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Abstract Details

Disparities in Care Patterns and Outcomes for Paraneoplastic Neurologic Syndromes
Autoimmune Neurology
P3 - Poster Session 3 (11:45 AM-12:45 PM)
8-002
To describe disparities in the diagnosis, treatment, and survival of paraneoplastic neurologic syndromes (PNS).
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.
Retrospective cohort study at a tertiary care center utilizing data from January 1, 2003 to July 31, 2023.
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.
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.
Authors/Disclosures
Alaina Prince
PRESENTER 		Ms. Prince has nothing to disclose.
B J. Distad, MD (University of Washington) Dr. Distad has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amylyx. Dr. Distad has received personal compensation in the range of $500-$4,999 for serving as a Discussant with Soleo Health.
Michael J. Persenaire, MD (University of Washington) Dr. Persenaire has nothing to disclose.
Jerome J. Graber, MD, MPH, FAAN (University of Washington) Dr. Graber has received personal compensation for serving as an employee of Binaytara Foundation. Dr. Graber has received personal compensation in the range of $500-$4,999 for serving as a Consultant for 好色先生. Dr. Graber has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Dickie McCamey Attorneys at Law. Dr. Graber has a non-compensated relationship as a Editorial Board member with Neuro-Oncology: Practice, published by Oxford that is relevant to AAN interests or activities. Dr. Graber has a non-compensated relationship as a Editorial Board Member with Journal of Pain and Symptom Management that is relevant to AAN interests or activities. Dr. Graber has a non-compensated relationship as a Board of Directors with American Society of Neuroimaging that is relevant to AAN interests or activities. Dr. Graber has a non-compensated relationship as a Board of Directors and Certification Exam Committee Member with United Council of Neurological Subspecialties that is relevant to AAN interests or activities. Dr. Graber has a non-compensated relationship as a Question of the Day 'app' committee and NeuroSAE and Continuum with 好色先生 that is relevant to AAN interests or activities. Dr. Graber has a non-compensated relationship as a Editorial Board Member with Practical Neurology (BMC) that is relevant to AAN interests or activities.