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Wallner LP, Slezak JM, Quinn VP, Loo RK, Schottinger JE, Bastani R, Jacobsen SJ. Quality of preventive care before and after prostate cancer diagnosis. JOURNAL OF MEN'S HEALTH 2015; 11:14-21. [PMID: 26430473 PMCID: PMC4587561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
OBJECTIVE To examine if the use of general preventive services were diminished in a cohort of men following their diagnosis of prostate cancer. PATIENTS AND METHODS 16,604 men enrolled in Kaiser Permanente Southern California who were newly diagnosed with prostate cancer from January 1, 2002 through December 31, 2009 were passively followed through electronic medical records to determine the use of preventive services, including screening for colorectal cancer (colonoscopy and/or fecal occult blood tests (FOBT)), tests for diabetes (glucose and hemoglobin A1c) and heart disease (serum cholesterol, high density lipoprotein (HDL) and triglycerides) and vaccinations (influenza and pneumococcal). Preventive service use was compared in the two years prior to and following prostate cancer diagnosis using matched odds ratios (MOR) and 95% confidence intervals (CI) in 2013. RESULTS Men were more likely to receive a flu vaccine (MOR: 2.70, 95% CI: 2.52-2.90), lipid tests (MOR: 1.51, 95% CI: 1.42-1.61), diabetes tests (MOR: 2.13, 95% CI: 2.00-2.26) and screening for colorectal cancer (MOR: 1.80, 95% CI: 1.71-1.89) in the two years after prostate cancer diagnosis compared to before. Men with advanced disease at diagnosis were more likely to receive all types of preventive services after diagnosis when compared to men with localized disease. CONCLUSIONS Once diagnosed with prostate cancer in this setting, no less attention was paid to general preventive care, although there remains room for improvement in pneumococcal vaccination and colon cancer screening rates. The delivery of high-quality continuing care after diagnosis is critical for aging cancer patients.
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Affiliation(s)
- Lauren P Wallner
- Department of Medicine and Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI
| | - Jeff M Slezak
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, US
| | - Virginia P Quinn
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, US
| | - Ronald K Loo
- Department of Urology, Southern California Permanente Medical Group, Downey, CA, US
| | - Joanne E Schottinger
- Department of Quality and Clinical Analysis, Southern California Permanente Medical Group, Pasadena, CA, US
| | - Roshan Bastani
- Department of Health Services and Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, CA, US
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, US
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Kenzik K, Pisu M, Johns SA, Baker T, Oster RA, Kvale E, Fouad MN, Martin MY. Unresolved Pain Interference among Colorectal Cancer Survivors: Implications for Patient Care and Outcomes. PAIN MEDICINE 2015; 16:1410-25. [PMID: 25799885 DOI: 10.1111/pme.12727] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 02/04/2015] [Accepted: 02/11/2015] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Using a large sample of colorectal cancer (CRC) survivors we 1) describe pain interference (PI) prevalence across the cancer continuum; 2) identify demographic and clinical factors associated with PI and changes in PI; and 3) examine PI's relationship with survivors' job changes. METHODS CRC participants of the Cancer Care Outcomes Research and Surveillance Consortium completed surveys during the initial phase of care (baseline, < 1 year, n = 2,961) and follow-up (about 1-year postdiagnosis, n = 2,303). PI was measured using the SF-12 item. Multiple logistic regression was used to identify predictors of PI. Model 1 evaluated moderate/high PI at baseline, Model 2 evaluated new/continued/increasing PI postdiagnosis follow-up, and Model 3 restricted to participants with baseline PI (N = 603) and evaluated predictors of equivalent/increasing PI. Multivariable logistic regression was also used to examine whether PI predicted job change. RESULTS At baseline and follow-up, 24.7% and 23.7% of participants reported moderate/high PI, respectively. Among those with baseline PI, 46% had equivalent/increasing PI at follow-up. Near diagnosis and at follow-up, female gender, comorbidities, depression, chemotherapy and radiation were associated with moderate/high PI while older age was protective of PI. Pulmonary disease and heart failure comorbidities were associated with equivalent/increasing PI. PI was significantly associated with no longer having a job at follow-up among employed survivors. CONCLUSION Almost half of survivors with PI during the initial phase of care had continued PI into post-treatment. Comorbidities, especially cardiovascular and pulmonary conditions, contributed to continued PI. PI may be related to continuing normal activities, that is, work, after completed treatment.
