Treatment patterns, survival, and hospitalization in adult patients with acute lymphoblastic leukemia: an observational cohort study using SEER Medicare data

Abstract

There is little evidence about whether additional risk stratification for adult patients with acute lymphoblastic leukemia age 65 and older is warranted. Using the Surveillance, Epidemiology, and End Results data linked to Medicare claims, we examined the effects of age, comorbid conditions, and mobility limitations on treatment and survival in a cohort of 795 patients diagnosed with ALL between 1 January 2000 and 31 December 2009. In the cohort, 54% received chemotherapy within the first 90 days, of whom 74% were hospitalized during the first chemotherapy administration. Unadjusted median survival was 172 days (95% CI = 244–379) for the overall cohort, 325 days (95% CI = 244–379) for those age 65–69, but only 59 days (95% CI = 45–76) for those age ≥80. In multivariate analyses, older age groups (70–74, 75–79, and ≥80) and comorbidity score ≥2 were independently associated with poorer survival. Treatment and outcomes vary considerably among subgroups of older patients suggesting that further risk stratification may be useful.

Keywords:

• Leukemia
• adult
• treatment
• comorbidity
• health status
• hospitalization
• survival
• mortality

Acknowledgements

This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the SEER Program tumor registries in the creation of the SEER-Medicare database.

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article online at http:\\doi:10.1080/10428194.2018.1555329

Additional information

Funding

This research was funded by Amgen Inc. Mark Danese and Michelle Gleeson are employees of Outcomes Insights, Inc., which received funding from Amgen Inc. Aaron Katz, Karynsa Cetin, and Michael Kelsh are employees of Amgen Inc. Robert Griffiths was an employee of Outcomes Insights, Inc. when the majority of this research was initiated and received consulting fees from Outcomes Insights, Inc. during the completion of the work. The authors have no other conflicts to disclose.