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Hospital facility characteristics and socioeconomic factors on outcomes and treatment in patients with multiple myeloma: National Cancer Database analysis

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Abstract

Previous studies have shown that socioeconomic factors play an important role in multiple myeloma (MM) health outcomes. We postulated that the type of treatment facilities and their volume of cases also affect overall survival, utilization of various therapies including palliative care services in newly diagnosed MM. Using the National Cancer Database (NCDB), we analyzed 174,551 newly diagnosed MM participants from across the country. We found that at high volume facility centers (over 90th percentile of new patient volume from 2004 to 2016), the median overall survival (OS) was 62.3 months versus 35.3 months at lower volume facilities (p <0.001). Similarly, high volume academic cancer centers had an improved median OS of 66.4 months (65.3–67.4 CI) versus 39.2 months (37.9–40.4 months CI) in lower volume academic centers (p <0.001). The odds of utilizing chemotherapy, immunotherapy, and autologous transplants were higher in academic cancer centers compared to community cancer centers, after adjusting for demographic and socioeconomic factors (OR 1.10, 1.23, and 2.06 respectively, all with p<0.001). There was significantly decreased odds of receiving palliative care (OR 0.89, 95% CI 0.85–0.93) in high volume facilities compared to low volume. Palliative care services were more frequently utilized at integrated network cancers and comprehensive community cancer centers compared to community cancer centers, with similar odds of receiving palliative care between community and academic facility types. Our results likely reflect increased provider experience and resources in higher volume and academic facilities. This highlights the need to integrate resources and improve access to community programs.

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Acknowledgements

The NCDB is a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. The data used in the study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator.

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Authors and Affiliations

  1. Divison of Hematology and Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC, USA

    Kimberley Doucette, Bryan Chan & David H. Vesole

  2. Department of Medicine, Duke University Hospital, Durham, NC, USA

    Allison O. Taylor

  3. Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center, Washington, DC, USA

    Xiaoyang Ma & Jaeil Ahn

  4. Division of Hematology and Oncology, Hackensack Meridian John Theurer Cancer Center, Hackensack, NJ, USA

    David H. Vesole

  5. Division of Hematology and Oncology, Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Catherine Lai

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Contributions

K.D. and C.L. developed the concept and designed the study; K.D., A.O.T., J.A., X.M., and C.L. were involved with data analysis; all authors contributed to the interpretation of the results; the initial manuscript was drafted by K.D., D.H.V., A.O.T., C.L., and B.C.; all authors reviewed and critically revised the manuscript, and all authors approved the final version of the manuscript.

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Correspondence to Kimberley Doucette.

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Conflict of interest

Kimberley Doucette: Consulting/Advisory: Cellectar biosciences and Sanofi Genzyme

Allison Taylor, Xiaoyang Ma and Bryan Chan have no conflicts of interest.

Jaeil Ahn: Biostatistical consultant: Keiferx

David Vesole: Speakers’ Bureau for Janssen, GSK, BMS, Takeda, Amgen, Sanofi, Karyopharm

Catherine Lai: Honoraria: OncLive, Consulting/Advisory: Jazz Pharmaceuticals, Genentech, Novartis, Abbvie, Taiho Oncology, Pfizer, PDS Biotechnology, Macrogenics, Astellas Pharma, BioAscent, Speakers’ Bureau: Jazz Pharmaceuticals, Astellas Pharma, Travel, Accommodation, Expenses: DAVA Pharmaceuticals

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Doucette, K., Taylor, A.O., Chan, B. et al. Hospital facility characteristics and socioeconomic factors on outcomes and treatment in patients with multiple myeloma: National Cancer Database analysis. Ann Hematol 102, 1443–1458 (2023). https://doi.org/10.1007/s00277-023-05194-6

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