Patterns of Diagnostic Evaluation and Determinants of Treatment in Older Patients with Non-transfusion Dependent Myelodysplastic Syndromes

Authors

• Sudipto Mukherjee, Case Western Reserve UniversityFollow
• Weichuan Dong, Case Western Reserve UniversityFollow
• Nicholas K. Schiltz, Case Western Reserve UniversityFollow
• Kurt C. Stange, Case Western Reserve UniversityFollow
• Jennifer Cullen, Case Western Reserve UniversityFollow
• Aaron T. Gerds, Case Western Reserve UniversityFollow
• Hetty E. Carraway, Case Western Reserve UniversityFollow
• Abhay Singh, Case Western Reserve UniversityFollow
• Anjali S. Advani, Case Western Reserve UniversityFollow
• Siran M. Koroukian, Case Western Reserve UniversityFollow

Document Type

Article

Publication Date

4-29-2023

Abstract

Background: Older patients with myelodysplastic syndromes (MDS), particularly those with no or one cytopenia and no transfusion dependence, typically have an indolent course. Approximately, half of these receive the recommended diagnostic evaluation (DE) for MDS. We explored factors determining DE in these patients and its impact on subsequent treatment and outcomes. Patients and Methods: We used 2011-2014 Medicare data to identify patients ≥66 years of age diagnosed with MDS. We used Classification and Regression Tree (CART) analysis to identify combinations of factors associated with DE and its impact on subsequent treatment. Variables examined included demographics, comorbidities, nursing home status, and investigative procedures performed. We conducted a logistic regression analysis to identify correlates associated with receipt of DE and treatment. Results: Of 16 851 patients with MDS, 51% underwent DE. patients with MDS with no cytopenia (n = 3908) had the lowest uptake of DE (34.7%). Compared to patients with no cytopenia, those with any cytopenia had nearly 3 times higher odds of receiving DE [adjusted odds ratio (AOR), 2.81: 95% CI, 2.60-3.04] and the odds were higher for men than for women [AOR, 1.39: 95%CI, 1.30-1.48] and for Non-Hispanic Whites [vs. everyone else (AOR, 1.17: 95% CI, 1.06-1.29)]. The CART showed DE as the principal discriminating node, followed by the presence of any cytopenia for receiving MDS treatment. The lowest percentage of treatment was observed in patients without DE, at 14.6%. Conclusion: In this select older patients with MDS, we identified disparities in accurate diagnosis by demographic and clinical factors. Receipt of DE influenced subsequent treatment but not survival.

Keywords

diagnostic evaluation, disparities, MDS, myelodysplastic syndromes

Language

English

Publication Title

Oncologist

Grant

—CELG1611SM

Rights

© 2023 The Author(s). This is an open access work distributed under the terms of the Creative Commons Attribution-Non-Commercial (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

Recommended Citation

Sudipto Mukherjee, Weichuan Dong, Nicholas K Schiltz, Kurt C Stange, Jennifer Cullen, Aaron T Gerds, Hetty E Carraway, Abhay Singh, Anjali S Advani, Mikkael A Sekeres, Siran M Koroukian, Patterns of Diagnostic Evaluation and Determinants of Treatment in Older Patients With Non-transfusion Dependent Myelodysplastic Syndromes, The Oncologist, Volume 28, Issue 10, October 2023, Pages 901–910, https://doi.org/10.1093/oncolo/oyad114