Is There a Difference in Treatment Patterns Among Follicular Lymphoma Patients Receiving Care in the Outpatient Hospital Versus the Community Clinic Setting?

No studies have addressed whether the site of care involved in the treatment of patients with follicular lymphoma (FL) affects the delivery of appropriate treatment for this condition. We investigated the differences in treatment patterns between two sites of care: the outpatient hospital (OH) and the community clinic (CC) setting.

Using the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we conducted a retrospective cohort analysis of 4225 FL patients diagnosed between January 1, 1998 to December 31, 2007, >66 years, enrolled in Medicare Part A and B, and received initial treatment with rituximab (R), chemotherapy (CT), or R+CT. Chi-square test for categorical variables and ANOVA or t-test for continuous variables were used to assess differences in patient and disease related characteristics by site of care. Kaplan-Meier curves and corresponding log-rank test were used to compare time to initial treatment by site of care.

There were 3149 CC patients and 541 OH patients. The mean age was 75 years, 55% were female, and 92% were white. In general, the demographic and clinical characteristics were balanced between both sites of care, with the exception of disease stage at diagnosis where patients treated in the OH setting were more likely to be diagnosed with stage IV disease (39% vs. 34%; p<.05). Overall, 29% of patients received CT, 25% received R and 45% received R+CT. The mean time to treatment initiation was generally shorter in the CC (10 months versus 11 months) across all treatment categories (log rank p=0.1961). In the CC, the mean time to treatment initiation was 10 months for CT, 14 months for R, and 8 months for R+CT. In the OH, the mean time to treatment initiation was 12 months for CT, 16 months for R and 9 months for R+CT. Duration of treatment was similar in the CC and OH for CT and R+CT, but R had a slightly longer duration in the CC (median = 66 days) compared to the OH (median =59 days). There were more treatment cycles delivered in the CC compared to the OH. In the CC, 61% of patients received <6 cycles, 21% received 6–8 cycles and 18% received >8 cycles. In the OH, 77% received <6 cycles, 12% received 6–8 cycles and 11% received >8 cycles. Compliance with the R+CT dosing schedule (once every 3 weeks for up to 8 cycles) was higher in the CC (54%) compared to the OH (34%) cohorts (p<.0001).

This observational study showed that patients treated in the OH setting tend to have longer time to treatment initiation, less cycles across all regimens, and were less likely to receive a compliant R+CT dosing schedule for FL compared to patients in the CC. These results suggest an opportunity to improve delivery of treatment to optimize outcomes in different treatment settings.

Satram-Hoang:Genentech, Inc: Consultancy. Reyes:Genentech, Inc: Employment.