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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 796 Research Studies DisplayedAmu-Nnadi CN, Ross ES, Garcia NH
Health system integration and cancer center access for rural hospitals.
This study’s goal was to assess health system integration and cancer center access for rural hospitals. The authors compared health systems with and without cancer centers based on rural hospital presence. They found that 90% of cancer centers are in a health system, and 72% of health systems (434/607) have a cancer center. Larger health systems with more trainees more often have cancer centers but are no more likely to include rural hospitals (11% vs 6%). The minority of cancer centers not in health systems (N = 95) more often serve low complexity patient populations in non-metropolitan areas.
AHRQ-funded; HS013852.
Citation: Amu-Nnadi CN, Ross ES, Garcia NH .
Health system integration and cancer center access for rural hospitals.
Am Surg 2024 May; 90(5):1023-29. doi: 10.1177/00031348231216497..
Keywords: Health Systems, Cancer, Rural Health, Rural/Inner-City Residents, Access to Care
Rosenberg SM, McCue S, He J
Alliance A151945: accrual and characteristics of adolescent and young adult patients in Alliance trials from 2000 to 2017.
Alliance trials analyzed factors influencing clinical trial enrollment among adolescents and young adults (AYAs) with cancer. Among 188 Alliance trials, AYAs comprised 11% of accrual, varying by cancer type. Hispanic and non-White AYAs were more represented in breast and colorectal cancer trials compared to non-AYAs. Disease characteristics differed by age in selected trials. AYA-specific survival showed no significant age-based differences. The results emphasize the challenge of ensuring equitable access to trials for AYAs.
AHRQ-funded; HS023680.
Citation: Rosenberg SM, McCue S, He J .
Alliance A151945: accrual and characteristics of adolescent and young adult patients in Alliance trials from 2000 to 2017.
Cancer 2024 Mar 1; 130(5):750-69. doi: 10.1002/cncr.35078.
Keywords: Children/Adolescents, Cancer
Kerlikowske K, Zhu W, Su YR
Supplemental magnetic resonance imaging plus mammography compared with magnetic resonance imaging or mammography by extent of breast density.
This study compared using supplemental magnetic resonance imaging (MRI) with or without mammography to inform discussions about supplemental MRI in women with dense breasts. The authors evaluated 52, 237 women aged 40-79 years who underwent 2611 screening MRIs alone and 6518 supplemental MRI plus mammography pairs propensity score-matched to 65, 810 screening mammograms. They estimated rates per 1000 examinations of interval, advanced, and screen-detected early-stage invasive cancers and false-positive recall and biopsy recommendation by breast density (nondense = almost entirely fatty or scattered fibroglandular densities; dense = heterogeneously/extremely dense) adjusting for registry, examination year, age, race and ethnicity, family history of breast cancer, and prior breast biopsy. Screen-detected early-stage cancer rates were statistically higher for MRI plus mammography vs mammography for nondense (9.3 vs 2.9) and dense (7.5 vs 3.5) breasts and for MRI vs MRI plus mammography for dense breasts (19.2 vs 7.5). Interval rates were not statistically different for MRI plus mammography vs mammography for nondense (0.8 vs 0.5) or dense breasts (1.5 vs 1.4), nor were advanced cancer rates. MRI plus mammography had statistically higher false-positive recall and biopsy recommendation rates than mammography alone.
AHRQ-funded; HS018366.
Citation: Kerlikowske K, Zhu W, Su YR .
Supplemental magnetic resonance imaging plus mammography compared with magnetic resonance imaging or mammography by extent of breast density.
J Natl Cancer Inst 2024 Feb 8; 116(2):249-57. doi: 10.1093/jnci/djad201.
Keywords: Imaging, Cancer
Khalaf N, Ali B, Liu Y
Emergency presentations predict worse outcomes among patients with pancreatic cancer.
