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 46 Research Studies DisplayedChilders CP, Childers KK, Maggard-Gibbons M
National estimates of genetic testing in women with a history of breast or ovarian cancer.
In the United States, 3.8 million women have a history of breast (BC) or ovarian cancer (OC). Up to 15 percent of cases are attributable to heritable mutations, which, if identified, provide critical knowledge for treatment and preventive care. This study found that fewer than one in five individuals with a history of BC or OC meeting select National Cancer Comprehensive Network criteria have undergone genetic testing.
AHRQ-funded; HS025079.
Citation: Childers CP, Childers KK, Maggard-Gibbons M .
National estimates of genetic testing in women with a history of breast or ovarian cancer.
J Clin Oncol 2017 Dec 1;35(34):3800-06. doi: 10.1200/jco.2017.73.6314.
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Keywords: Cancer, Cancer: Breast Cancer, Cancer: Ovarian Cancer, Family Health and History, Genetics, Quality of Care, Screening, Women
Kelly G, Wang SY, Lucas G
Facilitating meaningful engagement on community advisory committees in patient-centered outcome research.
In this study, the investigators conducted a process evaluation of ongoing activities of a Patient Advisory Committee (PAC) formed around the development of an individualized decision aid for older women with early stage breast cancer. They indicated that their results suggested that engaging committee members in a process of evaluation and collective reflection during a research collaboration can break down barriers to collaboration, build relationships, create opportunities for co-learning and strengthen researchers' capacity to engage meaningfully with stakeholders.
AHRQ-funded; HS023900.
Citation: Kelly G, Wang SY, Lucas G .
Facilitating meaningful engagement on community advisory committees in patient-centered outcome research.
Prog Community Health Partnersh 2017;11(3):243-51. doi: 10.1353/cpr.2017.0029..
Keywords: Cancer, Cancer: Breast Cancer, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Research Methodologies
Rauscher GH, Dabbous F, Dolecek TA
Absence of an anticipated racial disparity in interval breast cancer within a large health care organization.
The researchers sought to estimate the extent of an anticipated racial disparity in interval breast cancer (IBC) within a single, large health care organization. Contrary to expectation, in patient-adjusted models, there was no IBC racial disparity. The sorting of patients by race across facilities appears to have mitigated an otherwise anticipated disparity in IBC.
AHRQ-funded; HS018366.
Citation: Rauscher GH, Dabbous F, Dolecek TA .
Absence of an anticipated racial disparity in interval breast cancer within a large health care organization.
Ann Epidemiol 2017 Oct;27(10):654-58. doi: 10.1016/j.annepidem.2017.09.002.
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Keywords: Cancer: Breast Cancer, Cancer, Disparities, Racial and Ethnic Minorities, Women, Screening, Screening, Imaging
Farias AJ, Du XL
Racial differences in adjuvant endocrine therapy use and discontinuation in association with mortality among Medicare breast cancer patients by receptor status.
The purpose of this study was to determine whether racial/ethnic differences in use and discontinuation of adjuvant endocrine therapy (AET) differed by hormone receptor status and whether discontinuation was associated with mortality. There are racial/ethnic differences in AET use and discontinuation. Discontinuing treatment was associated with higher risk of all-cause and cancer-specific mortality regardless of hormone receptor status.
AHRQ-funded; HS018956.
Citation: Farias AJ, Du XL .
Racial differences in adjuvant endocrine therapy use and discontinuation in association with mortality among Medicare breast cancer patients by receptor status.
Cancer Epidemiol Biomarkers Prev 2017 Aug;26(8):1266-75. doi: 10.1158/1055-9965.epi-17-0280.
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Keywords: Cancer: Breast Cancer, Disparities, Elderly, Mortality, Racial and Ethnic Minorities
Wang SY, Kelly G, Gross C
Information needs of older women with early-stage breast cancer when making radiation therapy decisions.
The researchers identified the information older women with early-stage breast cancer need when making radiation therapy decisions, and who patients identify as the main decision maker. They found that older women consider themselves to be the main decision maker; they desire information and have more agency and input in the decision-making process than prior literature would suggest.
AHRQ-funded; HS023900.
Citation: Wang SY, Kelly G, Gross C .
Information needs of older women with early-stage breast cancer when making radiation therapy decisions.
Int J Radiat Oncol Biol Phys 2017 Jul 15;98(4):733-40. doi: 10.1016/j.ijrobp.2017.02.001.
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Keywords: Cancer: Breast Cancer, Decision Making, Education: Patient and Caregiver, Treatments
Ballard TNS, Zhong L, Momoh AO
Improved rates of immediate breast reconstruction at safety net hospitals.
