Differential Receipt of Sentinel Lymph Node Biopsy Within Practice-based Research Networks

Abstract

Background Provider-based research networks (PBRNs) are promising for accelerating not only research, but also dissemination of research-based evidence into broader community practice. Sentinel lymph node biopsy (SLNB) is an innovation in breast cancer care associated with equivalent survival and lower morbidity, as compared to standard axillary lymph node dissection. We examined the diffusion of SLNB into practice and whether affiliation with the Community Clinical Oncology Program (CCOP), a cancer-focused PBRN, was associated with more rapid uptake of SLNB. Research Design Surveillance Epidemiology and End Results(SEER)-Medicare data were used to study women diagnosed with stage I or II breast cancer in the years 2000 to 2005 and undergoing breast conserving surgery with axillary staging (n=6,226). The primary outcome was undergoing SLNB. CCOP affiliation of the surgical physician was ascertained from NCI records. Multivariable generalized linear modeling with generalized estimating equations was used to measure association between CCOP exposure and undergoing SLNB, controlling for potential confounders. Results Women treated by a CCOP physician had significantly higher odds of receiving SLNB compared to women treated by a non-CCOP physician (OR 2.68; 95% CI 1.35, 5.34). The magnitude of this association was larger than that observed among patients treated by physicians operating in medical school-affiliated hospitals (OR 1.76; 95% CI 1.30–2.39). Conclusion Women treated by CCOP-affiliated physicians were more likely to undergo SLNB irrespective of the hospital’s medical school affiliation, suggesting that the CCOP PBRN may play a role in the rapid adoption of research-based innovation in community practice.

Racial Differences in Diffusion of Intensity-Modulated Radiation Therapy for Localized Prostate Cancer

“…The current results and those reported by Meyer et al (2013), suggest that one way to reduce disparities in cancer treatment, specifically related to receipt of innovative treatments and technologies, may be to improve access to these treatments for minority patients living in the South, areas that have a high proportion of minority patients, or receiving treatment in organizations that were found to slowly adopt new treatment technology. Operationalizing this concept has always been challenging.…”

Enrollment and Racial Disparities in Cancer Treatment Clinical Trials in North Carolina

“…Moreover, there is growing evidence of their effectiveness in facilitating the diffusion of trial-proven interventions to broader populations. For example, in the context of colorectal cancer, PBRNs have been associated with patients having a greater probability of receiving innovative cancer care [7, 8]. We previously reported on a novel statewide system for ongoing monitoring and public reporting of NCI clinical trial enrollment, developed to extend clinical trials access to broader patient populations [3].…”

Breast Cancer Disparities at Home and Abroad: A Review of the Challenges and Opportunities for System-Level Change

“…We and others have noted slower adoption and lower rates of sentinel lymph node biopsy, an innovative morbidity-sparing surgical procedure, among eligible Black women compared to Whites,(21,22) and these differences are partially explained by the concentration of White patients within National Cancer Institute (NCI)-designated comprehensive cancer centers, hospitals with high breast cancer volume, greater affiliation with research cooperative groups and the American College of Surgeons Oncology Group (ACOSOG), and the NCI’s Comprehensive Community Oncology Program (CCOP). (23,24) Breast reconstruction is also less utilized by minority women, which appears to be related to lower access to plastic surgeons. (25) Interestingly, one large study showed that Black women were less actively involved in choosing their surgeon or hospital for breast surgery.…”