Facility-level disparities in outcomes of subcutaneous panniculitis-like T-cell lymphoma: A national cancer database analysis

Abstract

Abstract Background Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is an exceptionally rare malignancy, representing less than 1% of all mature T-cell lymphomas. In the United States, it occurs most commonly in Caucasian and African American patients (J Clin Oncol 41, 2023 [suppl 16; abstre19548]). Due to its rarity, the impact of institutional setting and sociodemographic variables on clinical outcomes in SPTCL remains poorly characterized. This study aims to assess the influence of treatment facility type, race/ethnicity, and socioeconomic indicators on treatment patterns and survival outcomes among patients with SPTCL in the United States, using data from the National Cancer Database (NCDB).Methods We conducted a retrospective cohort study of patients diagnosed with SPTCL between 2004 and 2022 using data from the NCDB. Patient demographics, clinical features, socioeconomic indicators, time to treatment intervals, treatment modalities, and survival outcomes were compared between academic cancer programs (ACPs) and community cancer programs (CCPs). ACPs included academic and research programs, including NCI-designated comprehensive cancer centers. CCPs comprised community, comprehensive community, and integrated network cancer programs. Survival analysis was performed using Kaplan-Meier (KM) curves. Adjusted median survival times were calculated using a Cox proportional hazards model, adjusting for age, ethnicity, insurance status, Charlson-Deyo comorbidity score, and Great Circle Distance to the treatment center.Results A total of 460 patients with SPTCL were included: 229 (50%) treated at ACPs and 93 (20%) at CCPs; facility type was not available for 138 patients (30%). The median age at diagnosis was lower among ACP patients (57 years) compared to CCP patients (60 years; p<0.001). Patients treated at ACPs were more likely to live in metropolitan areas (82% vs. 71%, p<0.001) and have higher income. Private insurance was more common among ACP patients (54%) than CCP patients (47%), while Medicare coverage was more frequent in CCPs (39% vs. 32%). The proportion of uninsured patients remained low and comparable between groups (2% in CCPs vs. 3% in ACPs). Treatment rates were similar across facility types (57% in ACPs vs. 55% in CCPs, p=0.78). The median time from diagnosis to chemotherapy initiation was shorter for ACP patients (53 days) than for CCP patients (56 days, p=0.024). Radiation therapy was more frequently used in CCPs (19% vs. 11%). Survival analysis showed no significant differences between facility types. The adjusted median overall survival of 16.67 years in ACPs and 17.86 years in CCPs (p=0.799). Adjusted survival probabilities at ACPs were 78% at 2 years, 67% at 5 years, and 64% at 10 years and at CCPs were 72% at 2 years, 67% at 5 years and 63% at 10 years.ConclusionAmong patients with SPTCL documented in the NCDB, adjusted survival outcomes were favorable and comparable between academic and community cancer programs. Differences in patient characteristics such as younger age, private insurance, and metropolitan residence among those treated at ACPs highlight variations in access to care but did not translate into disparities in clinical outcomes. Future efforts should explore how care delivery models can reduce barriers and ensure timely, equitable management of this rare lymphoma.