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
101 to 125 of 197 Research Studies DisplayedTina Shih YC, Dong W, Xu Y
Assessing the cost-effectiveness of updated breast cancer screening guidelines for average-risk women.
The goal of this study was to evaluate the cost-effectiveness of recently updated US-based mammography screening guidelines. Researchers developed a microsimulation model to generate the natural history of invasive breast cancer and capture how screening and treatment modified the natural course of the disease, and used the model to assess the cost-effectiveness of screening strategies. Results indicated that the hybrid screening strategy that starts annual mammography at the age of 45 years and switches to biennial screening between the ages of 55 and 75 years was the most cost-effective.
AHRQ-funded; HS020263.
Citation: Tina Shih YC, Dong W, Xu Y .
Assessing the cost-effectiveness of updated breast cancer screening guidelines for average-risk women.
Value Health 2019 Feb;22(2):185-93. doi: 10.1016/j.jval.2018.07.880..
Keywords: Cancer: Breast Cancer, Cancer, Screening, Evidence-Based Practice, Prevention, Healthcare Costs
Matsen CB, Lyons S, Goodman MS
Decision role preferences for return of results from genome sequencing amongst young breast cancer patients.
The purpose of this study was to better understand decision role preferences in women diagnosed with breast cancer at a young age for return of results of genome sequencing in research and clinical settings. The investigators found that most women in their study preferred to share in decision making and that participants had somewhat different role preferences for clinical and research contexts, with greater preference for active roles in the research context.
AHRQ-funded; HS024784.
Citation: Matsen CB, Lyons S, Goodman MS .
Decision role preferences for return of results from genome sequencing amongst young breast cancer patients.
Patient Educ Couns 2019 Jan;102(1):155-61. doi: 10.1016/j.pec.2018.08.004..
Keywords: Cancer, Cancer: Breast Cancer, Decision Making, Genetics, Women
Farias AJ, Wu WH, Du XL
Racial differences in long-term adjuvant endocrine therapy adherence and mortality among Medicaid-insured breast cancer patients in Texas: findings from TCR-Medicaid linked data.
There are racial/ethnic disparities in breast cancer mortality that may be attributed to differences in receipt of adjuvant cancer treatment. The purpose of this article was to determine whether the mortality disparities could be explained by racial/ethnic differences in long-term adherence to adjuvant endocrine therapy (AET). The investigators concluded that long-term adherence in the Medicaid population was suboptimal and racial/ethnic differences in AET adherence may partially explain disparities in mortality.
AHRQ-funded; HS018956.
Citation: Farias AJ, Wu WH, Du XL .
Racial differences in long-term adjuvant endocrine therapy adherence and mortality among Medicaid-insured breast cancer patients in Texas: findings from TCR-Medicaid linked data.
BMC Cancer 2018 Dec 4;18(1):1214. doi: 10.1186/s12885-018-5121-z..
Keywords: Cancer: Breast Cancer, Disparities, Medicaid, Patient Adherence/Compliance, Racial and Ethnic Minorities
Ostby PL, Armer JM, Smith K
Patient perceptions of barriers to self-management of breast cancer-related lymphedema.
This article reports on results from a study which used an IRB-approved focus group and mailed surveys to identify barriers to lymphedema self-management, definitions of education and support from breast cancer survivors with lymphedema, types of education and support they had received, what kind of education and support they wanted. Lack of education about lymphedema treatment and risk reduction was identified as a main barrier. Women’s responses also make it unclear whether or not they were exposed to support options other than medical treatment.
AHRQ-funded; HS022140.
Citation: Ostby PL, Armer JM, Smith K .
Patient perceptions of barriers to self-management of breast cancer-related lymphedema.
West J Nurs Res 2018 Dec;40(12):1800-17. doi: 10.1177/0193945917744351..
Keywords: Cancer: Breast Cancer, Education: Patient and Caregiver, Patient Self-Management
Lee CI, Zhu W, Onega TL
The effect of digital breast tomosynthesis adoption on facility-level breast cancer screening volume.
