Association between physician characteristics and the use of 21-gene recurrence score genomic testing among Medicare beneficiaries with early-stage breast cancer, 2008–2011
- 53 Downloads
We sought to determine whether physician-level characteristics were associated with 21-gene recurrence score (RS) genomic testing to evaluate recurrence risk and benefit of adjuvant chemotherapy in patients with estrogen receptor-positive, node-negative breast cancer.
Retrospective cohort study of a nationally representative sample of Medicare beneficiaries using Surveillance, Epidemiology, and End Results program-Medicare data linked with the American Medical Association physician master file. The main outcome was receipt of genomic testing within 1 year of diagnosis as a function of physician-level factors.
A total of 24,463 patients met the study criteria; they received care from 3172 surgeons and 2475 medical oncologists. Of 4124 tests ordered, 70% were ordered by a medical oncologist and 16% by a surgeon. In multivariable regression models, multiple variables were associated with receipt of testing, including having a medical oncologist (odds ratio [OR] 2.77; 95% CI 2.00–3.82), a surgeon specializing in surgical oncology (OR 1.20; 95% CI 1.09–1.31), and a female medical oncologist (OR 1.10; 95% CI 1.02–1.20). Having a medical oncologist with 5 or more years in practice was associated with lower odds of testing (OR 0.83; 95% CI 0.76–0.92). Surgical procedures performed at academic centers were associated with higher odds of testing (OR 1.11; 95% CI 1.02–1.20).
Although most RS testing was ordered by medical oncologists, physicians in other specialties ordered roughly one-third of the tests. Physician characteristics, including gender and time in practice, were associated with receiving testing, creating opportunities for targeting interventions to help patients receive optimal care.
KeywordsBiomarkers Tumor Breast neoplasms Chemotherapy Adjuvant Gene expression profiling Genetic testing Practice patterns Physicians’ SEER program
American Medical Association
Human epidermal growth factor receptor 2
International classification of diseases, ninth revision, clinical modification
National Comprehensive Cancer Network
Surveillance, Epidemiology, and End Results
This work was supported by the Agency for Healthcare Research and Quality, US Department of Health and Human Services (Grant R00HS022189). Erin Campbell, MS, and Damon M. Seils, MA, Duke University, provided editorial assistance and prepared the manuscript. They did not receive compensation for their assistance apart from their employment at the institution where the study was conducted. The authors acknowledge the efforts of the Applied Research Program, National Cancer Institute; the Office of Research, Development and Information, Centers for Medicare & Medicaid Services; Information Management Services, Inc; and the SEER Program tumor registries in the creation of the SEER-Medicare database.
Compliance with ethical standards
Conflicts of interest
The authors declare that they have no conflict of interest.
The institutional review board of the Duke University Health System approved the study.
- 2.Paik S, Tang G, Shak S, Kim C, Baker J, Kim W, Cronin M, Baehner FL, Watson D, Bryant J, Costantino JP, Geyer CE Jr, Wickerham DL, Wolmark N (2006) Gene expression and benefit of chemotherapy in women with node-negative, estrogen receptor-positive breast cancer. J Clin Oncol 24(23):3726–3734CrossRefPubMedGoogle Scholar
- 4.Albanell J, González A, Ruiz-Borrego M, Alba E, García-Saenz JA, Corominas JM, Burgues O, Furio V, Rojo A, Palacios J, Bermejo B, Martínez-García M, Limon ML, Muñoz AS, Martín M, Tusquets I, Rojo F, Colomer R, Faull I, Lluch A (2012) Prospective transGEICAM study of the impact of the 21-gene Recurrence Score assay and traditional clinicopathological factors on adjuvant clinical decision making in women with estrogen receptor-positive (ER+) node-negative breast cancer. Ann Oncol 23(3):625–631CrossRefPubMedGoogle Scholar
- 7.Harris L, Ismaila N, McShane LM, Andre F, Coliyar DE, Gonzalez-Angulo AM, Hammond EH, Kuderer NM, Liu MC, Mennel RG, Van Poznak C, Bast RC, Hayes DF, American Society of Clinical Oncology (2016) Use of biomarkers to guide decisions on adjuvant systemic therapy for women with early-stage invasive breast cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 34(10):1134–1150CrossRefGoogle Scholar
- 8.National Comprehensive Cancer Network. NCCN guidelines for treatment of cancer by site: breast, version 3. http://www.nccn.org
- 16.Kimmick GG, Camacho F, Mackley HB, Kern T, Yao N, Matthews SA, Fleming S, Lipscomb J, Liao J, Hwang W, Anderson RT (2015) Individual, area, and provider characteristics associated with care received for stages I to III breast cancer in a multistate region of Appalachia. J Oncol Pract 11(1):e9–e18CrossRefPubMedGoogle Scholar
- 17.Thompson CA, Gomez SL, Chan A, Chan JK, McClellan SR, Chung S, Olson C, Nimbal V, Palaniappan LP (2014) Patient and provider characteristics associated with colorectal, breast, and cervical cancer screening among Asian Americans. Cancer Epidemiol Biomarkers Prev 23(11):2208–2217CrossRefPubMedPubMedCentralGoogle Scholar
- 20.McLaughlin JM, Balkrishnan R, Paskett ED, Kimmick GG, Anderson RT (2009) Patient and provider determinants associated with the prescription of adjuvant hormonal therapies following a diagnosis of breast cancer in Medicaid-enrolled patients. J Natl Med Assoc 101(11):1112–1118CrossRefPubMedGoogle Scholar
- 21.Surveillance, Epidemiology, and End Results Program. Overview of the SEER program. http://seer.cancer.gov/about/overview.html. Accessed 17 Apr 2015
- 22.Warren JL, Klabunde CN, Schrag D, Bach PB, Riley GF (2002) Overview of the SEER-medicare data: content, research applications, and generalizability to the United States elderly population. Med Care 40(8 Suppl):IV-3-18Google Scholar