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
51 to 75 of 792 Research Studies DisplayedGriesemer I, Lightfoot AF, Eng E
Examining ACCURE's nurse navigation through an antiracist lens: transparency and accountability in cancer care.
This paper discussed an intervention that was conducted to eliminate racial disparity in cancer treatment through a program called Accountability for Cancer Care through Undoing Racism and Equity (ACCURE). The program successfully eliminated the Black-White disparity in cancer treatment completion among patients with early-stage breast and lung cancer. It used specially trained nurse navigators who leveraged real-time data to follow-up with patients during their treatment journeys. Thematic analysis on all clinical notes that were written by ACCURE navigators after each contact with patients in the specialized navigation arm (n = 162) was conducted by community and academic research partners. The authors identified six themes in the navigator notes that demonstrated enhanced accountability of the care system to patient needs. Those themes include: (1) patient-centered advocacy, (2) addressing system barriers to care, (3) connection to resources, (4) re-engaging patients after lapsed treatment, (5) addressing symptoms and side effects, and (6) emotional support.
AHRQ-funded; HS000032.
Citation: Griesemer I, Lightfoot AF, Eng E .
Examining ACCURE's nurse navigation through an antiracist lens: transparency and accountability in cancer care.
Health Promot Pract 2023 May; 24(3):415-25. doi: 10.1177/15248399221136534..
Keywords: Cancer, Racial and Ethnic Minorities, Disparities, Health Promotion
Lee CI, Abraham L, Miglioretti DL
National performance benchmarks for screening digital breast tomosynthesis: update from the Breast Cancer Surveillance Consortium.
The purpose of this study was to develop performance benchmarks for digital breast tomosynthesis (DBT) screening and assess longitudinal performance patterns in United States community practice. Between 2011 and 2018 the researchers collected DBT screening examinations from five Breast Cancer Surveillance Consortium (BCSC) registries. Measures of performance were calculated based on the American College of Radiology Breast Imaging Reporting and Data System, fifth edition and included abnormal interpretation rate (AIR), cancer detection rate (CDR), sensitivity, specificity, and false-negative rate (FNR). These rates were compared with previously published BCSC and National Mammography Database benchmarks, concurrent BCSC DM screening examinations, and expert opinion acceptable performance ranges. The study included a total of 896,101 women undergoing 2,301,766 screening examinations and 1,843,591 DM examinations were included in this study. All performance measures were higher for DBT except sensitivity and FNR, when compared with BCSC DM screening examinations from the same time period and previously published BCSC and National Mammography Database performance benchmarks. The following rates of radiologists received acceptable performance ranges with DBT: 97.6% for CDR, 91.8% for sensitivity, 75.0% for AIR, and 74.0% for specificity.
AHRQ-funded; HS018366.
Citation: Lee CI, Abraham L, Miglioretti DL .
National performance benchmarks for screening digital breast tomosynthesis: update from the Breast Cancer Surveillance Consortium.
Radiology 2023 May; 307(4):e222499. doi: 10.1148/radiol.222499..
Keywords: Cancer: Breast Cancer, Cancer, Screening, Imaging, Prevention, Women
Richmond J, Murray MH, Milder CM
Racial disparities in lung cancer stage of diagnosis among adults living in the southeastern United States.
The purpose of this study was to identify factors contributing to racial disparities in stage of lung cancer stage diagnosis in low-income adults. The researchers identified cases of incident lung cancer from the prospective observational Southern Community Cohort Study by linking them with state cancer registries in 12 southeastern states. A subset of participants who answered psychosocial questions such as those related to racial discrimination experiences were assessed to determine if model predictive power improved. The study identified 1,572 patients with incident lung cancer with available lung cancer stage. Compared with White participants Black participants with lung cancer reflected higher unadjusted odds of distant stage diagnosis. Higher neighborhood area deprivation was related with distant stage diagnosis. No significant differences were found in distant stage disease for Black vs White participants after controlling for individual- and area-level factors, but participants with COPD showed decreased odds of distant stage diagnosis in the primary model.
AHRQ-funded; HS026122.
Citation: Richmond J, Murray MH, Milder CM .
Racial disparities in lung cancer stage of diagnosis among adults living in the southeastern United States.
Chest 2023 May; 163(5):1314-27. doi: 10.1016/j.chest.2022.11.025..
