Ashley T. Freeman, MD of BC Cancer explains commonly asked questions by colleagues: why do myeloma patients seem to do better when they are treated at a high volume facility or by high volume myeloma oncologist?
New research adds to accumulating evidence of benefit for patients treated at high-volume facilities or by high-volume providers.
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.