High-volume centers tied to better survival with multiple myeloma

  • Freeman AT & al.
  • J Natl Compr Canc Netw
  • 1 Sep 2019

  • curated by David Reilly
  • Univadis Clinical Summaries
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Takeaway

  • Patients evaluated or treated by multiple myeloma specialists at the National Cancer Institute Comprehensive Cancer Centers (NCICCC) experience improved survival vs those treated by community oncologists.
  • Community oncologists with the highest patient volumes achieved comparable survival outcomes vs NCICCC specialists.

Why this matters

  • Evidence suggests a link between improved survival in hematologic malignancies and treatment at high-volume facilities.

Study design

  • Study to investigate associations between treatment facility characteristics and survival in 1029 patients with multiple myeloma.
  • Data source: A North Carolina cancer registry.
  • Funding: University Cancer Research Fund.

Key results

  • Higher risk for mortality in patients:
    • Not evaluated at an NCICCC facility: HR, 1.50; 95% CI, 1.21-1.86; P<.001.>
    • Treated by a community provider vs an NCICCC multiple myeloma specialist, regardless of patient volume:
      • High-volume community provider: HR, 1.29; 95% CI, 1.04-1.61; P<.05.>
      • Low-volume community provider: HR, 1.47; 95% CI, 1.14-1.90; P<.01.>
  • No significant difference in mortality risk in patients treated by NCICCC multiple myeloma specialists vs those treated by community providers with the highest patient volume (P=.5591).
  • Higher risk for mortality in patients treated by a community oncologist with patient-sharing history vs an NCICCC multiple myeloma specialist: HR, 1.49; 95% CI, 1.10-2.02; P<.05.>

Limitations

  • Retrospective data.