Keywords: Disparities, Racial and Ethnic Minorities, Cancer: Lung Cancer, Cancer
Hu FY, Tabata-Kelly M, Johnston FM
Surgeon-reported factors influencing adoption of quality standards for goal-concordant care in patients with advanced cancer: a qualitative study.
This study’s objective was to explore surgical oncologists' perspectives on factors influencing adoption of quality standards in patients with advanced cancer. While the American College of Surgeons has adopted a Geriatric Surgery Verification Program that includes communication standards designed to facilitate goal-concordant care, little is known about how surgeons believe these standards align with clinical practice. The authors conducted semistructured video-based interviews from November 2020 to January 2021 with academic surgical oncologists purposively sampled based on demographics, region, palliative care certification, and years in practice. These interviews addressed: (1) adherence to standards documenting care preferences for life-sustaining treatment, surrogate decision-maker, and goals of surgery; and (2) factors influencing their adoption into practice. Participants included 26 surgeons (57.7% male, 8.5 mean years in practice, 19.2% palliative care board-certified). While goals of surgery are commonly discussed, there is low consistency of documenting these goals. There were conflicting views about the relevance of care preferences to preoperative conversations and surrogate decision-maker documentation by the surgeon and questioned the direct connection between documentation of quality standards and higher value patient care. Key themes in adopting quality standards of documentation included organizational culture, workflow, and multidisciplinary collaboration.
AHRQ-funded; HS024736.
Citation: Hu FY, Tabata-Kelly M, Johnston FM .
Surgeon-reported factors influencing adoption of quality standards for goal-concordant care in patients with advanced cancer: a qualitative study.
Ann Surg 2023 May; 277(5):e1000-e05. doi: 10.1097/sla.0000000000005441..
Keywords: Surgery, Provider: Physician, Cancer
Agochukwu-Mmonu N, Qin Y, Kaufman S
Understanding the role of urology practice organization and racial composition in prostate cancer treatment disparities.
This study examined the associations between urology practice organization and racial composition and treatment patterns for Medicare beneficiaries with incident prostate cancer. The authors used a 20% sample of national Medicare data to identify beneficiaries diagnosed with prostate cancer between January 2010 and December 2015 and followed them through 2016. They then linked urologists to their practices with tax identification numbers and patients to their practices based on their primary urologist. They identified 54,443 patients with incident prostate cancer, with most (87%) White and 9% Black. They found wide variation in racial practice composition and practice segregation. Patients in practices with the highest proportion of Black patients had the lowest socioeconomic status (43.1%), highest comorbidity (9.9% with comorbidity score ≥ 3), and earlier age at prostate cancer diagnosis (33.5% age 66-69 years). Black patients had lower odds of definitive therapy and underwent less treatment than White patients in every practice context. Black patients had lower predicted probability of treatment (66%) than White patients (69%).
AHRQ-funded; HS025707.
Citation: Agochukwu-Mmonu N, Qin Y, Kaufman S .
Understanding the role of urology practice organization and racial composition in prostate cancer treatment disparities.
JCO Oncol Pract 2023 May; 19(5):e763-e72. doi: 10.1200/op.22.00147..
Keywords: Cancer: Prostate Cancer, Cancer, Men's Health, Disparities, Racial and Ethnic Minorities
Gupta N, Zebib L, Wittmann D
Understanding the sexual health perceptions, concerns, and needs of female partners of prostate cancer survivors.