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Affiliation(s)
- Kelly Kenzik
- Center for Outcomes and Effectiveness Research and Education, University of Alabama at Birmingham, School of Medicine, MT617, Birmingham, Alabama, 35233, USA
| | - Maria Pisu
- Division of Preventive Medicine, University of Alabama at Birmingham, School of Medicine, MT617, Birmingham, Alabama, 35233, USA
| | - Shelley A Johns
- Division of General Internal Medicine and Geriatrics, Indiana University, School of Medicine, Indianapolis, Indiana, 46202-3082, USA
| | - Tamara Baker
- Department of Psychology, University of Kansas, College of Liberal Arts and Science, Lawrence, USA
| | - Robert A Oster
- Division of Preventive Medicine, University of Alabama at Birmingham, School of Medicine, MT617, Birmingham, Alabama, 35233, USA
| | - Elizabeth Kvale
- University of Alabama at Birmingham, School of Medicine, MT617, Birmingham, Alabama, 35233, USA
| | - Mona N Fouad
- Division of Preventive Medicine, University of Alabama at Birmingham, School of Medicine, MT617, Birmingham, Alabama, 35233, USA
| | - Michelle Y Martin
- Division of Preventive Medicine, University of Alabama at Birmingham, School of Medicine, MT617, Birmingham, Alabama, 35233, USA
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Role of Comorbidity on Survival after Radiotherapy and Chemotherapy for Nonsurgically Treated Lung Cancer. J Thorac Oncol 2015; 10:272-9. [DOI: 10.1097/jto.0000000000000416] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Comorbidities and Their Management: Potential Impact on Breast Cancer Outcomes. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 862:155-75. [DOI: 10.1007/978-3-319-16366-6_11] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Lowenstein LM, Ouellet JA, Dale W, Fan L, Gupta Mohile S. Preventive care in older cancer survivors. J Geriatr Oncol 2014; 6:85-92. [PMID: 25547206 DOI: 10.1016/j.jgo.2014.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 09/29/2014] [Accepted: 12/09/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To study factors that influence receipt of preventive care in older cancer survivors. METHODS We analyzed a nationally representative sample of 12,458 older adults from the 2003 Medicare Current Beneficiary Survey. Factors associated with non-receipt of preventive care were explored among cancer and non-cancer survivors, using logistic regression. RESULTS Among the cancer survivors, 1883 were diagnosed >1 year at survey completion. A cancer history was independently associated with receipt of mammogram (AOR = 1.57, 95% CI = 1.34-1.85), flu shot (AOR = 1.33, 95% CI = 1.16-1.53), measurement of total cholesterol in the previous six months (AOR = 1.20, 95% CI = 1.07-1.34), pneumonia vaccination (AOR = 1.33, 95% CI = 1.18-1.49), bone mineral density (BMD) testing (AOR = 1.38, 95% CI = 1.21-1.56), and lower endoscopy (AOR = 1.46, 95% CI = 1.29-1.65). However, receipt of preventive care was not optimal among older cancer survivors with only 51.2% of the female cancer survivors received a mammogram, 63.8% of all the cancer survivors received colonoscopy, and 42.5% had BMD testing. Among the cancer survivors, factors associated with non-receipt of mammogram included age ≥85 years (AOR = 0.43, 95% CI = 0.26-0.74), and scoring ≥three points on the Vulnerable Elders Survey-13 (AOR = 0.94, 95% CI = 0.80-1.00). Factors associated with non-receipt of colonoscopy included low education (AOR= 0.43, 95% CI = 0.27-0.68) and rural residence (AOR = 0.51, 95% CI = 0.34-0.77). Factors associated with non-receipt of BMD testing included age ≥70 (AOR = 0.59, 95% CI = 0.39-0.90), African American race (AOR = 0.51, 95% CI= 0.27-0.95), low education (AOR = 0.23, 95% CI = 0.14-0.38), and rural residence (AOR = 0.43, 95% CI = 0.27-0.70). CONCLUSION Although older cancer survivors are more likely to receive preventive care services than other older adults, factors other than health status considerations (e.g., education, rural residence) are associated with non-receipt of preventive care services.
