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
1 to 25 of 196 Research Studies DisplayedPeipert JD, Lad T, Khosla PG
A low literacy, multimedia health information technology intervention to enhance patient-centered cancer care in safety net settings increased cancer knowledge in a randomized controlled trial.
In this study, the investigators tested whether a low-literacy-friendly, multimedia information and assessment system used in daily clinical practice enhanced patient-centered care and improved patient outcomes. This was a prospective, parallel-group, randomized controlled trial with 2 arms, CancerHelp-Talking Touchscreen (CancerHelp-TT) versus control, among adults with Stage I-III breast or colorectal cancer receiving chemotherapy and/or radiation therapy in safety net settings.
AHRQ-funded; HS017300.
Citation: Peipert JD, Lad T, Khosla PG .
A low literacy, multimedia health information technology intervention to enhance patient-centered cancer care in safety net settings increased cancer knowledge in a randomized controlled trial.
Cancer Control 2021 Jan-Dec;28:10732748211036783. doi: 10.1177/10732748211036783..
Keywords: Health Literacy, Patient-Centered Healthcare, Cancer, Education: Patient and Caregiver, Health Information Technology (HIT)
Chhatre S, Malkowicz SB, Jayadevappa R
Continuity of care in acute survivorship phase, and short and long-term outcomes in prostate cancer patients.
This study examined the association between continuity of care and outcomes in Medicare beneficiaries with localized prostate cancer, and the moderating effect of race using SEER – Medicare data between 2000 and 2016. Continuity of care was defined as visits dispersion and density in the acute survivorship phase. Outcomes measured were emergency room visits, hospitalizations, and cost during the acute survivorship phase and mortality over the follow-up phase. Higher continuity of care was associated with improved outcomes. The interaction between race and continuity of care was significant.
AHRQ-funded; HS024106.
Citation: Chhatre S, Malkowicz SB, Jayadevappa R .
Continuity of care in acute survivorship phase, and short and long-term outcomes in prostate cancer patients.
Prostate 2021 Dec;81(16):1310-19. doi: 10.1002/pros.24228..
Keywords: Cancer: Prostate Cancer, Cancer, Transitions of Care
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
Wing SE, Hu H, Lopez L
Recall of genomic testing results among patients with cancer.
Genomic testing of somatic and germline DNA has transformed cancer care. However, low genetic knowledge among patients may compromise care and health outcomes. Given the rise in genomic testing, we sought to understand patients' knowledge of their genetic test results. The investigators conducted a survey-based study with 85 patients at a comprehensive cancer center and compared self-reported recall of (a) having had somatic/germline testing and (b) their specific somatic/germline results to the genomic test results documented in the medical record.
AHRQ-funded; HS024984.
Citation: Wing SE, Hu H, Lopez L .
Recall of genomic testing results among patients with cancer.
Oncologist 2021 Dec;26(12):e2302-e05. doi: 10.1002/onco.13928..
Keywords: Cancer, Genetics, Health Literacy
Greenzang KA, Kelly CA, Al-Sayegh H
Thinking ahead: parents' worries about late effects of childhood cancer treatment.
This study examined parental perceived likelihood, impact, and worry about late effects of treatment for childhood cancer. The authors surveyed 96 parents of pediatric cancer patients at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center within a year of diagnosis. Most parents (96%) valued information about late effects, and 93% considered late effects in their treatment decision-making. However, 24% could not recall receiving information about late effects, and only 51% felt well-prepared for potential late effects. Only one-fifth of parents consider late effects to be likely for their child, while 61% were extremely/very worried about late effects.
AHRQ-funded; HS022986.
Citation: Greenzang KA, Kelly CA, Al-Sayegh H .
Thinking ahead: parents' worries about late effects of childhood cancer treatment.
Pediatr Blood Cancer 2021 Dec;68(12):e29335. doi: 10.1002/pbc.29335..
