Lower Risk of All-Cause Mortality in Multiple Myeloma Reported With Treatment at Higher-Volume Facilities


Key Points

  • Unadjusted median overall survival was 49.1 months at the highest-volume facilities vs 26.9 to 31.9 months at lower-volume facilities.
  • Compared with highest-volume facilities, risk of death was increased by 12% to 22% at lower-volume facilities.

In an analysis of data from the National Cancer Database reported in the Journal of Clinical Oncology, Go et al found a lower risk of all-cause mortality among patients with multiple myeloma treated at higher-volume facilities.

Study Details

The study included patients diagnosed with multiple myeloma between 2003 and 2011. Treating facilities were characterized by quartiles (Q) according to the mean number of patients treated per year: Q1 = < 3.6; Q2 = 3.6–6.1; Q3 = 6.1–10.3; and Q4 > 10.3. The volume-outcome relationship was adjusted for demographic (sex, age, race, ethnicity), socioeconomic (income, education, insurance type), and geographic (area of residence, treatment facility location, travel distance) characteristics, comorbidity (Charlson-Deyo score), and year of diagnosis.

Overall, 94,722 patients were treated at 1,333 facilities. Patients had a median age at diagnosis of 67 years, and 54.7% were men. The median annual facility volume was 6.1 patients per year, with a range of 0.2 to 109.9. The distribution of patients according to facility volume was 5.2% in Q1, 12.6% in Q2, 21.9% in Q3, and 60.3% in Q4.

Survival Outcomes

Unadjusted median overall survival according to facility volume was 26.9 months for Q1, 29.1 months for Q2, 31.9 months for Q3, and 49.1 months for Q4 facilities (P < .001). On multivariate analysis, facility volume was independently associated with all-cause mortality: compared with patients treated at Q4 facilities, hazard ratios for death were 1.12 (95% confidence interval [CI] = 1.08–1.16) for Q3, 1.17 (95% CI = 1.12–1.21) for Q2, and 1.22 (95% CI = 1.17–1.28) for Q1 facilities.

The investigators concluded: “Patients who were treated for [multiple myeloma] at higher-volume facilities had a lower risk of mortality compared with those who were treated at lower-volume facilities.”

The study was supported by the Eagles Cancer Research Fund Pilot Grant, Mayo Clinic Division of Hematology, and Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

Ronald S. Go, MD, of the Division of Hematology, Mayo Clinic, Rochester, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.