Journal
JOURNAL OF CLINICAL ONCOLOGY
Volume 35, Issue 6, Pages 598-+Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1200/JCO.2016.68.3805
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Funding
- Eagles Cancer Research Fund Pilot Grant
- Mayo Clinic Division of Hematology
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
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Purpose To determine the association between the number of patients with multiple myeloma (MM) treated annually at a treatment facility (volume) and all-cause mortality (outcome). Methods Using the National Cancer Database, we identified patients diagnosed with MM between 2003 and 2011. We classified the facilities by quartiles (Q; mean patients with MM treated per year): Q1:,3.6; Q2: 3.6 to 6.1, Q3: 6.1 to 10.3, and Q4:. 10.3. We used random intercepts to account for clustering of patients within facilities and Cox regression to determine the volume- outcome relationship, adjusting for demographic (sex, age, race, ethnicity), socioeconomic (income, education, insurance type), geographic (area of residence, treatment facility location, travel distance), and comorbid (Charlson-Deyo score) factors and year of diagnosis. Results There were 94,722 patients with MM treated at 1,333 facilities. The median age at diagnosis was 67 years, and 54.7% were men. The median annual facility volume was 6.1 patients per year (range, 0.2 to 109.9). The distribution of patients according to facility volume was: Q1: 5.2%, Q2: 12.6%, Q3: 21.9%, and Q4: 60.3%. The unadjusted median overall survival by facility volume was: Q1: 26.9 months, Q2: 29.1 months, Q3: 31.9 months, and Q4: 49.1 months (P<.001). Multivariable analysis showed that facility volume was independently associated with all- cause mortality. Compared with patients treated at Q4 facilities, patients treated at lower-quartile facilities had a higher risk of death (Q3 hazard ratio [HR], 1.12 [95% CI, 1.08 to 1.16]; Q2 HR, 1.17 [95% CI, 1.12 to 1.21]; Q1 HR, 1.22 [95% CI, 1.17 to 1.28]). Conclusion Patients who were treated forMMat higher- volume facilities had a lower risk of mortality compared with those who were treated at lower- volume facilities. (C) 2016 by American Society of Clinical Oncology
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