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Affiliation(s)
- Lisa M Lowenstein
- James Wilmot Cancer Center, University of Rochester, Rochester, NY, USA
| | | | - William Dale
- Department of Medicine, Section of Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL, USA
| | - Lin Fan
- James Wilmot Cancer Center, University of Rochester, Rochester, NY, USA
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Venepalli NK, Shergill A, Dorestani P, Boyd AD. Conducting Retrospective Ontological Clinical Trials in ICD-9-CM in the Age of ICD-10-CM. Cancer Inform 2014; 13:81-8. [PMID: 25452683 PMCID: PMC4226400 DOI: 10.4137/cin.s14032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 06/30/2014] [Accepted: 07/01/2014] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To quantify the impact of International Classification of Disease 10th Revision Clinical Modification (ICD-10-CM) transition in cancer clinical trials by comparing coding accuracy and data discontinuity in backward ICD-10-CM to ICD-9-CM mapping via two tools, and to develop a standard ICD-9-CM and ICD-10-CM bridging methodology for retrospective analyses. BACKGROUND While the transition to ICD-10-CM has been delayed until October 2015, its impact on cancer-related studies utilizing ICD-9-CM diagnoses has been inadequately explored. MATERIALS AND METHODS Three high impact journals with broad national and international readerships were reviewed for cancer-related studies utilizing ICD-9-CM diagnoses codes in study design, methods, or results. Forward ICD-9-CM to ICD-10-CM mapping was performing using a translational methodology with the Motif web portal ICD-9-CM conversion tool. Backward mapping from ICD-10-CM to ICD-9-CM was performed using both Centers for Medicare and Medicaid Services (CMS) general equivalence mappings (GEMs) files and the Motif web portal tool. Generated ICD-9-CM codes were compared with the original ICD-9-CM codes to assess data accuracy and discontinuity. RESULTS While both methods yielded additional ICD-9-CM codes, the CMS GEMs method provided incomplete coverage with 16 of the original ICD-9-CM codes missing, whereas the Motif web portal method provided complete coverage. Of these 16 codes, 12 ICD-9-CM codes were present in 2010 Illinois Medicaid data, and accounted for 0.52% of patient encounters and 0.35% of total Medicaid reimbursements. Extraneous ICD-9-CM codes from both methods (Centers for Medicare and Medicaid Services general equivalent mapping [CMS GEMs, n = 161; Motif web portal, n = 246]) in excess of original ICD-9-CM codes accounted for 2.1% and 2.3% of total patient encounters and 3.4% and 4.1% of total Medicaid reimbursements from the 2010 Illinois Medicare database. DISCUSSION Longitudinal data analyses post-ICD-10-CM transition will require backward ICD-10-CM to ICD-9-CM coding, and data comparison for accuracy. Researchers must be aware that all methods for backward coding are not comparable in yielding original ICD-9-CM codes. CONCLUSIONS The mandated delay is an opportunity for organizations to better understand areas of financial risk with regards to data management via backward coding. Our methodology is relevant for all healthcare-related coding data, and can be replicated by organizations as a strategy to mitigate financial risk.
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Affiliation(s)
- Neeta K Venepalli
- Department of Medicine, Section of Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Ardaman Shergill
- Department of Medicine, Section of Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Parvaneh Dorestani
- Departments of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Andrew D Boyd
- Departments of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, IL, USA. ; Institute for Translational Health Informatics, University of Illinois at Chicago, Chicago, IL, USA. ; Department of Strategic Initiatives, University of Illinois Hospital and Health Science System, Chicago, IL, USA. ; Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
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Neff R, McCann GA, Carpenter KM, Cohn DE, Noria S, Mikami D, Needleman BJ, O'Malley DM. Is bariatric surgery an option for women with gynecologic cancer? Examining weight loss counseling practices and training among gynecologic oncology providers. Gynecol Oncol 2014; 134:540-5. [PMID: 24933102 DOI: 10.1016/j.ygyno.2014.06.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 06/05/2014] [Accepted: 06/08/2014] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate gynecologic oncology provider (GOP) practices regarding weight loss (WL) counseling, and to assess their willingness to initiate weight loss interventions, specifically bariatric surgery (WLS). METHODS Members of the Society of Gynecologic Oncology were invited to complete an online survey of 49 items assessing knowledge, attitudes, and behaviors related to WL counseling. RESULTS A total of 454 participants initiated the survey, yielding a response rate of 30%. The majority of respondents (85%) were practicing GOP or fellows. A majority of responders reported that >50% of their patient population is clinically obese (BMI ≥ 30). Only 10% reported having any formal training in WL counseling, most often in medical school or residency. Providers who feel adequate about WL counseling were more likely to offer multiple WL options to their patients (p<.05). Over 90% of responders believe that WLS is an effective WL option and is more effective than self-directed diet and medical management of obesity. Providers who were more comfortable with WL counseling were significantly more likely to recommend WLS (p<.01). Approximately 75% of respondents expressed interest in clinical trials evaluating WLS in obese cancer survivors. CONCLUSIONS The present study suggests that GOP appreciate the importance of WL counseling, but often fail to provide it. Our results demonstrate the paucity of formal obesity training in oncology. Providers seem willing to recommend WLS as an option to their patients but also in clinical trials examining gynecologic cancer outcomes in women treated with BS.
