Physician characteristics are associated with quality of cancer care

April 08, 2016

Many breast cancer patients do not receive radiation after undergoing breast conservation surgery, despite the fact that this treatment is considered a standard of quality cancer care and has been shown to reduce breast cancer recurrence. Previous studies have shown that certain patient characteristics, such as a patient's race and distance from a radiation therapy facility, are associated with receiving post-surgical radiation. But it has been unclear whether physician characteristics also play a role in the quality of breast cancer care.

Dawn Hershman, M.D., of Herbert Irving Comprehensive Cancer Center at Columbia University in New York and colleagues investigated whether surgeon characteristics were associated with a patient receiving radiation after breast cancer surgery. They identified and analyzed data on nearly 30,000 women aged 65 and older with breast cancer who were diagnosed between 1991 and 2002 and who received breast-conserving surgery. They also collected information on the 4,453 surgeons who operated on these women??”including their sex, year of graduation, medical school location, patient volume, and type of medical degree.

About 75 percent of the women received radiation after surgery. Each year from 1991 to 2002, the proportion of women receiving radiation increased. Nonetheless, older women, black women, unmarried women, and those living outside urban areas were less likely to receive radiation. After adjusting for patient and tumor characteristics, the researchers found that women who received radiation were more likely to have a surgeon who was female, had an M.D. degree (compared to a D.O. degree), or was trained in the United States.

???Our study is one of the first to demonstrate associations between certain surgeon characteristics and quality of breast cancer care??¦ If confirmed, more research is needed on whether they reflect surgeon behavior, patient response, or physician-patient interactions,??? the authors write.

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Lead researcher, Professor Margot Cleary, said "In the developed world, as the average body mass index climbs, it's vital that we understand the interaction of adiponectin with other growth factors such as leptin in breast cancer spread.

"Our findings indicate that adiponectin, which is released from fat tissue may protect against oestrogen receptor positive tumour development when levels are high, it's also likely that a balance between leptin and Acrp30 determines whether a tumour increases or decreases in size."

Dr Lesley Walker, director of cancer information at Cancer Research UK, said: "We've known for some time that the overproduction of oestrogen in women who are overweight can play a part in the development of different types of breast cancer. This study which examines how obesity linked proteins interact, adds to the compelling evidence that maintaining a healthy body weight can help prevent disease."

Margot Cleary, Ph.D., is professor of nutrition and metabolism at the University of Minnesota's Hormel Institute and member of the University's Cancer Center.

The University of Minnesota Cancer Center is a Comprehensive Cancer Center designated by the National Cancer Institute in Washington, D.C. Advancing knowledge about cancer and enhancing care for patients is the mission of the Cancer Center. Its faculty and staff foster that mission by conducting basic, clinical, and population research; providing treatment to patients; and presenting educational programs.

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