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Funni, Shealeigh

Mayo Clinic

Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.

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Association between facility volume and mortality of patients with classic Hodgkin lymphoma
Goyal, Gaurav , Tella, Sri Harsha , Funni, Shealeigh A., Kommalapati, Anuhya , Inselman, Jonathan , Shah, Nilay D. , Ansell, Stephen M. , Funni, Shealeigh, Inselman, Jonathan W, Goyal, Guarav , Kommalapati, Anuhya , Go, Ronald S.

Cancer | November 12, 2019 | Volume: 126 | Issue: 4 | Pages: 757-764

10.1002/cncr.32584 Get It

BackgroundPrior 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 (2003‐2014) to analyze whether such a relationship exists for this disease.MethodsThe 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.ResultsThere 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.ConclusionsPatients 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.