SEER reports date of diagnosis as month and year only. with survival. Outcomes variables in the survival analysis were all-cause mortality, non-Hodgkin’s lymphoma (NHL) mortality, and other/unknown cause mortality. == Results == Overall, 84% (n = 5,887) received C-I therapy or radiation treatment during the observation period: both, 26%; C-I therapy alone, 53%; and radiation alone, 5%. Median age at diagnosis was 77 years, 54% were female, 88% were white, and 43% had Stage III or IV disease at diagnosis. The median time to first treatment was 42 days, and 92% of these patients had received their first treatment by day 180 following diagnosis. In multivariate analysis, the treatment rate was significantly lower among patients 80 years old, blacks versus whites, those living in a census tract with 12% poverty, and extra-nodal disease. Blacks had a lower treatment rate overall (Hazard Ratio [HR] 0.77; P < 0.001), and were less likely to receive treatment within 180 days of diagnosis (Odds Ratio [OR] 0.63; P = 0.002) than whites. In multivariate survival analysis, black race was associated with higher all-cause mortality (HR 1.24; P = 0.01) and other/unknown cause mortality (HR 1.35; P = 0.01), but not mortality due to NHL (HR 1.16; P = 0.19). == Conclusions == In elderly patients diagnosed with DLBCL, there are PNU-176798 large differences in treatment access and survival between blacks and whites. == Background == DLBCL is the most common type of NHL, with an estimated 20,300 new cases in the United States in 2010 2010 [1-3]. It is classified as an aggressive form of NHL [3] because survival is limited in the absence of effective treatment [4]. There have been substantial changes in the treatment of DLBCL in the past two decades. For instance, prior to the introduction of the monoclonal antibody rituximab (Genentech, South San Francisco, CA), the mainstay of treatment for DLBCL was CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone), with a three year overall survival of approximately 54% [5]. In 2002, a landmark study by Coiffier et al. exhibited that rituximab plus CHOP (R-CHOP) significantly improved overall survival compared to CHOP alone in elderly patients with DLBCL [6]. Based on this study, PNU-176798 and later studies that confirmed the findings [7-10], R-CHOP is now recommended as frontline therapy for most patients with advanced (Ann Arbor Stage III-IV) disease and many with localized (Ann Arbor stage I-II) disease [3]. The presence of racial and ethnic disparities in health care access and outcomes is usually well-documented. An Institute of Medicine report [11] found that even when access-related factors such as insurance status and the ability to pay for care are the same, African Americans and Hispanics tend to receive a lower quality of health care across a range of PNU-176798 disease areas and clinical services, including cancer. According to the American Cancer Society, African Americans are more likely to develop and die from cancer than any other racial or ethnic group [1]. Not surprisingly, therefore, considerable attention has been focused on better understanding racial and ethnic disparities in cancer care and outcomes, including KLHL22 antibody NHL [12-14]. One recent study by Wang and colleagues examined ethnic variations in treatment and survival in patients diagnosed with NHL, including DLBCL and two indolent types of NHL: chronic lymphocytic leukemia (CLL); and follicular lymphoma (FL) [14]. This was a retrospective cohort study of patients diagnosed with NHL from 1992 to 1999, using the SEER-Medicare linked database. Based on multivariate analysis, the investigators found that among all patients diagnosed with NHL, blacks were significantly less likely than whites to receive chemotherapy (OR, 0.69; 95% confidence interval [CI], 0.50-0.95). The study found no difference in all-cause mortality between blacks and whites, either overall or in any of the specific types of NHL, including DLBCL. Several changes in.
