Variations in chemotherapy and radiation therapy in a large nationwide and community-based cohort of elderly patients with non-Hodgkin lymphoma

OBJECTIVE: The objective of this study was to determine the variations in the use of chemotherapy and radiation therapy in a large nationwide and population-based cohort of older patients with non-Hodgkin lymphoma (NHL). METHODS: We studied a retrospective cohort of 13,570 patients diagnosed with incident NHL at age ≥65 in 1992 through 1999 identified from the Surveillance, Epidemiology and End Results-Medicare-linked database. RESULTS: Of 13,570 patients with NHL, 52% received chemotherapy within 6 months of diagnosis. A higher proportion (61%) of patients aged 65 to 69 received chemotherapy than those ≥80 (39%). Forty-three percent of black patients received chemotherapy compared with whites (52%) and other ethnicities (54%). A greater proportion of patients with lower comorbidity scores received chemotherapy than those with higher comorbidity scores. In multivariate analysis, there was no significant association between the receipt of chemotherapy and gender or year of diagnosis, but blacks had statistically significant lower odds of receiving chemotherapy than white patients (odds ratio = 0.66, 95% confidence interval: 0.55-0.80). Significant predictors of receiving chemotherapy were age, ethnicity, comorbidity, tumor stage, nodal site, geographic area, and radiation therapy. The percentages of patients receiving radiation therapy, chemotherapy, or both were 11%, 39%, and 13%, respectively; 37% of patients with NHL did not receive any of these treatments within 6 months of diagnosis. CONCLUSION: There were significant variations in the use of chemotherapy by patient and tumor characteristics and geographic areas. A substantial number of patients with NHL did not receive either chemotherapy or radiation therapy, suggesting that the rate for receipt of these therapies may be improved.