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Affiliation(s)
- Robert Neff
- Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States
| | - Georgia A McCann
- University of Texas Health Sciences at San Antonio, San Antonio, TX, United States
| | - Kristen M Carpenter
- Department of Psychiatry & Behavioral Health, The Ohio State University, Columbus, OH, United States
| | - David E Cohn
- Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States
| | - Sabrena Noria
- Division of General and Gastrointestinal Surgery, The Ohio State University, Columbus, OH, United States
| | - Dean Mikami
- Division of General and Gastrointestinal Surgery, The Ohio State University, Columbus, OH, United States
| | - Bradley J Needleman
- Division of General and Gastrointestinal Surgery, The Ohio State University, Columbus, OH, United States
| | - David M O'Malley
- Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, United States. David.O'
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Salz T, Baxi SS, Blinder VS, Elkin EB, Kemeny MM, McCabe MS, Moskowitz CS, Onstad EE, Saltz LB, Temple LKF, Oeffinger KC. Colorectal cancer survivors' needs and preferences for survivorship information. J Oncol Pract 2014; 10:e277-82. [PMID: 24893610 DOI: 10.1200/jop.2013.001312] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Before developing a survivorship care plan (SCP) that colorectal cancer (CRC) survivors will value, understanding the informational needs of CRC survivors is critical. METHODS We surveyed survivors treated for nonmetastatic CRC at two hospitals in New York about their needs and preferences for survivorship information. Participants completed treatment 6 to 24 months before the interview and had not received an SCP. We evaluated whether survivors knew their treatment history (10 topics), whether they understood ongoing risks (four topics), and their preferences for receiving 16 topics of survivorship information. RESULTS One hundred seventy-five survivors completed the survey. Most survivors remembered information about past treatment (98% to 99% for each treatment). Fewer survivors knew their risks of local recurrence, distant recurrence, or developing a new CRC (69%, 77%, and 40%, respectively). Most participants reported receiving information about their cancer history and ongoing oncology visits (77% to 86% across topics). Across all topics, 93% to 99% of those who reported receiving information found the information useful. A minority of survivors reported they received information about symptoms to report to doctors, returning to work, or financial or legal issues (5% to 48% across topics), but those who did found the information useful (89% to 100% across topics). CONCLUSIONS In the absence of an SCP, CRC survivors still generally understood their cancer history. However, many lacked knowledge of ongoing risks and prevention. Most survivors stated that they found the survivorship information they received useful. SCPs for CRC survivors should focus less on past care and more on helping survivors understand their risks and plan for the future.