This study examined whether adoption of digital breast tomosynthesis (DBT) was associated with a decrease in screening mammography capacity across Breast Cancer Screening Consortium facilities. Facility characteristics and examination volume data were collected from facilities that adopted DBT from 2011 and 2014. The majority of facilities had no academic affiliation (73%), were nonprofit (80%) and were general radiology practices (66.7%). Monthly screening volumes were slightly higher after the adoption period but otherwise remained relatively stable before and after adoption of DBT.
AHRQ-funded; HS018366.
Citation: Lee CI, Zhu W, Onega TL .
The effect of digital breast tomosynthesis adoption on facility-level breast cancer screening volume.
AJR Am J Roentgenol 2018 Nov;211(5):957-63. doi: 10.2214/ajr.17.19350..
Keywords: Cancer: Breast Cancer, Cancer, Imaging, Screening, Women
Lee SC, Higashi RT, Sanders JM
Effects of program scale-up on time to resolution for patients with abnormal screening mammography results.
Effects of geographic program expansion to rural areas on mammogram screening program outcomes are understudied. The authors of this study sought to determine whether time-to-resolution (TTR) varied significantly by service delivery time period, location, and participant characteristics across 19 North Texas counties.
AHRQ-funded; HS022418.
Citation: Lee SC, Higashi RT, Sanders JM .
Effects of program scale-up on time to resolution for patients with abnormal screening mammography results.
Cancer Causes Control 2018 Oct;29(10):995-1005. doi: 10.1007/s10552-018-1074-4..
Keywords: Cancer: Breast Cancer, Cancer, Imaging, Screening, Women, Rural Health, Access to Care, Prevention
Wilson LE, Pollack CE, Greiner MA
Association between physician characteristics and the use of 21-gene recurrence score genomic testing among Medicare beneficiaries with early-stage breast cancer, 2008-2011.
This study sought to determine whether physician-level characteristics were associated with 21-gene recurrence score (RS) genomic testing to evaluate recurrence risk and benefit of adjuvant chemotherapy in patients with estrogen receptor-positive, node-negative breast cancer. The study concluded that although most RS testing was ordered by medical oncologists, physicians in other specialties ordered roughly one-third of the tests. Physician characteristics, including gender and time in practice, were associated with receiving testing.
AHRQ-funded; HS022189.
Citation: Wilson LE, Pollack CE, Greiner MA .
Association between physician characteristics and the use of 21-gene recurrence score genomic testing among Medicare beneficiaries with early-stage breast cancer, 2008-2011.
Breast Cancer Res Treat 2018 Jul;170(2):361-71. doi: 10.1007/s10549-018-4746-6..
Keywords: Cancer, Cancer: Breast Cancer, Genetics, Practice Patterns, Women
Farias AJ, Wu WH, Du XL
Racial and geographic disparities in adherence and discontinuation to adjuvant endocrine therapy in Texas Medicaid-insured patients with breast cancer.
The purpose of the study is to examine disparities in adjuvant endocrine therapy (AET) adherence and discontinuation among Texas Medicaid-insured early-stage breast cancer patients. The studies concluded that patients from the Texas/Mexico border had higher odds of adherence compared to other regions. There are substantial racial and geographic disparities in AET adherence and discontinuation among Texas Medicaid-insured women.
AHRQ-funded; HS018956.
Citation: Farias AJ, Wu WH, Du XL .
Racial and geographic disparities in adherence and discontinuation to adjuvant endocrine therapy in Texas Medicaid-insured patients with breast cancer.
Med Oncol 2018 Jun 20;35(7):113. doi: 10.1007/s12032-018-1168-6..
Keywords: Cancer: Breast Cancer, Disparities, Medicaid, Patient Adherence/Compliance, Racial and Ethnic Minorities
Pappadis MR, Volk RJ, Krishnan S
Perceptions of overdetection of breast cancer among women 70 years of age and older in the USA: a mixed-methods analysis.
