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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.
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1 to 25 of 184 Research Studies DisplayedConley CC, Wernli KJ, Knerr S
Using protection motivation theory to predict intentions for breast cancer risk management: intervention mechanisms from a randomized controlled trial.
The objective of this study was to evaluate direct and indirect effects of a web-based, Protection Motivation Theory (PMT)-informed education and decision support tool for risk-reducing medication and breast MRI among women with high risk of breast cancer. Findings indicated that PMT-informed intervention effected behavioral intentions. No direct intervention effect on intentions for risk-reducing medication or MRI were found, but there were significant indirect effects on risk-reducing medication intentions via perceived risk, self-efficacy, and response efficacy, and on MRI intentions via perceived risk and response efficacy, The authors suggested that future research should extend these findings from intentions to behavior.
AHRQ-funded; HS022982.
Citation: Conley CC, Wernli KJ, Knerr S .
Using protection motivation theory to predict intentions for breast cancer risk management: intervention mechanisms from a randomized controlled trial.
J Cancer Educ 2023 Feb; 38(1):292-300. doi: 10.1007/s13187-021-02114-y..
Keywords: Cancer: Breast Cancer, Cancer, Risk, Education: Patient and Caregiver, Health Information Technology (HIT)
Khoong EC, Rivadeneira NA, Pacca L
Extent of follow-up on abnormal cancer screening in multiple California public hospital systems: a retrospective review.
This report’s objective was to describes patterns of performance on follow-up of abnormal colon and breast cancer screening tests and explores the extent to which racial/ethnic disparities exist in public hospital systems. The authors conducted a retrospective cohort study using data from five California public hospital systems between July 2015 and June 2017. The authors assessed follow-up rates of colonoscopy after positive fecal immunochemical tests (FIT) and breast tissue biopsy within 21 days after a BIRADS 4/5 mammogram. Negative associations with follow-up colonoscopy were associated with older age, Medicaid insurance, lack of insurance, English language and site; while Hispanic ethnicity and Asian race were positively associated with follow-up colonoscopy. Of 1702 BIRADS 4/5 mammograms, 64% received a timely biopsy; only site was associated with timely follow-up biopsy. Site-level factors were found to have a larger, more consistent impact on follow-up rates than patient sociodemographic traits.
AHRQ-funded; HS024412.
Citation: Khoong EC, Rivadeneira NA, Pacca L .
Extent of follow-up on abnormal cancer screening in multiple California public hospital systems: a retrospective review.
J Gen Intern Med 2023 Jan; 38(1):21-29. doi: 10.1007/s11606-022-07657-4..
Keywords: Cancer: Breast Cancer, Cancer: Colorectal Cancer, Cancer, Screening, Disparities, Women
Schumacher JR, Zahrieh D, Chow S
Increasing socioeconomically disadvantaged patients' engagement in breast cancer surgery decision-making through a shared decision-making intervention (A231701CD): protocol for a cluster randomised clinical trial.
This paper describes the protocol for a multisite randomized trial to test the impact of a newly developed decision aid to increase socioeconomically disadvantaged patients' engagement in breast cancer surgery decision-making. The study will be conducted through 10 surgical clinics within the National Cancer Institute Community Oncology Research Program (NCORP). A stepped-wedge design with clinics will be randomized to the time of transition from usual care to the decision aid arm. Study participants will be female, aged ≥18 years, with newly diagnosed stage 0-III breast cancer who are planning breast surgery. Data collection will include a baseline surgeon survey, baseline patient survey, audio-recording of the surgeon-patient consultation, a follow-up patient survey and medical record data review. A subset of patients, surgeons, and clinic stakeholders will participate in interviews and focus groups.
AHRQ-funded; HS025194.
Citation: Schumacher JR, Zahrieh D, Chow S .
Increasing socioeconomically disadvantaged patients' engagement in breast cancer surgery decision-making through a shared decision-making intervention (A231701CD): protocol for a cluster randomised clinical trial.
