Importance of Radiation Oncologist Experience Among Patients With Head-and-Neck Cancer Treated With Intensity-Modulated Radiation Therapy

Boero, Isabel J.; Paravati, Anthony J.; Xu, Beibei; Cohen, Ezra E.W.; Mell, Loren K.; Le, Quynh‐Thu; Murphy, James D.

doi:10.1200/jco.2015.63.9898

Cited by 134 publications

(124 citation statements)

References 24 publications

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“…An increasing amount of data supports the hypothesis that radiation therapy by high-volume providers is associated with improved outcomes in HNC [13,14] and multiple non-HNC malignancies like lung, cervical, and prostate cancers [15][16][17][18]. In HNC, two recent large national database analyses have noted disparities in access to high-volume providers, which may serve as another proxy for access to high-quality cancer care.…”

Section: Evidence Of Radiation Therapy Delivery Disparities In Hncmentioning

confidence: 97%

“…In HNC, two recent large national database analyses have noted disparities in access to high-volume providers, which may serve as another proxy for access to high-quality cancer care. First, Boero et al found that in the SEERMedicare linked database, white patients receiving 3D-conformal radiation therapy and intensity-modulated radiation therapy for HNC were more significantly likely to be treated by high-volume radiation oncologists than non-white patients [13]. Second, Wuthrick et al reported that patients with private insurance were more likely to receive HNC treatment at highaccruing facilities into Radiation Therapy Oncology Group trials than those without private insurance [14].…”

Section: Evidence Of Radiation Therapy Delivery Disparities In Hncmentioning

confidence: 99%

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Disparities in radiation therapy delivery: current evidence and future directions in head and neck cancer

Park

Decker

2016

Cancers Head Neck

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Background: Though treatments for head and neck cancer have improved in recent years, significant variation persists in the delivery of surgery, radiation therapy, and systemic therapy to patients throughout the United States. Body: In this review, we explore the current evidence regarding radiation therapy utilization inequities across the spectra of race, socioeconomic status, and age. We also discuss hypothesized mechanisms for how non-clinical factors may influence shared clinical decisions between patients and providers. Finally, we suggest future directions for research in treatment disparities. Conclusions: Radiation therapy continues to be delivered inequitably among certain subpopulations with head and neck cancer and other cancers. More research into the drivers of these disparities and interventions designed to address them are necessary.

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Section: Evidence Of Radiation Therapy Delivery Disparities In Hncmentioning

confidence: 97%

Section: Evidence Of Radiation Therapy Delivery Disparities In Hncmentioning

confidence: 99%

Disparities in radiation therapy delivery: current evidence and future directions in head and neck cancer

Park

Decker

2016

Cancers Head Neck

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“…We identified the treating radiation oncologist (provider) using previously described methods (25). Briefly, we identified the specific provider using the Unique Physician Identification Number (UPIN) or National Physician Identifier (NPI) associated with the provider-specific weekly management code 77247.…”

Section: Radiation Therapy and Providermentioning

confidence: 99%

The Impact of Radiation Oncologists on the Early Adoption of Hypofractionated Radiation Therapy for Early-Stage Breast Cancer

Boero

Gillespie

Hou

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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SummaryThis study evaluated the impact of radiation oncologists on the early adoption of hypofractionated radiation therapy for early-stage breast cancer. Using SEERMedicare data and multilevel, multivariable logistic models, we assessed the impact of radiation oncologist and geographic practice area on the likelihood of receiving hypofractionated radiation therapy. The key finding of our study was that the individual radiation oncologist heavily influenced the decision to pursue hypofractionation.Purpose: Despite multiple randomized trials showing the efficacy of hypofractionated radiation therapy in early-stage breast cancer, the United States has been slow to adopt this treatment. The goal of this study was to evaluate the impact of individual radiation oncologists on the early adoption of hypofractionated radiation therapy for early-stage breast cancer. Methods: We identified 22,233 Medicare beneficiaries with localized breast cancer that was diagnosed from 2004 to 2011 who underwent breast-conserving surgery with adjuvant radiation. Multilevel, multivariable logistic models clustered by radiation oncologist and geographic practice area were used to determine the impact of the provider and geographic region on the likelihood of receiving hypofractionated compared with standard fractionated radiation therapy while controlling for a patient's clinical and demographic covariates. Odds ratios (OR) describe the impact of demographic or clinical covariates, and the median OR (MOR) describes the relative impact of the individual radiation oncologist and geographic region on the likelihood of undergoing hypofractionated radiation therapy. Results: Among the entire cohort, 2333 women (10.4%) were treated with hypofractionated radiation therapy, with unadjusted rates ranging from 0.0% in the bottom quintile of radiation oncologists to 30.4% in the top quintile. Multivariable analysis found that the individual radiation oncologist (MOR 3.08) had a greater impact on the use of hypofractionation than did geographic region (MOR 2. Radiation OncologyInternational Journal of biology physics www.redjournal.org long-term randomized trial results in early 2010. Male physician and radiation oncologists treating the highest volume of breast cancer patients were less likely to perform hypofractionation (P<.05). Conclusions: The individual radiation oncologist strongly influenced the likelihood of a patient's receiving hypofractionated radiation therapy, and this trend increased despite the publication of long-term data showing equivalence to standard fractionation. Future research should focus on physician-related factors that influence this decision. Ó

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“…Grit, motivation, reputation, and integrity are the types of personal qualities that will prove elusive for any big data approach. Finally, it would be interesting to determine if high volume physicians had better outcomes than lower volume physicians as demonstrated in previous studies [27].…”

Section: Discussionmentioning

confidence: 91%

Radiation Oncology Physician Practice in the Modern Era: A Statewide Analysis of Medicare Reimbursement

Kao

Zucker

Wong

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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Importance of Radiation Oncologist Experience Among Patients With Head-and-Neck Cancer Treated With Intensity-Modulated Radiation Therapy

Cited by 134 publications

References 24 publications

Disparities in radiation therapy delivery: current evidence and future directions in head and neck cancer

Disparities in radiation therapy delivery: current evidence and future directions in head and neck cancer

The Impact of Radiation Oncologists on the Early Adoption of Hypofractionated Radiation Therapy for Early-Stage Breast Cancer

Radiation Oncology Physician Practice in the Modern Era: A Statewide Analysis of Medicare Reimbursement

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