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Allografting

Practice variation in physician referral for allogeneic hematopoietic cell transplantation

Bone Marrow Transplantation volume 48, pages 63–67 (2013)Cite this article

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Abstract

Hematological malignancy patients not referred by their primary hematologist/medical oncologist suffer disparate access to allogeneic hematopoietic cell transplantation (HCT). However, investigation into physician, system and patient factors relevant to this decision making is lacking. We surveyed a national randomized sample of practicing hematologists/medical oncologists identified through the AMA (American Medical Association) masterfile. A modified Dillman approach was utilized to encourage survey response. From 1200 surveyed, a total of 113 physicians responded. In all, 68% were male, 62% identified as White/non-Hispanic, 79% practiced in non-academic settings and 80% reported spending 75–100% of their professional effort in clinical care. Using clinical vignettes, we detected significantly increased odds for HCT non-referral according to age (age 60 vs 30, odds ratio (OR) 8.3, 95% confidence interval (CI): 5.9–11.7, P<0.0001), insurance coverage (no coverage vs coverage, OR 6.9, 95% CI: 5.2–9.1, P<0.0001) and race (African–American vs Caucasian, OR 2.4, 95% CI: 1.9–2.9, P<0.0001). Physician (perception of HCT risks), system (insurance coverage) and patient (age, social support and co-morbid illness) factors were strongly endorsed by respondents as important determinants of their HCT referral practices. These data speak to important factors relevant to HCT referral practices, and highlight several opportunities for education and intervention to reduce current disparities.

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References

  1. Anasetti C, Hillgruber R, Nye V, Ayala E, Kharfan-Dabaja M, Fernandez H et al. Patient ethnicity markedly affects the probability of finding an HLA-A, B, C, and DRB1 allele matched unrelated donor for hemopoietic cell transplantation. Biol Blood Marrow Transplant 2010; 16: S172.

    Article  Google Scholar 

  2. Majhail NS, Omondi NA, Denzen E, Murphy EA, Rizzo JD . Access to hematopoietic cell transplantation in the United States. Biol Blood Marrow Transplant 2010; 16: 1070–1075.

    Article  Google Scholar 

  3. Cho C . Factors affecting stem cell transplantation for leukemia and lymphoma, Available at http://hdl.handle.net/1961/3595.

  4. Hwang JP, Lam TP, Cohen DS, Donato ML, Geraci JM . Hematopoietic stem cell transplantation among patients with leukemia of all ages in Texas. Cancer 2004; 101: 2230–2238.

    Article  Google Scholar 

  5. Mehta P, Pollock BH, Nugent M, Horowitz M, Wingard JR . Access to stem cell transplantation: do women fare as well as men? Am J Hematol 2003; 72: 99–102.

    Article  Google Scholar 

  6. Mitchell JM, Meehan KR, Kong J, Schulman KA . Access to bone marrow transplantation for leukemia and lymphoma: the role of sociodemographic factors. J Clin Oncol 1997; 15: 2644–2651.

    Article  CAS  Google Scholar 

  7. Joshua T, Rizzo JD, Zhang MJ, Horowitz MM . Access to hematopoietic stem cell transplantation: effect of race and gender (abstract). Biol Blood Marrow Transplant 2007; 13 (Suppl): 22.

    Article  Google Scholar 

  8. Baker KS, Davies SM, Majhail NS, Hassebroek A, Klein JP, Ballen KK et al. Race and socioeconomic status influence outcomes of unrelated donor hematopoietic cell transplantation. Biol Blood Marrow Transplant 2009; 15: 1543–1554.

    Article  Google Scholar 

  9. Baker KS, Loberiza FR, Yu H, Cairo MS, Bolwell BJ, Bujan-Boza WA et al. Outcome of ethnic minorities with acute or chronic leukemia treated with hematopoietic stem-cell transplantation in the United States. J Clin Oncol 2005; 23: 7032–7042.

    Article  Google Scholar 

  10. Serna DS, Lee SJ, Zhang MJ, Baker S, Eapen M, Horowitz MM et al. Trends in survival rates after allogeneic hematopoietic stem-cell transplantation for acute and chronic leukemia by ethnicity in the United States and Canada. J Clin Oncol 2003; 21: 3754–3760.

    Article  Google Scholar 

  11. Silla L, Fischer GB, Paz A, Daudt LE, Mitto I, Katz B et al. Patient socioeconomic status as a prognostic factor for allo-SCT. Bone Marrow Transplant 2009; 43: 571–577.

    Article  CAS  Google Scholar 

  12. Flynn TN, Louviere JJ, Peters TJ, Coast J . Best–worst scaling: what it can do for health care research and how to do it. J Health Econ 2007; 26: 171–189.

    Article  Google Scholar 

  13. Asch DA, Jedrziewski MK, Christakis NA . Response rates to mail surveys published in medical journals. J Clin Epidemiol 1997; 50: 1129–1136.

    Article  CAS  Google Scholar 

  14. McCloskey SA, Tao ML, Rose CM, Fink A, Amadeo AM . National survey of perspectives of palliative radiation therapy: role, barriers, and needs. Cancer J 2007; 13: 130–137.

    Article  Google Scholar 

  15. Thorpe C, Ryan B, McLean SL, Burt A, Stewart M, Brown JB et al. How to obtain excellent response rates when surveying physicians. Fam Pract 2009; 26: 65–68.

