{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T15:13:28Z","timestamp":1747149208794,"version":"3.40.5"},"reference-count":26,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2022,12,27]],"date-time":"2022-12-27T00:00:00Z","timestamp":1672099200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl Journal of Cancer"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>During the last decade completion axillary lymph node dissection (cALND) was gradually omitted in sentinel lymph node positive (SLN+) breast cancer patients. However, adoption varies among hospitals. We analyzed factors associated with the omission of cALND in all Dutch SLN+ patients. As one of the focus hospital\u2010related factors we defined \u201cinnovative\u201d as the percentage of gene\u2010expression profile (GEP) deployment within the indicated group of patients per hospital as a proxy for early adoption of innovations. cT1\u20102N0M0 SLN+ patients treated between 2011 and 2018 were selected from the Netherlands Cancer Registry. Hospitals were defined to be innovative based on their GEP use. Multivariable logistic regression (MLR) was performed to assess the relationship between innovative capacity, patient\u2010, treatment\u2010 and hospital\u2010related characteristics and cALND performance. 14\u2009317 patients were included. Treatment in a hospital with high innovative capacity was associated with a lower probability of receiving cALND (OR 0.69, OR 0.46 and OR 0.35 in modestly, fairly and very innovative, respectively). Other factors associated with a lower probability of receiving a cALND were age 70 and 79\u2009years and \u226579\u2009years (ORs 0.59 [95% CI: 0.50\u20100.68] and 0.21 [95% CI: 0.17\u20100.26]) and treatment in an academic hospital (OR 0.41 [95% CI: 0.33\u20100.51]). Factors associated with an increased probability of undergoing cALND were HR\u2212\/HER2\u2212 tumors (OR 1.46 [95% CI: 1.19\u20101.80]), macrometastatic lymph node involvement (OR 6.37 [95% CI: 5.70\u20107.13]) and mastectomy (OR 4.57 [95% CI: 4.09\u20105.10]). Patients treated in a hospital that early adopted innovations were less likely to receive cALND. Our findings endorse the need for studies on barriers and facilitators of implementing innovations.<\/jats:p>","DOI":"10.1002\/ijc.34400","type":"journal-article","created":{"date-parts":[[2022,12,16]],"date-time":"2022-12-16T05:21:25Z","timestamp":1671168085000},"page":"1378-1387","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Inequalities in the omission of axillary dissection in sentinel lymph node positive patients in the Netherlands: Innovative hospitals are early adopters of a de\u2010escalating approach"],"prefix":"10.1002","volume":"152","author":[{"given":"Julia E. C.","family":"van Steenhoven","sequence":"first","affiliation":[{"name":"Department of Surgery Erasmus MC  Rotterdam The Netherlands"},{"name":"Department of Pathology University Medical Center Utrecht  Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marissa C.","family":"van Maaren","sequence":"additional","affiliation":[{"name":"Department of Research and Development Netherlands Comprehensive Cancer Organisation  Utrecht The Netherlands"},{"name":"Department of Health Technology and Services Research, Technical Medical Centre University of Twente  Enschede The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eline E. 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P.","family":"Nieuwenhuijzen","sequence":"additional","affiliation":[{"name":"Department of Surgery Catharina Hospital Eindhoven  Eindhoven The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6666-1368","authenticated-orcid":false,"given":"Anne","family":"Kuijer","sequence":"additional","affiliation":[{"name":"Department of Surgery St. Antonius Hospital  Nieuwegein The Netherlands"},{"name":"Department of Surgery University Medical Center Utrecht  Utrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabine","family":"Siesling","sequence":"additional","affiliation":[{"name":"Department of Research and Development Netherlands Comprehensive Cancer Organisation  Utrecht The Netherlands"},{"name":"Department of Health Technology and Services Research, Technical Medical Centre University of Twente  Enschede The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thijs","family":"van Dalen","sequence":"additional","affiliation":[{"name":"Department of Surgery Erasmus MC  Rotterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,12,27]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0906260"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.90"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.11470"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(13)70035-4"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(14)70460-7"},{"volume-title":"Clinical Practice Guidelines in Oncology: Breast Cancer (ver 2.2017)","year":"2017","author":"National Comprehensive Cancer 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