Research Activities, January 2014
Women with breast cancer more likely to have sentinel lymph node biopsy if physician affiliated with community oncology program
Practice-based research networks (PBRNs) are research partnerships between academic researchers and community-based practitioners. Their goal is to expedite research by providing greater access to larger and more diverse populations. As a result, patients can benefit from cutting-edge discoveries in treatment and care. One area where PBRNs are making a difference is in the treatment of breast cancer.
A recent study found that women treated by physicians affiliated with PBRNs are more likely to undergo sentinel lymph node biopsy (SLNB). These are lymph nodes close to the tumor rather than farther away, such as under the arm. These biopsies are associated with equivalent survival and lower morbidity compared with standard axillary lymph node dissection (ALND). ALND can have a devastating effect on women, including arm swelling and other morbidities.
Anne-Marie Meyer, Ph.D., and colleagues at the University of North Carolina at Chapel Hill, examined women undergoing SLNB in a National Cancer Institute's Community Clinical Oncology Program (CCOP), a cancer-focused PBRN. SEER-Medicare linked data provided information on 17,177 women who received care for stage I or II breast cancer. All received breast-conserving surgery. Those undergoing SLNB and ALND were identified using ICD-9 procedure codes.
A total of 874 patients received care from 84 providers affiliated with CCOPs. The majority of women (95 percent) received care outside of CCOPs. Of the 874 women who were CCOP patients, 770 received SLNB. These women were also more likely to receive SLNB through the study period from 2000 to 2005. Women receiving SLNB at CCOPs increased from 73 percent to 96 percent.
The researchers found that the odds of receiving SLNB from a CCOP physician were nearly 2.7 times that of non-CCOP women. These odds were also significantly increased when the woman received treatment at a medical school-affiliated hospital. Factors associated with receiving SLNB included having lower stage disease and better-differentiated tumors. Those less likely to have SLNB included women who were black, over 80 years of age, and those with lower socioeconomic status. The study was supported in part by AHRQ (HS19468).
See "Differential receipt of sentinel lymph node biopsy within practice-based research networks," by Anne-Marie Meyer, Ph.D., Katherine E. Reeder-Hayes, M.D., M.B.A., Huan Liu, M.S., and others, in the September 2013 Medical Care 51(9), pp. 812-818.