National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
26 to 50 of 797 Research Studies DisplayedKrouse RS, Anderson GL, Arnold KB
Surgical versus non-surgical management for patients with malignant bowel obstruction (S1316): a pragmatic comparative effectiveness trial.
The purpose of this study was to compare surgical versus non-surgical management with the goal of determining the optimal approach for managing malignant bowel obstruction. From May 11, 2015, to April 27, 2020, 221 patients were enrolled, with 199 evaluable participants. The study found no variation between surgery and non-surgery for the primary outcome of good days: mean 42·6 days in the randomized surgery group, 43·9 days (29·5) in the randomized non-surgery group, 54·8 days (27·0) in the patient choice surgery group, and 52·7 days (30·7) in the patient choice non-surgery group. During their initial hospital stay, six participants died, five due to cancer progression and one due to malignant bowel obstruction treatment complications The most common grade 3-4 malignant bowel obstruction treatment complication was anemia.
AHRQ-funded; HS021491.
Citation: Krouse RS, Anderson GL, Arnold KB .
Surgical versus non-surgical management for patients with malignant bowel obstruction (S1316): a pragmatic comparative effectiveness trial.
Lancet Gastroenterol Hepatol 2023 Oct; 8(10):908-18. doi: 10.1016/s2468-1253(23)00191-7..
Keywords: Cancer, Surgery, Treatments, Comparative Effectiveness, Evidence-Based Practice
Nguyen CA, Beaulieu ND, Wright AA
Organization of cancer specialists in US physician practices and health systems.
This study’s objective was to describe the supply of cancer specialists, the organization of cancer care within versus outside of health systems, and the distance to multispecialty cancer centers. The authors used the 2018 Health Systems and Provider Database from the National Bureau of Economic Research and 2018 Medicare data to identify 46,341 unique physicians providing cancer care. They stratified physicians by discipline (adult/pediatric medical oncologists, radiation oncologists, surgical/gynecologic oncologists, other surgeons performing cancer surgeries, or palliative care physicians), system type (National Cancer Institute [NCI] Cancer Center system, non-NCI academic system, nonacademic system, or nonsystem/independent practice), practice size, and composition (single disciplinary oncology, multidisciplinary oncology, or multispecialty). They computed the density of cancer specialists by county and calculated distances to the nearest NCI Cancer Center. Results found that more than half of all cancer specialists (57.8%) practiced in health systems, but 55.0% of cancer-related visits occurred in independent practices. A majority of system-based physicians were in large practices with more than 100 physicians, while those in independent practices were in smaller practices. Breakdown by specialty type showed that practices in NCI Cancer Center systems (95.2%), non-NCI academic systems (95.0%), and nonacademic systems (94.3%) were primarily multispecialty, while fewer independent practices (44.8%) were. Many rural areas had sparse cancer specialty density, where the median travel distance to an NCI Cancer Center was 98.7 miles. Higher-income areas had shorter distances to NCI Cancer centers than low-income areas, even for individuals in suburban and rural areas.
AHRQ-funded; HS024072.
Citation: Nguyen CA, Beaulieu ND, Wright AA .
Organization of cancer specialists in US physician practices and health systems.
J Clin Oncol 2023 Sep 10; 41(26):4226-35. doi: 10.1200/jco.23.00626..
Keywords: Cancer, Provider: Physician, Workforce
Kwon Y, Perraillon MC, Drake C
Comparison of primary payer in cancer registry and discharge data.
The purpose of this cross-sectional study was to ascertain agreement between variables capturing the primary payer at cancer diagnosis across the Pennsylvania Cancer Registry (PCR) and statewide facility discharge records (Pennsylvania Health Care Cost Containment Council [PHC4]) for adults under 65 years, and to examine variables related with misclassification of Medicaid status in the registry given the role of managed care. The researchers evaluated agreement of payer at diagnosis across data sources. The study found that agreement of payers was high for private insurance, but there was misclassification and/or underreporting of Medicaid in the registry. Among cases with "other" and "unknown" insurance, 73.8% and 62.1%, respectively, had private insurance. Medicaid managed care was related with a statistically significant increase of 12.6 percentage points in the probability of misclassifying Medicaid enrollment as private insurance in the registry.
AHRQ-funded; HS027396.
