National analysis of facility-level survival differences in elderly splenic marginal zone lymphoma patients.

e13740 Background: Splenic marginal zone lymphoma (SMZL) is an uncommon indolent B-cell lymphoma primarily affecting older adults. Although the prognosis is generally favorable, advanced age is associated with poorer outcomes. Limited data exist on the influence of treatment setting on survival in elderly patients. Academic centers often demonstrate advantages in broader lymphoma populations through specialized expertise and multidisciplinary care, but applicability to SMZL is unclear. We evaluated differences in treatment patterns and overall survival (OS) among patients aged ≥75 years with SMZL treated in Academic Cancer Programs (ACP) vs Community Cancer Programs (CCP). Methods: We performed a retrospective cohort study of National Cancer Database (NCDB) cases diagnosed from 2004–2022 with SMZL. Facility type was categorized as ACP or CCP. We compared demographics, socioeconomic indicators, comorbidity (Charlson–Deyo score), geography, management, and time from diagnosis to therapy initiation. OS was assessed by Kaplan–Meier estimates at 2, 5, and 10 years, and adjusted median OS by facility type. Results: Among 2,883 patients aged ≥75 with SMZL, 1,553 were treated at ACP and 1,330 at CCP. Median age was 80 (ACP) vs 81 (CCP). White patients were the majority in both cohorts (92% ACP vs 95% CCP). Only 3% of ACP and 2% of CCP patients were Hispanic (p = 0.158). Socioeconomic differences were notable, with CCP patients more often from lower-education areas and ACP patients from higher-income regions (p < 0.001). Most patients lived in metropolitan areas, with a higher representation in ACP. Median straight-line distance to the treating facility was slightly greater for ACP (9 vs 7 miles; P < 0.001). Charlson–Deyo scores were similar (0–1 in ~87%: 71% score 0 and 16% score 1 in ACP; 70% and 17% in CCP; p = 0.179). Primary payer was predominantly Medicare (90% ACP vs 91% CCP). Disease characteristics and management were similar between cohorts. Watchful waiting occurred in 15% vs 14%, and any treatment in 57% vs 57%. Median time to treatment was 24 days ACP vs 23 days CCP. Survival outcomes favored ACP. At two years, OS was 75% for ACP compared with 74% for CCP; at five years, 55% vs 51%; and at ten years, 25% vs 22%. Median OS was longer in ACP (5.8 vs 5.1 years, P = 0.041). Conclusions: Among elderly patients with SMZL, OS differed significantly by facility type, with a modest but statistically significant survival advantage observed at ACP. Despite largely similar disease characteristics and management strategies, differences in socioeconomic context and urban residence were evident and may influence access to specialized care and longitudinal disease management. These findings highlight the value of multidisciplinary expertise and support efforts to strengthen referral pathways and academic–community partnerships to ensure equitable access to high-quality care for older adults with indolent lymphomas.