Patients With AML Have Significantly Lower Early Mortality at NCI-Designated Cancer Centers

Patients with acute myeloid leukemia (AML) who were treated at a National Cancer Institute (NCI)-designated cancer center had a 53% lower risk of early mortality, according to a study published in Cancer.

The researchers used linked data from the California Cancer Registry and the Patient Discharge Dataset (1999-2014) to identify patients age 18 or older with AML who had received inpatient treatment within 30 days of their diagnosis. Of the 7007 patients with AML who were identified, 1762 (25%) were treated at an NCI-designated cancer center.

“We found the early mortality, deaths less than 60 days after diagnosis, was significantly lower at the NCI-designated cancer centers compared to non—NCI-designated cancer centers in California,” Brian Jonas, MD, PhD, assistant professor of medicine at the University of California Davis Comprehensive Cancer Center and co-author on the paper, said in a statement. “We were surprised by the magnitude of the differential.”

The patients in the study who were treated at NCI-designated cancer centers were more likely to be older (at least 65 years), live in higher socioeconomic status neighborhoods, have fewer comorbidities, have public health insurance, had higher rates of renal failure, and had lower rates of respiratory failure and cardiac arrest.

The researchers found that after adjusting for baseline characteristics, patients who were treated at NCI-designated cancer centers had an average early mortality rate of 12% compared with 24% for patients treated at non—NCI-designated cancer centers. Complication rates did not vary significantly.

“This is clearly provocative data that makes you want to understand exactly why,” said Jonas. “We’re going to have to dive into that question in a more significant way.”

The authors noted that the findings highlight that there needs to be more work to fully understand the differences in care driving these issues. Potential contributing factors could be volume of patients seen, access to clinical trials, better nursing ratios, and more significant intensive care units, the authors hypothesize.

“Lower early mortality may result from differences in hospital or provider experience and supportive care,” the authors concluded.

Reference

Ho G, Wun T, Muffly L, et al. Decreased early mortality associated with the treatment of acute myeloid leukemia at National Cancer Institute-designated cancer centers in California. [published online February 16, 2018]. Cancer. doi:10.1002/cncr.31296.