Regional disparities in the use of intensive chemotherapy for AML in the Netherlands: does it influence survival?
Objective Acute myeloid leukaemia (AML) prognosis is enhanced with intensive remission induction chemotherapy (ICT) in eligible patients. However, ICT eligibility perceptions may differ among healthcare professionals. This nationwide, population-based study aimed to explore regional variation in ICT...
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BMJ Publishing Group
2024-07-01
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| Series: | BMJ Oncology |
| Online Access: | https://bmjoncology.bmj.com/content/3/1/e000264.full |
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| author | Hester F Lingsma David van Klaveren Arjan A van de Loosdrecht Anna van Rhenen Otto Visser Valery E P P Lemmens Nikki van Leeuwen Gerwin Huls Z L Rana Kaplan Eduardus F M Posthuma Danielle van Lammeren-Venema Tjeerd J F Snijders Catharina H M J van Elssen Peter A von dem Borne Nicole M A Blijlevens Jan J Cornelissen Marc H G P Raaijmakers Avinash G Dinmohamed |
| author_facet | Hester F Lingsma David van Klaveren Arjan A van de Loosdrecht Anna van Rhenen Otto Visser Valery E P P Lemmens Nikki van Leeuwen Gerwin Huls Z L Rana Kaplan Eduardus F M Posthuma Danielle van Lammeren-Venema Tjeerd J F Snijders Catharina H M J van Elssen Peter A von dem Borne Nicole M A Blijlevens Jan J Cornelissen Marc H G P Raaijmakers Avinash G Dinmohamed |
| author_sort | Hester F Lingsma |
| collection | DOAJ |
| description | Objective Acute myeloid leukaemia (AML) prognosis is enhanced with intensive remission induction chemotherapy (ICT) in eligible patients. However, ICT eligibility perceptions may differ among healthcare professionals. This nationwide, population-based study aimed to explore regional variation in ICT application and its relation with overall survival (OS).Methods and analysis We compared nine Dutch regional networks using data from the Netherlands Cancer Registry. Regional variance was assessed for the entire population and age subgroups (ie, ≤60 years and >60 years) using multivariable mixed effects logistic and Cox proportional hazard regression analyses, expressed via median OR (MOR) and median HR (MHR).Results Including all adult AML patients from 2014 to 2018 (N=4060 patients; 58% males; median age, 70 years), 1761 (43%) received ICT. ICT application varied from 36% to 57% (MOR 1.36 (95% CI 1.11 to 1.58)) across regions, with minor variations for patients aged ≤60 years (MOR 1.16 (95% CI 1.00 to 1.40)) and more extensive differences for those aged >60 years (MOR 1.43 (95% CI 1.16 to 1.63)). Median OS spanned 4.9–8.4 months across regions (MHR 1.11 (95% CI 1.00 to 1.15)), with pronounced differences in older patients (MHR 1.12 (95% CI 1.08 to 1.20)) but negligible differences in the younger group (MHR 1.02 (95% CI 1.00 to 1.14)). Survival differences for the total population and the older patients decreased to respectively, MHR 1.09 (95% CI 1.00 to 1.13) and 1.10 (95% CI 1.04 to 1.18), after additional adjustment for the probability of receiving ICT within a region, indicating approximately 10% unexplained differences.Conclusion Regional disparities in ICT application and survival exist, especially in older AML patients. However, ICT application differences partially explain survival disparities, indicating the need for more standardised ICT eligibility criteria and a better understanding of underlying causes of outcome disparities. |
| format | Article |
| id | doaj-art-1ccfa978daa64b508cdfbda59b2174a6 |
| institution | Kabale University |
| issn | 2752-7948 |
| language | English |
| publishDate | 2024-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Oncology |
| spelling | doaj-art-1ccfa978daa64b508cdfbda59b2174a62025-01-30T10:05:10ZengBMJ Publishing GroupBMJ Oncology2752-79482024-07-013110.1136/bmjonc-2023-000264Regional disparities in the use of intensive chemotherapy for AML in the Netherlands: does it influence survival?Hester F Lingsma0David van Klaveren1Arjan A van de Loosdrecht2Anna van Rhenen3Otto Visser4Valery E P P Lemmens5Nikki van Leeuwen6Gerwin Huls7Z L Rana Kaplan8Eduardus F M Posthuma9Danielle van Lammeren-Venema10Tjeerd J F Snijders11Catharina H M J van Elssen12Peter A von dem Borne13Nicole M A Blijlevens14Jan J Cornelissen15Marc H G P Raaijmakers16Avinash G Dinmohamed17Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The NetherlandsDepartment of Public Health, Erasmus MC, Rotterdam, The NetherlandsDepartment of Hematology, Amsterdam UMC Location VUmc, Amsterdam, The NetherlandsDepartment of Hematology, Utrecht