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Barriers to Lymphoma Treatment during the COVID-19 Pandemic

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Identifying Factors that Affect Barriers to Lymphoma Treatment during the COVID-19 Pandemic

Authors: A. Watson¹, S. Kaloger², C. Bace², A.L. Warwick²
¹ Lymphoma Coalition, Research, Mississauga, ON, Canada
² Lymphoma Coalition

Introduction

Lymphoma Coalition (LC) supports over 80 patient organizations across more than 50 countries. LC’s overarching goal is to facilitate a community of patient organizations supporting efforts to help patients with lymphoma receive care and support.

Barriers to accessing treatment therapy for patients with lymphoma are an essential topic across the globe.

LC’s biennial Global Patient Survey (GPS) aims to understand the barriers faced by patients with lymphoma in seeking medical attention or accessing treatment. With the added challenge posed by the COVID-19 pandemic, this study aimed to rank the influence of core demographic variables in their ability to predict barriers to lymphoma treatment in 2020 and 2022.

Methods

Study Design

  • Sub-analysis of the LC 2022 and 2020 GPS, a global online survey of patients with lymphoma and CLL conducted every two years.
  • Survey links were distributed via LC member organizations worldwide.
  • Patients and caregivers completed surveys through a third-party portal.

Core Demographic Variables

  • Age: Continuous variable, 18–97 years.
  • COVID Delay: Delay in seeking treatment due to fear of contracting COVID-19.
  • Education: Secondary vs. post-secondary.
  • Household Status: Single or partnered.
  • Indolent/Aggressive: Behaviour of the lymphoma subtype.
  • Local Area: Urban, suburban, or rural.
  • Sex/Gender: Biological sex where gender not specified.

Respondents

YearDatesTotal RespondentsPatientsCaregivers
2020Jan–Mar11,8789,1792,699
2022Jan–Apr8,6377,1131,524

Statistical Analysis

  • Incomplete responses removed.
  • SAS EM used for grouped logistic regression; results exported to IBM SPSS Statistics v27.
  • Frequency tables and charts used to identify trends.
  • Statistical significance tested across groups.
  • Logistic regression modeled outcomes against demographics.
  • Variable importance quantified using Monte Carlo resampling.

Results

  • Barriers to care significantly increased across all regions in 2022 (p<0.0001).
  • South America saw the largest increase (63%) in barriers, followed by Middle East & Africa (49%).
  • COVID Delay was the most consistent barrier in South America (99%), Europe (97%), and Asia-Pacific (93%).
  • Indolent vs. aggressive lymphoma increased in importance as a barrier by 35% during the pandemic.
  • Younger age was unexpectedly associated with higher barriers.

Odds Ratio for Age: OR = 0.965, 95% CI [0.962–0.968]

Conclusions

  1. Advocates should push for equitable access to care regardless of geography.
  2. COVID-19 magnified barriers to treatment, with wide variation across regions.
  3. Younger patients faced unexpected increases in barriers.
  4. Health providers should develop emergency care plans for cancer patients in crises.

Addressing Future Areas

  • Identify groups at higher risk of increased barriers to care.
  • Consider broader healthcare system issues beyond COVID-19, such as:
    • Resource shortages
    • Workforce challenges
    • Other health crises
  • Support patient organizations to advocate effectively.
  • Policymakers and providers must address psychosocial impacts of health emergencies.

Disclosures & Contact Information

  • 2022 study sponsored by: Pfizer Inc., AbbVie Corporation, Takeda Oncology, Novartis, Incyte, Bristol Myers Squibb, BeiGene, Regeneron.
  • No authors received personal benefit from this research.

Further details: https://lymphomacoalition.org/global-patient-survey

Contact:
Amanda Watson, Director of Research & Information, Lymphoma Coalition
📧 amanda@lymphomacoalition.org

Abstract #802

Summary

The Lymphoma Coalition conducted global patient surveys in 2020 and 2022 to identify barriers to treatment among patients with lymphoma and CLL during the COVID-19 pandemic. Over 20,000 respondents (patients and caregivers) from multiple regions participated.

Key Findings

  • Barriers increased in all regions in 2022 (p<0.0001).
  • South America (+63%) and Middle East & Africa (+49%) had the largest increases.
  • COVID-related delays were the most consistent barrier (up to 99% in South America).
  • Indolent vs. aggressive lymphoma became a stronger predictor of barriers (+35% during COVID).
  • Younger patients unexpectedly faced more barriers.

Conclusions

  • COVID-19 magnified existing treatment access issues, with large regional differences.
  • Equitable access to care must be prioritized, regardless of geography.
  • Health providers should develop emergency care plans for cancer patients.
  • Policymakers and patient organizations need to address both medical and psychosocial impacts of health emergencies.