Patients with multiple myeloma can benefit from treatment at a high-volume center, according to a new study published in the Journal of the National Comprehensive Cancer Network.

“Our study builds on these data by introducing 2 novel variables — provider volume and patient-sharing — to better understand the impact of individual provider experience and collaboration between multiple specialists and community oncologists,” the researchers wrote. 

The researchers gathered data from a state cancer registry linked to public and private health insurance claims to identify a cohort of patients diagnosed with multiple myeloma from 2006 to 2012. They identified 1029 patients. They wanted to see how 3 factors affected overall survival.

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The first factor was evaluation at an National Cancer Institute (NCI)-designated Comprehensive Cancer Center (NCICCC). Those patients who were not evaluated at 1 of these centers had a 50% increased risk for mortality compared with patients who received care at these centers (hazard ratio (HR), 1.50; 95% CI, 1.21-1.86; P <.001). 

The second factor was outcomes according to the primary oncologists’ volume of patients with myeloma. Those patients treated by low-volume community providers (HR, 1.47; 95% CI, 1.14-1.90; P <.01) and high-volume community providers (HR, 1.29; 95% CI, 1.04-1.61) had significantly higher risk for mortality compared with patients treated by NCICCC specialists. However, no difference was seen in patients treated by NCICCC myeloma specialists and those treated by the highest-volume community oncologists. 

“It is possible that survival for patients treated by the highest-volume community providers (eg, ninth and tenth deciles of volume) would be similar to that for patients treated by NCICCC multiple myeloma specialists,” the researchers wrote. 

Finally, the researchers looked at outcomes according to patient-sharing between myeloma specialists and community oncologists. 

“Because it is not feasible for all patients with multiple myeloma to be treated at an NCICCC, a common practice among community oncologists is to refer a patient to an multiple myeloma specialist for initial treatment recommendations or transplant evaluation, but to perform most care in the community,” the researchers wrote. 

Again, patients treated by community oncologists had a higher risk for mortality regardless of patient-sharing compared with patients treated by myeloma specialists. 


Freeman AT, Kuo M, Zhou L, et al. Influence of treating facility, provider volume, and patient-sharing on survival of patients with multiple myeloma J Natl Compr Canc Netw. 2019;17(9):10.6004/jnccn.2019.7298.