BMJ Open 2022 Nov 17;12(11):e063895. doi: 10.1136/bmjopen-2022-063895..
Keywords: Cancer: Breast Cancer, Cancer, Patient and Family Engagement, Decision Making, Patient-Centered Healthcare, Surgery, Women
Ross RL, Rubio K, Rodriguez HP
Mammography and decision aid use for breast cancer screening in older women.
This study examines the association between practice-level decision-aid use and mammography use among older women. Physician practice responses to the 2017/2018 National Survey of Healthcare Organizations and Systems were linked to 2016-17 Medicare fee-for-service beneficiary data from eligible beneficiaries aged 65-74 years. Findings showed that health information technology-enabled automation of mammography reminders and other advanced health information technology functions may support mammography, whereas breast cancer decision aids may reduce patients' propensities to be screened through the alignment of their preferences and screening decision.
AHRQ-funded; HS022241; HS024075.
Citation: Ross RL, Rubio K, Rodriguez HP .
Mammography and decision aid use for breast cancer screening in older women.
Am J Prev Med 2022 Oct;63(4):630-35. doi: 10.1016/j.amepre.2022.04.014..
Keywords: Imaging, Screening, Decision Making, Cancer: Breast Cancer, Women, Prevention, Cancer, Elderly
Warren DK, Peacock KM, Nickel KB
Postdischarge prophylactic antibiotics following mastectomy with and without breast reconstruction.
The authors investigated factors associated with post-discharge prophylactic antibiotic use after mastectomy with and without immediate reconstruction and the impact on surgical-site infection (SSI). They found that anti-methicillin-sensitive Staphylococcus aureus antibiotics were associated with decreased risk of SSI for patients who had mastectomy only and those who had mastectomy with immediate reconstruction. They concluded that the high numbers needed to treat suggest that potential benefits of post-discharge antibiotics should be weighed against potential harms associated with antibiotic overuse.
AHRQ-funded; HS019455.
Citation: Warren DK, Peacock KM, Nickel KB .
Postdischarge prophylactic antibiotics following mastectomy with and without breast reconstruction.
Infect Control Hosp Epidemiol 2022 Oct;43(10):1382-88. doi: 10.1017/ice.2021.400..
Keywords: Antibiotics, Cancer: Breast Cancer, Cancer, Medication, Surgery, Healthcare-Associated Infections (HAIs), Prevention, Women, Practice Patterns
Golmakani MK, Hubbard RA, Miglioretti DL
Nonhomogeneous Markov chain for estimating the cumulative risk of multiple false positive screening tests.
This study addressed the general challenge of estimating the cumulative risk of multiple false positive test results. The authors proposed a nonhomogeneous multistate model to describe the screening process including competing events and developed alternative approaches for estimating the cumulative risk of multiple false positive results using this multistate model based on existing estimators for the cumulative risk of a single false positive. The multistate model was based on existing estimators for the cumulative risk of a single false positive. They compared the performance of the newly proposed models through simulation studies and illustrated model performance using data on screening mammography from the Breast Cancer Surveillance Consortium. They found that in the context of screening mammography that the cumulative risk of multiple false positive results is high. For a high-risk individual, the cumulative probability of at least two false positive mammography results after 10 rounds of annual screening is 40.4.
AHRQ-funded; HS018366.
Citation: Golmakani MK, Hubbard RA, Miglioretti DL .
Nonhomogeneous Markov chain for estimating the cumulative risk of multiple false positive screening tests.
Biometrics 2022 Sep;78(3):1244-56. doi: 10.1111/biom.13484..
Keywords: Research Methodologies, Screening, Imaging, Cancer: Breast Cancer, Cancer
Wernli KJ, Smith RE, Henderson LM
Decision quality and regret with treatment decisions in women with breast cancer: pre-operative breast MRI and breast density.
