Pollack Craig Evan, Soulos Pamela R, Gross Cary P
Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
Departments of Epidemiology and Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
Cancer. 2015 Aug 15;121(16):2799-807. doi: 10.1002/cncr.29409. Epub 2015 Apr 22.
New technologies, often with limited evidence to support their effectiveness, frequently diffuse into clinical practice and increase the costs of cancer care. The authors studied whether physician peer exposure was associated with the subsequent adoption of a new approach to adjuvant radiotherapy (brachytherapy) for the treatment of women with early-stage breast cancer.
A retrospective cohort study was performed using Surveillance, Epidemiology, and End Results (SEER)-Medicare data. Data from 2003 through 2004 were used to classify surgeons as early brachytherapy adopters and, among non-early adopters, whether they shared patients with early adopters (peer exposure). Data from 2005 through 2006 were used to examine whether women were more likely to receive brachytherapy if their surgeons were exposed to early adopters.
Overall, the percentage of women receiving brachytherapy increased from 3.2% in 2003 through 2004 to 4.7% in 2005 through 2006. In this latter period, a total of 2087 patients were assigned to 328 non-early adopting surgeons. In unadjusted analyses, patients whose surgeons were connected to early adopters during 2003 through 2004 were found to be significantly more likely to receive brachytherapy in 2005 through 2006 compared with those whose surgeons were not connected to early adopters (8.0% vs 4.1%; P = .003). In adjusted analyses, the predicted probability of receiving brachytherapy among patients whose surgeon did have an early-adopting peer was 3.9% versus 1.0% among those whose surgeons did not have an early-adopting peer (P = .03).
Exposure to peers who were early adopters of brachytherapy was found to be associated with a surgeon's subsequent uptake of brachytherapy. The results of the current study provide an example of a novel approach to examining the diffusion of innovation in cancer care.
新技术常常缺乏足够证据支持其有效性，却频繁渗透到临床实践中，增加了癌症治疗成本。作者研究了医生同行接触是否与随后采用一种新的辅助放疗方法（近距离放射疗法）治疗早期乳腺癌女性有关。
使用监测、流行病学和最终结果（SEER）-医疗保险数据进行了一项回顾性队列研究。2003年至2004年的数据用于将外科医生分类为近距离放射疗法的早期采用者，以及在非早期采用者中，他们是否与早期采用者共享患者（同行接触）。2005年至2006年的数据用于检查如果女性的外科医生接触过早期采用者，她们是否更有可能接受近距离放射疗法。
总体而言，接受近距离放射疗法的女性比例从2003年至2004年的3.2%增加到2005年至2006年的4.7%。在后者期间，共有2087名患者被分配给328名非早期采用的外科医生。在未调整的分析中，发现其外科医生在2003年至2004年期间与早期采用者有联系的患者，在2005年至2006年接受近距离放射疗法的可能性明显高于其外科医生未与早期采用者有联系的患者（8.0%对4.1%；P = 0.003）。在调整分析中，外科医生有早期采用同行的患者接受近距离放射疗法的预测概率为3.9%，而外科医生没有早期采用同行的患者为1.0%（P = 0.03）。
发现接触近距离放射疗法早期采用者的同行与外科医生随后采用近距离放射疗法有关。本研究结果提供了一种检查癌症治疗中创新扩散的新方法的示例。