Keywords: Children/Adolescents, Cancer, Education: Patient and Caregiver, Health Literacy, Caregiving
Tobin JN, Cassells A, Weiss E
Integrating cancer screening and mental health services in primary care: protocol and baseline results of a patient-centered outcomes intervention study.
AHRQ-funded; HS021667.
Citation: Tobin JN, Cassells A, Weiss E .
Integrating cancer screening and mental health services in primary care: protocol and baseline results of a patient-centered outcomes intervention study.
J Health Care Poor Underserved 2021;32(4):1907-34. doi: 10.1353/hpu.2021.0173..
Keywords: Patient-Centered Healthcare, Cancer, Behavioral Health, Primary Care, Depression, Women, Screening
Alagoz O, Lowry KP, Kurian AW
Impact of the COVID-19 pandemic on breast cancer mortality in the US: estimates from collaborative simulation modeling.
This study’s objective was to project the impact of COVID-19 on future breast cancer mortality between 2020 and 2030. Three established Cancer Intervention and Surveillance Modeling Network breast cancer models were used to model reductions in mammography screening use, delays in symptomatic cancer diagnosis, and reduced use of chemotherapy for women with early-stage disease for the first 6 months of the pandemic with return to prepandemic patterns after that time. The models project by 2030 950 cumulative excess breast cancers deaths related to reduced screening, 1314 deaths associated with delayed diagnosis of symptomatic cases, and 151 deaths associated with reduced chemotherapy use in women with hormone positive, early-stage cancer.
AHRQ-funded; HS018366.
Citation: Alagoz O, Lowry KP, Kurian AW .
Impact of the COVID-19 pandemic on breast cancer mortality in the US: estimates from collaborative simulation modeling.
J Natl Cancer Inst 2021 Nov 2;113(11):1484-94. doi: 10.1093/jnci/djab097..
Keywords: COVID-19, Cancer: Breast Cancer, Cancer, Mortality, Women
Bowles EJA, O'Neill SC, Li T
Effect of a randomized trial of a web-based intervention on patient-provider communication about breast density.
This study evaluated a personalized web-based intervention between women and their providers designed to improve breast cancer risk communication. This randomized trial included women aged 40-69 years with 504 women in the control group and 492 women who used the intervention website. The website included information about breast density, personalized breast cancer risk, chemoprevention, and magnetic resonance imaging. Participants self-reported their communication about density with providers at 6 weeks and 12 months. Women in the intervention arm were 2.39 times more likely to report density communication at 6 weeks than the control arm. This effect persisted at 12 months. At 6 weeks the effect was only significant among women who reported versus those who did not report any previous density discussions. A quarter of women in each arm did not have a density conversation at any point during the study.
AHRQ-funded; HS022982.
Citation: Bowles EJA, O'Neill SC, Li T .
Effect of a randomized trial of a web-based intervention on patient-provider communication about breast density.
J Womens Health 2021 Nov;30(11):1529-37. doi: 10.1089/jwh.2021.0053.
AHRQ-funded; HS022982..
AHRQ-funded; HS022982..
Keywords: Communication, Women, Cancer: Breast Cancer, Cancer, Health Information Technology (HIT)
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
Hong AS, Nguyen DQ, Lee SC
Prior frequent emergency department use as a predictor of emergency department visits after a new cancer diagnosis.
This study’s objective was to determine whether emergency department (ED) visit history prior to cancer diagnosis is associated with ED visit volume after cancer diagnosis. This retrospective cohort study included adults with an incident cancer diagnosis (excluding nonmelanoma skin cancers or leukemia) at an academic medical center between 2008 and 2018 and a safety-net hospital between 2012 and 2016. Primary outcome was the number of ED visits in the first 6 months after cancer diagnosis. Among 35,090 patients with cancer, 57% had ≥ 1 ED visit in the 6 months immediately following cancer diagnosis and 20% had ≥ 1 ED visit in the 6-12 months prior to cancer diagnosis. The strongest predictor of postdiagnosis ED visits was frequent (4 or more) prediagnosis ED visits. Other covariates associated with greater postdiagnosis ED use was having 1-3 prediagnosis ED visits, Hispanic and Black race, homelessness, advanced-stage cancer, and treatment regiments including chemotherapy.
