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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
76 to 100 of 185 Research Studies DisplayedIstl AC, Ruck JM, Morris CD
Call for improved design and reporting in soft tissue sarcoma studies: a systematic review and meta-analysis of chemotherapy and survival outcomes in resectable STS.
Researchers completed a meta-analysis of chemotherapy in localized STS, assessing OS, PFS, and local and distant recurrence. They found no benefit of chemotherapy over locoregional therapy alone for all-comers or site-specific STS. Recommendations to improve outcome reporting and quality indices are suggested.
AHRQ-funded; HS024736.
Citation: Istl AC, Ruck JM, Morris CD .
Call for improved design and reporting in soft tissue sarcoma studies: a systematic review and meta-analysis of chemotherapy and survival outcomes in resectable STS.
J Surg Oncol 2019 Jun;119(7):824-35. doi: 10.1002/jso.25401..
Keywords: Cancer, Treatments, Evidence-Based Practice, Mortality, Outcomes, Research Methodologies
Shaker M, Greenhawt M
Estimation of health and economic benefits of commercial peanut immunotherapy products: a cost-effectiveness analysis.
The goal of this study was to evaluate critical inputs associated with the cost-effectiveness of epicutaneous peanut immunotherapy (EPIT) and peanut oral immunotherapy (POIT) from a societal perspective. In microsimulations with Markov modeling, virtual children aged 4 years over received EPIT, POIT, or no immunotherapy treatment. The main outcomes and measures were rates of therapy-associated adverse reactions; quality-of-life improvements associated with changes in tolerated peanut doses were modeled along with quality-adjusted life-years (QALY), anaphylaxis, therapy-associated anaphylaxis, and fatalities. The findings of this simulated analysis indicate that EPIT and POIT may be cost-effective, but the authors note that further research is needed.
AHRQ-funded; HS024599.
Citation: Shaker M, Greenhawt M .
Estimation of health and economic benefits of commercial peanut immunotherapy products: a cost-effectiveness analysis.
JAMA Netw Open 2019 May 3;2(5):e193242. doi: 10.1001/jamanetworkopen.2019.3242..
Keywords: Healthcare Costs, Outcomes, Respiratory Conditions, Treatments
Ellis CT, Cole AL, Sanoff HK
Evaluating surveillance patterns after chemoradiation-only compared with conventional management for older patients with rectal cancer.
This study examined surveillance patterns for elderly patients who were treated only with chemoradiation (CR) as opposed to traditional treatment (chemoradiation and protectomy). In the cohort study, a total of 2,482 individuals met the inclusion criteria, with 21% receiving CR-only treatment, and 79% had conventional treatment. In comparison to patients who had traditional treatment, patients with CR-only treatment had far less follow-up during the first 2 years post-treatment. Adherence to guideline-recommended surveillance was poor for all Medicare patients, but especially for CR-only treated patients.
AHRQ-funded; HS000032.
Citation: Ellis CT, Cole AL, Sanoff HK .
Evaluating surveillance patterns after chemoradiation-only compared with conventional management for older patients with rectal cancer.
J Am Coll Surg 2019 May;228(5):782-91.e2. doi: 10.1016/j.jamcollsurg.2019.01.010..
Keywords: Cancer, Cancer: Colorectal Cancer, Care Management, Treatments, Elderly, Patient-Centered Outcomes Research
Chapman WC, Subramanian M, Jayarajan S
First, do no harm: rethinking routine diversion in sphincter-preserving rectal cancer resection.
The authors hypothesized that routine temporary diversion is not associated with decreased rates of leak or reintervention in cancer patients at large undergoing sphincter-sparing procedures. Using HCUP data from the Florida State Inpatient Database, they found no association between diversion and anastomotic leak. However, temporary diversion was associated with increased incidence of nonelective reinterventions, readmissions, and higher costs. They recommended additional study to identify which patients would benefit most from diversion.
AHRQ-funded; HS019455.
Citation: Chapman WC, Subramanian M, Jayarajan S .
First, do no harm: rethinking routine diversion in sphincter-preserving rectal cancer resection.
J Am Coll Surg 2019 Apr;228(4):547-56.e8. doi: 10.1016/j.jamcollsurg.2018.12.012..
