What question did this study set out to answer?

To examine clinician- and facility-level factors associated with the use of nonguideline chemotherapy in women treated for stage I-IIIA breast cancer.

December 11, 2025Open Access

Clinician- and Facility-Level Factors Associated With Receipt of Nonguideline Chemotherapy Regimens in Women With Stage I-IIIA Breast Cancer

Puntos clave

To examine clinician- and facility-level factors associated with the use of nonguideline chemotherapy in women treated for stage I-IIIA breast cancer.
Data collected from the Optimal Breast Cancer Chemotherapy Dosing Study
Included 9,758 women treated from 2006 to 2019 at Kaiser Permanente Northern California
Estimated prevalence ratios for factors influencing nonguideline regimen use
Stratified analyses pre- and post-2015 to assess changes over time
Older clinicians (30+ years since medical school) more likely to prescribe nonguideline regimens
Larger practice size (10+ oncologists) associated with lower use of nonguideline drug combinations
Associations with clinician sex diminished after 2015, indicating changes in care delivery

Resumen

PURPOSE We examined clinician- and facility-level factors associated with selection of nonguideline chemotherapy at treatment initiation in women with stage I-IIIA breast cancer (BC). METHODS The Optimal Breast Cancer Chemotherapy Dosing Study collected information on chemotherapy delivery in an integrated health care delivery system. This analysis included 9,758 women treated with chemotherapy for stage I-IIIA BC between 2006 and 2019 at Kaiser Permanente Northern California (KPNC). Prevalence ratios (PRs) and corresponding 95% CIs were estimated for the clinician and facility factors in relation to nonguideline regimen (NGR) use. Analyses were stratified by time (pre- and post-2015) to reflect the period before and after KPNC's transition to a subspecialized care model. Secondary outcomes focused on nonguideline drug combinations (NGDCs) and nonguideline administration schedules (NGASs). RESULTS Women treated by clinicians with substantially greater time since medical school (30+ years v <10 years since medical school) were more likely to receive NGR (PR, 1.38; 95% CI, 1.01 to 1.88; P trend = .01) with significant associations observed for both NGDC and NGAS. While not associated in the primary analysis, larger practice size (10+ oncologists) was associated with a lower likelihood of NGDC use compared with smaller practices (<5 oncologists; PR, 0.43; 95% CI, 0.26 to 0.70; P trend = .01). Time stratification revealed that, in the study's early years, clinician sex and years since medical school were associated with NGR use, but neither association remained post-2015. CONCLUSION Clinician and facility characteristics significantly influenced the use of NGR in stage I-IIIA BC treatment. Notably, associations diminished over time, suggesting that health system changes in care delivery may enhance guideline adherence and reduce the impact of nonclinical factors on treatment decisions.

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