Impact of academic medical center access on outcomes in multiple myeloma

Abstract

Treatment at academic cancer centers (ACs) is associated with improved survival across hematologic malignancies, though the benefit in multiple myeloma (MM) has not been examined. This study aims to evaluate survival outcomes at Commission on Cancer accredited ACs compared to non‐academic centers (NACs) for patients receiving MM‐directed therapy. The National Cancer Database (NCDB) was used to identify demographics and overall survival (OS) of MM patients diagnosed from 2004 to 2017 and to compare outcomes by facility type. Survival analysis was repeated in a propensity score matched cohort, with NACs matched 1:1 to ACs by age, race, comorbidity score, insurance, year of diagnosis, distance traveled, and income. Of 163 375 MM patients, 44.5% were treated at ACs. Patients at ACs were more likely to receive MM‐directed therapy compared to NACs (81% vs. 73%, p < .001). For patients receiving treatment, median OS at ACs was 71.3 months versus 41.2 months at NACs (p < .001). When adjusted for baseline demographics, patients treated at ACs had reduced mortality; hazard ratio (HR) 0.79 (95% CI 0.78–0.81, p < .001). The propensity score matched cohort maintained this survival benefit with a median OS of 59.9 months at ACs versus 37.0 months at NACs (p < .001), HR of 0.66 (95% CI 0.64–0.67, p < .001). ACs treated younger patients with fewer comorbidities and were more likely to treat racial minorities and patients with Medicaid or private insurance, and the uninsured. In this analysis, MM patients treated at ACs have significantly improved survival. While potentially related to access to specialized care, socioeconomic factors that drive facility selection may also contribute.

Comparing Multivisceral Resection with Tumor-only Resection of Liposarcoma Using the Win Ratio

“…Academic centers were defined as academic/research program facilities, and Community Cancer Programs (CCP), Comprehensive Community Cancer Programs (CCCP), and Integrated Cancer Programs (INCP) were categorized as nonacademic centers. 20 , 21 …”

“…Academic centers were defined as academic/research program facilities, and Community Cancer Programs (CCP), Comprehensive Community Cancer Programs (CCCP), and Integrated Cancer Programs (INCP) were categorized as nonacademic centers. 20,21 Among the patients who underwent TO resection, 25 (7.6%) patients required readmission within 30 days of surgical discharge, whereas five (1.5%) patients died within 30 days. Among the patients who underwent multivisceral resection, 50 (7.8%) patients required readmission within 30 days of surgical discharge, whereas seven (1.1%) patients died within 30 days.…”

Factors Determining Utilization of Stem Cell Transplant for Initial Therapy of Multiple Myeloma by Patient Race: Exploring Intra-racial Healthcare Disparities.

“…25,26 Receiving care at large volume and academic medical centers has been previously reported to be associated with superior outcomes in MM care. 27,28 SCT access and utilization could certainly play a role in this among other factors such as access to clinical trials and evidence-based care in general.…”

Factors determining utilization of stem cell transplant for initial therapy of multiple myeloma by patient race: exploring intra-racial healthcare disparities

“…Having private insurance is associated with a higher socioeconomic status (SES), being employed, and having resources at disposal, which can help facilitate a rather resource-intensive SCT process [ 25 , 26 ]. Receiving care at large volumes and academic medical centers has been previously reported to be associated with superior outcomes in MM care [ 27 , 28 ]. SCT access and utilization could certainly play a role in this, among other factors such as access to clinical trials and evidence-based care in general.…”