title: The relationship of membership in research networks to compliance with treatment guidelines for early-stage breast cancer.
abstract: BACKGROUND
  Research has shown that older women with breast cancer are less likely than younger women to receive treatment in accordance with accepted guidelines. Cancer-related research networks (eg, Comprehensive Cancer Centers) have been funded by the National Cancer Institute to increase the dissemination of new treatment strategies, but little is known about their relationship to cancer treatment patterns.
  
  
  OBJECTIVE
  We used a 3-level hierarchical regression model to examine the relationship of treating facilities' memberships in cancer research networks to compliance with guidelines for primary treatment of early stage breast cancer, controlling for patient and facility factors.
  
  
  METHODS
  We analyzed data from a database linking SEER registry data and Medicare claims in patients aged 65 years of age or older with early-stage breast cancer to data on the treating facility, including variables that indicate membership(s) in cancer research networks.
  
  
  METHODS
  A total of 16,600 women with stage I or stage II breast cancer, diagnosed between 1990 and 1994, and who received treatment in one of 423 facilities were studied.
  
  
  METHODS
  The key independent variable in this analysis was membership in NCI-funded cancer research networks. The outcome measure is a 3-category variable defined as (1) mastectomy (MAST), (2) breast-conserving surgery plus radiation therapy (BCS+RT), or (3) BCS alone.
  
  
  RESULTS
  Patients treated at facilities that were members of 2 or more cancer research networks were more likely to receive guideline-concordant treatment (ie, MAST or BCS+RT) than similar patients treated at non-member facilities.
  
  
  CONCLUSIONS
  Organizational factors may influence compliance with treatment guidelines and be useful in improving the quality of care.
authors.affiliation: Center for Gerontology and Healthcare Research, Brown University, Providence, Rhode Island 02912, USA. Linda_Laliberte-Cote@brown.edu
authors.forename: Linda
authors.initials: L
authors.lastname: Laliberte
authors.forename: Mary L
authors.initials: ML
authors.lastname: Fennell
authors.forename: George
authors.initials: G
authors.lastname: Papandonatos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D035843:Biomedical Research / Q000458:organization & administration*; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D002173:Cancer Care Facilities / Q000458:organization & administration / Q000592:standards*; D003299:Cooperative Behavior; D019992:Databases as Topic; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008408:Mastectomy / Q000706:statistics & numerical data; D006278:Medicare / Q000592:standards*; D009316:National Institutes of Health (U.S.); D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data; D018426:SEER Program; D014481:United States