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Oncologist and organizational factors associated with variation in breast cancer multigene testing.
Lieu, Tracy A; Ray, G Thomas; Prausnitz, Stephanie R; Habel, Laurel A; Alexeeff, Stacey; Li, Yan; Ramsey, Scott D; Phelps, Charles E; Chawla, Neetu; C O'Neill, Suzanne; Mandelblatt, Jeanne S.
Afiliação
  • Lieu TA; Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA. tracy.lieu@kp.org.
  • Ray GT; Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
  • Prausnitz SR; Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
  • Habel LA; Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
  • Alexeeff S; Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
  • Li Y; Department of Oncology, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA.
  • Ramsey SD; Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
  • Phelps CE; University of Rochester, Rochester, NY, USA.
  • Chawla N; Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
  • C O'Neill S; Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.
  • Mandelblatt JS; Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.
Breast Cancer Res Treat ; 163(1): 167-176, 2017 May.
Article em En | MEDLINE | ID: mdl-28224383
PURPOSE: Multigene testing for breast cancer recurrence risk became available in 2007, yet many eligible patients remain untested. This study evaluated variation in testing rates, and oncologist and organizational factors associated with variation, in a setting without financial influences on testing. METHODS: We conducted a retrospective cohort study using electronic data and oncologist surveys within Kaiser Permanente Northern California, a large integrated health care system. Analyses included all 2974 test eligible patients from 2013 to 2015, 113 oncologists, and 15 practice groups. Receipt of multigene testing was evaluated with generalized linear mixed models. RESULTS: Overall, 39% of eligible patients had multigene testing, but rates varied widely among practice groups, ranging from 24 to 48% after case mix adjustment. This 24% difference among practices was greater than the variation associated with most patient characteristics, including comorbidities and race/ethnicity, and similar to that associated with tumor size. Practice group and oncologist factors were statistically significant contributors to the variation in testing after adjusting for patient factors. Patients were more likely to be tested if they had a female oncologist (aOR 1.60, 95% CI 1.21-2.12) or were in a practice whose chief had a high testing rate (aOR 1.20, 95% CI 1.12-1.29 per 10% increase in the percent tested). CONCLUSIONS: Oncologist and leadership practices play a key role in the variation in genomic test use for cancer recurrence risk even in a healthcare system without financial barriers to testing and could be a leverage point for implementing desired practice changes for new genomic advances.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Neoplasias da Mama / Testes Genéticos / Recidiva Local de Neoplasia Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Middle aged País como assunto: America do norte Idioma: En Ano de publicação: 2017 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Neoplasias da Mama / Testes Genéticos / Recidiva Local de Neoplasia Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Middle aged País como assunto: America do norte Idioma: En Ano de publicação: 2017 Tipo de documento: Article