Researchers Say Postoperative Outcomes for Mesothelioma More 'Favorable' at High Volume Facilities
Mesothelioma is a devastating disease with no cure. However, diagnostic methods and treatments for the condition have come a long way over the years, making early detection possible, which often leads to better treatment options and outcomes. Now, a group of researchers says seeking treatment at a high volume facility (HVF) could also have an impact on outcomes.
Recently published in the journal Lung Cancer, the study 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 study, Facility volume and postoperative outcomes for malignant pleural mesothelioma: A National Cancer Data Base analysis, involved querying the National Cancer Database (NCDB) for “newly-diagnosed non-metastatic MPM undergoing definitive surgery (extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D)).” More than 1,300 patients were separated into those receiving treatment at HVFs (686, 52%), “defined a priori at the 90th percentile of case volume,” with all others (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 research team reported the following results:
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 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, and are considering surgery, this promising new study suggests that it would be beneficial to seek out a facility that has a proven track record of performing a large number of successful surgeries related to MPM. You can begin your search by talking to your doctor, who will have a list of facilities best suited to handle your unique case. Talk to your doctor today.
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.