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Am J Manag Care. Author manuscript; available in PMC 2016 November 01. Published in final edited form as: Am J Manag Care. ; 22(5): e153–e160.
Breast cancer multigene testing trends and impact on chemotherapy use G. Thomas Ray, MBA, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA
Author Manuscript
Jeanne Mandelblatt, MD, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Department of Oncology, Washington, DC Laurel A. Habel, PhD, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA Scott Ramsey, MD, PhD, Fred Hutchinson Cancer Research Center, Seattle, Washington Lawrence H. Kushi, ScD, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA Yan Li, MD, and Department of Oncology, Kaiser Permanente Oakland Medical Center, Oakland, CA
Author Manuscript
Tracy A. Lieu, MD, MPH Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA
Abstract Objectives—A 21-gene test that predicts recurrence risk among women with hormone receptor positive (HR+), localized breast cancer was nationally recommended in 2007, but we know little about its subsequent impact. We evaluated (1) patient characteristics associated with test use; (2) correlations between Recurrence Score (RS) and chemotherapy, and; (3) whether test introduction was associated with a reduction in chemotherapy use.
Author Manuscript
Address correspondence and reprint requests to: G. Thomas Ray, Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612 (Telephone 510-891-3732; fax 510-891-3836; [email protected]). This is the pre-publication version of a manuscript that has been accepted for publication in The American Journal of Managed Care (AJMC). This version does not include post-acceptance editing and formatting. The editors and publisher of AJMC are not responsible for the content or presentation of the prepublication version of the manuscript or any version that a third party derives from it. Readers who wish to access the definitive published version of this manuscript and any ancillary material related to it (eg, correspondence, corrections, editorials, etc) should go to www.ajmc.com or to the print issue in which the article appears. Those who cite this manuscript should cite the published version, as it is the official version of record. Authors’ contributions: GTR contributed to the design of the study, made substantial contributions to the data acquisition, data analysis, and interpretation of data, and was primarily responsible for drafting the manuscript. TAL, JSM, and LAH contributed to the design of the study, made substantial contributions to the interpretation of data, and helped to draft the manuscript and revise it for important intellectual content. SDR, LHK, and YL made substantial contributions to the interpretation of data, and helped to draft the manuscript and revise it for important intellectual content. All authors read and approved the final manuscript. Disclaimer: All statements in this report, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of the National Institutes of Health.
Ray et al.
Page 2
Study Design—Retrospective cohort study.
Author Manuscript
Methods—The Kaiser Permanente Northern California tumor registry and electronic medical records from 2005–2012 were used to identify HR+, human epidermal growth factor receptor 2 negative, node-negative cancers. Analyses used logistic regression with propensity-score matching and two-level logistic regression.
Author Manuscript
Results—Of the 7,004 patients who met guidelines for testing, 22% were tested and 26% had chemotherapy. Test use was more likely in younger women (OR 1.22; 95% CI, 1.04–1.44 for 40– 49 vs. 50–2 cm), and women from higher-income neighborhoods (OR 1.05; 95% CI, 1.03–1.07 for each $10,000 increase in area median income). Among patients with low RS, 8% had chemotherapy vs. 72% among patients with high RS (p
Am J Manag Care. Author manuscript; available in PMC 2016 November 01. Published in final edited form as: Am J Manag Care. ; 22(5): e153–e160.
Breast cancer multigene testing trends and impact on chemotherapy use G. Thomas Ray, MBA, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA
Author Manuscript
Jeanne Mandelblatt, MD, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Department of Oncology, Washington, DC Laurel A. Habel, PhD, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA Scott Ramsey, MD, PhD, Fred Hutchinson Cancer Research Center, Seattle, Washington Lawrence H. Kushi, ScD, Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA Yan Li, MD, and Department of Oncology, Kaiser Permanente Oakland Medical Center, Oakland, CA
Author Manuscript
Tracy A. Lieu, MD, MPH Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA
Abstract Objectives—A 21-gene test that predicts recurrence risk among women with hormone receptor positive (HR+), localized breast cancer was nationally recommended in 2007, but we know little about its subsequent impact. We evaluated (1) patient characteristics associated with test use; (2) correlations between Recurrence Score (RS) and chemotherapy, and; (3) whether test introduction was associated with a reduction in chemotherapy use.
Author Manuscript
Address correspondence and reprint requests to: G. Thomas Ray, Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612 (Telephone 510-891-3732; fax 510-891-3836; [email protected]). This is the pre-publication version of a manuscript that has been accepted for publication in The American Journal of Managed Care (AJMC). This version does not include post-acceptance editing and formatting. The editors and publisher of AJMC are not responsible for the content or presentation of the prepublication version of the manuscript or any version that a third party derives from it. Readers who wish to access the definitive published version of this manuscript and any ancillary material related to it (eg, correspondence, corrections, editorials, etc) should go to www.ajmc.com or to the print issue in which the article appears. Those who cite this manuscript should cite the published version, as it is the official version of record. Authors’ contributions: GTR contributed to the design of the study, made substantial contributions to the data acquisition, data analysis, and interpretation of data, and was primarily responsible for drafting the manuscript. TAL, JSM, and LAH contributed to the design of the study, made substantial contributions to the interpretation of data, and helped to draft the manuscript and revise it for important intellectual content. SDR, LHK, and YL made substantial contributions to the interpretation of data, and helped to draft the manuscript and revise it for important intellectual content. All authors read and approved the final manuscript. Disclaimer: All statements in this report, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of the National Institutes of Health.
Ray et al.
Page 2
Study Design—Retrospective cohort study.
Author Manuscript
Methods—The Kaiser Permanente Northern California tumor registry and electronic medical records from 2005–2012 were used to identify HR+, human epidermal growth factor receptor 2 negative, node-negative cancers. Analyses used logistic regression with propensity-score matching and two-level logistic regression.
Author Manuscript
Results—Of the 7,004 patients who met guidelines for testing, 22% were tested and 26% had chemotherapy. Test use was more likely in younger women (OR 1.22; 95% CI, 1.04–1.44 for 40– 49 vs. 50–2 cm), and women from higher-income neighborhoods (OR 1.05; 95% CI, 1.03–1.07 for each $10,000 increase in area median income). Among patients with low RS, 8% had chemotherapy vs. 72% among patients with high RS (p
