Association between facility volume and mortality of patients with classic Hodgkin lymphoma

Gaurav Goyal, Sri Harsha Tella, Shealeigh Funni, Anuhya Kommalapati, Jonathan W. Inselman, Nilay D. Shah, Ronald S. Go, Stephen M. Ansell

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: Prior studies in oncology have shown that a higher annual facility patient volume is associated with reduced mortality. Because classic Hodgkin lymphoma is uncommon but highly curable, this study used the National Cancer Database (2003-2014) to analyze whether such a relationship exists for this disease. Methods: The facilities were classified by quartiles, and random intercepts were used to account for clustering of patients within facilities. A Cox regression model was used to determine the volume-outcome relationship. Results: There were 47,633 patients with classic Hodgkin lymphoma treated at 1310 facilities. The first quartile (Q1), which included 58.4% of the facilities, treated 3 or fewer patients per year, whereas the fourth quartile (Q4), which included 5.9% of the facilities, treated more than 9 patients per year. Compared with the patients treated at Q4 facilities, those treated at lower quartile facilities had a higher risk of death (hazard ratio for the third quartile [HR], 1.19; 95% confidence interval [CI], 1.1-1.29; HR for the second quartile, 1.28; 95% CI, 1.19-1.38; HR for Q1, 1.29; 95% CI, 1.2-1.39) after adjustments for all other factors (P <.0001). Compared with facilities treating 10 patients per year, facilities treating 40 patients per year had approximately 27% lower overall mortality rates. Conclusions: Patients with classic Hodgkin lymphoma treated at high-volume centers had lower overall mortality than those treated at lower volume centers. Because this is a highly curable malignancy, such differences may suggest a benefit from referral to higher volume facilities or the emulation of their care models.

Original languageEnglish (US)
Pages (from-to)757-764
Number of pages8
Issue number4
StatePublished - Feb 15 2020


  • Hodgkin lymphoma
  • National Cancer Database (NCDB)
  • hospital volume
  • overall survival

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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