Oncologist volume and outcomes in older adults diagnosed with diffuse large B cell lymphoma

Huntington, Scott F.; Hoag, Jessica R.; Zhu, Weiwei; Wang, Rong; Zeidan, Amer M.; Giri, Smith; Podoltsev, Nikolai A.; Gore, Steven D.; Ma, Xiaomei; Gross, Cary P.; Davidoff, Amy J.

doi:10.1002/cncr.31688

Cited by 12 publications

(12 citation statements)

References 45 publications

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“…37 More recently, our group found that Medicare beneficiaries with newly diagnosed DLBCL were more likely to receive standard immunochemotherapy and have better survival when managed by oncologists with greater experience treating older adults with lymphoma. 40 By focusing on outcomes after rituximab initiation, our current analysis suggests that provider experience may be associated with treatmentspecific management in addition to the therapy selection observed in our earlier work. 40 Along with establishing an association between physician volume and rituximab discontinuation, we found that early discontinuation was associated with worse survival.…”

Section: Discussionmentioning

confidence: 75%

“…40 By focusing on outcomes after rituximab initiation, our current analysis suggests that provider experience may be associated with treatmentspecific management in addition to the therapy selection observed in our earlier work. 40 Along with establishing an association between physician volume and rituximab discontinuation, we found that early discontinuation was associated with worse survival. This is not surprising, given that multiple placebo-controlled clinical trials have established that rituximab-containing regimens improve survival in older adults with NHL.…”

Section: Discussionmentioning

confidence: 75%

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Physician Experience and Risk of Rituximab Discontinuation in Older Adults With Non-Hodgkin’s Lymphoma

Huntington

Hoag

Wang

et al. 2019

Journal of the National Comprehensive Cancer Network

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Background: Provider experience, or clinical volume, is associated with improved outcomes in many complex healthcare settings. Despite increased complexity of anticancer therapies, studies evaluating physician-level experience and cancer treatment outcomes are lacking. Methods: A population-based study was conducted of older adults (aged ≥66 years) diagnosed with B-cell non-Hodgkin’s lymphoma in 2004 through 2011 using SEER-Medicare data. Analysis focused on outcomes in patients receiving rituximab, the first approved monoclonal anticancer immunotherapy. We hypothesized that lower physician experience using rituximab and managing its infusion-related reactions would be associated with early treatment discontinuation. A 12-month look-back from each initiation of rituximab was used to categorize physician volume (0, 1–2, or ≥3 initiations per year). Modified Poisson regression was used to account for provider-level correlation and estimated relative risk (RR) of early rituximab discontinuation (<3 cycles within 180 days of rituximab initiation). Cox proportional hazards were used to measure the impact of rituximab discontinuation on survival. Results: Among 15,110 patients who initiated rituximab with 2,684 physicians, 7.6% experienced early rituximab discontinuation. Approximately one-fourth of patients (26.1%) initiated rituximab with a physician who had no rituximab initiations during the preceding 12 months. Compared with patients treated by physicians who had ≥3 rituximab initiations in the prior year, those treated by physicians without initiations were 57% more likely to experience early discontinuation (adjusted RR [aRR], 1.57; 95% CI, 1.35–1.82; P<.001 for 0 vs ≥3, and aRR, 1.19; 95% CI, 1.03–1.37; P=.02 for 1–2 vs ≥3). Additionally, rituximab discontinuation was associated with higher risk of death (adjusted hazard ratio, 1.39; 95% CI, 1.28–1.52; P<.001). Conclusions: Lower oncologist experience with rituximab was associated with increased risk of early rituximab discontinuation in Medicare beneficiaries with non-Hodgkin’s lymphoma. Physician-level volume may be an important factor in providing high-quality cancer care in the modern era.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 75%

Physician Experience and Risk of Rituximab Discontinuation in Older Adults With Non-Hodgkin’s Lymphoma

Huntington

Hoag

Wang

et al. 2019

Journal of the National Comprehensive Cancer Network

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“…As a facility‐level predictor of interest, we categorized whether patients were receiving care in a physician's office setting or a hospital outpatient setting. This was identified on the basis of the presence/absence of outpatient hospital‐based claims from each patient's provider on his or her index date of treatment …”

Section: Methodsmentioning

confidence: 99%

“…This was identified on the basis of the presence/absence of outpatient hospital-based claims from each patient's provider on his or her index date of treatment. 32…”

Section: Key Explanatory Variablesmentioning

confidence: 99%

Underutilization of guideline‐recommended supportive care among older adults with multiple myeloma in the United States

Giri

Zhu

Wang

et al. 2019

Cancer

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Background With improving survival for patients with multiple myeloma (MM), supportive care that is focused on optimizing quality of life and minimizing treatment‐related toxicities is increasingly important. The extent to which patients with MM are receiving recommended supportive care is unknown. Methods This study used the Surveillance, Epidemiology, and End Results–Medicare database to identify older adults (age ≥66 years) diagnosed with MM in 2008‐2013 who had received active treatment and survived 1 year or longer after their diagnosis. Outcomes of interest included guideline‐recommended supportive care, which was defined as 1) bone‐modifying drugs (BMDs) within the 12 months after the diagnosis, 2) influenza vaccination in the first season after the diagnosis, and 3) concomitant use of prophylactic antivirals with proteasome inhibitors. Multivariable logistic regression models were used to evaluate associations between patient/facility‐level characteristics and supportive care use. Results Among 1996 patients receiving MM‐directed therapy, 64%, 52%, and 49% received BMDs, an influenza vaccination, and antiviral prophylaxis, respectively. Non‐Hispanic black patients (odds ratio [OR] vs white patients, 0.63; 95% confidence interval [CI], 0.46‐0.88) and patients with baseline renal impairment (OR, 0.43; 95% CI, 0.34‐0.54) had lower odds of BMDs. Non‐Hispanic blacks (OR, 0.52; 95% CI, 0.37‐0.73) and those with dual Medicaid enrollment (OR, 0.76; 95% CI, 0.58‐0.99) had lower odds of influenza vaccination. Treatment in a community‐based setting was associated with reduced odds of antiviral prophylaxis (OR, 0.58; 95% CI, 0.46‐0.72). Conclusions Substantial underutilization of guideline‐recommended supportive care was observed among older adults with MM in the United States, and this was associated with both patient and facility characteristics. Targeted interventions are needed to improve supportive care for patients with MM.

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“…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%

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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Oncologist volume and outcomes in older adults diagnosed with diffuse large B cell lymphoma

Cited by 12 publications

References 45 publications

Physician Experience and Risk of Rituximab Discontinuation in Older Adults With Non-Hodgkin’s Lymphoma

Physician Experience and Risk of Rituximab Discontinuation in Older Adults With Non-Hodgkin’s Lymphoma

Underutilization of guideline‐recommended supportive care among older adults with multiple myeloma in the United States

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

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