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Peer Influence on Physician Use of Shorter Course External Beam Radiation Therapy for Patients with Breast Cancer.

Abstract

PURPOSE

Social contagion among physicians may affect the dissemination of innovative and high-value cancer care. We applied social contagion theory to investigate the role of physician peer influence on the use of short courses of external beam radiation therapy (EBRT) for patients with breast cancer.

METHODS AND MATERIALS

Using a cohort of Medicare beneficiaries with breast cancer, we constructed physician peer groups based on patient-sharing relationships. Outcomes were a patient's receipt of (1) moderately hypofractionated adjuvant EBRT after breast-conserving surgery and (2) short-course palliative EBRT for bone metastases. Using a longitudinal design, we used mixed-effects logistic regression to examine the association between physician peer group rate of short-course EBRT in 2011 to 2012 (T1) and patients' receipt of short-course EBRT in 2013 to 2014 (T2).

RESULTS

During T2, a total of 17,248 patients received adjuvant therapy (32.3% moderately hypofractionated) from 3235 physicians in 1202 physician peer groups. Compared with patients treated within peer groups in which no moderately hypofractionated adjuvant EBRT was used in T1, patients treated by a physician in a peer group with higher T1 use of moderately hypofractionated adjuvant EBRT were more likely to receive moderately hypofractionated adjuvant EBRT in T2 (adjusted odds ratio = 2.03; 95% confidence interval, 1.62-2.54, vs adjusted odds ratio = 2.61; 95% confidence interval, 2.04-3.35, for peer groups where 21%-46% and 47%-100% of radiation oncologists used moderately hypofractionated adjuvant EBRT in T1, respectively, compared with peer groups with no use of moderately hypofractionated adjuvant EBRT). In contrast, there was no significant relationship between T1 peer group use and T2 receipt of short-course palliative EBRT for bone metastases.

CONCLUSIONS

Physician peer groups significantly influenced use of short-course EBRT in adjuvant therapy but not in palliative therapy for patients with breast cancer.

Authors+Show Affiliations

Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center at Yale, New Haven, Connecticut; Yale Cancer Center, New Haven, Connecticut. Electronic address: james.b.yu@yale.edu.Johns Hopkins University, Baltimore, Maryland.Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center at Yale, New Haven, Connecticut.Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center at Yale, New Haven, Connecticut.Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center at Yale, New Haven, Connecticut.Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center at Yale, New Haven, Connecticut; Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut.Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center at Yale, New Haven, Connecticut; Yale Cancer Center, New Haven, Connecticut.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31785370

Citation

Yu, James B., et al. "Peer Influence On Physician Use of Shorter Course External Beam Radiation Therapy for Patients With Breast Cancer." Practical Radiation Oncology, 2019.
Yu JB, Pollack CE, Herrin J, et al. Peer Influence on Physician Use of Shorter Course External Beam Radiation Therapy for Patients with Breast Cancer. Pract Radiat Oncol. 2019.
Yu, J. B., Pollack, C. E., Herrin, J., Soulos, P. R., Zhu, W., Xu, X., & Gross, C. P. (2019). Peer Influence on Physician Use of Shorter Course External Beam Radiation Therapy for Patients with Breast Cancer. Practical Radiation Oncology, doi:10.1016/j.prro.2019.11.001.
Yu JB, et al. Peer Influence On Physician Use of Shorter Course External Beam Radiation Therapy for Patients With Breast Cancer. Pract Radiat Oncol. 2019 Nov 27; PubMed PMID: 31785370.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Peer Influence on Physician Use of Shorter Course External Beam Radiation Therapy for Patients with Breast Cancer. AU - Yu,James B, AU - Pollack,Craig E, AU - Herrin,Jeph, AU - Soulos,Pamela R, AU - Zhu,Weiwei, AU - Xu,Xiao, AU - Gross,Cary P, Y1 - 2019/11/27/ PY - 2019/08/07/received PY - 2019/10/31/revised PY - 2019/11/06/accepted PY - 2019/12/1/pubmed PY - 2019/12/1/medline PY - 2019/12/1/entrez JF - Practical radiation oncology JO - Pract Radiat Oncol N2 - PURPOSE: Social contagion among physicians may affect the dissemination of innovative and high-value cancer care. We applied social contagion theory to investigate the role of physician peer influence on the use of short courses of external beam radiation therapy (EBRT) for patients with breast cancer. METHODS AND MATERIALS: Using a cohort of Medicare beneficiaries with breast cancer, we constructed physician peer groups based on patient-sharing relationships. Outcomes were a patient's receipt of (1) moderately hypofractionated adjuvant EBRT after breast-conserving surgery and (2) short-course palliative EBRT for bone metastases. Using a longitudinal design, we used mixed-effects logistic regression to examine the association between physician peer group rate of short-course EBRT in 2011 to 2012 (T1) and patients' receipt of short-course EBRT in 2013 to 2014 (T2). RESULTS: During T2, a total of 17,248 patients received adjuvant therapy (32.3% moderately hypofractionated) from 3235 physicians in 1202 physician peer groups. Compared with patients treated within peer groups in which no moderately hypofractionated adjuvant EBRT was used in T1, patients treated by a physician in a peer group with higher T1 use of moderately hypofractionated adjuvant EBRT were more likely to receive moderately hypofractionated adjuvant EBRT in T2 (adjusted odds ratio = 2.03; 95% confidence interval, 1.62-2.54, vs adjusted odds ratio = 2.61; 95% confidence interval, 2.04-3.35, for peer groups where 21%-46% and 47%-100% of radiation oncologists used moderately hypofractionated adjuvant EBRT in T1, respectively, compared with peer groups with no use of moderately hypofractionated adjuvant EBRT). In contrast, there was no significant relationship between T1 peer group use and T2 receipt of short-course palliative EBRT for bone metastases. CONCLUSIONS: Physician peer groups significantly influenced use of short-course EBRT in adjuvant therapy but not in palliative therapy for patients with breast cancer. SN - 1879-8519 UR - https://www.unboundmedicine.com/medline/citation/31785370/Peer_influence_on_physician_use_of_shorter_course_external_beam_radiation_therapy_for_patients_with_breast_cancer L2 - https://linkinghub.elsevier.com/retrieve/pii/S1879-8500(19)30328-5 DB - PRIME DP - Unbound Medicine ER -