The adverse effects of prostate cancer (PCa) and its treatment can critically undermine the sexual well-being of patients and couples. However, limited research has been dedicated to understanding the influence of PCa-induced sexual dysfunction on the female partners of survivors. The purpose of this study was to carry out a qualitative investigation to comprehensively capture the perceptions of female partners regarding the repercussions of PCa on their sex lives, and their partners’ sexual health concerns and unfulfilled needs. The researchers conducted semi-structured telephonic interviews concerning sexual health and unfulfilled needs with female partners of PCa survivors. Participants were recruited from multiple clinical sites and PCa caregivers' support groups from September 2021 to March 2022. Interviews were recorded, transcribed, and independently coded. The study outcomes were on the sexual health concerns and unfulfilled needs of the female partners. Of the 12 participants, the median age was 65 (between 53 and 81), nine identified as White, the median duration since their partner's PCa diagnosis was 2.25 years (ranging from 11 months to 20 years), and most reported their partner had undergone radical prostatectomy, radiation, and/or hormonal therapy. Major themes emerging from the study concerned the substantial effect of age- and PCa-related sexual dysfunction on the sexual quality of life for women, the joint nature of sexual dysfunction and recovery, the partner's role in managing and adapting to sexual dysfunction, communication barriers regarding sexual dysfunction within an intimate relationship, the absence of sexual health counseling and support from physicians, and the advantage of peer interactions and proactive information seeking in addressing unfulfilled sexual health needs. The study concluded that female partners perceive PCa-related sexual dysfunction as a shared issue for couples, express sorrow due to age- and PCa-related sexual losses, and experience a void in physician-led sexual health counseling and information.
AHRQ-funded; HS026120.
Citation: Gupta N, Zebib L, Wittmann D .
Understanding the sexual health perceptions, concerns, and needs of female partners of prostate cancer survivors.
J Sex Med 2023 Apr 27; 20(5):651-60. doi: 10.1093/jsxmed/qdad027..
Keywords: Cancer: Prostate Cancer, Cancer, Sexual Health, Women
Henrikson NB, Ivlev I, Blasi PR
Skin cancer screening: updated evidence report and systematic review for the US Preventive Services Task Force.
The purpose of this study was to investigate the advantages and potential risks of skin cancer screening to assist the decision-making of the US Preventive Services Task Force. The researchers utilized the data sources MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials, dated between June 1, 2015, and January 7, 2022. Two independent reviewers evaluated the articles and extracted pertinent data from studies of fair or good quality; the findings were summarized narratively. The primary outcomes and indicators were morbidity; mortality; stage, precursor lesions, or lesion thickness of skin cancer at detection; potential harms of screening. Twenty studies from 29 articles were included (N = 6,053,411). Direct evidence on the effectiveness of screening was obtained from 3 nonrandomized analyses of 2 population-based skin cancer screening initiatives in Germany (n = 1,791,615), indicating no significant reduction in melanoma mortality benefit at the population level over a period of 4 to 10 years of follow up activities. Six studies (n = 2,935,513) offered inconclusive evidence on the relationship between physician-conducted skin examination and lesion thickness or stage at diagnosis. Usual care vs. routine physician-conducted skin examination was not associated with increased detection of skin cancer or precursor lesions (5 studies) or stage at melanoma detection (3 studies). The correlation between physician-conducted skin examination and lesion thickness at detection was inconsistent (3 studies). Nine studies (n = 1 326 051) found a consistent positive association between more advanced stage at melanoma detection and increasing risk of melanoma-associated and all-cause mortality. Two studies (n = 232) found negligible enduring cosmetic or psychosocial harms related to screening.
AHRQ-funded; 75Q80120D00004.
Citation: Henrikson NB, Ivlev I, Blasi PR .
Skin cancer screening: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2023 Apr 18; 329(15):1296-307. doi: 10.1001/jama.2023.3262..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer: Skin Cancer, Cancer, Screening, Prevention, Evidence-Based Practice, Guidelines
Lowry KP, Ichikawa L, Hubbard RA
Variation in second breast cancer risk after primary invasive cancer by time since primary cancer diagnosis and estrogen receptor status.
This study examined the timing of second breast cancers by primary cancer estrogen receptor (ER) status in the Breast Cancer Surveillance Consortium. The cohort studied included women who were diagnosed with American Joint Commission on Cancer stage I-III breast cancer identified within six Breast Cancer Surveillance Consortium registries from 2000 to 2017. Characteristics collected during primary breast cancer diagnosis included demographics, ER status, and treatment. Second breast cancer events included subsequent ipsilateral or contralateral breast cancers diagnosed >6 months after primary diagnosis. Cumulative incidence and second breast cancer rates by primary cancer ER status during 1-5 versus 6-10 years after diagnosis was examined. At 10 years, the cumulative second breast cancer incidence was 11.8% for women with ER-negative disease and 7.5% for those with ER-positive disease. Women with ER-negative cancer had higher second breast cancer rates than those with ER-positive cancer during the first 5 years of follow-up. After 5 years, second breast cancer rates were similar for women with ER-negative versus ER-positive breast cancer.