The authors explored older women's perceptions about the concept of overdetection of breast cancer and its influence on future screening intentions. Semistructured interviews were conducted with 59 English-speaking women aged 70 years or older with no prior history of breast cancer. The authors found that many older women did not understand the concept of overdetection, in addition to being suspicious of or resistant to the concept. Providing older women with descriptions of overdetection may not be sufficient to influence screening intentions.
AHRQ-funded; HS022134.
Citation: Pappadis MR, Volk RJ, Krishnan S .
Perceptions of overdetection of breast cancer among women 70 years of age and older in the USA: a mixed-methods analysis.
BMJ Open 2018 Jun 14;8(6):e022138. doi: 10.1136/bmjopen-2018-022138..
Keywords: Cancer: Breast Cancer, Cancer, Elderly, Screening, Decision Making, Women, Prevention, Imaging
Rosenberg SM, Greaney ML, Patenaude AF
"I don't want to take chances.": a qualitative exploration of surgical decision making in young breast cancer survivors.
The purpose of this study was to better understand the choice of contralateral prophylactic mastectomy (CPM) through a qualitative exploration of surgical decision-making in young breast cancer survivors, including how issues particular to younger women affected their decision and the post-surgical experience. Through focus groups, themes emerged and were categorized. The authors concluded that informational resources and decision aids may enhance patient-doctor communication and help young survivors better understand risk and manage expectations surrounding short- and longer-term physical and emotional effects after surgery.
AHRQ-funded; HS023680.
Citation: Rosenberg SM, Greaney ML, Patenaude AF .
"I don't want to take chances.": a qualitative exploration of surgical decision making in young breast cancer survivors.
Psychooncology 2018 Jun;27(6):1524-29. doi: 10.1002/pon.4683.
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Keywords: Cancer: Breast Cancer, Decision Making, Education: Patient and Caregiver, Clinician-Patient Communication, Surgery
Childers KK, Maggard-Gibbons M, Macinko J
National distribution of cancer genetic testing in the United States: evidence for a gender disparity in hereditary breast and ovarian cancer.
Identifying mutation carriers is critical for treatment decisions, cancer prevention, and early detection. This study analyzed the 2015 US National Health Interview Survey (NHIS), a cross-sectional in-person interview gathering self-reported health data for the US population. The study found that while cancer genetic testing seems to reach a broad geographic and sociodemographic population in the national survey, there remain underrepresented groups, including Hispanics, the uninsured, noncitizens, and those with less education.
AHRQ-funded; HS025079.
Citation: Childers KK, Maggard-Gibbons M, Macinko J .
National distribution of cancer genetic testing in the United States: evidence for a gender disparity in hereditary breast and ovarian cancer.
JAMA Oncol 2018 Jun;4(6):876-79. doi: 10.1001/jamaoncol.2018.0340..
Keywords: Cancer, Cancer: Breast Cancer, Cancer: Ovarian Cancer, Genetics, Racial and Ethnic Minorities, Screening, Social Determinants of Health, Women
Housten AJ, Pappadis MR, Krishnan S
Resistance to discontinuing breast cancer screening in older women: a qualitative study.
Screening mammography is associated with reduced breast cancer-specific mortality; however, among older women, evidence suggests that the potential harms of screening may outweigh the benefits. This study used a qualitative approach to examine the willingness of older women from different racial/ethnic groups to discontinue breast cancer screening. The authors found that among older women who planned to continue screening, intentions to continue breast cancer screening appear to be highly resilient and resistant to recommendations from physicians or expert/government panels.
AHRQ-funded; HS022134.
Citation: Housten AJ, Pappadis MR, Krishnan S .
Resistance to discontinuing breast cancer screening in older women: a qualitative study.
Psychooncology 2018 Jun;27(6):1635-41. doi: 10.1002/pon.4708..
Keywords: Cancer: Breast Cancer, Elderly, Screening, Prevention, Women
Dabbous F, Dolecek TA, Friedewald SM
Performance characteristics of digital vs film screen mammography in community practice.
