Identifying Barriers for Slow Update of Effective Radiotherapy Method for Cancer

确定有效癌症放射治疗方法更新缓慢的障碍

基本信息

批准号：
9750676
负责人：
Dezheng Huo
金额：
$ 4.95万
依托单位：
UNIVERSITY OF CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-01 至 2020-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9750676
关键词：
Identifying Barriers Slow Update Effective

项目摘要

Project Summary About 1 in 8 American women will develop invasive breast cancer over the course of her lifetime. It is the most common malignancy in American women, accounting for 30% of new cancer cases. Radiation therapy is a cornerstone of breast cancer treatment, and can improve local disease control and prolong life of breast cancer patients. Over the past decade, post-lumpectomy radiotherapy has evolved and a short version of radiotherapy called hypofractionated whole breast irradiation (HF-WBI) was introduced. HF-WBI is usually delivered over 3-4 weeks, as compare to 5-7 weeks in conventional fractionation, and can save 21 days of patient time on average. Several randomized trials have showed that HF-WBI is equivalent in local recurrence and disease-free survival to conventional fractionation, but it adoption in the U.S. remained low (<20%). HF- WBI represents an exemplary type of medical care with demonstrated effectiveness, promise of economic efficiency, but low adoption rates, and thus investigation of barriers of HF-WBI slow adoption may be relevant for understanding potentially modifiable factors of clinically effective and cost treatments of other diseases. In this proposal, we plan to investigate financial factors or incentives that are related to use of HF-WBI using a large insurance claims database, which covers claims for over 40 million people. The study has three specific aims: 1) To examine the variation of HF-WBI use relative to CF-WBI across health care providers and communities in the U.S.; 2) To investigate the influence of patient characteristics, insurance policies and financial burden to patients on HF-WBI use; and 3) To determine whether physician reimbursement structure affects HF-WBI use. Approximately 67,000 breast cancer patients diagnosed between 2008 and 2013 will be included in the analysis. We will use cross-classified multilevel models to take into account issues of clustering of patients within hospitals and within communities and to decompose the variance in HF-WBI use. To test the hypothesis that financial reasons are the driving force of the slow adoption of HF-WBI, we will examine the influence of type of insurance plans, out-of-pocket cost, and physician payment structure on HF-WBI use. HF- WBI has shown to be less costly than conventional radiotherapy, so the study has a great potential to identify strategies to increase the adoption of new treatment method and reduce the cost of medical care.

项目概要大约八分之一的美国女性在一生中会患上浸润性乳腺癌。它是美国女性最常见的恶性肿瘤，占新发癌症病例的 30%。放射治疗是乳腺癌治疗的基石，可以改善局部疾病控制并延长乳腺寿命癌症患者。在过去的十年中，肿瘤切除术后放射治疗已经发展，并且是一种简短的放射治疗引入了称为大分割全乳放疗（HF-WBI）的放射疗法。 HF-WBI 通常是与传统分割的 5-7 周相比，在 3-4 周内交付，并且可以节省 21 天的时间平均患者时间。多项随机试验表明 HF-WBI 在局部复发方面具有同等效果与传统分割相比，其无病生存率更高，但其在美国的采用率仍然很低（<20%）。高频- WBI 代表了医疗保健的典范，其有效性和经济前景得到了证实效率高，但采用率低，因此调查 HF-WBI 缓慢采用的障碍可能是相关的了解其他疾病的临床有效和成本治疗的潜在可改变因素。在根据该提案，我们计划使用以下方法来调查与使用 HF-WBI 相关的财务因素或激励措施：庞大的保险理赔数据库，覆盖超过4000万人的理赔。该研究有三项具体内容目标： 1) 研究不同卫生保健提供者之间 HF-WBI 相对于 CF-WBI 的使用差异美国的社区； 2) 调查患者特征、保险政策和医疗费用的影响使用 HF-WBI 给患者带来的经济负担； 3) 确定医生报销结构是否影响 HF-WBI 的使用。 2008 年至 2013 年间，大约有 67,000 名乳腺癌患者将接受治疗。纳入分析。我们将使用跨分类的多级模型来考虑聚类问题医院内和社区内的患者并分解 HF-WBI 使用的差异。测试假设财务原因是 HF-WBI 缓慢采用的驱动力，我们将研究保险计划类型、自付费用和医生支付结构对 HF-WBI 使用的影响。高频- WBI 已被证明比传统放疗成本更低，因此该研究具有巨大的潜力来确定增加采用新治疗方法并降低医疗费用的策略。