Patients who are treated for multiple myeloma at high-volume cancer centers have better survival outcomes than those receiving care at low-volume facilities, according to a study published in the Journal of Clinical Oncology.1
“If there is a choice, I would recommend seeking care at higher-volume facilities or being managed by higher-volume physicians,” said lead study author Ronald S. Go, MD, of the Mayo Clinic Division of Hematology in Rochester, Minnesota, in light of his team’s findings. “If that is not possible, then at least a referral to — or co-management with — a high-volume center or physician.”
“Multiple myeloma is increasingly complicated to treat and monitor,” C. Ola Landgren, MD, PhD, chief of myeloma service at Memorial Sloan Kettering Cancer Center in New York, New York, told Cancer Therapy Advisor. “When I look at referrals I see every week, I see how private practice and smaller centers are reaching out, asking how to handle situations with individual patients.
“I change my practice every 6 months — the field is going so fast-forward with all these new complicated tests and drugs and their integration into care. It does not surprise me at all that there are different outcomes. I predict that difference will become even greater over time.”
Dr Go and colleagues reviewed the care and outcomes of 94,722 patients diagnosed between 2003 and 2011 using the National Cancer Database. Patients at the lowest- and highest-volume centers had a median overall survival rate of 26.9 vs 49.1 months, respectively.
All-cause mortality was associated with the volume of myeloma patients treated at cancer centers; patients cared for at centers with the lowest volumes (fewer than a mean of 3.6 patients per year) had significantly higher risk of death than those at centers seeing more patients (the highest volumes of care were a mean of 10.3 or more patients annually).
Low-volume hospitals have limited experience in managing myeloma and fewer supportive care experts like infectious disease specialists, radiation oncologists, and cardiologists, to help manage complications, Dr Go told Cancer Therapy Advisor.
“There are also many nuances in the care of a patient, myeloma included, such as dose adjustment of drugs for frail patients, when to start or stop a treatment, [and] what supportive care measures to implement in conjunction with chemotherapy to minimize treatment complications,” he said.
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Patients with sufficient resources and insurance coverage — and good functional status — may seek referrals to regional centers with high volumes of care. But excluding such “referral bias,” high volume is a proxy measure for myeloma expertise and clinical experience, noted authors of an essay published alongside the study.2
Experience in managing a complex disease like myeloma is critical, said Jayesh Mehta, MD, a professor of medicine at Northwestern University’s Feinberg School of Medicine in Chicago, Illinois.