Citation: Kwon Y, Perraillon MC, Drake C .
Comparison of primary payer in cancer registry and discharge data.
Am J Manag Care 2023 Sep; 29(9):455-62. doi: 10.37765/ajmc.2023.89425..
Keywords: Cancer, Payment
Marcotte LM, Khor S, Flum DR
Factors associated with lung cancer risk factor documentation.
This cross-observational study’s objective was to identify factors associated with the minimum necessary information to determine an individual’s eligibility for lung cancer screening (ie, sufficient risk factor documentation) and to characterize clinic-level variability in documentation. The authors calculated the relative risk of sufficient lung cancer risk factor documentation by patient-, provider-, and system-level variables using Poisson regression models, clustering by clinic. They compared unadjusted, risk-adjusted, and reliability-adjusted proportions of patients with sufficient smoking documentation across 31 clinics using logistic regression models and 2-level hierarchical logit models to estimate reliability-adjusted proportions across clinics. A majority (60%) of 20,632 individuals were found to have sufficient risk factor documentation to determine screening eligibility. Patient-level factors were inversely associated with risk factor documentation including Black race, non-English preferred language, Medicaid insurance, and nonactivated patient portal, with documentation varying across clinics.
AHRQ-funded; HS026369.
Citation: Marcotte LM, Khor S, Flum DR .
Factors associated with lung cancer risk factor documentation.
Am J Manag Care 2023 Sep; 29(9):89354..
Keywords: Cancer: Lung Cancer, Cancer, Risk
Offit LR, Chikarmane SA, Lacson RC
Frequency and outcomes of BI-RADS category 3 assessments in patients with a personal history of breast cancer: full-field digital mammography versus digital breast tomosynthesis.
The purpose of this article was to compare the frequency, outcomes, and additional characteristics of BI-RADS category 3 assessments between full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) in patients with a personal history of breast cancer (PHBC). This retrospective study examined electronic health records from 14,845 mammograms in 10,118 patients (mean age, 63 years) with PHBC who had undergone mastectomy and/or lumpectomy. Of these, 8422 examinations were performed by FFDM from October 2014 to October 2016 and the rest examinations by FFDM with DBT from February 2017 to December 2018. The frequency of category 3 assessment was lower for DBT than FFDM (5.6% vs 6.4%). DBT, compared with FFDM, showed a lower malignancy rate for category 3 lesions (1.8% vs 5.0%), higher malignancy rate for category 4 lesions (32.0% vs 23.2%), and no difference in malignancy rate for category 5 lesions (100.0% vs 75.0%). An analysis of index category 3 lesions included 438 lesions for FFDM and 274 lesions for DBT. For category 3 lesions, DBT, compared with FFDM, showed lower PPV3 (13.9% vs 36.1%) and a more frequent mammographic finding of mass (33.2% vs 23.1%).
AHRQ-funded; HS028616.
Citation: Offit LR, Chikarmane SA, Lacson RC .
Frequency and outcomes of BI-RADS category 3 assessments in patients with a personal history of breast cancer: full-field digital mammography versus digital breast tomosynthesis.
AJR Am J Roentgenol 2023 Sep; 221(3):313-22. doi: 10.2214/ajr.23.29067..
Keywords: Cancer: Breast Cancer, Cancer, Imaging, Women
Landy R, Gomez I, Caverly TJ
Methods for using race and ethnicity in prediction models for lung cancer screening eligibility.
The purpose of this study was to compare eligibility for lung cancer screening in a representative United States population by refitting the life-years gained from screening-computed tomography (LYFS-CT) model to exclude race and ethnicity versus a counterfactual eligibility method that recalculates life expectancy for racial and ethnic minority individuals utilizing the same covariates but substitutes White race and utilizes the higher predicted life expectancy, preventing historically underserved groups from being penalized. The National Health Interview Survey (NHIS) 2015-2018 included 25,601 individuals aged 50 to 80 years who ever smoked. The study found that removing race and ethnicity from the submodels underestimated lung cancer death risk and all-cause mortality in African American individuals. It also overestimated mortality in Hispanic American and Asian American individuals. As a result, the LYFS-CT NoRace model increased Hispanic American and Asian American eligibility by 108% and 73%, respectively, while decreasing African American eligibility by 39%. Utilizing LYFS-CT with the counterfactual all-cause mortality model better maintained calibration across groups and increased African American eligibility by 13% without decreasing eligibility for Hispanic American and Asian American individuals.
