Social deprivation among patients with chronic lymphocytic leukemia (CLL) was found to independently impact clinical outcomes in these patients, according to a study published in Haematologica.
The single-center study took place between August 2005 and December 2019, before the COVID-19 pandemic began. The study included 665 prospectively diagnosed participants, comprised of 413 males (62.1%) and 252 females (37.9%), according to the baseline study characteristics.
To evaluate levels of social deprivation, the investigators used the Welsh Index of Multiple Deprivation (WIMD), which provides a weighted scoring system derived from 8 sectors: income (22%), employment (22%), health (15%), education (14%), access to services (10%), housing (7%), community safety (5%) and physical environment (5%).
Study participants were assigned categories of relative deprivation. The median age of the participants at diagnosis was 67 years, with most patients (87.3%) presenting with early-stage disease and positive prognostic markers, the investigators wrote.
Analysis of the study results showed significantly better overall survival among participants who were the least deprived compared with the most deprived participants (second most deprived HR, 0.85; 95% CI, 0.59-1.25; P = .413); (second least deprived HR, 0.8; 95% CI, 0.52-1.22; P = .294); (least deprived HR, 0.59; 95% CI, 0.42-0.82; P = .002).
There was no statistically significant difference in progression-free survival (PFS) or time to first treatment (TTFT) between the different deprivation quartiles (P = .084 and P = .23, respectively) or between the most deprived and the least deprived quartile (P = .087 and P = .236, respectively).
At the same time, the investigators found that, after examining just patients who required treatment, survival from the time of receiving the first treatment was much worse among the most deprived patients when comparing the 4 quartiles (P < .001).
As the researchers expected, advanced stage disease resulted in significantly earlier death (81 years vs 71 years, P < .001) among the 263 patients in the study who died. Earlier death was also associated with increasing deprivation (P = .052); the most deprived early-stage patients died 1.5 years earlier (P = .077), though the age of death among patients with advanced stage disease was similar (P = .529), the researchers found.
This was not only the first study to assess the impact of deprivation on CLL outcomes, but also the first to explore the possible underlying reasons behind these outcomes, the investigators wrote. Furthermore, the study showed for the first time that social deprivation leads to more advanced stage disease and worse survival once therapy begins.
Notably, the investigators couldn’t determine why deprivation impacts the stage and age at presentation of the disease. They postulated that higher risk lifestyle behaviors, such as smoking or obesity, could lead to other illnesses that increase with deprivation. Additionally, they noted that deprivation could increase the fear of cancer or its treatments, which could contribute to more advanced disease at presentation.
Investigators also discussed the unknown reasoning behind deprivation leading to worse overall clinical outcomes, even after the patient began therapy. They noted that comorbidities such as heart or lung disease could lead to worse outcomes after beginning therapy due to the reduction of available treatment options or the duration of treatment itself.
Additionally, the investigators discussed the prospect of deprivation impacting patient compliance during treatment, such as not attending hospital visits due to concerns about missing work or associated costs with attaining treatment.
“Given the significant impact deprivation has on overall survival and survival from treatment, increased medical staff awareness, additional patient education and increased attention to any potential compliance issues an individual patient may have, may improve outcomes,” the study investigators wrote.
Reference
Fegan G, Tod D, Downing A, et al. Social deprivation independently impacts clinical outcomes in patients with chronic lymphocytic leukemia. Haematologica. Published online January 25, 2024. doi:10.3324/haematol.2023.283527
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Social Deprivation Independently Impacts Outcomes in Patients With Chronic Lymphocytic Leukemia
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The study was the first of its kind to analyze social deprivation among CLL patients and observe the underlying reasons behind their clinical outcomes.
Social deprivation among patients with chronic lymphocytic leukemia (CLL) was found to independently impact clinical outcomes in these patients, according to a study published in Haematologica.
The single-center study took place between August 2005 and December 2019, before the COVID-19 pandemic began. The study included 665 prospectively diagnosed participants, comprised of 413 males (62.1%) and 252 females (37.9%), according to the baseline study characteristics.
Financial burden of health care illustration | Image credit: janews094 - stock.adobe.com
To evaluate levels of social deprivation, the investigators used the Welsh Index of Multiple Deprivation (WIMD), which provides a weighted scoring system derived from 8 sectors: income (22%), employment (22%), health (15%), education (14%), access to services (10%), housing (7%), community safety (5%) and physical environment (5%).
Study participants were assigned categories of relative deprivation. The median age of the participants at diagnosis was 67 years, with most patients (87.3%) presenting with early-stage disease and positive prognostic markers, the investigators wrote.
Analysis of the study results showed significantly better overall survival among participants who were the least deprived compared with the most deprived participants (second most deprived HR, 0.85; 95% CI, 0.59-1.25; P = .413); (second least deprived HR, 0.8; 95% CI, 0.52-1.22; P = .294); (least deprived HR, 0.59; 95% CI, 0.42-0.82; P = .002).
There was no statistically significant difference in progression-free survival (PFS) or time to first treatment (TTFT) between the different deprivation quartiles (P = .084 and P = .23, respectively) or between the most deprived and the least deprived quartile (P = .087 and P = .236, respectively).
At the same time, the investigators found that, after examining just patients who required treatment, survival from the time of receiving the first treatment was much worse among the most deprived patients when comparing the 4 quartiles (P < .001).
As the researchers expected, advanced stage disease resulted in significantly earlier death (81 years vs 71 years, P < .001) among the 263 patients in the study who died. Earlier death was also associated with increasing deprivation (P = .052); the most deprived early-stage patients died 1.5 years earlier (P = .077), though the age of death among patients with advanced stage disease was similar (P = .529), the researchers found.
This was not only the first study to assess the impact of deprivation on CLL outcomes, but also the first to explore the possible underlying reasons behind these outcomes, the investigators wrote. Furthermore, the study showed for the first time that social deprivation leads to more advanced stage disease and worse survival once therapy begins.
Notably, the investigators couldn’t determine why deprivation impacts the stage and age at presentation of the disease. They postulated that higher risk lifestyle behaviors, such as smoking or obesity, could lead to other illnesses that increase with deprivation. Additionally, they noted that deprivation could increase the fear of cancer or its treatments, which could contribute to more advanced disease at presentation.
Investigators also discussed the unknown reasoning behind deprivation leading to worse overall clinical outcomes, even after the patient began therapy. They noted that comorbidities such as heart or lung disease could lead to worse outcomes after beginning therapy due to the reduction of available treatment options or the duration of treatment itself.
Additionally, the investigators discussed the prospect of deprivation impacting patient compliance during treatment, such as not attending hospital visits due to concerns about missing work or associated costs with attaining treatment.
“Given the significant impact deprivation has on overall survival and survival from treatment, increased medical staff awareness, additional patient education and increased attention to any potential compliance issues an individual patient may have, may improve outcomes,” the study investigators wrote.
Reference
Fegan G, Tod D, Downing A, et al. Social deprivation independently impacts clinical outcomes in patients with chronic lymphocytic leukemia. Haematologica. Published online January 25, 2024. doi:10.3324/haematol.2023.283527
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