AHRQ-funded; HS022418.
Citation: Hong AS, Nguyen DQ, Lee SC .
Prior frequent emergency department use as a predictor of emergency department visits after a new cancer diagnosis.
JCO Oncol Pract 2021 Nov;17(11):1738-e52. doi: 10.1200/op.20.00889..
Keywords: Emergency Department, Cancer
Lai LY, Shahinian VB, Oerline MK
Understanding active surveillance for prostate cancer.
Understanding active surveillance for prostate cancer.
AHRQ-funded; HS025707.
Citation: Lai LY, Shahinian VB, Oerline MK .
Understanding active surveillance for prostate cancer.
JCO Oncol Pract 2021 Nov;17(11):e1678-e87. doi: 10.1200/op.20.00929..
Keywords: Cancer: Prostate Cancer, Cancer
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
Schuttner L, Haraldsson B, Maynard C
Factors associated with low-value cancer screenings in the Veterans Health Administration.
Most clinical practice guidelines recommend stopping cancer screenings when risks exceed benefits, yet low-value screenings persist. The Veterans Health Administration focuses on improving the value and quality of care, using a patient-centered medical home model that may affect cancer screening behavior. The objective of this study was to understand rates and factors associated with outpatient low-value cancer screenings.
AHRQ-funded; HS026369.
Citation: Schuttner L, Haraldsson B, Maynard C .
Factors associated with low-value cancer screenings in the Veterans Health Administration.
JAMA Netw Open 2021 Oct;4(10):e2130581. doi: 10.1001/jamanetworkopen.2021.30581..
Keywords: Screening, Cancer
Parikh DA, Ragavan M, Dutta R
Financial toxicity of cancer care: an analysis of financial burden in three distinct health care systems.
The financial toxicity of cancer care is a source of significant distress for patients with cancer. The purpose of this study is to understand factors associated with financial toxicity in three distinct care systems. The investigators concluded that low AHI, high OOPCs, and employment changes contributed to financial toxicity; however, there were variations based on site of care.
AHRQ-funded; HS026128.
Citation: Parikh DA, Ragavan M, Dutta R .
Financial toxicity of cancer care: an analysis of financial burden in three distinct health care systems.
JCO Oncol Pract 2021 Oct;17(10):e1450-e59. doi: 10.1200/op.20.00890..
Keywords: Cancer, Healthcare Costs
Kaufmann TL, Getz KD, Hsu JY
Identification of patient-reported outcome phenotypes among oncology patients with palliative care needs.
This retrospective study used patient-reported outcome (PRO) data to characterize oncology patients with palliative care needs. The objective was to determine if PRO data can identify latent phenotypes that characterize indications for specialty palliative care referral. Self-reported symptoms were collected on the Edmonton Symptom Assessment Symptom from solid tumor oncology patients (n = 745) referred to outpatient palliative care at eight community and academic sites from October 2012 to October 2018. The authors identified four PRO phenotypes: low symptoms (39.6%); moderate pain/fatigue + mood (24.2%); moderate pain/fatigue + appetite + dypsnea (27%); and high symptoms (9.3%). A secondary analysis of 421 patients found that two brief items assessing social and existential needs aligned with higher severity symptoms and psychological distress phenotypes.
AHRQ-funded; HS023681.
Citation: Kaufmann TL, Getz KD, Hsu JY .
Identification of patient-reported outcome phenotypes among oncology patients with palliative care needs.
JCO Oncol Pract 2021 Oct;17(10):e1473-e88. doi: 10.1200/op.20.00849..
