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 37 Research Studies DisplayedKrouse RS, Anderson GL, Arnold KB
Surgical versus non-surgical management for patients with malignant bowel obstruction (S1316): a pragmatic comparative effectiveness trial.
The purpose of this study was to compare surgical versus non-surgical management with the goal of determining the optimal approach for managing malignant bowel obstruction. From May 11, 2015, to April 27, 2020, 221 patients were enrolled, with 199 evaluable participants. The study found no variation between surgery and non-surgery for the primary outcome of good days: mean 42·6 days in the randomized surgery group, 43·9 days (29·5) in the randomized non-surgery group, 54·8 days (27·0) in the patient choice surgery group, and 52·7 days (30·7) in the patient choice non-surgery group. During their initial hospital stay, six participants died, five due to cancer progression and one due to malignant bowel obstruction treatment complications The most common grade 3-4 malignant bowel obstruction treatment complication was anemia.
AHRQ-funded; HS021491.
Citation: Krouse RS, Anderson GL, Arnold KB .
Surgical versus non-surgical management for patients with malignant bowel obstruction (S1316): a pragmatic comparative effectiveness trial.
Lancet Gastroenterol Hepatol 2023 Oct; 8(10):908-18. doi: 10.1016/s2468-1253(23)00191-7..
Keywords: Cancer, Surgery, Treatments, Comparative Effectiveness, Evidence-Based Practice
Treadwell JR, Kessler SK, Wu M
Pharmacologic and dietary treatments for epilepsies in children aged 1-36 months: a systematic review.
The purpose of this systematic review study was to assess the effectiveness and harms of pharmacologic and dietary treatments for epilepsy in children aged 1-36 months without infantile spasms. The researchers searched EMBASE, MEDLINE, PubMed, and the Cochrane Library for studies published from 1/1/1999 to 8/19/21 to identify studies reporting data on children aged 1-36 months receiving pharmacologic or dietary treatments for epilepsy. Twenty-three studies met the inclusion criteria. The study found that Levetiracetam leads to seizure freedom in some infants but the data on 6 other medications (lamotrigine, phenytoin, rufinamide, stiripentol, topiramate, and vigabatrin) were too limited to allow conclusions about their effectiveness. Three medications (lamotrigine, levetiracetam, and topiramate) were rarely discontinued due to adverse effects, and severe events were also rare. In the category of diets, the ketogenic diet lead to seizure freedom in some infants and both the ketogenic diet and modified Atkins diet reduced average seizure frequency.
AHRQ-funded; 75Q80120D00002.
Citation: Treadwell JR, Kessler SK, Wu M .
Pharmacologic and dietary treatments for epilepsies in children aged 1-36 months: a systematic review.
Neurology 2023 Jan 3;100(1):e16-e27. doi: 10.1212/wnl.0000000000201026..
Keywords: Children/Adolescents, Neurological Disorders, Newborns/Infants, Medication, Nutrition, Treatments, Evidence-Based Practice
Tsou AY, Kessler SK, Wu M
Surgical treatments for epilepsies in children aged 1-36 months: a systematic review.
The purpose of this article was to summarize the findings of a systematic review commissioned by the American Epilepsy Society to evaluate evidence and describe evidence gaps for surgical treatments for epilepsy in children aged 1 to 36 months without infantile spasms. The researchers searched EMBASE, MEDLINE, PubMed, and the Cochrane Library for studies published from 1/1/1999 to 8/19/21 and included studies reporting data on children aged 1 month to 36 months or less enrolled in surgical interventions or neurostimulation for epilepsy. Eighteen studies met inclusion criteria. The review found that seizure freedom for infants undergoing hemispherectomy/hemispherotomy ranged from 7% to 76% at 1 year after surgery. For non-hemispheric surgeries seizure freedom ranged from 40% to 70%. Over half of infants undergoing hemispherectomy/hemispherotomy achieved a favorable outcome (Engel I or II, ILAE I to IV, or >50% seizure reduction) at follow-up of over 1 year. The researchers note that the studies had important limitations. The researchers concluded that while evidence remains sparse and low quality, some infants achieve seizure freedom after surgery and 50% or greater achieve favorable outcomes.
AHRQ-funded; 75Q80120D00002.
Citation: Tsou AY, Kessler SK, Wu M .
Surgical treatments for epilepsies in children aged 1-36 months: a systematic review.
