Association between facility volume and mortality of patients with classic Hodgkin lymphoma

Abstract

BACKGROUND: Prior studies in oncology have shown that a higher annual facility patient volume is associated with reduced mortality. Because classic Hodgkin lymphoma is uncommon but highly curable, this study used the National Cancer Database (2003Database ( -2014 to analyze whether such a relationship exists for this disease. METHODS: The facilities were classified by quartiles, and random intercepts were used to account for clustering of patients within facilities. A Cox regression model was used to determine the volume-outcome relationship. RESULTS: There were 47,633 patients with classic Hodgkin lymphoma treated at 1310 facilities. The first quartile (Q1), which included 58.4% of the facilities, treated 3 or fewer patients per year, whereas the fourth quartile (Q4), which included 5.9% of the facilities, treated more than 9 patients per year. Compared with the patients treated at Q4 facilities, those treated at lower quartile facilities had a higher risk of death (hazard ratio for the third quartile [HR], 1.19; 95% confidence interval [CI], 1.1-1.29; HR for the second quartile, 1.28; 95% CI, 1.19-1.38; HR for Q1, 1.29; 95% CI, 1.2-1.39) after adjustments for all other factors (P < .0001). Compared with facilities treating 10 patients per year, facilities treating 40 patients per year had approximately 27% lower overall mortality rates. CONCLUSIONS: Patients with classic Hodgkin lymphoma treated at high-volume centers had lower overall mortality than those treated at lower volume centers. Because this is a highly curable malignancy, such differences may suggest a benefit from referral to higher volume facilities or the emulation of their care models. Cancer 2020;126:757-764.

The influence of facility volume on patient treatments and survival outcomes in nasopharyngeal carcinoma

“…Elucidating the influence of facility volume on short‐ or long‐term patient outcomes (i.e., volume–outcomes relationship) is an important endeavor that can lead to better delivery of quality care and more centralized cancer treatment in the future 14,15 . Although recent studies have demonstrated improved survival with increasing hospital volume in a variety of cancers including lung cancer, 16 Hodgkin lymphoma, 17 Merkel cell carcinoma, 18 meningioma, 19 and malignant bone tumors, 20 a thorough investigation regarding NPC is needed. Herein, this study investigates a large US‐based patient population from the National Cancer Database (NCDB) to elucidate the facility‐volume–outcomes relationships in patients with NPC.…”

Current perspectives on the management of refractory or relapsed classic hodgkin lymphoma in brazil: Balancing efficacy, safety, and tolerability

“…Moreover, analysis of PFS and OS according to socioeconomic status (SES) has disclosed statistically significant differences favoring higher versus lower SES [35], thus echoing findings from Brazil and other countries in HL and other cancer types [42][43][44][45][46][47]. These results suggest considerable room for improvement, particularly in light of the fact that registered patients are likely to represent those seen in referral centers, and given the (6) association between hospital volume and outcomes in HL [48]; in other words, results may be worse among Brazilian patients with CHL not participating in the registry. Given the availability of novel agents with activity in refractory or relapsed CHL [14,15,24,26,29] (discussed in more detail below regarding their role in refractory and relapsed disease), the standard of care for frontline therapy is subject to change soon.…”

Controversies in the Management of Early-Stage Hodgkin Lymphoma

“…"Finally, there is a disturbing association between facility volume and mortality of patients with HL," she said. 9 "This is one of the most highly curable diseases, with a median age of 30 years at time of diagnosis, but outcomes are best in large-volume centers," she added. "So if you are in a center that sees ,9 to 10 patients a year, reach out to centers of expertise and look at the NCCN Guidelines, as they have been developed to guide physicians in state-of-the-art practice.…”