University Medical Center, Utrecht, The NetherlandsDepartment of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The NetherlandsDepartment of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The NetherlandsDepartment of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The NetherlandsDepartment of Hematology, University Medical Center, Groningen, The NetherlandsDepartment of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The NetherlandsDepartment of Internal Medicine, Reinier de Graaf Gasthuis, Delft, The NetherlandsDepartment of Hematology, Haga Hospital, The Hague, The NetherlandsDepartment of Hematology, Medisch Spectrum Twente, Enschede, The NetherlandsDepartment of Internal Medicine, Maastricht University Medical Center, Maastricht, The NetherlandsDepartment of Hematology, Leiden University Medical Center, Leiden, The NetherlandsDepartment of Hematology, Radboud University Medical Center, Nijmegen, The NetherlandsDepartment of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, NetherlandsDepartment of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, NetherlandsDepartment of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The NetherlandsObjective Acute myeloid leukaemia (AML) prognosis is enhanced with intensive remission induction chemotherapy (ICT) in eligible patients. However, ICT eligibility perceptions may differ among healthcare professionals. This nationwide, population-based study aimed to explore regional variation in ICT application and its relation with overall survival (OS).Methods and analysis We compared nine Dutch regional networks using data from the Netherlands Cancer Registry. Regional variance was assessed for the entire population and age subgroups (ie, ≤60 years and >60 years) using multivariable mixed effects logistic and Cox proportional hazard regression analyses, expressed via median OR (MOR) and median HR (MHR).Results Including all adult AML patients from 2014 to 2018 (N=4060 patients; 58% males; median age, 70 years), 1761 (43%) received ICT. ICT application varied from 36% to 57% (MOR 1.36 (95% CI 1.11 to 1.58)) across regions, with minor variations for patients aged ≤60 years (MOR 1.16 (95% CI 1.00 to 1.40)) and more extensive differences for those aged >60 years (MOR 1.43 (95% CI 1.16 to 1.63)). Median OS spanned 4.9–8.4 months across regions (MHR 1.11 (95% CI 1.00 to 1.15)), with pronounced differences in older patients (MHR 1.12 (95% CI 1.08 to 1.20)) but negligible differences in the younger group (MHR 1.02 (95% CI 1.00 to 1.14)). Survival differences for the total population and the older patients decreased to respectively, MHR 1.09 (95% CI 1.00 to 1.13) and 1.10 (95% CI 1.04 to 1.18), after additional adjustment for the probability of receiving ICT within a region, indicating approximately 10% unexplained differences.Conclusion Regional disparities in ICT application and survival exist, especially in older AML patients. However, ICT application differences partially explain survival disparities, indicating the need for more standardised ICT eligibility criteria and a better understanding of underlying causes of outcome disparities.https://bmjoncology.bmj.com/content/3/1/e000264.full |
| spellingShingle | Hester F Lingsma David van Klaveren Arjan A van de Loosdrecht Anna van Rhenen Otto Visser Valery E P P Lemmens Nikki van Leeuwen Gerwin Huls Z L Rana Kaplan Eduardus F M Posthuma Danielle van Lammeren-Venema Tjeerd J F Snijders Catharina H M J van Elssen Peter A von dem Borne Nicole M A Blijlevens Jan J Cornelissen Marc H G P Raaijmakers Avinash G Dinmohamed Regional disparities in the use of intensive chemotherapy for AML in the Netherlands: does it influence survival? BMJ Oncology |
| title | Regional disparities in the use of intensive chemotherapy for AML in the Netherlands: does it influence survival? |
| title_full | Regional disparities in the use of intensive chemotherapy for AML in the Netherlands: does it influence survival? |
| title_fullStr | Regional disparities in the use of intensive chemotherapy for AML in the Netherlands: does it influence survival? |
| title_full_unstemmed | Regional disparities in the use of intensive chemotherapy for AML in the Netherlands: does it influence survival? |
| title_short | Regional disparities in the use of intensive chemotherapy for AML in the Netherlands: does it influence survival? |
| title_sort | regional disparities in the use of intensive chemotherapy for aml in the netherlands does it influence survival |
| url | https://bmjoncology.bmj.com/content/3/1/e000264.full |
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