Oncotype DX® (ODX) is used to assess risk of disease recurrence in hormone receptor positive, HER2-negative breast cancer and to guide decisions regarding adjuvant chemotherapy. Little is known about how physician factors impact treatment decisions. The purpose of this study was to examine patient and physician factors associated with ODX testing and adjuvant chemotherapy for breast cancer patients in New Hampshire. We examined New Hampshire State Cancer Registry data on 5630 female breast cancer patients diagnosed from 2010 to 2016. We performed unadjusted and adjusted hierarchical logistic regression to identify factors associated with a patient’s receipt of ODX, being recommended and receiving chemotherapy, and refusing chemotherapy. We calculated intraclass correlation coefficients (ICCs) to examine the proportion of variance in clinical decisions explained by between-physician and between-hospital variation. Over the study period, 1512 breast cancer patients received ODX. After adjustment for patient and tumor characteristics, we found that patients seen by a male medical oncologist were less likely to be recommended chemotherapy following ODX (OR = 0.50 (95% CI = 0.34–0.74), p < 0.01). Medical oncologists with more clinical experience (reference: less than 10 years) were more likely to recommend chemotherapy (20–29 years: OR = 4.05 (95% CI = 1.57–10.43), p < 0.01; > 29 years: OR = 4.48 (95% CI = 1.68–11.95), p < 0.01). A substantial amount of the variation in receiving chemotherapy was due to variation between physicians, particularly among low risk patients (ICC = 0.33). In addition to patient clinicopathologic characteristics, physician gender and clinical experience were associated with chemotherapy treatment following ODX testing. The significant variation between physicians indicates the potential for interventions to reduce variation in care.

中文翻译：

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2010-2016 年新罕布什尔州乳腺癌患者与 Oncotype DX 和辅助化疗使用相关的患者和医生因素。

Oncotype DX® (ODX) 用于评估激素受体阳性、HER2 阴性乳腺癌的疾病复发风险，并指导辅助化疗的决策。人们对医生因素如何影响治疗决策知之甚少。本研究的目的是检查新罕布什尔州乳腺癌患者与 ODX 检测和辅助化疗相关的患者和医生因素。我们检查了 2010 年至 2016 年间诊断的 5630 名女性乳腺癌患者的新罕布什尔州癌症登记数据。我们进行了未经调整和调整的分层逻辑回归，以确定与患者接受 ODX、推荐和接受化疗以及拒绝化疗相关的因素。我们计算了组内相关系数 (ICC)，以检查由医生之间和医院之间的差异解释的临床决策中的差异比例。在研究期间，1512 名乳腺癌患者接受了 ODX 治疗。在对患者和肿瘤特征进行调整后，我们发现男性肿瘤科医生就诊的患者在 ODX 后不太可能被推荐化疗（OR = 0.50（95% CI = 0.34–0.74），p < 0.01）。具有更多临床经验（参考：少于10年）的肿瘤内科医师更有可能推荐化疗（20-29岁：OR = 4.05（95% CI = 1.57-10.43），p < 0.01；> 29岁：OR = 4.48 （95% CI = 1.68–11.95），p < 0.01）。接受化疗的很大一部分差异是由于医生之间的差异造成的，特别是在低风险患者中（ICC = 0.33）。除了患者的临床病理特征外，医生性别和临床经验也与 ODX 测试后的化疗治疗相关。医生之间的显着差异表明干预措施有可能减少护理差异。