This study evaluated the association between pancreatic emergency presentation (EP) and cancer stage, treatment, and survival. The authors conducted a retrospective cohort study among patients with pancreatic adenocarcinoma diagnosed from 2007 to 2019 at a tertiary-care Veterans Affairs medical center. They used electronic health records to identify EP cases, defined as a new pancreatic cancer diagnosis made within 30 days of an ED visit where cancer was suspected. Of 243 identified pancreatic cancer patients, 66.7% had EPs. Although there was no difference in stage by EP status, patients diagnosed through EPs were 72% less likely to receive cancer treatment compared to non-emergency presenters. Patients with EPs also had a 73% higher mortality risk. This difference in mortality remained statistically significant after adjusting for cancer stage and receipt of cancer treatment.
AHRQ-funded; HS029347; HS028595.
Citation: Khalaf N, Ali B, Liu Y .
Emergency presentations predict worse outcomes among patients with pancreatic cancer.
Dig Dis Sci 2024 Feb; 69(2):603-14. doi: 10.1007/s10620-023-08207-6.
Keywords: Cancer, Emergency Department, Outcomes
Pozzar RA, Wall JA, Tavormina A
Experiences of patients with peritoneal carcinomatosis-related complex care needs and their caregivers.
The study explored the needs of patients with peritoneal carcinomatosis (PC) and caregivers during care transitions. Findings showed limited prognostic understanding and advance care planning among patients, with most caregivers providing daily care without proper training. Many participants experienced anxiety and depression. Interviewees emphasized the lack of guidance and called for health system changes. The study concluded that interventions providing clinical training, facilitating serious illness conversations, and offering psychosocial support are necessary.
AHRQ-funded; HS013852.
Citation: Pozzar RA, Wall JA, Tavormina A .
Experiences of patients with peritoneal carcinomatosis-related complex care needs and their caregivers.
Gynecol Oncol 2024 Feb; 181:68-75. doi: 10.1016/j.ygyno.2023.12.013.
Keywords: Cancer, Caregiving, Palliative Care, Women
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.
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
De Castro GC, Slatnick LR, Shannon M
Impact of time-to-antibiotic delivery in pediatric patients with cancer presenting with febrile neutropenia.
Researchers abstracted episodes of febrile neutropenia (FN) in pediatric patients with cancer occurring at Vanderbilt Children's Hospital and Colorado Children's Hospital to capture time-to-antibiotic (TTA) metrics and clinical outcomes including major complications. Results showed that only 0.6% of episodes required immediate ICU management, with a median TTA of 28 minutes; for the remaining patients, the median TTA was 56 minutes. TTA was not associated with major nor any other complications in adjusted analysis. The researchers concluded that there was no clear evidence that a reduced TTA improves clinical outcomes in pediatric oncology FN and it should not be used as a primary quality measure.
AHRQ-funded; HS025696.
Citation: De Castro GC, Slatnick LR, Shannon M .
Impact of time-to-antibiotic delivery in pediatric patients with cancer presenting with febrile neutropenia.
JCO Oncol Pract 2024 Feb; 20(2):228-38. doi: 10.1200/op.23.00583..
Keywords: Children/Adolescents, Cancer, Antibiotics, Medication
Al Hussein Al Awamlh B, Wallis CJD, Penson DF
Functional outcomes after localized prostate cancer treatment.
The objective of this observational cohort study was to compare rates of adverse functional outcomes between specific treatments for localized prostate cancer. Researchers used data from five U.S. Surveillance, Epidemiology, and End Results Program registries. Participants were patients treated for localized prostate cancer in 2011-2012. The results indicated that radical prostatectomy was associated with worse urinary incontinence, but not with worse sexual function, at 10-year followup when compared with radiotherapy or surveillance. Among patients with unfavorable-prognosis disease, external beam radiotherapy with androgen deprivation therapy was associated with worse bowel and hormone function at 10-year followup compared with radical prostatectomy.
AHRQ-funded; HS019356; HS022640.
Citation: Al Hussein Al Awamlh B, Wallis CJD, Penson DF .
Functional outcomes after localized prostate cancer treatment.
JAMA 2024 Jan 23; 331(4):302-17. doi: 10.1001/jama.2023.26491.
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Keywords: Cancer: Prostate Cancer, Cancer, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
Balbin CA, Kawamoto K
The SIMPLE architectural pattern for integrating patient-facing apps into clinical workflows: desiderata and application for lung cancer screening.
