Fax: (507) 266-4972
Hematologist/oncologist disease-specific expertise and survival: Lessons from chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL)
Article first published online: 26 AUG 2011
Copyright © 2011 American Cancer Society
Volume 118, Issue 7, pages 1827–1837, 1 April 2012
How to Cite
Shanafelt, T. D., Kay, N. E., Rabe, K. G., Inwards, D. J., Zent, C. S., Leis, J. F., Schwager, S. M., Thompson, C. A., Bowen, D. A., Witzig, T. E., Slager, S. L. and Call, T. G. (2012), Hematologist/oncologist disease-specific expertise and survival: Lessons from chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL). Cancer, 118: 1827–1837. doi: 10.1002/cncr.26474
- Issue published online: 19 MAR 2012
- Article first published online: 26 AUG 2011
- Manuscript Accepted: 29 JUN 2011
- Manuscript Revised: 6 JUN 2011
- Manuscript Received: 30 MAR 2011
- chronic lymphocytic lymphoma (CLL);
- small lymphocytic lymphoma (SLL);
- physician expertise
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.
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).
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).
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. Cancer 2012. © 2011 American Cancer Society.