Impact of facility type on outcomes for elderly patients (≥ 75 years) with Burkitt lymphoma: Real-world data of academic vs community cancer programs.

e19059 Background: Burkitt lymphoma (BL) is an aggressive B-cell malignancy characterized by rapid proliferation. While highly curable in children and young adults, prognosis remains inferior in the elderly due to poor tolerance for intensive chemotherapy and higher baseline comorbidities which presents as a significant treatment challenging. This is the first real-world study to compare demographic characteristics, treatment patterns, and survival outcomes for patients aged 75 and older treated at Academic Cancer Programs (ACP) versus Community Cancer Programs (CCP). Methods: A retrospective analysis using the National Cancer Database was conducted on 1,618 patients (ACP n=837; CCP n=781) diagnosed with BL between 2004 and 2022 was carried out. ACP included academic and National Cancer Institute-designated research centers; CCP included community, comprehensive community, and integrated network cancer programs. Kaplan-Meier and Cox regression models were used to compare overall survival (OS), adjusting for: age, race/ethnicity, insurance status, Charlson-Deyo comorbidity score, and distance from treating facility. Results: ACP demonstrated significantly superior OS outcomes compared to CCP p=0.004. Patients at ACP were slightly younger with a median age of 80 vs 81 years p=0.001. No difference in sex, race or ethnicity was noted in both groups. Although most patients had Medicare, almost 10% for both groups had private insurance. Patients treated at ACP were more likely from the Metropolitan area, 83% vs 77% in CCP p=0.016, with the median distance in miles was 9.2 vs 8.1, respectively. ACP had a higher proportion of Stage IV disease, 50% vs 43%, p=0.029. Treatment was more frequently administered at ACP with 58% vs 52% p=0.001, and when administered it was initiated faster than CCP with median of 12 vs 14 days p=0.018. Median follow-up time was longer in the ACP cohort with 5.4 months vs 3.1 months, P<0.001. Two, five, and ten-year survival probabilities were higher at ACP than CCP: 36% vs 28%, 26% vs 21%, and 14% vs 11%, respectively. The adjusted median OS was 0.48 years for ACP and 0.27 years for CCP. Conclusions: Among patients aged ≥75 years with BL, treatment at ACP was associated with a statistically significant and clinically meaningful improvement in OS compared with CCP (log-rank p=0.004). Patients treated at ACP were more likely to receive therapy and experienced shorter time to initiation of treatment, despite also having a higher proportion of patients with more advanced-stage disease. These findings highlight the persistent vulnerability of elderly patients with BL and reinforce the need for integrated ACP-CCP care models. Such system-level strategies are essential to early referral, timely treatment delivery, risk-adapted strategies to mitigate toxicity, and provide robust supportive care for this population.