Patterns and predictors of referral to the specialized chronic lymphocytic leukemia clinic in Manitoba, Canada

Abstract

Background

Better CLL patient survival has been reported for specialized CLL clinics/hematologists (compared to other CLL patients). It is possible that improved survival is driven by a better prognosis of referred patients.

Methods

We used logistic regression to calculate the odds ratios (ORs) and 95 % confidence intervals 95 %CIs) of the association between patient characteristics and CLL referral of all persons diagnosed in 2005–2016 with a pathologically-confirmed CLL or SLL.

Results

Two-thirds of 1293 patients were referred to the CLL clinic. Referred patients were younger (16 % vs 44 % were 80 +) and in better health (47 % vs 56 % with a chronic diseases) than non-referred patients. Referral increased over time: in 2005–2010, about 60 % of patients were referred; in 2011–2016, this increased to 76 %. Gender did not affect referral (the OR for females is 1.0, 95 %CI 0.8–1.2), but age played a major role; CLL patients diagnosed at age 80 + were less likely to be referred than patients diagnosed < 60, 0.2 (0.1–0.3).

Conclusion

Because referral to Manitoba’s specialized CLL clinic is associated with age and the patient’s overall health before referral, one should be careful in interpreting differences in outcomes between CLL patients based on referral status alone.

Highlights

• • It is possible that improved survival for specialized hematologic care is driven by a better prognosis of referred patients.
• • We found that age is the major predictor of referral to Manitoba’s CLL clinic.
• • Differences in outcomes for CLL patients receiving specialized care require a careful interpretation.