Table 2.
Factors associated with frequency of discussions about costs of genomic testing and related treatment*
| Sample characteristics | Unadjusted (sometimes vs never or rarely) | Unadjusted (often vs never or rarely) | Adjusted† (sometimes vs never or rarely) | Adjusted† (often vs never or rarely) |
|---|---|---|---|---|
| OR (95% CI) | OR (95% CI) | OR (95% CI) | OR (95% CI) | |
| Physician characteristics | ||||
| Age, y | ||||
| <40 | Referent | Referent | — | — |
| 40–49 | 0.94 (0.60 to 1.48) | 1.27 (0.85 to 1.90) | — | — |
| 50–59 | 1.04 (0.64 to 1.67) | 1.39 (0.91 to 2.13) | — | — |
| ≥60 | 1.09 (0.67 to 1.76) | 1.54 (1.00 to 2.38) | — | — |
| Years since medical school graduation | ||||
| 7–14 | Referent | Referent | Referent | Referent |
| 15–24 | 1.07 (0.70 to 1.65) | 1.17 (0.80 to 1.72) | 1.08 (0.68 to 1.70) | 1.21 (0.78 to 1.87) |
| 25–34 | 1.17 (0.72 to 1.90) | 1.62 (1.06 to 2.49) | 1.35 (0.80 to 2.26) | 2.28 (1.40 to 3.71) |
| 35–51 | 1.14 (0.71 to 1.83) | 1.53 (1.00 to 2.33) | 1.24 (0.73 to 2.12) | 1.97 (1.19 to 3.25) |
| Sex | ||||
| Female | Referent | Referent | — | — |
| Male | 0.99 (0.69 to 1.42) | 1.07 (0.78 to 1.46) | — | — |
| Race/ethnicity | ||||
| White, non-Hispanic | Referent | Referent | — | — |
| Other | 0.89 (0.64 to 1.24) | 0.78 (0.58 to 1.05) | — | — |
| Types of tumors treated | ||||
| Hematologic cancers only | Referent | Referent | Referent | Referent |
| Hematologic cancers and solid tumors | 1.37 (0.87 to 2.17) | 3.07 (1.93 to 4.88) | 1.31 (0.75 to 2.30) | 2.82 (1.58 to 5.02) |
| Solid tumors only | 1.49 (0.85 to 2.63) | 4.77 (2.78 to 8.19) | 1.47 (0.81 to 2.69) | 4.01 (2.21 to 7.29) |
| Percentage of time providing patient care | ||||
| <76 | Referent | Referent | — | — |
| ≥76 | 1.08 (0.75 to 1.54) | 0.97 (0.71 to 1.33) | — | — |
| Affiliation with medical school or hospital | ||||
| No | Referent | Referent | — | — |
| Yes | 0.99 (0.71 to 1.40) | 0.89 (0.66 to 1.20) | — | — |
| Formal training in genomic testing | ||||
| No | Referent | Referent | Referent | Referent |
| Yes | 1.22 (0.87 to 1.69) | 1.68 (1.26 to 2.25) | 1.15 (0.80 to 1.66) | 1.74 (1.25 to 2.42) |
| Uses next-generation sequencing gene panel tests | ||||
| No | Referent | Referent | Referent | Referent |
| Yes | 1.74 (1.21 to 2.51) | 1.11 (0.85 to 1.45) | 1.59 (1.07 to 2.37) | 1.93 (1.34 to 2.77) |
| Practice characteristics | ||||
| Practice type | ||||
| Solo | Referent | Referent | Referent | Referent |
| Single specialty | 1.23 (0.50 to 3.03) | 0.91 (0.44 to 1.90) | 1.18 (0.43 to 3.18) | 0.75 (0.33 to 1.71) |
| Multispecialty | 1.11 (0.45 to 2.72) | 0.73 (0.35 to 1.52) | 1.11 (0.40 to 3.07) | 0.61 (0.26 to 1.41) |
| Other | 0.68 (0.24 to 1.91) | 0.49 (0.21 to 1.13) | 0.78 (0.26 to 2.37) | 0.50 (0.19 to 1.29) |
| Located in metropolitan statistical area | ||||
| Small/Medium | Referent | Referent | — | — |
| Large | 1.19 (0.63 to 2.25) | 1.00 (0.55 to 1.82) | — | — |
