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Oncologist experience associated with improved survival in diffuse large B-cell lymphoma
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Patients with newly diagnosed diffuse large B-cell lymphoma had improved survival outcomes under the care of high-volume oncologists, who were more likely to administer guideline-adherent therapy, according to a retrospective Medicare population-based study.
“For cancer patients undergoing complex procedures, hospital and surgeon-level case volume is frequently associated with important clinical outcomes,” Scott F. Huntington, MD, MPH, assistant professor of medicine at Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale University, and colleagues wrote. “In recognition of increasing complexity within medical oncology, recent observational studies have measured the association of facility-level volume with survival in select malignancies. However, little is known about the relationship between oncologist experience and nonsurgical cancer outcomes.”
To assess the role of oncologist experience on patient outcomes, Huntington and colleagues reviewed data on 8,247 Medicare beneficiaries with newly diagnosed DLBCL and 2,518 of their oncologists.
Researchers measured treatment volume by using the number of patients with newly diagnosed lymphoma for whom oncologists initiated therapy during a 12-month look-back period.
Oncologists had a median of two treatment initiations. Researchers defined high-volume oncologists as those who initiated treatment for three or more patients with lymphoma in the past 12 months.
About one in four Medicare beneficiaries with newly diagnosed DLBCL underwent treatment by an oncologist who had not initiated therapy for non-Hodgkin lymphoma on another Medicare beneficiary during the previous 12 months.
Overall, 75.2% of patients received chemotherapy, and 71.4% of cytotoxic regimens contained an anthracycline.
Patients treated by higher-volume oncologists appeared more likely to receive chemotherapy (adjusted OR = 1.45; 95% CI, 1.24-1.7) than patients treated by oncologists who had no DLBCL treatment initiations in the previous 12 months. Higher-volume oncologists also appeared more likely to treat with an anthracycline-containing regimen (adjusted OR = 1.26; 95% CI, 1.06-1.5).
Guidelines generally recommend an anthracycline-containing or equivalent regimen for DLBCL regardless of patient age, researchers noted.
Among patients who received cytotoxic chemotherapy, 25.7% experienced one or more hospitalizations within 30 days of treatment initiation.
Treatment by higher-volume oncologists appeared associated with 20% lower odds of hospitalization (adjusted OR = 0.8; 95% CI, 0.69-0.94) and a 15% reduced risk for death (adjusted HR = 0.85; 95% CI, 0.79-0.92) compared with treatment by low-volume oncologists
The limitations of the study included its restriction to the Medicare fee-for-service population and lack of adjustment for facility-level case volume.
“Recent advances have increased the complexity of providing high-quality cancer care,” the researchers wrote. “Research outside the field of medical oncology suggests clinical volume may be an important factor behind optimal delivery of specialized health care. We found oncologist experience with lymphoma treatment associated with survival in older adults newly diagnosed with DLBCL. Furthermore, lower oncologist volume was associated with reduced odds of receiving cytotoxic chemotherapy, and this treatment selection likely contributed to the observed volume-survival association.” – by Cassie Homer
Disclosures: Huntington reports consultant roles with Bayer, Celgene, Janssen and Pharmacyclics. Please see the study for all other authors’ relevant financial disclosures.
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