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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 20 of 20 Research Studies DisplayedSchumacher 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
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
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 and Ethnic Minorities, Rural Health
Kho RM, Desai VB, Schwartz PE
Endometrial sampling for preoperative diagnosis of uterine leiomyosarcoma.
This retrospective cohort study examined the effectiveness of endometrial sampling for preoperative detection of uterine leiomyosarcoma in women undergoing hysterectomy, identified factors associated with missed diagnosis, and compared the outcomes of patients who had a preoperative diagnosis with those patients who had a missed diagnosis. A total of 79 patients with uterine leiomyosarcoma were included in the study. Of those patients, 46 (58.2%) were diagnosed preoperatively and 33 postoperatively. The groups were similar in age, race/ethnicity, bleeding symptoms, and comorbidities. Women who had endometrial sampling performed with hysteroscopy had a higher likelihood of preoperative diagnosis. Patients with localized stage (vs distant stage) or tumor size >11 cm were less likely to be diagnosed preoperatively.
AHRQ-funded; HS024702.
Citation: Kho RM, Desai VB, Schwartz PE .
Endometrial sampling for preoperative diagnosis of uterine leiomyosarcoma.
J Minim Invasive Gynecol 2022 Jan;29(1):119-27. doi: 10.1016/j.jmig.2021.07.004.
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Keywords: Cancer, Diagnostic Safety and Quality, Surgery, Women
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
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
Baskin AS, Wang T, Bredbeck BC
Trends in contralateral prophylactic mastectomy utilization for small unilateral breast cancer.
This study describes trends in contralateral prophylactic mastectomy (CPM) utilization for small unilateral breast cancer instead of breast-conserving surgery (BCS) which is recommended. The authors used the National Cancer Database to identify women with unilateral, T1 breast cancer. Of the total cohort of 765,487, 69% underwent BCS and 31% chose mastectomy. Of 176,673 women aged 70 years or older, 75% underwent BCS and 25% chose mastectomy. CPM rates have increased in both cohorts since 2006. Patient factors such as younger age, white rate, private insurance, tumor factors, and facility factors were associated with increased CPM rates compared with unilateral mastectomy.
Citation: Baskin AS, Wang T, Bredbeck BC .
Trends in contralateral prophylactic mastectomy utilization for small unilateral breast cancer.
J Surg Res 2021 Jun;262:71-84. doi: 10.1016/j.jss.2020.12.057..
Keywords: Cancer: Breast Cancer, Cancer, Women, Surgery, Prevention, Healthcare Utilization
Wang T, Bredbeck BC, Sinco B
Variations in persistent use of low-value breast cancer surgery.
Through the Choosing Wisely campaign, surgical specialties identified 4 low-value breast cancer operations. Preliminary data suggest varying rates of deimplementation and have identified patient-level and clinician-level determinants of continued overuse. However, little information exists about facility-level variation or determinants of differential deimplementation. In this retrospective cohort study the investigators sought to identify variation and determinants of persistent use of low-value breast cancer surgical care.
AHRQ-funded; HS026030.
Citation: Wang T, Bredbeck BC, Sinco B .
Variations in persistent use of low-value breast cancer surgery.
JAMA Surg 2021 Apr;156(4):353-62. doi: 10.1001/jamasurg.2020.6942..
Keywords: Cancer: Breast Cancer, Cancer, Surgery, Women
Rosenberg SM, Dominici LS, Gelber S
Association of breast cancer surgery with quality of life and psychosocial well-being in young breast cancer survivors.
This study looked at the short-term and long-term effects of breast cancer surgery on young breast cancer survivors (aged 40 and younger). The researchers compared the effects of bilateral mastectomy (BM), unilateral mastectomy (UM), and breast conserving surgery (BCS) among women diagnosed with Stage 0-3 unilateral breast cancer between 2006 and 2016 who had surgery and completed QOL and psychosocial assessments. Out of 826 women, 45% had BM, 31% BCS, and 24% UM. Of the women who had BM/UM, 84% also underwent reconstructive surgery. Women who had BM vs BCS or UM had consistently worse sexuality and body image. Anxiety improved across all groups, but adjusted mean scores remained higher among women who had BM vs BCS/UM at 1 year. There were minimal between-group differences in depression levels.
AHRQ-funded; HS023680.
Citation: Rosenberg SM, Dominici LS, Gelber S .
Association of breast cancer surgery with quality of life and psychosocial well-being in young breast cancer survivors.
JAMA Surg 2020 Nov;155(11):1035-42. doi: 10.1001/jamasurg.2020.3325..
Keywords: Cancer: Breast Cancer, Cancer, Women, Quality of Life, Surgery
Gutnik L, Allen CM, Presson AP
Breast cancer surgery decision role perceptions and choice of surgery.