Neurology 2023 Jan 3;100(1):e1-e15. doi: 10.1212/wnl.0000000000201012..
Keywords: Children/Adolescents, Newborns/Infants, Surgery, Treatments, Evidence-Based Practice
Rastogi V, Marcaccio CL, Kim NH
The effect of supraceliac versus infraceliac landing zone on outcomes following fenestrated endovascular repair of juxta-/pararenal aortic aneurysms.
The purpose of this study was to assess perioperative outcomes in patients in the Vascular Quality Initiative who underwent juxta-/pararenal FEVAR with supraceliac vs infraceliac sealing. 1,486 Patients who received an elective FEVAR for juxta-/pararenal aortic aneurysms in the Vascular Quality Initiative between 2014 and 2021were identified and included.
The researchers defined supraceliac sealing as proximal sealing in aortic zone 5, or zone 6 with a celiac scallop/fenestration/branch or celiac occlusion. The study’s primary outcomes were perioperative and 3-year mortality, and secondary outcomes were completion endoleaks, in-hospital complications, and variables related with 3-year mortality. The study found that of the included patients, 84% underwent infraceliac sealing, and 16% underwent supraceliac sealing. Of the supraceliac patients, 60% had a celiac fenestration/branch, 31% had a celiac scallop, and 9.2% had a celiac occlusion (intentional or unintentional). Compared with infraceliac sealing, there were no differences after risk-adjusted analysis in perioperative mortality following supraceliac sealing. Supraceliac sealing was associated with lower odds of type-IA completion endoleaks, but higher odds of any complication including cardiac complications, lower extremity ischemia and acute kidney injury when compared with infraceliac sealing. The researchers concluded that supraceliac sealing was associated with lower risk of type IA endoleaks and similar mortality compared with sealing at an infraceliac level. The researchers advise that providers should be aware that supraceliac sealing was related with higher perioperative morbidity.
The researchers defined supraceliac sealing as proximal sealing in aortic zone 5, or zone 6 with a celiac scallop/fenestration/branch or celiac occlusion. The study’s primary outcomes were perioperative and 3-year mortality, and secondary outcomes were completion endoleaks, in-hospital complications, and variables related with 3-year mortality. The study found that of the included patients, 84% underwent infraceliac sealing, and 16% underwent supraceliac sealing. Of the supraceliac patients, 60% had a celiac fenestration/branch, 31% had a celiac scallop, and 9.2% had a celiac occlusion (intentional or unintentional). Compared with infraceliac sealing, there were no differences after risk-adjusted analysis in perioperative mortality following supraceliac sealing. Supraceliac sealing was associated with lower odds of type-IA completion endoleaks, but higher odds of any complication including cardiac complications, lower extremity ischemia and acute kidney injury when compared with infraceliac sealing. The researchers concluded that supraceliac sealing was associated with lower risk of type IA endoleaks and similar mortality compared with sealing at an infraceliac level. The researchers advise that providers should be aware that supraceliac sealing was related with higher perioperative morbidity.
AHRQ-funded; HS027285.
Citation: Rastogi V, Marcaccio CL, Kim NH .
The effect of supraceliac versus infraceliac landing zone on outcomes following fenestrated endovascular repair of juxta-/pararenal aortic aneurysms.
J Vasc Surg 2023 Jan;77(1):9-19.e2. doi: 10.1016/j.jvs.2022.08.007..
Keywords: Cardiovascular Conditions, Surgery, Evidence-Based Practice, Patient-Centered Outcomes Research, Outcomes, Comparative Effectiveness, Treatments
De B, Pasalic D, Barocas DA
Patient-reported outcomes after external beam radiotherapy with low dose rate brachytherapy boost vs radical prostatectomy for localized prostate cancer: five-year results from a prospective comparative effectiveness study.
The purpose of this study was to compare patient reported outcomes through 5 years following radical prostatectomy or external beam radiation therapy with low dose rate brachytherapy boost for localized prostate cancer. The researchers enrolled men 80 years of age or under who had localized prostate adenocarcinoma and followed them longitudinally from 2011 to 2012. The study found that when compared with radical prostatectomy, external beam radiation therapy with low dose rate brachytherapy boost was related with clinically meaningful worse urinary irritative/obstructive and better urinary incontinence function through 5 years. Urinary function bother was similar between groups. Treatment with external beam radiation therapy with low dose rate brachytherapy boost was associated with worse bowel function through 5 years compared to radical prostatectomy. Treatment with external beam radiation therapy with low dose rate brachytherapy boost was associated with better sexual function at 1 year compared to radical prostatectomy, but there was insufficient evidence to reject the supposition that no difference was seen at 3 or 5 years. The researcher concluded that external beam radiation therapy with low dose rate brachytherapy boost was related with clinically meaningful worse urinary irritative/obstructive and bowel functions but better urinary incontinence function through 5 years after treatment compared to radical prostatectomy.
