Physician peer group characteristics and timeliness of breast cancer surgery

Abstract

The likelihood of surgical delay varied substantially across physician peer groups and was associated with provider density and patient racial composition.

Physician trajectories of abandoning long‐course breast radiotherapy and their cost impact

“…Research has shown that hypofractionated whole-breast irradiation (HF-WBI) is as effective as conventionally fractionated whole-breast irradiation (CF-WBI) in reducing the risk of recurrence and mortality following breast conserving surgery in patients with early-stage breast cancer. 1,2 Compared to CF-WBI, which typically involves 25-33 radiation treatments, HF-WBI uses a higher radiation dose per fraction but requires fewer (approximately [15][16][17][18][19][20] treatments. Hence, HF-WBI is less expensive and more convenient than CF-WBI, 3 and yields improved patient quality of life (eg, improved cosmetic outcome, less toxic effects, and less fatigue).…”

“…13,14 Several studies have shown that physicians' use of cancer care therapies is influenced by "peer groups" (groups of physicians who frequently share patients with one another). 13,15,16 There is also evidence for large variation in clinical practice across physician peer groups, 13,17 suggesting possible distinct practice styles. For instance, use of magnetic resonance imaging before breast cancer surgery varied from 0% to 81% across physician peer groups.…”

“…Likewise, while the exact role of surgeons in influencing peer providers' adoption of HF-WBI warrants further examination, radiation oncology is a tertiary referral specialty and as such the opinions of referring doctors and surgeons may have an important impact on decisions about radiation treatment 34,35. There is also evidence that physician composition and other peer group characteristics could influence the delivery of breast cancer care (eg, use of new imaging techniques and timeliness of breast cancer surgery) 16,17. Therefore, addressing financial incentives of providers in free-standing facilities and appropriately leveraging the influence of peer physicians may offer opportunities to contain overutilization of CF-WBI.Use of conventional vs hypofractionated radiotherapy carries important implications for health care costs.…”

Disparities in Time to Treatment for Breast Cancer: Shifting Focus to the Root Cause

“… 1 Disparities in time to treatment are well documented, with AA women facing a longer time to treatment than white women for surgery, chemotherapy, radiation, and endocrine therapy. 2 – 5 Because delays in treatment correlate with worse outcomes and reduced overall survival, it is imperative to address this inequity. 5 …”

“…1 Disparities in time to treatment are well documented, with AA women facing a longer time to treatment than white women for surgery, chemotherapy, radiation, and endocrine therapy. [2][3][4][5] Because delays in treatment correlate with worse outcomes and reduced overall survival, it is imperative to address this inequity. 5 Song et al 6 conducted a retrospective review of the National Cancer Database (NCDB), identifying 557,816 women older than 65 years with non-metastatic breast cancer (2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017).…”