AHRQ-funded; HS026198.
Citation: Landy R, Gomez I, Caverly TJ .
Methods for using race and ethnicity in prediction models for lung cancer screening eligibility.
JAMA Netw Open 2023 Sep; 6(9):e2331155. doi: 10.1001/jamanetworkopen.2023.31155..
Keywords: Racial and Ethnic Minorities, Cancer: Lung Cancer, Cancer, Screening, Prevention
Landon BE, Lam MB, Landrum MB
Opportunities for savings in risk arrangements for oncologic care.
High spending for cancer care is a target for savings as the United States hastens adoption of alternative payment through global payment models such as Accountable Care Organizations (ACOs) or Medicare Advantage (MA). The purpose of this study was to quantify the level at which Accountable Care Organizations ACOs and other risk-bearing organizations operating in a specific geographic area could realize savings by directing patients to efficient medical oncology practices. The incident cohort included 1,309,825 patients Options for directing differed across markets; the top quartile market had 10 or more oncology practices, but the bottom quartile had 3 or fewer oncology practices. Total spending (including Medicare Part D) in the incident cohort increased from a mean of $57,314 in 2009 to 2010 to $66,028 in 2016 to 2017. Within markets, total spending for practices in the highest spending quartile was 19% greater than in the lowest quartile. Hospital spending was the single largest component of spending in both time periods followed by Part B (infused) chemotherapy. Correlations in practice-level spending between the first-year (2009) and second-year (2010) spending were high.
Citation: Landon BE, Lam MB, Landrum MB .
Opportunities for savings in risk arrangements for oncologic care.
JAMA Health Forum 2023 Sep; 4(9):e233124. doi: 10.1001/jamahealthforum.2023.3124..
Keywords: Cancer, Medicare, Healthcare Costs, Payment
Murphy DR, Zimolzak AJ, Upadhyay DK
Developing electronic clinical quality measures to assess the cancer diagnostic process.
Electronic clinical quality measures (eCQMs) to evaluate quality of cancer diagnosis could facilitate quantification and improvement of diagnostic performance. The purpose of this study was to developed 2 eCQMs to evaluate diagnostic assessment of red-flag clinical findings for colorectal cancer (CRC) and lung cancer. At each site the researchers assessed 100 positive and 20 negative randomly chosen records for each eCQM at each site to validate accuracy and categorized missed opportunities associated with system, provider, or patient factors. The researchers applied the CRC eCQM at both sites, while the lung cancer eCQM was only applied at the VA due to an absence of structured data indicating level of cancer suspicion on most chest imaging results at Geisinger. The study found that for the CRC eCQM, the appropriate follow-up took place in 26, 746 out of 74, 314 patients (36.0%) in the VA after removing clinical exclusions and in 1,009 out of 2,461 patients (41.1%) at Geisinger. The appropriate assessment for lung cancer in the VA took place in 25, 166 out of 40, 924 patients (61.5). Provider factors were cited by reviewers the primary source of missed opportunities at both sites.
AHRQ-funded; HS022087.
Citation: Murphy DR, Zimolzak AJ, Upadhyay DK .
Developing electronic clinical quality measures to assess the cancer diagnostic process.
J Am Med Inform Assoc 2023 Aug 18; 30(9):1526-31. doi: 10.1093/jamia/ocad089..
Keywords: Cancer: Lung Cancer, Cancer, Quality Measures, Diagnostic Safety and Quality, Quality of Care
Sprague BL, Ichikawa L, Eavey J
Breast cancer risk characteristics of women undergoing whole-breast ultrasound screening versus mammography alone.
This study evaluated mammography screening failure risk among women undergoing supplemental ultrasound screening in clinical practice in comparison with women undergoing mammography alone. Screening ultrasounds and screening mammograms without supplemental screening were identified within three Breast Cancer Surveillance Consortium registries. A clinically significant proportion of women who had undergone mammography screening alone were at high mammography screening failure risk. Ultrasound screening was highly targeted to women with dense breasts, but only a small proportion were high mammography screening failure risk.