| Very large | 0.69 (0.43 to 1.12) | 0.75 (0.48 to 1.17) | — | — |
| US geographic region | ||||
| Northeast | Referent | Referent | Referent | Referent |
| Midwest | 1.32 (0.82 to 2.14) | 1.61 (1.05 to 2.45) | 1.25 (0.74 to 2.11) | 1.60 (0.98 to 2.62) |
| South | 1.05 (0.69 to 1.59) | 1.04 (0.72 to 1.51) | 0.93 (0.57 to 1.52) | 0.98 (0.62 to 1.53) |
| West | 1.28 (0.75 to 2.17) | 1.82 (1.16 to 2.86) | 1.28 (0.72 to 2.29) | 1.92 (1.15 to 3.21) |
| Patient volume per month | ||||
| 1–99 | Referent | Referent | Referent | Referent |
| ≥100 | 1.46 (1.05 to 2.04) | 1.79 (1.33 to 2.40) | 1.35 (0.94 to 1.92) | 1.53 (1.11 to 2.10) |
| Practice provides internal policies or protocols for genomic testing | ||||
| No | Referent | Referent | Referent | Referent |
| Yes | 1.14 (0.82 to 1.58) | 1.35 (1.01 to 1.81) | 1.06 (0.70 to 1.59) | 1.25 (0.86 to 1.79) |
| Practice has electronic medical record alerts for genomic testing | ||||
| No | Referent | Referent | Referent | Referent |
| Yes | 2.32 (1.38 to 3.90) | 2.56 (1.59 to 4.12) | 2.09 (1.19 to 3.69) | 2.22 (1.30 to 3.79) |
| Practice has genomic and/or molecular tumor board for genomic testing | ||||
| No | Referent | Referent | Referent | Referent |
| Yes | 1.08 (0.76 to 1.54) | 1.31 (0.96 to 1.78) | 1.19 (0.74 to 1.90) | 1.47 (0.96 to 2.25) |
| Proportion of patients insured by Medicaid ≥ 10% or self-pay or uninsured ≥10% | ||||
| No | Referent | Referent | Referent | Referent |
| Yes | 1.70 (1.14 to 2.47) | 1.47 (1.07 to 2.02) | 1.60 (1.09 to 2.36) | 1.55 (1.09 to 2.20) |
| Area-level characteristics | ||||
| Mean per capita income | ||||
| >$60 000 | Referent | Referent | Referent | Referent |
| $45 000–60 000 | 1.43 (0.95 to 2.14) | 1.98 (1.39 to 2.82) | 1.12 (0.65 to 1.92) | 1.84 (1.09 to 3.09) |
| ≤$45 000 | 1.61 (1.05 to 2.45) | 1.59 (1.09 to 2.33) | 1.08 (0.56 to 2.07) | 1.55 (0.81 to 2.97) |
| % persons ≥25 years with ≥4 years of college | ||||
| >45 | Referent | Referent | Referent | Referent |
| 30%–45 | 1.63 (1.06 to 2.51) | 1.68 (1.16 to 2.42) | 1.57 (0.91 to 2.71) | 1.27 (0.75 to 2.16) |
| ≤30 | 2.01 (1.27 to 3.18) | 1.71 (1.14 to 2.55) | 1.96 (0.98 to 3.90) | 1.19 (0.62 to 2.28) |
| Median gross rent | ||||
| >$1000 | Referent | Referent | — | — |
| $850–1000 | 1.14 (0.77 to 1.67) | 1.07 (0.77 to 1.50) | — | — |
| ≤$850 | 1.50 (0.99 to 2.27) | 1.80 (1.24 to 2.61) | — | — |
*
N = 1220. Data from the National Survey of Precision Medicine in Cancer Treatment. All analyses account for complex survey design and survey nonresponse. CI = confidence interval; OR = odds ratio.
†
Final multivariable model included year of graduation, types of tumors treated, training in genomic testing, next-generation sequencing use, practice type, US geographic region, primary practice provides internal policies or protocols, electronical medical record alerts, practice has genomic and/or molecular tumor board for genomic testing, patient insurance status, area-level per capita income, and college education.