Abstract
For most patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL), R-CHOP immunochemotherapy leads to complete remission and 60–70% of patients remain progression-free after 5 years. Given a median age of 65, it is relevant to disentangle how DLBCL and DLBCL therapy influence health care use among the survivors. In this nationwide study, the health care use among Danish DLBCL patients diagnosed in 2007–2015, who achieved complete remission after R-CHOP(-like) therapy, was explored and compared to matched comparators from the Danish general population. The post-remission 5-year risk of hospitalization was significantly higher among DLBCL survivors (55%) compared to matched comparators (49%, P < 0.001). DLBCL survivors had on average 10.3 (9.3–11.3) inpatient bed days within 5 years of response evaluation, whereas matched comparators had 8.4 (7.9–8.8). The rate of outpatient visits was also significantly higher(excluding routine follow-up visits, incidence rate ratio, 1.3, P < 0.001), but translated into only a very small absolute difference of <1 outpatient visits within 5 years between DLBCL survivors (4.2 visits, 95% CI, 4.0–4.4) and matched comparators (3.8 visits, 95% CI, 3.7–3.9). In conclusion, DLBCL survivors have an increased incidence of hospital visits due to a wide range of conditions, but in absolute terms the excess use of health care services in DLBCL survivors was small.
Highlights
Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma in the western world with an annual incidence of 7 per 100,000 person-years in the United States [1]
The IR ratios (IRRs) of outpatient visits in each ICD-10 chapter decreased over time and approached one (Table S7), pointing towards less differences between DLBCL survivors and matched comparators as time. In this nationwide study, we investigated the use of health care services among Danish DLBCL survivors in complete remission (CR) after first-line treatment with 6–8 cycles of R-CHOP(-like) immunochemotherapy
We observed an increased risk of hospitalization among DLBCL survivors, but the differences were limited with DLBCL survivors having 1.9 inpatient bed day more than matched comparators during the 5 years following the index date
Summary
Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma in the western world with an annual incidence of 7 per 100,000 person-years in the United States [1]. Patients in first CR have good survival outcomes compared to many other cancer patients with the risk of relapse during the first 5 years being 18% and as low as 8% for patients without progression during the first 2 years following response evaluation [4] This means that the majority of DLBCL patients in first CR can be considered cured of their lymphoma. Observational studies have an advantage in size and follow-up, these studies typically focus on one or a few specific late complications and not the overall health care use among DLBCL survivors, which can be considered a surrogate for overall health [8]. This nationwide register study investigated the use of health care services among Danish DLBCL survivors by quantifying the risk of Received: 4 November 2021 Revised: 7 January 2022 Accepted: 13 January 2022
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