AHRQ-funded; HS018366.
Citation: Sprague BL, Ichikawa L, Eavey J .
Breast cancer risk characteristics of women undergoing whole-breast ultrasound screening versus mammography alone.
Cancer 2023 Aug 15; 129(16):2456-68. doi: 10.1002/cncr.34768..
Keywords: Cancer: Breast Cancer, Cancer, Women, Imaging, Screening, Risk
Jayadevappa R, Malkowicz SB, Vapiwala N
Association between hospital competition and quality of prostate cancer care.
The purpose of this retrospective study was to explore the relationship between hospital competition and outcomes in elderly with localized prostate cancer (PCa). The researchers also evaluated whether race moderated the relationship. The researchers applied the Hirschman-Herfindahl index (HHI) to measure hospital competition. The study outcomes were emergency room (ER) visits, hospitalizations, Medicare expenditure and mortality assessed in acute survivorship phase (two years post-PCa diagnosis), and long-term mortality. The study found that among 253,176 patients, percent change in incident rate of ER visit was 17% higher for one unit increase in HHI. Incident rate of ER was 24% higher for whites and 48% higher for African Americans. For one unit increase in HHI, hazard of short-term all-cause mortality was 7% higher for whites and 11% lower for African Americans. The hazard of long-term all-cause mortality was 10% higher for whites and 13% higher for African Americans.
AHRQ-funded; HS024106.
Citation: Jayadevappa R, Malkowicz SB, Vapiwala N .
Association between hospital competition and quality of prostate cancer care.
BMC Health Serv Res 2023 Aug 5; 23(1):828. doi: 10.1186/s12913-023-09851-4..
Keywords: Cancer: Prostate Cancer, Cancer, Men's Health, Hospitals, Quality of Care
McGee-Avila JK, Richmond J, Henry KA
Disparities in geospatial patterns of cancer care within urban counties and structural inequities in access to oncology care.
This study examined geospatial patterns of cancer care utilization across diverse populations in New Jersey-a state where most residents live in urban areas. The authors used data from the New Jersey State Cancer Registry. They examined the location of cancer treatment among patients 20-65 years of age diagnosed with breast, colorectal, or invasive cervical cancer and investigated differences in geospatial patterns of care by individual and area-level (e.g., census tract-level) characteristics. They observed significant differences in geospatial patterns of cancer treatment by race/ethnicity, insurance type, and area-level factors. They found that Black patients had a 5.6% higher likelihood of receiving care within their own residential county compared to non-Hispanic White patients. Patients living in census tracts with the highest quintile of social vulnerability were 4.6% more likely to receive treatment within their residential county and were 2.7% less likely to seek out-of-state care.
AHRQ-funded; HS026122.
Citation: McGee-Avila JK, Richmond J, Henry KA .
Disparities in geospatial patterns of cancer care within urban counties and structural inequities in access to oncology care.
Health Serv Res 2023 Aug; 58(Suppl 2):152-64. doi: 10.1111/1475-6773.14182..
Keywords: Disparities, Urban Health, Rural/Inner-City Residents, Cancer, Cancer: Breast Cancer, Cancer: Colorectal Cancer, Cancer: Cervical Cancer
Gupta N, Kucirka L, Semerjian A
Practice patterns regarding female reproductive organ-sparing and nerve-sparing radical cystectomy among urologic oncologists in the United States.
The purpose of this study was to describe practice patterns regarding female reproductive organ-sparing (ROS) and nerve-sparing radical cystectomy nerve-sparing radical cystectomy (RC) among US urologists. The researchers conducted a cross-sectional survey of members of the Society of Urologic Oncology to evaluate provider-reported frequency of ROS and nerve-sparing RC in premenopausal and postmenopausal patients with non-muscle-invasive bladder cancer that failed intravesical therapy or clinically localized muscle-invasive bladder cancer. The study found that among 101 urologists, 79.2% reported that they routinely resect the uterus/cervix, 67.3% the neurovascular bundle, 48.5% the ovaries, and 18.8% a portion of the vagina when performing RC in premenopausal patients with organ-confined disease. When asked about changes to approach in postmenopausal patients, 70.3% reported that they were less likely to spare the uterus/cervix, 43.6% were less likely to spare the neurovascular bundle, 69.3% were less likely to spare the ovaries, and 22.8% were less likely to spare a portion of the vagina.
