The Association Between Genomic Test Use and Chemotherapy Use Among Breast Cancer Patients Open Access

Abstract

Importance: Chemotherapy is recommended and widely used in the treatment for estrogen receptor – positive invasive breast cancer at early stages. However, tumors with similar clinical and pathological profiles have distinct responsiveness to chemotherapy. Improper chemotherapy use can result in tremendous economic and health burdens. The association between the receipt Oncotype DX 21-gene recurrence score assay (RS test) test and the receipt of chemotherapy remains to be assessed since the recommendation of the RS test by guidelines.

 

Objective: To identify the association between the receipt of the RS test and the receipt of chemotherapy in a nationally representative sample of early-stage breast cancer patients.

 

Study design: Analytic retrospective cohort study of Medicare beneficiaries with a primary diagnosis of breast cancer between 2006 and 2014 using Surveillance, Epidemiology, and End Results data set - Medicare claims linked database.

 

Results: Among a total sample of 45,692 patients, 8,052 received chemotherapy and 37,640 did not receive chemotherapy. The multivariable analysis showed that there was no significant association between the receipt of the RS test and the receipt of chemotherapy (marginal effects (ME, -0.0008; standard error, 0.0044). Age and clinical staging had significant effects on the receipt of chemotherapy. The impact of the RS test was most significant among subsample aged 65-70 (ME, -0.02) and 76 and above (ME, 0.04). The use for both the RS test and chemotherapy have increased between 2006 and 2014.

 

Conclusion and contribution of this study: The receipt of the RS test reduced the probability of receiving chemotherapy, but the association was not significant. The use of RS test and chemotherapy increased between 2006 and 2014.

Table of Contents

TABLE OF CONTENTS

CHAPTER 1: INTRODUCTION.. 1

CHAPTER 2: REVIEW OF THE LITERATURE. 4

1.   Breast Cancer is a Public Health Issue. 4

2.   Historical Background of the RS Test 6

3.   Current Empirical Literature Relevant to Research. 8

4.   Summary. 10

CHAPTER 3: METHODS. 12

1.   Database. 12

2.   Study Sample. 13

3.   Research Design. 14

4.   Measures. 16

5.   Data Analysis 16

CHAPTER 4: RESULTS. 18

CHAPTER 5: DISCUSSION.. 28

1.   Summary. 28

2.   Conclusions 28

3.   Strengths and Limitations 32

4.   Implications 34

5.   Recommendations for Future Research. 35

References 35

About this Master's Thesis

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School	Rollins School of Public Health
Department	Health Policy and Management
Degree	M.S.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Breast cancer Chemotherapy Medicare Genomic testing
Committee Chair / Thesis Advisor	Howard, David H., Emory University
Committee Members	von Esenwein, Silke , Emory University Lipscomb, Joseph , Emory University

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