The authors evaluated self-report of decision quality and regret with breast cancer surgical treatment by pre-operative breast MRI use in women recently diagnosed with breast cancer. They found that breast MRI use in the diagnostic work-up of breast cancer does not negatively alter women's perceptions of surgical treatment decisions in early survivorship.
AHRQ-funded; HS018366.
Citation: Wernli KJ, Smith RE, Henderson LM .
Decision quality and regret with treatment decisions in women with breast cancer: pre-operative breast MRI and breast density.
Breast Cancer Res Treat 2022 Aug;194(3):607-16. doi: 10.1007/s10549-022-06648-7..
Keywords: Cancer: Breast Cancer, Cancer, Decision Making, Women, Patient-Centered Outcomes Research
Bredbeck BC, Mott NM, Wang T
Facility-level variation of low-value breast cancer treatments in older women with early-stage breast cancer: analysis of a statewide claims registry.
The goal of this retrospective cohort study was to determine facility-level variation of sentinel lymph node biopsy (SLNB) and adjuvant radiotherapy in older women with early-stage, hormone receptor-positive (HR+) breast cancer who were undergoing breast-conserving surgery (BCS). Researchers used a statewide registry of claims data and included a cohort of women aged 70 or older who were diagnosed with breast cancer and who underwent BCS at 80 hospitals in the Michigan Value Collaborative. They concluded that SLNB and radiotherapy rates remain high with significant variation in utilization at the facility level, and that high utilizers of SLNB are also likely to be high utilizers of radiotherapy.
AHRQ-funded; HS026030.
Citation: Bredbeck BC, Mott NM, Wang T .
Facility-level variation of low-value breast cancer treatments in older women with early-stage breast cancer: analysis of a statewide claims registry.
Ann Surg Oncol 2022 Jul; 29(7):4155-64. doi: 10.1245/s10434-022-11631-z..
Keywords: Cancer: Breast Cancer, Cancer, Elderly, Women
Parikh DA, Kody L, Brain S
Patient perspectives on window of opportunity clinical trials in early-stage breast cancer.
This qualitative study aimed to understand patient perspectives on participation in window of opportunity (WOT) clinical trials with women diagnosed with early-stage breast cancer. The authors recruited 25 women diagnosed with early-stage breast cancer who were awaiting definitive therapy at a single-academic medical center to participate in semi-structured interviews. Interviewees indicated positive attitudes toward participation in such a trial were a desire to contribute to research and a hope for personal benefit. The most common concerns were the potential for side effects and how they impact fitness for planned treatment. Family was indicated as an important normative factor. Participation could be hindered by delay in standard treatment and the requirement for additional visits or procedures. Ultimately, 17 out of 25 interviewees stated that they would participate in a WOT if offered.
AHRQ-funded; HS026128.
Citation: Parikh DA, Kody L, Brain S .
Patient perspectives on window of opportunity clinical trials in early-stage breast cancer.
Breast Cancer Res Treat 2022 Jul;194(1):171-78. doi: 10.1007/s10549-022-06611-6..
Keywords: Cancer: Breast Cancer, Cancer, Women
Kerlikowske K, Su YR, Sprague BL
Association of screening with digital breast tomosynthesis vs digital mammography with risk of interval invasive and advanced breast cancer.