AHRQ-funded; HS026120.
Citation: Gupta N, Kucirka L, Semerjian A .
Practice patterns regarding female reproductive organ-sparing and nerve-sparing radical cystectomy among urologic oncologists in the United States.
Clin Genitourin Cancer 2023 Aug; 21(4):e236-e41. doi: 10.1016/j.clgc.2023.01.010..
Keywords: Practice Patterns, Women, Sexual Health, Surgery, Cancer
Young AL, Monuteaux MC, Cooney TM
Predictors of delayed diagnosis of pediatric CNS tumors in the emergency department.
Delays in the diagnosis of central nervous system (CNS) tumors in children may lead to adverse outcomes and undue burdens on families. The purpose of this study was to examine factors related with delayed emergency department (ED) diagnosis to identify approaches to reduce delays. Researchers included 2828 children, 76% were controls, 24% were cases). Among cases, 68% had 1 preceding ED visit, 21% had 2, and 11% had 3 or more. The study found significant predictors of delayed diagnosis included presence of a complex chronic condition, rural hospital location, nonteaching hospital status, age younger than 5 years, public insurance, and black race.
AHRQ-funded; HS026503.
Citation: Young AL, Monuteaux MC, Cooney TM .
Predictors of delayed diagnosis of pediatric CNS tumors in the emergency department.
Pediatr Emerg Care 2023 Aug; 39(8):617-22. doi: 10.1097/pec.0000000000002943..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Cancer, Emergency Department
Rao G, Ufholz K, Saroufim P
Recognition, diagnostic practices, and cancer outcomes among patients with unintentional weight loss (UWL) in primary care.
The objective of this study was to identify the incidence, rate of physician recognition, diagnostic practices, and cancer outcomes for unintentional weight loss. Researchers completed a secondary analysis of structured and unstructured EHR data collected from adult, established primary care patients with a minimum of two weight measurements in 2020 and in 2021. The results indicated that unintentional weight loss is poorly recognized across a diverse range of patients. The researchers concluded that lack of research-informed guidance may explain low rates of recognition and variability in diagnostic practices.
AHRQ-funded; HS029358.
Citation: Rao G, Ufholz K, Saroufim P .
Recognition, diagnostic practices, and cancer outcomes among patients with unintentional weight loss (UWL) in primary care.
Diagnosis 2023 Aug 1; 10(3):267-74. doi: 10.1515/dx-2023-0002..
Keywords: Cancer, Primary Care, Diagnostic Safety and Quality, Provider: Physician
Chen LW, Usinger DS, Katz AJ
Telehealth use and perceptions among prostate cancer survivors.
Researchers surveyed a sociodemographically diverse population-based cohort of prostate cancer survivors about their usage and perceptions of telehealth during the COVID-19 pandemic. While less than a third of survivors used telehealth at the time of survey and only 10% thought telehealth care was comparable an in-person visit, more than half felt telehealth was a good option for initial consultations or basic care. Survivors with lower education had marginally lower use of telehealth. The researchers concluded that differences in survivor perceptions of telehealth by education level highlighted underlying disparities in telehealth use and offered potential targets for interventions.
AHRQ-funded; 29020050040.
Citation: Chen LW, Usinger DS, Katz AJ .
Telehealth use and perceptions among prostate cancer survivors.
Cancer Med 2023 Aug; 12(16):17308-12. doi: 10.1002/cam4.6328..
Keywords: Telehealth, Health Information Technology (HIT), Cancer: Prostate Cancer, Cancer
Foraker R, Phommasathit C, Clevenger K
Using the sociotechnical model to conduct a focused usability assessment of a breast reconstruction decision tool.