This study examined the finding that breast cancer patients who reported more personal responsibility for the surgery decision were more likely to undergo aggressive surgery. Retrospective cohort data was used from 100 newly diagnosed breast cancer patients. Surgery types compared were mastectomy, lumpectomy, and unilateral versus bilateral mastectomy. Patients’ decision-making role was identified using the Patient Preference Scale. Type of surgery and patient role concordance was compared as well as patient decision role performance, role perception, and provider role perception. Patient decision role and perceptions were not associated with type of surgery. Patient role preference depended on the stage of disease. Stage III patients preferred the most active roles with stage I and stage II patients preferring a more collaborative role. Providers perceived more passive patient roles in the mastectomy group.
AHRQ-funded; HS024784.
Citation: Gutnik L, Allen CM, Presson AP .
Breast cancer surgery decision role perceptions and choice of surgery.
Ann Surg Oncol 2020 Oct;27(10):3623-32. doi: 10.1245/s10434-020-08485-8.
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Keywords: Cancer: Breast Cancer, Cancer, Decision Making, Surgery, Women
Yu J, Olsen MA, Margenthaler JA
Indications for readmission following mastectomy for breast cancer: an assessment of patient and operative factors.
In this study, the investigators examined the impact of patient and operative factors on 30-day hospital readmission following mastectomy for breast cancer. Using the 2011 HCUP California State Inpatient Database, they evaluated readmissions in adult women undergoing mastectomy for invasive, in situ, or history of breast cancer. The investigators found that surgical site infection and wound complications were the most common diagnoses requiring readmission and resulted in over half of readmissions in their study population at 30 days.
AHRQ-funded; HS19455.
Citation: Yu J, Olsen MA, Margenthaler JA .
Indications for readmission following mastectomy for breast cancer: an assessment of patient and operative factors.
Breast J 2020 Oct;26(10):1966-72. doi: 10.1111/tbj.14029..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospital Readmissions, Surgery, Cancer: Breast Cancer, Cancer, Women
Azad AD, Bozkurt S, Wheeler AJ
Acute pain after breast surgery and reconstruction: a two-institution study of surgical factors influencing short-term pain outcomes.
This study analyzed the relationship between differing breast cancer excisional procedures, reconstruction, and short-term pain outcomes. Women who underwent breast cancer surgery with and without reconstruction were included from two institutions: an academic hospital (AH) and a Veterans Health Administration (VHS) facility. Average pain scores at time of discharge and at 30-day follow-up were analyzed. The study included 1402 patients at AH and 1435 at VHA. Of those, 425 AH and 165 VHA patients underwent breast reconstruction. Pain scores were highest at discharge and improved over time. Younger age, preoperative opioid use, and longer length of stay were all associated with worse pain scores.
AHRQ-funded; HS024096.
Citation: Azad AD, Bozkurt S, Wheeler AJ .
Acute pain after breast surgery and reconstruction: a two-institution study of surgical factors influencing short-term pain outcomes.
J Surg Oncol 2020 Sep 15;122(4):623-31. doi: 10.1002/jso.26070..
Keywords: Pain, Cancer: Breast Cancer, Cancer, Surgery, Outcomes, Women
Smith ME, Vitous CA, Hughes TM
Barriers and facilitators to de-implementation of the Choosing Wisely((R)) guidelines for low-value breast cancer surgery.
The objective of this study was to understand why surgeons stop performing certain unnecessary cancer operations but not others and how best to de-implement entrenched and emerging unnecessary procedures. The investigators concluded that with a growing focus on the elimination of ineffective, unproven or low value practices, it is imperative that the behavioral determinants are understood and targeted with specific interventions to decrease utilization rapidly.
AHRQ-funded; HS026030.
Citation: Smith ME, Vitous CA, Hughes TM .
Barriers and facilitators to de-implementation of the Choosing Wisely((R)) guidelines for low-value breast cancer surgery.
Ann Surg Oncol 2020 Aug;27(8):2653-63. doi: 10.1245/s10434-020-08285-0..
Keywords: Cancer: Breast Cancer, Cancer, Surgery, Decision Making, Guidelines, Women
Wang T, Baskin AS, Dossett LA
Deimplementation of the choosing wisely recommendations for low-value breast cancer surgery: a systematic review.
Overtreatment of early-stage breast cancer results in increased morbidity and cost without improving survival. Major surgical organizations participating in the Choosing Wisely campaign identified 4 breast cancer operations as low value. The purpose of this study was to evaluate the extent to which these procedures have been deimplemented, determine the implications of decreased use, and recognize possible barriers and facilitators to deimplementation.
AHRQ-funded; HS026030.
Citation: Wang T, Baskin AS, Dossett LA .
Deimplementation of the choosing wisely recommendations for low-value breast cancer surgery: a systematic review.
JAMA Surg 2020 Aug;155(8):759-70. doi: 10.1001/jamasurg.2020.0322..