The purpose of this study was to compare digital breast tomosynthesis (DBT) with digital mammography to determine whether DBT was correlated with lower rates of internal invasive cancer and advanced breast cancer, taking into consideration breast density and breast cancer risk. From 2011 through 2018, the researchers studied a cohort of 504,427 women between the ages of 40 and 79 who underwent 375,189 screening DBT exams and 1,003,900 screening digital mammography exams, and who were then followed up for cancer diagnoses between 2011 and 2019 after being identified via linkage to state or regional cancer registries. The median age at the time of screening was 58 years (IQR 50-65 years) and the diagnostic screenings took place at 44 Breast Cancer Surveillance Consortium (BCSC) facilities in the United States. The study found that among women at low to average risk, or at high risk with almost entirely fatty, scattered fibroglandular densities, or heterogeneously dense breasts, advanced cancer rates were not significantly different for DBT vs digital mammography. There was no significant difference between DBT and digital mammography for interval cancer rates per 1000 exams. Interval invasive cancer rates were also not significantly different among the 413,061 examinations with BCSC 5-year risk of 1.67% or higher (high risk) across breast density categories, or among all the 836,250 examinations with BCSC 5-year risk less than 1.67% (low to average-risk). For the 3.6% of women with extremely dense breasts and at high risk of breast cancer (13,291 examinations in the DBT group and 31,300 in the digital mammography group) advanced cancer rates per 1000 examinations were significantly lower for DBT vs digital mammography, but not for women at low to average risk (10,611 examinations in the DBT group and 37,796 in the digital mammography group). The researchers reported that there was no significant difference in the 96.4% of women with extremely dense breasts not at high risk, heterogeneously dense breasts, or nondense breasts, and concluded that screening with DBT vs digital mammography was associated with a significantly lower risk of advanced breast cancer among the 3.6% of women with extremely dense breasts and at high risk of breast cancer, and was not associated with a significant difference in risk of interval invasive cancer.
AHRQ-funded; HS018366.
Citation: Kerlikowske K, Su YR, Sprague BL .
Association of screening with digital breast tomosynthesis vs digital mammography with risk of interval invasive and advanced breast cancer.
JAMA 2022 Jun 14;327(22):2220-30. doi: 10.1001/jama.2022.7672..
Keywords: Cancer: Breast Cancer, Cancer, Screening, Women, Imaging, Risk
Roberson ML, Nichols HB, Olshan AF
Trends in surgical treatment of early-stage breast cancer reveal decreasing mastectomy use between 2003 and 2016 by age, race, and rurality.
The authors sought to examine trends in the surgical treatment of breast cancer by age, rurality, and among Black women in a populous, racially diverse, state in the Southeastern United States of America. Using data from the North Carolina Central Cancer Registry, they found declining mastectomy rates in the early 2000s in a Southern US state with a racially and geographically diverse population. These decreasing trends were consistent among key subgroups affected by cancer inequities, including Black and White rural women.
AHRQ-funded; HS027299.
Citation: Roberson ML, Nichols HB, Olshan AF .
Trends in surgical treatment of early-stage breast cancer reveal decreasing mastectomy use between 2003 and 2016 by age, race, and rurality.
Breast Cancer Res Treat 2022 Jun;193(2):445-54. doi: 10.1007/s10549-022-06564-w..
Keywords: Cancer: Breast Cancer, Cancer, Women, Surgery, Racial / Ethnic Minorities, Rural Health
Loo S, Mullikin K, Robbins C
Patient navigator team perceptions on the implementation of a citywide breast cancer patient navigation protocol: a qualitative study.
This study’s goal was to assess the implementation of the 2018 Translating Research Into Practice (TRIP), an evidence-based patient navigation intervention aimed at addressing breast cancer care disparities, across six Boston hospitals. Patient navigator team member perspectives regarding implementation barriers and facilitators one-year post-study implementation were assessed. Seventeen interviews were conducted with patient navigators, patient navigator supervisors, and designated clinical champions. The following benefits were identified by participants: 1) increased networking and connections for navigators across clinical sites (Cosmopolitanism), 2) formalization of the patient navigation process (Goals and Purpose, Access to Knowledge and Information, and Relative Advantage), and 3) flexibility within the TRIP intervention that allowed for diversity in implementation and use of TRIP components across sites (Adaptability). Barriers included documentation requirements and the structured patient follow up guidelines that did not always align with the timeline of existing site navigation processes.
AHRQ-funded; HS022242.
Citation: Loo S, Mullikin K, Robbins C .
