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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 16 of 16 Research Studies Displayed
Onaitis MW, Furnary AP, Kosinski AS
Equivalent survival between lobectomy and segmentectomy for clinical stage IA lung cancer.
This study compared the effectiveness of lobectomy and segmentectomy for treatment of clinical stage IA (T1N0) lung cancer patients. The Society of Thoracic Surgeons General Thoracic Surgery Database was linked to Medicare data in 14,286 lung cancer patients who underwent segmentectomy (n = 1654) or lobectomy (n = 12,632) from 2002 to 2015. Survival rates were found to be similar.
Citation: Onaitis MW, Furnary AP, Kosinski AS . Equivalent survival between lobectomy and segmentectomy for clinical stage IA lung cancer. Ann Thorac Surg 2020 Dec;110(6):1882-91. doi: 10.1016/j.athoracsur.2020.01.020..
Keywords: Cancer: Lung Cancer, Cancer, Surgery, Mortality, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
Friese CR, Fauer AJ, Kuisell C
Patient-reported outcomes collected in ambulatory oncology practices: feasibility, patterns, and correlates.
The purpose of this study was to examine the feasibility of soliciting outcomes from adults who received chemotherapy treatment for cancer and to describe the patterns and correlates of patient-reported toxicities. Results determined that querying patients on chemotherapy treatment experiences and toxicities was feasible. Toxicity rates varied across practices, informing quality improvement. Toxicity severity and service use incidence exceed previously published trial data, particularly for pain, fatigue, and gastrointestinal issues. Open-text questions enabled exploration with newer treatment regimens.
Citation: Friese CR, Fauer AJ, Kuisell C . Patient-reported outcomes collected in ambulatory oncology practices: feasibility, patterns, and correlates. Health Serv Res 2020 Dec;55(6):966-72. doi: 10.1111/1475-6773.13574..
Keywords: Ambulatory Care and Surgery, Cancer, Treatments, Quality of Care, Patient-Centered Outcomes Research, Outcomes
Huelster Huelster, Laviana AA, Joyce DD
Radiotherapy after radical prostatectomy: effect of timing of postprostatectomy radiation on functional outcomes.
This study sought to compare patient-reported functional outcomes after radical prostatectomy (RP) and postprostatectomy radiation as well as elucidate the timing of radiation to allow optimal recovery of function. Findings showed that, in men with localized prostate cancer, post-RP radiotherapy was associated with significantly worse sexual, urinary, and bowel function domain scores at 5 years compared to RP alone. Radiation delayed for approximately 24 months after RP may be optimal for preserving erectile function compared to radiation administered closer to the time of RP.
AHRQ-funded; HS019356; HS022640.
Citation: Huelster Huelster, Laviana AA, Joyce DD . Radiotherapy after radical prostatectomy: effect of timing of postprostatectomy radiation on functional outcomes. Urol Oncol 2020 Dec;38(12):930.e23-30.e32. doi: 10.1016/j.urolonc.2020.06.022..
Keywords: Cancer: Prostate Cancer, Cancer, Men's Health, Surgery, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice, Comparative Effectiveness
Brajcich BC, Bentrem DJ, Yang AD
Short-term risk of performing concurrent procedures with hepatic artery infusion pump placement.
This study’s objective was to characterize the short-term outcomes of concurrent surgery with hepatic artery infusion pump (HAIP) placement using data from the 2005-2017 ACS NSQIP dataset. Findings showed that HAIP placement is not associated with additional morbidity when performed with hepatic and/or colorectal surgery. Decisions regarding HAIP placement should consider the risks of concurrent operations as well as patient- and disease-specific factors.
Citation: Brajcich BC, Bentrem DJ, Yang AD . Short-term risk of performing concurrent procedures with hepatic artery infusion pump placement. Ann Surg Oncol 2020 Dec;27(13):5098-106. doi: 10.1245/s10434-020-08938-0..
Keywords: Quality Improvement, Quality of Care, Surgery, Risk, Cancer, Outcomes
Lara OD, O'Cearbhaill RE, Smith MJ
COVID-19 outcomes of patients with gynecologic cancer in New York City.
