Insurance Status and Other Non-biological Factors Predict Outcomes in Acute Myelogenous Leukemia: Analysis of Data from the National Cancer Database

Master, Samip; Munker, Reinhold; Shi, Zhenzhen; Mills, Glenn; Shi, Runhua

doi:10.21873/anticanres.11057

Cited by 36 publications

(14 citation statements)

References 32 publications

(42 reference statements)

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“…We observed that even for the same leukemia subtype, the survival rate would gradually decrease with the increase in age of diagnosis, which is somewhat consistent with prior studies that demonstrated worsening survival among the older population, compared to the younger population [11,21,27,31]. In particular, among above-75 leukemia patients other than CLL the 5-year relative survival rate is almost below 45% in 2012, which partly may be explained as the patients with other comorbidities, prior organ dysfunction, and unbearable for intensive chemotherapy, lack of insurance [32][33][34][35]. As a result, new therapeutic strategies, such as monoclonal antibodies, CAR-T cells, better supportive care, more effective disease monitoring, and combinations with other investigational agents, need be developed and verified to improve the prognosis of all leukemia types, especially in the elder patients [7,20,32].…”

Section: Discussionsupporting

confidence: 86%

Secular trends in the incidence and survival of all leukemia types in the United States from 1975 to 2017

Yang¹,

Chen²,

Man³

et al. 2021

J. Cancer

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Background: Various studies have indicated that the prognosis of leukemia has been improved in recent years, but the secular trends of incidence and long-term survival of all leukemia have not been thoroughly examined. Methods: We estimated the leukemia incidence and 5-year survival rate along with the temporal trends by sex, race, age, and subtype in the United States over the past four decades using Surveillance, Epidemiology, and End Results (SEER) database. Results: The overall incidence of leukemia steadily increased from 12.39/100 000 in 1975 to 14.65/100 000 in 2011, and then began to decline in recent years (13.73/100 000 in 2017), with average annual percent changes (APC) of 0.350 (P<0.001). The 5-year relative survival rate of leukemia patients significantly improved from 33.2% in 1975 to 66.1% in 2012 (APC=1.980, P<0.001). The main subtypes of leukemia, including acute lymphoblastic leukemia, acute myeloid leukemia, chronic lymphocytic leukemia, and chronic myeloid leukemia, increased in most age groups; conversely, the incidences of all other subtypes were gradually declined during the monitoring period. The incremental advancement in leukemia prognosis had been achieved in almost all histological subtypes, especially among young patients. Conclusions: Based on SEER data, the leukemia incidence increased gradually over the past decades, and then began to decline in recent years in the United States. The 5-year relative survival rate increased incrementally over time, especially among young patients. However, the huge disparities among different sexes, races, histological subtypes, and age groups, emphasize that precise causes control and innovative treatments need to be developed to reduce the incidence and improve the prognosis, especially among specific populations.

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Section: Discussionsupporting

confidence: 86%

Secular trends in the incidence and survival of all leukemia types in the United States from 1975 to 2017

Yang¹,

Chen²,

Man³

et al. 2021

J. Cancer

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“…Interestingly, two US acute leukemia studies conducted in completely different settings have previously found comparable results. Master et al13 examined 67,443 AML patients and found no survival difference between patients living <30 vs >30 miles from the treatment center (HR for OS=0.99; 95% CI=0.99–1.02),whereas Rodriguez et al,12 in a single center study including only 281 intensive therapy AML patients, found no correlation of OS with an increase in distance to treatment center by 20 mile intervals (HR for OS=0.99; 95% CI=0.98–1.02). Though these studies imply that distance, also in large countries with insurance-based healthcare, does not affect treatment and outcomes in AML, bias and important methodological limitations might explain the results in selected cohorts of patients who are able to make it to these treatment centers.…”

Section: Discussionmentioning

confidence: 99%

“…As such, two previous studies investigated the impact of distance to treatment center in AML patients and found no effect on survival 12,13. Limitations included lack of individual-level socioeconomic-, cytogenetic-, and treatment information, as well as small and selected populations.…”

Section: Introductionmentioning

confidence: 98%

<p>Longer distance to specialized treatment centers does not adversely affect treatment intensity or outcomes in adult acute myeloid leukemia patients. A Danish national population-based cohort study</p>