AHRQ-funded; HS019356; HS022640.
Citation: De B, Pasalic D, Barocas DA .
Patient-reported outcomes after external beam radiotherapy with low dose rate brachytherapy boost vs radical prostatectomy for localized prostate cancer: five-year results from a prospective comparative effectiveness study.
J Urol 2022 Dec;208(6):1226-39. doi: 10.1097/ju.0000000000002902..
Keywords: Cancer: Prostate Cancer, Cancer, Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Outcomes Research, Treatments
McDonagh MS, Morasco BJ, Wagner J
Cannabis-based products for chronic pain : a systematic review.
Researchers sought to evaluate the benefits and harms of cannabinoids for chronic pain. They found that oral, synthetic cannabis products with high THC-to-CBD ratios and sublingual, extracted cannabis products with comparable THC-to-CBD ratios may be associated with short-term improvements in chronic pain and increased risk for dizziness and sedation.
AHRQ-funded; 75Q80120D00006.
Citation: McDonagh MS, Morasco BJ, Wagner J .
Cannabis-based products for chronic pain : a systematic review.
Ann Intern Med 2022 Aug;175(8):1143-53. doi: 10.7326/m21-4520.
AHRQ-funded; 75Q80120D00006..
AHRQ-funded; 75Q80120D00006..
Keywords: Pain, Chronic Conditions, Complementary and Alternative Medicine, Treatments, Evidence-Based Practice
Korthuis PT, Cook RR, Lum PJ
HIV clinic-based extended-release naltrexone versus treatment as usual for people with HIV and opioid use disorder: a non-blinded, randomized non-inferiority trial.
Opioid Use Disorder (OUD) treatment medications can improve outcomes for human immunodeficiency virus (HIV) and also reduce opioid use. The purpose of the study was to determine if outpatient naltrexone treatment could also reduce opioid use and improve outcomes for HIV. The researchers reported that enrollment was stopped early because of slower than expected recruitment, resulting in 114 final participants with untreated OUD and HIV, with 62% positive for fentanyl, 60% positive for cocaine, and 47% positive for other opioids at the baseline. The intervention compared treatment as usual (TAU) of methadone or buprenorphine with extended-release naltrexone (XR-NTX) on group differences in viral suppression at 24 weeks and past 30-day use of opioids at 24 weeks. The study reported that at 24 weeks the outcome of viral suppression was similar for TAU and XR-NTX, and that fewer XR-NTX participants initiated medication than TAU participants. The outcome of previous 30-day use of opioids was similar for TAU as compared to XR-NTX. Of those participants who did initiate medication, those administered XR-NTX experienced less days of opioid use when compared with TAU in the prior 30 days. The researchers reported that the study evidence was not conclusive but did support that XR-NTX is not inferior to TAU for HIV viral suppression, and that study participants who started XR-NTX used less opioids at 24 weeks than participants who were administered TAU.
AHRQ-funded; HS026370.
Citation: Korthuis PT, Cook RR, Lum PJ .
HIV clinic-based extended-release naltrexone versus treatment as usual for people with HIV and opioid use disorder: a non-blinded, randomized non-inferiority trial.
Addiction 2022 Jul;117(7):1961-71. doi: 10.1111/add.15836..
Keywords: Human Immunodeficiency Virus (HIV), Opioids, Substance Abuse, Behavioral Health, Medication, Treatments, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Drewry AM, Mohr NM, Ablordeppey EA
Therapeutic hyperthermia is associated with improved survival in afebrile critically ill patients with sepsis: a pilot randomized trial.