In this study, the investigators examined performance characteristics of digital vs film screen mammography in community practice by comparing the performance characteristics of 297 629 full field digital (FFDM) and 416 791 screen film mammograms (SFM). In their study, modest gains in performance were achieved with the introduction of FFDM as a replacement for SFM, in a large health care organization.
AHRQ-funded; HS018366.
Citation: Dabbous F, Dolecek TA, Friedewald SM .
Performance characteristics of digital vs film screen mammography in community practice.
Breast J 2018 May;24(3):369-72. doi: 10.1111/tbj.12942..
Keywords: Cancer: Breast Cancer, Cancer, Screening, Imaging, Women, Prevention, Comparative Effectiveness, Diagnostic Safety and Quality
Sun D, Simon GJ, Skube S
Causal phenotyping for susceptibility to cardiotoxicity from antineoplastic breast cancer medications.
Cardiotoxicity is a relatively common and particularly important adverse event caused by chemotherapy for breast cancer patients. The authors of this study propose three phenotyping algorithms to assess breast cancer patients' susceptibility to cardiotoxicity caused by five first-line antineoplastic drugs. The study demonstrates the potential utility of causal phenotyping.
AHRQ-funded; HS022085.
Citation: Sun D, Simon GJ, Skube S .
Causal phenotyping for susceptibility to cardiotoxicity from antineoplastic breast cancer medications.
AMIA Annu Symp Proc 2018 Apr 16;2017:1655-64..
Keywords: Adverse Drug Events (ADE), Cancer: Breast Cancer, Medication, Risk
Richards CA, Rundle AG, Wright JD
Association between hospital financial distress and immediate breast reconstruction surgery after mastectomy among women with ductal carcinoma in situ.
Hospital financial distress may reduce the services a hospital can offer, particularly unprofitable ones. This study examined the association between hospital financial distress (HFD) and receipt of immediate breast reconstruction surgery after mastectomy among women diagnosed with ductal carcinoma in situ (DCIS). It concluded that the financial strength of the hospital where a patient receives treatment is associated with receipt of immediate breast reconstruction surgery.
AHRQ-funded; HS021709.
Citation: Richards CA, Rundle AG, Wright JD .
Association between hospital financial distress and immediate breast reconstruction surgery after mastectomy among women with ductal carcinoma in situ.
JAMA Surg 2018 Apr;153(4):344-51. doi: 10.1001/jamasurg.2017.5018.
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Keywords: Cancer: Breast Cancer, Healthcare Costs, Healthcare Utilization, Healthcare Cost and Utilization Project (HCUP), Surgery
Punglia RS, Jiang W, Lipsitz SR
Clinical risk score to predict likelihood of recurrence after ductal carcinoma in situ treated with breast-conserving surgery.
In this article, the investigators developed a score to provide individualized information about ipsilateral breast tumor recurrence risk to guide treatment decisions. The authors indicate that their simple, no-cost risk score may be used by patients and physicians to facilitate preference-based decision-making about ductal carcinoma in situ management informed by a more accurate understanding of risks.
AHRQ-funded; 29020050016I.
Citation: Punglia RS, Jiang W, Lipsitz SR .
Clinical risk score to predict likelihood of recurrence after ductal carcinoma in situ treated with breast-conserving surgery.
Breast Cancer Res Treat 2018 Feb;167(3):751-59. doi: 10.1007/s10549-017-4553-5..
Keywords: Cancer: Breast Cancer, Risk, Surgery, Patient-Centered Outcomes Research
Murphy DR, Meyer AND, Vaghani V
Electronic triggers to identify delays in follow-up of mammography: harnessing the power of big data in health care.
Because of the unique clinical, logistic, and legal aspects of mammography, this study was conducted to evaluate the effectiveness of a trigger to flag delayed follow-up on mammography. The investigators found that care delays appeared to continue despite federal laws requiring patient notification of mammographic results within 30 days. They suggest that clinical application of mammography-related triggers could help detect these delays.
AHRQ-funded; HS022901.
Citation: Murphy DR, Meyer AND, Vaghani V .
Electronic triggers to identify delays in follow-up of mammography: harnessing the power of big data in health care.
