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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
1 to 25 of 119 Research Studies DisplayedMontgomery KB, Fazendin JM, Chen H
Contemporary trends in extent of surgery for differentiated thyroid cancer with extrathyroidal extension.
The study aimed to investigate trends in surgical approaches for differentiated thyroid cancer (DTC) with gross extrathyroidal extension (ETE). Using the National Cancer Database, patients with +ETE DTC from 2010 to 2020 were analyzed. Among 5,851 patients, 92% underwent total thyroidectomy (TT), but later years showed increased lobectomy rates. The results of the study suggest a potential shift towards preferring lobectomy in low-risk DTC cases, while raising concerns about undertreating high-risk patients.
AHRQ-funded; HS013852.
Citation: Montgomery KB, Fazendin JM, Chen H .
Contemporary trends in extent of surgery for differentiated thyroid cancer with extrathyroidal extension.
The study aimed to investigate trends in surgical approaches for differentiated thyroid cancer (DTC) with gross extrathyroidal extension (ETE). Using the National Cancer Database, patients with +ETE DTC from 2010 to 2020 were analyzed. Among 5,851 patients, 92% underwent total thyroidectomy (TT), but later years showed increased lobectomy rates. The results of the study suggest a potential shift towards preferring lobectomy in low-risk DTC cases, while raising concerns about undertreating high-risk patients..
Keywords: Cancer, Surgery, Cancer
Bonner SN, Lagisetty K, Reddy RM
Clinical implications of removing race-corrected pulmonary function tests for African American patients requiring surgery for lung cancer.
This study’s objective was to identify how many hospitals providing lung cancer surgery use race correction in pulmonary function tests (PFTs), examine the association of race correction with predicted lung function, and test the effect of decorrection on surgeons' treatment recommendations. Percent predicted preoperative and postoperative forced expiratory volume in 1 second (FEV1) was calculated for African American patients who underwent lung cancer resection between January 1, 2015, and September 31, 2022, using race-corrected and race-neutral equations for hospitals performing race correction. Randomization of US cardiothoracic surgeons was conducted to receive 1 clinical vignette that differed by the use of Global Lung Function Initiative equations for (1) African American patients (percent predicted postoperative FEV1, 49%), (2) other race or multiracial patients (percent predicted postoperative FEV1, 45%), and (3) race-neutral patients (percent predicted postoperative FEV1, 42%). A total of 515 African American patients (308 [59.8%] female; mean age, 66.2 years) were included in the study. Among these patients, the percent predicted preoperative FEV1 and postoperative FEV1 would have decreased by 9.2% and 7.6%, respectively, if race-neutral equations had been used. A total of 225 surgeons (194 male [87.8%]; mean time in practice, 19.4 years) were successfully randomized and completed the vignette items regarding risk perception and treatment outcomes (76% completion rate). Surgeons randomized to the vignette with African American race-corrected PFTs were more likely to recommend lobectomy (79.2%) compared with surgeons randomized to the other race or multiracial-corrected (61.7%) or race-neutral PFTs (52.8%).
AHRQ-funded; HS028038.
Citation: Bonner SN, Lagisetty K, Reddy RM .
Clinical implications of removing race-corrected pulmonary function tests for African American patients requiring surgery for lung cancer.
JAMA Surg 2023 Oct; 158(10):1061-68. doi: 10.1001/jamasurg.2023.3239..
Keywords: Racial and Ethnic Minorities, Cancer: Lung Cancer, Cancer, Surgery, Diagnostic Safety and Quality
Montgomery KB, Fazendin JM, Broman KK
Evolving variation in the extent of surgery for low-risk papillary thyroid cancer in the United States.