AHRQ-funded; HS018366.
Citation: Lowry KP, Ichikawa L, Hubbard RA .
Variation in second breast cancer risk after primary invasive cancer by time since primary cancer diagnosis and estrogen receptor status.
Cancer 2023 Apr 15;129(8):1173-82. doi: 10.1002/cncr.34679.
Keywords: Cancer: Breast Cancer, Cancer, Women, Risk
Su YR, Buist DSM, Lee JM
Performance of statistical and machine learning risk prediction models for surveillance benefits and failures in breast cancer survivors.
The authors compared the relative predictive performance of statistical and machine learning (ML) models to guide modeling strategy selection for surveillance mammography outcomes in women with a personal history of breast cancer. They cross-validated seven risk prediction models for two surveillance outcomes, using 9,447 mammograms. The results suggested that regularized regression outperformed other modeling approaches for predicting breast cancer surveillance mammography outcomes and balanced the trade-off between model flexibility and interpretability.
AHRQ-funded; HS018366.
Citation: Su YR, Buist DSM, Lee JM .
Performance of statistical and machine learning risk prediction models for surveillance benefits and failures in breast cancer survivors.
Cancer Epidemiol Biomarkers Prev 2023 Apr 3; 32(4):561-71. doi: 10.1158/1055-9965.Epi-22-0677..
Keywords: Cancer: Breast Cancer, Cancer, Health Information Technology (HIT), Imaging
Katz AJ, Chen RC, Usinger DS
Cardiovascular disease prevention and management of pre-existent cardiovascular disease in a cohort of prostate cancer survivors.
This study examined receipt of preventive care and management of pre-existing cardiovascular disease (CVD) in a prospective cohort of men newly diagnosed with prostate cancer between 2011 and 2013 throughout North Carolina linked to Medicare and private insurance claims and clinical data from the Veterans Affairs (VA). Primary outcome for patients with pre-existent CVD was a composite measure of annual preventive care (blood glucose screening, cholesterol level testing, and ≥ 1 primary care provider visit). The sample comprised 492 patients successfully linked to insurance claims and/or VA data, among whom 103 (20.9%) had pre-existent CVD. Receipt of preventive care declined from 52.7% during the first year after prostate cancer diagnosis to 40.8% during the third year. Among patients with pre-existent CVD, only 23.4% saw a cardiologist in all 3 years. Black men were more likely than White men to visit a cardiologist during the first year after diagnosis.
AHRQ-funded; 29020050040I.
Citation: Katz AJ, Chen RC, Usinger DS .
Cardiovascular disease prevention and management of pre-existent cardiovascular disease in a cohort of prostate cancer survivors.
J Cancer Surviv 2023 Apr;17(2):351-59. doi: 10.1007/s11764-022-01229-5.
Keywords: Cardiovascular Conditions, Cancer: Prostate Cancer, Cancer, Prevention
Wong CI, Vannatta K, Gilleland Marchak J
Preventable harm because of outpatient medication errors among children with leukemia and lymphoma: a multisite longitudinal assessment.
The goal of this longitudinal study was to characterize rates and types of medication errors and harm to outpatient children with leukemia and lymphoma over seven months of treatment. The study included children taking medications at home for leukemia or lymphoma from three pediatric cancer centers. Ten percent experienced adverse drug events because of outpatient medication errors. Twenty-six percent of caregivers reported miscommunication leading to missed doses or overdoses. The authors concluded that improvements addressing communication with and among caregivers should be based on human-factors engineering and codeveloped with families.
AHRQ-funded; HS024390.
Citation: Wong CI, Vannatta K, Gilleland Marchak J .
Preventable harm because of outpatient medication errors among children with leukemia and lymphoma: a multisite longitudinal assessment.
Cancer 2023 Apr 1;129(7):1064-74. doi: 10.1002/cncr.34651.
Keywords: Children/Adolescents, Cancer, Adverse Drug Events (ADE), Adverse Events, Medical Errors, Ambulatory Care and Surgery, Medication: Safety, Patient Safety
Ray EM, Hinton SP, Reeder-Hayes KE
Risk factors for return to the emergency department and readmission in patients with hospital-diagnosed advanced lung cancer.
