Association of 21-Gene Assay (OncotypeDX) Testing and Receipt of Chemotherapy in the Medicare Breast Cancer Patient Population Following Initial Adoption
| Autor: | Michaela A. Dinan, Edward C. Norton, Shelby D. Reed, Jennifer J. Griggs, Lauren E. Wilson |
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| Rok vydání: | 2020 |
| Předmět: |
Male
0301 basic medicine Oncology Cancer Research medicine.medical_specialty Referral medicine.medical_treatment media_common.quotation_subject Breast Neoplasms Medicare Risk Assessment Breast Neoplasms Male 03 medical and health sciences 0302 clinical medicine Breast cancer Internal medicine Biomarkers Tumor medicine Humans Breast Genetic Testing Mastectomy Aged Neoplasm Staging Retrospective Studies media_common Selection bias Chemotherapy business.industry Gene Expression Profiling Confounding Instrumental variable medicine.disease United States Confidence interval 030104 developmental biology Chemotherapy Adjuvant 030220 oncology & carcinogenesis Female Personalized medicine Neoplasm Recurrence Local business SEER Program |
| Zdroj: | Clinical Breast Cancer. 20:487-494.e1 |
| ISSN: | 1526-8209 |
| Popis: | Background Our objective was to investigate why early studies regarding adoption of the 21-gene recurrence score (RS) assay did not show an initial reduction in the number of patients with breast cancer receiving real-world chemotherapy. Materials and Methods We addressed 2 sources of confounding suspected in previous studies: (1) the early time frame during the initial adoption phase of the RS assay, and (2) suspected selective, increased administration to patients more likely to have been chemotherapy candidates. To address selective use during initial adoption, we used updated SEER-Medicare data from 2004 and 2011. To address individual selection bias, we examined whether RS test utilization was negatively associated with rates of local chemotherapy use assessed at the hospital referral region level using conventional ordinary least squares and instrumental variable approaches to adjust for selection bias. Results A total of 26,009 patients met inclusion criteria. Assay use was associated with a decrease in absolute percentage use of chemotherapy of 4.5% (95% confidence interval [CI], 3.2%-5.7%), which was even more pronounced in sensitivity analyses limited to later study years (2008-2011), with a decrease of 6.8% (95% CI, 5.3%-8.3%). Instrumental variable models yielded similar point estimates but were insufficiently powered to draw conclusions. Conclusion Receipt of the 21-gene assay was associated with decreased utilization of chemotherapy by 2008. |
| Databáze: | OpenAIRE |
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