JCO Early Release, published online ahead of print Sep 14 2009
Journal of Clinical Oncology, 10.1200/JCO.2009.22.0038
Received January 14, 2009
Accepted May 21, 2009
Survival Disparities in Patients With Lymphoma According to Place of Residence and Treatment Provider: A Population-Based Study
Fausto R. Loberiza Jr,* Anthony J. Cannon, Dennis D. Weisenburger, Julie M. Vose, Matt J. Moehr, Martin A. Bast, Philip J. Bierman, R. Gregory Bociek, and James O. Armitage
From the Section of Oncology-Hematology; Summer Undergraduate Research Program, Department of Internal Medicine; Department of Pathology, University of Nebraska Medical Center, Omaha, NE.
Purpose: Health disparities exist according to an individual'splace of residence. We evaluated the association between primaryarea of residence (urban v rural) according to treatment provider(university based v community based) and overall survival inpatients with lymphoma and determined whether there are patientgroups that could benefit from better coordination of care.
Patientsand Methods: Population-based, retrospective cohort study of2,330 patients with centrally confirmed lymphoma from Nebraskaand surrounding states and treated by university-based or community-basedoncologists from 1982 to 2006.
Results: Among urban residents,321 (14%) were treated by university-based providers (UUB) and816 (35%) were treated by community-based providers (UCB). Amongrural residents, 332 (14%) were treated by university-basedproviders (RUB), and 861 (37%) were treated by community-basedproviders (RCB). The relative risk (RR) of death among UUB,UCB, and RUB were not statistically different. However, RCBhad a higher risk of death (RR, 1.37; 95% CI, 1.14 to 1.65;P = .01; and RR, 1.26; 95% CI, 1.06 to 1.49; P = .01) when comparedwith UUB and RUB, respectively. This association was true inboth low- and intermediate-risk patients. Among high-risk patients,UCB, RUB, and RCB were all at higher risk of death when comparedwith UUB.
Conclusion: Survival outcomes of patients with lymphomamay be associated with place of residence and treatment provider.High-risk patients from rural areas may benefit from bettercoordination of care.