Keywords: Healthcare Cost and Utilization Project (HCUP), Cancer: Colorectal Cancer, Cancer, Surgery, Treatments
Yin LX, Padula WV, Gadkaree S
Health care costs and cost-effectiveness in laryngotracheal stenosis.
The goal of this study was to conduct a cost-effectiveness analysis comparing open reconstruction surgery versus endoscopic dilation in the treatment of laryngotracheal stenosis (LTS). Cricotracheal/tracheal resection (CTR/TR) and endoscopic dilation were compared at a willingness-to-pay threshold of $50,000 per quality-adjusted life year (QALY) over 5 and 10 years. Annual treatment costs were derived from the Department of Otolaryngology-Head and Neck Surgery at Johns Hopkins University. The results indicate that patients with intubation-related stenosis have higher annual costs than idiopathic patients. The major risk factor for increased cost was etiology of stenosis. Although CTR/TR contributes significantly to cost in LTS, it is more cost-effective than endoscopic dilations for appropriately selected patients over the 5- and 10-year periods.
AHRQ-funded; HS000029.
Citation: Yin LX, Padula WV, Gadkaree S .
Health care costs and cost-effectiveness in laryngotracheal stenosis.
Otolaryngol Head Neck Surg 2019 Apr;160(4):679-86. doi: 10.1177/0194599818815068..
Keywords: Healthcare Costs, Surgery, Treatments
Wilkinson ST, Holtzheimer PE, Gao S
Leveraging neuroplasticity to enhance adaptive learning: the potential for synergistic somatic-behavioral treatment combinations to improve clinical outcomes in depression.
This article reviews the potential of synergistically combining plasticity-enhancing and behavioral therapies to develop translational treatment approaches for depression. After reviewing relevant neuroplasticity deficits in depression, the article surveys biological treatments that appear to reverse such deficits in humans; evidence that directly or indirectly supports the hypothesis that a robust enhancement of neuroplasticity through these methods might promote the uptake of cognitive and behavioral interventions to enhance longer-term treatment outcomes is then reviewed. The authors identify missing pieces of key evidence and discuss future directions that could enhance this line of research.
AHRQ-funded; HS023000.
Citation: Wilkinson ST, Holtzheimer PE, Gao S .
Leveraging neuroplasticity to enhance adaptive learning: the potential for synergistic somatic-behavioral treatment combinations to improve clinical outcomes in depression.
Biol Psychiatry 2019 Mar 15;85(6):454-65. doi: 10.1016/j.biopsych.2018.09.004..
Keywords: Behavioral Health, Depression, Patient-Centered Outcomes Research, Treatments
Dinan MA, Wilson LE, Reed SD
Chemotherapy costs and 21-gene recurrence score genomic testing among Medicare beneficiaries with early-stage breast cancer, 2005 to 2011.
This study examined whether associations between 21-gene recurrence score (RS) genomic testing and lower costs among patients with early-stage, estrogen receptor-positive breast cancer were observable in real-world data from the Medicare population. The investigators found that RS testing was associated with lower overall and chemotherapy-related costs in patients with high-risk disease, consistent with lower chemotherapy use among these patients. Higher overall costs for patients with intermediate-risk and low-risk disease were driven largely by non-treatment-related costs.
AHRQ-funded; HS022189.
Citation: Dinan MA, Wilson LE, Reed SD .
Chemotherapy costs and 21-gene recurrence score genomic testing among Medicare beneficiaries with early-stage breast cancer, 2005 to 2011.
J Natl Compr Canc Netw 2019 Mar;17(3):245-54. doi: 10.6004/jnccn.2018.7097..
Keywords: Cancer, Cancer: Breast Cancer, Treatments, Genetics, Healthcare Costs, Medicare, Women
Antle BF, Owen JJ, Eells TD
Dissemination of computer-assisted cognitive-behavior therapy for depression in primary care.
Computer-assisted cognitive-behavior therapy (CCBT) for depression in primary care was evaluated in a trial with 240 patients randomly assigned to CCBT or treatment as usual (TAU). The study, described in this paper, disseminated a therapy method found to be effective in psychiatric settings into primary care - a setting in which there have been significant problems in the delivery of adequate, evidence-based treatment for depression.