To address the need for electronic health record (EHR) systems to accept the connection of any patient-facing digital health app using the SMART on FHIR standard, the authors proposed the Standards-based Implementation Maximizing Portability Leveraging the EHR (SIMPLE). SIMPLE’s architectural pattern was designed to meet several key requirements, such as not requiring patients to install new software; not retaining patient data outside of the EHR; leveraging existing personal health record (PHR) capabilities to optimize user experience; and maximizing portability.
AHRQ-funded; HS028791.
Citation: Balbin CA, Kawamoto K .
The SIMPLE architectural pattern for integrating patient-facing apps into clinical workflows: desiderata and application for lung cancer screening.
AMIA Annu Symp Proc 2024 Jan 11; 2023:844-53..
Keywords: Workflow, Health Information Technology (HIT), Cancer: Lung Cancer, Cancer, Screening
Watterson TL, Stone JA, Kleinschmidt PC
CancelRx case study: implications for clinic and community pharmacy work systems.
This study examined the impact of implementation of CancelRx, a health IT system that automatically communicates medication discontinuations from the clinic electronic health record to the community pharmacy dispensing platform, theoretically improving communication. The system was implemented across a Midwest academic health system in October 2017, using their 15 outpatient community pharmacies to test it. Interviews were conducted with 9 medical assistants, 12 community pharmacists, and 3 pharmacy administrators employed by the health system across 3-time periods between 2017 and 2018: 3-months prior to CancelRx implementation, 3-months after CancelRx implementation, and 9-months after CancelRx implementation. While CancelRx automated and streamlined how medication discontinuation messages were received and processed, it also increased workload and introduced new errors.
AHRQ-funded; HS025793.
Citation: Watterson TL, Stone JA, Kleinschmidt PC .
CancelRx case study: implications for clinic and community pharmacy work systems.
BMC Health Serv Res 2023 Dec 6; 23(1):1360. doi: 10.1186/s12913-023-10396-9..
Keywords: Cancer, Provider: Pharmacist, Medication
Danan ER, Than C, Chawla N
Abnormal cervical cancer screening results among US veteran and non-veteran participants in the National Health Interview Survey (NHIS).
Researchers tested whether Veterans with a recent cervical cancer screening test were more likely than non-Veterans to have received an abnormal result. Data was taken from the National Health Interview Survey (NHIS). An adjusted regression model of the date indicated that a previously observed association between Veteran status and abnormal screening result was explained by differences in sociodemographic and health factors between Veterans and non-Veterans. The researchers concluded that clinicians should address modifiable risk factors and provide evidence-based follow-up for abnormal results.
AHRQ-funded; HS026379.
Citation: Danan ER, Than C, Chawla N .
Abnormal cervical cancer screening results among US veteran and non-veteran participants in the National Health Interview Survey (NHIS).
Prev Med Rep 2023 Dec; 36:102472. doi: 10.1016/j.pmedr.2023.102472..
Keywords: Cancer: Cervical Cancer, Cancer, Screening, Women, Prevention
Tallman JE, Wallis CJD, Zhao Z
Prostate volume, baseline urinary function, and their association with treatment choice and post-treatment urinary function in men treated for localized prostate cancer.
The purpose of this study was to assess the relationship between prostate volume (PV) and baseline urinary function with treatment choice and post-treatment urinary function among men with localized prostate cancer. The researchers identified 1,647 patients from CEASAR, a multicenter population-based, prospective cohort study of men with localized prostate cancer. The primary study outcomes were treatment choice and health-related quality of life (HRQOL) assessed at pre-specified intervals up to 5 years. The study found that median baseline PV was 36 mL (IQR 27-48), and baseline urinary irritative/obstructive domain score was 87 (IQR 75-100). The study did not find any observed clinically meaningful relationship between PV and treatment choice or post-treatment urinary function. In participants with poor baseline urinary function, treatment with radiation or surgery was related with statistically and clinically significant improvement in urinary function at 6 months which endured through 5 years.
