Rahul Garg

Date of Graduation

2017

Document Type

Dissertation

Degree Type

PhD

College

School of Pharmacy

Department

Pharmaceutical Sciences

Committee Chair

Kimberly M Kelly

Committee Co-Chair

Soumit K Basu

Committee Member

Treah Haggerty

Committee Member

Usha Sambamoorthi

Committee Member

Xi Tan

Abstract

Diffuse Large B-Cell Lymphoma (DLBCL) is an aggressive form of Non-Hodgkin's lymphoma with a median age of diagnosis of 67 years. The intensive treatment of DLBCL can negatively influence elderly patients' preventive and chronic care, which can increase the costs of different chronic conditions. DLBCL diagnosis and treatment can affect patients' visits to their primary care providers (PCPs) and other specialists, which are important for patients' preventive screenings and chronic care. Further, having DLBCL increases the risk for breast cancer, and DLBCL treatment is associated with cardiotoxicity and increases the risk of osteoporosis and fractures. Thus, mammography and bone mineral density testing (BDT) are critical areas of screening for individuals with DLBCL, and a change in visits to PCPs can affect preventive and chronic care. Along with these challenges to care quality in DLBCL patients, the costs of different chronic conditions may increase. Currently, there is a dearth of studies that have examined visits to PCPs and specialists, preventive screenings, and costs of chronic conditions among DLBCL patients as compared to individuals with no cancer. We conducted this study to reduce this knowledge gap and to provide actionable strategies to improve the preventive care and reduce the costs of DLBCL patients. The three specific aims of this study were to: 1) analyze the impact of DLBCL on visits to PCPs and specialists over a three-year period of DLBCL diagnosis, treatment, and follow-up; 2) examine the receipt of mammography and BDT by female DLBCL patients during two years after DLBCL diagnosis; and 3) examine the costs of common chronic conditions and total cost over a three-year period of DLBCL diagnosis, treatment, and follow-up among fee-for-service elderly Medicare beneficiaries with newly diagnosed DLBCL as compared to Medicare beneficiaries without cancer. (Abstract shortened by ProQuest.).

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