Care at high-volume facility may cut mortality in multiple myeloma

(HealthDay)—Patients with multiple myeloma (MM) may receive a survival benefit from being treated at high-volume facilities, according to a study published in the September issue of the Journal of the National Comprehensive Cancer Network.

Ashley T. Freeman, M.D., from BC Cancer-Victoria in Canada, and colleagues identified a cohort of 1,029 patients diagnosed with MM in 2006 through 2012. The authors examined the impact of treating facility, individual provider volume, and patient sharing between MM specialists and community providers on patient outcomes.

The researchers found that compared with patients evaluated at a National Cancer Institute-designated Comprehensive Cancer Center (NCICCC), those not evaluated at an NCICCC had an increased risk for mortality (hazard ratio [HR], 1.50; 95 percent confidence interval [CI], 1.21 to 1.86; P < 0.001). Patients treated by both low-volume community providers and high-volume community providers had an increased risk for mortality compared with those treated by NCICCC MM specialists (HRs, 1.47 [95 percent CI, 1.14 to 1.90; P < 0.01] and 1.29 [95 percent CI, 1.04 to 1.61; P < 0.05], respectively). Mortality did not differ for those treated by NCICCC MM specialists and those treated by the highest-volume community oncologists in the ninth and 10th deciles (HR, 1.08; 95 percent CI, 0.84 to 1.37; P = 0.5591). The risk for mortality was higher for patients treated by community oncologists, regardless of patient sharing compared with patients treated by MM specialists (e.g., HR, 1.49 [95 percent CI, 1.10 to 2.02; P < 0.05] for community oncologist with history of sharing versus NCICCC MM specialist).

"Our results show that provider experience, and potentially access to resources at a comprehensive cancer center, may improve survival in patients with multiple myeloma," a coauthor said in a statement.

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