TY - JOUR
T1 - Factors and Considerations in No-Treatment Decisions in Patients With Key Hematological Malignancies
T2 - A Nationwide, Population-Based Study in the Netherlands
AU - Zijlstra, Myrte
AU - Snijders, Rolf A.H.
AU - de Boer, Fransien
AU - Chamuleau, Martine E.D.
AU - Fransen, Heidi P.
AU - Oerlemans, Simone
AU - van der Padt-Pruijsten, Annemieke
AU - Posthuma, Eduardus F.M.
AU - Visser, Otto
AU - Zweegman, Sonja
AU - Raijmakers, Natasja J.H.
AU - Dinmohamed, Avinash G.
N1 - Publisher Copyright:
© 2025 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
PY - 2025/5
Y1 - 2025/5
N2 - Comprehensive insights are lacking into why patients with hematological malignancies (HMs) receive no cancer-directed treatment. We evaluated socio-demographic and cancer-related characteristics, decision-making rationales, and overall survival in patients with three common HMs―diffuse large B-cell lymphoma (DLBCL), symptomatic multiple myeloma (MM), and acute myeloid leukemia (AML)―who do not receive cancer-directed treatment, using the nationwide Netherlands Cancer Registry. A total of 26 945 patients diagnosed with DLBCL (47%), symptomatic MM (29%), or AML (25%) between 2014 and 2021 were included. About 16% of the patients did not receive cancer-directed treatment, ranging from 26% in AML to 15% in DLBCL and 10% in MM. The primary reason for not receiving cancer-directed treatment in all three HMs was related to physical condition. The second main reason was patient/family choice in DLBCL and MM, whereas in AML it was rapid disease progression. In female patients, patient/family choice was a more prevalent reason for not receiving cancer-directed treatment than in male patients. Patients with a lower socio-economic position more often did not receive cancer-directed treatment. Median OS varied by reason for not receiving cancer-directed treatment, with the shortest OS in patients experiencing rapid disease progression or death before treatment initiation (0·4 to 0·6 months).
AB - Comprehensive insights are lacking into why patients with hematological malignancies (HMs) receive no cancer-directed treatment. We evaluated socio-demographic and cancer-related characteristics, decision-making rationales, and overall survival in patients with three common HMs―diffuse large B-cell lymphoma (DLBCL), symptomatic multiple myeloma (MM), and acute myeloid leukemia (AML)―who do not receive cancer-directed treatment, using the nationwide Netherlands Cancer Registry. A total of 26 945 patients diagnosed with DLBCL (47%), symptomatic MM (29%), or AML (25%) between 2014 and 2021 were included. About 16% of the patients did not receive cancer-directed treatment, ranging from 26% in AML to 15% in DLBCL and 10% in MM. The primary reason for not receiving cancer-directed treatment in all three HMs was related to physical condition. The second main reason was patient/family choice in DLBCL and MM, whereas in AML it was rapid disease progression. In female patients, patient/family choice was a more prevalent reason for not receiving cancer-directed treatment than in male patients. Patients with a lower socio-economic position more often did not receive cancer-directed treatment. Median OS varied by reason for not receiving cancer-directed treatment, with the shortest OS in patients experiencing rapid disease progression or death before treatment initiation (0·4 to 0·6 months).
UR - https://www.scopus.com/pages/publications/85216382392
U2 - 10.1111/ejh.14390
DO - 10.1111/ejh.14390
M3 - Article
C2 - 39888067
AN - SCOPUS:85216382392
SN - 0902-4441
VL - 114
SP - 872
EP - 882
JO - European Journal of Haematology
JF - European Journal of Haematology
IS - 5
ER -