Keywords: Cancer: Breast Cancer, Cancer, Surgery, Decision Making, Women, Evidence-Based Practice
Gibson DC, Chou LN, Raji MA
Opioid prescribing trends in women following mastectomy or breast-conserving surgery before and after the 2014 federal reclassification of hydrocodone.
This study compares changes in opioid prescribing among surgical breast cancer patients following the 2014 federal reclassification of hydrocodone. Data from 2009 to 2017 was used from a large nationally representative commercial insurance health program. Women aged 18 years and older who were diagnosed with carcinoma in-situ or malignant breast cancer and received breast-conserving surgery or a mastectomy from 2010 to 2016 were included. Patients in 2015 or 2016 who had surgery were less likely to receive a greater than 1-day supply of opioid prescriptions or 30 days or more supply than in 2013. However, only in 2016 were surgical breast cancer patients less likely to receive a 90-day supply than in 2013.
AHRQ-funded; HS026133.
Citation: Gibson DC, Chou LN, Raji MA .
Opioid prescribing trends in women following mastectomy or breast-conserving surgery before and after the 2014 federal reclassification of hydrocodone.
Oncologist 2020 Apr;25(4):281-89. doi: 10.1634/theoncologist.2019-0758..
Keywords: Opioids, Medication, Surgery, Cancer: Breast Cancer, Cancer, Women
Xu X, Lin H, Wright JD
Association between power morcellation and mortality in women with unexpected uterine cancer undergoing hysterectomy or myomectomy.
Despite concerns that power morcellation may adversely affect prognosis of patients with occult uterine cancer, empirical evidence has been limited and inconclusive. In this study, the investigators aimed to determine whether uncontained power morcellation at the time of hysterectomy or myomectomy was associated with increased mortality risk in women with occult uterine cancer.
AHRQ-funded; HS024702.
Citation: Xu X, Lin H, Wright JD .
Association between power morcellation and mortality in women with unexpected uterine cancer undergoing hysterectomy or myomectomy.
J Clin Oncol 2019 Dec 10;37(35):3412-24. doi: 10.1200/jco.19.00562..
Keywords: Cancer, Mortality, Women, Surgery, Risk, Adverse Events
Desai VB, Wright JD, Gross CP
Risk of unexpected uterine cancer in women undergoing myomectomy: a population-based study.
Data on the risk of unexpected uterine cancer specifically for women undergoing myomectomy are limited, as prior research has centered on hysterectomies (surgical removal of the uterus). In this correspondence, the authors discuss how they addressed this important gap using a large population-based sample.
AHRQ-funded; HS024702.
Citation: Desai VB, Wright JD, Gross CP .
Risk of unexpected uterine cancer in women undergoing myomectomy: a population-based study.
Eur J Obstet Gynecol Reprod Biol 2019 Jul;238:188-90. doi: 10.1016/j.ejogrb.2019.03.021..
Keywords: Cancer, Risk, Surgery, Women
Borah BJ, Yao X, Laughlin-Tommaso SK
Comparative effectiveness of uterine leiomyoma procedures using a large insurance claims database.
The objective of this retrospective analysis of administrative claims from a large U.S. commercial insurance database, was to compare risk of reintervention, long-term clinical outcomes, and health care utilization among women who have bulk symptoms from leiomyoma and who underwent the following procedures: hysterectomy, myomectomy, uterine artery embolization, and magnetic resonance-guided, focused ultrasound surgery.
AHRQ-funded; HS023418.
Citation: Borah BJ, Yao X, Laughlin-Tommaso SK .
Comparative effectiveness of uterine leiomyoma procedures using a large insurance claims database.
Obstet Gynecol 2017 Nov;130(5):1047-56. doi: 10.1097/AOG.0000000000002331..
Keywords: Cancer, Comparative Effectiveness, Health Insurance, Outcomes, Patient-Centered Outcomes Research, Surgery, Women
Olsen MA, Nickel KB, Margenthaler JA
Increased risk of surgical site infection among breast-conserving surgery re-excisions.
The aim of this study was to determine the risk of surgical site infection (SSI) after primary breast-conserving surgery (BCS) versus re-excision among women with carcinoma in situ or invasive breast cancer. It found that the risk of SSI after re-excision remained significantly higher after accounting for multiple procedures within a woman.
AHRQ-funded; HS019713.
Citation: Olsen MA, Nickel KB, Margenthaler JA .
Increased risk of surgical site infection among breast-conserving surgery re-excisions.
Ann Surg Oncol 2015;22(6):2003-9. doi: 10.1245/s10434-014-4200-x..
Keywords: Surgery, Risk, Cancer: Breast Cancer, Cancer, Healthcare-Associated Infections (HAIs), Injuries and Wounds, Adverse Events, Patient Safety, Women