This study looked at contemporary trends in the extent of surgery in patients with clinically node-negative papillary thyroid cancer ≤4 cm. Since 2015 there has been a debate over total thyroidectomy versus lobectomy and declining favor for prophylactic central neck dissection in this low-risk cohort. The authors used retrospective data from the National Cancer Database to identify adult patients with clinically node-negative papillary thyroid cancer ≤4 cm who underwent resection from 2012 to 2020. Primary outcome was the extent of surgery (lobectomy or total thyroidectomy, with or without prophylactic central neck dissection). Of 83,464 included patients, 79.3% were female with a median age of 51 years. Most patients underwent total thyroidectomy either with prophylactic central neck dissection (39.1%) or without (37.5%) versus lobectomy with prophylactic central neck dissection (7.2%) or without (16.2%). There was an increase in lobectomy from 18.3% in 2012 to 29.9% in 2020. Prophylactic central neck dissection rates also increased from 42.9% to 52.1%. There was a decreased likelihood of total thyroidectomy in patients who were male sex, Asian American, had smaller tumors or were treated at community cancer programs. There was a decreased likelihood of prophylactic central neck dissection in patients who were older, male sex, Black race, with smaller tumors, or were treated at community cancer programs or mid- or low-volume facilities.
AHRQ-funded; HS013852.
Citation: Montgomery KB, Fazendin JM, Broman KK .
Evolving variation in the extent of surgery for low-risk papillary thyroid cancer in the United States.
Surgery 2023 Oct; 174(4):828-35. doi: 10.1016/j.surg.2023.07.001.
Keywords: Surgery, Cancer
Krouse 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
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
Hu FY, Tabata-Kelly M, Johnston FM
Surgeon-reported factors influencing adoption of quality standards for goal-concordant care in patients with advanced cancer: a qualitative study.
This study’s objective was to explore surgical oncologists' perspectives on factors influencing adoption of quality standards in patients with advanced cancer. While the American College of Surgeons has adopted a Geriatric Surgery Verification Program that includes communication standards designed to facilitate goal-concordant care, little is known about how surgeons believe these standards align with clinical practice. The authors conducted semistructured video-based interviews from November 2020 to January 2021 with academic surgical oncologists purposively sampled based on demographics, region, palliative care certification, and years in practice. These interviews addressed: (1) adherence to standards documenting care preferences for life-sustaining treatment, surrogate decision-maker, and goals of surgery; and (2) factors influencing their adoption into practice. Participants included 26 surgeons (57.7% male, 8.5 mean years in practice, 19.2% palliative care board-certified). While goals of surgery are commonly discussed, there is low consistency of documenting these goals. There were conflicting views about the relevance of care preferences to preoperative conversations and surrogate decision-maker documentation by the surgeon and questioned the direct connection between documentation of quality standards and higher value patient care. Key themes in adopting quality standards of documentation included organizational culture, workflow, and multidisciplinary collaboration.
AHRQ-funded; HS024736.
Citation: Hu FY, Tabata-Kelly M, Johnston FM .
Surgeon-reported factors influencing adoption of quality standards for goal-concordant care in patients with advanced cancer: a qualitative study.
Ann Surg 2023 May; 277(5):e1000-e05. doi: 10.1097/sla.0000000000005441..
Keywords: Surgery, Provider: Physician, Cancer
Logan CD, Feinglass J, Halverson AL
Rural-urban disparities in receipt of surgery for potentially resectable non-small cell lung cancer.
This study examined the reasons there are lower rates of surgical treatment for potentially resectable non-small cell lung cancer (NSCLC) for patients living in rural areas than in urban areas. The National Cancer Database was used to identify patients with clinical stage I-IIIA NSCLC between 2004 and 2018. Reasons for nonreceipt of surgery was evaluated for rural and urban area patients. The study included 328,785 patients with NSCLC with 13% from rural areas. Overall, 62.4% of patients from urban areas and 58.8% of patients from rural areas underwent surgery. Patients from rural areas had increased odds of (1) being recommended primary nonsurgical management, (2) surgery being deemed contraindicated due to risk, (3) surgery being recommended but not performed, and (4) overall failure to receive surgery.
AHRQ-funded; HS026385.
Citation: Logan CD, Feinglass J, Halverson AL .
Rural-urban disparities in receipt of surgery for potentially resectable non-small cell lung cancer.
J Surg Res 2023 Mar;283:1053-63. doi: 10.1016/j.jss.2022.10.097.
