Survival and socioeconomic disparities in the elderly population with mycosis fungoides and Sézary syndrome: A comparative analysis of 2,690 patients by facility type.

Abstract

7069 Background: Mycosis fungoides (MF) and Sézary syndrome (SS) are rare T-cell malignancies (0.26 and 0.36/100,000 person-years, respectively), that predominantly affect elderly patients, a population frequently underrepresented in clinical trials and with limited access to specialized care. While population-level outcomes are known, the impact of facility type on management and survival remains poorly studied. We utilized the National Cancer Database (NCDB) to conduct the largest retrospective cohort analysis comparing patient demographics, treatment patterns, and survival (OS) between Academic Cancer Programs (ACPs) and Community Cancer Programs (CCPs). Methods: Patients ≥75 years old diagnosed with MF/SS in the US from 2000 to 2020 were identified. Facilities were categorized as ACPs (Academic/research programs) and CCPs (Comprehensive community/integrated network programs). Demographic and clinical variables were compared. Overall survival (OS) was estimated using Kaplan–Meier methods, with Cox proportional hazards models performed to assess associations between facility type and survival. Results: A total of 2690 patients were identified (ACPs: 2176;CCPs: 514). Both cohorts showed male predominance (ACPs: 58%;CCPs: 64%) and were primarily White (ACPs: 84%;CCPs: 92%). Socioeconomic analysis revealed that ACP patients were more likely to belong to the highest income quartiles compare to CCP patients across all periods (2000: 43% vs 32%; 2008–2012: 36% vs 26%; 2012–2016: 39% vs 29%; and 2016–2020: 40% vs 30%; all p < 0.01). Notably, ACP patients were more likely to receive systemic treatment (71% vs 65%; p<0.05) and experienced shorter median times to treatment initiation (37 vs 48 days; p<0.05). Conversely, radiotherapy was utilized more frequently at CCPs (29% vs 15.2%; p<0.01). With a longer median follow-up at ACPs (37 vs 31 months; p< 0.05), a higher proportion of patients remained alive at the end of the study (42% vs 30%). OS was superior among patients treated at ACPs, with higher 2-, 5-, and 10-year survival rates and a longer median OS (4.9 vs 3.0 years; log-rank p=0.001). Conclusions: In elderly patients with mycosis fungoides and Sézary syndrome, management at an Academic Cancer Program was associated with a statistically significant and clinically meaningful overall survival advantage compared with Community Cancer Programs. This survival difference occurred alongside more frequent use of systemic therapies, expedited treatment initiation, and distinct socioeconomic differences between care settings. These findings highlight important system-level disparities and underscore the critical need to strengthen referral pathways and academic–community partnerships to improve access to specialized care and optimize outcomes for this vulnerable population.