Researchers studied clinical characteristics and outcomes of vulnerable populations with gynecologic cancer who developed COVID-19 infections. Among patients from six New York City area hospital systems with known gynecologic cancer and a COVID-19 diagnosis, the researchers found a case fatality rate of 14 percent, with no association between cytotoxic chemotherapy and cancer-directed surgery and COVID-19 severity or death. They recommended that patients be counseled regarding the safety of continued anticancer treatments during the pandemic, as the ability to continue cancer therapies for cancer control and cure is critical.
Citation: Lara OD, O'Cearbhaill RE, Smith MJ . COVID-19 outcomes of patients with gynecologic cancer in New York City. Cancer 2020 Oct 1;126(19):4294-303. doi: 10.1002/cncr.33084..
Keywords: COVID-19, Respiratory Conditions, Cancer, Women, Vulnerable Populations, Outcomes, Urban Health
Azad AD, Bozkurt S, Wheeler AJ
Acute pain after breast surgery and reconstruction: a two-institution study of surgical factors influencing short-term pain outcomes.
This study analyzed the relationship between differing breast cancer excisional procedures, reconstruction, and short-term pain outcomes. Women who underwent breast cancer surgery with and without reconstruction were included from two institutions: an academic hospital (AH) and a Veterans Health Administration (VHS) facility. Average pain scores at time of discharge and at 30-day follow-up were analyzed. The study included 1402 patients at AH and 1435 at VHA. Of those, 425 AH and 165 VHA patients underwent breast reconstruction. Pain scores were highest at discharge and improved over time. Younger age, preoperative opioid use, and longer length of stay were all associated with worse pain scores.
Citation: Azad AD, Bozkurt S, Wheeler AJ . Acute pain after breast surgery and reconstruction: a two-institution study of surgical factors influencing short-term pain outcomes. J Surg Oncol 2020 Sep 15;122(4):623-31. doi: 10.1002/jso.26070..
Keywords: Pain, Cancer: Breast Cancer, Cancer, Surgery, Outcomes, Women
Sauder CAM, Bateni SB, Davidson AJ
Breast conserving surgery compared with mastectomy in male breast cancer: a brief systematic review.
The surgical guidelines for male breast cancer (MBC) have been largely guided by female-predominant clinical trials. Because no clinical trial has been conducted to examine the surgical treatment of MBC, the investigators performed a systematic review comparing the survival of patients with MBC who had undergone breast conserving surgery (BCS) and those who had undergone mastectomy and evaluated the patients' radiotherapy compliance after BCS.
Citation: Sauder CAM, Bateni SB, Davidson AJ . Breast conserving surgery compared with mastectomy in male breast cancer: a brief systematic review. Clin Breast Cancer 2020 Jun;20(3):e309-e14. doi: 10.1016/j.clbc.2019.12.004..
Keywords: Cancer: Breast Cancer, Cancer, Surgery, Evidence-Based Practice, Comparative Effectiveness, Patient-Centered Outcomes Research, Outcomes
Dominici LS, Rosenberg SM
Ductal carcinoma in situ (DCIS): the importance of patient-reported outcomes (PRO).
This review summarizes patient-reported outcomes (PROs) frequently assessed in the setting of a ductal carcinoma in situ (DCIS) diagnosis. Findings indicated that PROs provide critical information regarding the experiences of women following a DCIS diagnosis. Continued inclusion of PROs in clinical trials is warranted, further informing treatment decisions and adequately preparing patients for what to expect following treatment.
Citation: Dominici LS, Rosenberg SM . Ductal carcinoma in situ (DCIS): the importance of patient-reported outcomes (PRO). Curr Breast Cancer Rep 2020 Jun;12(2):90-97. doi: 10.1007/s12609-020-00363-2..
Keywords: Cancer: Breast Cancer, Cancer, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice, Women, Quality of Life
Cooper AJ, Keller SP, Chan C
Improvements in sepsis-associated mortality in hospitalized patients with cancer versus those without cancer. a 12-year analysis using clinical data.
The goal of this study was to assess trends in sepsis-associated mortality in hospitalized patients with and without cancer using objective clinical criteria to identify sepsis and detailed clinical data to adjust for severity of illness. Findings showed that sepsis-associated mortality rates declined significantly over a 12-year period in patients with cancer, but not in patients without cancer. Potential explanations include advances in the management of cancer and/or better sepsis treatments specifically in patients with cancer.
