Impact of provider volume on outcomes of patients with Hodgkin lymphoma.

Abstract

Background: While the provider volume-outcome relationship has been established for many complex surgeries and invasive procedures, the provider volume impact on outcomes for Hodgkin lymphoma (HL) is less certain. We hypothesized that high-volume providers (HVPs) may have superior outcomes compared with low-volume providers (LVPs). Methods: We performed a chart-based, retrospective review of all patients receiving adriamycin, doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) for HL at the West Cancer Center from January 2010 to June 2015. Patients were divided into HVP (> 3 inpatient chemotherapy (CT)/month (m)) versus LVP (< 3 CT per m) groups. Of 95 patients identified, 93 received at least one dose of ABVD, 21 treated by HVP and 72 by LVP. Patient characteristics were well balanced between groups.

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

“…Using the NCDB, we found that patients with Hodgkin lymphoma managed at high-volume centers (9 or more patients per year) had approximately 20% lower mortality than those managed at low-volume centers, and this persisted even after adjustments for patientand disease-related factors. 18 The authors found that low-volume providers (providers treating fewer than 3 patients with Hodgkin lymphoma annually) were more likely to hold chemotherapy doses for afebrile neutropenia. Furthermore, the impact of a higher volume on lower mortality did not attain a ceiling at 9 patients per year, as was evidenced by continual improvement as the volume increased.…”

“…These results also show that the mortality for facilities treating fewer than 9 patients per year (Q1-Q3) was similar. 18 Moreover, low-volume providers were more likely to prescribe dose delays than their counterparts. Our study also found that the majority of high-volume facilities were academic centers and research programs.…”

“…Furthermore, the impact of a higher volume on lower mortality did not attain a ceiling at 9 patients per year, as was evidenced by continual improvement as the volume increased. 18 High-volume centers may have more experienced multidisciplinary care geared toward lymphoma management, especially radiologists who evaluate the interim positron emission tomography response by the Deauville system, which may affect management decisions. Several factors might have contributed to this volume-outcome disparity.…”