Impact of Provider Volume on Outcomes of Patients With Hodgkin Lymphoma

Ireland, Catherine G.; Wiedower, Eric; Mirza, Muhammad M.; Crawley, Melissa; Tran, Alexandria; Yaghmour, George; Martin, Mike G.

doi:10.14740/wjon1093w

Cited by 5 publications

(9 citation statements)

References 22 publications

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“…The association of better survival with increased clinical volume has been identified in hematologic oncology within populations and single institutions. 10,[12][13][14] However, this has not been addressed for nonhematologic cancers at the provider level. The Ontario jurisdiction offered a unique opportunity to study this question, with data on all therapies, consultations, and outcomes reliably available for an entire population.…”

Section: Discussionmentioning

confidence: 99%

“…Increased clinical volume has been associated with higher quality of care and better outcomes in hematologic cancers. [10][11][12][13][14] However, whether medical oncologists' clinical experience and volume affect patterns of care and outcomes of systemic therapy in solid cancers is unknown. In a review of volume outcome in cancer care, the Institute of Medicine outlined the need to examine volume-outcome relationships in both surgical and medical interventions.…”

Section: Introductionmentioning

confidence: 99%

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Benefits of High-Volume Medical Oncology Care for Noncurable Pancreatic Adenocarcinoma: A Population-Based Analysis

Hallet

Davis

Mahar

et al. 2020

Journal of the National Comprehensive Cancer Network

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Background: Although pancreatic adenocarcinoma (PA) surgery performed by high-volume (HV) providers yields better outcomes, volume–outcome relationships are unknown for medical oncologists. This study examined variation in practice and outcomes in noncurative management of PA based on medical oncology provider volume. Methods: This population-based cohort study linked administrative healthcare datasets and included nonresected PA from 2005 through 2016. The volume of PA consultations per medical oncology provider per year was divided into quintiles, with HV providers (≥16 patients/year) constituting the fifth quintile and low-volume (LV) providers the first to fourth quintiles. Outcomes were receipt of chemotherapy and overall survival (OS). The Brown-Forsythe-Levene (BFL) test for equality of variances was performed to assess outcome variability between provider-volume quintiles. Multivariate regression models were used to examine the association between management by HV provider and outcomes. Results: A total of 7,062 patients with noncurable PA consulted with medical oncology providers. Variability was seen in receipt of chemotherapy and median survival based on provider volume (BFL, P<.001 for both), with superior 1-year OS for HV providers (30.1%; 95% CI, 27.7%–32.4%) compared with LV providers (19.7%; 95% CI, 18.5%–20.6%) (P<.001). After adjustment for age at diagnosis, sex, comorbidity burden, rural residence, income, and diagnosis period, HV provider care was independently associated with higher odds of receiving chemotherapy (odds ratio, 1.19; 95% CI, 1.05–1.34) and with superior OS (hazard ratio, 0.79; 95% CI, 0.74–0.84). Conclusions: Significant variation was seen in noncurative management and outcomes of PA based on provider volume, with management by an HV provider being independently associated with superior OS and higher odds of receiving chemotherapy. This information is important to inform disease care pathways and care organization. Cancer care systems could consider increasing the number of HV providers to reduce variation and improve outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Benefits of High-Volume Medical Oncology Care for Noncurable Pancreatic Adenocarcinoma: A Population-Based Analysis

Hallet

Davis

Mahar

et al. 2020

Journal of the National Comprehensive Cancer Network

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“…In one singlecenter study, it was found that patients treated by oncologists who treated more than 3 patients with Hodgkin lymphoma (with inpatient chemotherapies) had better survival outcomes than those treated by physicians who handled fewer than 3 Hodgkin lymphoma-related inpatient chemotherapies. 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. 18 Moreover, low-volume providers were more likely to prescribe dose delays than their counterparts.…”

Section: Discussionmentioning

confidence: 99%

“…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. 18 Moreover, low-volume providers were more likely to prescribe dose delays than their counterparts. 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.…”

Section: Discussionmentioning

confidence: 99%

“…18 Moreover, low-volume providers were more likely to prescribe dose delays than their counterparts. 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. Similarly, the availability of lymphoma-specific radiation therapy expertise might be better at high-volume centers than low-volume centers.…”

Section: Discussionmentioning

confidence: 99%

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

Goyal

Tella

Funni

et al. 2019

Cancer

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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.

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Variation in receipt of therapy and survival with provider volume for medical oncology in non-curative esophago-gastric cancer: a population-based analysis

et al. 2019

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Background While surgical care by high-volume providers for esophago-gastric cancer (EGC) yields better outcomes, volume-outcome relationships are unknown for systemic therapy. We examined receipt of therapy and outcomes in the non-curative management of EGC based on medical oncology provider volume. Methods We conducted a population based retrospective cohort study of non-curative EGC over 2005-2017 by linking administrative healthcare datasets. The volume of new EGC consultations per medical oncology provider per year was calculated and divided into quintiles. High-volume (HV) medical oncologists were defined as the 4-5th quintiles. Outcomes were receipt of chemotherapy and overall survival (OS). Multivariate logistic and Cox-proportional hazards regressions examined the association between management by HV medical oncologist, receipt of systemic therapy, and OS. Results 7011 EGC patients with non-curative management consulted with medical oncology. 1-year OS was superior for HV medical oncologists (> 11 patients/year), with 28.4% (95% CI 26.7-30.2%) compared to 25.1% (95% CI 23.8-26.3%) for low volume (p < 0.001). After adjusting for age, sex, comorbidity burden, rurality, income quintile, and diagnosis year, HV medical oncologist was independently associated with higher odds of receiving chemotherapy (OR 1.13, 95% CI 1.01-1.26), and independently associated with superior OS (HR 0.89, 95% CI 0.84-0.93). Conclusions Medical oncology provider volume was associated with variation in non-curative management and outcomes of EGC. Care by an HV medical oncologist was independently associated with higher odds of receiving chemotherapy and superior OS, after adjusting for case mix. This information is important to inform disease care pathways and care organization; an increase in the number of HV medical oncologists may reduce variation and improve outcomes.

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Impact of Provider Volume on Outcomes of Patients With Hodgkin Lymphoma

Cited by 5 publications

References 22 publications

Benefits of High-Volume Medical Oncology Care for Noncurable Pancreatic Adenocarcinoma: A Population-Based Analysis

Benefits of High-Volume Medical Oncology Care for Noncurable Pancreatic Adenocarcinoma: A Population-Based Analysis

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

Variation in receipt of therapy and survival with provider volume for medical oncology in non-curative esophago-gastric cancer: a population-based analysis

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