New research adds to accumulating evidence of benefit for patients treated at high-volume facilities or by high-volume providers.
PLYMOUTH MEETING, PA [September 17, 2019] — New research in the September 2019 issue of JNCCN—Journal of the National Comprehensive Cancer Network finds that providers with more experience treating people with multiple myeloma have better outcomes than those with more limited experience. In general, providers who saw the most cases were more likely to be located at academic, NCI-designated cancer centers. However, the researchers found that the very highest-volume providers at community facilities did achieve equally low mortality rates as clinicians at NCI-designated cancer centers.
“Multiple myeloma care is complicated and nuanced, with many specific treatments and management scenarios,” said senior researcher William A. Wood, MD, MPH, UNC Lineberger Comprehensive Cancer Center. “Our results show that provider experience, and potentially access to resources at a comprehensive cancer center, may improve survival in patients with multiple myeloma. 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. 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. More research is needed to help sort this out.”
The study was based on data from 1,029 patients in the University of North Carolina Cancer Information and Population Health Resource (CIPHR) who were diagnosed with multiple myeloma between 2006 and 2012. People who did not have continuous insurance enrollment for 6 months before and 12 months after diagnosis were excluded, along with those who did not receive chemotherapy within 12 months of diagnosis. Patients ranged in age from 25 to 98 years, with a mean of 68.
The researchers found that people with multiple myeloma were less likely to be referred to NCI-designated specialists if they were older. Patients who didn’t have private insurance or were any race other than non-Hispanic white were also less likely to be seen at high-volume facilities. The study also examined the impact of patient-sharing between multiple myeloma specialists and community oncologists, and did not find it correlated with better outcomes than when a patient was seen only by a lower-volume provider.
“The treatment of multiple myeloma has become more complex given the increasing number of treatment options for patients with newly diagnosed as well as relapsed disease,” commented Shaji K. Kumar, MD, Mayo Clinic Cancer Center, and Chair of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Multiple Myeloma—who was not involved with the research. “Given the median age at diagnosis of over 65, it is important that patients are carefully followed for toxicity, especially with the use of multidrug combinations. In this scenario, the current study reiterates the importance of clinical experience in the management of multiple myeloma patients. While the study does not completely remove the bias of sicker patients not getting to the large referral centers and being treated in the community, the findings of comparable outcome in community centers with higher volumes clearly support the importance of provider experience.”
To read the entire study and view tables on cohort demographics, factors associated with evaluation at NCI-designated centers, and mortality risks, visit JNCCN.org. Complimentary access to “Influence of Treating Facility, Provider Volume, and Patient-Sharing on Survival of Patients with Multiple Myeloma” is available until December 10, 2019.
The September issue also includes an NCCN Policy Report on Advocating for Equity in Cancer Care, and the debut of JNCCN’s new vision statement: To further the mission of NCCN, JNCCN will be the primary resource for information on NCCN Clinical Practice Guidelines, innovation in translational medicine, and on scientific studies related to oncology health services research, including quality care and value, bioethics, comparative effectiveness, public policy, and interventional research on supportive care and survivorship.
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About JNCCN—Journal of the National Comprehensive Cancer Network
More than 25,000 oncologists and other cancer care professionals across the United States read JNCCN—Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about innovation in translational medicine, and scientific studies related to oncology health services research, including quality care and value, bioethics, comparative and cost effectiveness, public policy, and interventional research on supportive care and survivorship. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside. Visit JNCCN.org. To inquire if you are eligible for a FREE subscription to JNCCN, visit http://www.nccn.org/jnccn/subscribe.asp. Follow JNCCN on Twitter @JNCCN.
About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network® (NCCN®) is a not-for-profit alliance of 28 leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to improving and facilitating quality, effective, efficient, and accessible cancer care so patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. By defining and advancing high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers around the world.
The NCCN Member Institutions are: Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Fred & Pamela Buffett Cancer Center, Omaha, NE; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; City of Hope National Medical Center, Duarte, CA; Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH; O'Neal Comprehensive Cancer Center at UAB, Birmingham, AL; Roswell Park Comprehensive Cancer Center, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Rogel Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT.
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