J Am Coll Radiol 2018 Feb;15(2):287-95. doi: 10.1016/j.jacr.2017.10.001..
Keywords: Cancer: Breast Cancer, Cancer, Electronic Health Records (EHRs), Health Information Technology (HIT), Imaging, Diagnostic Safety and Quality, Prevention, Women
Yanez BR, Buitrago D, Buscemi J
Study design and protocol for My Guide: an e-health intervention to improve patient-centered outcomes among Hispanic breast cancer survivors.
This article describes a randomized controlled trial designed to investigate the feasibility and efficacy of a Smartphone application intended to improve health-related quality of life (HRQoL) among Hispanic breast cancer survivors. Participants are randomized to receive either the intervention application My Guide, or the health education control condition application My Health for six weeks, and also receive weekly telecoaching to enhance adherence to both applications. The study's outcomes are measured prior to intervention, immediately after, and eight weeks following initial application use.
AHRQ-funded; HS023011.
Citation: Yanez BR, Buitrago D, Buscemi J .
Study design and protocol for My Guide: an e-health intervention to improve patient-centered outcomes among Hispanic breast cancer survivors.
Contemp Clin Trials 2018 Feb;65:61-68. doi: 10.1016/j.cct.2017.11.018..
Keywords: Cancer, Cancer: Breast Cancer, Health Information Technology (HIT), Outcomes, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Quality of Life, Racial and Ethnic Minorities, Women
Milata JL, Otte JL, Carpenter JS
Oral endocrine therapy nonadherence, adverse effects, decisional support, and decisional needs in women with breast cancer.
Adverse effects contribute to breast cancer survivors’ decisions to stop oral endocrine therapy (OET), yet there has been little investigation of the process through which that occurs. This review serves as a call to action for providers to provide support to breast cancer survivors experiencing OET adverse effects and facing decisions related to nonadherence.
AHRQ-funded; HS024241.
Citation: Milata JL, Otte JL, Carpenter JS .
Oral endocrine therapy nonadherence, adverse effects, decisional support, and decisional needs in women with breast cancer.
Cancer Nurs 2018 Jan/Feb;41(1):E9-E18. doi: 10.1097/ncc.0000000000000430..
Keywords: Adverse Events, Cancer: Breast Cancer, Decision Making, Medication, Patient Adherence/Compliance
Black KZ, Johnson LS, Samuel-Hodge CD
Perceived barriers and preferred components for physical activity interventions in African-American survivors of breast or endometrial cancer with type 2 diabetes: the S.U.C.C.E.S.S. framework.
The study’s objectives were to explore the perspectives of African American survivors with type 2 diabetes on perceived barriers to physical activity (PA) and preferences for a PA intervention and develop a framework for a PA program after cancer treatment. Nine themes were identified that focused on post-treatment physical symptoms. The S.U.C.C.E.S.S. framework summarizes the survivors' preferences for effective lifestyle interventions such as supporting efforts to maintain PA.
AHRQ-funded; HS023418.
Citation: Black KZ, Johnson LS, Samuel-Hodge CD .
Perceived barriers and preferred components for physical activity interventions in African-American survivors of breast or endometrial cancer with type 2 diabetes: the S.U.C.C.E.S.S. framework.
Support Care Cancer 2018 Jan;26(1):231-40. doi: 10.1007/s00520-017-3839-9.
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Keywords: Cancer, Cancer: Breast Cancer, Diabetes, Lifestyle Changes, Racial and Ethnic Minorities
Sun D, Sarda G, Skube SJ
Phenotyping and visualizing infusion-related reactions for breast cancer patients.
Researchers developed and evaluated a phenotyping algorithm to detect Infusion-related reactions (IRRs) for breast cancer patients. They also designed a visualization prototype to render IRR patients' medications, lab tests and vital signs over time. By comparing with the 42 randomly selected doses that are manually labeled by a domain expert, the sensitivity, positive predictive value, specificity, and negative predictive value of the algorithms are 69 percent, 60 percent, 79 percent, and 85 percent, respectively.
AHRQ-funded; HS022085.
