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Influence of private practice setting and physician characteristics on the use of breast cancer adjuvant chemotherapy for elderly women†‡

  1. Dawn L. Hershman MD, MS1,2,§,*,
  2. Donna Buono MS2,
  3. Russell B. McBride MPH2,
  4. Wei Yann Tsai PhD3,
  5. Alfred I. Neugut MD, PhD1,2

Article first published online: 10 JUN 2009

DOI: 10.1002/cncr.24448

Issue

Cancer

Cancer

Volume 115, Issue 17, pages 3848–3857, 1 September 2009

Additional Information

How to Cite

Hershman, D. L., Buono, D., McBride, R. B., Tsai, W. Y. and Neugut, A. I. (2009), Influence of private practice setting and physician characteristics on the use of breast cancer adjuvant chemotherapy for elderly women. Cancer, 115: 3848–3857. doi: 10.1002/cncr.24448

Author Information

  1. 1

    Department of Medicine and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, New York

  2. 2

    Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York

  3. 3

    Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York

  1. §

    Fax: (212) 305-0178

*Division of Medical Oncology, Herbert Irving Comprehensive Cancer Center, Columbia Presbyterian Hospital, 161 Fort Washington Avenue, Room 1068, New York, NY 10032

  1. †

    This study used the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database. We acknowledge the efforts of the Applied Research Branch, Division of Cancer Prevention and Population Sciences, National Cancer Institute; the Office of Information Services and the Office of Strategic Planning, Health Care Financing Administration; Information Management Services, Inc; and the SEER Program tumor registries in the creation of the SEER-Medicare database.

  2. ‡

    This article is US Government work and, as such, is in the public domain in the United States of America.

Publication History

  1. Issue published online: 20 AUG 2009
  2. Article first published online: 10 JUN 2009
  3. Manuscript Accepted: 28 JAN 2009
  4. Manuscript Revised: 14 JAN 2009
  5. Manuscript Received: 28 OCT 2008

Funded by

  • American Society of Clinical Oncology Advanced Clinical Research Award
  • American Cancer Society. Grant Numbers: RSGT-08-009-01-CPHPS, RSGT-01-02,404-CPHPS)
  • National Cancer Institute. Grant Number: CA09461

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Keywords:

  • breast cancer;
  • chemotherapy;
  • private practice;
  • oncology;
  • elderly patient

The association between oncologist characteristics and the receipt of chemotherapy in elderly women with breast cancer was studied. Oncologists in a private practice were more likely to administer chemotherapy to their elderly patients with breast cancer than those employed in nonprivate setttings.

Abstract

BACKGROUND:

Although >70% of younger women with nonmetastatic breast cancer (BC) received adjuvant chemotherapy, only approximately 15% to 20% of elderly women with BC received chemotherapy. The decision to treat may be associated with nonmedical factors, such as patient, physician, or practice characteristics. In the current study, the association between oncologist characteristics and the receipt of chemotherapy in elderly women with BC was evaluated.

METHODS:

Women aged >65 years who were diagnosed with American Joint Committee on Cancer stages I to III BC between 1991 and 2002 were identified in the Surveillance, Epidemiology, and End Results-Medicare database. The Physician Unique Identification Number was linked to the American Medical Association Masterfile to obtain information on oncologists. Investigated was the association between demographic, tumor, and oncologist-related factors and the receipt of chemotherapy, using Generalized Estimating Equations to control for clustering. Patients were defined as low risk (estrogen/progesterone receptor positive, stage I/II disease) and high risk (estrogen/progesterone receptor-negative, stage II/III disease).

RESULTS:

Of 42,544 women identified, 8714 (20%) were treated with adjuvant chemotherapy. In a hierarchical analysis, women who underwent chemotherapy were more likely be treated by oncologists primarily employed in a private practice (odds ratio [OR], 1.40; 95% confidence interval [95% CI], 1.23-1.59) and who graduated after 1975 (OR, 1.12; 95% CI, 1.01-1.26) and were less likely to have an oncologist trained in the United States (OR, 0.83; 95% CI, 0.74-0.93). The association between a private practice setting and the receipt of chemotherapy was found to be similar for patients at high risk (OR, 1.55) and low risk (OR, 1.35) for cancer recurrence.

CONCLUSIONS:

Elderly women with BC treated by oncologists who were employed in a private practice were more likely to receive chemotherapy. Efforts to determine whether these associations reflected experience, practice setting, insurance type, or other economic incentives are warranted. Cancer 2009. Published 2009 by the American Cancer Society.

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