Influence of provider factors and race on uptake of breast cancer gene expression profiling. Issue 8 (16th January 2018)

• Record Type: Journal Article
• Authors: Reeder‐Hayes, Katherine E.; Wheeler, Stephanie B.; Baggett, Christopher D.; Zhou, Xi; Meng, Ke; Roberts, Megan C.; Carey, Lisa A.; Meyer, Anne‐Marie
• Is Part Of: Cancer. Volume 124:Issue 8(2018)
• Page Start: 1743
• Page End: 1751
• Publication Date: 2018-01-16
• Subjects: breast cancer -- gene profiling -- health care disparities -- minority health -- provider factors; Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.31222
• Languages: English
• ISSNs: 0008-543X

Abstract

Abstract : BACKGROUND: Gene expression profiling (GEP) has been rapidly adopted for early breast cancer and can aid in chemotherapy decision making. Study results regarding racial disparities in testing are conflicting, and may reflect different care settings. To the authors' knowledge, data regarding the influence of provider factors on testing are scarce. METHODS: The authors used a statewide, multipayer, insurance claims database linked to cancer registry records to examine the impact of race and provider characteristics on GEP uptake in a cohort of patients newly diagnosed with breast cancer between 2005 and 2012. Incidence proportion models were used to examine the adjusted likelihood of testing. Models were stratified by lymph node status (N0 vs N1). RESULTS: Among 11, 958 eligible patients, 23% of black and 26% of non‐Hispanic white patients received GEP. Among patients with N0 disease, black individuals were 16% less likely to receive testing after adjustment for clinical factors and the provider's specialty and volume of patients with breast cancer (95% confidence interval, 0.77‐0.93). Adjustment for provider characteristics did not attenuate the effect of race on testing. Patients of middle‐volume providers were more likely to be tested compared with those with either high‐volume or low‐volume providers, whereas patients seeing a medical oncologist were more likely to be tested compared with those whose only providers were from surgical specialties. CONCLUSIONS: Provider volume and specialty were found to be significant predictors of GEP use, but did not explain racial disparities in testing. Further research concerning the key contributors to lagging test use among black women is needed to optimize the equitable use of GEPs and support personalized treatment decision making for all patients. Cancer 2018;124:1743‐51 . © 2018 American Cancer Society Abstract : Gene expression profiling is an innovation designed to improve prognostic and predictive accuracy in patients with early breast cancer, but it is not used equitably among all patient groups. The current study examines whether provider factors may explain racial disparities in testing.