Keywords: Cancer: Lung Cancer, Cancer, Disparities, Surgery, Rural Health, Access to Care
Schumacher JR, Zahrieh D, Chow S
Increasing socioeconomically disadvantaged patients' engagement in breast cancer surgery decision-making through a shared decision-making intervention (A231701CD): protocol for a cluster randomised clinical trial.
This paper describes the protocol for a multisite randomized trial to test the impact of a newly developed decision aid to increase socioeconomically disadvantaged patients' engagement in breast cancer surgery decision-making. The study will be conducted through 10 surgical clinics within the National Cancer Institute Community Oncology Research Program (NCORP). A stepped-wedge design with clinics will be randomized to the time of transition from usual care to the decision aid arm. Study participants will be female, aged ≥18 years, with newly diagnosed stage 0-III breast cancer who are planning breast surgery. Data collection will include a baseline surgeon survey, baseline patient survey, audio-recording of the surgeon-patient consultation, a follow-up patient survey and medical record data review. A subset of patients, surgeons, and clinic stakeholders will participate in interviews and focus groups.
AHRQ-funded; HS025194.
Citation: Schumacher JR, Zahrieh D, Chow S .
Increasing socioeconomically disadvantaged patients' engagement in breast cancer surgery decision-making through a shared decision-making intervention (A231701CD): protocol for a cluster randomised clinical trial.
BMJ Open 2022 Nov 17;12(11):e063895. doi: 10.1136/bmjopen-2022-063895..
Keywords: Cancer: Breast Cancer, Cancer, Patient and Family Engagement, Shared Decision Making, Patient-Centered Healthcare, Surgery, Women
Wu A, Wu JY, Lim M
Updates in intraoperative strategies for enhancing intra-axial brain tumor control.
This review looked at recent advances in intraoperative strategies for enhancing intra-axial brain tumor control. The authors looked at published research centered on different innovative tools and techniques, including fluorescence-guided surgery, new methods of drug delivery, and minimally invasive procedural options.
AHRQ-funded; HS028747.
Citation: Wu A, Wu JY, Lim M .
Updates in intraoperative strategies for enhancing intra-axial brain tumor control.
Neuro Oncol 2022 Nov 2;24(suppl 6):S33-S41. doi: 10.1093/neuonc/noac170..
Keywords: Cancer, Surgery, Imaging
Warren DK, Peacock KM, Nickel KB
Postdischarge prophylactic antibiotics following mastectomy with and without breast reconstruction.
The authors investigated factors associated with post-discharge prophylactic antibiotic use after mastectomy with and without immediate reconstruction and the impact on surgical-site infection (SSI). They found that anti-methicillin-sensitive Staphylococcus aureus antibiotics were associated with decreased risk of SSI for patients who had mastectomy only and those who had mastectomy with immediate reconstruction. They concluded that the high numbers needed to treat suggest that potential benefits of post-discharge antibiotics should be weighed against potential harms associated with antibiotic overuse.
AHRQ-funded; HS019455.
Citation: Warren DK, Peacock KM, Nickel KB .
Postdischarge prophylactic antibiotics following mastectomy with and without breast reconstruction.
Infect Control Hosp Epidemiol 2022 Oct;43(10):1382-88. doi: 10.1017/ice.2021.400..
Keywords: Antibiotics, Cancer: Breast Cancer, Cancer, Medication, Surgery, Healthcare-Associated Infections (HAIs), Prevention, Women, Practice Patterns
Herb J, Holmes M, Stitzenberg K
Trends in rural-urban disparities among surgical specialties treating cancer, 2004-2017.
The purpose of this study was to assess trends over time in rural and urban disparities in the supply of surgeons treating patients with cancer. The researchers utilized the Area Health Resource File to conduct a retrospective observational study of medical workforce changes from 2004-2017. The study found that the density of surgical specialists in rural areas declined from 16 to 14 per 100,000 population and in urban areas from 33 to 31 per 100,000 population for a rural-urban disparity increase of 8%. The percentage increase in the supply disparity between the rural and urban workforce was largest for colorectal surgeons (66%) and general surgeons (72%). The study concluded that temporal changes in the rural-urban physician workforce depend on community factors, region, and area of specialization.
