Functional Status Impacts Receipt of Treatment and Outcomes in Older Patients with DLBCL

Up to one-quarter of older Medicare beneficiaries with diffuse large B-cell lymphoma (DLBCL) do not receive any therapy. Functional impairment may compromise DLBCL therapy, but data are lacking about treatment and outcomes of home health services (HHS) recipients. In a novel population-based study, researchers found that functional impairment was an independent predictor of treatment and outcomes in older patients with DLBCL. The results of the study were presented at the 2020 ASH Annual Meeting.

Researchers used the Surveillance, Epidemiology, and End Results-Medicare database to select beneficiaries diagnosed with DLBCL between 2011 and 2015. HHS recipients who had Outcome and Assessment Information Set (OASIS) assessments within three months before diagnosis or treatment were identified. Scores were categorized as mild (OASIS 0-9), moderate (10-16), and severe (17-40).

Among 8,914 beneficiaries with DLBCL, 1,317 (median age, 80 years; 46% were male; 83% were white) had OASIS assessments. Median OASIS score was 13 (range, 7-18). Chemotherapy was administered to 63% of HHS recipients compared with 75% of other beneficiaries (odds ratio [OR], 0.66; 95% confidence interval [CI], 0.57-0.76). HHS recipients were significantly more likely to experience 30-day emergency department (ED) visit, hospitalization, intensive care unit (ICU) admission, and mortality after chemotherapy (OR, 1.24-1.52) and have shorter overall survival (OS; 7 vs. 40 months) compared with other beneficiaries with DLBCL (adjusted hazard ratio [aHR], 1.55; 95% CI, 1.44-1.67).

Severe functional impairment was associated with lower odds of receiving any therapy, as well as higher rates of acute mortality, hospitalization, and ICU admission. Patients with moderate impairment had an increased risk of 30-day ED visit and ICU admission after chemotherapy. OS was worse with severe functional impairment, even after adjusting for other clinical factors (aHR, 1.64; 95% CI, 1.24-2.17).

Functional status was not significantly associated with the use of standard or non-standard regimen, and OS was better with R-CHOP-like therapy in all functional groups (aHR, 0.50-0.56; P=0.85).

“Our results highlight the need for novel, less toxic strategies in this population, supporting research on emerging chemotherapy-free approaches,” the researchers concluded. “Clinicians should consider a dedicated functional assessment (such as a comprehensive geriatric assessment) to optimize treatment selection in DLBCL. OASIS assessments for HHS recipients are easily available to clinicians and could be incorporated into pre-chemotherapy evaluation to improve patient selection for intensive therapies, potentially avoiding under-treatment with attenuated regimens.”

Reference

Di M, Keeney T, Belanger E, et al. Functional Status and Therapy for Older Patients with Diffuse Large B-Cell Lymphoma (DLBCL): A Population-Based Study. Abstract 743. Presented at the 62nd American Society of Hematology Annual Meeting & Exposition, December 2-11, 2020.