OBJECTIVES: The objective of this study was to describe racial differences in the prevalence of a cognitive impairment or dementia diagnosis, likelihood of chemo-immunotherapy utilization and subsequent survival in elderly diffuse large B-cell lymphoma (DLBCL) patients.

METHODS: We conducted a retrospective cohort study using cancer data from the Surveillance, Epidemiology, and End Results (SEER)–Medicare linked database. We identified Medicare beneficiaries with a first primary DLBCL diagnosis between 2001 and 2011. A validated algorithm for use with administrative claims data was used to determine presence of neurocognitive impairment or dementia diagnosis at baseline and throughout the study period based on International Classification of Diseases, Ninth Revision (ICD-9) and procedural codes.

RESULTS: Of the 10,626 Medicare beneficiaries identified with a DLBCL diagnosis, 410 (3.9%) patients also had evidence of a neurocognitive impairment or dementia diagnosis during the study period. The proportion of patients with comorbid neurocognitive impairment or dementia with DLBCL diagnosis was slightly higher among Non-Hispanic Black (6.1%) and Hispanic (4.6%) patients compared to non-Hispanic White (3.7%) and Asian/Pacific Islander (3.3%) patients. In multivariable models, patients with neurocognitive impairment or dementia had significantly lower odds of systemic treatment with chemo-immunotherapy (OR: 0.43; 95% CI: 0.34–0.54) with even lower odds of treatment among Black (OR: 0.16; 95% CI: 0.04–0.48) and Hispanic patients (OR: 0.17; 95% CI: 0.06–0.46). Poorer cancer-specific survival was observed among DLBCL patients with documented neurocognitive impairment or dementia (HR: 1.61, 95% CI: 1.43, 1.81), but this association was attenuated when adjusting for differences in curative treatment received (HR: 1.39, 95% CI: 1.24, 1.57).

CONCLUSIONS: There are racial differences in neurocognitive impairment and dementia and chemo-immunotherapy utilization among elderly DLBCL patients. Further research is needed to understand patient, caregiver and provider preferences in the care of lymphoma patients with these conditions.