AHRQ-funded; HS000032.
Citation: Herb J, Holmes M, Stitzenberg K .
Trends in rural-urban disparities among surgical specialties treating cancer, 2004-2017.
J Rural Health 2022 Sep;38(4):838-44. doi: 10.1111/jrh.12658..
Keywords: Rural Health, Disabilities, Surgery, Cancer, Workforce
Roberson ML, Nichols HB, Olshan AF
Trends in surgical treatment of early-stage breast cancer reveal decreasing mastectomy use between 2003 and 2016 by age, race, and rurality.
The authors sought to examine trends in the surgical treatment of breast cancer by age, rurality, and among Black women in a populous, racially diverse, state in the Southeastern United States of America. Using data from the North Carolina Central Cancer Registry, they found declining mastectomy rates in the early 2000s in a Southern US state with a racially and geographically diverse population. These decreasing trends were consistent among key subgroups affected by cancer inequities, including Black and White rural women.
AHRQ-funded; HS027299.
Citation: Roberson ML, Nichols HB, Olshan AF .
Trends in surgical treatment of early-stage breast cancer reveal decreasing mastectomy use between 2003 and 2016 by age, race, and rurality.
Breast Cancer Res Treat 2022 Jun;193(2):445-54. doi: 10.1007/s10549-022-06564-w..
Keywords: Cancer: Breast Cancer, Cancer, Women, Surgery, Racial and Ethnic Minorities, Rural Health
Taylor K, Diaz A, Nuliyalu U
Association of dual Medicare and Medicaid eligibility with outcomes and spending for cancer surgery in high-quality hospitals.
The purpose of this study was to assess whether treatment at high-quality hospitals mitigates dual-eligibility-associated disparities in outcomes and spending for cancer surgery. Medicare beneficiaries 65 years or older who underwent colectomy, rectal resection, lung resection, or pancreatectomy were evaluated. The findings indicate that, even among the highest-quality hospitals, dual-eligibility patients had poorer outcomes and higher spending. Dually eligible patients were more likely to be discharged to a facility and thus incurred higher post-acute care costs. Although treatment at high-quality hospitals is associated with reduced differences in outcomes, dual-eligibility patients remain at high risk for adverse post-operative outcomes as well as increased readmissions and post-acute care use.
AHRQ-funded; HS024763.
Citation: Taylor K, Diaz A, Nuliyalu U .
Association of dual Medicare and Medicaid eligibility with outcomes and spending for cancer surgery in high-quality hospitals.
JAMA Surg 2022 Apr;157(4):e217586. doi: 10.1001/jamasurg.2021.7586..
Keywords: Cancer, Surgery, Medicare, Medicaid, Outcomes, Hospitals
Roberson ML, Nichols HB, Wheeler
Validity of breast cancer surgery treatment information in a state-based cancer registry.
Surgery is an important part of early stage breast cancer treatment that affects overall survival. Statewide cancer registries contain data on first course of cancer treatment for all patients diagnosed with cancer but the accuracy of these data are uncertain. In this study, the authors examined validity of breast cancer surgery treatment information in a state-based cancer registry.
AHRQ-funded; HS027299.
Citation: Roberson ML, Nichols HB, Wheeler .
Validity of breast cancer surgery treatment information in a state-based cancer registry.
Cancer Causes Control 2022 Feb;33(2):261-69. doi: 10.1007/s10552-021-01520-3..
Keywords: Cancer: Breast Cancer, Cancer, Surgery, Registries
Kho RM, Desai VB, Schwartz PE
Endometrial sampling for preoperative diagnosis of uterine leiomyosarcoma.
This retrospective cohort study examined the effectiveness of endometrial sampling for preoperative detection of uterine leiomyosarcoma in women undergoing hysterectomy, identified factors associated with missed diagnosis, and compared the outcomes of patients who had a preoperative diagnosis with those patients who had a missed diagnosis. A total of 79 patients with uterine leiomyosarcoma were included in the study. Of those patients, 46 (58.2%) were diagnosed preoperatively and 33 postoperatively. The groups were similar in age, race/ethnicity, bleeding symptoms, and comorbidities. Women who had endometrial sampling performed with hysteroscopy had a higher likelihood of preoperative diagnosis. Patients with localized stage (vs distant stage) or tumor size >11 cm were less likely to be diagnosed preoperatively.
