BACKGROUND Factors influencing the adoption of genomic testing are poorly understood, which may lead to inequitable and suboptimal treatment in cancer patients. Oncotype DX (ODX) is one of the first and most widely used genomic assays to stratify risk in women with early-stage breast cancer (BC). Physician networks have emerged as a significant and modifiable driver of emerging medical technology adoption. OBJECTIVE To investigate the association between physician network connections and the use of ODX testing. METHODS A retrospective study of women diagnosed with BC using SEER-Medicare from 2008 to 2012 was used. Medical oncologists were "connected" if they shared two or more patients during the early-adoption period (2008-2009). Parallel physician- and patient-level analyses employed logistic mixed models to determine the impact of being "connected" to an early-adopting oncologist on ODX use in 2011-2012. RESULTS 24,463 women met study criteria; 12,874 were diagnosed with BC in the early-adoption time period. 2129 medical oncologists treated these patients from 2008 to 2009. Medical oncologists had a median number of peer connections of 4 (IQR: 2-7). Peer connection to an early-adopting provider in 2008-2009 was associated with a 1.7-fold increase in providers' adopting ODX (95% CI: 1.1-2.6) and a 1.5-fold increase in their patients receiving ODX (95% CI: 1.1-2.0) in 2010-2012. CONCLUSIONS Peer connectedness to an early-adopting physician predicts ODX adoption in both physician-level and patient-level analyses. Provider networks may provide a potent and modifiable means to modulate the diffusion of emerging medical technologies. Efforts to increase testing, where appropriate, may benefit from peer-to-peer-based connection strategies.

中文翻译：

---

共享患者的医生网络及其对乳腺癌基因组检测的影响。

背景技术人们对影响基因组测试采用的因素了解甚少，这可能导致癌症患者接受不公平且次优的治疗。癌型DX（ODX）是最早且应用最广泛的基因组测定方法之一，用于对早期乳腺癌（BC）妇女的风险进行分层。医师网络已成为新兴医疗技术采用的重要且可修改的驱动力。目的研究医师网络连接与ODX测试使用之间的关联。方法使用回顾性研究方法，对2008年至2012年使用SEER-Medicare诊断为BC的女性进行回顾性研究。如果在早期采用期间（2008年至2009年），医学肿瘤学家共享两个或更多患者，则是“有联系的”。医师和患者水平的并行分析采用逻辑混合模型确定2011-2012年与早期采用的肿瘤学家“联系”对ODX使用的影响。结果24,463名妇女符合研究标准；在早期采用期间，有12,874被诊断出患有BC。从2008年到2009年，共有2129名医学肿瘤学家对这些患者进行了治疗。医学肿瘤学家的同伴关系中位数为4（IQR：2-7）。在2008-2009年，与早期采用服务提供商的同伴联系使提供商采用ODX的比例增加了1.7倍（95％CI：1.1-2.6），而接受ODX的患者的比例增加了1.5倍（95％CI： 1.1-2.0）。结论与早期采用医师的同伴联系会在医师水平和患者水平的分析中预测ODX的采用。提供商网络可以提供有效且可修改的方式来调节新兴医疗技术的传播。在适当的情况下，增加测试的工作可能会受益于基于对等的连接策略。