21基因檢測（Oncotype DX）是第一個也是最為普及的基因組檢測方法之一,，可以對早期乳腺癌患者的風(fēng)險進(jìn)行分層,。不過,，乳腺癌基因組檢測的影響因素尚不明確,，這可能造成乳腺癌患者治療的不統(tǒng)一和不理想。醫(yī)師網(wǎng)絡(luò)（類似于微信群）已經(jīng)成為新興醫(yī)療技術(shù)推廣的重要和可變驅(qū)動力,，可能有助于乳腺癌基因組檢測推廣。

　　2019年4月26日,，施普林格·自然《乳腺癌研究與治療》在線發(fā)表美國杜克大學(xué)醫(yī)學(xué)院,、霍普金斯大學(xué)醫(yī)學(xué)院的研究報告，調(diào)查了醫(yī)師網(wǎng)絡(luò)與21基因檢測之間的相關(guān)性,。

　　該回顧研究利用國家癌癥研究所（NCI）監(jiān)測流行病學(xué)最終結(jié)果（SEER）與聯(lián)邦醫(yī)療保險（Medicare）關(guān)聯(lián)數(shù)據(jù)對2008～2012年24463例雌激素受體陽性浸潤性非轉(zhuǎn)移乳腺癌女性進(jìn)行回顧分析,。2008～2009年早期應(yīng)用期間，如果腫瘤內(nèi)科醫(yī)師共同患者至少有兩例,，即被認(rèn)為有“聯(lián)系”（相當(dāng)于同一個微信群）,。同時通過邏輯混合模型進(jìn)行醫(yī)患分析，確定腫瘤內(nèi)科醫(yī)師早期應(yīng)用“聯(lián)系”對2011～2012年21基因檢測應(yīng)用的影響,。

　　結(jié)果,，2008～2009年早期應(yīng)用階段乳腺癌女性12874例，2129位腫瘤內(nèi)科醫(yī)師對這些患者進(jìn)行了治療,，有“聯(lián)系”（相當(dāng)于同一個微信群）的腫瘤內(nèi)科醫(yī)師中位數(shù)為4（四分位：2～7）,。

　　與2008～2009年早期應(yīng)用者的“聯(lián)系”每增加一個，2010～2012年：

• 應(yīng)用21基因檢測的醫(yī)師增加1.7倍（95%置信區(qū)間：1.1～2.6）

• 接受21基因檢測的患者增加1.5倍（95%置信區(qū)間：1.1～2.0）

　　因此,，該研究結(jié)果表明,，與早期應(yīng)用醫(yī)師的“聯(lián)系”數(shù)量,，可以同時預(yù)測醫(yī)師和患者的21基因檢測應(yīng)用,，醫(yī)師網(wǎng)絡(luò)可以提供有效和可變的手段對新興醫(yī)療技術(shù)推廣進(jìn)行改變，加強(qiáng)同行“聯(lián)系”措施可能有助于合理增加21基因檢測,。

Breast Cancer Res Treat. 2019 Apr 26.

Shared-patient physician networks and their impact on the uptake of genomic testing in breast cancer.

Jason Rotter, Lauren Wilson, Melissa A. Greiner, Craig E. Pollack, Michaela Dinan.

Duke University School of Medicine, Durham, USA; Johns Hopkins School of Medicine, Baltimore, USA.

BACKGROUND: Factors influencing the adoption of genomic testing are poorly understood, which may lead to inequitable and suboptimal treatment in cancer patients. Oncotype DX (ODX) is one of the first and most widely used genomic assays to stratify risk in women with early-stage breast cancer (BC). Physician networks have emerged as a significant and modifiable driver of emerging medical technology adoption.

OBJECTIVE: To investigate the association between physician network connections and the use of ODX testing.

METHODS: A retrospective study of women diagnosed with BC using SEER-Medicare from 2008 to 2012 was used. Medical oncologists were "connected" if they shared two or more patients during the early-adoption period (2008-2009). Parallel physician- and patient-level analyses employed logistic mixed models to determine the impact of being "connected" to an early-adopting oncologist on ODX use in 2011-2012.

RESULTS: 24,463 women met study criteria; 12,874 were diagnosed with BC in the early-adoption time period. 2129 medical oncologists treated these patients from 2008 to 2009. Medical oncologists had a median number of peer connections of 4 (IQR: 2-7). Peer connection to an early-adopting provider in 2008-2009 was associated with a 1.7-fold increase in providers' adopting ODX (95% CI: 1.1-2.6) and a 1.5-fold increase in their patients receiving ODX (95% CI: 1.1-2.0) in 2010-2012.

CONCLUSIONS: Peer connectedness to an early-adopting physician predicts ODX adoption in both physician-level and patient-level analyses. Provider networks may provide a potent and modifiable means to modulate the diffusion of emerging medical technologies. Efforts to increase testing, where appropriate, may benefit from peer-to-peer-based connection strategies.

KEYWORDS: Provider network Breast cancer Oncotype DX Genetic testing

DOI: 10.1007/s10549-019-05248-2