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Affiliation(s)
- Talya Salz
- Memorial Sloan-Kettering Cancer Center; Queens Cancer Center of Queens Hospital, New York, NY; and Harvard School of Public Health, Boston, MA
| | - Shrujal S Baxi
- Memorial Sloan-Kettering Cancer Center; Queens Cancer Center of Queens Hospital, New York, NY; and Harvard School of Public Health, Boston, MA
| | - Victoria S Blinder
- Memorial Sloan-Kettering Cancer Center; Queens Cancer Center of Queens Hospital, New York, NY; and Harvard School of Public Health, Boston, MA
| | - Elena B Elkin
- Memorial Sloan-Kettering Cancer Center; Queens Cancer Center of Queens Hospital, New York, NY; and Harvard School of Public Health, Boston, MA
| | - Margaret M Kemeny
- Memorial Sloan-Kettering Cancer Center; Queens Cancer Center of Queens Hospital, New York, NY; and Harvard School of Public Health, Boston, MA
| | - Mary S McCabe
- Memorial Sloan-Kettering Cancer Center; Queens Cancer Center of Queens Hospital, New York, NY; and Harvard School of Public Health, Boston, MA
| | - Chaya S Moskowitz
- Memorial Sloan-Kettering Cancer Center; Queens Cancer Center of Queens Hospital, New York, NY; and Harvard School of Public Health, Boston, MA
| | - Erin E Onstad
- Memorial Sloan-Kettering Cancer Center; Queens Cancer Center of Queens Hospital, New York, NY; and Harvard School of Public Health, Boston, MA
| | - Leonard B Saltz
- Memorial Sloan-Kettering Cancer Center; Queens Cancer Center of Queens Hospital, New York, NY; and Harvard School of Public Health, Boston, MA
| | - Larissa K F Temple
- Memorial Sloan-Kettering Cancer Center; Queens Cancer Center of Queens Hospital, New York, NY; and Harvard School of Public Health, Boston, MA
| | - Kevin C Oeffinger
- Memorial Sloan-Kettering Cancer Center; Queens Cancer Center of Queens Hospital, New York, NY; and Harvard School of Public Health, Boston, MA
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Pollack CE, Frick KD, Herbert RJ, Blackford AL, Neville BA, Wolff AC, Carducci MA, Earle CC, Snyder CF. It's who you know: patient-sharing, quality, and costs of cancer survivorship care. J Cancer Surviv 2014; 8:156-66. [PMID: 24578154 PMCID: PMC4064794 DOI: 10.1007/s11764-014-0349-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 02/07/2014] [Indexed: 12/31/2022]
Abstract
PURPOSE Cancer survivors frequently receive care from a large number of physicians, creating challenges for coordination. We sought to explore whether cancer survivors whose providers have more patients in common (e.g., shared patients) tend to have higher quality and lower cost care. METHODS We performed a retrospective cohort study of 8,661 patients diagnosed with loco-regional breast, prostate, or colorectal cancer. We examined survivorship care from days 366 to 1,095 following their cancer diagnosis. Our primary independent variable was "care density," a novel metric of the extent to which a patient's providers share patients with one another. Our outcome measures were health care utilization, quality metrics, and costs. RESULTS In adjusted analyses, we found that patients with high care density--indicating high levels of patient-sharing among their providers--had significantly lower rates of hospitalization (OR 0.87, 95% CI 0.75-1.00) and higher odds of an eye examination for diabetes (OR 1.31, 95% CI 1.03-1.66) compared to patients with low care density. High care density was not associated with emergency department visits, avoidable outcomes, lipid profile following an angina diagnosis, or odds of glycosylated hemoglobin testing for diabetes. Patients with high care density had significantly lower total costs of care over 24 months (beta coefficient -$2,116, 95% CI -$3,107 to -$1,125) along with lower inpatient and outpatient costs. CONCLUSION Cancer survivors treated by physicians who share more patients with one another tend to have some higher aspects of quality and lower cost care. IMPLICATIONS OF CANCER SURVIVORS If validated, care density may be a useful indicator for monitoring care coordination among cancer survivors and potentially targeting interventions that seek to improve care delivery.
