Provider-based research networks (PBRNs)—collaborative research partnerships between academic centers and community-based practitioners—are a promising model for accelerating the translation of research into practice; however, empirical evidence of accelerated translation is limited. Oxaliplatin in adjuvant combination chemotherapy is an innovation with clinical trial-proven survival benefit compared with prior therapies. The goal of this study is to examine the diffusion of oxaliplatin into community practice, and whether affiliation with the National Cancer Institute’s (NCI’s) Community Clinical Oncology Program (CCOP)—a nationwide cancer-focused PBRN—is associated with accelerated innovation adoption.
This retrospective observational study used linked Surveillance, Epidemiology, and End Results-Medicare and NCI CCOP data to examine Medicare participants with stage III colon cancer initiating treatment in 2003 through 2006, the years surrounding oxaliplatin’s Food and Drug Administration approval. A fixed-effects analysis examined chemotherapy use among patients treated outside academic centers at CCOP-affiliated practices compared with non-CCOP practices. Two-group modeling controlled for multiple levels of clustering, year of chemotherapy initiation, tumor characteristics, patient age, race, comorbidity, Medicaid dual-eligibility status, and education.
Of 4055 community patients, 35% received 5-fluoruracil, 20% received oxaliplatin, 7% received another chemotherapy, and 38% received no chemotherapy. Twenty-five percent of CCOP patients received oxaliplatin, compared with 19% of non-CCOP patients. In multivariable analysis, CCOP exposure was associated with higher odds of receiving guideline-concordant treatment in general, and oxaliplatin specifically.
These findings contribute to a growing set of evidence linking PBRNs with a greater probability of receiving treatment innovations and high-quality cancer care, with implications for clinical and research policy.
*Department of Health Policy and Management, Gillings School of Global Public Health UNC, Chapel Hill, NC
†Cecil G. Sheps Center for Health Services Research, UNC, Chapel Hill, NC
‡UNC-Lineberger Comprehensive Cancer Center, Chapel Hill, NC
§Department of Biostatistics, Gillings School of Global Public Health, UNC, Chapel Hill, NC
∥Department of Medicine, University of Virginia, Charlottesville, VA
¶Department of Hematology/Oncology, School of Medicine, UNC, Chapel Hill, NC
Supported by NCI Grant 5R01CA124402, and directly informed by work performed in support of NCI Contract HHSN261200800726P. The work was supported in part by the Integrated Cancer Information and Surveillance System (ICISS), UNC Lineberger Comprehensive Cancer Center, through the University Cancer Research Fund through the State of North Carolina. This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS) Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database. The collection of the California cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; NCI contracts N01-PC-35136, N01-PC-35139, and N02-PC-15105; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement #U55/CCR921930-02. This work was conducted after IRB review and approval at the University of North Carolina (IRB 05-2761).
The NCI had no role in the design and conduct of the study, in the collection, management, analysis, and interpretation of the data, or in the preparation, review, or approval of the manuscript. ICISS members (W.R.C., A.M.M., and Y.W.) were involved in the design and conduct of the study, collection, management, analysis and interpretation of the data, and preparation, review, and approval of the manuscript.
The authors declare no conflict of interest.
Reprints: William R. Carpenter, MHA, PhD, CB 7411-1101 McGavran Greenberg-Hall, Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7411. E-mail: firstname.lastname@example.org.