AHRQ-funded; HS024702.
Citation: Kho RM, Desai VB, Schwartz PE .
Endometrial sampling for preoperative diagnosis of uterine leiomyosarcoma.
J Minim Invasive Gynecol 2022 Jan;29(1):119-27. doi: 10.1016/j.jmig.2021.07.004.
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Keywords: Cancer, Diagnostic Safety and Quality, Surgery, Women
Popp J, Weinberg DS, Ems E
Reevaluating the evidence for intensive postoperative extracolonic surveillance for nonmetastatic colorectal cancer.
This study reevaluated the evidence for intensive postoperative extracolonic surveillance for nonmetastatic colorectal cancer. The authors looked at the FACS, GILDA, and COLOFOL trials and used a model to predict the large-sample mortality reduction expected for each trial and the implied statistical power. An investigation was done of a potential recurrence imbalance in the FACS trial. The model predicted a mortality reduction of ≤5% and power of <10% for all 3 trials. The FACS recurrence imbalance most likely led to a large relative bias (>2.5) in the hazard ratio for overall survival favoring control. After adjustment, both COLOFOL and FACS results were consistent with model predictions. A 2.6 and 3.6 month increase in life expectancy is predicted comparing intensive extracolonic surveillance-routine computed tomography scans and carcinoembryonic antigen assays with 1 computed tomography scan at 12 months or no surveillance, respectively. A larger trial that would randomize at least 200 to 300 patients is needed, but is not feasible at this time. The authors concluded recent trial results do not warrant de novo skepticism or metastasectomy nor targeted extracolonic surveillance.
AHRQ-funded; HS022998.
Citation: Popp J, Weinberg DS, Ems E .
Reevaluating the evidence for intensive postoperative extracolonic surveillance for nonmetastatic colorectal cancer.
Value Health 2022 Jan; 25(1):36-46. doi: 10.1016/j.jval.2021.07.017..
Keywords: Cancer: Colorectal Cancer, Cancer, Surgery, Evidence-Based Practice
Hughes TM, Ellsworth B, Berlin NL
Statewide episode spending variation of mastectomy for breast cancer.
The purpose of this study was to characterize variations in episode spending related to volume and complication rates for mastectomy. A secondary study aim was to identify patient- and facility-level determinants of variation. The researchers assessed mean spending for 7,342 patients undergoing mastectomy at 74 facilities across Michigan state. The study found that mean 30-day spending by facility ranged from $11,129 to $20,830 and ninety-day spending ranged from $17,303 to $31,060. Patient-level factors associated with greater spending included bilateral surgery, simultaneous breast reconstruction, length of stay, and readmission. The researchers concluded that Michigan hospitals have considerable variation in mastectomy spending, and that reducing the frequency of bilateral surgery and length of stay may increase value, without risking patient safety or oncologic outcomes.
AHRQ-funded; HS026030.
Citation: Hughes TM, Ellsworth B, Berlin NL .
Statewide episode spending variation of mastectomy for breast cancer.
J Am Coll Surg 2022 Jan;234(1):14-23. doi: 10.1097/xcs.0000000000000005..
Keywords: Cancer: Breast Cancer, Cancer, Women, Surgery
Gupta AR, Brajcich BC, Yang AD
Necessity of posttreatment surveillance for low-grade appendiceal mucinous neoplasms.
This study’s objectives were to characterize posttreatment surveillance and determine the risk of recurrence following surgical resection of low-grade appendiceal mucinous neoplasms (LAMNs). Patients who underwent surgical rection of localized LAMNs in an 11-hospital regional healthcare system from 2000 to 2019 were included. A total of 114 patients with LAMNs were identified with various tumor grades, most of them pTis (80.7%). Patients were followed up with posttreatment surveillance (n = 39). No patients experienced tumor recurrence after a mean follow-up duration of 4.7 years, suggesting that routine surveillance may be unnecessary.