Tøstesen¹,

Nørgaard²,

Nørgaard³

et al. 2019

CLEP

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BackgroundTreatment of acute myeloid leukemia (AML) is widely centralized. Longer distances to a specialized treatment center may affect patients’ access to curative-intended treatment. Especially during outpatient treatment, distance may also affect survival.Methods and patientsThe authors conducted a national population-based cohort study including all AML patients diagnosed in Denmark between 2000 and 2014. We investigated effects of distance (<10 kilometers [km; reference], 10–25, 25–50, 50–100, >100) to the nearest specialized treatment facility on the probability of receiving intensive chemotherapy, HSCT, and achieving a complete remission (CR) using logistic regression analysis (odds ratios; ORs). For overall survival, we used Cox proportional hazards regression (hazard ratios [HRs]) and adjusted (a) for relevant baseline characteristics.ResultsOf 2,992 patients (median age=68.5 years), 53% received intensive chemotherapy and 12% received low-dose chemotherapy outpatient regimens. The median distance to a specialized treatment center was 40 km (interquartile range=10–77 km). No impact of distance to specialized treatment centers was seen on the probability of receiving intensive chemotherapy (10–25 km, aOR=1.1 (CI=0.7–1.7), 25–50 km, aOR=1.1 (CI=0.7–1.7), 50–100 km, aOR=1.3 (CI=0.9–1.9), and >100 km, aOR=1.4 [CI=0.9–2.2]). Overall survival in patients regardless of therapy (<10 km, aOR=1.0 vs >100 km, aOR=1.0 [CI=0.9–1.2]), in intensive therapy patients, or in patients’ choice of post-remission was not affected by distance to specialized treatment center. Distance to a transplant center also did not affect the probability of HSCT or survival post-HSCT.ConclusionIn Denmark, distance to a specialized treatment facility offering remission-induction chemotherapy and HSCT does not negatively affect access to curative-indented therapy, treatment-response, or survival in AML patients.

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“…For example, a historical cohort study conducted on patient records included in the US National Trauma Data Bank shows that the health insurance type independently affects the outcome and mortality rate of patients, with uninsured and publicly insured patients at a significantly higher risk of in‐hospital mortality compared with privately insured patients . In another study on more than 65 000 patients registered in the US National Cancer Database with the diagnosis of acute myeloid leukemia, after adjusting for confounding variables, insurance type was found to be an independent predictor of mortality in patients; those privately insured had the lowest mortality compared with patients with Medicaid and those without insurance …”

Section: Discussionmentioning

confidence: 99%

“…12 In another study on more than 65 000 patients registered in the US National Cancer Database with the diagnosis of acute myeloid leukemia, after adjusting for confounding variables, insurance type was found to be an independent predictor of mortality in patients; those privately insured had the lowest mortality compared with patients with Medicaid and those without insurance. 13 For the calculation of YLL, we used the life expectancy table of Japanese people. 6,7 If we would have calculated the YLL based on the life expectancy table of Iranian people, which has a lower life expectancy than the Japanese, we came to even a lower YLL value.…”

Section: Discussionmentioning

confidence: 99%

Accessing free quality health care services and premature death

Habibzadeh

Yadollahie

Simi

et al. 2018

Health Planning & Management

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Summary Background The type of health insurance may affect the likelihood of mortality of insured people. We conducted this study to determine if accessing free quality health care services could decrease the premature mortality of people in a developing country. Methods In a multicenter cross sectional study, “years‐life‐lost” (YLL) due to premature death was evaluated in 202 671 insured people residing in six large regions in Iran. The participants had access to free quality health care services. The number of insured people that died in the six regions during March 20, 2014, to March 20, 2015, as well as their sex, age, and cause of the death, were collected, and the YLL was calculated based on assumptions made in Global Burden of Disease Study 2010 (GBD2010). Results The crude mortality rate was 2.3 per 1000, significantly lower than the overall rate of 4.6 per 1000 people in general population of Iran. The average YLL was 47 years per 1000 persons, significantly lower than that in general population of Iran and many industrialized countries. The most common causes of death (and YLL) were cardiovascular diseases and malignancies. Conclusion Having access to free quality health care services is associated with a significant decrease in premature death.

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Insurance Status and Other Non-biological Factors Predict Outcomes in Acute Myelogenous Leukemia: Analysis of Data from the National Cancer Database

Abstract: We observed that payer status has a statistically significant relationship with overall survival from AML.

Cited by 36 publications

References 32 publications

Secular trends in the incidence and survival of all leukemia types in the United States from 1975 to 2017

Secular trends in the incidence and survival of all leukemia types in the United States from 1975 to 2017

<p>Longer distance to specialized treatment centers does not adversely affect treatment intensity or outcomes in adult acute myeloid leukemia patients. A Danish national population-based cohort study</p>

Accessing free quality health care services and premature death

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