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Facility-Level Variation of Low-Value Breast Cancer Treatments in Older Women with Early-Stage Breast Cancer: Analysis of a Statewide Claims Registry

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Since 2004, national guidelines have supported the omission of sentinel lymph node biopsy (SLNB) and radiotherapy for women ≥ 70 years of age with early-stage, hormone receptor-positive (HR+) breast cancer, but many women continue to receive at least one of these services. Provider- and patient-level factors may contribute to persistent utilization, but the role of facility-level factors is unknown. We aimed to determine facility-level variation of SLNB and adjuvant radiotherapy utilization in older women with early-stage, HR+ breast cancer undergoing breast-conserving surgery (BCS). Additionally, we aimed to explore factors associated with SLNB and radiotherapy utilization and the intra-facility correlation in their utilization.

Methods

We conducted a retrospective cohort study using a statewide registry of claims data. We included women ≥70 years of age diagnosed with breast cancer who underwent BCS from 2012 to 2019 at 80 hospitals in the Michigan Value Collaborative. The main outcome was inter-facility rates and variation of SLNB and radiotherapy, as well as intra-facility correlation in their utilization.

Results

The cohort included 7253 women (median age 77 years). Only 20% (n = 1440) underwent BCS alone, whereas 71% (n = 5122) underwent SLNB and 52% (n = 3793) received radiotherapy. Inter-facility rates of SLNB ranged from 35 to 82% (median 70%), and radiotherapy ranged from 19 to 72% (median 49%). SLNB and radiotherapy were positively correlated (r = 0.27, p = 0.016).

Conclusions

SLNB and radiotherapy rates remain high with significant variation in utilization at the facility level. High utilizers of SLNB are likely to be high utilizers of radiotherapy, suggesting the opportunity for strategic targeting of these facilities and their clinicians.

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Acknowledgment

Support for the MVC is provided by the BCBSM as part of the BCBSM Value Partnerships program; however, the opinions, beliefs, and viewpoints expressed by the authors do not necessarily reflect those of the BCBSM or any of its employees.

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Authors and Affiliations

  1. Department of Surgery, University of Michigan, Ann Arbor, MI, USA

    Brooke C. Bredbeck MD, Ton Wang MD, Tasha M. Hughes MD, MPH, Hari Nathan MD, PhD & Lesly A. Dossett MD, MPH

  2. Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA

    Brooke C. Bredbeck MD, Nicole M. Mott BS, Ton Wang MD, Brandy R. Sinco MS, Tasha M. Hughes MD, MPH, Hari Nathan MD, PhD & Lesly A. Dossett MD, MPH

  3. University of Michigan Medical School, Ann Arbor, MI, USA

    Nicole M. Mott BS

Authors
  1. Brooke C. Bredbeck MD
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  2. Nicole M. Mott BS
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Correspondence to Lesly A. Dossett MD, MPH.

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Disclosure

Brooke C. Bredbeck is supported by the Ruth L. Kirschstein Research Service Award from the National Cancer Institute (NCI; T32 CA009672); Nicole M. Mott is supported by a grant from the National Institutes of Health (NIH; 5 TL1 TR002242-05); and Lesly A. Dossett is supported by a grant from the Agency for Healthcare Research and Quality (AHRQ; 5 K08 HS026030-02). Ton Wang, Brandy R. Sinco, Tasha M. Hughes, and Hari Nathan have no disclosures to declare.

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Appendix 1

Appendix 1

See Table 4.

Table 4 STROBE statement—checklist of items that should be included in reports of cohort studies
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Bredbeck, B.C., Mott, N.M., Wang, T. et al. Facility-Level Variation of Low-Value Breast Cancer Treatments in Older Women with Early-Stage Breast Cancer: Analysis of a Statewide Claims Registry. Ann Surg Oncol 29, 4155–4164 (2022). https://doi.org/10.1245/s10434-022-11631-z

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  • DOI: https://doi.org/10.1245/s10434-022-11631-z

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