REAL-WORLD SURVIVAL AND PREDICTORS OF MORTALITY IN HEMATOLOGIC MALIGNANCIES DURING AN ERA OF THERAPEUTIC ADVANCEMENT AND HEALTHCARE DISRUPTION: A POPULATION-BASED SEER STUDY
Author(s)
Akwasi A. Akosah, MPH, PharmD1, Lorenzo A. Villa Zapata, PhD2;
1University of Georgia College of Pharmacy, Pharmaceutical Health Services Outcomes and Policy, Athens, GA, USA, 2University of Georgia, Pharmaceutical Health Services Outcomes and Policy, Athens, GA, USA
1University of Georgia College of Pharmacy, Pharmaceutical Health Services Outcomes and Policy, Athens, GA, USA, 2University of Georgia, Pharmaceutical Health Services Outcomes and Policy, Athens, GA, USA
OBJECTIVES: This study aimed to (1) describe real-world survival outcomes and predictors of mortality in patients with hematologic malignancies in the modern oncology care era and (2) evaluate whether survival patterns and treatment-related disparities differed across the pre- and post-COVID-19 periods, considering health system performance indicators.
METHODS: We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) data from 2017 to 2022, including patients with a first primary diagnosis of hematologic malignancy and complete survival information. Primary exposures included baseline demographic and clinical characteristics, malignancy subtype, chemotherapy, radiation/surgery, median household income, rurality, and time to treatment initiation (TTI). The diagnosis period (pre-COVID: 2017-2019; post-COVID: 2020-2022) was evaluated as a secondary exposure. Overall survival was assessed using Kaplan-Meier methods and Cox proportional hazards models.
RESULTS: The cohort included 302,452 patients (49.7% pre-COVID-19; 50.1% post-COVID-19). Median follow-up was 19 months, during which 97,035 deaths (32.1%) occurred. Post-COVID diagnosis was associated with a modestly higher hazard of death in unadjusted analyses (HR 1.04; 95% CI 1.03-1.06), which was attenuated after multivariable adjustment (aHR 1.02; 95% CI 1.00-1.03). Chemotherapy receipt was associated with improved survival (aHR 0.83; 95% CI 0.81-0.84). Longer time to treatment initiation was associated with lower mortality (15-30 days: aHR 0.85; >30 days: aHR 0.73), whereas unknown timing and unknown radiation status were associated with higher mortality. Mortality increased sharply with age (aHR 14.71 for ≥75 vs 0-14 years), and male sex was associated with higher mortality (aHR 1.17). Compared with White patients, American Indian/Alaska Native and Black patients experienced higher mortality.
CONCLUSIONS: Adjusted overall survival differed statistically across diagnosis periods; however, the magnitude of this difference was small and suggests largely preserved survival outcomes across periods, with limited clinical impact. This highlights both the resilience of modern oncology care and the need to address structural barriers to equitable cancer outcomes.
METHODS: We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) data from 2017 to 2022, including patients with a first primary diagnosis of hematologic malignancy and complete survival information. Primary exposures included baseline demographic and clinical characteristics, malignancy subtype, chemotherapy, radiation/surgery, median household income, rurality, and time to treatment initiation (TTI). The diagnosis period (pre-COVID: 2017-2019; post-COVID: 2020-2022) was evaluated as a secondary exposure. Overall survival was assessed using Kaplan-Meier methods and Cox proportional hazards models.
RESULTS: The cohort included 302,452 patients (49.7% pre-COVID-19; 50.1% post-COVID-19). Median follow-up was 19 months, during which 97,035 deaths (32.1%) occurred. Post-COVID diagnosis was associated with a modestly higher hazard of death in unadjusted analyses (HR 1.04; 95% CI 1.03-1.06), which was attenuated after multivariable adjustment (aHR 1.02; 95% CI 1.00-1.03). Chemotherapy receipt was associated with improved survival (aHR 0.83; 95% CI 0.81-0.84). Longer time to treatment initiation was associated with lower mortality (15-30 days: aHR 0.85; >30 days: aHR 0.73), whereas unknown timing and unknown radiation status were associated with higher mortality. Mortality increased sharply with age (aHR 14.71 for ≥75 vs 0-14 years), and male sex was associated with higher mortality (aHR 1.17). Compared with White patients, American Indian/Alaska Native and Black patients experienced higher mortality.
CONCLUSIONS: Adjusted overall survival differed statistically across diagnosis periods; however, the magnitude of this difference was small and suggests largely preserved survival outcomes across periods, with limited clinical impact. This highlights both the resilience of modern oncology care and the need to address structural barriers to equitable cancer outcomes.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
PT28
Topic
Epidemiology & Public Health
Disease
SDC: Oncology