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The impact of healthcare settings on survival time of patients with chronic myeloid leukemia Michael Lauseker

Michael Lauseker1,Joerg Hasford1, Markus Pfirrmann1, and Rüdiger Hehlmann2 Key points * Chronic myeloid leukemia patients enjoyed superior survival chances when treated in teaching hospitals.

* Less experience of a treatment center with chronic myeloid leukemia patients did not affect the patient's survival chances.

Abstract
With the introduction of tyrosine kinase inhibitors the treatment of chronic myeloid leukemia (CML) patients has migrated extensively to municipal hospitals (MH) and office-based physicians (OBP). Thus we wanted to check whether the health care setting has an impact on outcome. Based on 1491 patients of the German CML study IV, we compared the outcomes of patients from teaching hospitals (TH) to those from MH and OBP. Adjusting for age, EUTOS score, Karnofsky performance status, year of diagnosis and experience with chronic myeloid leukemia (CML), a significant survival advantage for TH patients (HR: 0.632 resp. 0.609) was found. In particular, when treated in TH, patients with blast crisis showed a superior outcome (2 year survival rate: 47.7% vs. 22.3% vs. 25.0%). As such an impact of the health care setting on the outcome of CML patients has not been reported before these findings need confirmation by other study groups.
This study is registered at ClinicalTrials.gov, identifier: NCT00055874.

Submitted November 20, 2013.
Accepted March 5, 2014.
Copyright © 2014 American Society of Hematology