Citation: Cooper AJ, Keller SP, Chan C . Improvements in sepsis-associated mortality in hospitalized patients with cancer versus those without cancer. a 12-year analysis using clinical data. Ann Am Thorac Soc 2020 Apr;17(4):466-73. doi: 10.1513/AnnalsATS.201909-655OC..
Keywords: Sepsis, Mortality, Cancer, Hospitalization, Outcomes
Gawron AJ, Shah SC, Altayar O
AGA technical review on gastric intestinal metaplasia-natural history and clinical outcomes.
This technical review from the American Gastroenterological Association (AGA) describes the natural history and clinical outcomes of gastric intestinal metaplasia (GIM) which can be a precursor to gastric cancer. A comprehensive systematic literature review was first conducted to provide guidance for formulating evidence-based recommendations on the management of GIM in the absence of concurrence neoplasia (dysplasia or cancer). The purpose of the literature review was to gather the evidence to determine what the best recommendations would be. A technical review team consisting of 1 GRADE methodologist, 3 gastroenterologists, 1 pathologist, and 2 gastroenterology fellows came to together to identify 4 questions using the PICO (population, intervention, comparator, and outcomes) format. H. pylori is sometimes concurrent with GIM and the first question is whether testing for it can affect patient-important outcomes. The other questions involve whether an upper endoscopy should be conducted depending on a patient’s risk. The systematic review process is described and out of a total of 3716 articles, 580 were reviewed, with 121 included in the meta-analyses. The panel was able to find evidence to inform the first 3 questions, but there was no direct evidence to inform PICO 4 so they used indirect evidence to reach a consensus. In general, they concluded H. pylori testing and treatment in patients with confirmed infection provided some protection against incident gastric cancer. However there was only indirect evidence to support use of an endoscopy in patients with GIM.
Citation: Gawron AJ, Shah SC, Altayar O . AGA technical review on gastric intestinal metaplasia-natural history and clinical outcomes. Gastroenterology 2020 Feb;158(3):705-31.e5. doi: 10.1053/j.gastro.2019.12.001..
Keywords: Evidence-Based Practice, Cancer, Outcomes
Hu QL, Liu JB, Ellis RJ
Association of preoperative biliary drainage technique with postoperative outcomes among patients with resectable hepatobiliary malignancy.
Endoscopic biliary stenting (EBS) and percutaneous transhepatic biliary drainage (PTBD) are two techniques used for preoperative biliary drainage prior to hepatobiliary resection. The objectives of this study were to determine predictors of the drainage technique selection and to evaluate the association between drainage technique and postoperative outcomes. The investigators concluded that patients undergoing hepatobiliary resection selected for PTBD had significantly more preoperative co-morbidities and nutritional deficits. Compared to EBS, PTBD was associated with significantly higher odds of postoperative morbidity and mortality.
AHRQ-funded; HS026385; 233201500020I.
Citation: Hu QL, Liu JB, Ellis RJ . Association of preoperative biliary drainage technique with postoperative outcomes among patients with resectable hepatobiliary malignancy. HPB 2020 Feb;22(2):249-57. doi: 10.1016/j.hpb.2019.06.011..
Keywords: Cancer, Surgery, Adverse Events, Outcomes
Lange JM, Laviana AA, Penson DF
Prostate cancer mortality and metastasis under different biopsy frequencies in North American active surveillance cohorts.
This study projected the comparative benefits of different active surveillance (AS) schedules in men diagnosed with prostate cancer who had Gleason score (GS) </=6 disease and risk profiles similar to those in North American AS cohorts. Results showed that, among men diagnosed with GS </=6 prostate cancer, obtaining a biopsy every 3 or 4 years appeared to be an acceptable alternative to more frequent biopsies. Reducing surveillance intensity for those who have a low risk of progression reduces the number of biopsies while preserving the benefit of more frequent schedules.
Citation: Lange JM, Laviana AA, Penson DF . Prostate cancer mortality and metastasis under different biopsy frequencies in North American active surveillance cohorts. Cancer 2020 Feb 1;126(3):583-92. doi: 10.1002/cncr.32557..
Keywords: Cancer: Prostate Cancer, Cancer, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice, Men's Health
Khorfan R, Schlick CJR, Yang AD
Utilization of minimally invasive surgery and its association with chemotherapy for locally advanced gastric cancer.
