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

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Title: Patterns and predictors of referral to the specialized chronic lymphocytic leukemia clinic in Manitoba, Canada
Author: Christiaan H. Righolt a, Geng Zhang a, Spencer B. Gibson b,c, James B. Johnston b,c,d,Versha Banerji b,c,d,e, Salaheddin M. Mahmud a,
Publication: Cancer Epidemiology
Publisher: Elsevier Inc
Date: 2022
Language: English
Pages: 4
Format: PDF
File size: 364
DOI: 10.1016/j.canep.2022.102279
ID: CBR124

Categories: Researches, Medical Researches Tags: Canada, Medical Researches, Patterns and predictors of referral to the specialized chronic lymphocytic leukemia clinic in Manitoba

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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.

1Introduction

Chronic lymphocytic leukemia (CLL) is the most common adult leukemia in the western world. CLL is only distinguishable from small lymphocytic lymphoma (SLL) by its leukemic manifestation and it has a higher concentration of B lymphocytes in peripheral blood than monoclonal B lymphocytosis (MBL) . The etiology of CLL remains poorly understood, although certain chemicals, infections, blood transfusions, organ transplantation, and variations in certain loci have been associated with increased CLL risk . Race and family history, and, because of this, region of residence, affect CLL risk as well .

Manitoba CLL patients can be referred to a specialized central CLL clinic for their CLL care. We previously reported better CLL patient survival after referral in Manitoba . A study for patients of the Mayo Clinic reported better outcomes for patients of CLL hematologists compared to non-CLL hematologists . It is possible that improved survival is driven by a better prognosis of referred patients, especially with recent advances in CLL treatment. We aimed to examine differences between referred (to Manitoba’s CLL clinic) and non-referred patients.