The objectives of this study were to examine the patterns of care and risk factors for subsequent acute care utilization among patients with hospital-diagnosed advanced lung cancer (ALC). Researchers identified patients with incident ALC from 2007-13 and an index hospitalization within 7 days of diagnosis in Surveillance, Epidemiology, and End Results-Medicare. Results showed that more than half of the incident ALC patients were hospitalized around the time of diagnosis; among those who survived to discharge, only 37% received systemic cancer treatment. Many patients experienced an early readmittance and most died within 6 months. The researchers conclude that such patients may benefit from increased access to palliative and other supportive care during hospitalization to prevent subsequent health care utilization.
AHRQ-funded; HS000032.
Citation: Ray EM, Hinton SP, Reeder-Hayes KE .
Risk factors for return to the emergency department and readmission in patients with hospital-diagnosed advanced lung cancer.
Med Care 2023 Apr;61(4):237-46. doi: 10.1097/mlr.0000000000001829.
Keywords: Emergency Department, Hospital Readmissions, Cancer: Lung Cancer, Cancer, Risk
Wahid KA, Lin D, Sahin O
Large scale crowdsourced radiotherapy segmentations across a variety of cancer anatomic sites.
This article describes a data process in which over 200 expert and non-expert clinician annotators manually generated segmentations for regions of interest (ROIs) on computed tomography images across a variety of cancer sites for the Contouring Collaborative for Consensus in Radiation Oncology challenge. The author converted the data into Neuroimaging Informatics Technology Initiative format with standardized nomenclature for ease of use, and generated consensus segmentations using the Simultaneous Truth and Performance Level Estimation method. They conclude that these standardized, structured, and easily accessible data are a valuable resource for the systematic study of variability in segmentation applications, which is crucial for radiotherapy.
AHRQ-funded; HS026881.
Citation: Wahid KA, Lin D, Sahin O .
Large scale crowdsourced radiotherapy segmentations across a variety of cancer anatomic sites.
Sci Data 2023 Mar 22;10(1):161. doi: 10.1038/s41597-023-02062-w.
Keywords: Cancer, Imaging
Carroll CE, Landrum MB, Wright AA
Adoption of innovative therapies across oncology practices-evidence from immunotherapy.
Immunotherapy has emerged as a crucial development in cancer care, significantly enhancing patient outcomes for various cancer forms, yet limited information exists regarding the adoption of this innovative treatment by different practices or the speed of uptake. The purpose of this study was to evaluate the adoption of immunotherapy across oncology practices in the United States and examine variations in adoption based on practice characteristics. This cohort investigation utilized Medicare fee-for-service data from beneficiaries undergoing six-month chemotherapy cycles between 2010 and 2017. Data analysis was conducted from January 19, 2021, to September 28, 2022, for patients diagnosed with cancers for which the US Food and Drug Administration (FDA) approved immunotherapy during the study period: melanoma, kidney cancer, lung cancer, and head and neck cancer. The primary outcome assessed whether a practice adopted immunotherapy. The data included 71,659 episodes from 1,732 oncology practices. The study found that among these, 264 practices (15%) were rural, 900 (52%) were independent, and 492 (28%) had 1 to 5 physicians. The study also found that the majority of practices adopted immunotherapy within two years of FDA approval, but considerable variations in adoption rates existed across practice types. Following FDA approval, immunotherapy adoption was 11 percentage points lower in rural practices compared to urban practices and 27 percentage points lower in practices with 1 to 5 physicians than those with six or more physicians. Adoption rates were comparable between independent practices and nonacademic institutions; however, both practice types exhibited lower adoption than academic institutions (independent practice difference, -6 percentage points; nonacademic systems difference, -9 percentage points).
AHRQ-funded; HS024072
Citation: Carroll CE, Landrum MB, Wright AA .
Adoption of innovative therapies across oncology practices-evidence from immunotherapy.
JAMA Oncol 2023 Mar;9(3):324-33. doi: 10.1001/jamaoncol.2022.6296.
Keywords: Cancer, Treatments
JE Wallis, CJD Huang, LC
AHRQ Author: Tallman
Association between adherence to radiation therapy quality metrics and patient reported outcomes in prostate cancer.
