Identifying Barriers for Slow Update of Effective Radiotherapy Method for Cancer

确定有效癌症放射治疗方法更新缓慢的障碍

基本信息

批准号：
9750676
负责人：
Dezheng Huo
金额：
$ 4.95万
依托单位：
UNIVERSITY OF CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-01 至 2020-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9750676
关键词：
Identifying Barriers Slow Update Effective

项目摘要

Project Summary About 1 in 8 American women will develop invasive breast cancer over the course of her lifetime. It is the most common malignancy in American women, accounting for 30% of new cancer cases. Radiation therapy is a cornerstone of breast cancer treatment, and can improve local disease control and prolong life of breast cancer patients. Over the past decade, post-lumpectomy radiotherapy has evolved and a short version of radiotherapy called hypofractionated whole breast irradiation (HF-WBI) was introduced. HF-WBI is usually delivered over 3-4 weeks, as compare to 5-7 weeks in conventional fractionation, and can save 21 days of patient time on average. Several randomized trials have showed that HF-WBI is equivalent in local recurrence and disease-free survival to conventional fractionation, but it adoption in the U.S. remained low (<20%). HF- WBI represents an exemplary type of medical care with demonstrated effectiveness, promise of economic efficiency, but low adoption rates, and thus investigation of barriers of HF-WBI slow adoption may be relevant for understanding potentially modifiable factors of clinically effective and cost treatments of other diseases. In this proposal, we plan to investigate financial factors or incentives that are related to use of HF-WBI using a large insurance claims database, which covers claims for over 40 million people. The study has three specific aims: 1) To examine the variation of HF-WBI use relative to CF-WBI across health care providers and communities in the U.S.; 2) To investigate the influence of patient characteristics, insurance policies and financial burden to patients on HF-WBI use; and 3) To determine whether physician reimbursement structure affects HF-WBI use. Approximately 67,000 breast cancer patients diagnosed between 2008 and 2013 will be included in the analysis. We will use cross-classified multilevel models to take into account issues of clustering of patients within hospitals and within communities and to decompose the variance in HF-WBI use. To test the hypothesis that financial reasons are the driving force of the slow adoption of HF-WBI, we will examine the influence of type of insurance plans, out-of-pocket cost, and physician payment structure on HF-WBI use. HF- WBI has shown to be less costly than conventional radiotherapy, so the study has a great potential to identify strategies to increase the adoption of new treatment method and reduce the cost of medical care.

项目摘要在她的一生中，大约有八分之一的美国妇女将患上侵入性的乳腺癌。是美国妇女最常见的恶性肿瘤，占新癌症病例的30％。放射治疗是乳腺癌治疗的基石，可以改善局部疾病控制和延长乳房的寿命癌症患者。在过去的十年中，倾斜后切除术放射疗法已经发展出来，很短的版本引入了被放射疗法，称为低分化全乳腺照射（HF-WBI）。 HF-WBI通常是超过3-4周，与常规分馏相比之下，可以节省21天平均时间。几个随机试验表明，HF-WBI在局部复发中等效和无疾病的常规分级生存期，但在美国采用的生存率仍然很低（<20％）。 HF- WBI代表了一种示范的医疗服务类型效率，但采用率低，因此对HF-WBI缓慢采用的障碍的调查可能是相关的理解其他疾病的临床有效和成本治疗的潜在可修改因素。在这项建议，我们计划调查与使用HF-WBI使用的财务因素或激励措施大型保险索赔数据库，涵盖了超过4000万人的索赔。该研究有三个特定目的：1）检查HF-WBI使用相对于CF-WBI在医疗保健提供者和美国社区； 2）调查患者特征，保险单和 HF-WBI使用给患者的经济负担； 3）确定医师的报销结构是否影响HF-WBI使用。在2008年至2013年之间，大约有67,000名被诊断出的乳腺癌患者将是包括在分析中。我们将使用跨分类的多级模型来考虑聚类的问题医院内和社区内的患者的分解HF-WBI使用方差。测试假设财务原因是HF-WBI缓慢采用的推动力，我们将研究保险计划类型，自付费用和医师支付结构对HF-WBI使用的影响。 HF- WBI证明比常规放射疗法的成本较低，因此该研究具有识别的巨大潜力增加采用新治疗方法并降低医疗成本的策略。