Although disparities in receipt of breast reconstruction persist at the patient level, the extent to which hospital factors contribute to these differences remains unclear. This study concluded that, after accounting for sociodemographic factors, women undergoing mastectomies at safety net hospitals remain less likely to undergo immediate breast reconstruction. However, the differences in rates of reconstruction between safety net and non-safety net hospitals have narrowed over time.
AHRQ-funded; HS023313.
Citation: Ballard TNS, Zhong L, Momoh AO .
Improved rates of immediate breast reconstruction at safety net hospitals.
Plast Reconstr Surg 2017 Jul;140(1):1-10. doi: 10.1097/prs.0000000000003412.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Cancer: Breast Cancer, Cancer, Surgery
Aliu O, Zhong L, Chetta MD
Comparing health care resource use between implant and autologous reconstruction of the irradiated breast: a national claims-based assessment.
Nationwide data were used to examine health care resource use associated with implant and autologous reconstruction. Thirty-two percent of implant reconstructions failed, compared with 5 percent of autologous cases. In aggregate, failures constituted more than 20 percent of the cumulative costs of implant reconstruction compared with less than 5 percent for autologous reconstruction.
AHRQ-funded; HS023313.
Citation: Aliu O, Zhong L, Chetta MD .
Comparing health care resource use between implant and autologous reconstruction of the irradiated breast: a national claims-based assessment.
Plast Reconstr Surg 2017 Jun;139(6):1224e-31e. doi: 10.1097/prs.0000000000003336.
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Keywords: Cancer: Breast Cancer, Healthcare Costs, Surgery
Taylor C, Correa C, Duane FK
Estimating the risks of breast cancer radiotherapy: evidence from modern radiation doses to the lungs and heart and from previous randomized trials.
The researchers estimated the absolute long-term risks of modern breast cancer radiotherapy. They concluded that, for long-term smokers, the absolute risks of modern radiotherapy may outweigh the benefits, yet for most nonsmokers (and ex-smokers), the benefits of radiotherapy far outweigh the risks. Hence, smoking can determine the net effect of radiotherapy on mortality, but smoking cessation substantially reduces radiotherapy risk.
AHRQ-funded; HS021681.
Citation: Taylor C, Correa C, Duane FK .
Estimating the risks of breast cancer radiotherapy: evidence from modern radiation doses to the lungs and heart and from previous randomized trials.
J Clin Oncol 2017 May 20;35(15):1641-49. doi: 10.1200/jco.2016.72.0722.
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Keywords: Adverse Events, Cancer: Breast Cancer, Risk, Treatments
Vyas A, Madhavan SS, Sambamoorthi U
Differences in Medicare expenditures between Appalachian and nationally representative cohorts of elderly women with breast cancer: an application of decomposition technique.
The objective of this study was to determine Medicare expenditures during the initial phase of care among women in West Virginia (WV) who were Medicare beneficiaries with BC and compare them with national estimates. It found that the difference in average Medicare expenditures between the elderly beneficiaries with BC from a rural state (WV) and their national counterparts narrowed but remained significantly lower after multivariate adjustment.
AHRQ-funded; HS018622.
Citation: Vyas A, Madhavan SS, Sambamoorthi U .
Differences in Medicare expenditures between Appalachian and nationally representative cohorts of elderly women with breast cancer: an application of decomposition technique.
J Natl Compr Canc Netw 2017 May;15(5):578-87.
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Keywords: Cancer: Breast Cancer, Elderly, Healthcare Costs, Medicare, Rural Health
Inrig SJ, Higashi RT, Tiro JA
Assessing local capacity to expand rural breast cancer screening and patient navigation: an iterative mixed-method tool.
To expand rural breast cancer screening , the researchers proposed a regional hub-and-spoke model, partnering with local providers to expand access across North Texas. Their capacity assessment tool enabled the hub to establish partnerships with county organizations by tailoring support to local capacity and needs.
AHRQ-funded; HS022418.
Citation: Inrig SJ, Higashi RT, Tiro JA .
Assessing local capacity to expand rural breast cancer screening and patient navigation: an iterative mixed-method tool.
Eval Program Plann 2017 Apr;61:113-24. doi: 10.1016/j.evalprogplan.2016.11.006.
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Keywords: Access to Care, Cancer: Breast Cancer, Patient-Centered Healthcare, Rural Health, Screening
Chetta MD, Aliu O, Zhong L
Reconstruction of the irradiated breast: a national claims-based assessment of postoperative morbidity.