Patient navigator team perceptions on the implementation of a citywide breast cancer patient navigation protocol: a qualitative study.
BMC Health Serv Res 2022 May 21;22(1):683. doi: 10.1186/s12913-022-08090-3..
Keywords: Patient-Centered Healthcare, Cancer: Breast Cancer, Cancer, Patient-Centered Outcomes Research, Evidence-Based Practice
Lowry KP, Bissell MCS, Miglioretti DL
Breast biopsy recommendations and breast cancers diagnosed during the COVID-19 pandemic.
The authors sought to examine breast biopsy recommendations and breast cancers diagnosed before and during the COVID-19 pandemic by mode of detection and women's characteristics. Using data from the Breast Cancer Surveillance Consortium, they found that there were substantially fewer breast biopsies with cancer diagnoses during the COVID-19 pandemic from March to September 2020 compared to the same period in 2019, with Asian and Hispanic women experiencing the largest declines followed by Black women.
AHRQ-funded; HS018366.
Citation: Lowry KP, Bissell MCS, Miglioretti DL .
Breast biopsy recommendations and breast cancers diagnosed during the COVID-19 pandemic.
Radiology 2022 May;303(2):287-94. doi: 10.1148/radiol.2021211808..
Keywords: COVID-19, Cancer: Breast Cancer, Cancer, Diagnostic Safety and Quality
Rosenberg SM, Gierisch JM, Revette AC
"Is it cancer or not?" A qualitative exploration of survivor concerns surrounding the diagnosis and treatment of ductal carcinoma in situ.
This study investigated the impact of a ductal carcinoma in situ (DCIS) diagnosis by engaging self-identified patients regarding their experience. Findings showed that, in a large, national sample, participants with a history of DCIS reported confusion and concern about the diagnosis and treatment, which caused worry and significant uncertainty.
AHRQ-funded; HS023680.
Citation: Rosenberg SM, Gierisch JM, Revette AC .
"Is it cancer or not?" A qualitative exploration of survivor concerns surrounding the diagnosis and treatment of ductal carcinoma in situ.
Cancer 2022 Apr 15;128(8):1676-83. doi: 10.1002/cncr.34126..
Keywords: Cancer: Breast Cancer, Cancer, Decision Making, Women, Patient-Centered Healthcare, Clinician-Patient Communication, Patient and Family Engagement, Communication
Saulsberry L, Liao C, Huo D
Hypofractionated radiation therapy for breast cancer: financial risk and expenditures in the United States, 2008 to 2017.
This study examined the costs of hypofractionated whole breast irradiation (HF-WBI) compared with conventional whole breast irradiation (CF-WBI) and investigated the influences of patient characteristics and commercial insurance on HF-WBI use. This retrospective study used private employer-sponsored insurance claims to obtain a pooled cross-sectional evaluation of radiation therapy in patients with commercial insurance from 2008 to 2017. The study population included female patients with early-stage breast cancer treated with lumpectomy and whole breast irradiation. A total of 15,869 women received HF-WBI, and 59,328 CF-WBI. A higher proportion of college graduates and greater mixed racial composition was associated with increased HF-WBI use. Mean insurer-paid radiation therapy expenditures were significantly lower for HB-WBI versus CF-WBI (adjusted difference $6375). Mean patient out-of-pocket expenditures for HF-WBI was $139 less than for CF-WBI. Geographic variation existed across the United States with no consistent relationship between HF-WBI use and correspondent average cost differences.
AHRQ-funded; HS025806.
Citation: Saulsberry L, Liao C, Huo D .
Hypofractionated radiation therapy for breast cancer: financial risk and expenditures in the United States, 2008 to 2017.
Int J Radiat Oncol Biol Phys 2022 Mar;112(3):654-62. doi: 10.1016/j.ijrobp.2021.10.005..