AHRQ-funded; HS026385.
Citation: Gupta AR, Brajcich BC, Yang AD .
Necessity of posttreatment surveillance for low-grade appendiceal mucinous neoplasms.
J Surg Oncol 2021 Dec;124(7):1115-20. doi: 10.1002/jso.26621..
Keywords: Cancer, Surgery, Care Management
Shipe ME, Baechle JJ, Deppen SA
Modeling the impact of delaying surgery for early esophageal cancer in the era of COVID-19.
Surgical society guidelines have recommended changing the treatment strategy for early esophageal cancer during the novel coronavirus (COVID-19) pandemic. Delaying resection can allow for interim disease progression, but the impact of this delay on mortality is unknown. The COVID-19 infection rate at which immediate operative risk exceeds benefit is unknown. In this study, the investigators sought to model immediate versus delayed surgical resection in a T1b esophageal adenocarcinoma.
AHRQ-funded; HS026122.
Citation: Shipe ME, Baechle JJ, Deppen SA .
Modeling the impact of delaying surgery for early esophageal cancer in the era of COVID-19.
Surg Endosc 2021 Nov;35(11):6081-88. doi: 10.1007/s00464-020-08101-6..
Keywords: COVID-19, Cancer, Surgery, Shared Decision Making, Risk
Kuijer A, Dominici LS, Rosenberg SM
Arm morbidity after local therapy for young breast cancer patients.
This study assessed patient-reported arm morbidity in the Young Women's Breast Cancer Study (YWS). Participants were over 1300 women with breast cancer diagnosed at age 40 or younger and who were enrolled in the YWS. Findings showed that high rates of self-reported arm morbidity in young breast cancer survivors were reported, particularly in patients receiving axillary lymph node dissection and post-mastectomy radiation therapy. Recommendations included attention to the risks and benefits of differing local therapy strategies for axillary lymph node dissection and post-mastectomy radiation therapy patients.
AHRQ-funded; HS023680.
Citation: Kuijer A, Dominici LS, Rosenberg SM .
Arm morbidity after local therapy for young breast cancer patients.
Ann Surg Oncol 2021 Oct;28(11):6071-82. doi: 10.1245/s10434-021-09947-3..
Keywords: Cancer: Breast Cancer, Cancer, Women, Surgery
Dominici L, Hu J, Zheng Y
Association of local therapy with quality-of-life outcomes in young women with breast cancer.
Researchers examined the association of surgery with longer-term satisfaction and quality of life (QOL) in young breast cancer survivors. Participants were women 40 years or older who enrolled in the Young Women's Breast Cancer Study. The results suggested that local therapy in young breast cancer survivors is persistently associated with poorer scores in multiple QOL domains, particularly among those treated with mastectomy and radiotherapy, irrespective of breast reconstruction. Socioeconomic stressors also appear to play a role.
AHRQ-funded; HS023680.
Citation: Dominici L, Hu J, Zheng Y .
Association of local therapy with quality-of-life outcomes in young women with breast cancer.
JAMA Surg 2021 Oct;156(10):e213758. 2021. doi: 10.1001/jamasurg.2021.3758..
Keywords: Cancer: Breast Cancer, Cancer, Quality of Life, Women, Surgery
Garsa A, Jang JK, Baxi S
Radiation therapy for brain metastases: a systematic review.
This systematic review synthesizes the available evidence on radiation therapy for brain metastases. A literature search was conducted using the major medical databases and included randomized controlled trials and large observational studies which evaluated whole brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS) alone or in combination as initial or postoperative treatment, with or without systemic therapy for adults with brain metastases due to lung cancer, breast cancer, or melanoma. No statistically significant difference in overall survival was found with a combination of SRS plus WBRT compared with SRS alone or WBRT alone. Radiation therapy after surgery did not improve overall survival compared with surgery alone. WBRT plus systemic therapy was associated with increased risks for vomiting compared with WBRT alone. There was not enough data on patient-relevant outcomes such as quality of life, functional status, and cognitive effects.
AHRQ-funded; 290201500010I.