AHRQ-funded; HS024047.
Citation: Antle BF, Owen JJ, Eells TD .
Dissemination of computer-assisted cognitive-behavior therapy for depression in primary care.
Contemp Clin Trials 2019 Mar;78:46-52. doi: 10.1016/j.cct.2018.11.001..
Keywords: Behavioral Health, Depression, Primary Care, Treatments
Schmidt B, Eapen RS, Cowan JE
Practice patterns of primary EBRT with and without ADT in prostate cancer treatment.
This study investigated usage of external-beam radiation therapy (EBRT), with or without neoadjuvant androgen deprivation therapy (ADT), using data from a community-based prospective disease registry (CaPSURE). Data on 1337 men diagnosed between 1990 and 2014 with localized disease who received EBRT as primary treatment was compared. The authors conclude that use of ADT in conjunction with primary EBRT has increased in frequency and duration since 1990, and that men who received ADT have higher risk characteristics than those who receive EBRT alone.
AHRQ-funded; HS019356.
Citation: Schmidt B, Eapen RS, Cowan JE .
Practice patterns of primary EBRT with and without ADT in prostate cancer treatment.
Prostate Cancer Prostatic Dis 2019 Mar;22(1):117-24. doi: 10.1038/s41391-018-0084-3..
Keywords: Cancer: Prostate Cancer, Cancer, Patient-Centered Outcomes Research, Practice Patterns, Evidence-Based Practice, Comparative Effectiveness, Outcomes, Treatments
Childers CP, Dworsky JQ, Maggard-Gibbons M
The contemporary appendectomy for acute uncomplicated appendicitis in adults.
Epidemiologic data related to the surgical management of appendicitis are out of date. In this study, the authors contemplated the role of nonoperative therapy in uncomplicated appendicitis and developed a contemporary profile of the risks and benefits of operative appendectomy by merging the 2016 National Surgical Quality Improvement Program essential and appendectomy-targeted participant use files.
AHRQ-funded; HS025079.
Citation: Childers CP, Dworsky JQ, Maggard-Gibbons M .
The contemporary appendectomy for acute uncomplicated appendicitis in adults.
Surgery 2019 Mar;165(3):593-601. doi: 10.1016/j.surg.2018.09.009..
Keywords: Care Management, Quality Improvement, Surgery, Treatments
Kitay BM, Katz RB, Wilkinson ST
The successful use of electroconvulsive therapy in a patient with cerebral aneurysms and a pituitary lesion.
This letter to the editor describes a case study in which a 52-year old women with a history of cerebral aneurysms and a pituitary lesion received electroconvulsive therapy (ECT) after unsuccessful treatment for recurrent severe major depressive disorder with psychosis and catatonia. After extensive workup and consultations with other specialists, 14 total treatments were given at 2-week intervals. The treatments were considered successful, and the woman returned to the community and continues to receive outpatient treatment. No other complications occurred.
AHRQ-funded; HS023000.
Citation: Kitay BM, Katz RB, Wilkinson ST .
The successful use of electroconvulsive therapy in a patient with cerebral aneurysms and a pituitary lesion.
J ECT 2019 Mar;35(1):e4-e5. doi: 10.1097/yct.0000000000000516..
Keywords: Case Study, Outcomes, Treatments
Gani F, Conca-Cheng AM, Nettles B
Trends in outcomes after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.
The goal of this study was to describe temporal trends in clinical outcomes among patients undergoing cytoreductive surgery or hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). Operative time, postoperative morbidity, and length of stay after CRS/HIPEC were observed to improve over the study period. Careful patient selection may result in favorable outcomes for select patients undergoing CRS/HIPEC.
AHRQ-funded; HS024736.
Citation: Gani F, Conca-Cheng AM, Nettles B .
Trends in outcomes after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.
J Surg Res 2019 Feb;234:240-48. doi: 10.1016/j.jss.2018.09.032..
Keywords: Adverse Events, Treatments, Cancer, Surgery, Outcomes
Vakharia PP, Chopra R, Silverberg NB
Efficacy and safety of topical cantharidin treatment for molluscum contagiosum and warts: a systematic review.
