Primary Central Nervous System Lymphoma: A Real-World Comparison of Therapy Access and Outcomes by Hospital Setting

Abstract Background This study analyzes sociodemographic barriers for primary CNS lymphoma (PCNSL) treatment and outcomes at a public safety-net hospital versus a private tertiary academic institution. We hypothesized that these barriers would lead to access disparities and poorer outcomes in the safety-net population. Methods We reviewed records of PCNSL patients from 2007-2020 (n = 95) at a public safety-net hospital (n = 33) and a private academic center (n = 62) staffed by the same university. Demographics, treatment patterns, and outcomes were analyzed. Results Patients at the safety-net hospital were significantly younger, more commonly Black or Hispanic, and had a higher prevalence of HIV/AIDS. They were significantly less likely to receive induction chemotherapy (67% vs 86%, p = 0.003) or consolidation autologous stem cell transplantation (0% vs. 44%, p = 0.001), but received more whole-brain radiation therapy (35% vs 15%, p = 0.001). Younger age and receiving any consolidation therapy were associated with improved progression-free (PFS, p = 0.001) and overall survival (OS, p = 0.001). Hospital location had no statistical impact on PFS (p = 0.725) or OS (p = 0.226) on an age-adjusted analysis. Conclusions Our study shows significant differences in treatment patterns for PCNSL between a public safety-net hospital and an academic cancer center. A significant survival difference was not demonstrated, which is likely multifactorial, but likely was positively impacted by the shared multidisciplinary care delivery between the institutions. As personalized therapies for PCNSL are being developed, equitable access including clinical trials should be advocated for resource-limited settings.

Download Full-text

Primary Central Nervous System Lymphoma: A Real-World Comparison of Therapy Access and Outcomes by Hospital Setting

10.21203/rs.3.rs-685267/v1 ◽

2021 ◽

Author(s):

Akshat Maneesh Patel ◽

Omer Ali ◽

Radhika Kainthla ◽

Syed M. Rizvi ◽

Farrukh T. Awan ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Public Safety ◽

Central Nervous System Lymphoma ◽

Safety Net ◽

Treatment Patterns ◽

Survival Outcomes ◽

Academic Center ◽

Safety Net Hospital ◽

To Receive

Abstract Purpose: Primary central nervous system lymphoma (PCNSL) is an aggressive disease with many tools for management that may be subject to resource barriers. This study compares the treatment patterns and survival outcomes among PCNSL patients treated at a safety-net hospital versus a tertiary academic institution.Methods:We retrospectively reviewed records of PCNSL patients from 2007-2020 (n = 95) at a public safety-net hospital (n = 33) and a private academic center (n = 62) staffed by the same university. Demographics, treatment patterns, and outcomes were analyzed.Results:Compared to the tertiary academic center, patients at the safety-net hospital were significantly younger, more commonly Black or Hispanic, and had a higher proportion of presenting patients with HIV. The safety-net hospital cohort was significantly less likely to receive induction chemotherapy (67% vs 86%, p = 0.003) than those at the academic center. Safety-net hospital patients were significantly less likely to receive autologous stem cell transplant (ASCT) consolidation (0% vs. 44%, p = 0.001) and had higher rates of consolidative WBRT (35% vs 15%, p = 0.001). Younger age and receiving consolidation were associated with improved progression-free survival (PFS, p = 0.001) and overall survival (OS, p = 0.001). Hospital location had no statistical effect on PFS (p = 0.725) or OS (p = 0.226) on age-adjusted analysis. Conclusions:Our study showed significant treatment differences between a public safety-net hospital and an academic cancer center reflecting access disparities. Despite variable treatment patterns, survival outcomes were not different. Further research is needed to determine optimal treatments for an orphan disease like PCNSL and it will be essential to advocate for equitable access in resource-limited settings.

Download Full-text

Comprehensive Analysis of Breast Cancer Survival Outcomes in a Public Safety-Net Hospital Compared with an Adjacent Academic Cancer Center

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2019.08.324 ◽

2019 ◽

Vol 229 (4) ◽

pp. S146-S147

Author(s):

Kristin N. Kelly ◽

Emily Ryon ◽

Francis Igor B. Macedo ◽

Dido Franceschi ◽

Mecker Moller ◽

...