The purpose of this study was to collect patients' and clinicians' perspectives on barriers and facilitators for implementing BREASTChoice, a web-based breast reconstruction decision aid, into the clinical workflow. From August 2020 to April 2021, the researchers conducted 12 qualitative interviews with patients and clinicians from two Midwestern medical specialty centers. The study found patients and clinicians agreed that BREASTChoice could provide benefits in a number of areas including: 1) BREASTChoice could assist patients make more informed decisions about their reconstruction and improve preparation for their first plastic surgery appointment; 2) BREASTChoice could improve communication and processes if the patient could view the tool at home and/or in the waiting room; 3) Clinicians recommended the information from BREASTChoice about patients' risks and preferences could be included in the patient's chart or the clinician electronic health record (EHR) inbox for access during the consultation; 5) Patients and clinicians indicated that the BREASTChoice tool does not require much time for the patient to use, efficiently fills gaps in knowledge, includes helpful information. Patients did report requiring time to properly read and digest the information.
AHRQ-funded; HS026699.
Citation: Foraker R, Phommasathit C, Clevenger K .
Using the sociotechnical model to conduct a focused usability assessment of a breast reconstruction decision tool.
BMC Med Inform Decis Mak 2023 Jul 28; 23(1):140. doi: 10.1186/s12911-023-02236-x..
Keywords: Shared Decision Making, Women, Cancer: Breast Cancer, Cancer
Hill D, Kaufman SR, Oerline MK
In-office dispensing of oral targeted agents by urology practices in men with advanced prostate cancer.
Researchers investigated the dispensing oral targeted agents for advanced prostate cancer treatment directly to patients in urologists’ offices, and whether this delivery model improves access to these agents especially for Black men who are historically undertreated. Their retrospective cohort study used national Medicare data for men with advanced prostate cancer managed by urology practices with and without in-office dispensing. They concluded that this model of delivery could improve access to this class of medications.
AHRQ-funded; HS025707.
Citation: Hill D, Kaufman SR, Oerline MK .
In-office dispensing of oral targeted agents by urology practices in men with advanced prostate cancer.
JNCI Cancer Spectr 2023 Jul 3; 7(5). doi: 10.1093/jncics/pkad062..
Keywords: Cancer: Prostate Cancer, Cancer, Men's Health, Medication
Alford CM, Wahlquist AE, Sterba KR
A quality improvement study on the feasibility and potential benefits of a yogic breathing program for cancer survivors and caregivers during treatment in a lodging facility.
This study assessed the acceptability and feasibility of a yogic breathing program in cancer patients and caregivers during the treatment period, and then investigated whether it provided any benefits. The authors designed a 20-minute yogic breathing regimen and introduced them to all-site cancer patients and their caregivers during the cancer treatment period at a lodging facility, Hope Lodge in Charleston, SC. The classes were advertised via intercom, displays, and word of mouth. Participants were taught five different breathing exercises. After completion of the exercises in a single session, a self-reported quality improvement questionnaire was administered assessing sociodemographic/clinical factors, expectations about the session, and ratings of satisfaction with the session. There were 52 participants who provided feedback during the nine months of the collection period, with patients and caregivers in almost equal numbers. The findings indicated that yogic breathing is acceptable to patients and caregivers and may alleviate key symptoms from cancer treatment, in particular stress. The lodging facility continues to offer weekly yogic breathing sessions to their patients conducted by Hope Lodge volunteers trained by the study team.
AHRQ-funded; HS024533.
Citation: Alford CM, Wahlquist AE, Sterba KR .
A quality improvement study on the feasibility and potential benefits of a yogic breathing program for cancer survivors and caregivers during treatment in a lodging facility.
Brain Behav Immun Integr 2023 Jul; 3. doi: 10.1016/j.bbii.2023.100019..
Keywords: Complementary and Alternative Medicine, Cancer, Quality of Life
Estenson L, Kim N, Jacobson M
Do age-based discontinuation recommendations influence cervical cancer screening rates? Evidence from the United States' Behavioral Risk Factor Surveillance System, 2016 and 2018.
The purpose of this study was to determine how the United States Preventive Services Task Force (USPSTF) recommendation of discontinuing routine cervical cancer screening for certain women after age 65 affects Papanicolaou (Pap) test rates among women at age 66 in the United States. The researchers utilized nationally representative 2016 and 2018 Behavioral Risk Factor Surveillance System (BRFSS) data for 226,031 women ages 56-76 to calculate changes in annual Pap test rates at age 66. Among women 66-76, 22.5% indicated they had received a Pap test within the past year. At age 66, annual Pap rates decreased by 5.9 percentage points (p.p.) off a pre-66 rate of 39 percent. The change differed by race/ethnicity, education, and marital status. Pap rates did not change discretely for non-Hispanic Black women but did change for women from other racial/ethnic groups. The decrease was larger for women who graduated college than for women without a college degree and for women who were never married than for women who were married/partnered or divorced/separated. The USPSTF recommendation to stop cervical cancer screening after the age of 65 resulted in a substantial decrease in the rate of Pap tests at age 66 but disparately affects women based on marital status, education and race.
