Affordable Cancer Care Research Articles

Cancer Epidemiology and Cancer Care: Transforming the Landscape

Abstract Cancer poses the highest clinical, social, and economic burden in terms of cause-specific disability-adjusted life years. Between 30% and 50% of these cancers can currently be prevented by avoiding risk factors and implementing existing evidence-based prevention strategies. The 6th Amrita International Public Health Conference centered around the theme of “Advancing Public Health Strategies for Cancer Control.” It was a holistic approach toward discussing explicit stratagems for cancer control. The objective of this study is to document the important discussions in the trends of cancer epidemiology with a special focus on molecular epidemiology and digital technologies for screening. A model for improving the accessibility and affordability of cancer care in India is also highlighted by experts.

Building Career Pathways for Cancer Nurses: Ensuring Cancer Nursing's Future

Objectives: It is well established that cancer nurses and Advanced Practice Nurses (APN) are critical to the delivery of high-quality, accessible, safe and affordable cancer care globally. Specialised cancer nurses and APNs with a strong foundation in the pillars of nursing practice (clinical, leadership, education, and research) are essential to optimise patient outcomes, create increased cost-efficiencies through innovative models of care delivery, and can further leverage interprofessional collaboration in cancer care. To address the existing shortcomings in cancer control, Australian cancer nurses, including APNs, and cancer nurses and APNs globally, need an evidence-informed consensus drive framework to harmonize clinical, educational and career pathways leading to specialization, advanced practice, promotion, and equitable and accessible education. Methods: Critical perspective. Results: Scoping work has begun to build on the 2009 seminal Australian EdCaN framework, with ambitions to develop a contemporary practice and career framework for all cancer nurses which details clear pathways to specialised and APN roles inclusive of navigating to and through direct clinical care, research, academia, education and management or executive leadership. Conclusions: A revised framework that is cognisant of the changing landscape of contemporary cancer care, and the growing diversity of nursing roles is needed to address the imminent nursing workforce crisis. Implications for Nursing Practice: The revised framework may support the implementation of the newly released Australian Cancer Plan and provide a career pathway model that may be adopted internationally, including in low and middle income countries.

Practice Consolidation Among US Medical Oncologists, 2015-2022.

Health care consolidation has significantly affected cancer care delivery, with oncology practices undergoing substantial consolidation over the past two decades. This study investigates practice consolidation trends among medical oncologists (MOs), factors associated with consolidation, and changes in MO geographic distribution. Medicare data from 2015 to 2022 were used to assess MO practice consolidation in hospital referral regions (HRRs), linked with regional health care market data and physician demographics. The Herfindahl-Hirschman Index (HHI) was used to measure consolidation, and the Gini coefficient was used to measure MO distribution across counties. Multivariable linear regression explored factors associated with MO practice consolidation. Between 2015 and 2022, the number of MOs increased by 14.5% (11,727-13,433), whereas the number of MO practices decreased by 18.0% (2,774-2,276). The mean number of MOs per practice increased by 40% (4.26-5.95; P < .001). The percentage of MOs in small practices decreased, whereas larger practices saw an increase. MO consolidation, as indicated by the HHI, increased by 9% (median HHI, 0.3204-0.3480). HRRs with higher baseline hospital consolidation and more hospital beds per capita were more likely to have MO practice consolidation. Despite MO practice consolidation, the county-level distribution of MOs did not change substantially. On the basis of Federal Trade Commission classifications, MO practices were highly concentrated in 2015 and consolidated even further by 2022. While distribution of MOs at the county level remained stable, further research is needed to assess the effects of rapid consolidation on cancer care cost, quality, and access. These data have important implications for policymakers and payers as they design programs that ensure high-quality, affordable cancer care.

Cancer care and economic burden-A narrative review.