    Article  CAS  Google Scholar 

  16. Dillman DA . Mail and telephone surveys: the total design method, In: Sons JWa (ed). Wiley, New York, 1978.

    Google Scholar 

  17. Field TS, Cadoret CA, Brown ML, Ford M, Greene SM, Hill D et al. Surveying physicians: do components of the ‘Total Design Approach’ to optimizing survey response rates apply to physicians? Med Care 2002; 40: 596–605.

    Article  Google Scholar 

  18. Edwards P, Roberts I, Clarke M, DiGuiseppi C, Pratap S, Wentz R et al. Methods to increase response rates to postal questionnaires. Cochrane Database Syst Rev 2007; 2: MR000008.

    Google Scholar 

  19. Arora M, Weisdorf DJ, Spellman SR, Haagenson MD, Klein JP, Hurley CK et al. HLA-identical sibling compared with 8/8 matched and mismatched unrelated donor bone marrow transplant for chronic phase chronic myeloid leukemia. J Clin Oncol 2009; 27: 1644–1652.

    Article  Google Scholar 

  20. Gupta V, Tallman MS, He W, Logan BR, Copelan E, Gale RP et al. Comparable survival after HLA-well-matched unrelated or matched sibling donor transplantation for acute myeloid leukemia in first remission with unfavorable cytogenetics at diagnosis. Blood 2010; 116: 1839–1848.

    Article  CAS  Google Scholar 

  21. Hows JM, Passweg JR, Tichelli A, Locasciulli A, Szydlo R, Bacigalupo A et al. Comparison of long-term outcomes after allogeneic hematopoietic stem cell transplantation from matched sibling and unrelated donors. Bone Marrow Transplant 2006; 38: 799–805.

    Article  CAS  Google Scholar 

  22. Moore J, Nivison-Smith I, Goh K, Ma D, Bradstock K, Szer J et al. Equivalent survival for sibling and unrelated donor allogeneic stem cell transplantation for acute myelogenous leukemia. Biol Blood Marrow Transplant 2007; 13: 601–607.

    Article  Google Scholar 

  23. Ringden O, Pavletic SZ, Anasetti C, Barrett AJ, Wang T, Wang D et al. The graft-versus-leukemia effect using matched unrelated donors is not superior to HLA-identical siblings for hematopoietic stem cell transplantation. Blood 2009; 113: 3110–3118.

    Article  CAS  Google Scholar 

  24. Schetelig J, Bornhauser M, Schmid C, Hertenstein B, Schwerdtfeger R, Martin H et al. Matched unrelated or matched sibling donors result in comparable survival after allogeneic stem-cell transplantation in elderly patients with acute myeloid leukemia: a report from the cooperative German Transplant Study Group. J Clin Oncol 2008; 26: 5183–5191.

    Article  Google Scholar 

  25. Walter RB, Pagel JM, Gooley TA, Petersdorf EW, Sorror ML, Woolfrey AE et al. Comparison of matched unrelated and matched related donor myeloablative hematopoietic cell transplantation for adults with acute myeloid leukemia in first remission. Leukemia 2010; 24: 1276–1282.

    Article  CAS  Google Scholar 

  26. Weisdorf DJ, Anasetti C, Antin JH, Kernan NA, Kollman C, Snyder D et al. Allogeneic bone marrow transplantation for chronic myelogenous leukemia: comparative analysis of unrelated versus matched sibling donor transplantation. Blood 2002; 99: 1971–1977.

    Article  CAS  Google Scholar 

  27. Weisdorf DJ, Nelson G, Lee SJ, Haagenson M, Spellman S, Antin JH et al. Sibling versus unrelated donor allogeneic hematopoietic cell transplantation for chronic myelogenous leukemia: refined HLA matching reveals more graft-versus-host disease but not less relapse. Biol Blood Marrow Transplant 2009; 15: 1475–1478.

    Article  Google Scholar 

  28. Gratwohl A, Schmid O, Baldomero H, Horisberger B, Urbano-Ispizua A . Haematopoietic stem cell transplantation (HSCT) in Europe 2002. Changes in indication and impact of team density. A report of the EBMT activity survey. Bone Marrow Transplant 2004; 34: 855–875.

    Article  CAS  Google Scholar 

  29. Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood 2005; 106: 2912–2919.

    Article  CAS  Google Scholar 

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Acknowledgements

The authors thank the staff in Dr Craig’s lab at Lee H Moffitt Cancer Center and Research Institute for their contributions to the research and creation of this paper: Shannon Hendrix-Buxton (best–worst scaling design) and Carol Templeton (copy editing). This study was supported by Interdisciplinary Health Disparities Pilot Research Grant (sponsored by USF/Moffitt Transdisciplinary Center to Address Cancer Health Disparities P20 MD003375-02, PI Richard Roetzheim, MD, MSPH): Practice variation in referral for hematopoietic cell transplantation. (PI: Pidala, J)

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Authors and Affiliations

  1. Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL, USA

    J Pidala & C Anasetti

  2. Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA

    B M Craig & G Quinn

  3. Fred Hutchinson Cancer Research Center, North Seattle, WA, USA

    S J Lee

  4. University of Minnesota, Minneapolis, MN, USA

    N Majhail

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  1. J Pidala
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Correspondence to J Pidala.

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Pidala, J., Craig, B., Lee, S. et al. Practice variation in physician referral for allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 48, 63–67 (2013). https://doi.org/10.1038/bmt.2012.95

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