TY - JOUR
T1 - Disparity in Utilization of Multiagent Therapy for Acute Promyelocytic Leukemia in the United States
AU - Dhakal, Prajwal
AU - Lyden, Elizabeth
AU - Joshi, Utsav
AU - Pyakuryal, Avantika
AU - Gundabolu, Krishna
AU - Zeidan, Amer M.
AU - Loh, Kah Poh
AU - Fisher, Alfred L.
AU - Bhatt, Vijaya Raj
N1 - Publisher Copyright:
© 2021
PY - 2022/5
Y1 - 2022/5
N2 - Background: Despite high rate of cure in acute promyelocytic leukemia (APL) in clinical trials, outcomes in real-world practice are dismal. We utilized National Cancer Database (NCDB) to explore utilization of multiagent therapy in APL and identify any disparities in treatment in real-world practices. Patients and Methods: NCDB categorizes use of systemic chemotherapy into single agent versus multiagent therapy. Some patients received hormonal therapy, immunotherapy, and unknown therapy; details of these treatments could not be ascertained. We therefore used multiple logistic regression analysis to evaluate effects of covariates on the probability of multiagent therapy use in 6678 patients. Results: Compared to patients >60 years, patients aged 0 to 18 years (hazard ratio[HR] 3.2, 95% confidence interval [CI] 1.8-5.5, P<.0001), 19 to 40 years (HR 1.6, 95% CI 1.03-2.54, P=.03), and 41 to 60 years (HR 1.6, 95% CI 1.3-1.9, P<.0001) were more likely to receive multiagent therapy. Patients with Charlson comorbidity index (CCI) of 0 (HR 1.6, 95% CI 1.2-2.3, P=.001) and CCI of 1 (HR 1.4, 95% CI 1.0-1.9, P=.04) had a higher likelihood of receiving multiagent therapy than patients with CCI ≥ 3. Patients treated at academic cancer centers, compared to those treated at community cancer center (HR 0.5, 95% CI 0.3-0.7, P=.001), comprehensive community cancer center (HR 0.7, 95% CI 0.6-0.8, P<.0001), and integrated network cancer center (HR 0.8, 95% CI 0.6-0.9, P=.02) were more likely to be treated with multiagent therapy. Compared to the patients with private insurance, those with Medicaid had increased likelihood (HR 1.2, 95% CI 1.0-1.4, P=.04) whereas uninsured patients had a lower likelihood of receiving multiagent therapy (HR 0.6, 95% CI 0.5-0.8, P=.0005). Conclusion: To our knowledge, this study is the first and the largest scale analysis of treatment practices in APL in real-world practices. Our findings highlight significant disparities in treatment of APL based on age, insurance, and health-system factors.
AB - Background: Despite high rate of cure in acute promyelocytic leukemia (APL) in clinical trials, outcomes in real-world practice are dismal. We utilized National Cancer Database (NCDB) to explore utilization of multiagent therapy in APL and identify any disparities in treatment in real-world practices. Patients and Methods: NCDB categorizes use of systemic chemotherapy into single agent versus multiagent therapy. Some patients received hormonal therapy, immunotherapy, and unknown therapy; details of these treatments could not be ascertained. We therefore used multiple logistic regression analysis to evaluate effects of covariates on the probability of multiagent therapy use in 6678 patients. Results: Compared to patients >60 years, patients aged 0 to 18 years (hazard ratio[HR] 3.2, 95% confidence interval [CI] 1.8-5.5, P<.0001), 19 to 40 years (HR 1.6, 95% CI 1.03-2.54, P=.03), and 41 to 60 years (HR 1.6, 95% CI 1.3-1.9, P<.0001) were more likely to receive multiagent therapy. Patients with Charlson comorbidity index (CCI) of 0 (HR 1.6, 95% CI 1.2-2.3, P=.001) and CCI of 1 (HR 1.4, 95% CI 1.0-1.9, P=.04) had a higher likelihood of receiving multiagent therapy than patients with CCI ≥ 3. Patients treated at academic cancer centers, compared to those treated at community cancer center (HR 0.5, 95% CI 0.3-0.7, P=.001), comprehensive community cancer center (HR 0.7, 95% CI 0.6-0.8, P<.0001), and integrated network cancer center (HR 0.8, 95% CI 0.6-0.9, P=.02) were more likely to be treated with multiagent therapy. Compared to the patients with private insurance, those with Medicaid had increased likelihood (HR 1.2, 95% CI 1.0-1.4, P=.04) whereas uninsured patients had a lower likelihood of receiving multiagent therapy (HR 0.6, 95% CI 0.5-0.8, P=.0005). Conclusion: To our knowledge, this study is the first and the largest scale analysis of treatment practices in APL in real-world practices. Our findings highlight significant disparities in treatment of APL based on age, insurance, and health-system factors.
KW - Curable leukemia
KW - Database study
KW - Health care disparities
KW - Inferior survival
KW - Real-world practice
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U2 - 10.1016/j.clml.2021.10.010
DO - 10.1016/j.clml.2021.10.010
M3 - Article
C2 - 34852977
AN - SCOPUS:85120303918
SN - 2152-2650
VL - 22
SP - 319
EP - 325
JO - Clinical Lymphoma, Myeloma and Leukemia
JF - Clinical Lymphoma, Myeloma and Leukemia
IS - 5
ER -