This study aims to assess the morbidity associated with various breast reconstruction techniques in irradiated patients. It found that overall complication rates were 45.3 percent and 30.8 percent for patients with implant and autologous reconstruction, respectively. Failure of reconstruction occurred in 29.4 percent of patients with implant reconstruction compared with 4.3 percent of patients with autologous reconstruction.
AHRQ-funded; HS023313.
Citation: Chetta MD, Aliu O, Zhong L .
Reconstruction of the irradiated breast: a national claims-based assessment of postoperative morbidity.
Plast Reconstr Surg 2017 Apr;139(4):783-92. doi: 10.1097/prs.0000000000003168.
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Keywords: Cancer, Cancer: Breast Cancer, Surgery, Adverse Events, Patient-Centered Outcomes Research
Kao CJ, Wurz GT, Lin YC
Repurposing ospemifene for potentiating an antigen-specific immune response.
The overall objective of the present series of preclinical studies was to evaluate the immunomodulatory activity of ospemifene in combination with a peptide cancer vaccine. The authors concluded that, taken together, ospemifene's dose response and schedule-dependent immune modulating activity offers a method of tailoring and augmenting the efficacy of previously failed antigen-specific cancer vaccines for a wide range of malignancies.
AHRQ-funded; HS022236.
Citation: Kao CJ, Wurz GT, Lin YC .
Repurposing ospemifene for potentiating an antigen-specific immune response.
Menopause 2017 Apr;24(4):437-51. doi: 10.1097/gme.0000000000000776.
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Keywords: Cancer: Breast Cancer, Cancer: Lung Cancer, Medication, Vaccination
Dabbous FM, Dolecek TA, Berbaum ML
Impact of a false-positive screening mammogram on subsequent screening behavior and stage at breast cancer diagnosis.
Researchers sought to examine the impact of a false positive (FP) screening mammogram on the subsequent screening mammography behavior. They found that experiencing a FP mammogram increases the risk of late stage at diagnosis compared with prior true negative (TN) mammogram Also, women with a FP mammogram were more likely to delay their subsequent screening compared with women with a TN mammogram.
AHRQ-funded; HS018366.
Citation: Dabbous FM, Dolecek TA, Berbaum ML .
Impact of a false-positive screening mammogram on subsequent screening behavior and stage at breast cancer diagnosis.
Cancer Epidemiol Biomarkers Prev 2017 Mar;26(3):397-403. doi: 10.1158/1055-9965.epi-16-0524.
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Keywords: Cancer: Breast Cancer, Cancer, Imaging, Screening, Diagnostic Safety and Quality, Women, Prevention
Harowicz MR, Robinson TJ, Dinan MA
Algorithms for prediction of the Oncotype DX recurrence score using clinicopathologic data: a review and comparison using an independent dataset.
This study analyzed 305 patients with invasive breast cancer who had Oncotype DX recurrence scores (ODX RS) available. Five equations were selected that provide a surrogate measure of ODX by Klein (Magee equations 1-3), Gage et al., and Tang et al. Although commonly available surrogates for ODX appear to predict high-risk ODX RS, the study was unable to reliably rule out the presence of patients with intermediate-risk disease by ODX.
AHRQ-funded; HS022189.
Citation: Harowicz MR, Robinson TJ, Dinan MA .
Algorithms for prediction of the Oncotype DX recurrence score using clinicopathologic data: a review and comparison using an independent dataset.
Breast Cancer Res Treat 2017 Feb;162(1):1-10. doi: 10.1007/s10549-016-4093-4.
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Keywords: Cancer, Cancer: Breast Cancer, Genetics, Women
Farias AJ, Du XL
Association between out-of-pocket costs, race/ethnicity, and adjuvant endocrine therapy adherence among Medicare patients with breast cancer.
This study aimed to determine whether there are racial/ethnic differences in 1-year adherence to adjuvant endocrine therapy (AET) and whether out-of-pocket costs explain the racial/ethnic disparities in adherence. It concluded that racial/ethnic disparities in AET adherence were largely explained by women's differences in socioeconomic status and out-of-pocket medication costs.
AHRQ-funded; HS018956.
Citation: Farias AJ, Du XL .
Association between out-of-pocket costs, race/ethnicity, and adjuvant endocrine therapy adherence among Medicare patients with breast cancer.
J Clin Oncol 2017 Jan;35(1):86-95.