AHRQ-funded; HS019356; HS022640.
Citation: Tallman JE, Wallis CJD, Zhao Z .
Prostate volume, baseline urinary function, and their association with treatment choice and post-treatment urinary function in men treated for localized prostate cancer.
Prostate Cancer Prostatic Dis 2023 Dec; 26(4):787-94. doi: 10.1038/s41391-022-00627-1..
Keywords: Cancer: Prostate Cancer, Cancer, Men's Health
Salwei ME, Ancker JS, Weinger MB
The decision aid is the easy part: workflow challenges of shared decision making in cancer care.
The authors indicate that widespread use of shared decision making (SDM) in clinical care has been limited even though both the National Academy of Medicine and the American Society of Clinical Oncology recommend SDM methods to improve patient-centered care. The purpose of this commentary is to explore 3 workflow-related barriers to SDM, and to discuss human factors engineering and demonstrate its potential value to decision aid design through a decision-making case study.
AHRQ-funded; HS026395.
Citation: Salwei ME, Ancker JS, Weinger MB .
The decision aid is the easy part: workflow challenges of shared decision making in cancer care.
J Natl Cancer Inst 2023 Nov 8; 115(11):1271-77. doi: 10.1093/jnci/djad133..
Keywords: Shared Decision Making, Cancer, Patient-Centered Healthcare
Marcotte LM, Deeds S, Wheat C
Automated opt-out vs opt-in patient outreach strategies for breast cancer screening: a randomized clinical trial.
The objective of this study was to evaluate the effect on breast cancer screening of an opt-out automatic mammography referral strategy compared with an opt-in automated telephone message strategy. Participants in the pragmatic randomized clinical trial, conducted at a Veterans Affairs (VA) medical center, were female veterans aged 45-75 eligible for breast cancer screening and enrolled in VA primary care. The results indicated that the opt-out population-based breast cancer screening outreach approach compared with an opt-in approach did not result in a significant difference in mammography completion, but did lead to more canceled mammography referrals, which increased staff burden.
AHRQ-funded; HS026369.
Citation: Marcotte LM, Deeds S, Wheat C .
Automated opt-out vs opt-in patient outreach strategies for breast cancer screening: a randomized clinical trial.
JAMA Intern Med 2023 Nov; 183(11):1187-94. doi: 10.1001/jamainternmed.2023.4321..
Keywords: Cancer: Breast Cancer, Cancer, Screening, Prevention, Health Promotion
Stevens ER, Caverly T, Butler JM
Considerations for using predictive models that include race as an input variable: the case study of lung cancer screening.
Indiscriminate use of predictive models incorporating race can reinforce biases present in source data and lead to an exacerbation of health disparities. In some countries, such as the United States, there is therefore a push to remove race from prediction models; however, there are still many prediction models that use race as an input. Biomedical informaticists who are given the responsibility of using these predictive models in healthcare environments are likely to be faced with questions like how to deal with race covariates in these models. The authors report that there is a need for a practical framework to facilitate model user thinking on how to incorporate race in their chosen model to avoid inadvertently amplifying disparities. The purpose of this paper is to utilize a case study of lung cancer screening to propose a simple framework to guide model users in approaching race inputs in the predictive models they are attempting to leverage in electronic health records and clinical workflows.
AHRQ-funded; HS028791.
Citation: Stevens ER, Caverly T, Butler JM .
Considerations for using predictive models that include race as an input variable: the case study of lung cancer screening.
J Biomed Inform 2023 Nov; 147:104525. doi: 10.1016/j.jbi.2023.104525..
Keywords: Cancer: Lung Cancer, Cancer, Racial and Ethnic Minorities
Mahenthiran AK, Logan CD, Janczewski LM
Evaluation of nationwide trends in nodal sampling guideline adherence for gastric cancer: 2005-2017.
