Access to care and survival outcomes in older adults with chronic lymphocytic leukemia/small lymphocytic lymphoma: A National Cancer Database study.

e19035 Background: Chronic lymphocytic leukemia and small lymphocytic lymphoma (CLL/SLL) predominantly affect older adults and are managed in both academic and community cancer settings. Outcomes in elderly patients are influenced by comorbidity burden and treatment tolerance, but the impact of treatment facility type in patients aged ≥75 years remains incompletely defined. We examined institutional differences in patient characteristics, management strategies, and overall survival (OS) in elderly patients with CLL/SLL treated at Academic Cancer Programs (ACP) versus Community Cancer Programs (CCP). Methods: We conducted a retrospective cohort study using the National Cancer Database, identifying patients aged ≥75 years diagnosed with CLL/SLL between 2004 and 2022. Patients were stratified by facility type (ACP vs CCP). Demographic, socioeconomic, clinical, and treatment characteristics were compared. Time to systemic therapy, early mortality, and OS were assessed. OS was estimated using Kaplan–Meier methods, with associations evaluated using multivariable Cox proportional hazards models adjusting for race and ethnicity, insurance status, Charlson–Deyo comorbidity score, and distance to the treating facility. Results: Among 69,328 patients aged ≥75 years with CLL/SLL (ACP 32,752; CCP 36,576), median age was similar (81 years). ACP treated a more racially and ethnically diverse population, including higher proportions of Black (7% vs 5%) and Hispanic (3% vs 2%) patients, and more patients with Medicaid, private insurance, or no insurance, while CCP treated more Medicare beneficiaries and patients from lower-income and lower-education regions (all p<0.001). Comorbidity burden was slightly higher at CCP (Charlson–Deyo score ≥2: 13% vs 12%; p<0.001). Management differed modestly, with active surveillance more common at ACP (34% vs 30%), while treatment initiation rates, median time to systemic therapy (29 days), and 30- and 90-day mortality were similar. OS differed modestly by facility type. Median OS was longer at ACPs (4.7 vs 4.5 years). Two, five, and ten-year OS was numerically higher at ACP (72% vs 71%, 48% vs 46%, and 20% vs 19%, respectively), with statistical significance driven by cohort size. Conclusions: In patients aged ≥75 years with CLL/SLL, treatment facility type was associated with modest but statistically significant differences in OS amid sociodemographic variation and similar treatment timing. Although absolute survival differences were small, the population size highlights the cumulative impact of health system factors. These findings support strengthening partnerships between CCP and ACP to expand access to clinical trials, geriatric-informed supportive care, and evolving targeted therapies, promoting more equitable, high-quality care for older adults with CLL/SLL.