This study’s objective was to test the hypothesis that forced-air warming of critically ill afebrile sepsis patients improves immune function compared to standard temperature management. Patients were considered eligible patients if they were mechanically ventilated septic adults with: 1) a diagnosis of sepsis within 48 hours of enrollment; 2) anticipated need for mechanical ventilation of greater than 48 hours; and 3) a maximum temperature less than 38.3°C within the 24 hours prior to enrollment. Intervention treatment was external warming using a forced-air warming blanket for 48 hours, with a goal temperature 1.5°C above the lowest temperature documented in the previous 24 hours. The authors enrolled 56 patients in this randomized, controlled trial. Participants allocated to external warming had lower 28-day mortality (18% vs 43%) and more 28-day hospital-free days. No differences were observed between the groups in HLA-DR expression or IFN-γ production.
AHRQ-funded; HS025753.
Citation: Drewry AM, Mohr NM, Ablordeppey EA .
Therapeutic hyperthermia is associated with improved survival in afebrile critically ill patients with sepsis: a pilot randomized trial.
Crit Care Med 2022 Jun;50(6):924-34. doi: 10.1097/ccm.0000000000005470..
Keywords: COVID-19, Sepsis, Treatments, Comparative Effectiveness, Evidence-Based Practice, Outcomes
Sun D, Heimall JR, Greenhawt MJ
Cost utility of lifelong immunoglobulin replacement therapy vs hematopoietic stem cell transplant to treat agammaglobulinemia.
This study evaluated the cost utility of lifelong immunoglobulin replacement therapy (IRT) versus hematopoietic stem cell transplant (HSCT) to treat agammaglobulinemia. This economic evaluation used Markov analysis to model the base-case scenario of a patient aged 12 months to receive lifelong IRT vs matched sibling donor (MSD) or matched unrelated donor (MUD) HSCT. In this evaluation, lifelong IRT cost more than HSCT ($1,512,946 compared with $563,776 [MSD] and $637,036 [MUD]) and generated similar quality-adjusted life-years (QALYs) (20.61 vs 17.25 [MSD] and 17.18 [MUD]). While choosing IRT over HSCT generated higher incremental cost-effectiveness ratios (ICERs), it exceeded US willing-to-pay threshold of $100,000/QALY. However, IRT prevented at least 2488 premature deaths per 10,000 microsimulations compared with HSCT treatment. But when the annual IRT price was reduced from $60,145 to below $29,469, IRT became the cost-effective strategy.
AHRQ-funded; HS024599.
Citation: Sun D, Heimall JR, Greenhawt MJ .
Cost utility of lifelong immunoglobulin replacement therapy vs hematopoietic stem cell transplant to treat agammaglobulinemia.
JAMA Pediatr 2022 Feb; 176(2):176-84. doi: 10.1001/jamapediatrics.2021.4583..
Keywords: Medication, Healthcare Costs, Treatments, Evidence-Based Practice
Garsa A, Jang JK, Baxi S
Radiation therapy for brain metastases: a systematic review.
This systematic review synthesizes the available evidence on radiation therapy for brain metastases. A literature search was conducted using the major medical databases and included randomized controlled trials and large observational studies which evaluated whole brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS) alone or in combination as initial or postoperative treatment, with or without systemic therapy for adults with brain metastases due to lung cancer, breast cancer, or melanoma. No statistically significant difference in overall survival was found with a combination of SRS plus WBRT compared with SRS alone or WBRT alone. Radiation therapy after surgery did not improve overall survival compared with surgery alone. WBRT plus systemic therapy was associated with increased risks for vomiting compared with WBRT alone. There was not enough data on patient-relevant outcomes such as quality of life, functional status, and cognitive effects.
AHRQ-funded; 290201500010I.
Citation: Garsa A, Jang JK, Baxi S .
Radiation therapy for brain metastases: a systematic review.
Pract Radiat Oncol 2021 Sep-Oct;11(5):354-65. doi: 10.1016/j.prro.2021.04.002..
Keywords: Cancer, Surgery, Treatments, Patient-Centered Outcomes Research, Evidence-Based Practice
Pasalic D, Barocas DA, Huang LC
Five-year outcomes from a prospective comparative effectiveness study evaluating external-beam radiotherapy with or without low-dose-rate brachytherapy boost for localized prostate cancer.
This retrospective cohort study’s objective was to determine if there were differences in treatment-related regret or survival between prostate cancer patients who received external-beam radiation therapy (EBRT) with or without a brachytherapy boost (EBRT-LDR), over a 5-year period. The cohort included 695 men who met inclusion criteria and received either EBRT (n=583) or EBRT-LDR (n=112). Men who received either treatment reported clinically worse urinary irritation and bowel function through 3 years but resolved after 5 years. Men who received EBRT-LDR continued to report moderate- to-big problems with urinary function bother and frequent urination at 5 years. There was no difference in treatment-related regret or survival between patients who received either treatment.