The objective of this systematic review was to assess the efficacy and safety of topical cantharidin treatment for molluscum contagiosum and warts. The investigators found that topical cantharidin demonstrated clearance of warts, particularly in combination with podophyllotixin and salicylic acid, and modest benefit for pediatric molluscum contagiosum with good tolerability and safety.
AHRQ-funded; HS023011.
Citation: Vakharia PP, Chopra R, Silverberg NB .
Efficacy and safety of topical cantharidin treatment for molluscum contagiosum and warts: a systematic review.
Am J Clin Dermatol 2018 Dec;19(6):791-803. doi: 10.1007/s40257-018-0375-4..
Keywords: Evidence-Based Practice, Skin Conditions, Treatments
Drucker AM, Adam GP, Rofeberg V
Treatments of primary basal cell carcinoma of the skin: a systematic review and network meta-analysis.
The purpose of the study was to evaluate the comparative effectiveness and safety of treatments of primary basal cell carcinoma (BCC) in adults. The investigators concluded that surgical treatments and external-beam radiation have low recurrence rates for the treatment of low-risk BCC, but substantial uncertainty exists about their comparative effectiveness versus other treatments. Gaps remain regarding high-risk BCC subtypes and important outcomes, including costs.
AHRQ-funded; 290201500002I.
Citation: Drucker AM, Adam GP, Rofeberg V .
Treatments of primary basal cell carcinoma of the skin: a systematic review and network meta-analysis.
Ann Intern Med 2018 Oct 2;169(7):456-66. doi: 10.7326/m18-0678.
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Keywords: Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Outcomes Research, Cancer: Skin Cancer, Treatments
Kuzniewicz MW, Niki H, Walsh EM
Hyperbilirubinemia, phototherapy, and childhood asthma.
The purpose of this retrospective cohort study was to quantify the associations of both hyperbilirubinemia and phototherapy with childhood asthma with total serum bilirubin (TSB) levels. Infants born after at least 35 weeks’ gestation within the Kaiser Permanente Northern California health system between 2010 and 2014 made up the study population. Cox models were used to estimate hazard ratios for a diagnosis of asthma. The researchers conclude that moderate levels of hyperbilirubinemia are associated with increased risk of asthma, but this association was not seen at higher levels. No dose-response relationship was observed.
AHRQ-funded; HS020618.
Citation: Kuzniewicz MW, Niki H, Walsh EM .
Hyperbilirubinemia, phototherapy, and childhood asthma.
Pediatrics 2018 Oct;142(4). doi: 10.1542/peds.2018-0662..
Keywords: Asthma, Children/Adolescents, Treatments
Shen NT, Schneider Y, Congly SE
Cost effectiveness of early insertion of transjugular intrahepatic portosystemic shunts for recurrent ascites.
Treatment options for recurrent ascites resulting from decompensated cirrhosis include serial large-volume paracentesis and albumin infusion (LVP+A) or insertion of a transjugular intrahepatic portosystemic shunt (TIPS). In this study, the investigators examined whether TIPS insertion was cost effective. The investigators concluded that based on Markov model analysis, early placement of TIPSs appeared to be a cost-effective strategy for management of specific patients with cirrhosis and recurrent ascites.
AHRQ-funded; HS000066.
Citation: Shen NT, Schneider Y, Congly SE .
Cost effectiveness of early insertion of transjugular intrahepatic portosystemic shunts for recurrent ascites.
Clin Gastroenterol Hepatol 2018 Sep;16(9):1503-10.e3. doi: 10.1016/j.cgh.2018.03.027..
Keywords: Healthcare Costs, Surgery, Patient-Centered Outcomes Research, Treatments
Lin SY, Azar A, Suarez-Cuervo C
Role of sublingual immunotherapy in the treatment of asthma: an updated systematic review.
This systematic review analyzed a number of studies on sublingual immunotherapy treatment (SLIT) for asthma caused by allergies. Fourteen randomized control trials (RCTs) studies were identified to analyze effective for allergies of house mites, birch, and grasses. However, a total of 20 RCTs and 10 observational studies were identified and used in this review. The review showed moderate-to-high strength evidence that SLIT is effective in improving allergic asthma symptoms. It also reduced long-term medication use and improved FEV1.
