A new study published in the journal Lung Cancer says treatment at high volume facilities (HVFs) leads to better mesothelioma outcomes. The study, Facility volume and postoperative outcomes for malignant pleural mesothelioma: A National Cancer Data Base analysis, was based on an analysis of a large, contemporary national database of postoperative outcomes and overall survival (OS) for malignant pleural mesothelioma (MPM) by facility volume.
The research team queried the National Cancer Database (NCDB) for “newly-diagnosed non-metastatic MPM undergoing definitive surgery (extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D)).” Approximately 1,307 patients were separated into those receiving treatment at HVFs (686, 52%), with the remainder (621, 48%) categorized as LVFs.
“Statistics included multivariable logistic regression, Kaplan-Meier analysis, propensity-matching, and multivariable Cox proportional hazards modeling. Sensitivity analysis varied the dichotomized HVF-LVF cutoff and evaluated effects on postoperative outcomes and OS.” The following results were reported:
HVFs were more often in the Middle/South Atlantic regions, and less likely in New England, South, and Midwest. Notably, 75% of procedures at HVFs were P/Ds, versus 84% at LVFs (p < 0.001). Patients treated at HVFs experienced shorter length of postoperative hospitalization (p = 0.035), lower 30-day readmission rates (4.6% vs. 6.1%, p = 0.021), and lower 90-day mortality rates (10.0% vs. 14.6%, p = 0.029). Median OS for respective groups were 18 versus 15 months (p = 0.010), which were not significant following propensity-matching (p = 0.540). On multivariable analysis, facility volume did not independently predict for OS. Sensitivity analyses confirmed the postoperative outcomes and OS findings.
According to the team, this promising new study is the largest investigation to date assessing facility volume and postoperative outcomes for MPM. “Although no independent effects on OS were observed,” wrote the team, “postoperative outcomes were more favorable at HVFs. These findings have implications for postoperative management, patient counseling, referring providers, and cost-effectiveness.”
If you have been diagnosed with mesothelioma, the recent study discussed here supports the benefits of seeking treatment at a high volume facility. The best place to begin your search for a HVF is with your doctor. He can provide referrals to facilities with a long history of treating large numbers of mesothelioma patients, successfully. Talk your doctor about the options available to you today.
Sources
Ahern, Christopher A., Christopher G. Berlind and Verma, Vivek. “Facility volume and postoperative outcomes for malignant pleural mesothelioma: A National Cancer Data Base analysis,” Lungcancerjournal.info. Elsevier, Inc., Jun. 2018. Web. 23 Aug. 2018.