AHRQ-funded; HS019356; HS022640.
Citation: Pasalic D, Barocas DA, Huang LC .
Five-year outcomes from a prospective comparative effectiveness study evaluating external-beam radiotherapy with or without low-dose-rate brachytherapy boost for localized prostate cancer.
Cancer 2021 Jun 1;127(11):1912-25. doi: 10.1002/cncr.33388..
Keywords: Cancer: Prostate Cancer, Cancer, Comparative Effectiveness, Evidence-Based Practice, Outcomes, Patient-Centered Outcomes Research, Treatments
Campbell JI, Sandora TJ, Haberer JE
A scoping review of paediatric latent tuberculosis infection care cascades: initial steps are lacking.
This literature review looked at current studies on the diagnosis and treatment of pediatric latent tuberculosis infection (TB infection), commonly known as the TB infection care cascade. The authors conducted a systematic search of several medical databases and included articles and meeting abstracts that studied children and adolescents 21 years or younger who were screened for or diagnosed with TB infection. They identified 146 studies examining steps in the pediatric TB infection care cascade, including 31 in children living in low- and middle-income countries. Most literature described the final cascade step, which is treatment initiation to completion. Strengths and gaps were identified and future research in examining cascade steps upstream of treatment initiation was recommended.
AHRQ-funded; HS000063.
Citation: Campbell JI, Sandora TJ, Haberer JE .
A scoping review of paediatric latent tuberculosis infection care cascades: initial steps are lacking.
BMJ Glob Health 2021 May;6(5). doi: 10.1136/bmjgh-2020-004836..
Keywords: Children/Adolescents, Respiratory Conditions, Diagnostic Safety and Quality, Treatments, Care Management, Evidence-Based Practice
Gupta A, Sedhom R, Sharma R
Nonpharmacological interventions for managing breathlessness in patients with advanced cancer: a systematic review.
The purpose of this review was to evaluate the advantages and harms of nonpharmacological interventions for managing breathlessness in adults with advanced cancer. PubMed, Embase, CINAHL, Web of Science, and the Cochrane Central Register of Controlled Trials databases were searched for English-language studies about randomized and nonrandomized clinical trials, controlled trials, and observational studies. Findings included the safety and association with improved breathlessness of several nonpharmacological interventions for adults with advanced cancer. Recommendations included incorporating nonpharmacological interventions as first-line treatment for adults with advanced cancer and breathlessness.
AHRQ-funded; 290201500006I.
Citation: Gupta A, Sedhom R, Sharma R .
Nonpharmacological interventions for managing breathlessness in patients with advanced cancer: a systematic review.
JAMA Oncol 2021 Feb;7(2):290-98. doi: 10.1001/jamaoncol.2020.5184..
Keywords: Cancer, Respiratory Conditions, Treatments, Evidence-Based Practice, Comparative Effectiveness, Quality of Life, Outcomes, Patient-Centered Outcomes Research
Feliciano JL, Waldfogel JM, Sharma R
Pharmacologic interventions for breathlessness in patients with advanced cancer: a systematic review and meta-analysis.
This systematic review and meta-analysis examined the use of pharmacological interventions for breathlessness in patients with advanced cancer. Studies were identified from database inception to May 2020 using predefined eligibility criteria. Pharmacologic intervention benefits and harms were compared, focusing on breathlessness, anxiety, exercise capacity and health-related quality of life. Out of 7729 unique citations, 19 studies with a total of 1424 patients were included. Opioids were not associated with more effectiveness than placebo for improving breathlessness or exercise capacity. Anxiolytics were also not associated with more effectiveness than placebo for breathlessness or anxiety. There was limited evidence for other pharmacologic interventions. There was some harm, but it was minimal in those short-term studies.
AHRQ-funded; 290201500006I.
Citation: Feliciano JL, Waldfogel JM, Sharma R .
Pharmacologic interventions for breathlessness in patients with advanced cancer: a systematic review and meta-analysis.
JAMA Netw Open 2021 Feb;4(2):e2037632. doi: 10.1001/jamanetworkopen.2020.37632..
