Dr. Hershman suggests the fact that patients at low risk for cancer recurrence, those with estrogen/progesterone receptor positive, stage I/II disease, received treatment regardless of risk factor, could relate to patient volume -- since oncologists in private practice generally have a higher patient volume, or it could be due to patient selection factors -- patients often choose to see physicians for chemotherapy in private settings for convenience, noting that "those with more complicated medical conditions often are treated at university hospitals," says Dr. Hershman. Patient insurance status also may play a role, she observes, since "research has shown that payment mechanisms do, in fact, influence physicians' clinical decision making."
"A less honorable possibility is that recommendations for chemotherapy are influenced by considerations of financial reimbursement and personal compensation that ensue from chemotherapy administration," suggests Alfred I. Neugut, MD, PhD, professor of Epidemiology at the Mailman School of Public Health, professor of Medicine and head of Cancer Prevention and Control for the Herbert Irving Comprehensive Cancer Center, and the study's senior author. "While the majority of oncologists are motivated by patient desires, the potential for conflict of interest in the system has raised concerns, and has resulted in proposals to regulate the reimbursement system."
However, Dr. Neugut notes, one must also consider that patients do, in fact, play a large role in the ultimate decision to undergo treatment with adjuvant chemotherapy. Acceptance of adjuvant chemotherapy by a woman with breast cancer occurs often after an assessment of risk and benefi
|Contact: Stephanie Berger|
Columbia University's Mailman School of Public Health