Cancer care poses a significant economic burden in India, where noncommunicable diseases contribute to a large number of deaths and disability-adjusted life-years. Despite economic growth, equitable wealth distribution remains a challenge, leading to inequalities in healthcare access. India's healthcare system is primarily privatized, financed through out-of-pocket expenditure (OOPE), and lacks coverage for a majority of the population. As a result, individuals without financial means face catastrophic health consequences when seeking necessary healthcare. OOPE in India's healthcare system is a major concern, with medicines accounting for a significant portion of expenses, followed by diagnostic tests and consultation fees. Nonmedical expenses also contribute to the financial burden. Cancer care specifically faces substantial financial challenges, with high treatment costs, reduced workforce participation, and the need for distress financing. Cancer-related OOPE is predominantly borne by patients and their families, leading to significant financial strain. The lack of comprehensive health insurance coverage and limited access to publicly funded healthcare services exacerbate the problem. Catastrophic health expenditure (CHE) in cancer care is prevalent, pushing households into financial distress and potentially impoverishment. Efforts have been made to address this issue, such as increasing public spending on healthcare and implementing health insurance schemes. However, challenges remain in ensuring their effectiveness and reach. The role of family care physicians is crucial in supporting patients and their families during catastrophic health expenditures related to cancer-related palliative care. They coordinate care, provide advocacy, emotional support, symptom management, and facilitate end-of-life discussions. Comprehensive measures are needed to strengthen healthcare infrastructure, improve access to affordable cancer care, enhance health insurance coverage, and implement supportive measures for cancer patients. Additionally, promoting preventive measures and early detection can help reduce the need for expensive treatments and decrease the risk of catastrophic health expenditures.

Community reporting on cost and quality in Washington state: Lessons learned.

39 Background: As part of an ongoing initiative to improve the quality and affordability of cancer care in WA state., the Hutchinson Institute for Cancer Outcomes Research (HICOR) releases open access reports showing cost and quality across several cancer care domains. Here, using the Agency for Healthcare Research and Quality’s (AHRQ) framework for quality reporting as a guide, we report processes, successes, challenges, and lessons learned. Methods: In 2014, HICOR began a transparent, inclusive, multi-stakeholder approach to identify priority metrics of oncology care quality and cost. Using a registry-claims database covering over 70% of cancer patients in WA state, HICOR constructed clinic-level adherence and episode costs for community-prioritized metrics. From 2018 to 2023, five reports were released. The 2018, 2019, and 2021 reports covered 4 domains (appropriate therapy, hospitalizations during chemotherapy, surveillance testing, and end-of-life care). The 2020 report compared quality measures between commercial and Medicaid-enrolled patients. The 2023 report expands the measure list to include biomarker and germline testing and timeliness of care. Between 2020 and 2022, HICOR reported on the impact of COVID-19 on cancer care in WA State. HICOR hosts an annual gathering of oncology practice leaders, payors, and patients to review findings, share best practices, and identify areas for regional research and quality improvement efforts. Results: HICOR’s processes relative to the AHRQ framework are summarized in the table. Conclusions: Community reporting of cancer cost and quality measure requires a flexible framework, balancing parsimony, relevance, and actionability of measures, transparency, and trust in methods, and providing multiple opportunities for feedback. Engaging the community in quality improvement research is critical but challenging due to unpredictability in funding. [Table: see text]

Financial Toxicity: Unveiling the Burden of Cancer Care on Patients in Rwanda.

Cancer is a major public health problem in Rwanda and other low- and middle-income countries (LMICs). While there have been some improvements in access to cancer treatment, the cost of care has increased, leading to financial toxicity and treatment barriers for many patients. This study explores the financial toxicity of cancer care in Rwanda. This prospective cross-sectional study was conducted at 3 referral hospitals in Rwanda, which deliver most of the country's cancer care. Data were collected over 6 months from June 1 to December 1, 2022 by trained research assistants (RAs) using a modified validated data collection tool. RAs interviewed consecutive eligible patients with breast cancer, cervical cancer, colorectal cancer, Hodgkin's and non-Hodgkin's lymphoma who were on active systemic therapy. The study aimed to identify sources of financial burden. Data were analyzed using descriptive statistics. 239 patients were included; 75% (n = 180/239) were female and mean age was 51 years. Breast, cervix, and colorectal cancers were the most common diagnoses (42%, 100/239; 24%, 58/239; and 24%, 57/239, respectively) and 54% (n = 129/239) were diagnosed with advanced stage (stages III-IV). Financial burden was high; 44% (n = 106/239) of respondents sold property, 29% (n = 70/239) asked for charity from public, family, or friends, and 16% (n = 37/239) took loans with interest to fund cancer treatment. Despite health insurance which covers many elements of cancer care, a substantial proportion of patients on anti-cancer treatment in Rwanda experience major financial toxicity. Novel health financing solutions are needed to ensure accessible and affordable cancer care.