Researchers evaluated the impact of compliance with nationally recognized radiation therapy quality measures on patient-reported health-related quality of life outcomes in the Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) population-based, prospective cohort study of men with localized prostate cancer. Eight quality measures were identified based on national guidelines. In multivariable analyses, no clinically significant associations were discovered between compliance with evaluated radiation therapy quality measures and patient-reported outcomes such as urinary irritation, urinary incontinence, bowel, sexual or hormonal function. The researchers concluded that further work would be needed to identify patient-centered quality measures of prostate cancer care.
AHRQ-funded; HS019356.
Citation: JE Wallis, CJD Huang, LC .
Association between adherence to radiation therapy quality metrics and patient reported outcomes in prostate cancer.
Prostate Cancer Prostatic Dis 2023 Mar;26(1):80-87. doi: 10.1038/s41391-022-00518-5.
Keywords: Cancer: Prostate Cancer, Cancer, Patient-Centered Outcomes Research, Evidence-Based Practice, Quality Measures
Vo H, Valentine KD, Barry MJ
Evaluation of the shared decision-making process scale in cancer screening and medication decisions.
The objectives of this study were to examine the reliability and validity of the Shared Decision-Making (SDM) Process scale for cancer screening and medication decisions. Researchers conducted a secondary data analysis of more than 6,000 participants who made decisions about breast, colon, or prostate cancer screening or taking medication for menopause, depression, hypertension or high cholesterol. They concluded that the SDM Process scale demonstrated construct validity and retest reliability.
AHRQ-funded; HS025718.
Citation: Vo H, Valentine KD, Barry MJ .
Evaluation of the shared decision-making process scale in cancer screening and medication decisions.
Patient Educ Couns 2023 Mar;108:107617. doi: 10.1016/j.pec.2022.107617.
Keywords: Shared Decision Making, Cancer, Medication, Screening
Ho TH, Bissell MCS, Lee CI
Prioritizing screening mammograms for immediate interpretation and diagnostic evaluation on the basis of risk for recall.
The purpose of this study was to establish a prioritization method for immediate interpretation of screening mammograms and potential diagnostic assessment. A cohort based on the population, comprising screening mammograms conducted from 2012 to 2020 at 126 radiology centers from 7 Breast Cancer Surveillance Consortium registries, was examined. Classification trees were used to identify combinations of clinical history (age, BI-RADS density, time elapsed since the previous mammogram, history of false-positive recall or biopsy outcome), screening technique (digital mammography, digital breast tomosynthesis), and facility features (profit status, location, screening volume, practice type, academic affiliation) that grouped screening mammograms by recall rate, with ≥12/100 classified as high and ≥16/100 as very high. The efficiency ratio was calculated as the percentage of recalls divided by the percentage of mammograms. The research cohort consisted of 2,674,051 screening mammograms in 925,777 women, with 235,569 recalls. The study found that the primary predictor of recall was the time interval since the last mammogram, followed by age, history of false-positive recall, breast density, history of benign biopsy, and screening method. Recall rates were extremely high for baseline mammograms and high for women with ≥5 years since their previous mammogram. The 9.2% of mammograms in subgroups with very high and high recall rates represented 19.2% of recalls, yielding an efficiency ratio of 2.1 compared to a random strategy. Including women under 50 with dense breasts accounted for 20.3% of mammograms and 33.9% of recalls (efficiency ratio = 1.7). Findings incorporating facility-level characteristics were analogous.
AHRQ-funded; HS018366
Citation: Ho TH, Bissell MCS, Lee CI .
Prioritizing screening mammograms for immediate interpretation and diagnostic evaluation on the basis of risk for recall.
J Am Coll Radiol 2023 Mar;20(3):299-310. doi: 10.1016/j.jacr.2022.09.030.
Keywords: Cancer: Breast Cancer, Cancer, Screening, Imaging, Women, Prevention, Diagnostic Safety and Quality
Logan CD, Feinglass J, Halverson AL
Rural-urban disparities in receipt of surgery for potentially resectable non-small cell lung cancer.