This study’s purpose was to evaluate trends in program-level disparities in adherence to gastric cancer nodal sampling guidelines. The cohort included 55,421 patients who underwent resection of gastric cancer from 2005 to 2017 identified in the National Cancer Database. Of that total 27,201 (49.1%) of patients met adherence criteria for lymph node sampling. Academic hospitals treated 44.4% of the total cohort. Overall, lymph node sampling criteria were met in 59.2% of patients treated at high-volume academic programs and 37.0% of patients treated at low-volume nonacademic programs. Adherence rates improved overall from 2005 to 2017 for both low-volume nonacademic programs (27.8% in 2005 to 50.1% in 2017) and high-volume academic programs (46.0% in 2005 to 69.8% in 2017).
AHRQ-funded; HS026385.
Citation: Mahenthiran AK, Logan CD, Janczewski LM .
Evaluation of nationwide trends in nodal sampling guideline adherence for gastric cancer: 2005-2017.
J Surg Res 2023 Nov; 291:514-26. doi: 10.1016/j.jss.2023.07.011..
Keywords: Cancer, Guidelines, Evidence-Based Practice
Kerlikowske K, Bissell MCS, Sprague BL
Impact of BMI on prevalence of dense breasts by race and ethnicity.
Researchers evaluated differences in body mass index (BMI) in relation to differences in dense breasts prevalence by race/ethnicity. Their results indicated that dense breasts were most prevalent among Asian women followed by non-Hispanic White, Hispanic, and Black women. Clinically important differences in breast density prevalence are present across racial/ethnic groups after accounting for age, menopausal status, and BMI. IMPACT: If breast density is the sole criterion used to notify women of dense breasts and discuss supplemental screening it may result in implementing inequitable screening strategies across racial/ethnic groups.
AHRQ-funded; HS018366.
Citation: Kerlikowske K, Bissell MCS, Sprague BL .
Impact of BMI on prevalence of dense breasts by race and ethnicity.
Cancer Epidemiol Biomarkers Prev 2023 Nov; 32(11):1524-30. doi: 10.1158/1055-9965.Epi-23-0049..
Keywords: Obesity, Women, Racial and Ethnic Minorities, Cancer: Breast Cancer, Cancer, Imaging
Kukhareva PV, Li H, Caverly TJ
Implementation of lung cancer screening in primary care and pulmonary clinics: pragmatic clinical trial of electronic health record-integrated everyday shared decision-making tool and clinician-facing prompts.
The authors conducted pre- and post-intervention analysis in primary care and pulmonary clinics to explore whether clinician-facing electronic health record (EHR) prompts and an EHR-integrated shared decision-making (SDM) tool designed to support incorporation of SDM into primary care could improve low-dose computer tomography scan imaging ordering and completion. Subjects were patients who met US Preventive Services Task Force criteria for lung cancer screening (LCS). The results indicated that EHR prompts and the EHR-integrated SDM tool were promising approaches to improving LCS in the primary care setting. The authors noted that further research is warranted.
AHRQ-funded; HS026198; HS028791.
Citation: Kukhareva PV, Li H, Caverly TJ .
Implementation of lung cancer screening in primary care and pulmonary clinics: pragmatic clinical trial of electronic health record-integrated everyday shared decision-making tool and clinician-facing prompts.
Chest 2023 Nov; 164(5):1325-38. doi: 10.1016/j.chest.2023.04.040..
Keywords: Cancer: Lung Cancer, Cancer, Screening, Primary Care, Electronic Health Records (EHRs), Health Information Technology (HIT), Shared Decision Making
Godfrey CM, Shipe ME, Welty VF
The thoracic research evaluation and treatment 2.0 model: a lung cancer prediction model for indeterminate nodules referred for specialist evaluation.
In this research study the authors updated and expanded the Thoracic Research Evaluation and Treatment (TREAT) model into a more generalized, robust approach for lung cancer prediction in patients referred for specialty evaluation to improve lung cancer prediction accuracy. Clinical and radiographic data on 1401 patients with indeterminate pulmonary nodules (IPNs) from six sites were collected retrospectively and divided into groups by clinical setting: pulmonary nodule clinic (n = 374; cancer prevalence, 42%), outpatient thoracic surgery clinic (n = 553; cancer prevalence, 73%), or inpatient surgical resection (n = 474; cancer prevalence, 90%). The new prediction model was developed using a missing data-driven pattern submodel approach and compared with the original TREAT, Mayo Clinic, Herder, and Brock models. Two-thirds of patients were found to have missing data; nodule growth and fluorodeoxyglucose-PET scan avidity were missing most frequently. The TREAT version 2.0 mean area under the receiver operating characteristic curve across missingness patterns was 0.85 compared with the original TREAT (0.80), Herder (0.73), Mayo Clinic (0.72), and Brock (0.68) models with improved calibration.