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Keywords: Cancer: Breast Cancer, Healthcare Costs, Patient Adherence/Compliance, Racial and Ethnic Minorities, Social Determinants of Health
Pruitt SL, Tiro JA, Xuan L
Hispanic and immigrant paradoxes in U.S. breast cancer mortality: impact of neighborhood poverty and Hispanic density.
The researchers tested the Hispanic and Immigrant Paradoxes-i.e., survival advantages despite a worse risk factor profile-and the modifying role of neighborhood context. They found no evidence of an Immigrant Paradox and some evidence of a Hispanic Paradox where protective effects were limited to U.S.-born Hispanics. Contrary to prior studies, foreign birthplace and residence in higher Hispanic density neighborhoods were associated with increased mortality.
AHRQ-funded; HS022418.
Citation: Pruitt SL, Tiro JA, Xuan L .
Hispanic and immigrant paradoxes in U.S. breast cancer mortality: impact of neighborhood poverty and Hispanic density.
Int J Environ Res Public Health 2016 Dec 14;13(12):E1238. doi: 10.3390/ijerph13121238.
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Keywords: Cancer: Breast Cancer, Low-Income, Racial and Ethnic Minorities, Mortality, Racial and Ethnic Minorities
Giordano SH, Niu J, Chavez-MacGregor M
Estimating regimen-specific costs of chemotherapy for breast cancer: observational cohort study.
The objective of the current study was to generate cost estimates for guideline-concordant adjuvant chemotherapy regimens from payers' and patients' perspectives in a large, insured US population. It concluded that the costs of breast cancer chemotherapy vary widely across regimens, and patients bear a substantial out-of-pocket burden.
AHRQ-funded; HS020263.
Citation: Giordano SH, Niu J, Chavez-MacGregor M .
Estimating regimen-specific costs of chemotherapy for breast cancer: observational cohort study.
Cancer 2016 Nov 15; 122(2):3447-3455. doi: 10.1002/cncr.30274.
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Keywords: Cancer, Cancer: Breast Cancer, Treatments, Healthcare Costs
Elmore JG, Cook AJ, Bogart A
Radiologists' interpretive skills in screening vs. diagnostic mammography: are they related?
This study aimed to determine whether radiologists who perform well in screening also perform well in interpreting diagnostic mammography. It evaluated the accuracy of 468 radiologists interpreting 2,234,947 screening and 196,164 diagnostic mammograms and found a moderate correlation for radiologists' accuracy when interpreting screening versus their accuracy on diagnostic examinations.
AHRQ-funded; HS010591.
Citation: Elmore JG, Cook AJ, Bogart A .
Radiologists' interpretive skills in screening vs. diagnostic mammography: are they related?
Clin Imaging 2016 Nov - Dec;40(6):1096-103. doi: 10.1016/j.clinimag.2016.06.014.
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Keywords: Cancer: Breast Cancer, Diagnostic Safety and Quality, Screening, Imaging, Women, Provider Performance
Goodwin JS, Sheffield K, Li S
Receipt of cancer screening is a predictor of life expectancy.
The researchers sought to determine the association between receipt of screening mammography or PSA and overall survival. They found that the subjects with prior cancer screening had actual median survivals higher than those who were not screened, with differences ranging from 1.7 to 2.1 years for women and 0.9 to 1.1 years for men.
AHRQ-funded; HS022134.
Citation: Goodwin JS, Sheffield K, Li S .
Receipt of cancer screening is a predictor of life expectancy.
J Gen Intern Med 2016 Nov;31(11):1308-14. doi: 10.1007/s11606-016-3787-y.
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Keywords: Cancer, Cancer: Breast Cancer, Cancer: Prostate Cancer, Screening, Women, Men's Health, Health Status
Scarinci IC, Garces-Palacio IC, Morales-Aleman MM
Sowing the seeds of health: training of community health advisors to promote breast and cervical cancer screening among Latina immigrants in Alabama.
The researchers sought to develop and evaluate a culturally relevant training for Community Health Advisors (CHA) to promote breast and cervical cancer screening among Latina immigrants in Alabama. They found that a knowledge and skills training increased the CHAs' (1) knowledge of cancer screening and other health topics and (2) their perceived confidence to communicate with women in their communities about cancer screening and to motivate them to attain screenings.
AHRQ-funded; HS013852.
Citation: Scarinci IC, Garces-Palacio IC, Morales-Aleman MM .
Sowing the seeds of health: training of community health advisors to promote breast and cervical cancer screening among Latina immigrants in Alabama.
J Health Care Poor Underserved 2016;27(4):1779-93. doi: 10.1353/hpu.2016.0162.
