Abstract 802: Identifying factors that affect barriers to lymphoma treatment during the COVID - 19 pandemic
Authors: Bates Cherie D. , Kalloger Steve E. , Warwick Lorna E. 
Published: April 2023

Abstract
Introduction: Barriers to therapy for patients with lymphoma are an essential topic. The Lymphoma Coalition biennial global patient survey collects data on patient experiences, including challenges or limitations patients face in seeking medical attention or access to treatment. Due to Covid-19, patients with lymphoma have experienced high barriers. This study aims to rank the influence of core demographic variables in their ability to predict barriers to lymphoma treatment in 2020 and 2022.
Methods: The survey was deployed globally to lymphoma patients and caregivers in 2020 & 2022. The outcome variable was the identification of any barrier to receiving lymphoma treatment. Logit regression was used to model the outcome against core demographics. Variable importance was quantified with independent Monte Carlo resampling.
Results: Barriers were significantly elevated in all regions in 2022 (p&lt;0.0001). Those who are of older age were found to have fewer barriers to treatment: Unit OR = 0.965; 95%CI [0.962 - 0.968]. Age was consistently a variable of high importance across most regions in both survey years (Table 1). In 2022, treatment delay due to concerns over COVID-19 was the second-ranked variable of importance in three regions.
Conclusions: Barriers to treatment for patients with lymphoma increased dramatically across all regions from 2020-2022. Increased barriers to treatment in those of younger age were an unexpected finding. Heterogeneity in the impact of variables that influence access to treatment appears to be enhanced by participants' psychosocial impacts due to the pandemic. Policymakers and providers should actively rectify access disparities in their respective regions.
Table 1. Assessment of variable importance for encountering barriers to lymphoma treatment with the top two contributors to the model for each region displayed in bold. Global Patient Survey 2020 Variables Asia-Pacific Europe Middle East & Africa North America South America N 2116 2476 30 820 99 Percent with barrier 50.3% 11.7% 40.0% 18.9% 13.1% Age 0.473 0.286 0.087 0.493 0.309 Education 0.148 0.029 0.322 0.011 0.004 Household Status 0.006 0.432 0.074 0.157 0.149 Indolent/Aggressive 0.014 0.126 0.199 0.189 0.150 Local Area 0.353 0.112 0.316 0.059 0.483 Sex/Gender 0.052 0.047 0.104 0.011 0.074 Global Patient Survey 2022 Variables Asia-Pacific Europe Middle East & Africa North America South America N 1573 2224 32 871 52 Percent with barrier 85.7% 46.7% 88.9% 54.7% 76.1% Age 0.720 0.465 0.001 0.320 0.067 COVID Delay 0.157 0.386 0.002 0.145 0.294 Education 0.001 0.008 0.195 0.046 0.033 Household Status 0.003 0.014 0.173 0.069 0.182 Indolent/Aggressive 0.052 0.007 0.546 0.053 0.312 Local Area 0.141 0.058 0.304 0.375 0.256 Sex/Gender 0.026 0.056 0.152 0.013 0.023 Age is treated as a continuous variable. COVID delay represents a deliberate delay in seeking lymphoma treatment due to fear of contracting COVID-19. Education was binary with the cut-point between secondary and post-secondary. Household status refers to those who are either single or with a partner. Indolent/Aggressive refers to typical clinical behaviour of a lymphoma subtype. Local Area refers to whether a respondent lives in an urban, suburban, or rural setting. Sex/Gender refers to biological sex in the absence of stated gender.
Citation Format: Cherie D. Bates, Steve E. Kalloger, Lorna E. Warwick. Identifying factors that affect barriers to lymphoma treatment during the COVID - 19 pandemic [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 802.