Low-Income, Female Patients Likely to Face Delayed Leukemia Diagnoses

A new study showed that leukemia and lymphoma, which typically present with nonspecific symptoms, take longer before diagnosis for female or low-income (< 40k) patients.

The data, presented the American Society of Clinical Oncology (ASCO) 2019 Annual Meeting in Chicago, IL, found limited differences among privately insured patients with leukemia and lymphoma aside from gender and low-income disparities.

The leukemia or lymphoma diagnosis is known to be evasive during initial stages, but this is the first study to consider causal factors outside of symptomatic generality.

Investigators from various US hospitals—led by Lena Winestone, MD, MSHP, of the Benioff Children’s Hospital at the University of California-San Francisco&mdash;used the OptumLabs Data Warehouse to identify 17,536 privately insured pediatric (aged 0-14), adolescent (aged 15-21), and young adult (aged 22-39) patients diagnosed with acute leukemia or lymphoma between 2001-2017.

Cancer-related symptoms—most commonly lymphadenopathy, fever, and/or cytopenias&mdash;presented within 6 months prior to diagnosis for 78% of patients.

Delay was categorized as any amount of time exceeding 3 months from symptom onset to diagnosis. Sociodemographic factors were considered with contingency table analysis, chi-squared tests, and unconditional logistic regression.

Multivariable analysis associated young adult age, female sex, and low household income most strongly with delays in diagnosis, while differences due to race/ethnicity were negligible.

Associated odds ratios for each patient group were 0.74 (95% CI: 0.63 — 0.88) for patients aged 15-21 years; 0.85 (0.75 – 0.97) for patients aged 21-39 years; 0.74 (0.67 – 0.81) for male patients; 1.21 (1.02 – 1.44) for low-income patients (P < .05 for all); 1.05 (0.87 — 1.27) for black patients; 0.88 (0.75 – 1.03) for Hispanic patients; and 1.05 (0.94 – 1.17) for medium income patients.

Median days to diagnosis were greater among young adults than children or adolescents (93 vs 86 vs 81; P < .0001). Median days diagnosis for pediatric patients versus adolescent/young adult patients differed for constitutional symptoms (18 vs 37; P < .001); infectious symptoms (93 vs 74; P < .001); and cytopenias (11 vs 22; P < .001).

This research potentially could improve medical professionals’ awareness of unconscious bias in making difficult diagnoses.

The study, “Delays in diagnosis in young patients with leukemia and lymphoma,” was presented at ASCO 2019.