Antitumor effect of plant-produced anti-CTLA-4 monoclonal antibody in a murine model of colon cancer.

Cytotoxic T lymphocyte-associated protein 4 (CTLA-4) is an immune checkpoint regulator exclusively expressed on T cells that obstructs the cell's effector functions. Ipilimumab (Yervoy®), a CTLA-4 blocking antibody, emerged as a notable breakthrough in modern cancer treatment, showing upfront clinical benefits in multiple carcinomas. However, the exhilarating cost of checkpoint blockade therapy is discouraging and even utmost prominent in developing countries. Thereby, affordability of cancer care has become a point of emphasis in drug development pipelines. Plant expression system blossomed as a cutting-edge platform for rapid, facile to scale-up, and economical production of recombinant therapeutics. Here, we describe the production of an anti-CTLA-4 2C8 antibody in Nicotiana benthamiana. ELISA and bio-layer interferometry were used to analyze antigen binding and binding kinetics. Anticancer responses in vivo were evaluated using knocked-in mice implanted with syngeneic colon tumor. At 4 days post-infiltration, the antibody was transiently expressed in plants with yields of up to 39.65 ± 8.42 μg/g fresh weight. Plant-produced 2C8 binds to both human and murine CTLA-4, and the plant-produced IgG1 also binds to human FcγRIIIa (V158). In addition, the plant-produced 2C8 monoclonal antibody is as effective as Yervoy® in inhibiting tumor growth in vivo. In conclusion, our study underlines the applicability of plant platform to produce functional therapeutic antibodies with promising potential in cancer immunotherapy.

Redefining Cancer Research Priorities in Low- and Middle-Income Countries in the Post-COVID-19 Global Context: A Modified Delphi Consensus Process.

The post-COVID-19 funding landscape for cancer research globally has become increasingly challenging, particularly in resource-challenged regions (RCRs) lacking strong research ecosystems. We aimed to produce a list of priority areas for cancer research in countries with limited resources, informed by researchers and patients. Cancer experts in lower-resource health care systems (as defined by the World Bank as low- and middle-income countries; N = 151) were contacted to participate in a modified consensus-seeking Delphi survey, comprising two rounds. In round 1, participants (n = 69) rated predetermined areas of potential research priority (ARPs) for importance and suggested missing ARPs. In round 2, the same participants (n = 49) rated an integrated list of predetermined and suggested ARPs from round 1, then undertook a forced choice priority ranking exercise. Composite voting scores (T-scores) were used to rank the ARPs. Importance ratings were summarized descriptively. Findings were discussed with international patient advocacy organization representatives. The top ARP was research into strategies adapting guidelines or treatment strategies in line with available resources (particularly systemic therapy) (T = 83). Others included cancer registries (T = 62); prevention (T = 52); end-of-life care (T = 53); and value-based and affordable care (T = 51). The top COVID-19/cancer ARP was strategies to incorporate what has been learned during the pandemic that can be maintained posteriorly (T = 36). Others included treatment schedule interruption (T = 24); cost-effective reduction of COVID-19 morbidity/mortality (T = 19); and pandemic preparedness (T = 18). Areas of strategic priority favored by cancer researchers in RCRs are related to adaptive treatment guidelines; sustainable implementation of cancer registries; prevention strategies; value-based and affordable cancer care; investments in research capacity building; epidemiologic work on local risk factors for cancer; and combatting inequities of prevention and care access.