Citation: Garsa A, Jang JK, Baxi S .
Radiation therapy for brain metastases: a systematic review.
Pract Radiat Oncol 2021 Sep-Oct;11(5):354-65. doi: 10.1016/j.prro.2021.04.002..
Keywords: Cancer, Surgery, Treatments, Patient-Centered Outcomes Research, Evidence-Based Practice
Rosko AJ, Gay BL, Reyes-Gastelum D
Surgeons' attitudes on total thyroidectomy vs lobectomy for management of papillary thyroid microcarcinoma.
The incidence of papillary thyroid cancer has increased in the past 25 years without a clear increase in thyroid cancer deaths. Given these findings, there has been a shift toward recommending conservative surgical options, with current management guidelines favoring lobectomy, especially for patients with papillary thyroid microcarcinoma. The aim of this study was to identify surgeons’ attitudes regarding surgical management of microcarcinomas with the hypothesis that surgeons consider other factors, in addition to tumor size, when selecting a surgical procedure.
AHRQ-funded; HS024512.
Citation: Rosko AJ, Gay BL, Reyes-Gastelum D .
Surgeons' attitudes on total thyroidectomy vs lobectomy for management of papillary thyroid microcarcinoma.
JAMA Otolaryngol Head Neck Surg 2021 Jul;147(7):667-69. doi: 10.1001/jamaoto.2021.0525..
Keywords: Cancer, Surgery, Practice Patterns, Provider: Physician
Herb JN, Ollila DW, Stitzenberg KB
Use and costs of sentinel lymph node biopsy in non-ulcerated T1b melanoma: analysis of a population-based registry.
This study looked at the utility of sentinel lymph node biopsy (SLNB) for non-ulcerated T1b melanoma. The aim of the study was to estimate SLNB use, positivity, prevalence, and procedural costs in patients with non-ulcerated T1b melanoma using a population-based registry. Patients with clinically node-negative, non-ulcerated T1b melanoma were identified in the SEER database from 2010 to 2016. Among 7245 included patients, 53% underwent SLNB of which 156 (4.1%) had a positive SLNB. Higher odds of positivity were associated with younger age, >1 mitosis per mm2, female sex, and truncal tumor location. Estimated SLNB costs to identify one patient with Stage II disease was $71,700. Out-of-pocket expenses for a Medicare patient was estimated to be $652 for a wide local excision (WLE) and SLNB and $79 for WLE alone.
AHRQ-funded; HS000032.
Citation: Herb JN, Ollila DW, Stitzenberg KB .
Use and costs of sentinel lymph node biopsy in non-ulcerated T1b melanoma: analysis of a population-based registry.
Ann Surg Oncol 2021 Jul;28(7):3470-78. doi: 10.1245/s10434-021-09998-6..
Keywords: Cancer: Skin Cancer, Cancer, Surgery, Healthcare Costs, Skin Conditions
Brauer DG, Wu N, Keller MR
Care fragmentation and mortality in readmission after surgery for hepatopancreatobiliary and gastric cancer: a patient-level and hospital-level analysis of the Healthcare Cost and Utilization Project administrative database.
This study investigates patient-level and hospital-level variables associated with the mortality difference at referral centers and, postoperatively, outside hospitals, in patients undergoing hepatopancreatobiliary (HPB) and gastric oncologic surgeries. Using HCUP data, findings showed that, for readmissions following HPB and gastric oncologic surgery, travel distance and timing were major determinants of care fragmentation. However, these variables were not associated with mortality, nor was annual hospital surgical volume after risk-adjustment.
AHRQ-funded; HS019455.
Citation: Brauer DG, Wu N, Keller MR .
Care fragmentation and mortality in readmission after surgery for hepatopancreatobiliary and gastric cancer: a patient-level and hospital-level analysis of the Healthcare Cost and Utilization Project administrative database.
J Am Coll Surg 2021 Jun;232(6):921-32. doi: 10.1016/j.jamcollsurg.2021.03.017..
Keywords: Healthcare Cost and Utilization Project (HCUP), Cancer, Surgery, Hospital Readmissions, Mortality