Association between a network-based physician linchpin score and cancer patient mortality: A SEER-Medicare analysis
Menée à partir des données des registres de cancers américains et de la base Medicare portant sur 19 117 patients atteints d'un cancer du poumon non à petites cellules de stade I-III ou d'un cancer colorectal diagnostiqués entre 2016 et 2017, cette étude examine les caractéristiques des spécialistes référents dont le réseau médical est constitué de confrères ayant peu d'interactions avec d'autres médecins de leur spécialité (oncologues médicaux, radio-oncologues ou chirurgiens) puis évalue l'association entre le fait d'être pris en charge par l'un de ces spécialistes référents et la survie des patients
Patients with cancer frequently require multidisciplinary teams for optimal cancer outcomes. Network analysis can capture relationships among cancer specialists, and we developed a novel physician linchpin score to characterize “linchpin” physicians whose peers have fewer ties to other physicians of the same oncologic specialty. Our study examined whether being treated by a linchpin physician was associated with worse survival.In this cross-sectional study, we analyzed Surveillance, Epidemiology, and End Results (SEER)-Medicare data for patients diagnosed with stage I-III non-small cell lung or colorectal cancer in 2016-2017. We assembled patient-sharing networks and calculated linchpin scores for medical oncologists, radiation oncologists, and surgeons. Physicians were considered a linchpin if their linchpin score was within the top 15% for their specialty. We used Cox proportional hazards models to examine associations between being treated by a linchpin physician and survival with a two-year follow-up period.The study cohort included 10,081 patients with non-small cell lung cancer and 9,036 patients with colorectal cancer. Patients with lung cancer treated by a linchpin radiation oncologist had a 17% (95% CI = 1.04-1.32) greater hazard of mortality and similar trends were observed for linchpin medical oncologists. Patients with colorectal cancer treated by a linchpin surgeon had a 22% (95% CI = 1.03-1.43) greater hazard of mortality.In an analysis of Medicare beneficiaries with non-metastatic lung or colorectal cancer, those treated by linchpin physicians often experienced worse survival. Efforts to improve outcomes can leverage network analysis to identify areas with less access to multidisciplinary specialists.
Journal of the National Cancer Institute , résumé, 2022