AHRQ-funded; HS026488.
Citation: Estenson L, Kim N, Jacobson M .
Do age-based discontinuation recommendations influence cervical cancer screening rates? Evidence from the United States' Behavioral Risk Factor Surveillance System, 2016 and 2018.
Prev Med 2023 Jul; 172:107543. doi: 10.1016/j.ypmed.2023.107543..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer: Cervical Cancer, Cancer, Screening, Prevention, Evidence-Based Practice, Women, Sexual Health
Di M, Keeney T, Belanger E
Functional status and therapy for older adults with diffuse large B-cell lymphoma in nursing homes: a population-based study.
The purpose of this study was to describe the prevalence of functional and cognitive impairments, and relationships between impairments and treatment in older patients with diffuse large B cell lymphoma (DLBCL) receiving nursing home (NH) care. The study found that of the eligible 649 NH patients 45% received chemoimmunotherapy; among the recipients, 47% received multi-agent, anthracycline-containing regimens. Those patients in a NH were less likely to receive chemoimmunotherapy, had higher 30-day mortality, and poorer OS compared with community-dwelling patients. NH patients with severe functional (61%) or any cognitive impairment (48%) were less likely to receive chemoimmunotherapy.
AHRQ-funded; HS000011.
Citation: Di M, Keeney T, Belanger E .
Functional status and therapy for older adults with diffuse large B-cell lymphoma in nursing homes: a population-based study.
J Am Geriatr Soc 2023 Jul; 71(7):2239-49. doi: 10.1111/jgs.18302..
Keywords: Elderly, Nursing Homes, Medicare, Cancer, Treatments
Jazowski SA, Vaidya AU, Donohue JM
Time to confirmatory study initiation after accelerated approval of cancer and noncancer drugs in the US.
The FDA requires that studies must be conducted to confirm a drug’s clinical benefit, but the accelerated approval pathway has been criticized because of delays by manufacturers in completing the studies. A possible source of delays is that the needed confirmatory studies are often not taking place at the time of accelerated approval. The aim of this study was to explore and compare the time elapsed between the accelerated approval of cancer and noncancer drugs to the commencement of confirmatory studies in the United States. The study found that for 103 cancer–indication pairs and noncancer products, 20.31% of confirmatory studies were not underway at the time of accelerated approval, and the median time from approval to study initiation was 1.41. Noncancer products had a greater proportion of confirmatory studies with initiation occurring after accelerated approval and a longer median time from approval to study initiation compared with cancer product–indication pairs. When evaluating delays in confirmatory study completion, studies underway at the time of accelerated approval were less likely to be submitted past FDA-designated deadlines relative to studies initiated after approval. Similar patterns were observed for cancer and noncancer products, but delays in confirmatory study completion were more distinct within studies commenced after approval for noncancer products than for cancer product–indication pairs.
AHRQ-funded; HS026122.
Citation: Jazowski SA, Vaidya AU, Donohue JM .
Time to confirmatory study initiation after accelerated approval of cancer and noncancer drugs in the US.
JAMA Intern Med 2023 Jul; 183(7):737-39. doi: 10.1001/jamainternmed.2023.0777..
Keywords: Cancer, Medication
Pagani K, Lukac D, Olbricht SM
Urgent referrals from primary care to dermatology for lesions suspicious for skin cancer: patterns, outcomes, and need for systems improvement.
The purpose of this study was to explore primary care and dermatology triaging and processing of urgent dermatology referrals. The researchers conducted chart reviews of all dermatology referrals designated by primary care as urgent for evaluation of a lesion concerning for skin cancer. Dermatology encounters for patients occurred on or before 30 days for 50.6% of referrals and on or after 31 days for 38.4% of referrals, with 10.9% never completed. The rate of non-English languages in the delayed group was 7.1% greater than in the timely group. The rate of all races excluding whites, non-Hispanic in the delayed appointment group (31 days or more) was 15.1% greater than in the timely appointment group (30 days or less). Overall, 15.8% of referrals yielded malignancy diagnoses, while 76.8% and 7.4% resulted in benign and pre-malignant diagnoses, respectively. The primary care team documented completed, incomplete, or pending referral status during their subsequent visits with the patients in only 37.5% of the referrals.
