Investigating the inequalities in route to diagnosis amongst patients with diffuse large B-cell or follicular lymphoma in England

• Published in: British journal of cancer 2021-10, Vol.125 (9), p.1299-1307
• Main Authors: Smith, Matthew J., Fernandez, Miguel Angel Luque, Belot, Aurélien, Quartagno, Matteo, Bonaventure, Audrey, Majano, Sara Benitez, Rachet, Bernard, Njagi, Edmund Njeru
• Format: Article
• Language: English
• Subjects: 692/308/174; 692/4028/67/1990/291/1621; 692/4028/67/2324; 692/700/478/174; Adult; Aged; Aged, 80 and over; Bayes Theorem; Bayesian analysis; Biomedical and Life Sciences; Biomedicine; Cancer Research; Comorbidity; Cross-Sectional Studies; Delayed Diagnosis - statistics & numerical data; Diagnosis; Drug Resistance; England; Epidemiology; Female; Humans; Life Sciences; Linear Models; Lymphocytes B; Lymphoma; Lymphoma, Follicular - diagnosis; Lymphoma, Follicular - pathology; Lymphoma, Large B-Cell, Diffuse - diagnosis; Lymphoma, Large B-Cell, Diffuse - pathology; Male; Medical diagnosis; Middle Aged; Molecular Medicine; Neoplasm Staging; Oncology; Patients; Risk Factors; Santé publique et épidémiologie; Young Adult
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/s41416-021-01523-6

Introduction Diagnostic delay is associated with lower chances of cancer survival. Underlying comorbidities are known to affect the timely diagnosis of cancer. Diffuse large B-cell (DLBCL) and follicular lymphomas (FL) are primarily diagnosed amongst older patients, who are more likely to have comorbidities. Characteristics of clinical commissioning groups (CCG) are also known to impact diagnostic delay. We assess the association between comorbidities and diagnostic delay amongst patients with DLBCL or FL in England during 2005–2013. Methods Multivariable generalised linear mixed-effect models were used to assess the main association. Empirical Bayes estimates of the random effects were used to explore between-cluster variation. The latent normal joint modelling multiple imputation approach was used to account for partially observed variables. Results We included 30,078 and 15,551 patients diagnosed with DLBCL or FL, respectively. Amongst patients from the same CCG, having multimorbidity was strongly associated with the emergency route to diagnosis (DLBCL: odds ratio 1.56, CI 1.40–1.73; FL: odds ratio 1.80, CI 1.45–2.23). Amongst DLBCL patients, the diagnostic delay was possibly correlated with CCGs that had higher population densities. Conclusions Underlying comorbidity is associated with diagnostic delay amongst patients with DLBCL or FL. Results suggest a possible correlation between CCGs with higher population densities and diagnostic delay of aggressive lymphomas.