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Sanford SD, Zhao F, Salsman JM, Chang VT, Wagner LI, Fisch MJ. Symptom burden among young adults with breast or colorectal cancer. Cancer 2014; 120:2255-63. [PMID: 24890659 DOI: 10.1002/cncr.28297] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 07/01/2013] [Accepted: 07/09/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND Cancer incidence has increased among young adults (YAs) and survival rates have not improved compared with other age groups. Patient-reported outcomes may enhance our understanding of this vulnerable population. METHODS In a multisite prospective study, patients completed a cancer symptom inventory at the time of enrollment (T1) and 4 weeks to 5 weeks later (T2). YAs (those aged ≤ 39 years) with breast or colorectal cancer were compared with older adults (those aged ≥ 40 years) with breast or colorectal cancer with regard to symptom severity, symptom interference, changes over time, and medical care. RESULTS Participants included 1544 patients with breast cancer (96 of whom were YAs) and 718 patients with colorectal cancer (37 of whom were YAs). Compared with older adults, YAs with breast cancer were more likely to report moderate/severe drowsiness, hair loss, and symptom interference with relationships at T1. YAs with colorectal cancer were more likely to report moderate/severe pain, fatigue, nausea, distress, drowsiness, shortness of breath, and rash plus interference in general activity, mood, work, relationships, and life enjoyment compared with older adults. Compared with older adults, shortness of breath, appetite, and sore mouth were more likely to improve in YAs with breast cancer; vomiting was less likely to improve in YAs with colorectal cancer. Referrals for supportive care were few, especially among patients with colorectal cancer. YAs with breast cancer were somewhat more likely to be referred to nutrition and psychiatry services than older patients. CONCLUSIONS YAs reported symptom severity, symptom interference, and variations over time that were distinct from older patients. Distinctions were found to differ by diagnostic group. These findings enhance the understanding of symptom burden in YAs and inform the development of targeted interventions and future research.
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Affiliation(s)
- Stacy D Sanford
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Edwards BK, Noone AM, Mariotto AB, Simard EP, Boscoe FP, Henley SJ, Jemal A, Cho H, Anderson RN, Kohler BA, Eheman CR, Ward EM. Annual Report to the Nation on the status of cancer, 1975-2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer. Cancer 2014; 120:1290-314. [PMID: 24343171 PMCID: PMC3999205 DOI: 10.1002/cncr.28509] [Citation(s) in RCA: 870] [Impact Index Per Article: 87.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 11/19/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND The American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to provide updates on cancer incidence and death rates and trends in these outcomes for the United States. This year's report includes the prevalence of comorbidity at the time of first cancer diagnosis among patients with lung, colorectal, breast, or prostate cancer and survival among cancer patients based on comorbidity level. METHODS Data on cancer incidence were obtained from the NCI, the CDC, and the NAACCR; and data on mortality were obtained from the CDC. Long-term (1975/1992-2010) and short-term (2001-2010) trends in age-adjusted incidence and death rates for all cancers combined and for the leading cancers among men and women were examined by joinpoint analysis. Through linkage with Medicare claims, the prevalence of comorbidity among cancer patients who were diagnosed between 1992 through 2005 residing in 11 Surveillance, Epidemiology, and End Results (SEER) areas were estimated and compared with the prevalence in a 5% random sample of cancer-free Medicare beneficiaries. Among cancer patients, survival and the probabilities of dying of their cancer and of other causes by comorbidity level, age, and stage were calculated. RESULTS Death rates continued to decline for all cancers combined for men and women of all major racial and ethnic groups and for most major cancer sites; rates for both sexes combined decreased by 1.5% per year from 2001 through 2010. Overall incidence rates decreased in men and stabilized in women. The prevalence of comorbidity was similar among cancer-free Medicare beneficiaries (31.8%), breast cancer patients (32.2%), and prostate cancer patients (30.5%); highest among lung cancer patients (52.9%); and intermediate among colorectal cancer patients (40.7%). Among all cancer patients and especially for patients diagnosed with local and regional disease, age and comorbidity level were important influences on the probability of dying of other causes and, consequently, on overall survival. For patients diagnosed with distant disease, the probability of dying of cancer was much higher than the probability of dying of other causes, and age and comorbidity had a smaller effect on overall survival. CONCLUSIONS Cancer death rates in the United States continue to decline. Estimates of survival that include the probability of dying of cancer and other causes stratified by comorbidity level, age, and stage can provide important information to facilitate treatment decisions.
