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Association between physician characteristics and the use of 21-gene recurrence score genomic testing among Medicare beneficiaries with early-stage breast cancer, 2008-2011.
Wilson, Lauren E; Pollack, Craig Evan; Greiner, Melissa A; Dinan, Michaela A.
Afiliação
  • Wilson LE; Department of Population Health Sciences, Duke University School of Medicine, Erwin Square Suite 720A, Box 104023, Durham, NC, 27705, USA. lauren.e.wilson@duke.edu.
  • Pollack CE; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MA, USA.
  • Greiner MA; Department of Population Health Sciences, Duke University School of Medicine, Erwin Square Suite 720A, Box 104023, Durham, NC, 27705, USA.
  • Dinan MA; Department of Population Health Sciences, Duke University School of Medicine, Erwin Square Suite 720A, Box 104023, Durham, NC, 27705, USA.
Breast Cancer Res Treat ; 170(2): 361-371, 2018 Jul.
Article em En | MEDLINE | ID: mdl-29536319
ABSTRACT

PURPOSE:

We sought to determine whether physician-level characteristics were associated with 21-gene recurrence score (RS) genomic testing to evaluate recurrence risk and benefit of adjuvant chemotherapy in patients with estrogen receptor-positive, node-negative breast cancer.

METHODS:

Retrospective cohort study of a nationally representative sample of Medicare beneficiaries using Surveillance, Epidemiology, and End Results program-Medicare data linked with the American Medical Association physician master file. The main outcome was receipt of genomic testing within 1 year of diagnosis as a function of physician-level factors.

RESULTS:

A total of 24,463 patients met the study criteria; they received care from 3172 surgeons and 2475 medical oncologists. Of 4124 tests ordered, 70% were ordered by a medical oncologist and 16% by a surgeon. In multivariable regression models, multiple variables were associated with receipt of testing, including having a medical oncologist (odds ratio [OR] 2.77; 95% CI 2.00-3.82), a surgeon specializing in surgical oncology (OR 1.20; 95% CI 1.09-1.31), and a female medical oncologist (OR 1.10; 95% CI 1.02-1.20). Having a medical oncologist with 5 or more years in practice was associated with lower odds of testing (OR 0.83; 95% CI 0.76-0.92). Surgical procedures performed at academic centers were associated with higher odds of testing (OR 1.11; 95% CI 1.02-1.20).

CONCLUSIONS:

Although most RS testing was ordered by medical oncologists, physicians in other specialties ordered roughly one-third of the tests. Physician characteristics, including gender and time in practice, were associated with receiving testing, creating opportunities for targeting interventions to help patients receive optimal care.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Padrões de Prática Médica / Neoplasias da Mama / Biomarcadores Tumorais / Testes Genéticos Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Aged80 / Female / Humans País/Região como assunto: America do norte Idioma: En Revista: Breast Cancer Res Treat Ano de publicação: 2018 Tipo de documento: Article País de afiliação: Estados Unidos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Padrões de Prática Médica / Neoplasias da Mama / Biomarcadores Tumorais / Testes Genéticos Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Aged80 / Female / Humans País/Região como assunto: America do norte Idioma: En Revista: Breast Cancer Res Treat Ano de publicação: 2018 Tipo de documento: Article País de afiliação: Estados Unidos