title: Impact of access to NCI- and NCCN-designated cancer centers on outcomes for multiple myeloma patients: A SEER registry analysis.
abstract: BACKGROUND
  National Cancer Institute (NCI)/National Comprehensive Cancer Network (NCCN)-designated cancer centers (CCs) offer patients state-of-the-art treatment, but their impact on multiple myeloma (MM) patient outcomes has not been evaluated.
  
  
  METHODS
  Adult MM patients diagnosed between 1973 and 2011 were identified from the Surveillance, Epidemiology, and End Results database and were stratified by the county of residence at the time of diagnosis and the year of CC designation. The influence of NCI/NCCN CC access, race, and the year of diagnosis on overall survival (OS) was evaluated with a Cox regression model.
  
  
  RESULTS
  A statistically significant OS improvement was noted in patients diagnosed after 1995 with access to 2 or more NCI CCs overall (P = .002 for 1996-2002; P < .001 for 2003-2011) and by race for whites (hazard ratio [HR] for 1996-2002, 0.85; 95% confidence interval [CI], 0.78-0.91; HR for 2003-2011, 0.85; 95% CI, 0.79-0.91) but not for nonwhites. For NCCN access, improvement was seen in 1996-2002 (P = .003), in 2003-2011 (P < .001), and by race for whites (HR, 0.917; 95% CI, 0.88-0.95) and nonwhites (0.94; 95% CI, 0.89-0.99), but within nonwhites, this was true only for African Americans (AAs; HR, 0.88; 95% CI, 0.81-0.97) and not for Asians, Hispanics, or Native Americans.
  
  
  CONCLUSIONS
  Improvement in OS was seen in MM patients diagnosed after 1995 with access to 1 NCCN CC or 2 or more NCI CCs. NCI access benefited only whites, whereas NCCN access benefited only white and AA patients. No OS benefit was seen for any subgroup with access to only 1 NCI center. Eliminating racial disparities in health care access and utilization is needed to improve outcomes.
authors.affiliation: Division of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida.
authors.forename: Sikander
authors.initials: S
authors.lastname: Ailawadhi
authors.affiliation: Division of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida.
authors.forename: Pooja
authors.initials: P
authors.lastname: Advani
authors.affiliation: Department of Biostatistics, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California.
authors.forename: Dongyun
authors.initials: D
authors.lastname: Yang
authors.affiliation: Division of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida.|Department of Pediatrics, Staten Island University Hospital, Staten Island, New York.
authors.forename: Radhika
authors.initials: R
authors.lastname: Ghosh
authors.affiliation: Division of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida.
authors.forename: Abhisek
authors.initials: A
authors.lastname: Swaika
authors.affiliation: Division of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida.
authors.forename: Vivek
authors.initials: V
authors.lastname: Roy
authors.affiliation: Division of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida.
authors.forename: James
authors.initials: J
authors.lastname: Foran
authors.affiliation: Division of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Colon-Otero
authors.affiliation: Division of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida.
authors.forename: Asher
authors.initials: A
authors.lastname: Chanan-Khan
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D001213:Asian / Q000706:statistics & numerical data; D002173:Cancer Care Facilities; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000208:ethnology / Q000401:mortality*; D054547:National Cancer Institute (U.S.); D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D018426:SEER Program; D015996:Survival Rate; D014481:United States; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
keywords: National Cancer Institute (NCI) cancer center; National Comprehensive Cancer Network (NCCN) cancer center; multiple myeloma; overall survival