Socioeconomic Status Influences Survival Rates in DLBCL

What are your odds of surviving a diagnosis of diffuse large B-cell lymphoma (DLBCL)? That depends on lots of factors … including your socioeconomic status.

According to a new study led by Li Tao of the Cancer Prevention Institute of California and colleagues at both the Mayo Clinic Florida and Stanford University, patients diagnosed with DLBCL who live in low socioeconomic status (SES) neighborhoods experience significantly worse survival from the disease than those living in 'better' neighborhoods, and the disparity was most striking in younger (non-Medicare) patients and after the introduction of rituximab.

Rituximab has been an absolutely game-changing cancer drug. The median overall survival after DLBCL went up from about 20 months before rituximab to 47 months after rituximab. Put another way, therapies such as R-CHOP boosted the overall 5-year survival rate from around 45 percent to as high as 70 percent (some factors notwithstanding).

But it doesn't work if you don't have access to it.

This study looked at about 33,000 patients in California diagnosed between 1988-2000 (the first group) and 2001-2009 (the second group), including their SES and their treatments for DLBCL.

The mean age at diagnosis was 63.3 in the first group and 63.6 in the second. Mean follow-up was 4.5 years. Median overall survival was 7.1 years for patients with localized disease and 1.48 years for those with advanced disease.

The introduction of rituximab made a big difference. Patients diagnosed after 2001 had 29 to 32 percent lower mortality versus patients diagnosed in the earlier group. Significantly increased mortality risk was found in patients with the following factors:

- Advanced stage disease
- B symptoms
- Unmarried
- Living in low SES neighborhoods

To the point, compared with people living in the top 20 percent of neighborhoods ranked by SES, patients in the lowest 20 percent experienced 34 percent increased risk of death from any cause, and a 24 percent increased risk of death from DLBCL.

Researchers concluded,

Prospective studies are needed to evaluate SES in association with existing prognostic factors in individual DLBCL patients so that those with lower SES can be identified prospectively in practice. This is critical to translating our observations into better outcomes, and would allow both an understanding of the true nature of the disparity in individual patients and the development of innovative strategies to extend the improvements in DLBCL survival with available therapies to all.

Their findings have been reported in the journal Blood.