Keywords: Cancer, Palliative Care, Patient-Centered Outcomes Research, Outcomes
Erim DO, Bennett AV, Gaynes BN
Mapping the Memorial Anxiety Scale for Prostate Cancer to the SF-6D.
The purpose of this study was to create a crosswalk that predicts Short Form 6D (SF-6D) utilities from Memorial Anxiety Scale for Prostate Cancer (MAX-PC) scores. Findings showed that this study provided a crosswalk that converts MAX-PC scores to SF-6D utilities for economic evaluation of clinically significant prostate cancer-related anxiety treatment options for prostate cancer survivors.
AHRQ-funded; 29020050040I.
Citation: Erim DO, Bennett AV, Gaynes BN .
Mapping the Memorial Anxiety Scale for Prostate Cancer to the SF-6D.
Qual Life Res 2021 Oct;30(10):2919-28. doi: 10.1007/s11136-021-02871-9..
Keywords: Cancer: Prostate Cancer, Cancer, Research Methodologies
Moazzezi M, Rose B, Kisling K
Prospects for daily online adaptive radiotherapy via ethos for prostate cancer patients without nodal involvement using unedited CBCT auto-segmentation.
This study’s objective was to assess the new online adaptive radiation therapy technology called Ethos for treating prostate cancer. Twenty-five prostate patients previously treated at the author’s clinic were re-planed using an Ethos emulator. Clinical margins of 3 mm posterior, 5 mm left/right/anterior, and 7 mm superior/inferior were used. Dose metrics were compared to unadapted plans to evaluate clinical target volumes (CTV) and online adaptive radiation (OAR) dose changes. Overall, 96% of fractions required auto-segmentation edits, although they were mostly minor. Adaptation improved CTV 98% for the 24 patients with minor auto-segmentation corrections. However, for one in 25 patients, large contour edits were required.
AHRQ-funded; HS025440.
Citation: Moazzezi M, Rose B, Kisling K .
Prospects for daily online adaptive radiotherapy via ethos for prostate cancer patients without nodal involvement using unedited CBCT auto-segmentation.
J Appl Clin Med Phys 2021 Oct;22(10):82-93. doi: 10.1002/acm2.13399..
Keywords: Cancer: Prostate Cancer, Cancer, Treatments, Imaging
Enzinger AC, Ghosh K, Keating NL
US trends in opioid access among patients with poor prognosis cancer near the end-of-life.
This study looked at trends in opioid prescriptions for cancer patients near the end-of-life (EOL) defined as the 30 days before death or hospice enrollment. The authors looked at Medicare part D data from 2007 to 2017 for 270,632 Medicare fee-for-service decedents with poor prognosis cancers. During that time, the proportion of decedents with poor prognosis cancers receiving 1 or greater opioid prescriptions near EOL declined 15.5% and the proportion receiving 1 or greater long-acting opioid prescriptions declined 36.5% to 18.1%. The mean daily dose fell from 24.5%, from 85.6 morphine milligram equivalents per day (MMED) to 64.6. The total amount of opioids prescribed fell from 1,075 morphine milligram equivalents per decedent to 666 morphine milligram equivalents per decedents. At the same time, the proportion of patients with pain-related ED visits increase 50.8% from 13.2% to 19.9%.
AHRQ-funded; HS024072.
Citation: Enzinger AC, Ghosh K, Keating NL .
US trends in opioid access among patients with poor prognosis cancer near the end-of-life.
J Clin Oncol 2021 Sep 10;39(26):2948-58. doi: 10.1200/jco.21.00476..
Keywords: Cancer, Opioids, Palliative Care, Pain, Access to Care, Medication, Practice Patterns
Kwee Wong, LL Sato, MM
Transarterial radioembolization for hepatocellular carcinoma with major vascular invasion: a nationwide propensity score-matched analysis with target trial emulation.
