Social inequalities impacts of care management and survival in patients with non-hodgkin lymphomas

Epidemiologyand public health

The principal aim of thisthesis will describe the care pathway of diffuse large B cell lymphoma (DBCL)and follicular lymphoma (FL) in the general population and identify the factorspredicting the place of care and survival in a population based cohort of nonHodgkin lymphoma (NHL) patients from three counties in France between 2002 and2008. The specific aims will 1/ identify the socioeconomicand medical factors predicting the place of care (teaching vs. non teachinghospitals) and 5 years survival, 2/ identify the socioeconomic andmedical factors predicting longest delays of care and to study theinfluence of longest delays on survival 3/ analyse all thesefactors on a frailty population defined by a high age and/or other criteria ofvulnerability (such as comorbidity).

To answer these questions, the followings methods are proposed:  

1/ case registration of all identified NHL (DLBCL and FL) by threehaematological malignancies registries in France (Côte d’Or, Basse Normandieand Gironde). 1977 patients are included. Individual medical data (e.g. patientcharacteristics, management and treatment) from NHL incident cases diagnosedbetween 2002 and 2008 was stored in a standardized database. 2/ we collectedand geocoded the patient’s place of residence at diagnosis. Each patient wasaffected to an IRIS (smallest area allowing for aggregate statistics) using ageographical information system. 3/ we applied successively Townsenddeprivation index and then the new French deprivation index available in 2012in univariate and multivariate analyses. 4/ we used adjusted multilevellogistic regression models to take into account the existence of aggregatedata. The overall survival probability at 1, 3 and 5 years were estimated bythe Kaplan Meier method and then Cox regression model for multivariateanalysis. Net survival (Pohar Perme) and Relative survival (Esteve’s method)was also being performed. Finally, to palliate to a non-negligible proportion of missing values on important prognosticfactors, we used Multiple imputation by Chained Equation (MICE) method. 

We will present results of analysis of theinfluence of socio-geographical, medical determinants and treatment provider onrelative survival of DBCL patients.

Cette présentation a été donnée dans le cadre du BRIO SIRICscientific day 3 organisé annuellement par le SIRIC BRIO et qui a pour but deréunir tous les acteurs du SIRIC BRIO et plus largement de la cancérologie àBordeaux.