Keywords: Cancer: Lung Cancer, Cancer, Respiratory Conditions, Medication, Treatments, Opioids, Evidence-Based Practice, Comparative Effectiveness, Quality of Life, Outcomes, Patient-Centered Outcomes Research
Fink HA, Linskens EJ, MacDonald R
Benefits and harms of prescription drugs and supplements for treatment of clinical Alzheimer-type dementia
This is a systematic review and meta-analysis of the benefits and harms of prescription drugs and supplements for treatment of clinical Alzheimer-type dementia (CATD). Studies with low or medium risk of bias (ROB) were analyzed and rated. The analysis concluded there was a slight reduction in short-term cognitive decline with cholinesterase inhibitors and memantime, and cholinesterase inhibitors slightly reduced reported functional decline. There was mostly insufficient evidence on drug treatment of behavioral and psychological symptoms of dementia and on supplements for all outcomes.
AHRQ-funded; 290201500008I.
Citation: Fink HA, Linskens EJ, MacDonald R .
Benefits and harms of prescription drugs and supplements for treatment of clinical Alzheimer-type dementia
Ann Intern Med 2020 May 19;172(10):656-68. doi: 10.7326/m19-3887..
Keywords: Elderly, Dementia, Neurological Disorders, Medication, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes, Adverse Drug Events (ADE), Adverse Events, Treatments
Dobler CC, Morrow AS, Beuschel B
Pharmacologic therapies in patients with exacerbation of chronic obstructive pulmonary disease: a systematic review with meta-analysis.
The authors evaluated the comparative effectiveness and adverse events of pharmacologic interventions for adults with exacerbation of COPD. Sixty-eight randomized controlled trials were selected for evaluation and data extraction. They found that antibiotics and systemic corticosteroids reduced treatment failure in adults with mild to severe exacerbation of COPD.
AHRQ-funded.
Citation: Dobler CC, Morrow AS, Beuschel B .
Pharmacologic therapies in patients with exacerbation of chronic obstructive pulmonary disease: a systematic review with meta-analysis.
Ann Intern Med 2020 Mar 17;172(6):413-23. doi: 10.7326/m19-3007..
Keywords: Respiratory Conditions, Chronic Conditions, Evidence-Based Practice, Patient-Centered Outcomes Research, Comparative Effectiveness, Medication, Antibiotics, Treatments, Adverse Drug Events (ADE), Adverse Events
Whiteside SPH, Sim LA, Morrow AS
A meta-analysis to guide the enhancement of CBT for childhood anxiety: exposure over anxiety management.
Cognitive behavior therapy (CBT) is the most empirically supported therapy for childhood anxiety disorders (CADs) but has not reliably outperformed other credible interventions. The current study used meta-analysis to examine the frequency with which the most common treatment components are included in outcome studies and the relation of these components to symptom improvement.
AHRQ-funded; 290201500013I.
Citation: Whiteside SPH, Sim LA, Morrow AS .
A meta-analysis to guide the enhancement of CBT for childhood anxiety: exposure over anxiety management.
Clin Child Fam Psychol Rev 2020 Mar;23(1):102-21. doi: 10.1007/s10567-019-00303-2..
Keywords: Children/Adolescents, Anxiety, Behavioral Health, Treatments, Patient-Centered Outcomes Research, Evidence-Based Practice
Ochs-Ross R, Daly EJ, Zhang Y
Efficacy and safety of esketamine nasal spray plus an oral antidepressant in elderly patients with treatment-resistant depression-TRANSFORM-3.
This phase 3 double-blind study randomized patients with treatment-resistant depression age 65 or older to flexibly-dosed esketamine nasal spray and new oral antidepressant (esketamine/antidepressant) or new oral antidepressant and placebo nasal spray (antidepressant/placebo). The primary endpoint was change in the Montgomery-Asberg Depression Rating Scale (MADRS) over 28 days from baseline. Results showed that esketamine/antidepressant did not achieve statistical significance for patients ages 75 and older; however, greater differences were seen for patients ages 65-74 and patients with earlier onset of depression younger than age 55.
AHRQ-funded; HS023000.
Citation: Ochs-Ross R, Daly EJ, Zhang Y .
Efficacy and safety of esketamine nasal spray plus an oral antidepressant in elderly patients with treatment-resistant depression-TRANSFORM-3.
Am J Geriatr Psychiatry 2020 Feb;28(2):121-41. doi: 10.1016/j.jagp.2019.10.008..
