Association of survival benefit with treatment at academic cancer programs in older adults with PTCL: A National Cancer Database analysis.

e19075 Background: Peripheral T cell lymphoma (PTCL) is an aggressive mature T cell neoplasm associated with poor prognosis and limited therapeutic options. It predominantly affects older adults and is frequently diagnosed at advanced stage. Outcomes for this disease remain inferior compared with many B cell lymphomas despite advances in contemporary lymphoma care. Evidence guiding optimal management in older adults with PTCL remains limited, in part due to the low representation of this population in prospective clinical studies. Population based and real world analyses have shown that older age, comorbidity burden, and differences in access to specialized lymphoma care are independently associated with inferior outcomes beyond underlying disease characteristics. The impact of treatment facility type on outcomes among older adults with PTCL remains insufficiently defined. Methods: We conducted a retrospective analysis of patients aged ≥75 y diagnosed with PTCL in the US between 2004-2022 using the National Cancer Database. Demographic, socioeconomic, clinical, treatment, and survival characteristics were compared between patients treated at Academic Cancer Programs (ACP) and Community Cancer Programs (CCP). Kaplan-Meier and Cox regression analyses were used to compare overall survival (OS) between the two cohorts. Variables used for adjustment included age, ethnicity, insurance status, distance from hospital, and Charlson-Deyo comorbidity score. Results: Of 4,533 patients aged ≥75 y with PTCL, 2,402 (53.0%) were treated at ACP and 2,131 (47.0%) at CCP. Patients treated at ACP were slightly younger, with a median age of 80 y compared to 81 y at CCP, p=0.002. Most patients in both groups presented with advanced stage disease. Most patients had Medicare coverage, and comorbidity burden did not differ meaningfully between cohorts. Treatment patterns differed by facility type. Patients treated at ACP were more likely to receive treatment, whereas a substantial proportion of patients treated at CCP had no documented treatment.Time from diagnosis to initiation of systemic therapy was shorter at ACP compared with CCP. On survival analysis, two year OS was 29% at ACP vs 26% at CCP, five year overall survival was 17% vs 14%, and ten year overall survival was 8% vs 6%. OS was significantly higher among patients treated at ACP compared with CCP, p=0.047. Conclusions: Among patients aged ≥75 y with PTCL in this national cohort, treatment at ACP was associated with superior OS compared with CCP. Differences in outcomes by facility type suggest that access to specialized lymphoma expertise may influence survival in this population. These findings support the need for timely referral to academic centers, consideration of transfer of care when appropriate, and greater use of expert consultation and guideline based management for older adults with aggressive T cell lymphomas.