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The use of optimal treatment for DLBCL is improving in all age groups and is a key factor in overall survival, but non-clinical factors influence treatment

Doo, Nicole Wong, White, Victoria M., Martin, Kara, Bassett, Julie K., Prince, H. Miles, Harrison, Simon J., Jefford, Michael, Winship, Ingrid, Millar, Jeremy L., Milne, Roger L., Seymour, John F. and Giles, Graham G. 2019, The use of optimal treatment for DLBCL is improving in all age groups and is a key factor in overall survival, but non-clinical factors influence treatment, Cancers, vol. 11, no. 7, doi: 10.3390/cancers11070928.

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Title The use of optimal treatment for DLBCL is improving in all age groups and is a key factor in overall survival, but non-clinical factors influence treatment
Author(s) Doo, Nicole Wong
White, Victoria M.ORCID iD for White, Victoria M. orcid.org/0000-0001-6619-8484
Martin, Kara
Bassett, Julie K.
Prince, H. Miles
Harrison, Simon J.
Jefford, Michael
Winship, Ingrid
Millar, Jeremy L.
Milne, Roger L.
Seymour, John F.
Giles, Graham G.
Journal name Cancers
Volume number 11
Issue number 7
Article ID 928
Total pages 12
Publisher MDPI
Place of publication Basel, Switzerland
Publication date 2019-07
ISSN 2072-6694
Keyword(s) cancer survival
chemotherapy
diffuse large B cell lymphoma
epidemiologic studies
patterns of care
Summary © 2019 by the authors. Introduction: Diffuse large B cell lymphoma (DLBCL) is an aggressive form of non-Hodgkin lymphoma for which a cure is usually the therapeutic goal of optimal treatment. Using a large population-based cohort we sought to examine the factors associated with optimal DLBCL treatment and survival. Methods: DLBCL cases were identified through the population-based Victorian Cancer Registry, capturing new diagnoses for two time periods: 2008–2009 and 2012–2013. Treatment was pre-emptively classified as ‘optimal’ or ‘suboptimal’, according to compliance with current treatment guidelines. Univariable and multivariable logistic regression models were fitted to determine factors associated with treatment and survival. Results: Altogether, 1442 DLBCL cases were included. Based on multivariable analysis, delivery of optimal treatment was less likely for those aged ≥80 years (p < 0.001), women (p = 0.012), those with medical comorbidity (p < 0.001), those treated in a non-metropolitan hospital (p = 0.02) and those who were ex-smokers (p = 0.02). Delivery of optimal treatment increased between 2008–2009 and the 2012–2013 (from 60% to 79%, p < 0.001). Delivery of optimal treatment was independently associated with a lower risk of death (hazard ratio (HR) = 0.60 (95% confidence interval (CI) 0.45–0.81), p = 0.001). Conclusion: Delivery of optimal treatment for DLBCL is associated with hospital location and category, highlighting possible demographic variation in treatment patterns. Together with an increase in the proportion of patients receiving optimal treatment in the more recent time period, this suggests that treatment decisions in DLBCL may be subject to non-clinical influences, which may have implications when evaluating equity of treatment access. The positive association with survival emphasizes the importance of delivering optimal treatment in DLBCL.
Language eng
DOI 10.3390/cancers11070928
Indigenous content off
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2019, The Authors
Free to Read? Yes
Persistent URL http://hdl.handle.net/10536/DRO/DU:30125854

Document type: Journal Article
Collections: Faculty of Health
School of Psychology
Open Access Collection
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.