Predictors of delay in diagnosis and treatment in diffuse large B-cell lymphoma and impact on survival

There is a paucity of data on the impact of diagnostic and treatment delays on outcomes in haematological malignancies, particularly in patients with diffuse large B-cell lymphoma (DLBCL). Our database of patients treated for DLBCL between 2002 and 2010 was interrogated. Univariate and multivariate analyses were performed to determine the relationship between sociodemographic or disease-specific variables and delays. Cox Regression analysis was used to discern the impact of delays on survival. Patients (n=278) waited a median of 4weeks before seeking medical attention. It took a median of 8weeks for a non-haematology physician to diagnose DLBCL and refer to a haematologist. A median of 3weeks elapsed between specialist consultation and chemotherapy initiation. In multivariate logistic regression analysis, bone marrow involvement [odds ratio (OR)=041, P=0018], Charlson comorbidity index (OR=142, P=0017) and urgent inpatient chemotherapy (OR=040, P=0012) were associated with diagnostic delays >6weeks. Lack of pathological diagnosis at the time of haematology referral was the only factor that independently predicted for treatment delays >4weeks (OR=825, P<001). Diagnostic or treatment delays did not impact survival or progression-free survival. In conclusion, selected disease and patient-related factors are associated with delays in management of DLBCL, but do not impact outcomes.