How Does Facility and Provider Volume Impact Survival in Multiple Myeloma?
Posted: Tuesday, November 5, 2019
According to a study published in JNCCN—Journal of the National Comprehensive Cancer Network, patients with multiple myeloma who are treated at high-volume National Cancer Institute (NCI)-designated cancer centers appear to have better survival outcomes than patients treated by providers at low-volume community centers. However, William A. Wood, MD, MPH, of the University of North Carolina, Chapel Hill, and colleagues suggest that community centers with a very high volume of patients with multiple myeloma achieved equally low mortality rates as those at NCI-designated cancer centers. This research supports existing evidence that patients benefit from care at high-volume facilities.
The research team identified 1,029 patients with multiple myeloma in the University of North Carolina Cancer Information and Population Health Resource. Patient survival was examined in relation to facility, provider volume, and patient-sharing between multiple myeloma specialists and community providers.
Patients who were treated at community centers had a higher risk of mortality than those treated at an NCI-designated Comprehensive Cancer Center (P < .001). Patients who were treated by low-volume community providers (P < .01) and high-volume community providers (P < .05) had a higher risk of mortality than those treated by NCI-designated multiple myeloma specialists. However, there was no difference in mortality between patients treated by the highest-volume community oncologists in the ninth and tenth deciles, compared with NCI-designated specialists.
“The reasons might have to do with familiarity with the benefits and best use of newer drugs and regimens, access to resources to help with management of toxicities or complications, or other factors,” Dr. Wood stated in a National Comprehensive Cancer Network press release. “Or, it might be that patients who are seen by higher-volume providers are more likely to have other unmeasured or confounding factors associated with better survival.”
Disclosure: The study authors reported no conflicts of interest.