Factors Associated with Palliative-Intent Treatment Receipt in Cutaneous T-Cell Lymphoma

Abstract

Cutaneous T-cell lymphoma (CTCL) is a chronic, generally incurable group of non-Hodgkin lymphomas associated with substantial symptom burden, yet receipt of palliative-intent treatment in this population remains uncharacterized. We conducted a cross-sectional retrospective study of 13,215 patients with CTCL using the National Cancer Database (2004–2023) to evaluate receipt of palliative-intent treatment by sociodemographic and disease characteristics using χ2 tests, Wilcoxon rank sum tests, Fisher’s exact tests, and multivariable logistic regression. Only 355 patients (2.7%) received palliative-intent treatment. In multivariable analysis, the strongest factors associated with palliative-intent treatment receipt were regional stage (OR, 3.19; 95% CI, 2.43–4.17) and distant stage (OR, 2.49; 95% CI, 1.86–3.31). Treatment at academic facilities was associated with significantly lower odds of NCDB-defined palliative care receipt (OR, 0.59; 95% CI, 0.47–0.76). Medicare insurance, primary cutaneous CD30+ histology, higher comorbidity burden, head and neck primary site, and more recent diagnosis were also independently associated with receipt of palliative-intent treatment. Sex, race, income, and distance to the facility were not significant. Palliative-intent treatment receipt is markedly low in CTCL despite guideline recommendations supporting early integration. Systematic screening for palliative care needs is warranted, particularly for patients with advanced-stage disease or high symptom burden.