This study examined the reasons there are lower rates of surgical treatment for potentially resectable non-small cell lung cancer (NSCLC) for patients living in rural areas than in urban areas. The National Cancer Database was used to identify patients with clinical stage I-IIIA NSCLC between 2004 and 2018. Reasons for nonreceipt of surgery was evaluated for rural and urban area patients. The study included 328,785 patients with NSCLC with 13% from rural areas. Overall, 62.4% of patients from urban areas and 58.8% of patients from rural areas underwent surgery. Patients from rural areas had increased odds of (1) being recommended primary nonsurgical management, (2) surgery being deemed contraindicated due to risk, (3) surgery being recommended but not performed, and (4) overall failure to receive surgery.
AHRQ-funded; HS026385.
Citation: Logan CD, Feinglass J, Halverson AL .
Rural-urban disparities in receipt of surgery for potentially resectable non-small cell lung cancer.
J Surg Res 2023 Mar;283:1053-63. doi: 10.1016/j.jss.2022.10.097.
Keywords: Cancer: Lung Cancer, Cancer, Disparities, Surgery, Rural Health, Access to Care
Gong F, Loeb S, Siu K
Sleep disturbances are underappreciated in prostate cancer survivorship.
Limited research exists on the prevalence of sleep issues in prostate cancer (PCa) survivors and the degree of urologist involvement in addressing sleep-related concerns. The researchers conducted a survey with PCa survivors (n = 167) and urologists (n = 145) to examine sleep problems and survivorship care practices. The study found a significant number of PCa survivors experienced sleep difficulties, with 50.9% reporting suboptimal sleep quality, 18.0% suffering from moderate/severe insomnia, and 36.5% at an elevated risk for sleep apnea. However, only a small number of urologists consistently screened for sleep disruptions, as advised in national cancer survivorship guidelines.
AHRQ-funded; HS026120
Citation: Gong F, Loeb S, Siu K .
Sleep disturbances are underappreciated in prostate cancer survivorship.
Prostate Cancer Prostatic Dis 2023 Mar;26(1):210-12. doi: 10.1038/s41391-022-00630-6.
Keywords: Cancer, Cancer: Prostate Cancer, Sleep Problems
Miyashita M, Balogun OB, Olopade OI
The optimization of postoperative radiotherapy in de novo stage IV breast cancer: evidence from real-world data to personalize treatment decisions.
The purpose of this study was to investigate the survival benefit of radiotherapy in de novo stage IV breast cancer. Data were taken from the National Cancer DataBase on Stage IV breast cancer patients who received breast surgery and had survived 12 months after diagnosis. Radiotherapy was found to be associated with improved survival in patients with bone or lung metastasis but not patients with liver or brain metastasis. It was also associated with improved survival in patients with one or two metastatic sites but not three or more. Survival impact did not differ among subtypes. The authors concluded that these “real-world data” show that postoperative radiotherapy might improve overall survival for de novo Stage IV breast cancer with bone or lung metastasis, regardless of subtypes.
AHRQ-funded; HS025806.
Citation: Miyashita M, Balogun OB, Olopade OI .
The optimization of postoperative radiotherapy in de novo stage IV breast cancer: evidence from real-world data to personalize treatment decisions.
Sci Rep 2023 Feb 18; 13(1):2880. doi: 10.1038/s41598-023-29888-z..
Keywords: Cancer: Breast Cancer, Cancer, Evidence-Based Practice, Women
Rosenberg SM, Zheng Y, Gelber S
Adjuvant endocrine therapy non-initiation and non-persistence in young women with early-stage breast cancer.
The purpose of this study was to describe oral adjuvant endocrine therapy (ET) non-initiation and non-persistence in young women with breast cancer to inform strategies to improve adherence. The researchers identified 693 women with hormone receptor-positive, stage I to III breast cancer enrolled in a cohort of women diagnosed with breast cancer at 40 years or less, assessed ET decision-making and identified variables related with non-initiation/non-persistence and to assess the relationship between non-persistence and recurrence. The study found that by 18 months, 9% had not initiated ET. Black women had a greater chances and women with a college degree had lower chances of non-initiation. Of the 607 women who initiated, 20% were non-persistent. The researchers specified that younger age, being married or partnered, and indicating greater weight issues were related with higher chances of non-persistence. Having received chemotherapy and higher burdens of hot flashes and vaginal symptoms were related with lower odds of non-persistence. Women who initiated therapy had an increased likelihood of reporting shared decision-making than non-initiators (57% vs. 38%), and women who were non-persistent were less likely to report high confidence with the decision than women who were persistent (40% vs. 63%).
