Oncologists’ influence on receipt of adjuvant chemotherapy: does it matter whom you see for treatment of curable breast cancer?
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We know little about whether it matters which oncologist a breast cancer patient sees with regard to receipt of chemotherapy. We examined oncologists’ influence on use of recurrence score (RS) testing and chemotherapy in the community.
We identified 7810 women with stages 0-II breast cancer treated in 2013-15 through the SEER registries of Georgia and Los Angeles County. Surveys were sent 2 months post-surgery, (70% response rate, n = 5080). Patients identified their oncologists (n = 504) of whom 304 responded to surveys (60%). We conducted multi-level analyses on patients with ER-positive HER2-negative invasive disease (N = 2973) to examine oncologists’ influence on variation in RS testing and chemotherapy receipt, using patient and oncologist survey responses merged to SEER data.
Half of patients (52.8%) received RS testing and 27.7% chemotherapy. One-third (35.9%) of oncologists treated >50 new breast cancer patients annually; mean years in practice was 15.8. Oncologists explained 17% of the variation in RS testing but little of the variation in chemotherapy receipt (3%) controlling for clinical factors. Patients seeing an oncologist who was one standard deviation above the mean use of RS testing had over two-times higher odds of receiving RS (2.47, 95% CI 1.47–4.15), but a parallel estimate of the association of oncologist with the odds of receiving chemotherapy was much smaller (1.39, CI 1.03–1.88).
Clinical algorithms have markedly reduced variation in chemotherapy use across oncologists. Oncologists’ large influence on variation in RS use suggests that they variably seek tumor profiling to inform treatment decisions.
KeywordsBreast cancer Oncologist Chemotherapy Recurrence score assay
Research reported in this publication was supported by the National Cancer Institute (NCI) of the National Institutes of Health under Award No. P01CA163233 to the University of Michigan. The collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under cooperative Agreement 5NU58DP003862-04/DP003862; the NCI’s Surveillance, Epidemiology and End Results Program under Contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, Contract HHSN261201000035C awarded to the University of Southern California (USC), and Contract HHSN261201000034C awarded to the Public Health Institute. The collection of cancer incidence data in Georgia was supported by Contract HHSN261201300015I, Task Order HHSN26100006 from the NCI and cooperative Agreement 5NU58DP003875-04-00 from the CDC. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Public Health, the NCI, and the CDC or their Contractors and Subcontractors is not intended nor should be inferred. We acknowledge the work of our project staff (Mackenzie Crawford, M.P.H. and Kiyana Perrino, M.P.H. from the Georgia Cancer Registry; Jennifer Zelaya, Pamela Lee, Maria Gaeta, Virginia Parker, B.A. and Renee Bickerstaff-Magee from USC; Rebecca Morrison, M.P.H., Alexandra Jeanpierre, M.P.H., Stefanie Goodell, B.S., Paul Abrahamse, M.A., and Rose Juhasz, Ph.D. from the University of Michigan). We acknowledge with gratitude our survey respondents.
Compliance with ethical standards
Conflict of interest
The author(s) declare that they have no competing interests.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Participants were informed that the return of a completed survey indicated their consent.
- 1.Li Y, Kurian AW, Bondarenko I, Taylor JM, Jagsi R, Ward KC, Hamilton AS, Katz SJ, Hofer TP (2017) The influence of 21-gene recurrence score assay on chemotherapy use in a population-based sample of breast cancer patients. Breast Cancer Res Treat 161(3):587–595. doi: 10.1007/s10549-016-4086-3 CrossRefPubMedGoogle Scholar
- 4.Gradishar WJ, Anderson BO, Balassanian R, Blair SL, Burstein HJ, Cyr A, Elias AD, Farrar WB, Forero A, Giordano SH, Goetz M, Goldstein LJ, Hudis CA, Isakoff SJ, Marcom PK, Mayer IA, McCormick B, Moran M, Patel SA, Pierce LJ, Reed EC, Salerno KE, Schwartzberg LS, Smith KL, Smith ML, Soliman H, Somlo G, Telli M, Ward JH, Shead DA, Kumar R (2016) Invasive breast cancer version 1.2016, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw 14(3):324–354CrossRefGoogle Scholar
- 5.Sparano JA, Gray RJ, Makower DF, Pritchard KI, Albain KS, Hayes DF, Geyer CEJ, Dees EC, Perez EA, Olson JAJ, Zujewski J, Lively T, Badve SS, Saphner TJ, Wagner LI, Whelan TJ, Ellis MJ, Paik S, Wood WC, Ravdin P, Keane MM, Gomez Moreno HL, Reddy PS, Goggins TF, Mayer IA, Brufsky AM, Toppmeyer DL, Kaklamani VG, Atkins JN, Berenberg JL, Sledge GW (2015) Prospective validation of a 21-gene expression assay in breast cancer. N Engl J Med 373(21):2005–2014. doi: 10.1056/NEJMoa1510764 CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Dillman D, Smyth J, Christian L (2009) Internet, mail, and mixed-mode surveys: the tailored design method, 3rd edn. Wiley, HobokenGoogle Scholar
- 10.Griggs JJ, Hamilton AS, Schwartz KL, Zhao W, Abrahamse PH, Thomas DG, Jorns JM, Jewell R, Saber MES, Haque R, Katz SJ (2017) Discordance between original and central laboratories in ER and HER2 results in a diverse, population-based sample. Breast Cancer Res Treat 161(2):375–384. doi: 10.1007/s10549-016-4061-z CrossRefPubMedGoogle Scholar
- 11.Perez EA, Suman VJ, Davidson NE, Martino S, Kaufman PA, Lingle WL, Flynn PJ, Ingle JN, Visscher D, Jenkins RB (2006) HER2 testing by local, central, and reference laboratories in specimens from the North Central Cancer Treatment Group N9831 intergroup adjuvant trial. J Clin Oncol 24(19):3032–3038. doi: 10.1200/jco.2005.03.4744 CrossRefPubMedGoogle Scholar
- 14.Kaufman PA, Bloom KJ, Burris H, Gralow JR, Mayer M, Pegram M, Rugo HS, Swain SM, Yardley DA, Chau M, Lalla D, Yoo B, Brammer MG, Vogel CL (2014) Assessing the discordance rate between local and central HER2 testing in women with locally determined HER2-negative breast cancer. Cancer 120(17):2657–2664. doi: 10.1002/cncr.28710 CrossRefPubMedPubMedCentralGoogle Scholar