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Breast Cancer Res Treat. 2017 Jul 8. doi: 10.1007/s10549-017-4377-3. [Epub ahead of print]

Oncologists' influence on receipt of adjuvant chemotherapy: does it matter whom you see for treatment of curable breast cancer?

Author information

1
Department of Internal Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109-2800, USA. skatz@med.umich.edu.
2
Department of Health Management and Policy, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA. skatz@med.umich.edu.
3
Department of Internal Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109-2800, USA.
4
Department of Health Management and Policy, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
5
Ann Arbor Veterans Affairs Center for Clinical Management Research, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, 48105, USA.
6
Department of Biostatistics, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
7
Department of Radiation Oncology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
8
Department of Epidemiology, Emory University, 1518 Clifton Rd, NE, Atlanta, GA, 30322, USA.
9
Department of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA.

Abstract

PURPOSE:

We know little about whether it matters which oncologist a breast cancer patient sees with regard to receipt of chemotherapy. We examined oncologists' influence on use of recurrence score (RS) testing and chemotherapy in the community.

METHODS:

We identified 7810 women with stages 0-II breast cancer treated in 2013-15 through the SEER registries of Georgia and Los Angeles County. Surveys were sent 2 months post-surgery, (70% response rate, n = 5080). Patients identified their oncologists (n = 504) of whom 304 responded to surveys (60%). We conducted multi-level analyses on patients with ER-positive HER2-negative invasive disease (N = 2973) to examine oncologists' influence on variation in RS testing and chemotherapy receipt, using patient and oncologist survey responses merged to SEER data.

RESULTS:

Half of patients (52.8%) received RS testing and 27.7% chemotherapy. One-third (35.9%) of oncologists treated >50 new breast cancer patients annually; mean years in practice was 15.8. Oncologists explained 17% of the variation in RS testing but little of the variation in chemotherapy receipt (3%) controlling for clinical factors. Patients seeing an oncologist who was one standard deviation above the mean use of RS testing had over two-times higher odds of receiving RS (2.47, 95% CI 1.47-4.15), but a parallel estimate of the association of oncologist with the odds of receiving chemotherapy was much smaller (1.39, CI 1.03-1.88).

CONCLUSIONS:

Clinical algorithms have markedly reduced variation in chemotherapy use across oncologists. Oncologists' large influence on variation in RS use suggests that they variably seek tumor profiling to inform treatment decisions.

KEYWORDS:

Breast cancer; Chemotherapy; Oncologist; Recurrence score assay

PMID:
28689364
DOI:
10.1007/s10549-017-4377-3
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