Keywords: Cancer: Breast Cancer, Cancer, Healthcare Costs, Women
Rosenberg SM, O'Neill A, Sepucha K
Quality of life following receipt of adjuvant chemotherapy with and without bevacizumab in patients with lymph node-positive and high-risk lymph node-negative breast cancer.
The authors sought to describe and evaluate factors associated with diminished quality of life (QOL) following completion of active breast cancer treatment. They conducted a survey with patients 18 months after enrollment and found that the addition of bevacizumab to chemotherapy was not negatively associated with QOL at 18 months. A substantial proportion of participants reported problems related to pain or discomfort and anxiety or depression; as many reported problems can be amenable to intervention, timely referral to supportive resources, especially for women of color and those who have more extensive local therapy, is indicated.
AHRQ-funded; HS023680.
Citation: Rosenberg SM, O'Neill A, Sepucha K .
Quality of life following receipt of adjuvant chemotherapy with and without bevacizumab in patients with lymph node-positive and high-risk lymph node-negative breast cancer.
JAMA Netw Open 2022 Feb;5(2):e220254. doi: 10.1001/jamanetworkopen.2022.0254..
Keywords: Quality of Life, Cancer: Breast Cancer, Cancer, Women
Dossett LA, Mott NM, Bredbeck BC
Using tailored messages to target overuse of Low-Value breast cancer care in older women.
The purpose of this study was to examine the role that an individual’s maximizing-minimizing trait, an inherent preference for more or less medical care, may influence the preference for low-value care in the omission of sentinel lymph node biopsy (SLNB) and post-lumpectomy radiotherapy in women 70 years of age or higher with early-stage, hormone-receptor positive invasive breast cancer. The researchers recruited women 70 years of age or higher (n=1600) who were maximizers (515), minimizers (550), or neutral (535), and presented them with a hypothetical breast cancer diagnosis and then randomized exposure to one of three follow-up messages. Messages included: 1) maximizer-tailored, 2) minimizer-tailored, or 3) neutral. The study reported that higher maximizing tendency correlated positively with electing both SLNB and radiotherapy on logistic regression. Any maximizer- or minimizer-tailoring decreased preference for SLNB in maximizing and neutral women but had no effect in minimizing women. Tailoring had no impact on radiotherapy decision, except for an increased probability of minimizers electing radiotherapy when presented with maximizer-tailored messaging. The study concluded that among women facing a hypothetical breast cancer diagnosis, tendencies for maximizing-minimizing are correlated with preferences for treatment.
AHRQ-funded; HS026030.
Citation: Dossett LA, Mott NM, Bredbeck BC .
Using tailored messages to target overuse of Low-Value breast cancer care in older women.
J Surg Res 2022 Feb;270:503-12. doi: 10.1016/j.jss.2021.10.005..
Keywords: Elderly, Cancer: Breast Cancer, Cancer, Women, Decision Making, Clinician-Patient Communication, Communication, Value
Roberson ML, Nichols HB, Wheeler
Validity of breast cancer surgery treatment information in a state-based cancer registry.
Surgery is an important part of early stage breast cancer treatment that affects overall survival. Statewide cancer registries contain data on first course of cancer treatment for all patients diagnosed with cancer but the accuracy of these data are uncertain. In this study, the authors examined validity of breast cancer surgery treatment information in a state-based cancer registry.
AHRQ-funded; HS027299.
Citation: Roberson ML, Nichols HB, Wheeler .
Validity of breast cancer surgery treatment information in a state-based cancer registry.
Cancer Causes Control 2022 Feb;33(2):261-69. doi: 10.1007/s10552-021-01520-3..
Keywords: Cancer: Breast Cancer, Cancer, Surgery, Registries
Schapira L, Zheng Y, Gelber SI
Trajectories of fear of cancer recurrence in young breast cancer survivors.