Https://www.hmpgloballearningnetwork.com/site/jcp/feature-story/oncology-pathways-drive-adoption-high-quality-treatment-regimens-and-deliver

In an environment of rapid innovation and sharply rising costs, on­cology clinical pathways are a solution that can help bridge knowledge gaps for providers and ensure patients get quality, affordable cancer care. Cigna and evi­Core Healthcare developed an Oncology Value-based Pathways (VP) program by incorporating several value frameworks and considering the perspectives of multiple stakeholders, including patients, providers, and payers. Starting Janu­ary 1, 2021, the VP program was implemented for a large commercial population, spanning 51 clinical pathways and covering 50% of cancers. Over an 18-month period, the VP program increased the on-pathway regimen rate by 5.2%, leading to a cost savings of $24 million or $0.13 per member per month in a commercial managed population. Direct peer-to-peer conversations with providers who or­dered off-pathway regimens led to updated requests for on-pathway regimens in 18.3% of cases. Additionally, 28.3% of total cases were moved to on-pathway regimens, regardless of whether there was a peer-to-peer discussion with the provider, indicating the VP program’s durable educational impact.

Facilitating Cancer Care Through Ayushman Bharat Scheme (PMJAY) in Rural Places of India: A Narrative Review

&#x0D; Pradhan Mantri Jan Arogya Yojana (PMJAY) also known as Ayushman Bharat or flagship National Health Protection Scheme is funded by the Government of India. The scheme takes into account not only the poor but rural families also, and that is why it is economically beneficial to the poor households in rural and urban areas. Either due to lack of funds or due to paucity of health care facilities at adjacent centres, cancer care in rural areas has always been suboptimal. Poor people are almost always on the verge of facing economic toxicities during cancer diagnosis, treatment or rehabilitation. Despite various available regional and national programs for healthcare in India, lack of insurance scheme was an inseparable problem. Ayushman Bharat scheme provides financial protection for access curative care at secondary and tertiary levels through engagement with both public and private sector. Pradhan Mantri Jan Arogya Yojana (PM-JAY) and Health and Wellness Centres (HWCs) are the two major components. Ayushman Bharat provides India with a great opportunity to improve the quality of health-care delivery by linking reimbursements directly to adherence to evidence-based management guidelines. Newer modalities of radiotherapy, chemotherapy and other biological therapies have been included under this scheme. Removes the burden of out of pocket expenditures. In Spite of multiple benefits PMJAY is not out of fallacies. Paucity of health care services, difficulties with implementation, failure in compensating associated indirect costs are the major drawbacks. Opportunities like delivering affordable and equitable cancer care in India, digitalization, removing heterogeneity across rural and urban India are the future perspectives. To conclude, if PMJAY can overcome these shortcomings, and also incorporate a hospital cash component, it could genuinely claim to be the world’s largest and most successful national health protection scheme.&#x0D;

Deficient state-supported cancer care: A source of deep concern

Deficient state-supported cancer care: A source of deep concern

Drug Development in Low- and Middle-Income Countries: Opportunity or Exploitation?

Low- and middle-income countries (LMICs) represent a diverse group of regions with varied cancer presentation. Drug development and accessibility across these regions have primarily been dependent on the trials initiated and conducted across high-income countries. Representation of LMIC regions in these trials in terms of study population has been minimal, leading to inequitable distribution of optimal and affordable cancer care. In spite of many challenges, LMICs have now increasingly been able to contribute to anticancer drug development. The opportunities present in LMICs must be explored and used in conjunction with due collaborative efforts from high-income countries, health care planners, and regulatory agencies. Global drug development trials should not only factor in suitable representation of LMICs but also design studies with pragmatic objectives and endpoints so that the trial results lead to equitable and affordable cancer care. Strengthening collaboration between cancer researchers from LMICs and high-income countries and empowering the local investigator with adequate resources will help remove current disparities.

