Many Older Patients Do Not Receive Chemotherapy for ALL

A new study found that more than one-third of patients aged older than 65 years do not receive chemotherapy for acute lymphoblastic leukemia (ALL) in the United States, despite National Comprehensive Cancer Network clinical practice guidelines recommending multiagent chemotherapy for successful management of the disease.

The study, published in Clinical Lymphoma, Myeloma & Leukemia, linked disparities in the use of chemotherapy to several different socioeconomic factors: age, marital status, income, education, and insurance status.

The five-year overall survival (OS) for older adults with ALL is 45%, highlighting the disparity in availability and use of chemotherapy, according to the authors.

The study was based on data from 16,196 patients in the Surveillance, Epidemiology, and End Results (SEER) database, which includes clinical information such as patient demographics, cancer site and incidence, tumor morphology, staging, initial course of treatment, survival statistics, and vital status updates.

The study documented decreasing chemotherapy use with advancing age, with 97.5% of patients receiving chemotherapy in the 0 to 18 years age group, 94.8% in the 19 to 40 years age group, 90.7% in the 41 to 65 years age group, and just 63.8% in the 65 years and older age group.

In a multivariate analysis of the SEER data, the likelihood of receiving chemotherapy decreased with advancing age, single or widowed status, low income and educational status, and lack of insurance. Insurance status was an independent predictor of receipt of chemotherapy across each age category.

Utsav J, Anurag A, Uttam B, et al. Effect of age and socioeconomic factors in the utilization of chemotherapy in Acute Lymphoblastic Leukemia (ALL): a SEER database study of 16,196 patients. Clin Lymphoma Myeloma Leuk. 2022. doi:10.1016/j.clml.2022.06.006