This prospective cohort study examined the effects of fear of cancer recurrence (FCR) among 965 young women enrolled in the Young Women’s Breast Cancer Study who are ≤40 years and had been diagnosed with stage 0 to stage III breast cancer. These women completed the 3-item Lasry Fear or Recurrence Index survey. Five FCR trajectories were identified with a majority of participants having moderate or high FCR that improved over time. A total of 6.9% participants had moderate FCR that worsened, and 21.7% had a high FCR at baseline that didn’t go lower throughout the study. White women had higher odds of being in a trajectory that improved over time than non-White women. One-third of women with severe FCR did not improve or worsened over 5 years after diagnosis. The authors indicated these women may require targeted mental health intervention.
AHRQ-funded; HS023680.
Citation: Schapira L, Zheng Y, Gelber SI .
Trajectories of fear of cancer recurrence in young breast cancer survivors.
Cancer 2022 Jan 15;128(2):335-43. doi: 10.1002/cncr.33921..
Keywords: Cancer: Breast Cancer, Cancer, Women
Kang MM, Hasan Y, Waller J
Has hypofractionated whole-breast radiation therapy become the standard of care in the United States? An updated report from National Cancer Database.
This study examined trends in the use of hypofractionated whole-breast irradiation (HF-WBI) over time in the United States and factors related to its adoption for patients undergoing a lumpectomy from 2004 to 2016. Lumpectomy patients in the National Cancer Database were identified, with 688,079 early-stage invasive breast cancer patients, and 248,218 patients diagnosed with ductal carcinoma in situ. Among invasive cancer patients, HB-WBI use increased from 0.7% in 2004 to 38.1% in 2016. Among ductal carcinoma in situ patients, HB-WBI use increased significantly from 0.42% in 2004 to 34.3% in 2016. Factors associated with HB-WBI use included age, geographic location, race/ethnicity, tumor stage, grade, treating facility type, and volume.
AHRQ-funded; HS025806.
Citation: Kang MM, Hasan Y, Waller J .
Has hypofractionated whole-breast radiation therapy become the standard of care in the United States? An updated report from National Cancer Database.
Clin Breast Cancer 2022 Jan;22(1):e8-e20. doi: 10.1016/j.clbc.2021.05.016..
Keywords: Cancer: Breast Cancer, Cancer, Treatments, Practice Patterns
Hughes TM, Ellsworth B, Berlin NL
Statewide episode spending variation of mastectomy for breast cancer.
The purpose of this study was to characterize variations in episode spending related to volume and complication rates for mastectomy. A secondary study aim was to identify patient- and facility-level determinants of variation. The researchers assessed mean spending for 7,342 patients undergoing mastectomy at 74 facilities across Michigan state. The study found that mean 30-day spending by facility ranged from $11,129 to $20,830 and ninety-day spending ranged from $17,303 to $31,060. Patient-level factors associated with greater spending included bilateral surgery, simultaneous breast reconstruction, length of stay, and readmission. The researchers concluded that Michigan hospitals have considerable variation in mastectomy spending, and that reducing the frequency of bilateral surgery and length of stay may increase value, without risking patient safety or oncologic outcomes.
AHRQ-funded; HS026030.
Citation: Hughes TM, Ellsworth B, Berlin NL .
Statewide episode spending variation of mastectomy for breast cancer.
J Am Coll Surg 2022 Jan;234(1):14-23. doi: 10.1097/xcs.0000000000000005..
Keywords: Cancer: Breast Cancer, Cancer, Women, Surgery
Alagoz O, Lowry KP, Kurian AW
Impact of the COVID-19 pandemic on breast cancer mortality in the US: estimates from collaborative simulation modeling.
This study’s objective was to project the impact of COVID-19 on future breast cancer mortality between 2020 and 2030. Three established Cancer Intervention and Surveillance Modeling Network breast cancer models were used to model reductions in mammography screening use, delays in symptomatic cancer diagnosis, and reduced use of chemotherapy for women with early-stage disease for the first 6 months of the pandemic with return to prepandemic patterns after that time. The models project by 2030 950 cumulative excess breast cancers deaths related to reduced screening, 1314 deaths associated with delayed diagnosis of symptomatic cases, and 151 deaths associated with reduced chemotherapy use in women with hormone positive, early-stage cancer.