Kerala Cancer Control Strategy 2018–30: a pragmatic vision of equitable, accessible, and affordable cancer care in low-resource settings

The Indian state of Kerala has achieved remarkable success in communicable disease prevention and in maternal and child health. Over the past 30-40 years, non-communicable diseases, such as cancer, have emerged as new public health challenges. The Kerala Cancer Control Strategy provides a roadmap to address the various cancer-related challenges in a timely manner. The goals and targets set in the document will complement larger efforts to meet sustainable development goals. A State Cancer Control Board was formed, with the Minister for Health of the Government of Kerala as the chairperson and representation by administrators and oncologists from both private and public institutions. District cancer control committees are being formed in all 14 districts of Kerala under the head of district administration and with the involvement of public representatives, civil society, medical professional associations, and health-care administrators. The committees will monitor and implement the cancer control strategy. The main objective of decentralising the approach by having District Cancer Control Committees is to promote early diagnosis and ensure a treatment-care continuum. It will focus not only on current cases but also take preventive measures at the individual and societal levels, and engage the Panchayathi Raj Institutions (local self-government) to take various measures to reduce the cancer burden in the state. The Kerala Cancer Care Grid is being formed to ensure equitable access to affordable cancer detection and treatment services within 50 km of the residence of patients. This grid is envisaged as a network of different tiers of public health institutions with assistance from private health facilities. Defined responsibilities in cancer awareness, public education, early cancer detection, referral pathway, appropriate management, rehabilitation, and patient follow-up form the core of function of the Kerala Cancer Care Grid, which will ensure that standard treatment protocols are used and that costs are contained. Integrated prevention and control of cancer risk factors through citizen participation and policy support will be implemented through the District Cancer Control Committee. The Kerala Cancer Control Strategy is in the initial implementation stage. District Cancer Control Committees act as a platform for partnership with private hospitals and civil society organisations. A District Cancer Control Programme was piloted in one district and is being extended to two more districts in 2022. The programme is expected to be extended to all districts in Kerala by the end of 2022. Decentralisation of cancer care has begun with district hospitals and sub-district hospitals to provide cancer chemotherapy services. Workshops were done to bring out uniform information, education, and communication materials and treatment protocols. To streamline cancer documentation and assess cancer burden, a state cancer registry is being implemented, which would also provide longitudinal details and survival data. The Kerala Cancer Control Strategy envisages a state-wide uniform strategy for cancer control. Decentralisation of cancer care will reduce the workload of apex cancer centres, freeing resources for those with greater needs. The Kerala Cancer Care Grid has the potential to revolutionise the delivery of cancer care in the state. Other low-resource countries could adapt this model to provide optimum cancer care for their population. None.

My Journey of Becoming a Doctorpreneur-Transforming Dream into Reality.

The dream of bringing affordable, accessible, and quality cancer care to the people is my dream, and it took me almost over a decade to turn it into reality. My dream took its shape in 2007 by starting Manavata Cancer Centre, a 75-bed regional cancer centre in Nashik, Maharashtra. We then collaborated with Dr. Ajai Kumar of Health Care Global Enterprises and added 200 additional beds making a total of 275 oncology beds dedicated exclusively to treat cancer patients. Over the years, we have emerged as a complete comprehensive cancer care centre with a team of 700 + members, ensuring multidisciplinary care under one roof. We have always kept ourselves forefront in terms of bringing advanced technology to our patients and in conducting various academic programs (DNB programs, breast and head and neck fellowships and industry-sponsored clinical trials etc.) for academic advancement. As of date, > 95,000 patients were treated at our centre and > 50,000 ladies were screened under our women's health initiative program - Arogya Saheli.

Exploring Sustainable and Affordable Cancer Care Using Artificial Intelligence

Now, in recent decades, AI and ML have become a major part in developing and maintaining the healthcare system. Now, by using AI and ML in healthcare, it can provide a massive help for the healthcare workers. AI and ML help the healthcare workers for making better decisions. In some practical areas, it may take the place of human action for making decisions such as radiology. It can help to gather medical knowledge or information from different journals, textbooks, or clinics, which will help in reducing time for study and research. AI and ML help in predicting the early diagnosis of disease based on the patient’s data and even help to prevent that disease. Breast cancer is the most frequent category. Breast cancer is followed by lung cancer, followed by mouth cancer. These statistics have triggered this research. Breast cancer is found in every one women among eight woman. Sustainable care shall help to fight with the disease. Sustainable care includes affordable cancer care and it’s possible through early prediction of cancer. In this research we are using artificial intelligence-based techniques for early prediction of cancer. Future direction of work will focus on usage of transfer learning and other models of AI-ML to help the society and mothers of nations to fight against the increasing spread of cancers.

