Background: Burkitt lymphoma (BL) is a highly aggressive B-cell neoplasm that can be treated with curative intent using combination chemotherapy (Blood PMID33171490). While several frontline regimens are endorsed by national guidelines (NCCN v2.2025), data comparing outcomes by treatment facility type remain limited. Despite the availability of treatment protocols, minimal real-world data exist comparing outcomes based on treatment facility type—particularly between Academic Cancer Programs (ACP) and Community Cancer Programs (CCP) (J Clin Oncol 38,8043–8043, 2020). This study represents the largest national retrospective analysis comparing demographic, clinical, and survival outcomes for patients with BL treated at ACP versus CCP.

Methods: We performed a retrospective analysis of patients diagnosed with BL in the United States between 2004 and 2022 using the National Cancer Database. ACP included academic and NCI-designated research centers; CCP included community, comprehensive community, and integrated network cancer programs. Kaplan-Meier and Cox regression models were used to compare overall survival (OS), adjusting for age, race/ethnicity, insurance status, Charlson-Deyo comorbidity score, and distance from treating facility.

Results: A total of 13,016 patients with BL were identified: 5,946 treated at ACP, 3,310 at CCP, and 3,760 excluded due to missing facility data. The majority were male (72% ACP, 71% CCP), with median ages of 58 years (y) in ACP and 62y in CCP [P<0.001]. Patients <60y comprised 54% at ACP vs 44% at CCP [P<0.001]. The most common race was White (82% ACP vs 88% CCP), followed by Black (10% vs 7%). Hispanic ethnicity was more frequent at ACP (13% vs. 10%; P<0.001).

In ACP, primary payer at diagnosis was Private insurance (44%), Medicare (34%), Medicaid (12%), uninsured (5%), and other (5%). CCP patients had equal rates of private and Medicare coverage (43% each), followed by Medicaid (7%), uninsured (4%), and other (3%). Both cohorts were predominantly located in the metropolitan area (82% ACP vs 77% CCP), with median travel distance in miles of 12.1 vs. 8.9 [P<0.001]. Most patients in both groups had an appropriate functional status as measured by the Charlson Deyo score of 0-1, 82% in ACP and 84% in CCP. Stage IV disease was more frequent in ACP than CCP (57% vs 49%; P<0.001). HIV positivity was noted in 4% (ACP) vs 3% (CCP), though missing data limited analysis. Epstein-Barr virus status was not available. Median time to treatment initiation was shorter in ACP compared to CCP, 11 vs 13 days [P<0.001], and treatment receipt was higher, 63% vs 58% [P<0.001], respectively.

Two-, five-, and ten-year OS probabilities were higher at ACP than CCP: 60% vs 50%, 49% vs 45%, and 41% vs 38%, respectively. The adjusted median OS was 4.3y for ACP and 2.1y for CCP [P<0.001]. Median follow-up time, measured as the interval from diagnosis to last contact, was longer in the ACP cohort (31 months vs 13 months, P<0.001).

Conclusions: This national analysis demonstrates that patients with BL have significantly better survival when treated at ACP. Despite presenting with more advanced disease, patients at ACP were more likely to receive systemic therapy and experienced a shorter interval to initiate treatment. The statistically significant outcomes suggest that there may be unaccounted influence of the multidisciplinary care coordination, disease-specific expertise and system level efficiencies that the ACP offer to patients. These findings suggest that multidisciplinary care coordination, disease-type expertise, and system-level efficiencies at ACP that contribute to statistically significant outcomes. The survival benefit at ACP may be a result of the familiarity with intensive treatment regimens, robust supportive care services, and streamlined access to chemotherapy protocols including those from clinical trials. Importantly, this analysis highlights that disparities in cancer care may be addressable through targeted systems-based interventions by strengthening the collaboration between ACP and CCP, including expedited referrals, shared treatment pathways, virtual tumor boards and telehealth-enabled co-management. Such strategies may help extend the benefits of high-quality care to a broader patient population and its implementation can assist in closing gaps in outcomes by ensuring equitable care access for patients with this aggressive and curable lymphoma.

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2025
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