Faculty Collaboration Database

Individual physician practice variation in hematopoietic cell transplantation. J Clin Oncol 2008 May 01;26(13):2162-70

Date

04/02/2008

Pubmed ID

18378566

DOI

10.1200/JCO.2007.15.0169

Scopus ID

2-s2.0-43749091065 (requires institutional sign-in at Scopus site)   41 Citations

Abstract

PURPOSE: Previous studies have evaluated practice variation in hematopoietic cell transplantation (HCT) among transplant centers and countries. There are no studies investigating individual physician practice variation in HCT.

METHODS: An international Internet-based survey of transplant physicians collected data on medical decisions made by adult and pediatric HCT physicians. Multivariable analyses identified practitioner and transplant center characteristics predictive of medical decision making.

RESULTS: Analysis of 526 assessable respondents showed a wide variation in management approaches to specific clinical scenarios. Pediatric and adult transplant physicians differed significantly in their management strategies for chronic myeloid leukemia, acute and chronic graft-versus-host disease, and choice of graft source for patients with aplastic anemia. Among adult transplant physicians, there was little agreement on the patient factors favoring reduced intensity conditioning or myeloablative conditioning.

CONCLUSION: These results emphasize the heterogeneity of worldwide transplant practices. Local preferences or biases likely result in similar patients being offered different transplant and treatment procedures. The degree of practice variation also highlights the need for clinical trials to clarify areas of controversy. Where clinical trials are not feasible, data from observational studies may be the best available evidence to guide practice.

Author List

Lee SJ, Joffe S, Artz AS, Champlin RE, Davies SM, Jagasia M, Kernan NA, Loberiza FR Jr, Soiffer RJ, Eapen M

Author

Mary Eapen MBBS, DCh, MRCPI, MS Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Anemia, Aplastic
Antineoplastic Combined Chemotherapy Protocols
Blast Crisis
Decision Making
Female
Graft vs Host Disease
Health Care Surveys
Health Services Accessibility
Healthcare Disparities
Hematopoietic Stem Cell Transplantation
Humans
Immunosuppressive Agents
Internet
Leukemia
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Leukemia, Myeloid, Acute
Lymphoma, Non-Hodgkin
Male
Middle Aged
Patient Selection
Practice Guidelines as Topic
Practice Patterns, Physicians'
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Quality of Health Care
Residence Characteristics
Surveys and Questionnaires
Transplantation Conditioning
Transplantation, Homologous