Disparities in Care Patterns and Outcomes for Paraneoplastic Neurologic Syndromes
Alaina Prince1, B Distad2, Michael Persenaire2, Jerome Graber3
1School of Medicine, University of Alaska Anchorage, 2University of Washington, 3Neurology and Neurosurgery, University of Washington
Objective:
To describe disparities in the diagnosis, treatment, and survival of paraneoplastic neurologic syndromes (PNS).
Background:
In both cancer and neurological conditions, there are proven disparities across sex, race, income, insurance status, and other variables. PNS are challenging to diagnose due to their rarity, the wide array of clinical presentations, and the need for a multidisciplinary care team (neurology, oncology, etc). Moreover, arriving at a definitive diagnosis is complicated by an expensive and complex diagnostic work-up involving serum or CSF antibody testing and detailed tests for various cancers.
Design/Methods:
Retrospective cohort study at a tertiary care center utilizing data from January 1, 2003 to July 31, 2023.
Results:
Of the 111 patients, 38 were male and 73 were female. For time to diagnosis (TTD), intervals were shorter for anti-NMDA-R encephalitis (28 days) than sensory neuronopathy (195 days), P = .01. TTD for patients with Lambert-Eaton Myasthenic Syndrome (LEMS) was longer for never smokers (351.5 days) than current smokers (38 days), P = .02. For the entire cohort, overall survival (OS) rates were associated with sex, smoking, and disability status. Male patients had lower OS rates (65.6% [95% CI, 55.2-97.6]) than female patients (91.9% [95% CI, 127.6-151.8]), P <.001, and patients who developed disabilities had shorter survival (65.4% [95% CI, 51.3-87.1]) than patients who did not have disability (90.9% [95% CI, 124.9-150.3]), P = .002. Current smokers had lower OS rates (58.3% [95% CI, 21.4-77.5]) than both former (74.2% [95% CI, 74.0-133.3]) and never smokers (95.9% [95% CI, 124.8-140.7]), p <.001.
Conclusions:
Different PNS have varying and often lengthy times until diagnosis, which may delay care, worsen morbidity, and delay diagnosis and treatment of occult cancers. The delayed diagnosis for non-smokers with LEMS highlights associations that may mislead providers. Shorter survival for men and those with disabilities may guide interventions to lessen these disparities.
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