Overall survival differences by treatment setting in older adults with classical Hodgkin lymphoma: A National Cancer Database analysis.

Abstract

e19037 Background: Classical Hodgkin lymphoma (cHL) has high cure rates in younger patients but worse outcomes in older adults. Five-year overall survival (OS) in elderly patients ranges from 49–65%, compared with nearly 90% in younger cohorts. These disparities are attributed to higher relapse rates, treatment-related mortality and intolerance. Despite this, data examining outcomes in elderly cHL patients remain limited. We evaluated the impact of treatment setting on survival in cHL patients aged > 75 years. To our knowledge, this is first analysis comparing characteristics and survival between older patients treated at academic cancer programs (ACP) versus community cancer programs (CCP). Methods: We performed a retrospective analysis of U.S. patients with cHL from 2004–2022 using the National Cancer Database (NCDB). Demographic, clinical, and survival data were compared between ACP and CCP. ACP included academic and NCI-designated centers; CCP included community, comprehensive community, and integrated network programs. Kaplan-Meier and Cox models compared OS, adjusting for age, race/ethnicity, insurance status, Charlson-Deyo score, and distance from facility. Results: Among 9,330 patients, 49% were treated at ACPs and 51% at CCPs. Sex distribution was similar (49% female, 51% male), with median age 80 years. Most patients were non-Hispanic (NH) and predominantly White. ACP treated more Hispanic patients (8.7% vs 7.3%, p = 0.02), while CCPs treated more NH patients (88% vs 87%, p < 0.001). Medicare was the most common insurance type (ACP 85%, CCP 88%, p < 0.001), followed by private insurance (9% vs 8%, p < 0.001). Charlson-Deyo score ≥2 was present in 12% of both groups. More patients with Stage III–IV disease were treated at ACP (55% vs 51%, p = 0.005). Median time to treatment was 25 days for ACPs and 26 days for CCP. More ACP patients underwent treatment than CCP patients (58% vs 54%, p < 0.001). Median time from diagnosis to last contact or death was 21 months at ACPs versus 14 months at CCP (p < 0.001). Two and five-year survival for ACP vs CCP was 52% vs 47% and 35% vs 32%, respectively. Median survival time was 2.25 years for ACP and 1.57 years for CCP, with a statistically significant overall survival advantage for ACP (p < 0.001). Conclusions: Among patients aged ≥75 years with cHL, treatment at ACP was associated with a statistically significant improvement in OS compared with CCP (log-rank p < 0.001), despite a higher proportion of advanced-stage disease at ACP. These differences occurred alongside higher treatment rates and longer follow-up at ACP. While outcomes for older adults with cHL remain inferior to those of younger patients, this analysis suggests that treatment setting is an important system-level factor influencing survival. Further studies are needed to identify modifiable components of care delivery and optimize treatment strategies for this high-risk population.