The interplay between hospital and surgeon factors and the use of sentinel lymph node biopsy for breast cancer
Identifieur interne : 000A06 ( Main/Exploration ); précédent : 000A05; suivant : 000A07The interplay between hospital and surgeon factors and the use of sentinel lymph node biopsy for breast cancer
Auteurs : Tina W. F. Yen [États-Unis] ; Jianing Li [États-Unis] ; Rodney A. Sparapani [États-Unis] ; Purushuttom W. Laud [États-Unis] ; Ann B. Nattinger [États-Unis]Source :
- Medicine [ 0025-7974 ] ; 2016.
Abstract
Several surgeon characteristics are associated with the use of sentinel lymph node biopsy (SLNB) for breast cancer. No studies have systematically examined the relative contribution of both surgeon and hospital factors on receipt of SLNB.
To evaluate the relationship between surgeon and hospital characteristics, including a novel claims-based classification of hospital commitment to cancer care (HC), and receipt of SLNB for breast cancer, a marker of quality care.
Observational prospective survey study was performed in a population-based cohort of Medicare beneficiaries who underwent incident invasive breast cancer surgery, linked to Medicare claims, state tumor registries, American Hospital Association Annual Survey Database, and American Medical Association Physician Masterfile. Multiple logistic regression models determined surgeon and hospital characteristics that were predictors of SLNB.
Of the 1703 women treated at 471 different hospitals by 947 different surgeons, 65% underwent an initial SLNB. Eleven percent of hospitals were high-volume and 58% had a high commitment to cancer care. In separate adjusted models, both high HC (odds ratio [OR] 1.53, 95% confidence interval [CI] 1.12–2.10) and high hospital volume (HV, OR 1.90, 95% CI 1.28–2.79) were associated with SLNB. Adding surgeon factors to a model including both HV and HC minimally modified the effect of high HC (OR 1.34, 95% CI 0.95–1.88) but significantly weakened the effect of high HV (OR 1.25, 95% CI 0.82–1.90). Surgeon characteristics (higher volume and percentage of breast cancer cases) remained strong independent predictors of SLNB, even when controlling for various hospital characteristics.
Hospital factors are associated with receipt of SLNB but surgeon factors have a stronger association. Since regionalization of breast cancer care in the U.S. is unlikely to occur, efforts to improve the surgical care and outcomes of breast cancer patients must focus on optimizing patient access to SLNB by ensuring hospitals have the necessary resources and training to perform SLNB, staffing hospitals with surgeons who specialize/focus in breast cancer and referring patients who do not have access to SLNB to an experienced center.
Url:
DOI: 10.1097/MD.0000000000004392
PubMed: 27495053
PubMed Central: 4979807
Affiliations:
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Yen</name><affiliation><nlm:aff id="aff1">Department of Surgery, Division of Surgical Oncology</nlm:aff><wicri:noCountry code="subfield">Division of Surgical Oncology</wicri:noCountry></affiliation><affiliation wicri:level="1"><nlm:aff id="aff4">Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, USA.</nlm:aff><country xml:lang="fr" wicri:curation="lc">États-Unis</country><wicri:regionArea>Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI</wicri:regionArea><wicri:noRegion>WI</wicri:noRegion></affiliation></author><author><name sortKey="Li, Jianing" sort="Li, Jianing" uniqKey="Li J" first="Jianing" last="Li">Jianing Li</name><affiliation><nlm:aff id="aff2">Division of Biostatistics</nlm:aff></affiliation><affiliation wicri:level="1"><nlm:aff id="aff4">Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, USA.</nlm:aff><country xml:lang="fr" wicri:curation="lc">États-Unis</country><wicri:regionArea>Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI</wicri:regionArea><wicri:noRegion>WI</wicri:noRegion></affiliation></author><author><name sortKey="Sparapani, Rodney A" sort="Sparapani, Rodney A" uniqKey="Sparapani R" first="Rodney A." last="Sparapani">Rodney A. 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F." last="Yen">Tina W. F. Yen</name><affiliation><nlm:aff id="aff1">Department of Surgery, Division of Surgical Oncology</nlm:aff><wicri:noCountry code="subfield">Division of Surgical Oncology</wicri:noCountry></affiliation><affiliation wicri:level="1"><nlm:aff id="aff4">Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, USA.</nlm:aff><country xml:lang="fr" wicri:curation="lc">États-Unis</country><wicri:regionArea>Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI</wicri:regionArea><wicri:noRegion>WI</wicri:noRegion></affiliation></author><author><name sortKey="Li, Jianing" sort="Li, Jianing" uniqKey="Li J" first="Jianing" last="Li">Jianing Li</name><affiliation><nlm:aff id="aff2">Division of Biostatistics</nlm:aff></affiliation><affiliation wicri:level="1"><nlm:aff id="aff4">Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, USA.</nlm:aff><country xml:lang="fr" wicri:curation="lc">États-Unis</country><wicri:regionArea>Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI</wicri:regionArea><wicri:noRegion>WI</wicri:noRegion></affiliation></author><author><name sortKey="Sparapani, Rodney A" sort="Sparapani, Rodney A" uniqKey="Sparapani R" first="Rodney A." last="Sparapani">Rodney A. Sparapani</name><affiliation><nlm:aff id="aff2">Division of Biostatistics</nlm:aff></affiliation><affiliation wicri:level="1"><nlm:aff id="aff4">Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, USA.