Treatment at academic cancer centers (ACs) has been associated with improved outcomes across hematologic malignancies. ACs offer the benefit of high treatment volume in addition to enrollment in clinical trials and expanded access to diagnostic and treatment-related services. This is the most extensive study to date examining the benefit of academic centers in multiple myeloma (MM).
The National Cancer Database was utilized to obtain data on patients diagnosed with MM between 2004- 2017. Patients treated at ACs were compared to those treated at non-academic centers (NACs).
Of the 179,769 MM patients available, 42.4% were treated at ACs (p<0.05). Patients treated at ACs were younger than those treated at NACs (mean age 64.7 years vs. 69.2 years, p<0.05). ACs were more likely to treat Black and other minority patients, with Black patients representing 23.5% vs. 18%, and other minorities 5.6% vs. 3.6% of patients treated at ACs vs. NACs; p<0.05. Academic centers were more likely to treat uninsured patients (6.3% vs. 4.1%), patients on Medicaid (7.9% vs. 5.5%) as well as privately insured patients (41.5% vs. 29.6%), (all p<0.05).
Median OS at ACs was longer than at NACs, with a median OS of 67.8 months (95% CI 66.89-68.79 months) compared to 38.6 months (95% CI 38.15-39.13 months) at NACs, p<0.05. When adjusted for age, gender, race, insurance, time to treatment, and use of autologous transplant on Cox Regression analysis, the improvement in OS remained. Patients treated at AC had a hazard ratio of 0.77 for all-cause mortality (95% CI 0.756-0.784) referenced to NACs on multivariate analysis (p<0.05).
Patients with multiple myeloma had significantly improved survival when treated at academic centers compared to other facility types. The improvement in OS remained when controlled for available treatment and demographic features.