The Lancet Commission on cancer and health systems: harnessing synergies to achieve solutions

The Lancet Commission on cancer and health systems: harnessing synergies to achieve solutions

Estimated annual prevalence, medical service utilization and direct costs of lung cancer in urban China.

BackgroundEvidence‐based policy making for delivering affordable lung cancer care relies on the breadth, depth and quality of knowledge of its treatment costs. This study estimates the annual prevalence, medical service utilization and direct treatment costs of lung cancer in urban China.Materials and MethodsUsing claim data from China's urban basic medical insurance between 2013 and 2016, we constructed a nationally representative sample of lung cancer patients in urban China. Weighted descriptive analyses, Poisson regressions and generalized linear modelling were used to analyse lung cancer medical service utilization and costs and their associations with patient characteristics.ResultsIn urban China, the annual prevalence of lung cancer was 87.65/100000, with nearly 0.65% of total health expenditures of urban residents spent on lung cancer treatments. Weighted average annual total medical costs of lung cancer was RMB33.78 (US$5.36) thousand, with annual out‐of‐pocket costs of RMB10.26 (US$1.63) thousand. The average yearly number of lung cancer‐related outpatient visits was 2.42 and inpatient admissions was 2.07, with an average cost of RMB0.75 (US$0.12) thousand for outpatients and RMB 15.67 (US$2.49) thousand for inpatients. Inpatient expenses were the major component (95%) of lung cancer medical costs, with roughly 67% of inpatient services occurring in high‐level tertiary hospitals. Medical care utilization and direct medical costs were associated with sex, age and insurance status. Western medicine costs were the major contributor (39.4%) to average lung cancer‐related medical costs.ConclusionLung cancer imposed a significant economic burden on China's health system and a financial cost on lung cancer sufferers and their families. Specific policies are required to efficiently allocate health resources, contain health expenditure and decrease the individual financial burden of lung cancer.

Out-of-Pocket, Catastrophic Health Expenditure and Distress Financing on Non-Communicable Diseases in India: A Systematic Review with Meta-Analysis.

Objective:The aim of this systematic review is to determine pooled estimates of out-of-pocket (OOPE) and catastrophic health expenditure (CHE), correlates of CHE, and most common modes of distress financing on the treatment of selected non-communicable disease (cancer) among adults in India. Methods:PubMed, Scopus and Embase were searched for eligible studies using strict inclusion and exclusion criteria. Data was extracted and pooled estimates using random effects model of meta-analysis were determined for different types of costs. Forest plots were created and heterogeneity among studies was checked. Results:The pooled estimate of direct OOPE on inpatient and outpatient cancer care were 83396.07 INR (4405.96 USD) (95% CI = 44591.05-122202.0) and 2653.12 (140.17 USD) INR (95% CI = -251.28-5557.53), respectively, total direct OOPE was 47138.95 INR (2490.43 USD) (95% CI = 37589.43-56690.74), indirect OOPE was 11908.50 INR (629.15 USD) (95% CI=-5909.33-29726.31) and proportion of individuals facing CHE was 62.7%. However, high heterogeneity was observed among the studies. Savings, income, borrowing money and sale of assets were the most common modes of distress financing for cancer treatment. Conclusion:Income- and treatment-related cancer policies are needed to address the evidently high and unaffordable cancer treatment cost. Economic studies are needed for estimating all types of costs using standardised definitions and tools for precise estimates. Robust cancer database/registries and programs focusing on affordable cancer care can reduce the economic burden and prevent impoverishment.

Comprehensive value-based cancer care in India: Opportunities for systems strengthening.

