Hematologist/oncologist disease-specific expertise and survival: Lessons from chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL)

Tait D. Shanafelt, Neil Elliot Kay, Kari G. Rabe, David J. Inwards, Clive S. Zent, Jose F. Leis, Susan M. Schwager, Carrie A Thompson, Deborah A. Bowen, Thomas Elmer Witzig, Susan L Slager, Timothy G. Call

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

BACKGROUND: The impact of physicians' disease-specific expertise on patient outcome is unknown. Although previous studies suggest a survival advantage for cancer patients cared for at high-volume centers, these observations may simply reflect referral bias or better access to advanced technologies, clinical trials, and multidisciplinary support at large centers. METHODS: We evaluated time to first treatment (TTFT) and overall survival (OS) of patients with newly diagnosed chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL) at a single academic center based on whether they were cared for by a hematologist/oncologist who subspecializes in CLL (CLL hematologist) or a hematologist/oncologist with expertise in other areas (non-CLL hematologist). RESULTS: Among 1309 newly diagnosed patients with CLL cared for between 1999 and 2009, 773(59%) were cared for by CLL hematologists and 536 were cared for by non-CLL hematologists. Among early-stage patients (Rai 0-I), median TTFT (9.2 vs 6.1 years; P < .001) and OS (10.5 years vs 8.8 years; P < .001) were longer for patients cared for by CLL hematologists. For all patients, OS was superior for patients cared for by CLL hematologists (10.5 years vs 8.4 years; P = .001). Physician's disease-specific expertise remained an independent predictor of OS after adjusting for age, sex, stage, and lymphocyte count at diagnosis. Patients seen by a CLL hematologist were also more likely to participate in clinical trials (48% vs 16%; P < .001). CONCLUSIONS: Physician disease-specific expertise appears to influence outcome in patients with CLL. To the greatest extent possible, patients should be cared for by a hematologist/oncologist expert in the care of their specific malignancy. When not possible, practice guidelines developed by disease-specific experts should be followed.

Original languageEnglish (US)
Pages (from-to)1827-1837
Number of pages11
JournalCancer
Volume118
Issue number7
DOIs
StatePublished - Apr 1 2012

Fingerprint

B-Cell Chronic Lymphocytic Leukemia
Survival
Lymphoid Leukemia
Physicians
Oncologists
Clinical Trials
Lymphocyte Count
Practice Guidelines
Neoplasms
Referral and Consultation
Technology

Keywords

  • Chronic lymphocytic lymphoma (CLL)
  • Physician expertise
  • Prognosis
  • Small lymphocytic lymphoma (SLL)

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Hematologist/oncologist disease-specific expertise and survival : Lessons from chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL). / Shanafelt, Tait D.; Kay, Neil Elliot; Rabe, Kari G.; Inwards, David J.; Zent, Clive S.; Leis, Jose F.; Schwager, Susan M.; Thompson, Carrie A; Bowen, Deborah A.; Witzig, Thomas Elmer; Slager, Susan L; Call, Timothy G.

In: Cancer, Vol. 118, No. 7, 01.04.2012, p. 1827-1837.

Research output: Contribution to journalArticle

Shanafelt, Tait D. ; Kay, Neil Elliot ; Rabe, Kari G. ; Inwards, David J. ; Zent, Clive S. ; Leis, Jose F. ; Schwager, Susan M. ; Thompson, Carrie A ; Bowen, Deborah A. ; Witzig, Thomas Elmer ; Slager, Susan L ; Call, Timothy G. / Hematologist/oncologist disease-specific expertise and survival : Lessons from chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL). In: Cancer. 2012 ; Vol. 118, No. 7. pp. 1827-1837.
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abstract = "BACKGROUND: The impact of physicians' disease-specific expertise on patient outcome is unknown. Although previous studies suggest a survival advantage for cancer patients cared for at high-volume centers, these observations may simply reflect referral bias or better access to advanced technologies, clinical trials, and multidisciplinary support at large centers. METHODS: We evaluated time to first treatment (TTFT) and overall survival (OS) of patients with newly diagnosed chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL) at a single academic center based on whether they were cared for by a hematologist/oncologist who subspecializes in CLL (CLL hematologist) or a hematologist/oncologist with expertise in other areas (non-CLL hematologist). RESULTS: Among 1309 newly diagnosed patients with CLL cared for between 1999 and 2009, 773(59{\%}) were cared for by CLL hematologists and 536 were cared for by non-CLL hematologists. Among early-stage patients (Rai 0-I), median TTFT (9.2 vs 6.1 years; P < .001) and OS (10.5 years vs 8.8 years; P < .001) were longer for patients cared for by CLL hematologists. For all patients, OS was superior for patients cared for by CLL hematologists (10.5 years vs 8.4 years; P = .001). Physician's disease-specific expertise remained an independent predictor of OS after adjusting for age, sex, stage, and lymphocyte count at diagnosis. Patients seen by a CLL hematologist were also more likely to participate in clinical trials (48{\%} vs 16{\%}; P < .001). CONCLUSIONS: Physician disease-specific expertise appears to influence outcome in patients with CLL. To the greatest extent possible, patients should be cared for by a hematologist/oncologist expert in the care of their specific malignancy. When not possible, practice guidelines developed by disease-specific experts should be followed.",
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T1 - Hematologist/oncologist disease-specific expertise and survival