AHRQ-funded; HS026122.
Citation: Godfrey CM, Shipe ME, Welty VF .
The thoracic research evaluation and treatment 2.0 model: a lung cancer prediction model for indeterminate nodules referred for specialist evaluation.
Chest 2023 Nov; 164(5):1305-14. doi: 10.1016/j.chest.2023.06.009..
Keywords: Cancer: Lung Cancer, Cancer
Liu C, Liu Z, Holmes J
Artificial general intelligence for radiation oncology.
This paper explores full-spectrum applications of artificial general intelligence (AGI) across radiation oncology including initial consultation, simulation, treatment planning, treatment delivery, treatment verification, and patient follow-up. The fusion of vision data with large language models (LLMs) such as GPT-4 and PaLM-2 also creates powerful multimodal models that elucidate nuanced clinical patterns. This fusion promises to catalyze a shift towards data-driven, personalized radiation therapy. This paper provides an overview of how AGI can transform radiation oncology to elevate the standard of patient care in radiation oncology, with the key insight being AGI's ability to exploit multimodal clinical data at scale.
AHRQ-funded; HS029009.
Citation: Liu C, Liu Z, Holmes J .
Artificial general intelligence for radiation oncology.
Meta Radiol 2023 Nov; 1(3). doi: 10.1016/j.metrad.2023.100045.
Keywords: Health Information Technology (HIT), Imaging, Cancer
Reed KG, Sun Z, Yabes JG
Assessing characteristics of populations seen at Commission on Cancer facilities using Pennsylvania linked data.
The purpose of this study was to evaluate variations among patients who do and do not visit Commission on Cancer (CoC) accredited facilities. The researchers utilized Pennsylvania Cancer Registry data linked to facility records for 87,472 patients diagnosed with cancer between 2018 and 2019. The study found that patients in the most advantaged Area Deprivation Index quartiles were more likely to visit CoC facilities compared with other quartiles. Urban patients were more likely than rural to be seen at a CoC facility as were Hispanic patients and non-Hispanic Black patients compared with White patients.
AHRQ-funded; HS027396.
Citation: Reed KG, Sun Z, Yabes JG .
Assessing characteristics of populations seen at Commission on Cancer facilities using Pennsylvania linked data.
JNCI Cancer Spectr 2023 Oct 31; 7(6). doi: 10.1093/jncics/pkad080..
Keywords: Cancer, Health Information Technology (HIT), Racial and Ethnic Minorities, Rural Health, Rural/Inner-City Residents
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
Gore Moses R, Nieters A, Valentine rKD
Performance of the shared decision-making process scale for use in evaluation of hereditary cancer genetic testing decisions.
This study’s objective was to evaluate the feasibility, acceptability, reliability, and validity of the four-item Shared Decision Making (SDM) Process Scale for use in for hereditary cancer genetic testing decision-making. Participants were patients from a large hereditary cancer genetics practice who responded to an online survey following pre-test genetic counseling; the survey included the SDM Process Scale and the SURE scale. The SDM Process Scale showed feasibility, acceptability, and retest reliability, but not convergent validity with decisional conflict. The authors concluded that their findings provided evidence for use of this scale to measure patient perceptions of SDM in pre-test counseling.
AHRQ-funded; HS025718.
Citation: Gore Moses R, Nieters A, Valentine rKD .
Performance of the shared decision-making process scale for use in evaluation of hereditary cancer genetic testing decisions.
J Genet Couns 2023 Oct; 32(5):957-64. doi: 10.1002/jgc4.1704..
Keywords: Shared Decision Making, Cancer, Genetics
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