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Keywords: Cancer, Cancer: Breast Cancer, Racial and Ethnic Minorities, Screening, Women
Mamtani R, Clark AS, Scott FI
Association between breast cancer recurrence and immunosuppression in rheumatoid arthritis and inflammatory bowel disease: a cohort study.
The researchers examined the rates of breast cancer recurrence in patients with immune-mediated disease and treated breast cancer who received therapy with methotrexate, thiopurines, or anti-tumor necrosis factor (anti-TNF). They found that the risk of breast cancer recurrence in patients who received methotrexate, thiopurine, or anti-TNF therapy was not statistically significantly increased, although they did not rule out a 2-fold or greater increased risk in those treated with thiopurines.
AHRQ-funded; HS021110; HS018517.
Citation: Mamtani R, Clark AS, Scott FI .
Association between breast cancer recurrence and immunosuppression in rheumatoid arthritis and inflammatory bowel disease: a cohort study.
Arthritis Rheumatol 2016 Oct;68(10):2403-11. doi: 10.1002/art.39738.
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Keywords: Cancer: Breast Cancer, Digestive Disease and Health, Medication, Patient-Centered Outcomes Research, Arthritis
Croswell J, Owings J
Screening for breast cancer.
This case study involves a 47-year-old woman who presents to your office for a well-woman visit. She is healthy, takes no medications, and has no health concerns. She has never been diagnosed with breast cancer, nor have any of her first-degree relatives. Her digital mammography two years ago was negative, and she asks whether she should be screened again this year. The study poses three multiple choice questions together with the U.S. Preventive Services Task Force recommendations and related background information.
AHRQ-authored.
Citation: Croswell J, Owings J .
Screening for breast cancer.
Am Fam Physician 2016 Jul 15;94(2):143-4.
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Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer: Breast Cancer, Cancer, Screening, Prevention, Evidence-Based Practice, Women, Imaging, Case Study
Bertrand KA, Baer HJ, Orav EJ
Early life body fatness, serum anti-mullerian hormone, and breast density in young adult women.
Researchers examined associations of early life body fatness, serum anti-Mullerian hormone (AMH) concentrations, and breast density among 172 women in the Dietary Intervention Study in Children (DISC). They found no evidence that current or early life BMI influences AMH concentrations in later life. Women with higher concentrations of AMH had similar percent and absolute dense breast volume, but lower nondense volume.
AHRQ-funded; HS019789.
Citation: Bertrand KA, Baer HJ, Orav EJ .
Early life body fatness, serum anti-mullerian hormone, and breast density in young adult women.
Cancer Epidemiol Biomarkers Prev 2016 Jul;25(7):1151-7. doi: 10.1158/1055-9965.epi-16-0185.
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Keywords: Cancer: Breast Cancer, Children/Adolescents, Obesity, Women, Young Adults
Ridner SH, Rhoten BA, Radina ME
Breast cancer survivors' perspectives of critical lymphedema self-care support needs.
The purpose of this paper was to solicit breast cancer survivors' perspectives on the variety of issues they face related to lymphedema self-care and to identify support needs perceived as critical for managing their chronic medical condition. The authors found that lack of support and the failure of others to recognize lymphedema as a chronic condition set this patient population apart from other patients with chronic diseases and decreases the amount of help needed to manage the condition.
AHRQ-funded; HS022990.
Citation: Ridner SH, Rhoten BA, Radina ME .
Breast cancer survivors' perspectives of critical lymphedema self-care support needs.
Support Care Cancer 2016 Jun;24(6):2743-50. doi: 10.1007/s00520-016-3089-2.
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Keywords: Cancer: Breast Cancer, Chronic Conditions, Patient-Centered Outcomes Research, Patient Self-Management
Roberts MC, Bryson A, Weinberger M
Patient-centered communication for discussing oncotype DX testing.
The researchers identified patient-centered communication strategies/gaps for discussing Oncotype DX testing (ODX) results. They applied a patient-centered communication framework to analyze qualitative interviews with oncologists about how they communicate about ODX with patients. Overall, providers discussed four patient-centered communication domains: exchanging information, assessing uncertainty, making decisions and cross-cutting themes.
AHRQ-funded; HS019468; HS022189.
Citation: Roberts MC, Bryson A, Weinberger M .
Patient-centered communication for discussing oncotype DX testing.
Cancer Invest 2016 May 27;34(5):205-12. doi: 10.3109/07357907.2016.1172637.
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Keywords: Cancer, Cancer: Breast Cancer, Communication, Clinician-Patient Communication, Decision Making, Genetics, Patient and Family Engagement, Patient-Centered Healthcare, Women