Keywords: Medication, Depression, Behavioral Health, Elderly, Comparative Effectiveness, Treatments, Evidence-Based Practice
Drucker AM, Adam GP, Rofeberg V
Treatments for primary squamous cell carcinoma and squamous cell carcinoma in situ of the skin: a systematic review and network meta-analysis summary of an Agency for Healthcare Research and Quality comparative effectiveness review.
This article discusses the results of a systematic review and network meta-analysis summary of treatments for primary squamous cell carcinoma (SCC) and squamous cell carcinoma in situ (SCCi) AHRQ comparative effective review. The authors included English-language randomized controlled trials (RCTs) with information on recurrence, histologic clearance, clinical clearance, cosmesis, and quality of life. They excluded studies enrolling less than 10 body lesions total or arms that had 5 or less lesions. They included 7 RCTs with a total of 418 participants. While they found some evidence of the best treatment options, there was little evidence to guide treatment of SC. There were no RCTs found on surgical modalities which is the first line of treatment for SCC.
AHRQ-funded; 290201500002I.
Citation: Drucker AM, Adam GP, Rofeberg V .
Treatments for primary squamous cell carcinoma and squamous cell carcinoma in situ of the skin: a systematic review and network meta-analysis summary of an Agency for Healthcare Research and Quality comparative effectiveness review.
J Am Acad Dermatol 2020 Feb;82(2):479-82. doi: 10.1016/j.jaad.2019.06.030..
Keywords: Cancer: Skin Cancer, Cancer, Comparative Effectiveness, Treatments, Evidence-Based Practice, Patient-Centered Outcomes Research
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.
AHRQ-funded; HS026385.
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.
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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
Chan B, Kondo K, Freeman M
Pharmacotherapy for cocaine use disorder-a systematic review and meta-analysis.
The authors sought a better understanding of the effectiveness of pharmacotherapy for cocaine use disorder. Their search included multiple data sources for systematic reviews and randomized controlled trials of pharmacological interventions in adults with cocaine use disorder. They found that most of the pharmacotherapies studied, including antidepressants, were not effective for treating cocaine use disorder. Bupropion, psychostimulants, and topiramate may improve abstinence, and antipsychotics may improve treatment retention. They recommend further study of contingency management and behavioral interventions along with pharmacotherapy.
AHRQ-funded; HS022981.
Citation: Chan B, Kondo K, Freeman M .
Pharmacotherapy for cocaine use disorder-a systematic review and meta-analysis.
J Gen Intern Med 2019 Dec;34(12):2858-73. doi: 10.1007/s11606-019-05074-8..
Keywords: Medication, Substance Abuse, Comparative Effectiveness, Treatments, Evidence-Based Practice, Patient-Centered Outcomes Research, Outcomes
Mullins BT, Basak R, Broughman JR
Patient-reported sexual quality of life after different types of radical prostatectomy and radiotherapy: analysis of a population-based prospective cohort.
This study compares the effects of different types of radical prostatectomy and radiotherapy on sexual function. A population-based cohort of 835 men with newly diagnosed prostate cancer from 2011 through 2013 was recruited in collaboration with the Rapid Case Ascertainment system of the North Carolina Central Cancer Registry. They were enrolled prior to treatment and followed retrospectively using the validated Prostate Cancer Symptom Indices (PCSI) instrument. The sexual function scores were compared among patients who received the following treatment types: external-beam RT (EBRT), EBRT with androgen deprivation therapy (ADT), brachytherapy, nerve-sparing radical prostatectomy (RP), and non-nerve-sparing RP. The cohort was surveyed at 24 months post-therapy, and RT alone was found to result in the best preservation of sexual function with brachytherapy, RT with ADT, and nerve-sparing RP yielding similar outcomes. Patients treated with non-nerve-sparing RP experienced the worst sexual function outcome.
AHRQ-funded.
Citation: Mullins BT, Basak R, Broughman JR .
Patient-reported sexual quality of life after different types of radical prostatectomy and radiotherapy: analysis of a population-based prospective cohort.
Cancer 2019 Oct 15;125(20):3657-65. doi: 10.1002/cncr.32288..
Keywords: Quality of Life, Sexual Health, Surgery, Treatments, Comparative Effectiveness, Patient-Centered Outcomes Research, Outcomes, Cancer: Prostate Cancer, Cancer, Evidence-Based Practice
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.
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
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