AHRQ-funded; 290201500006I.
Citation: Lin SY, Azar A, Suarez-Cuervo C .
Role of sublingual immunotherapy in the treatment of asthma: an updated systematic review.
Int Forum Allergy Rhinol 2018 Sep;8(9):982-92. doi: 10.1002/alr.22152..
Keywords: Asthma, Evidence-Based Practice, Patient-Centered Outcomes Research, Treatments
Su X, Pena AT, Liu L
Random forests of interaction trees for estimating individualized treatment effects in randomized trials.
Concerning experimental data collected from randomized trials, the authors describe a method, termed random forests of interaction trees (RFIT), for estimating individualized treatment effects on the basis of interaction trees.
AHRQ-funded; HS020263.
Citation: Su X, Pena AT, Liu L .
Random forests of interaction trees for estimating individualized treatment effects in randomized trials.
Stat Med 2018 Jul 30;37(17):2547-60. doi: 10.1002/sim.7660..
Keywords: Patient-Centered Outcomes Research, Treatments
Tyson MD, Koyama T, Lee D
Effect of prostate cancer severity on functional outcomes after localized treatment: comparative effectiveness analysis of surgery and radiation study results.
The purpose of this study was to determine whether differences in predicted function over time between radical prostatectomy (RP) or external beam radiotherapy (EBRT) for localized cancer varied by risk group. Patient-reported, disease-specific function was measured using the Expanded Prostate Index Composite and predicted function was estimated using regression models, compared by disease risk. The study found that sexual function was similar between surgery and radiation for patients with high-risk disease, and the authors conclude that high-risk patients undergoing radiation therapy should be counseled that their sexual function may not be as good as low-risk patients also undergoing radiation.
AHRQ-funded; HS019356; HS022640.
Citation: Tyson MD, Koyama T, Lee D .
Effect of prostate cancer severity on functional outcomes after localized treatment: comparative effectiveness analysis of surgery and radiation study results.
Eur Urol 2018 Jul;74(1):26-33. doi: 10.1016/j.eururo.2018.02.012..
Keywords: Cancer: Prostate Cancer, Cancer, Comparative Effectiveness, Treatments, Surgery, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Kanters AE, Morris AM, Albrahamse PH
The effect of peer support on colorectal cancer patients' adherence to guideline-concordant multidisciplinary care.
Dis Colon Rectum 2018 Jul;61(7):817-23. doi: 10.1097/dcr.0000000000001067.
The purpose of this study was to evaluate the effect of peer support on the attitudes of patients with colorectal cancer toward chemotherapy and their adherence to it. The study demonstrated that exposure to peer support is associated with higher adjuvant chemotherapy adherence.
The purpose of this study was to evaluate the effect of peer support on the attitudes of patients with colorectal cancer toward chemotherapy and their adherence to it. The study demonstrated that exposure to peer support is associated with higher adjuvant chemotherapy adherence.
AHRQ-funded; HS000053.
Citation: Kanters AE, Morris AM, Albrahamse PH .
The effect of peer support on colorectal cancer patients' adherence to guideline-concordant multidisciplinary care.
Dis Colon Rectum 2018 Jul;61(7):817-23. doi: 10.1097/dcr.0000000000001067..
Keywords: Cancer: Colorectal Cancer, Treatments, Guidelines, Medication, Patient Adherence/Compliance
Goode AP, Coeytaux RR, Maslow GR
Nonpharmacologic treatments for attention-deficit/hyperactivity disorder: a systematic review.
The authors assessed the comparative effectiveness of non-pharmacologic treatments for attention-deficit/hyperactivity disorder (ADHD) among individuals 17 years of age and younger. Non-pharmacologic treatments they identified included neurofeedback, cognitive training, cognitive behavioral therapy, child or parent training, dietary omega fatty acid supplementation, and herbal and/or dietary approaches. They identified no new guidance regarding the comparative effectiveness of non-pharmacologic treatments, concluding that, despite wide use, there are significant gaps in knowledge regarding the effectiveness of ADHD non-pharmacologic treatments.
AHRQ-funded; 290201500004I.
Citation: Goode AP, Coeytaux RR, Maslow GR .
