TY - JOUR
T1 - Effect of Surgeon Factors on Long-Term Patient-Reported Outcomes After Breast-Conserving Therapy in Older Breast Cancer Survivors
AU - Smith, Benjamin D.
AU - Lei, Xiudong
AU - Diao, Kevin
AU - Xu, Ying
AU - Shen, Yu
AU - Smith, Grace L.
AU - Giordano, Sharon H.
AU - DeSnyder, Sarah M.
AU - Hunt, Kelly K.
AU - Teshome, Mediget
AU - Jagsi, Reshma
AU - Shaitelman, Simona F.
AU - Peterson, Susan K.
AU - Swanick, Cameron W.
N1 - Funding Information:
Dr. Benjamin Smith is supported by the Andrew Sabin Family Fellowship, the Cancer Prevention and Research Institute of Texas (Grant RP 160674), and the National Cancer Institute (R01 CA207216-01). He has previously received research funding from Varian Medical Systems that is unrelated to the current project, and also has an equity interest in Oncora Medical. Dr. Grace Smith is supported by the National Institute of Health (Grant K07 CA211804-01). Dr. Shaitelman receives unrelated research funding from Varian Medical Systems, and Dr. DeSnyder receives unrelated research funding from Impedimed. Dr. Jagsi reports unrelated grant funding from the NIH, Doris Duke Foundation, Greenwall Foundation, and Komen Foundation; personal fees from Vizient and Amgen; and stock options in Equity Quotient. Dr. Giordano is supported by CPRIT RP160674 and Susan Komen SAC150061. Dr. Hunt is on the medical advisory board for Armada Health and Merck & Co. and receives research funding from Endomagnetics and Lumicell. The entities above had no role in the present study.
Funding Information:
This work was supported by an ASTRO Comparative Effectiveness Research Grant, The University of Texas MD Anderson Survivorship Institutional Research Grant, and, in part, by the Assessment, Intervention and Measurement (AIM) Shared Resource and Biostatistics Shared Resource through a Cancer Center Support Grant (CA016672; Principal Investigator: P. Pisters, MD Anderson Cancer Center), from the National Cancer Institute, National Institutes of Health. The study was additionally supported by the Center for Radiation Oncology Research, the Duncan Family Institute, a philanthropic gift from Ann and Clarence Cazalot, and by the Department of Health and Human Services National Cancer Institute (Grant P30CA016672).
Funding Information:
This work was supported by an ASTRO Comparative Effectiveness Research Grant, The University of Texas MD Anderson Survivorship Institutional Research Grant, and, in part, by the Assessment, Intervention and Measurement (AIM) Shared Resource and Biostatistics Shared Resource through a Cancer Center Support Grant (CA016672; Principal Investigator: P. Pisters, MD Anderson Cancer Center), from the National Cancer Institute, National Institutes of Health. The study was additionally supported by the Center for Radiation Oncology Research, the Duncan Family Institute, a philanthropic gift from Ann and Clarence Cazalot, and by the Department of Health and Human Services National Cancer Institute (Grant P30CA016672).
Publisher Copyright:
© 2020, Society of Surgical Oncology.
PY - 2020/4/1
Y1 - 2020/4/1
N2 - Background: The effect of surgeon factors on patient-reported quality-of-life outcomes after breast-conserving therapy (BCT) is unknown and may help patients make informed care decisions. Methods: We performed a survey study of women aged ≥ 67 years with non-metastatic breast cancer diagnosed in 2009 and treated with guideline-concordant BCT, to determine the association of surgeon factors with patient-reported outcomes. The treating surgeon was identified using Medicare claims, and surgeon factors were identified via the American Medical Association Physician Masterfile. The primary outcome was patient-reported cosmetic satisfaction measured by the Cancer Surveillance and Outcomes Research Team (CanSORT) Satisfaction with Breast Cosmetic Outcome instrument, while secondary outcomes included BREAST-Q subdomains. All patient, treatment, and surgeon covariables were included in a saturated multivariable linear regression model with backward elimination applied until remaining variables were p < 0.1. Results: Of 1650 women randomly selected to receive the questionnaire, 489 responded, of whom 289 underwent BCT. Median age at diagnosis was 72 years and the time from diagnosis to survey was 6 years. The mean adjusted CanSORT score was higher for patients treated by surgical oncologists than patients treated by non-surgical oncologists (4.01 [95% confidence interval [CI] 3.65–4.38] vs. 3.53 [95% CI 3.28–3.77], p = 0.006). Similarly, mean adjusted BREAST-Q Physical Well-Being (91.97 [95% CI 86.13–97.80] vs. 83.04 [95% CI 80.85–85.22], p = 0.006) and Adverse Radiation Effects (95.28 [95% CI 91.25–99.31] vs. 88.90 [95% CI 86.23–91.57], p = 0.004) scores were better among patients treated by surgical oncologists. Conclusions: Specialized surgical oncology training is associated with improved long-term patient-reported outcomes. These findings underscore the value of specialized training and may be useful to patients choosing their care team.
AB - Background: The effect of surgeon factors on patient-reported quality-of-life outcomes after breast-conserving therapy (BCT) is unknown and may help patients make informed care decisions. Methods: We performed a survey study of women aged ≥ 67 years with non-metastatic breast cancer diagnosed in 2009 and treated with guideline-concordant BCT, to determine the association of surgeon factors with patient-reported outcomes. The treating surgeon was identified using Medicare claims, and surgeon factors were identified via the American Medical Association Physician Masterfile. The primary outcome was patient-reported cosmetic satisfaction measured by the Cancer Surveillance and Outcomes Research Team (CanSORT) Satisfaction with Breast Cosmetic Outcome instrument, while secondary outcomes included BREAST-Q subdomains. All patient, treatment, and surgeon covariables were included in a saturated multivariable linear regression model with backward elimination applied until remaining variables were p < 0.1. Results: Of 1650 women randomly selected to receive the questionnaire, 489 responded, of whom 289 underwent BCT. Median age at diagnosis was 72 years and the time from diagnosis to survey was 6 years. The mean adjusted CanSORT score was higher for patients treated by surgical oncologists than patients treated by non-surgical oncologists (4.01 [95% confidence interval [CI] 3.65–4.38] vs. 3.53 [95% CI 3.28–3.77], p = 0.006). Similarly, mean adjusted BREAST-Q Physical Well-Being (91.97 [95% CI 86.13–97.80] vs. 83.04 [95% CI 80.85–85.22], p = 0.006) and Adverse Radiation Effects (95.28 [95% CI 91.25–99.31] vs. 88.90 [95% CI 86.23–91.57], p = 0.004) scores were better among patients treated by surgical oncologists. Conclusions: Specialized surgical oncology training is associated with improved long-term patient-reported outcomes. These findings underscore the value of specialized training and may be useful to patients choosing their care team.
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U2 - 10.1245/s10434-019-08165-2
DO - 10.1245/s10434-019-08165-2
M3 - Article
C2 - 31916092
AN - SCOPUS:85077532029
SN - 1068-9265
VL - 27
SP - 1013
EP - 1022
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 4
ER -