AHRQ-funded; HS023680.
Citation: Rosenberg SM, Zheng Y, Gelber S .
Adjuvant endocrine therapy non-initiation and non-persistence in young women with early-stage breast cancer.
Breast Cancer Res Treat 2023 Feb; 197(3):547-58. doi: 10.1007/s10549-022-06810-1..
Keywords: Cancer: Breast Cancer, Cancer, Women, Shared Decision Making, Patient Adherence/Compliance
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.
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)
Strayer TE, Spalluto LB, Burns A
Using the framework for reporting adaptations and modifications-expanded (frame) to study adaptations in lung cancer screening delivery in the Veterans Health Administration: a cohort study.
The purpose of this study was to apply the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to study adaptations in lung cancer screening delivery processes in a Veterans Health Administration (VHA) Initiative. Between 2019 and 2021 the researchers prospectively administered semi-structured interviews with lung cancer screening program navigators at 10 Veterans Affairs Medical Centers (VAMCs). Baseline process maps were developed for each program, and each program navigator reviewed process maps in subsequent years 1 and 2. Researchers then identified, documented, and mapped adaptations in screening processes to the FRAME categories. 16 interviews were conducted across 10 VHA lung cancer screening programs, with 6 of these being operational, and of those 3 reported adaptations to their screening processes that were planned or in response to COVID-19. In year 2 all 10 programs were operational and eligible. Programs reported 14 adaptations in year 2. The adaptations identified were both planned and unplanned and often prompted by increased workload; 57% of year 2 adaptations were associated with the identification and eligibility of Veterans and 43% were associated with follow-up with Veterans for screening results. During the 2 years, adaptations associated with data management and patient tracking took place in 60% of programs to improve the data collection and tracking of Veterans in the screening process. The study concluded that adaptations took place predominantly in the categories of patient identification and communication of results due to increased workload.
AHRQ-funded; HS026122; HS026395.
Citation: Strayer TE, Spalluto LB, Burns A .
Using the framework for reporting adaptations and modifications-expanded (frame) to study adaptations in lung cancer screening delivery in the Veterans Health Administration: a cohort study.
Implement Sci Commun 2023 Jan 12; 4(1):5. doi: 10.1186/s43058-022-00388-x..
Keywords: Cancer: Lung Cancer, Cancer, Screening, Evidence-Based Practice, Learning Health Systems
Sullivan CE, Day SW, Ivankova N
Establishing nursing-sensitive quality indicators for pediatric oncology: an international mixed methods Delphi study.
The purpose of this study was to create an initial core set of Nursing-sensitive indicators (NSIs) for international pediatric oncology nursing that would be important, actionable, and feasible to measure across different resource settings and countries. The researchers utilized purposive snowball sampling to identify 122 expert pediatric oncology nurses from 43 countries for participation. In round 1, the panelists identified five potential NSIs and constructs. These results were applied to round 2 in which panelists chose their top 10 NSIs and constructs and ranked them according to importance to patient care quality. Those results were then applied to round 3, in which panelists ranked the top 10 NSIs and constructs by order of importance for the particular population, then rated each NSI/Construct for actionability and feasibility of measurement. The study identified the preliminary core set of NSIs and constructs identified by the expert panel, and ranked them in the following order of importance: safe chemotherapy administration and handling, infection prevention/control, pediatric oncology nursing orientation program, early warning score system/recognition of patient deterioration, chemotherapy/biotherapy education/course, pain assessment/management, symptom assessment/management, patient and family education, palliative/end of life care, and continuing nursing education/competency. The study reported that all NSIs and constructs were rated as actionable; all constructs except palliative/end of life care were rated as feasible to measure. The researchers concluded that initial core NSIs and constructs offer improved insight into typical features of international pediatric oncology nursing practice that are important, actionable, and feasible for quality measurement.
AHRQ-funded; HS013852.
Citation: Sullivan CE, Day SW, Ivankova N .
Establishing nursing-sensitive quality indicators for pediatric oncology: an international mixed methods Delphi study.
J Nurs Scholarsh 2023 Jan; 55(1):388-400. doi: 10.1111/jnu.12798..
Keywords: Children/Adolescents, Quality Indicators (QIs), Quality of Care, Nursing, Cancer
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