Surgeon and Care Team Network Measures and Timely Breast Cancer Treatment

Abstract

Importance: Cancer treatment delay is a recognized marker of worse outcomes. Timely treatment may be associated with physician patient-sharing network characteristics, yet this remains understudied.

Objective: To examine the associations of surgeon and care team patient-sharing network measures with breast cancer treatment delay.

Design, setting, and participants: This cross-sectional study of Medicare claims in a US population-based setting was conducted from 2017 to 2020. Eligible participants included patients with breast cancer who received surgery and the subset who went on to receive adjuvant therapy. Patient-sharing networks were constructed for treating physicians. Data were analyzed from September 2023 to February 2024.

Exposures: Surgeon linchpin score (a measure of local uniqueness or scarcity) and care density (a measure of physician team familiarity) were assessed. Surgeons were considered linchpins if their linchpin score was in the top 15%. The care density of a patient's physician team was calculated on preoperative teams for surgically-treated patients and postoperative teams for adjuvant therapy-receiving patients.

Main outcomes and measures: The primary outcomes were surgical and adjuvant delay, which were defined as greater than 60 days between biopsy and surgery and greater than 60 days between surgery and adjuvant therapy, respectively.

Results: The study cohort included 56 433 patients (18 004 aged 70-74 years [31.9%]) who were mostly from urban areas (44 931 patients [79.6%]). Among these patients, 8009 (14.2%) experienced surgical delay. Linchpin surgeon status (locally unique surgeon) was not statistically associated with surgical delay; however, patients with high preoperative care density (ie, high team familiarity) had lower odds of surgical delay compared with those with low preoperative care density (odds ratio [OR], 0.58; 95% CI, 0.53-0.63). Of the 29 458 patients who received adjuvant therapy after surgery, 5700 (19.3%) experienced adjuvant delay. Patients with a linchpin surgeon had greater odds of adjuvant delay compared with those with a nonlinchpin surgeon (OR, 1.30; 95% CI, 1.13-1.49). Compared with those with low postoperative care density, there were lower odds of adjuvant delay for patients with high postoperative care density (OR, 0.77; 95% CI, 0.69-0.87) and medium postoperative care density (OR, 0.85; 95% CI, 0.77-0.94).

Conclusions and relevance: In this cross-sectional study of Medicare claims, network measures capturing physician scarcity and team familiarity were associated with timely treatment. These results may help guide system-level interventions to reduce cancer treatment delays.

Figure.. Illustration of the Network Measures of Interest

A, Focal surgeon v is connected to 3 physicians who lack ties to another surgeon in the patient-sharing network, and their edge weights sum to 10 (5 + 3 + 2). The sum of all edge weights is 20 (5 + 3 + 2 + 6 + 4). Therefore, the linchpin score (I) of surgeon v is calculated as 10 / 20 = 0.5. B, Over the course of their treatment, patient i received care from 5 physicians, of whom have 10 possible ties (5 × [5 - 1] / 2 = 10). The existing ties between this set of physicians have edge weights that sum to 16 (5 + 3 + 2 + 6). Therefore, the care density (cd) for patient i is calculated as 16 / 10 = 1.6.