Explaining Variation in Clinical Practice: Surgical Treatment of Early Stage Breast Cancer
Notice bibliographique
Résumé
Background: Breast conserving surgery (BCS) followed by radiation is the preferred treatment option for early stage breast cancer because it is less invasive than the alternative treatment, mastectomy, and provides a better cosmetic outcome and a superior quality of life. Positive surgical margins after breast conserving surgery (BCS), however, necessitate re-excision surgery by further BCS or by mastectomy. Re-excision is associated with greater morbidity, patient anxiety, poor cosmetic outcome, delayed initiation of adjuvant therapies, and increased medical cost. Objectives: The primary objectives of this research were to: 1) investigate the relationships between clinical, patient, provider and geographic factors and surgery type received; 2) investigate the relationships between clinical, patient, provider and geographic factors and receipt of re-excision surgery; 3) quantify residual surgeon and hospital-specific variation associated with surgery type received and receipt of re-excision and; 4) investigate if re-excision is associated with all cause and breast cancer-specific mortality among patients who receive re-excision, compared to those who receive BCS without re-excision and those who receive an initial mastectomy. Methods: All women diagnosed with stage I-III breast cancer in Alberta from 2002 to 2010 were identified from the Alberta Cancer Registry; demographic, clinical and treatment information was obtained from this source. Alberta Health Physician Claims data were used to identify the type of first breast cancer surgery after diagnosis, subsequent re-excisions within 1 year of initial surgery, and anonymized physician identifiers associated with each procedure. Multilevel logistic regression with surgeons and hospitals as crossed random effects were used to estimate the adjusted odds ratios of mastectomy and of re-excision by the factors of interest. Poisson regression models were fitted to compare all-cause and breast cancer-specific mortality by surgery pattern. Results: Mastectomy was received by 51% of patients and was found to be inversely related to surgeon volume among stage I and II patients. Odds ratios of mastectomy varied widely by individual surgeon and by hospital beyond the variation explained by the factors investigated. Re-excision surgery was received by 19% of patients who initially received BCS. Increasing patient age was associated with re-excision and the odds of re-excision varied significantly through the province. BCS followed by re-excision was not associated with greater all-cause or breast cancer-specific mortality compared to than those who received BCS without re-excision. Conclusions: Both clinical and health system factors are associated with mastectomy and re-excision among breast cancer patients in Alberta. The significant surgeon-specific variation in the likelihood of BCS, and the geographic and surgeon-specific variation of re-excision is concerning. Further research is necessary to understand the reasons for the observed variation so appropriate interventions can be developed and applied.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».