AHRQ-funded; HS018366.
Citation: Alagoz O, Lowry KP, Kurian AW .
Impact of the COVID-19 pandemic on breast cancer mortality in the US: estimates from collaborative simulation modeling.
J Natl Cancer Inst 2021 Nov 2;113(11):1484-94. doi: 10.1093/jnci/djab097..
Keywords: COVID-19, Cancer: Breast Cancer, Cancer, Mortality, Women
Bowles EJA, O'Neill SC, Li T
Effect of a randomized trial of a web-based intervention on patient-provider communication about breast density.
This study evaluated a personalized web-based intervention between women and their providers designed to improve breast cancer risk communication. This randomized trial included women aged 40-69 years with 504 women in the control group and 492 women who used the intervention website. The website included information about breast density, personalized breast cancer risk, chemoprevention, and magnetic resonance imaging. Participants self-reported their communication about density with providers at 6 weeks and 12 months. Women in the intervention arm were 2.39 times more likely to report density communication at 6 weeks than the control arm. This effect persisted at 12 months. At 6 weeks the effect was only significant among women who reported versus those who did not report any previous density discussions. A quarter of women in each arm did not have a density conversation at any point during the study.
AHRQ-funded; HS022982.
Citation: Bowles EJA, O'Neill SC, Li T .
Effect of a randomized trial of a web-based intervention on patient-provider communication about breast density.
J Womens Health 2021 Nov;30(11):1529-37. doi: 10.1089/jwh.2021.0053.
AHRQ-funded; HS022982..
AHRQ-funded; HS022982..
Keywords: Communication, Women, Cancer: Breast Cancer, Cancer, Health Information Technology (HIT)
Kuijer A, Dominici LS, Rosenberg SM
Arm morbidity after local therapy for young breast cancer patients.
This study assessed patient-reported arm morbidity in the Young Women's Breast Cancer Study (YWS). Participants were over 1300 women with breast cancer diagnosed at age 40 or younger and who were enrolled in the YWS. Findings showed that high rates of self-reported arm morbidity in young breast cancer survivors were reported, particularly in patients receiving axillary lymph node dissection and post-mastectomy radiation therapy. Recommendations included attention to the risks and benefits of differing local therapy strategies for axillary lymph node dissection and post-mastectomy radiation therapy patients.
AHRQ-funded; HS023680.
Citation: Kuijer A, Dominici LS, Rosenberg SM .
Arm morbidity after local therapy for young breast cancer patients.
Ann Surg Oncol 2021 Oct;28(11):6071-82. doi: 10.1245/s10434-021-09947-3..
Keywords: Cancer: Breast Cancer, Cancer, Women, Surgery
Dominici L, Hu J, Zheng Y
Association of local therapy with quality-of-life outcomes in young women with breast cancer.
Researchers examined the association of surgery with longer-term satisfaction and quality of life (QOL) in young breast cancer survivors. Participants were women 40 years or older who enrolled in the Young Women's Breast Cancer Study. The results suggested that local therapy in young breast cancer survivors is persistently associated with poorer scores in multiple QOL domains, particularly among those treated with mastectomy and radiotherapy, irrespective of breast reconstruction. Socioeconomic stressors also appear to play a role.
AHRQ-funded; HS023680.
Citation: Dominici L, Hu J, Zheng Y .
Association of local therapy with quality-of-life outcomes in young women with breast cancer.
JAMA Surg 2021 Oct;156(10):e213758. 2021. doi: 10.1001/jamasurg.2021.3758..
Keywords: Cancer: Breast Cancer, Cancer, Quality of Life, Women, Surgery