AHRQ-funded; HS027282.
Citation: Pagani K, Lukac D, Olbricht SM .
Urgent referrals from primary care to dermatology for lesions suspicious for skin cancer: patterns, outcomes, and need for systems improvement.
Arch Dermatol Res 2023 Jul; 315(5):1397-400. doi: 10.1007/s00403-022-02456-7..
Keywords: Cancer: Skin Cancer, Cancer, Primary Care, Skin Conditions, Access to Care
Ray EM, Teal RW, Carda-Auten J
Qualitative evaluation of barriers and facilitators to hepatocellular carcinoma care in North Carolina.
The authors sought to understand barriers and facilitators to hepatocellular carcinoma (HCC) care.. Patients with recently diagnosed HCC were identified through the University of North Carolina HCC clinic or local hospital cancer registrar, and were interviewed. Barriers included lack of transportation, cost of care, provider lack of knowledge about HCC, delays in scheduling, and poor communication with the medical team. Key facilitators of care were effective communication, physician knowledge, social and financial support. Participants suggested better coordination of appointments and inclusion of a primary contact within the healthcare team. The authors concluded that their study results should serve as a basis for tailored interventions aimed at improving access to appropriate, life-prolonging care for patients with HCC.
AHRQ-funded; HS000032.
Citation: Ray EM, Teal RW, Carda-Auten J .
Qualitative evaluation of barriers and facilitators to hepatocellular carcinoma care in North Carolina.
PLoS One 2023 Jun 22; 18(6):e0287338. doi: 10.1371/journal.pone.0287338..
Keywords: Cancer, Access to Care
Wong W, Dickerson JC, Valtis YK
Cancer demographics and time-to-care in Belize.
Researchers performed a retrospective chart review at the Karl Heusner Memorial Hospital (KHMH) cancer care clinic in Belize to report demographics from the clinic and describe time intervals to care milestones to target gaps. The demographics indicated that breast and cervical cancer were most the common types; most patients presented with stage 3 or 4 cancer and were uninsured and unemployed. Many patients had months between symptom onset and treatment. The researchers concluded that these results affirmed the need for infrastructure investment and early detection programs to improve cancer outcomes in Belize.
AHRQ-funded; HS026128.
Citation: Wong W, Dickerson JC, Valtis YK .
Cancer demographics and time-to-care in Belize.
Oncologist 2023 Jun 2; 28(6):e350-e58. doi: 10.1093/oncolo/oyad030..
Keywords: Cancer
Rivard SJ, Vitous CA, Bamdad MC
"I wish there had been resources": a photo-elicitation study of rectal cancer survivorship care needs.
Prior research reveals that healthcare providers are not skilled at identifying the most relevant rectal cancer survivorship issues. As a result, survivorship care is inadequate with most rectal cancer survivors reporting at least one unmet posttherapy need. The purpose of this photo-elicitation study was to explore rectal cancer survivors’ lived experiences using participant-submitted photographs and minimally structured qualitative interviews. Twenty rectal cancer survivors from a single center submitted photographs illustrative of their life after rectal cancer therapy. The study found that rectal cancer survivors’ recommendations to improve their survivorship care fell into three primary themes: 1) informational needs; 2) continued multidisciplinary follow up care; and 3) suggestions for support services. The study concluded that rectal cancer survivors want information that is more detailed and individualized, access to multidisciplinary follow-up care over time, and resources to alleviate the challenges of daily life.
AHRQ-funded; HS026772; HS000053.
Citation: Rivard SJ, Vitous CA, Bamdad MC .
"I wish there had been resources": a photo-elicitation study of rectal cancer survivorship care needs.
Ann Surg Oncol 2023 Jun; 30(6):3530-37. doi: 10.1245/s10434-022-13042-6..
Keywords: Cancer: Colorectal Cancer, Cancer, Quality of Life, Patient Experience