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Predictors of delay in diagnosis and treatment in diffuse large B‐cell lymphoma and impact on survival
Author(s) -
Nikonova Anna,
Guirguis Hany R.,
Buckstein Rena,
Cheung Matthew C.
Publication year - 2015
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.13150
Subject(s) - medicine , hematology , diffuse large b cell lymphoma , logistic regression , multivariate analysis , univariate analysis , lymphoma , proportional hazards model , comorbidity , chemotherapy , disease , large cell lymphoma , odds ratio , oncology
Summary There is a paucity of data on the impact of diagnostic and treatment delays on outcomes in haematological malignancies, particularly in patients with diffuse large B‐cell lymphoma ( DLBCL ). Our database of patients treated for DLBCL between 2002 and 2010 was interrogated. Univariate and multivariate analyses were performed to determine the relationship between sociodemographic or disease‐specific variables and delays. Cox Regression analysis was used to discern the impact of delays on survival. Patients ( n = 278) waited a median of 4 weeks before seeking medical attention. It took a median of 8 weeks for a non‐haematology physician to diagnose DLBCL and refer to a haematologist. A median of 3 weeks elapsed between specialist consultation and chemotherapy initiation. In multivariate logistic regression analysis, bone marrow involvement [odds ratio ( OR ) = 0·41, P = 0·018], Charlson comorbidity index ( OR = 1·42, P = 0·017) and urgent inpatient chemotherapy ( OR = 0·40, P = 0·012) were associated with diagnostic delays >6 weeks. Lack of pathological diagnosis at the time of haematology referral was the only factor that independently predicted for treatment delays >4 weeks ( OR = 8·25, P < 0·01). Diagnostic or treatment delays did not impact survival or progression‐free survival. In conclusion, selected disease and patient‐related factors are associated with delays in management of DLBCL , but do not impact outcomes.