In a presentation at the recent American Society of Hematology Annual Meeting and Exposition, researchers examined real-world data collected in an extensive community oncology setting in the United States.
The study’s objectives were to define the characteristics and clinical outcomes of patients with CLL and to evaluate whether there is an equitable advantage from contemporary CLL therapies across various racial and socioeconomic groups.
From January 2015 through June 2023, patients with CLL treated in the US Oncology Network (The Network) were included. Data were obtained from structured data fields in iKnowMed (iKM), an oncology-specific electronic health record (EHR) system that captures outpatient practice encounters, including data on demographic and relevant clinical information for nearly 40% of U.S. community oncology practices.
The authors wrote, “Considering that estimating the OS [overall survival] from the initial diagnosis date is subject to immortal time bias, we performed the following two analyses: 1) time from the first visit date at a Network practice on or after the diagnosis date to OS, and (2) time from the initial diagnosis date among those newly diagnosed patients. In the primary analysis of OS, patients without a death date were censored at their last visit at The Network.”
Across all four census regions in the U.S., the study included 12,253 patients who were diagnosed with CLL, 60% of whom were male. Of the 10,521 (86%) patients who reported race, the patient population comprised 91.0% white, 5.1% black, and 3.9% other races. The average (Q1, Q3) age was 69 years (61, 76), with black patients 1.2 years younger than white patients (average: 69.0 vs. 67.8 years, P = .004).
The initial CLL diagnosis was available for 11,576 (94%) patients, and the majority (6,874; 59%) either had their initial diagnosis in The Network or had their first visit in The Network within 30 days after their initial diagnosis elsewhere. The median time from initial diagnosis to the first visit in The Network was marginally smaller for black patients (2.4 weeks) compared with white patients (3.9 weeks, P = .001).
The results also revealed that at the initial diagnosis, more black patients had Rai Stage III or IV than white patients (54% vs. 46%, P = .002). Mortality dates were available for 2,231 (18%) patients. The investigation of time from first visit to mortality showed that the 8-year mortality rate was meaningfully higher for black patients (61%) than for white patients (43%, P = .002) with statistically significant hazard ratio (HR; 95% CI) of 1.34 (1.11, 1.61), P = .002, in the univariate analysis. The median (95% CI) OS was 7.5 (6.4, not estimable) years for black patients.
The authors wrote, “The median OS was not estimable for white patients for this study because the study was designed to use data in the last 8 years, and the median survival for white patients was longer than 8 years. After adjusting for education level and income, the race effect was no longer significant 1.25 (0.76, 2.05), P = 0.37. The wider CI was due to social determinants of health [SDoH] data being only available for 2,928 (24%) of patients. Even with reduced statistical power, income of <$30k was significantly associated with a higher risk of a shorter time to death with HR (95% CI) of 1.78 (1.32, 2.41), P <.001 as compared to >$75k in the adjusted model.”
The results also revealed that the analysis of time from the initial diagnosis date to OS among those newly diagnosed patients and the sensitivity analyses demonstrated comparable trends.
Based on their findings, the authors concluded, “This study identifies racial disparities in this modern era of CLL therapy using real-world data from a large community setting in the US. Black race and low income are prognostic of less favorable OS in CLL.”
Lastly, the researchers noted that additional research is warranted to ascertain whether racial and income disparities in CLL are the results of differences in access to therapy, quality of care, disease biology, comorbidities, or other factors, and this additional research may contribute to emergent interventions to guarantee that progress in CLL therapy aids all patients.
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