This study’s objective was to compare overall survival (OS) rates for hepatocellular carcinoma (HCC) with major vascular invasion (HCC-MVI) for patients undergoing either transarterial radioembolization (TARE) or systemic therapy. The National Cancer Database was used to identify 1,514 patients with HCC-MVI. TARE use had doubled between 2010 and 2015. OS was compared for the two treatments and TARE was found to be associated with significant survival benefits compared with systemic therapy.
AHRQ-funded; HS023185.
Citation: Kwee Wong, LL Sato, MM .
Transarterial radioembolization for hepatocellular carcinoma with major vascular invasion: a nationwide propensity score-matched analysis with target trial emulation.
J Vasc Interv Radiol 2021 Sep;32(9):1258-66.e6. doi: 10.1016/j.jvir.2021.07.001..
Keywords: Cancer, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
Singal AG, Patibandla S, Obi J
Benefits and harms of hepatocellular carcinoma surveillance in a prospective cohort of patients with cirrhosis.
The value of a cancer screening program is defined by its balance of benefits and harms; however, there are few data evaluating both attributes for hepatocellular carcinoma (HCC) surveillance. In this study, the investigators aimed to characterize benefits and harms of HCC surveillance in a large prospective cohort of patients with cirrhosis. The investigators concluded that in their cohort of patients with cirrhosis, HCC surveillance was associated with high early tumor detection and minimal physical harms.
AHRQ-funded; HS022418.
Citation: Singal AG, Patibandla S, Obi J .
Benefits and harms of hepatocellular carcinoma surveillance in a prospective cohort of patients with cirrhosis.
Clin Gastroenterol Hepatol 2021 Sep;19(9):1925-32.e1. doi: 10.1016/j.cgh.2020.09.014..
Keywords: Cancer
Papaleontiou M, Norton EC, Reyes-Gastelum D
Competing causes of death in older adults with thyroid cancer.
Understanding the impact of comorbidities and competing risks of death when caring for older adults with thyroid cancer is key for personalized management. The objective of this study was to determine whether older adults with thyroid cancer are more likely to die from thyroid cancer or other etiologies and determine patient factors associated with each.
AHRQ-funded; HS024512.
Citation: Papaleontiou M, Norton EC, Reyes-Gastelum D .
Competing causes of death in older adults with thyroid cancer.
Thyroid 2021 Sep;31(9):1359-65. doi: 10.1089/thy.2020.0929..
Keywords: Elderly, Cancer, Mortality
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
Fan T, Stefanos R
AHRQ Author: Fan T
Screening for colorectal cancer.
This AHRQ-authored Putting Preventions in Practice quiz has three questions and answers on the US Preventive Services Task Force final recommendation on screening for colorectal cancer. A case study is presented with questions on the best behavioral interventions, the effect of a patient’s age on the counseling approach, and what is an appropriate test and interval for colorectal screening. References are also provided at the end of the answers.
AHRQ-authored.
Citation: Fan T, Stefanos R .
Screening for colorectal cancer.
Am Fam Physician 2021 Sep 1;104(3):295-96..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer: Colorectal Cancer, Cancer, Screening, Prevention, Guidelines, Evidence-Based Practice, Case Study
Marchetti KA, Oerline M, Hollenbeck BK
Urology workforce changes and implications for prostate cancer care among Medicare enrollees.
The purpose of this study was to characterize national trends in urologist workforce, practice organization, and management of incident prostate cancer. The investigators characterized shifts in urologist membership from smaller, independent groups to larger, multispecialty or hospital-owned practices. They indicated that this trend coincided with higher utilization of observation and surgical treatment for prostate cancer.
AHRQ-funded; HS025707.
Citation: Marchetti KA, Oerline M, Hollenbeck BK .
Urology workforce changes and implications for prostate cancer care among Medicare enrollees.
Urology 2021 Sep;155:77-82. doi: 10.1016/j.urology.2020.12.051..
Keywords: Cancer: Prostate Cancer, Cancer, Workforce, Practice Patterns