Facility-level differences in treatment patterns and outcomes among patients aged ≥ 75 years with follicular lymphoma: A National Cancer Database analysis.

e19064 Background: Follicular lymphoma (FL) is one of the most common indolent non-Hodgkin lymphomas, typically affecting older adults (1). Patients aged ≥75 years are underrepresented in clinical trials, and there are limited data evaluating whether survival differs by treatment setting. Using the National Cancer Database (NCDB), we examined differences in treatment patterns and overall survival among elderly patients with FL treated at Academic Cancer Programs (ACP) versus Community Cancer Programs (CCP). Methods: We conducted a retrospective cohort study of patients aged ≥75 years diagnosed with FL between 2004 and 2022. Patients were stratified by treatment facility type: ACP and CCP. Demographic, socioeconomic, clinical, and survival data were compared between patients treated at ACP and CCP. Kaplan-Meier analysis and Cox proportional hazards models were used to estimate overall survival (OS), adjusting for age, race/ethnicity, insurance status, Charlson-Deyo comorbidity score, and distance from the treating facility. Results: A total of 38,443 patients were identified, with 18,197 (47%) treated at ACP and 20,246 (53%) at CCP. Median age was 80 years in both groups with comparable sex distribution. Most patients were non-Hispanic (~91–92%), with Hispanics comprising <5% in each cohort. Patients treated at ACP were more likely to reside in metropolitan areas, have higher income, and education levels, and travel longer distances for care (8.9 vs. 7.5 miles, p<0.001). Medicare was the primary payor in both settings. Comorbidity burden was low, with >70% of patients having a Charlson-Deyo score of 0 in both cohorts. Overall, 42% had early-stage disease (I–II) and 47% had advanced-stage disease (III–IV) across both settings. Treatment was administered to 49% of patients at ACP and 48% at CCP, with earlier initiation of treatment at CCP (23 vs 26 days; p<0.001). Median OS was slightly longer for patients treated at ACP compared with CCP (5.66 vs. 5.11 years, p < 0.001). Kaplan–Meier–estimated OS at 2, 5, and 10 years favored ACPs (75.3% vs 72.3%, 54.0% vs 50.6%, and 26.7% vs 24.2%). Conclusions: Our study revealed small but statistically significant survival advantages for elderly patients aged ≥75 years with FL treated at ACP. Despite comparable stage at diagnosis, comorbidity burden, and treatment receipt, patients treated at ACP demonstrated slightly longer OS, suggesting that specialized expertise, research-driven protocols, and comprehensive supportive care may contribute to better outcomes in this population. Prospective studies are warranted to validate these findings and identify interventions to improve equity in community settings. 1. Yar Cheema IBCL-1257: Mapping the Gaps: Understanding Survival Disparities in Follicular Lymphoma Across Socioeconomic Demographics (2000–2021). Clinical Lymphoma, Myeloma and Leukemia.