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 journalArticle

1 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)
StateAccepted/In press - Jan 1 2019


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

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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