Location-based cancer survival in Philadelphia chromosome-negative acute lymphoblastic leukemia: An urban center retrospective analysis.
Authors: Gor Juhi , Bouligny Ian Michael , Tran Valerie , Hang Yiwei , Ho Thuy , Zacholski Kyle , Venn Chad Michael , Alnimer Yanal Mufeed , Murray Graeme , Patel Tilak , Doyel Michael , Boron Josh , Wages Nolan , Grant Steven , Maher Keri Renee ,   LCRT
Published: June 2023

e18679

Background: Acute lymphoblastic leukemia (ALL) is an aggressive hematological malignancy requiring frequent transfusion support, receipt of multiagent chemotherapy, and for many patients, an allogeneic stem cell transplant. Social determinants of health impact access to care and overall survival in many cancers. However, findings by specific cancer types are inconsistent and vary widely. This study aimed to investigate the impact of location of residence and overall survival in Philadelphia chromosome-negative (Ph-) ALL in an underserved urban setting. Methods: We analyzed 112 patients with Ph- ALL at VCU Massey Cancer Center between 2010 and 2021 in a single-center, retrospective analysis. Sixteen patients did not have location data available. We stratified the remaining 96 patients into two cohorts based on travel distance from the patient's zip code to our center (greater than or less than 50 miles). We stratified patients based on urban or rural habitation using the Rural-Urban Commuting Area Codes (RUCA) classification system. Finally, we stratified patients by the region of Virginia from which the patients were traveling, creating four cohorts: Southside, Northern, Hampton Roads, and Eastern VA. We collected baseline demographics, performance status, disease characteristics, receipt of allogeneic stem cell transplant, and survival. We analyzed survival by the Kaplan-Meier method and compared groups with the Mantel-Cox test. The date of death was used to calculate overall survival; patients were censored at the date of the last contact. Results: Eleven patients (11%) living in rural areas were identified based on RUCA classification; 85 (81%) lived in an urban setting. Overall survival nonsignificantly favored the urban cohort (12.1 y. versus 3.8 y. in the rural cohort, p = 0.873). We combined 51 patients in urban and rural areas outside of Richmond into a single cohort and compared the survival of 45 patients from Richmond — the median survival in Richmond was not reached at a median follow-up time of 4.1 y. Comparatively, the median overall survival of areas outside of Richmond were as follows: 3.3 y. for Southside VA, 5.9 y. for Eastern VA, 12.1 y. for Northern VA, and not reached for Hampton Roads; there were no significant differences between these groups ( p = 0.131). The median overall survival was significantly worse for patients further than 50 miles from VCU compared to within 50 miles of VCU (6.5 years versus not reached at a median follow-up time of 4.2 y., p = 0.042). Conclusions: Areas surrounding Richmond, VA are medically underserved; those with aggressive malignancies — such as ALL — have an increased risk of toxicities with complicated treatment regimens. Indeed, our data demonstrate a survival benefit merely from living close to our center. These results may be influenced by socioeconomic factors impacting access to care.