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21.02.2017 | Epidemiology

Oncologist and organizational factors associated with variation in breast cancer multigene testing

verfasst von: Tracy A. Lieu, G. Thomas Ray, Stephanie R. Prausnitz, Laurel A. Habel, Stacey Alexeeff, Yan Li, Scott D. Ramsey, Charles E. Phelps, Neetu Chawla, Suzanne C. O’Neill, Jeanne S. Mandelblatt

Erschienen in: Breast Cancer Research and Treatment | Ausgabe 1/2017

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Abstract

Purpose

Multigene testing for breast cancer recurrence risk became available in 2007, yet many eligible patients remain untested. This study evaluated variation in testing rates, and oncologist and organizational factors associated with variation, in a setting without financial influences on testing.

Methods

We conducted a retrospective cohort study using electronic data and oncologist surveys within Kaiser Permanente Northern California, a large integrated health care system. Analyses included all 2974 test eligible patients from 2013 to 2015, 113 oncologists, and 15 practice groups. Receipt of multigene testing was evaluated with generalized linear mixed models.

Results

Overall, 39% of eligible patients had multigene testing, but rates varied widely among practice groups, ranging from 24 to 48% after case mix adjustment. This 24% difference among practices was greater than the variation associated with most patient characteristics, including comorbidities and race/ethnicity, and similar to that associated with tumor size. Practice group and oncologist factors were statistically significant contributors to the variation in testing after adjusting for patient factors. Patients were more likely to be tested if they had a female oncologist (aOR 1.60, 95% CI 1.21–2.12) or were in a practice whose chief had a high testing rate (aOR 1.20, 95% CI 1.12–1.29 per 10% increase in the percent tested).

Conclusions

Oncologist and leadership practices play a key role in the variation in genomic test use for cancer recurrence risk even in a healthcare system without financial barriers to testing and could be a leverage point for implementing desired practice changes for new genomic advances.

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Titel: Oncologist and organizational factors associated with variation in breast cancer multigene testing
verfasst von: Tracy A. Lieu
G. Thomas Ray
Stephanie R. Prausnitz
Laurel A. Habel
Stacey Alexeeff
Yan Li
Scott D. Ramsey
Charles E. Phelps
Neetu Chawla
Suzanne C. O’Neill
Jeanne S. Mandelblatt
Publikationsdatum: 21.02.2017
Verlag: Springer US
Erschienen in: Breast Cancer Research and Treatment / Ausgabe 1/2017
Print ISSN: 0167-6806
Elektronische ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-017-4158-z

Springer Medizin

Oncologist and organizational factors associated with variation in breast cancer multigene testing