Nonpharmacologic treatments for attention-deficit/hyperactivity disorder: a systematic review.
Pediatrics 2018 Jun;141(6). doi: 10.1542/peds.2018-0094.
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Keywords: Children/Adolescents, Behavioral Health, Comparative Effectiveness, Treatments, Evidence-Based Practice
Skrivankova V, Heagerty PJ
Single index methods for evaluation of marker-guided treatment rules based on multivariate marker panels.
Answering the scientific challenge to identify and validate the factors that can reliably be used to target treatment and to quantify the expected treatment benefit as a function of candidate markers, the authors of this article propose to focus on a smooth, non-parametric evaluation of a canonical single-index score that estimates the expected treatment benefit associated with patient characteristics. Their methods decouple the model used to generate the treatment benefit score from the methods adopted in order to evaluate the performance of the resulting single-index score. They also demonstrate that the canonical single-index treatment benefit score can be used for selecting subsets of patients with enriched expected treatment response.
AHRQ-funded; HS019222.
Citation: Skrivankova V, Heagerty PJ .
Single index methods for evaluation of marker-guided treatment rules based on multivariate marker panels.
Biometrics 2018 Jun;74(2):663-72. doi: 10.1111/biom.12752..
Keywords: Comparative Effectiveness, Decision Making, Outcomes, Treatments
Semenkovich TR, Panni RZ, Hudson JL
Comparative effectiveness of upfront esophagectomy versus induction chemoradiation in clinical stage T2N0 esophageal cancer: a decision analysis.
This study examined comparative effectiveness and survival rates for upfront esophagectomy versus induction chemoradiation in patients with clinical stage T2N20 esophageal cancer. A decision analysis model was created for the two treatment strategies. Results showed comparable median survival rates for both strategies. The optimal treatment strategy depended on the accuracy of endoscopic ultrasound staging.
AHRQ-funded; HS022330.
Citation: Semenkovich TR, Panni RZ, Hudson JL .
Comparative effectiveness of upfront esophagectomy versus induction chemoradiation in clinical stage T2N0 esophageal cancer: a decision analysis.
J Thorac Cardiovasc Surg 2018 May;155(5):2221-30.e1. doi: 10.1016/j.jtcvs.2018.01.006..
Keywords: Treatments, Cancer, Surgery, Comparative Effectiveness, Decision Making, Evidence-Based Practice, Patient-Centered Outcomes Research, Outcomes, Medication
Chen Y, Lairson DR, Chan W
Risk of adverse events associated with front-line anti-myeloma treatment in Medicare patients with multiple myeloma.
This study aims to examine the risks of adverse events associated with anti-multiple myeloma (MM) therapies in a large population-based cohort of elderly patients with MM. It found that novel agents significantly increased the risk of anemia, peripheral neuropathy, and thromboembolic events. Combination therapies consisting of proteasome inhibitor plus immunomodulatory drugs were associated with significantly higher risk for anemia, neutropenia and thromboembolic events.
AHRQ-funded; HS018956.
Citation: Chen Y, Lairson DR, Chan W .
Risk of adverse events associated with front-line anti-myeloma treatment in Medicare patients with multiple myeloma.
Ann Hematol 2018 May;97(5):851-63. doi: 10.1007/s00277-018-3238-4.
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Keywords: Adverse Drug Events (ADE), Cancer, Treatments, Medication, Risk
Khan SA, Pruitt SL, Xuan L
How does autoimmune disease impact treatment and outcomes among patients with lung cancer? A national SEER-Medicare analysis.
The advent of cancer immunotherapy has made autoimmune disease in oncology populations clinically important. The researchers analyzed the association of autoimmune disease with treatment and outcomes among lung cancer patients. They found that lung cancer treatment patterns were similar among patients with and without autoimmune disease and there was no significant association with mortality.
AHRQ-funded; HS022418.
Citation: Khan SA, Pruitt SL, Xuan L .
How does autoimmune disease impact treatment and outcomes among patients with lung cancer? A national SEER-Medicare analysis.
Lung Cancer 2018 Jan;115:97-102. doi: 10.1016/j.lungcan.2017.11.024.
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Keywords: Cancer: Lung Cancer, Patient-Centered Outcomes Research, Treatments