Delays in Breast Cancer Surgical Care Following Oncology Surgeon Departures

Résumé fourni par la source

BACKGROUND: Timely cancer treatment is a major component of high-quality cancer care and is associated with better outcomes. Disruption caused by physician departures may adversely affect timely care. OBJECTIVE: To examine the effects of breast cancer surgeon departures on timely breast cancer surgery. METHODS: Using Medicare fee-for-service claims, we identified patients 66-99 years of age diagnosed with breast cancer between 2017 and 2019 who underwent a cancer-directed surgery. Surgical oncologists, plastic and reconstructive surgeons, and general surgeons performing these surgeries were included in our breast cancer surgeon cohort. Surgeon movement was tracked using changes in billing locations. The exposure variable was the number of surgeon departures in the prior 12 months from the hospital service area (HSA) where a patient's diagnostic biopsy was performed. Multivariable hierarchical logistic regression was used to estimate the associations between surgeon departures and surgical delays of more than 60 days. RESULTS: Our study cohort included 122,159 patients with breast cancer, of whom 108,239 (89%) were non-Hispanic white and 97,565 (80%) resided in a metropolitan area. We found that 52,708 (43.1%) received care within an HSA that experienced at least 1 surgeon departure. Each additional surgeon departure was associated with a 4% increase in odds of delay >60 days (95% CI: 1.02-1.05; P<0.001). CONCLUSIONS: We found a modest association between surgeon departures and the odds of breast cancer surgical delay. These results suggest that, on average, hospitals are often able to deliver timely care in the context of surgeon departures. Additional research is needed to determine whether this finding generalizes to other cancer types and to identify the strategies that enable health system resilience to surgeon departures.

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