This study compared outcomes of patients with T3 or greater and/or N+ gastric carcinoma who had minimally invasive surgery (MIS) or traditional open surgery. Patients who received MIS had a greater likelihood of receiving postoperative chemotherapy. Patients from the National Cancer Database (21,872) from 2010 to 2015 were identified. The majority (72.2%) received open surgery although MIS rates went up during that time period. Predictors of MIS were Asian race, any insurance coverage and treatment at high-volume centers. Survival rates were higher for MIS patients although that could be explained by their increased likelihood of receiving adjuvant chemotherapy.
Citation: Khorfan R, Schlick CJR, Yang AD . Utilization of minimally invasive surgery and its association with chemotherapy for locally advanced gastric cancer. J Gastrointest Surg 2020 Feb;24(2):243-52. doi: 10.1007/s11605-019-04410-x.
Keywords: Surgery, Treatments, Cancer, Digestive Disease and Health, Healthcare Utilization, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Hoffman KE, Penson DF, Zhao Z
Patient-reported outcomes through 5 years for active surveillance, surgery, brachytherapy, or external beam radiation with or without androgen deprivation therapy for localized prostate cancer.
This study compared different treatment of men with favorable-risk prostate cancer and those with unfavorable-risk disease and their functional outcomes 5 years post-treatment. Treatment options for favorable-risk disease include active surveillance, nerve-sparing prostatectomy, external beam radiation therapy (EBRT), or low-dose-rate brachytherapy with prostatectomy being the most common. Treatment options for men with unfavorable-risk disease is prostatectomy or EBRT with androgen deprivation therapy (ADT). The cohort analyzed included men diagnosed with prostate cancer in 2011 through 2012, accrued from 5 Surveillance, Epidemiology and End Results Program sites and a US prostate cancer registry, using surveys through September 2017. A total of 2005 men met inclusion criteria. For men with favorable-risk disease low-dose-rate brachytherapy was associated with worse urinary irritative, and sexual and bowel function at 1 year compared with active surveillance. Nerve-sparing prostatectomy was associated with worse urinary incontinence at 5 years and sexual function at 3 years compared with active surveillance. EBRT was not associated with clinically different function changes from active surveillance at any point during the 5 years. For men with unfavorable-risk disease, EBRT with ADT was associated with lower hormonal function at 6 months, bowel function at 1 year, but better sexual function and incontinence than prostatectomy.
AHRQ-funded; HS019356; HS022640.
Citation: Hoffman KE, Penson DF, Zhao Z . Patient-reported outcomes through 5 years for active surveillance, surgery, brachytherapy, or external beam radiation with or without androgen deprivation therapy for localized prostate cancer. JAMA 2020 Jan 14;323(2):149-63. doi: 10.1001/jama.2019.20675..
Keywords: Cancer: Prostate Cancer, Cancer, Comparative Effectiveness, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice, Treatments, Men's Health, Adverse Events, Surgery
Yu K, Westbrook M, Brodie S
Gaps in treatment and surveillance: head and neck cancer care in a safety-net hospital.
Treatment delays and suboptimal adherence to posttreatment surveillance may adversely affect head and neck cancer (HNC) outcomes. Such challenges can be exacerbated in safety-net settings that struggle with limited resources and serve a disproportionate number of patients vulnerable to gaps in care. This study aimed to characterize treatment delays and adherence with posttreatment surveillance in HNC care at an urban tertiary care public hospital in San Francisco.
Citation: Yu K, Westbrook M, Brodie S . Gaps in treatment and surveillance: head and neck cancer care in a safety-net hospital. OTO Open 2020 Jan-Mar;4(1):2473974x19900761. doi: 10.1177/2473974x19900761..
Keywords: Cancer, Safety Net, Hospitals, Outcomes
Banerjee M, Muenz DG, Worden FP
Conditional survival in patients with thyroid cancer.
This study used data from Surveillance, Epidemiology, and End Results (SEER) registry to determine conditional 5-year disease-specific survival based on patient age, gender, and stage. It found that patients with localized thyroid cancer have excellent conditional 5-year survival, irrespective of where they are in their survivorship phase. In addition, patients with regional thyroid cancer have relatively stable conditional 5-year survival.
Citation: Banerjee M, Muenz DG, Worden FP . Conditional survival in patients with thyroid cancer. Thyroid 2014 Dec;24(12):1784-9. doi: 10.1089/thy.2014.0264..
Keywords: Cancer, Mortality, Outcomes, Registries