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The Role of Organizational Affiliations and Research Networks in the Diffusion of Breast Cancer Treatment Innovation

Carpenter, William R. PhD, MHA*†‡§; Reeder-Hayes, Katherine MD; Bainbridge, John MS; Meyer, Anne-Marie PhD; Amos, Keith D. MD†‡§∥; Weiner, Bryan J. PhD*†‡; Godley, Paul A. MD, PhD†‡§¶

doi: 10.1097/MLR.0b013e3182028ff2
Original Article

Introduction: The National Institutes of Health (NIH) sees provider-based research networks and other organizational linkages between academic researchers and community practitioners as promising vehicles for accelerating the translation of research into practice. This study examines whether organizational research affiliations and teaching affiliations are associated with accelerated diffusion of sentinel lymph node biopsy (SLNB), an innovation in the treatment of early-stage breast cancer.

Methods: Surveillance Epidemiology and End Results-Medicare data were used to examine the diffusion of SLNB for treatment of early-stage breast cancer among women aged 65 years and older diagnosed between 2000 and 2002, shortly after Medicare approved and began reimbursing for the procedure.

Results: In this population, patients treated at an organization affiliated with a research network—-the American College of Surgeons Oncology Group (ACOSOG) or other National Cancer Institute (NCI) cooperative groups—-were more likely to receive the innovative treatment (SLNB) than patients treated at unaffiliated organizations (odds ratio: 2.70, 95% confidence interval: 1.77–4.12; odds ratio: 1.84, 95% confidence interval: 1.26–2.69, respectively). Neither hospital teaching status nor surgical volume was significantly associated with differences in SLNB use.

Discussion: Patients who receive cancer treatment at organizations affiliated with cancer research networks have an enhanced probability of receiving SLNB, an innovative procedure that offers the promise of improved patient outcomes. Study findings support the NIH Roadmap and programs such as the NCI's Community Clinical Oncology Program, as they seek to accelerate the translation of research into practice by simultaneously accelerating and broadening cancer research in the community.

From the *Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; †Cecil G. Sheps Center for Health Services Research, UNC, Chapel Hill, NC; ‡UNC-Lineberger Comprehensive Cancer Center, Chapel Hill, NC; §North Carolina Comprehensive Cancer Program, Raleigh, NC; Departments of ¶Hematology/Oncology, and ∥Surgery, School of Medicine, UNC, Chapel Hill, NC.

The interpretation and reporting of these data are the sole responsibility of the authors.

This study was reviewed and approved by University of North Carolina IRB #05–2761 (HPAA-1332).

This study used the linked SEER-Medicare database.

Supported by NCI grant 5R01CA124402. 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.

Reprints: William R. Carpenter, PhD, MHA, Department of Health Policy and Management, University of North Carolina, School of Public Health, 1102A McGavran Greenberg Hall; CB 7411, Chapel Hill, NC 27516. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.