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 Using trial participation as a proxy for the volume of cancer
patients a hospital treats, the study found an overall 10 percent
difference in survival rates, and that patients at centers with
higher participation also had better disease management and fewer
adverse events.
“It’s hard to say conclusively but the underlying hypothesis and
belief is that at large volume centers, where physicians and care
team are specialized in treating that specific type of malignancy,
particularly in instances where treatment is life saving or the risk
for severe toxicity is high, that outcomes are better at high volume
centers, as opposed to small community centers where the people
there treat a variety of things,” said lead author Dr. Bree R. Eaton
of Winship Cancer Institute of Emory University in Atlanta.
“Radiation as a technology has advanced and is a lot more complex
than it used to be,” Eaton told Reuters Health. “In general there’s
a lot of nuances and subjectivity.”
Other studies have found that outcomes of high-risk surgery are
better at high-volume centers, but there hasn’t been much
investigation into the same question for radiation, said Dr. Evan J.
Wuthrick of The Ohio State University in Columbus, who was not part
of the new study.
Eaton and her coauthors compared outcomes for nearly 500 patients
treated at 180 different institutions and participating in a trial
of radiation and chemotherapy for locally advanced, or stage III,
lung cancer, meaning it has spread to the lymph nodes or invaded
critical structures and usually requires at least two types of
treatment.
They divided the patients into groups depending on whether their
institution was a low-volume center that contributed three or fewer
participants to the trial or a high-volume center, which enrolled
between 4 and 18 patients.
Half of patients treated at high-volume centers survived at least 26
months after treatment, compared with about 20 months for those at
low-volume centers, according to the results published in the
Journal of the National Cancer Institute.
At the two-year point, 55 percent of those treated at high-volume
centers had survived compared to 44 percent of patients at
low-volume centers. Adverse events related to treatment and
withdrawing from the trial because of adverse events were both more
common at low-volume centers.
“Approximately 25 percent of these patients live for at least 5
years,” said Dr. Henry Soo-Min Park of Yale University School of
Medicine in New Haven, Connecticut, who was not part of the new
study. “Therefore, this disease is difficult to control but is
potentially curable in some patients following aggressive
treatment.”
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Patients also got lower radiation doses to critical structures near
the tumor site like the heart, and fewer radiation treatment
interruptions, the study team notes.
“Optimal radiation therapy requires close collaboration among
radiation oncologists, medical oncologists, pharmacists,
dosimetrists, physicists, technicians, nurses, social workers and
administrative staff, and even the most well-designed treatments for
locally advanced non-small cell lung cancer can injure healthy
organs,” Park told Reuters Health by email. Survival can be
influenced by the quality of the treatments, the appropriateness of
side effect management and follow-up, and access to clinical trials,
which may depend at least partially on the experience and
specialization of the multidisciplinary treatment team, he added.
“In our large study of patients getting chemotherapy and radiation
therapy for head and neck cancer, there was a very large effect of
institutional volume on survival,” Wuthrick told Reuters Health.
It is too early to know if lung cancer patients should change
treatment center based on these findings, Park said.
“There are many factors that go into an individualized decision
about where to receive cancer treatment, and case volume should be
just one of many factors for each patient to consider,” Park said.
Patients at high-volume centers may be different in some ways from
those at low-volume centers, which could also affect their survival,
Eaton acknowledged, although in this study they saw no such
differences at the start.
SOURCE: http://bit.ly/1RqMkVO Journal of the National Cancer
Institute, online May 19, 2016.
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