Impact of socioeconomic status and distance from treatment center on survival in patients receiving remission induction therapy for newly diagnosed acute myeloid leukemia

Abstract

Background While socioeconomic status (SES) and the distance patients travel to a treatment center (DTC) impact survival of certain solid tumors, little is known of their influence in acute myeloid leukemia (AML). Methods We retrospectively reviewed patients receiving remission induction therapy for AML at the Cleveland Clinic between January 1997 and December 2005. Demographic data were obtained from medical records. Income and DTC were determined using online databases . Known prognostic factors (age, WBC count at diagnosis, cytogenetics, AML etiology) were collected and controlled for in Cox proportional hazards analysis. Results Induction chemotherapy was administered to 281 patients; 91% were Caucasian (C), 8% were African American (AA), and 1% were neither (non-AA non-C). The median DTC was 24 miles (range, 0.9–2058), and median annual household income was $38,972 (range, $17,496–143,220). With a median follow up of 22.6 months, the median overall survival (OS) was 11.3 months. In multivariable analyses, age ≥60 years, unfavorable cytogenetics, initial WBC count and secondary AML significantly influenced survival ( p < 0.001, p < 0.001, p = 0.035, and p = 0.010, respectively). OS was similar for AAs and non-AA non-Cs compared to Cs (HR = 1.12, 95% CI = .61–2.07, p = .71, and HR = 0.87, CI = 0.21–3.62, p = .84, respectively). Neither DTC (HR = 1.00, 95%CI = 0.98–1.01, p = .96 per 20 mile increment) nor SES (HR = 1.02, 95%CI = 0.92–1.13, p = .77 per $10000 annual income increase) had an impact on OS. Conclusion Unlike with many solid tumors, SES and DTC are not predictive of outcome in AML patients.