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JAMA Netw Open. 2020 Jan 3;3(1):e1918586. doi: 10.1001/jamanetworkopen.2019.18586.

Association of Physician Peer Influence With Subsequent Physician Adoption and Use of Bevacizumab.

Author information

Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Department of Biomedical Data Science and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Hanover, New Hampshire.
Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Department of Population Sciences and Medical Oncology, City of Hope Medical Center, Duarte, California.
Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.



Understanding adoption of new cancer therapies may help identify opportunities to increase use for high-value indications.


To determine whether use of bevacizumab in 2005 to 2006 by oncologists' peers was associated with greater bevacizumab use among oncologists in 2007 to 2010.

Design, Setting, and Participants:

This cohort study of physicians and their patients took place in 51 randomly selected hospital referral regions in the United States. Participants were 44 012 fee-for-service Medicare beneficiaries aged 65 years or older with cancers of the colorectum, lung, breast, kidney, brain, or ovary treated by 3261 oncologists in 2005 to 2010 and assigned to one of 252 communities. Data were analyzed in 2017 to 2018.


Among patients treated with chemotherapy during 2007 to 2010 by an oncologist who had not treated patients with bevacizumab in 2005 to 2006, models assessed the association of bevacizumab use with rates of bevacizumab use in their physician's community of connected physicians in 2005 to 2006. Models adjusted for patient and physician characteristics and physician, practice, and community random effects.

Main Outcomes and Measures:

Receipt of bevacizumab.


A total of 34 750 patients (14 126 [40.6%] aged ≥75 years; 21 321 [61.4%] female) with cancers of the colorectum, lung, breast, kidney, brain, and ovary were treated with chemotherapy in 2005 to 2006 in the 51 hospital referral regions. Among 9262 patients treated in 2007 to 2010 by 829 physicians whose patients did not use bevacizumab in 2005 to 2006, 3654 (39.5%) were aged 75 years or older and 6227 (67.2%) were female. The rate of bevacizumab use relative to other chemotherapy in 2007 to 2010 by tertile of use (bevacizumab for <4.4%, 4.4%-6.2%, and >6.2% of all patients receiving chemotherapy) among their physician's peers in 2005 to 2006 was 10.0%, 9.5%, and 13.6%, respectively. After adjustment, use of bevacizumab in 2007 to 2010 was greater among physicians in communities with the highest rates of bevacizumab use in 2005 to 2006 compared with those whose peers were in the lowest tertile of bevacizumab use in 2005 to 2006 (adjusted odds ratio, 1.64; 95% CI, 1.20-2.25).

Conclusions and Relevance:

This study found that an increase in oncologists' adoption and use of bevacizumab in the years after its approval was associated with their peer physicians being earlier adopters. As organizations seek to provide better care at lower costs, interventions that leverage physician ties may help to promote adoption of high-value use of new cancer treatments and deimplementation of low-value therapies.

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