Keyword(s):

Breast Cancer ◽

Public Safety ◽

Cancer Survival ◽

Safety Net ◽

Comprehensive Analysis ◽

Breast Cancer Survival ◽

Cancer Center ◽

Survival Outcomes ◽

Safety Net Hospital

Download Full-text

Comparison of Cancer Care and Outcomes between a Public Safety-Net Hospital and a Private Cancer Center

Journal of Health Care for the Poor and Underserved ◽

10.1353/hpu.2013.0145 ◽

2013 ◽

Vol 24 (3) ◽

pp. 1136-1149 ◽

Cited By ~ 4

Author(s):

Ulas Darda Bayraktar ◽

Sean Warsch ◽

Emerson Chen ◽

Caio Max Rocha Lima ◽

Denise Pereira

Keyword(s):

Cancer Care ◽

Public Safety ◽

Safety Net ◽

Cancer Center ◽

Safety Net Hospital

Download Full-text

Impact of HIV Status on Treatment Choice and Outcomes of Primary Central Nervous System Lymphoma in a Minority Enriched Population: Experience from a Safety Net Hospital

Blood ◽

10.1182/blood-2020-140908 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 14-15

Author(s):

Jude Khatib ◽

Hsiao Ching Li ◽

Radhika Kainthla ◽

Chul Ahn ◽

Navid Sadeghi

Keyword(s):

Overall Survival ◽

Clinical Characteristics ◽

Central Nervous System Lymphoma ◽

Safety Net ◽

Treatment Patterns ◽

Line Treatment ◽

First Line ◽

Hiv Patients ◽

Safety Net Hospital ◽

Progression Of Disease

Background Primary central nervous system lymphoma (PCNSL) is a rare and aggressive form of non-Hodgkin lymphoma. High-dose methotrexate is the cornerstone of treatment for PCNSL, often in combination with other agents. Outcomes are poor with an estimated 5-year overall survival (OS) of 30-40%. Outcomes in AIDS-related PCNSL have been historically inferior to immunocompetent individuals, although recent data suggests some improvement with anti-retroviral therapy. We sought to evaluate clinical characteristics, treatment patterns, and outcomes of patients with PCNSL at our institution. Methods A total of 30 patients were diagnosed and treated for PCNSL at Parkland Health and Hospital System (Dallas, TX) between 2010 and 2019. Parkland is a safety net hospital for Dallas County and is affiliated with the University of Texas Southwestern Medical Center. Electronic records were reviewed and data on demographics, clinical characteristics, treatment patterns, and outcomes were extracted. Descriptive statistics and survival data, comparing HIV(-) and HIV(+) patients, are presented. Results Median age at diagnosis was 51 years (range 24-78). Two thirds of patients were male and 40% (12 patients) were HIV(+). HIV(+) patients were younger compared to HIV(-) with a median age of 40 vs 57 years. Seventy three percent of patients belonged to minority groups (40% Hispanic; 33% Black). First line treatment consisted of chemotherapy in 18 (60%), chemotherapy and radiation in 4 (13%), and radiation alone in 8 (27%) patients; the latter was primarily used in HIV(+) patients (58%; 7/12). The most common chemotherapy regimen was CALGB 50202.HIV(+) patients were also started on anti-retroviral therapy. Fifty percent of the patients had a complete response (CR) to first line therapy. Five patients with a partial response converted to a CR with additional treatment for a final CR rate of 67%. CR rate was higher in HIV(+) patients. Five patients (17%), all HIV(-), experienced progression of disease while on 1st line treatment. Patients with progression of disease on treatment had poor response to salvage therapy and short survival (median OS 49 days). The majority of the patients were not eligible for autologous stem cell transplant (A-SCT) due to financial constraints or comorbid conditions. Only one patient underwent consolidation A-SCT, after achieving a second CR. After a median follow up of 51 months, median OS was not reached. Three-year OS was 74% for the entire cohort. HIV(+) patients had a longer 3-yr OS compared to HIV(-) patients (91% vs 61%), this difference was statistically significant (p=0.034). Conclusion We report the outcome of PCNSL in a minority enriched population treated at a safety net hospital. Compared to prospective clinical trials, HIV(-) patients in our cohort had a lower than expected CR rate, although survival rates were comparable. In addition, we observed higher response rates and better overall survival in HIV(+) patients, including in those who were treated with combination of antiretroviral agents and radiation. Disclosures No relevant conflicts of interest to declare.

Download Full-text

Models of Outpatient Palliative Care Clinics for Patients With Cancer

Journal of Oncology Practice ◽

10.1200/jop.18.00634 ◽

2019 ◽

Vol 15 (4) ◽

pp. 187-193 ◽

Cited By ~ 4

Author(s):

Esme Finlay ◽

Kristina Newport ◽

Shanthi Sivendran ◽

Laurel Kilpatrick ◽

Michelle Owens ◽

...

