Patient and physician factors associated with Oncotype DX and adjuvant chemotherapy utilization for breast cancer patients in New Hampshire, 2010–2016

Schwedhelm, Thomas M.; Rees, Judy R.; Onega, Tracy; Zipkin, Ronnie; Schaefer, Andrew P.; Celaya, Maria O.; Moen, Erika L.

doi:10.1186/s12885-020-07355-6

Cited by 6 publications

(7 citation statements)

References 45 publications

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“…Thereby demonstrating the importance of ODX testing to ensure that women with low RS do not receive unnecessary adjuvant chemotherapy. This accords with Schwedhelm et al [ 33 ], where women who were categorized as a low ODX risk group had decreasing rates of chemotherapy use from 2010 to 2016.…”

Section: Discussionsupporting

confidence: 88%

Oncotype DX Test Receipt among Latina/Hispanic Women with Early Invasive Breast Cancer in New Jersey: A Registry-Based Study

Acuna

Plascak

Tsui

et al. 2021

IJERPH

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Oncotype DX® (ODX) is a valid test of breast cancer (BC) recurrence risk and chemotherapy benefit. The purpose of this study was to examine prevalence of and factors associated with receipt of ODX testing among eligible Latinas/Hispanics diagnosed with BC. Sociodemographic and tumor data of BC cases diagnosed between 2008 and 2017 among Latina/Hispanic women (n = 5777) were from the New Jersey State Cancer Registry (NJSCR). Eligibility for ODX testing were based on National Comprehensive Cancer Network guidelines. Multivariable logistic regression models of ODX receipt among eligible women were used to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI) by demographic and clinicopathologic factors. One-third of Latinas/Hispanics diagnosed with BC were eligible for ODX testing. Among the eligible, 60.9% received ODX testing. Older age (AOR 0.08, 95% CI: 0.04, 0.14), low area-level SES (AOR 0.58, 95% CI: 0.42, 0.52), and being uninsured (AOR 0.58, 95% CI: 0.39, 0.86) were associated with lower odds of ODX testing. While there was relatively high ODX testing among eligible Latina/Hispanic women with BC in New Jersey, our findings suggest that age, insurance status, and area-level SES contribute to unequal access to genetic testing in this group, which might impact BC outcomes.

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Section: Discussionsupporting

confidence: 88%

Oncotype DX Test Receipt among Latina/Hispanic Women with Early Invasive Breast Cancer in New Jersey: A Registry-Based Study

Acuna

Plascak

Tsui

et al. 2021

IJERPH

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“…Demographic and clinical characteristics are known to influence the use of GEP tests for women diagnosed with early-stage breast cancer. Consistent with prior studies [ 14 , 15 , 17 , 20 , 21 ], the odds of GEP test use were greater among patients under the age of 60 at the time of diagnosis, among those who were married or living with a partner, among those residing in areas with higher median household income, and among those diagnosed with tumors measuring 2.0–4.0 cm as well as those with higher grade tumors. These patient characteristics were associated with location of the treating hospital.…”

Section: Discussionsupporting

confidence: 86%

“…Similar to previous studies [ 14 , 15 ], there was a high correlation between ODX recurrence score and receipt of adjuvant chemotherapy as recommended based on prespecified risk categories. The largest variation in adjuvant chemotherapy use between hospitals was observed among the intermediate risk group, with the lowest rate of chemotherapy use among patients treated at small rural hospitals [ 49 ].…”

Section: Discussionsupporting

confidence: 84%

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Hospital Rurality and Gene Expression Profiling for Early-Stage Breast Cancer among Iowa Residents (2010–2018)

et al. 2022

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Objective. Given the challenges rural cancer patients face in accessing cancer care as well as the slower diffusion and adoption of new medical technologies among rural providers, the aim of our study was to examine trends in gene expression profiling (GEP) testing and evaluate the association between hospital rurality and receipt of GEP testing. Methods. Data from the Iowa Cancer Registry (ICR) were used to identify women with newly diagnosed, histologically confirmed breast cancer from 2010 through 2018 who met eligibility criteria for GEP testing. Patients were allocated to the hospitals where their most definitive surgical treatment was received, and Rural-Urban Commuting Area codes were used to categorize hospitals into urban (N = 43), large rural (N = 16), and small rural (N = 48). Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression to evaluate the association between hospital rurality and GEP test use, adjusting for demographic and clinical characteristics. The association between test result and treatment received was assessed among patients who received Oncotype DX (ODX) testing. Results. Of 6,726 patients eligible for GEP test use, 46% (N = 3,069) underwent testing with 95% receiving ODX. While overall GEP testing rates increased over time from 42% between 2010 and 2012 to 51% between 2016 and 2018 ( P trend < 0.0001 ), use continued to be the lowest among patients treated at hospitals in small rural areas. The odds of GEP testing remained significantly lower among patients treated at hospitals located in small rural areas (aOR 0.55; 95% CI 0.43–0.71), after adjusting for demographic and clinical characteristics. ODX recurrence scores were highly correlated with chemotherapy use across all strata of hospital rurality. Conclusions. GEP testing continues to be underutilized, especially among those treated at small rural hospitals. Targeted interventions aimed at increasing rates of GEP testing to ensure the appropriate use of adjuvant chemotherapy may improve health outcomes and lower treatment-related costs.

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“…As found in prior studies 32,33 , younger age and nodal positivity were associated with increased use of adjuvant chemotherapy. Past literature has found 70-88% of women in receipt of a high ODX RS receive adjuvant chemotherapy [32][33][34][35] . Similarly, our analysis found receipt of AC following a high (≥26) ODX recurrence score to be 88.8% and 77.2% in women ≤40 years and 40-69 years, respectively.…”

Section: Discussionmentioning

confidence: 99%

The impact of age and nodal status on variations in oncotype DX testing and adjuvant treatment

et al. 2022

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Oncotype DX (ODX) recurrence score (RS) is a validated tool to guide the use of adjuvant chemotherapy (AC) in hormone receptor+/HER2- breast cancer. In this analysis, we examine (1) characteristics associated with ODX testing and (2) the association between ODX RS and receipt of AC across age and nodal status. Women with HR+/HER2–, early-stage (T1-2, N0-1) breast cancers from 2010–2017 in the National Cancer Database were included. 530,125 met inclusion and 255,971 received ODX testing. Older women were less likely to receive testing; however, nodal positivity increased use of testing. High ODX RS was associated with increased mortality, though the association was not consistent across age and was most strongly associated with mortality among younger, node-negative women. Older women with high ODX RS, regardless of nodal status, were less likely to receive AC. Clinicians may be employing ODX RS to support treatment decisions against the receipt of AC.

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Patient and physician factors associated with Oncotype DX and adjuvant chemotherapy utilization for breast cancer patients in New Hampshire, 2010–2016

Cited by 6 publications

References 45 publications

Oncotype DX Test Receipt among Latina/Hispanic Women with Early Invasive Breast Cancer in New Jersey: A Registry-Based Study

Oncotype DX Test Receipt among Latina/Hispanic Women with Early Invasive Breast Cancer in New Jersey: A Registry-Based Study

Hospital Rurality and Gene Expression Profiling for Early-Stage Breast Cancer among Iowa Residents (2010–2018)

The impact of age and nodal status on variations in oncotype DX testing and adjuvant treatment

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