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Patients with glioblastoma fare better when treated at high-volume facilities
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Patients diagnosed with glioblastoma appeared more likely to undergo treatment and survive longer if they sought care at high-volume facilities, according to study results.
“Improvements in neurosurgical techniques and the use of shorter courses of radiation have increased the number of patients with newly diagnosed glioblastoma who are eligible to receive treatment. However, thereF is a certain subset of patients who — based on clinical characteristics, such as age or performance status — will not be able to receive therapy,” Matthew Koshy, MD, radiation oncologist at University of Illinois Hospital & Health Sciences System, and colleagues wrote. “Furthermore, due to the historically poor prognosis associated with glioblastoma, some physicians [with less experience caring for this patient population] may be reluctant to offer therapy compared [with] facilities that have experienced neuro-oncology services.”
Koshy and colleagues used the National Cancer Data Base to identify 68,726 patients diagnosed with glioblastoma from 2006 to 2013. Researchers evaluated whether glioblastoma patient volume at hospitals affected the treatment patients received, as well as how long they survived.
HemOnc Today spoke with Koshy about the study results and their potential implications.
Question: What prompted this research?
Answer: At our central nervous system tumor boards, we anecdotally noticed differences in glioblastoma treatment from patients who came to us for a second opinion regarding initial therapy and treatment for recurrent disease. We decided to examine whether significant heterogeneity existed among how patients were treated for glioblastoma on a national level and, more importantly, whether treatment facility affected survival. Because patients diagnosed with glioblastoma typically have a poor prognosis, we also wanted to examine whether facilities with experienced neuro-oncology services could improve survival compared with other facilities.
Q: What did you find?
A: We grouped treating facilities by volume as defined by the average number of cases seen per year: low(<9.25), medium (9.26 to 23.88), and high(23.39). Among 66,726 patients, those diagnosed at high-volume facilities appeared 43% more likely to receive definitive therapy than those diagnosed at low-volume facilities. We also found a significant improvement in median survival among patients treated at high-volume facilities compared with low-volume facilities (12 months vs. 8.4 months).
Q: Can you explain the discrepan cies in treatment receipt and survival rates between high-volume and low-volume centers?
A: The cause of this finding is likely multifactorial. High-volume centers may have a larger range of clinical services, including multidisciplinary neuro-oncology tumor boards, increased physician expertise, and improved management of treatment-related toxicities. These centers also may be more likely to offer participation in clinical trials, as well as more aggressive salvage therapies for patients who experience recurrence.
Q: What are some potential strategies to narrow the gap?
A: Given the variability among facilities regarding outcomes, it is critical to explore approaches to improve this gap. Quality improvement groups and accrediting bodies can play a role in the standardization of care for glioblastoma patients across all facilities. A collaborative approach between low- and high-volume facilities via continuing education and adaptation of best practices also would be beneficial for improving outcomes for all patients with glioblastoma.
Q: Is there anything else that you would like to mention?
A: It has been very difficult to find new treatments for glioblastoma, and there has been little progress toward improving outcomes for patients suffering from this aggressive disease. To see a significant difference in outcomes based solely on type of facility offers strong and, more importantly, actionable evidence that physicians and patients can use as they consider treatment options. – by Cassie Homer
Reference:
Koshy M, et al. J Neurooncol. 2017;doi:10.1007/s11060-017-2598-2.
For more information:
Matthew Koshy, MD, can be reached at 1801 W. Taylor St., Chicago, IL 60612; email: mkoshy@radonc.uchicago.edu.
Disclosure: Koshy reports no relevant financial disclosures.