Citation: Sun D, Sarda G, Skube SJ .
Phenotyping and visualizing infusion-related reactions for breast cancer patients.
Stud Health Technol Inform 2017;245:599-603.
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Keywords: Adverse Drug Events (ADE), Cancer: Breast Cancer, Medication, Medication: Safety, Patient Safety
Childers CP, Childers KK, Maggard-Gibbons M
National estimates of genetic testing in women with a history of breast or ovarian cancer.
In the United States, 3.8 million women have a history of breast (BC) or ovarian cancer (OC). Up to 15 percent of cases are attributable to heritable mutations, which, if identified, provide critical knowledge for treatment and preventive care. This study found that fewer than one in five individuals with a history of BC or OC meeting select National Cancer Comprehensive Network criteria have undergone genetic testing.
AHRQ-funded; HS025079.
Citation: Childers CP, Childers KK, Maggard-Gibbons M .
National estimates of genetic testing in women with a history of breast or ovarian cancer.
J Clin Oncol 2017 Dec 1;35(34):3800-06. doi: 10.1200/jco.2017.73.6314.
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Keywords: Cancer, Cancer: Breast Cancer, Cancer: Ovarian Cancer, Family Health and History, Genetics, Quality of Care, Screening, Women
Kelly G, Wang SY, Lucas G
Facilitating meaningful engagement on community advisory committees in patient-centered outcome research.
In this study, the investigators conducted a process evaluation of ongoing activities of a Patient Advisory Committee (PAC) formed around the development of an individualized decision aid for older women with early stage breast cancer. They indicated that their results suggested that engaging committee members in a process of evaluation and collective reflection during a research collaboration can break down barriers to collaboration, build relationships, create opportunities for co-learning and strengthen researchers' capacity to engage meaningfully with stakeholders.
AHRQ-funded; HS023900.
Citation: Kelly G, Wang SY, Lucas G .
Facilitating meaningful engagement on community advisory committees in patient-centered outcome research.
Prog Community Health Partnersh 2017;11(3):243-51. doi: 10.1353/cpr.2017.0029..
Keywords: Cancer, Cancer: Breast Cancer, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Research Methodologies
Rauscher GH, Dabbous F, Dolecek TA
Absence of an anticipated racial disparity in interval breast cancer within a large health care organization.
The researchers sought to estimate the extent of an anticipated racial disparity in interval breast cancer (IBC) within a single, large health care organization. Contrary to expectation, in patient-adjusted models, there was no IBC racial disparity. The sorting of patients by race across facilities appears to have mitigated an otherwise anticipated disparity in IBC.
AHRQ-funded; HS018366.
Citation: Rauscher GH, Dabbous F, Dolecek TA .
Absence of an anticipated racial disparity in interval breast cancer within a large health care organization.
Ann Epidemiol 2017 Oct;27(10):654-58. doi: 10.1016/j.annepidem.2017.09.002.
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Keywords: Cancer: Breast Cancer, Cancer, Disparities, Racial and Ethnic Minorities, Women, Screening, Screening, Imaging
Farias AJ, Du XL
Racial differences in adjuvant endocrine therapy use and discontinuation in association with mortality among Medicare breast cancer patients by receptor status.
The purpose of this study was to determine whether racial/ethnic differences in use and discontinuation of adjuvant endocrine therapy (AET) differed by hormone receptor status and whether discontinuation was associated with mortality. There are racial/ethnic differences in AET use and discontinuation. Discontinuing treatment was associated with higher risk of all-cause and cancer-specific mortality regardless of hormone receptor status.
AHRQ-funded; HS018956.
Citation: Farias AJ, Du XL .
Racial differences in adjuvant endocrine therapy use and discontinuation in association with mortality among Medicare breast cancer patients by receptor status.
Cancer Epidemiol Biomarkers Prev 2017 Aug;26(8):1266-75. doi: 10.1158/1055-9965.epi-17-0280.
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Keywords: Cancer: Breast Cancer, Disparities, Elderly, Mortality, Racial and Ethnic Minorities