</nlm:aff><country xml:lang="fr" wicri:curation="lc">États-Unis</country><wicri:regionArea>Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI</wicri:regionArea><wicri:noRegion>WI</wicri:noRegion></affiliation></author><author><name sortKey="Laud, Purushuttom W" sort="Laud, Purushuttom W" uniqKey="Laud P" first="Purushuttom W." last="Laud">Purushuttom W. Laud</name><affiliation><nlm:aff id="aff2">Division of Biostatistics</nlm:aff></affiliation><affiliation wicri:level="1"><nlm:aff id="aff4">Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, USA.</nlm:aff><country xml:lang="fr" wicri:curation="lc">États-Unis</country><wicri:regionArea>Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI</wicri:regionArea><wicri:noRegion>WI</wicri:noRegion></affiliation></author><author><name sortKey="Nattinger, Ann B" sort="Nattinger, Ann B" uniqKey="Nattinger A" first="Ann B." last="Nattinger">Ann B. Nattinger</name><affiliation><nlm:aff id="aff3">Department of Medicine</nlm:aff></affiliation><affiliation wicri:level="1"><nlm:aff id="aff4">Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, USA.</nlm:aff><country xml:lang="fr" wicri:curation="lc">États-Unis</country><wicri:regionArea>Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI</wicri:regionArea><wicri:noRegion>WI</wicri:noRegion></affiliation></author></analytic><series><title level="j">Medicine</title><idno type="ISSN">0025-7974</idno><idno type="eISSN">1536-5964</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Abstract</title><sec sec-type="background"><title>Background:</title><p>Several surgeon characteristics are associated with the use of sentinel lymph node biopsy (SLNB) for breast cancer. No studies have systematically examined the relative contribution of both surgeon and hospital factors on receipt of SLNB.</p></sec><sec><title>Objective:</title><p>To evaluate the relationship between surgeon and hospital characteristics, including a novel claims-based classification of hospital commitment to cancer care (HC), and receipt of SLNB for breast cancer, a marker of quality care.</p></sec><sec><title>Data Sources/Study Design:</title><p>Observational prospective survey study was performed in a population-based cohort of Medicare beneficiaries who underwent incident invasive breast cancer surgery, linked to Medicare claims, state tumor registries, American Hospital Association Annual Survey Database, and American Medical Association Physician Masterfile. Multiple logistic regression models determined surgeon and hospital characteristics that were predictors of SLNB.</p></sec><sec sec-type="results"><title>Results:</title><p>Of the 1703 women treated at 471 different hospitals by 947 different surgeons, 65% underwent an initial SLNB. Eleven percent of hospitals were high-volume and 58% had a high commitment to cancer care. In separate adjusted models, both high HC (odds ratio [OR] 1.53, 95% confidence interval [CI] 1.12–2.10) and high hospital volume (HV, OR 1.90, 95% CI 1.28–2.79) were associated with SLNB. Adding surgeon factors to a model including both HV and HC minimally modified the effect of high HC (OR 1.34, 95% CI 0.95–1.88) but significantly weakened the effect of high HV (OR 1.25, 95% CI 0.82–1.90). Surgeon characteristics (higher volume and percentage of breast cancer cases) remained strong independent predictors of SLNB, even when controlling for various hospital characteristics.</p></sec><sec sec-type="conclusion"><title>Conclusions:</title><p>Hospital factors are associated with receipt of SLNB but surgeon factors have a stronger association. Since regionalization of breast cancer care in the U.S. is unlikely to occur, efforts to improve the surgical care and outcomes of breast cancer patients must focus on optimizing patient access to SLNB by ensuring hospitals have the necessary resources and training to perform SLNB, staffing hospitals with surgeons who specialize/focus in breast cancer and referring patients who do not have access to SLNB to an experienced center.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Lyman, Gh" uniqKey="Lyman G">GH Lyman</name></author><author><name sortKey="Temin, S" uniqKey="Temin S">S Temin</name></author><author><name sortKey="Edge, Sb" uniqKey="Edge S">SB Edge</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Veronesi, U" uniqKey="Veronesi U">U Veronesi</name></author><author><name sortKey="Viale, G" uniqKey="Viale G">G 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F." last="Yen">Tina W. F. Yen</name></noRegion><name sortKey="Laud, Purushuttom W" sort="Laud, Purushuttom W" uniqKey="Laud P" first="Purushuttom W." last="Laud">Purushuttom W. Laud</name><name sortKey="Li, Jianing" sort="Li, Jianing" uniqKey="Li J" first="Jianing" last="Li">Jianing Li</name><name sortKey="Nattinger, Ann B" sort="Nattinger, Ann B" uniqKey="Nattinger A" first="Ann B." last="Nattinger">Ann B. Nattinger</name><name sortKey="Sparapani, Rodney A" sort="Sparapani, Rodney A" uniqKey="Sparapani R" first="Rodney A." last="Sparapani">Rodney A. Sparapani</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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