Myeloma Patients Treated at High-volume Facilities Have Lower Risk of Death, Study Finds
Multiple myeloma (MM) patients treated at facilities that handle more patients may have better survival rates than those treated at lower-volume facilities, according to recent research.
The study, “Association Between Treatment Facility Volume and Mortality of Patients With Multiple Myeloma,” was published in the Journal of Clinical Oncology.
Multiple myeloma is a rare cancer, with approximately 30,000 new cases per year in the U.S. It is estimated that a hematologist-oncologist will see, on average, only two new and six established patients with myeloma annually. As a result, the clinical experience of a general hematologist-oncologist in the management of MM is likely to be limited compared with most other cancers.
Evidence from earlier studies has shown that higher volume of care, whether at the treatment facility or provider level, is associated with better clinical outcomes. Therefore, there has been an increasing focus on managing patients with rare cancers requiring surgeries at centers of excellence to optimize outcomes.
Ronald S. Go, MD, from the division of hematology at the Mayo Clinic in Rochester, Minnesota, and colleagues used the National Cancer Database to identify patients diagnosed with MM between 2003 and 2011, to determine the association between the number of myeloma patients treated annually at a treatment facility (volume) and all-cause mortality (outcome).
In total, 94,722 myeloma patients were treated (median age at diagnosis was 67 years; 54.7% were men) at 1,333 facilities. Treatment facilities were classified according to the mean number of myeloma patients treated per year by quartiles: Q1, less than 3.6 patients (5.2%),; Q2, 3.6 to 6.1 patients (12.6%); Q3, 6.2 to 10.3 patients (21.9%); and Q4, more than 10.3 patients (60.3%).
Patients were followed for an average of 57.6 months. The median annual facility volume was 6.1 patients per year.
Results showed that the median overall survival increased with the facility’s annual volume. While the median overall survival for Q1 was 26.9 months, those at Q2, Q3, and Q4 had median overall survival of 29.1 months, 31.9 months, and 49.1 months, respectively.
The researchers further found that facility volume was independently associated with all-cause mortality. Compared with patients treated at Q4 facilities, patients treated at Q3 facilities had a 12 percent higher risk of death. And the risk increased to 17 percent and 22 percent when patients were treated at Q2 and Q1 facilities, respectively.
The results from this study add to the evidence of an association between volume-outcome in the management of hematologic cancers.
“We found that patients with MM potentially benefit from being treated at high-volume facilities. Although knowledge on how to manage rare malignancies such as MM is now easily accessible, substantial gaps in clinical outcome continue to exist based on institutional volume of care,” the researchers wrote.
“Current efforts in reorganizing the cancer care delivery system should recognize the volume outcome relationship in the nonsurgical management of cancers,” they added.