Keyword(s):

Health Care ◽

Palliative Care ◽

Advanced Cancer ◽

Care Delivery ◽

Medical Center ◽

Academic Medical Center ◽

Safety Net ◽

Cancer Center ◽

Patients With Cancer ◽

Safety Net Hospital

PURPOSE: Early integration of outpatient palliative care (OPC) benefits patients with advanced cancer and also the health care systems in which these patients are seen. Successful development and implementation of models of OPC require attention to the needs and values of both the patients being served and the institution providing service. SUMMARY: In the 2016 clinical guideline, ASCO recommended integrating palliative care early in the disease trajectory alongside cancer-directed treatment. Despite strong endorsement and robust evidence of benefit, many patients with cancer lack access to OPC. Here we define different models of care delivery in four successful palliative care clinics in four distinct health care settings: an academic medical center, a safety net hospital, a community health system, and a hospice-staffed clinic embedded in a community cancer center. The description of each clinic includes details on setting, staffing, volume, policies, and processes. CONCLUSION: The development of robust and capable OPC clinics is necessary to meet the growing demand for these services among patients with advanced cancer. This summary of key aspects of functional OPC clinics will enable health care institutions to evaluate their specific needs and develop programs that will be successful within the environment of an individual institution.

Download Full-text

ANALYSIS OF AN OVARIAN CANCER COHORT IN A HEALTH SYSTEM WITH A SAFETY-NET HOSPITAL AND A COMPREHENSIVE CANCER CENTER

10.26226/morressier.5770e29dd462b80290b4bfe0 ◽

2016 ◽

Author(s):

Sophia George

Keyword(s):

Ovarian Cancer ◽

Health System ◽

Safety Net ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Safety Net Hospital

Download Full-text

Patient Capability, Confidence, and Interest in Telemedicine at a Public Safety Net Hospital Urology Clinic

Journal of Health Care for the Poor and Underserved ◽

10.1353/hpu.2021.0079 ◽

2021 ◽

Vol 32 (2) ◽

pp. 1047-1058

Author(s):

Andin Josipovic ◽

Jeffrey Reese ◽

Erin C. Cantarero ◽

Christopher S. Elliott

Keyword(s):

Public Safety ◽

Safety Net ◽

Safety Net Hospital ◽

Urology Clinic

Download Full-text

Receptiveness and barriers to clinical trial participation for oncology patients from a public safety-net hospital.

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.83 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 83-83

Author(s):

Victor Yundeh Chiu ◽

Jacob S. Berkowitz ◽

Joshua Rodriguez ◽

Jade Law ◽

Kristina Lee ◽

...

Keyword(s):

Clinical Trial ◽

Side Effects ◽

Public Safety ◽

Safety Net ◽

Trial Participation ◽

Religious Leader ◽

Annual Income ◽

Oncology Patients ◽

Wage Loss ◽

Safety Net Hospital

83 Background: Oncologic clinical trial enrollment is low, particularly in underserved populations. Increasing enrollment of public safety-net hospital patients is important to ensure representation of the general population and reduces cancer outcome disparities. To tailor clinical trial outreach, we sought to characterize attitudes towards trial participation of oncology patients at Olive View—UCLA Medical Center (OVMC), a public safety-net hospital in Los Angeles County. Methods: We developed a 39-question survey (Qualtrics, Provo, UT). It was administered via tablets to a convenience sample of patients in OVMC’s medical oncology clinic and infusion center during 2020—2021. The survey was offered to patients fluent in English or Spanish. Results: Of 165 patients who were offered the survey, 11 declined due to illiteracy in any language, 4 did not finish the survey. Median age was 54 (range: 20-81); 63% were female. The majority (76%) reported an annual income below $25,000; 39% did not complete high school. Self-identified ethnicity was Hispanic/Latino (73%), non-Hispanic White (12%), Asian-Pacific Islander (9%), and Black (4%). Based on a 5-point Likert scale of comfort speaking English, 48% had English proficiency (EP). Overall, 69% of patients expressed interest in trials. When considering participation, patients would seek advice from their physician (86%), family (32%), other medical staff (14%), alternative medicine practitioner (7%), friend (6%), or religious leader (4%). Concerns regarding trial participation were lack of knowledge regarding trials (47%), fear of side effects (43%), frequent visits (25%), cost (20%), transportation (14%), wage loss (9%), and inability to determine own treatment (4%). Patients found the following modalities useful for learning about trials: website (43%), paper handout (39%), video (37%), discussion with prior participants (34%). Patients with annual income > $25,000 were significantly more concerned about cost (33.3% v. 15.8%, p = 0.04) and treatment side effects (61.1% v. 36.8%, p = 0.02). EP patients were more likely to find a website (54.2% vs. 32.1%, p = 0.01) or discussion with prior participants (45.8% v. 23.1%, p < 0.01) helpful compared to low EP patients. Conclusions: There is considerable interest in oncologic clinical trials in this predominantly Hispanic/Latino population. This population had significant trust in physicians for guidance on trial enrollment, and had minimal concern for out-of-pocket cost, wage loss, or transportation issues. The majority of patients did not find additional informational resources helpful. Structural barriers rather than patient-level variables are likely the primary drivers of low oncologic trial enrollment. Future efforts should focus on improving access to appropriate trials and leveraging the physician-patient relationship for increasing trial participation.

Download Full-text