Impact of a scientific presentation on community treatment patterns for primary breast cancer.
BACKGROUND
The publication of results from randomized clinical trials can have a dramatic effect on treatment patterns, but the impact of oral presentations at national scientific meetings is unknown. We investigated the temporal association between the oral presentation of the results from the Cancer and Leukemia Group B (CALGB) Study 9344 at the May 1998 meeting of the American Society of Clinical Oncology, which showed that paclitaxel improves survival of women with lymph node-positive breast cancer, and use of taxane chemotherapy for breast cancer.


METHODS
We studied chemotherapy use in 3341 women identified through the Surveillance, Epidemiology, and End Results-Medicare database who were diagnosed with stage I-III breast cancer in 1994-1999 at age 65 years or older and received adjuvant chemotherapy, as identified through claims data, within 1 year of diagnosis. We assessed the temporal association between the CALBG presentation and taxane use with piecewise regression analysis. Multivariable logistic regression analysis was used to determine which patient characteristics were associated with taxane use.


RESULTS
The use of taxanes increased substantially after the CALGB presentation, with absolute rates of taxane use of 5.2% before May 1998 and 23.6% in May 1998 and later. Initially, this increase was confined to patients with lymph node-positive disease (40% of whom were receiving taxanes by the end of 1999), but over time it extended to patients with lymph node-negative disease (15% of whom were receiving taxanes by the end of 1999). In multivariable analysis, patients who were treated in May 1998 or later were statistically significantly more likely to have received a taxane than patients treated before this date (estimated relative risk = 6.84, 95% confidence interval = 5.71 to 8.07). Younger patient age, larger number of lymph nodes involved, higher tumor grade, and larger tumor size were also independently associated with adjuvant taxane use.


CONCLUSIONS
The oral presentation of a single study at a national conference was temporally associated with an increase in the use of taxanes for primary breast cancer, even before study publication or Food and Drug Administration approval.
Department of Breast Medical Oncology, University of Texas M. D. Anderson Cancer Center, Box 424, Houston, TX 77030, USA. sgiordan@mdanderson.org
Sharon H
SH
Giordano
Zhigang
Z
Duan
Yong-Fang
YF
Kuo
Gabriel N
GN
Hortobagyi
Jean
J
Freeman
James S
JS
Goodwin
D000368:Aged; D000369:Aged, 80 and over; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D003226:Congresses as Topic; D017277:Drug Approval; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D016015:Logistic Models; D008207:Lymphatic Metastasis; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000008:administration & dosage; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D018426:SEER Program; D043823:Taxoids / Q000008:administration & dosage*; D013997:Time Factors; D014481:United States; D014486:United States Food and Drug Administration
D000972:Antineoplastic Agents, Phytogenic; D043823:Taxoids; D017239:Paclitaxel