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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.

项目摘要大约八分之一的美国女性在一生中会患上浸润性乳腺癌。是这是美国女性最常见的恶性肿瘤，占新发癌症病例的30%。放射疗法是是治疗乳腺癌的基石，可改善局部疾病控制，延长乳腺寿命。癌症患者。在过去的十年中，乳房肿瘤切除术后的放射治疗已经发展，引入了称为大分割全乳房照射（HF-WBI）的放射疗法。HF-WBI通常在3-4周内交付，而传统分次中为5-7周，并且可以节省21天患者平均时间几项随机试验表明，HF-WBI在局部复发方面是等效的和无病生存率，但在美国采用率仍然很低（<20%）。氢氟酸 WBI代表了一种示范性的医疗护理类型，具有已证明的有效性、经济前景和可持续性。效率，但采用率低，因此调查HF-WBI采用缓慢的障碍可能是相关的了解其他疾病的临床有效性和成本治疗的潜在可修改因素。在在这项提案中，我们计划调查与使用HF-WBI相关的财务因素或激励措施，大型保险索赔数据库，涵盖超过4000万人的索赔。该研究有三个具体的目的：1）检查医疗保健提供者之间HF-WBI使用相对于CF-WBI的变化，美国的社区; 2)调查患者特征、保险政策和使用HF-WBI给患者带来的经济负担;以及3）确定医生报销结构是否影响HF-WBI的使用。2008年至2013年期间诊断的约67，000名乳腺癌患者将接受包括在分析中。我们将使用交叉分类的多级模型来考虑聚类问题在医院和社区内的患者，并分解在HF-WBI使用的差异。测试假设财务原因是HF-WBI采用缓慢的驱动力，我们将研究保险计划类型、自付费用和医生支付结构对HF-WBI使用的影响。HF- WBI已被证明比传统放射治疗成本更低，因此该研究具有很大的潜力来识别增加采用新的治疗方法和降低医疗费用的战略。