Treatment volumes.

Top Line: There’s a plethora of data out there suggesting higher surgical volume (or patient ratings?) results in better measurable operative outcomes. Could the same hold true for radiation?

The Study: This NCDB analysis captured all cases of curative-intent—i.e. (neo)adjuvant or definitive—radiation between 2004-2013 and separated treatment centers into quartiles: low, intermediate, high, and very-high patient volume. Among the almost countless analyses you can imagine, treatment at a very-high volume versus a low volume center was associated with a decreased risk of death after definitive radiation for prostate (HR 0.82), non-small cell lung (HR 0.89), pancreas (HR 0.84), and head and neck (HR 0.82) cancers. Oh and also after neoadjuvant radiation for rectal cancer (HR 0.75) and, get this, even after adjuvant radiation for breast (HR 0.83) and uterine (HR 0.77) cancers. While intriguing, one may postulate this all has to do with health disparities between populations seeking care at the highest versus lowest volume treatment centers… unless we can all get behind the idea that the quality of breast tangents at high volume centers is so superior to that at low volume centers that it confers an overall survival advantage--an elusive outcome of trials for adjuvant radiation for rectal, uterine and breast cancers. The authors graciously conclude that this should prompt measures to equalize quality across low and high volume centers rather than mass referrals to the highest volume centers.

TBL: While definitive radiation at the highest volume centers is associated with better survival than at the lowest volume centers in the NCDB, it is unclear what healthcare and socioeconomic factors influence this difference. | Tchelebi, Cancer 2021


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