Open AccessEndocrine Therapy Initiation and Medical Oncologist Utilization Among Women Diagnosed with Ductal Carcinoma in Situ
Author(s) -
Anderson Chelsea,
Meyer Anne Marie,
Wheeler Stephanie B.,
Zhou Lei,
ReederHayes Katherine E.,
Nichols Hazel B.
Publication year - 2017
Publication title -
the oncologist
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.176
H-Index - 164
eISSN - 1549-490X
pISSN - 1083-7159
DOI - 10.1634/theoncologist.2016-0397
Subject(s) - medicine , ductal carcinoma , radiation oncologist , radiation therapy , breast cancer , oncology , hormonal therapy , cancer , cancer registry , specialty , family medicine
Background Though randomized clinical trials have demonstrated a reduction in second breast events with endocrine therapy among women with ductal carcinoma in situ (DCIS), use of these therapies remains highly variable. The purpose of this study was to evaluate patient and treatment‐related factors associated with endocrine therapy initiation and medical oncology specialty utilization after DCIS. Materials and Methods We identified women with a DCIS diagnosis during 2006–2010 in the North Carolina Central Cancer Registry with linked public and private insurance claims in the University of North Carolina Integrated Cancer Information Surveillance System data resource. Multivariable generalized linear regression models were used to estimate risk ratios (RR) and 95% confidence intervals (CI) for endocrine therapy initiation in the year following DCIS diagnosis. Results Among 2,090 women with a DCIS diagnosis, 37% initiated endocrine therapy. Initiation was less common among women aged 75+ at diagnosis (RR = 0.79; 95% CI: 0.64–0.97 vs. age 45–54) and women treated with breast‐conserving surgery (BCS) who did not receive radiation (RR = 0.63; 95% CI: 0.50–0.78 vs. BCS plus radiation). Consultation with a medical oncologist was strongly associated with endocrine therapy initiation (RR = 1.40; 95% CI: 1.23–1.61). Women who saw a medical oncologist more often had private insurance, higher census tract‐level income, hormone receptor positive disease, and treatment with BCS and radiation. Conclusion Treatment strategies for DCIS remain controversial. Our data suggest that endocrine therapy is more often used in addition to standard therapies such as BCS plus radiation, rather than as an alternative to radiation. Implications for Practice Randomized trials have demonstrated a reduction in second breast cancer events with use of endocrine therapy for ductal carcinoma in situ (DCIS). However, notable variation exists in the uptake of these therapies among DCIS patients. In this study, factors associated with endocrine therapy initiation in the year following a DCIS diagnosis included consultation with a medical oncologist and treatment with breast‐conserving surgery with radiation. Our findings help to explain the wide variation in endocrine therapy initiation and suggest the need for clear guidelines in the treatment of DCIS.