外科医生及护理团队网络指标与乳腺癌及时治疗

癌症治疗延误是预后较差的重要指标。及时治疗可能与医生患者共享网络的特征有关，但相关研究仍相对不足。本研究旨在探讨外科医生和护理团队的患者共享网络指标与乳腺癌治疗延误的关系。本研究为一项基于美国医保索赔的横断面研究，时间范围为2017年至2020年。符合条件的患者包括接受手术治疗的乳腺癌患者及接受辅助治疗的子集。为治疗医生构建患者共享网络。本次分析于2023年9月至2024年2月进行。评估了外科医生的关键人物评分（反映局部独特性或稀缺性）及护理密度（反映医生团队熟悉度）。若外科医生的关键人物评分位于前15%，则视为关键人物。对手术前团队（手术治疗患者）和术后团队（接受辅助治疗患者）计算护理密度。主要结局为手术延误（定义为从活检到手术时间超过60天）及辅助治疗延误（定义为手术后到辅助治疗时间超过60天）。研究共纳入56,433名患者（其中18,004名（31.9%）年龄在70-74岁），大多来自城市地区（44,931例[79.6%]）。其中，8,009例（14.2%）发生手术延误。关键人物外科医生状态（局部唯一性）与手术延误无显著相关，但高术前护理密度（即团队熟悉度高）患者的手术延误风险较低（比值比[OR] 0.58；95% CI 0.53-0.63）。在接受术后辅助治疗的29,458名患者中，5,700例（19.3%）出现辅助治疗延误。拥有关键人物外科医生的患者辅助治疗延误的可能性较高（OR 1.30；95% CI 1.13-1.49）。与低术后护理密度的患者相比，高术后护理密度（OR 0.77；95% CI 0.69-0.87）和中等护理密度（OR 0.85；95% CI 0.77-0.94）患者更少发生辅助治疗延误。该研究结果表明，反映医生稀缺性及团队熟悉度的网络指标与治疗的及时性显著相关，为系统层面干预以减少癌症治疗延误提供了理论依据。

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