who were managed by other hematologists and general practitioners (HR 2.375, P 0.0002) when adjusted for age, gender, presence of pre- or post-CLL cancer, treatment and urban/rural location. In the nonreferred population there was a striking correlation between advancing age and decreasing OS. However, this correlation was almost eliminated in the referred population who were more likely to receive chemotherapy. Patients referred and seen in the CLL clinic have an improved OS compared to nonreferred patients and this appears to be primarily related to improved OS in the elderly. Possible explanations for this finding are discussed.
authors.affiliation: Department of Biochemistry and Medical Genetics, University of Manitoba, 745 Bannatyne Avenue, Winnipeg, Manitoba, R3E 0J9, Canada.|Manitoba Institute of Cell Biology, Cancer Care Manitoba, 675 McDermot Ave, Winnipeg, Manitoba, R3E 0V9, Canada.
authors.forename: Sara
authors.initials: S
authors.lastname: Beiggi
authors.affiliation: Department of Biochemistry and Medical Genetics, University of Manitoba, 745 Bannatyne Avenue, Winnipeg, Manitoba, R3E 0J9, Canada.|Manitoba Institute of Cell Biology, Cancer Care Manitoba, 675 McDermot Ave, Winnipeg, Manitoba, R3E 0V9, Canada.|Department of Internal Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, Manitoba, R3E 2N2, Canada.|Department of Hematology and Medical Oncology, Cancer Care Manitoba, 675 McDermot Ave, Winnipeg, Manitoba, R3E 0V9, Canada.
authors.forename: Versha
authors.initials: V
authors.lastname: Banerji
authors.affiliation: Department of Epidemiology and Cancer Registry, Cancer Care Manitoba, 675 McDermot Ave, Winnipeg, Manitoba, R3E 0V9, Canada.
authors.forename: Angela
authors.initials: A
authors.lastname: Deneka
authors.affiliation: Department of Epidemiology and Cancer Registry, Cancer Care Manitoba, 675 McDermot Ave, Winnipeg, Manitoba, R3E 0V9, Canada.|Department of Community Health Sciences, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, Manitoba, R3E 0W3, Canada.
authors.forename: Jane
authors.initials: J
authors.lastname: Griffith
authors.affiliation: Department of Biochemistry and Medical Genetics, University of Manitoba, 745 Bannatyne Avenue, Winnipeg, Manitoba, R3E 0J9, Canada.|Manitoba Institute of Cell Biology, Cancer Care Manitoba, 675 McDermot Ave, Winnipeg, Manitoba, R3E 0V9, Canada.
authors.forename: Spencer B
authors.initials: SB
authors.lastname: Gibson
authors.affiliation: Manitoba Institute of Cell Biology, Cancer Care Manitoba, 675 McDermot Ave, Winnipeg, Manitoba, R3E 0V9, Canada.|Department of Internal Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg, Manitoba, R3E 2N2, Canada.|Department of Hematology and Medical Oncology, Cancer Care Manitoba, 675 McDermot Ave, Winnipeg, Manitoba, R3E 0V9, Canada.
authors.forename: James B
authors.initials: JB
authors.lastname: Johnston
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D009026:Mortality; D016522:Oncology Service, Hospital; D063868:Patient Outcome Assessment; D011159:Population Surveillance; D012017:Referral and Consultation; D012042:Registries
keywords: CLL clinic; Chronic lymphocytic leukemia; outcome; overall survival; referral; small lymphocytic lymphoma