Cancer has been one of the leading causes of death in India in the past decade. The growing cancer burden has generated an unmet need to identify and address gaps in the healthcare system to enable access to affordable and quality cancer care for all in a manner that enhances the value of care. This paper provides an overview of the value-based care approach, identifies areas for enhancing the objectives of value-based care through multi-characteristic and multidimensional consideration of patient centricity and proposes health system strategies to improve comprehensive value-based care in India within the current context, focusing on implications for women’s cancers. The core characteristics of patient centricity – heterogeneity and complexity – are detailed to complement and expand on previously defined aspects of value-based care. Comprehensive value-based cancer care can serve as a test case and proof of concept for the rest of the health system in India and focusing on women’s cancers as a starting point can mandate attention to gender-responsive and transformative design and implementation.

Impact of Evidence-Based Chemotherapy Regimens on Health Outcomes, Utilization and Cost for Diffuse Large-b-Cell Lymphoma (DLBCL) Patients

Introduction Diffuse large-b-cell lymphoma (DCBCL), an important, prevalent sub-type of non-Hodgkin lymphoma, is treated with curative intent. A national commercial payer has designated certain chemotherapy regimens as "on-pathway" based on their efficacy, toxicities, and costs, to enhance high quality and affordable cancer care. This study compared health outcomes, healthcare utilization and cost among DLBCL patients receiving on-pathway versus off-pathway regimens. Methods Using administrative claims data and clinical data from the payer's Cancer Care Quality Program, we identified 1,012 DLBCL patients aged 18 or older, receiving first-line chemotherapy from 2014 to 2018. Those with a history of non-NHL cancer or prior exposure to chemotherapy were excluded. Outcomes, including complications, use of diagnostic imaging, additional therapies or treatments, hospice enrollment, all-cause mortality, healthcare utilization and cost, were assessed following chemotherapy until death or end of enrollment (up to 12 months). Generalized linear models examined the association between on-pathway regimens and outcome measures, adjusting for demographic characteristics, socioeconomic status, cancer stage, body mass index, comorbidities and healthcare utilization within 6 months prior to chemotherapy. Results A total of 695 (68.7%) patients received on-pathway regimens. Both groups had similar age (57.9 vs. 58.4, p=0.72), females (42.6% vs 44.8%, p=0.51) and follow-up time (10.6 vs.10.8 months). However, more on-pathway patients were obese (40.4% vs.33.8%, p=0.04) and had early-stage NHL (44.2% vs.24.0%, p=0.002). The use of on-pathway regimens was associated with significantly lower risk for blood transfusion (adjusted odds ratio (AOR): 0.64, 95% CI: 0.45-0.91), similar risk for infections (AOR:1.05, 95%CI: 0.74 -1.49) and granulocytopenia (AOR:1.16, 95%CI: 0.81-1.67) compared to off-pathway regimens. The on-pathway group also had significantly more use of PET scan (incidence rate ratio (IRR): 1.12, 95% CI: 1.04-1.21), radiotherapy (IRR: 1.57, 95% CI: 1.07-2.31), and higher likelihood of using granulocyte colony stimulating factors (G-CSF)(AOR: 1.95, 95% CI: 1.33-2.87). One potential explanation for the observed difference in G-CSF use was that 93% on-pathway patients used regimens with intermediate risk for febrile neutropenia while more than 25% off-pathway regimens had low risk. There was no difference in the risk of hospice enrollment (adjusted hazard ratio (AHR)=0.97, 95%CI: 0.56-1.70) and all-cause mortality (AHR=0.97, 95%CI: 0.51-1.88) during follow-up. Patients receiving on-pathway regimens had significantly fewer non-transplant hospital admissions (IRR: 0.75, 95% CI: 0.68-0.84), and lower overall healthcare costs (-$3,335 per patient per month, 95% CI: -$6,146 to -$525), mainly driven by the reduced hospital cost (-$2,517 per patient per month,95% CI: -$4,860 to -$173). Conclusions In our study, on-pathway regimens demonstrated lower risk of complications, and generally lower healthcare utilization and overall total costs. These findings provide a strong basis for promoting evidence-based chemotherapy regimens for DLBCL patients. Disclosures Fisch: AIM Specialty Health: Current Employment.