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Provider-based research networks and diffusion of surgical technologies among patients with early-stage kidney cancer
Hung-Jui Tan1, Anne-Marie Meyer, Tzy-Mey Kuo
1Veterans Administration/Robert Wood Johnson Clinical Scholars Program, University of California Los Angeles, Los Angeles, California; Department of Urology, University of California Los Angeles, Los Angeles, California.
Background:
Provider-based research networks such as the National Cancer Institute's Community Clinical Oncology Program (CCOP) have been shown to facilitate the translation of evidence-based cancer care into clinical practice. This study compared the utilization of laparoscopy and partial nephrectomy among patients with early-stage kidney cancer according to their exposure to CCOP-affiliated providers.
Methods:
With linked Surveillance, Epidemiology, and End Results-Medicare data, patients with T1aN0M0 kidney cancer who had been treated with nephrectomy from 2000 to 2007 were identified. For each patient, the receipt of care from a CCOP physician or hospital and treatment with laparoscopy or partial nephrectomy were determined. Adjusted for patient characteristics (eg, age, sex, and marital status) and other organizational features (eg, community hospital and National Cancer Institute-designated cancer center), multivariate logistic regression was used to estimate the association between each surgical innovation and CCOP affiliation.
Results:
During the study interval, 1578 patients (26.8%) were treated by a provider with a CCOP affiliation. Trends in the utilization of laparoscopy and partial nephrectomy remained similar between affiliated and nonaffiliated providers (P ≥ .05). With adjustments for patient characteristics, organizational features, and clustering, no association was noted between CCOP affiliation and the use of laparoscopy (odds ratio [OR], 1.11; 95% confidence interval [CI], 0.81-1.53) or partial nephrectomy (OR, 1.04; 95% CI, 0.82-1.32) despite the more frequent receipt of these treatments in academic settings (P < .05).
Conclusions:
At a population level, patients treated by providers affiliated with CCOP were no more likely to receive at least 1 of 2 surgical innovations for treatment of their kidney cancer, indicating perhaps a more limited scope to provider-based research networks as they pertain to translational efforts in cancer care.
Insights
Patients treated by Community Clinical Oncology Program (CCOP) providers did not show increased use of surgical innovations for early-stage kidney cancer. This suggests provider-based networks may have a limited impact on translating cancer care advancements.
Area of Science:
- Oncology
- Surgical Innovation
- Health Services Research
Background:
- Provider-based research networks, like the National Cancer Institute's Community Clinical Oncology Program (CCOP), aim to integrate evidence-based cancer care into practice.
- This study investigated the adoption of laparoscopic and partial nephrectomy for early-stage kidney cancer based on patient exposure to CCOP-affiliated providers.
Purpose of the Study:
- To compare the utilization of minimally invasive surgical techniques (laparoscopy and partial nephrectomy) for early-stage kidney cancer in patients treated by CCOP-affiliated versus non-affiliated providers.
- To assess the association between CCOP affiliation and the adoption of surgical innovations in kidney cancer treatment.
Main Methods:
- Utilized linked Surveillance, Epidemiology, and End Results-Medicare data for patients with T1aN0M0 kidney cancer treated with nephrectomy (2000-2007).
- Determined CCOP physician or hospital affiliation and surgical approach (laparoscopy vs. partial nephrectomy).
- Employed multivariate logistic regression, adjusting for patient and organizational factors, to analyze the association between CCOP affiliation and surgical innovation use.
Main Results:
- Of 1578 patients, 26.8% received care from CCOP-affiliated providers.
- No significant difference in the utilization trends of laparoscopy or partial nephrectomy was observed between CCOP-affiliated and non-affiliated providers (P ≥ .05).
- Multivariate analysis, after adjustments, found no association between CCOP affiliation and the use of laparoscopy (OR, 1.11; 95% CI, 0.81-1.53) or partial nephrectomy (OR, 1.04; 95% CI, 0.82-1.32), despite higher utilization in academic settings.
Conclusions:
- At a population level, CCOP affiliation did not increase the likelihood of patients receiving advanced surgical techniques for kidney cancer.
- Findings suggest that the scope of provider-based research networks in translating cancer care innovations into practice may be limited.
- Further research is needed to understand the barriers and facilitators for CCOP networks in promoting surgical advancements.