T2 - Lessons from chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL)

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AU - Kay, Neil Elliot

AU - Rabe, Kari G.

AU - Inwards, David J.

AU - Zent, Clive S.

AU - Leis, Jose F.

AU - Schwager, Susan M.

AU - Thompson, Carrie A

AU - Bowen, Deborah A.

AU - Witzig, Thomas Elmer

AU - Slager, Susan L

AU - Call, Timothy G.

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N2 - BACKGROUND: The impact of physicians' disease-specific expertise on patient outcome is unknown. Although previous studies suggest a survival advantage for cancer patients cared for at high-volume centers, these observations may simply reflect referral bias or better access to advanced technologies, clinical trials, and multidisciplinary support at large centers. METHODS: We evaluated time to first treatment (TTFT) and overall survival (OS) of patients with newly diagnosed chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL) at a single academic center based on whether they were cared for by a hematologist/oncologist who subspecializes in CLL (CLL hematologist) or a hematologist/oncologist with expertise in other areas (non-CLL hematologist). RESULTS: Among 1309 newly diagnosed patients with CLL cared for between 1999 and 2009, 773(59%) were cared for by CLL hematologists and 536 were cared for by non-CLL hematologists. Among early-stage patients (Rai 0-I), median TTFT (9.2 vs 6.1 years; P < .001) and OS (10.5 years vs 8.8 years; P < .001) were longer for patients cared for by CLL hematologists. For all patients, OS was superior for patients cared for by CLL hematologists (10.5 years vs 8.4 years; P = .001). Physician's disease-specific expertise remained an independent predictor of OS after adjusting for age, sex, stage, and lymphocyte count at diagnosis. Patients seen by a CLL hematologist were also more likely to participate in clinical trials (48% vs 16%; P < .001). CONCLUSIONS: Physician disease-specific expertise appears to influence outcome in patients with CLL. To the greatest extent possible, patients should be cared for by a hematologist/oncologist expert in the care of their specific malignancy. When not possible, practice guidelines developed by disease-specific experts should be followed.

AB - BACKGROUND: The impact of physicians' disease-specific expertise on patient outcome is unknown. Although previous studies suggest a survival advantage for cancer patients cared for at high-volume centers, these observations may simply reflect referral bias or better access to advanced technologies, clinical trials, and multidisciplinary support at large centers. METHODS: We evaluated time to first treatment (TTFT) and overall survival (OS) of patients with newly diagnosed chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL) at a single academic center based on whether they were cared for by a hematologist/oncologist who subspecializes in CLL (CLL hematologist) or a hematologist/oncologist with expertise in other areas (non-CLL hematologist). RESULTS: Among 1309 newly diagnosed patients with CLL cared for between 1999 and 2009, 773(59%) were cared for by CLL hematologists and 536 were cared for by non-CLL hematologists. Among early-stage patients (Rai 0-I), median TTFT (9.2 vs 6.1 years; P < .001) and OS (10.5 years vs 8.8 years; P < .001) were longer for patients cared for by CLL hematologists. For all patients, OS was superior for patients cared for by CLL hematologists (10.5 years vs 8.4 years; P = .001). Physician's disease-specific expertise remained an independent predictor of OS after adjusting for age, sex, stage, and lymphocyte count at diagnosis. Patients seen by a CLL hematologist were also more likely to participate in clinical trials (48% vs 16%; P < .001). CONCLUSIONS: Physician disease-specific expertise appears to influence outcome in patients with CLL. To the greatest extent possible, patients should be cared for by a hematologist/oncologist expert in the care of their specific malignancy. When not possible, practice guidelines developed by disease-specific experts should be followed.

KW - Chronic lymphocytic lymphoma (CLL)

KW - Physician expertise

KW - Prognosis

KW - Small lymphocytic lymphoma (SLL)

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