Shared-patient physician networks and their impact on the uptake of genomic testing in breast cancer.
Shared-patient physician networks and their impact on the uptake of genomic testing in breast cancer.
复制标题
共享患者医生网络及其对乳腺癌基因组检测的影响。
DOI：
10.1007/s10549-019-05248-2
复制
发表时间：
2019
影响因子：
3.8
通讯作者：
Dinan,Michaela
中科院分区：
文献类型：
--
作者：
Rotter,Jason;Wilson,Lauren;Greiner,MelissaA;Pollack,CraigE;Dinan,Michaela
背景影响基因组检测采用的因素尚不清楚，这可能导致癌症患者接受不公平和次优的治疗。Oncotype DX(ODX)是第一个也是最广泛使用的对早期乳腺癌(BC)妇女风险进行分层的基因组分析方法之一。医生网络已成为新兴医疗技术采用的重要且可修改的驱动因素。目的调查医生网络连接与ODX测试使用之间的关联。方法采用2008-2012年间使用SEER-Medicare诊断为BC的妇女的回顾性研究。如果内科肿瘤学家在早期采用期间(2008-2009年)共用两个或更多的患者，那么他们是“有联系的”。平行的医生和患者水平的分析采用Logistic混合模型来确定在2011-2012年间与早期采用的肿瘤科医生“联系”对ODX使用的影响。结果24,463名妇女符合研究标准；12,874名妇女在早期采用期间被诊断为BC。从2008年到2009年，2129名内科肿瘤学家治疗了这些患者。内科肿瘤学家的同伴关系中位数为4(IQR：2-7)。在2008-2009年间，与较早采用ODX的提供商建立同行关系与提供商采用ODX的人数增加1.7倍(95%CI：1.1-2.6)，而在2010-2012年间，接受ODX治疗的患者增加1.5倍(95%CI：1.1-2.0)。结论与较早采用ODX的医生建立同行联系可以在医生和患者级别的分析中预测ODX的采用。提供商网络可能提供一种强有力的、可修改的手段来调节新兴医疗技术的传播。在适当的情况下增加测试的努力可能会受益于基于对等的连接策略。
BackgroundFactors influencing the adoption of genomic testing are poorly understood, which may lead to inequitable and suboptimal treatment in cancer patients. Oncotype DX (ODX) is one of the first and most widely used genomic assays to stratify risk in women with early-stage breast cancer (BC). Physician networks have emerged as a significant and modifiable driver of emerging medical technology adoption.ObjectiveTo investigate the association between physician network connections and the use of ODX testing.MethodsA retrospective study of women diagnosed with BC using SEER-Medicare from 2008 to 2012 was used. Medical oncologists were “connected” if they shared two or more patients during the early-adoption period (2008–2009). Parallel physician- and patient-level analyses employed logistic mixed models to determine the impact of being “connected” to an early-adopting oncologist on ODX use in 2011–2012.Results24,463 women met study criteria; 12,874 were diagnosed with BC in the early-adoption time period. 2129 medical oncologists treated these patients from 2008 to 2009. Medical oncologists had a median number of peer connections of 4 (IQR: 2–7). Peer connection to an early-adopting provider in 2008–2009 was associated with a 1.7-fold increase in providers’ adopting ODX (95% CI: 1.1–2.6) and a 1.5-fold increase in their patients receiving ODX (95% CI: 1.1–2.0) in 2010–2012.ConclusionsPeer connectedness to an early-adopting physician predicts ODX adoption in both physician-level and patient-level analyses. Provider networks may provide a potent and modifiable means to modulate the diffusion of emerging medical technologies. Efforts to increase testing, where appropriate, may benefit from peer-to-peer-based connection strategies.