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Affiliation(s)
- Brenda K Edwards
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
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Chronic disease burden among cancer survivors in the California Behavioral Risk Factor Surveillance System, 2009-2010. J Cancer Surviv 2014; 8:448-59. [PMID: 24715532 DOI: 10.1007/s11764-014-0350-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 02/08/2014] [Indexed: 12/18/2022]
Abstract
PURPOSE The California Behavioral Risk Factor Surveillance System estimates that 56.6 % of cancer survivors report ever being diagnosed with a chronic disease. Few studies have assessed potential variability in comorbidity by cancer type. METHODS We used data collected from a representative sample of adult participants in the 2009 and 2010 California Behavioral Risk Factor Surveillance System (n = 18,807). Chronic diseases were examined with cancer survivorship in case/non-case and case/case analyses. Prevalence ratios (PR) and corresponding 95 % confidence intervals (95 % CI) were estimated using Cox proportional hazards models, with adjustment on race, sex, age, education, smoking, and drinking. RESULTS Obesity was associated with gynecological cancers (PR 1.74; 95 % CI 1.26-2.41), and being overweight was associated with gynecological (PR 1.40; 95 % CI 1.05-1.86) and urinary (PR 2.19; 95 % CI 1.21-3.95) cancers. Arthritis was associated with infection-related (PR 1.78; 95 % CI 1.12-2.83) and hormone-related (PR 1.20; 95 % CI 1.01-1.42) cancers. Asthma was associated with infection- (PR 2.26; 95 % CI 1.49-3.43), hormone- (PR 1.46; 95 % CI 1.21-1.77), and tobacco- (PR 1.86; 95 % CI 1.25-2.77) related cancers. Chronic obstructive pulmonary disease (COPD) was associated with infection- (PR 2.16; 95 % CI 1.22-3.83) and tobacco-related (PR 2.24; 95 % CI 1.37-3.66) cancers and with gynecological cancers (PR 1.60; 95 % 1.00-2.56). CONCLUSIONS This is the first study to examine chronic disease burden among cancer survivors in California. Our findings suggest that the chronic disease burden varies by cancer etiology. IMPLICATIONS FOR CANCER SURVIVORS A clear need has emerged for future biological and epidemiological studies of the interaction between chronic disease and cancer etiology in survivors.
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Holmes HM, Nguyen HT, Nayak P, Oh JH, Escalante CP, Elting LS. Chronic conditions and health status in older cancer survivors. Eur J Intern Med 2014; 25:374-8. [PMID: 24389373 DOI: 10.1016/j.ejim.2013.12.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 12/03/2013] [Accepted: 12/10/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND With the aging population and improved cancer care, the number of cancer survivors is steadily increasing. Planning for their care requires an understanding of the impact of cancer and chronic conditions on quality of life. We sought to determine chronic conditions and health status in older cancer survivors compared to controls. METHODS In this retrospective cross-sectional study, we used survey data from 18,133 cancer survivors and 94,407 controls age 65 and older who participated in the Behavioral Risk Factor Surveillance System 2009 telephonic survey. Our main measures were chronic conditions (cardiovascular disease, hypertension, diabetes mellitus, high cholesterol, and arthritis) and poor health status (poor or fair self-rated health). RESULTS Cancer survivors were older, more likely white, had higher education, and slightly more likely to have a healthcare provider and higher levels of emotional support. More survivors reported having 2 or more chronic conditions compared to controls (67.5% vs. 64.5%, respectively). Health status was lower for survivors, and was significantly different by racial/ethnic group. In a multivariable model for health status, having 2 or more chronic conditions was more strongly associated with poorer health status than cancer survivorship. CONCLUSIONS Cancer survivors had slightly higher numbers of chronic conditions and poorer health status than controls. However, chronic conditions were more strongly associated with poor health status than cancer. Monitoring for recurrence and second cancers is important in cancer survivors, but chronic conditions also need to be given priority due to their substantial impact on health status.
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Affiliation(s)
- Holly M Holmes
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Hoang Thanh Nguyen
- Department of Health Services Research, MD Anderson Cancer Center, Houston, TX, USA
| | - Pratibha Nayak
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeong H Oh
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carmelita P Escalante
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Linda S Elting
- Department of Health Services Research, MD Anderson Cancer Center, Houston, TX, USA
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Kurian AW, Mitani A, Desai M, Yu PP, Seto T, Weber SC, Olson C, Kenkare P, Gomez SL, de Bruin MA, Horst K, Belkora J, May SG, Frosch DL, Blayney DW, Luft HS, Das AK. Breast cancer treatment across health care systems: linking electronic medical records and state registry data to enable outcomes research. Cancer 2014; 120:103-11. [PMID: 24101577 PMCID: PMC3867595 DOI: 10.1002/cncr.28395] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 08/12/2013] [Accepted: 08/22/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND Understanding of cancer outcomes is limited by data fragmentation. In the current study, the authors analyzed the information yielded by integrating breast cancer data from 3 sources: electronic medical records (EMRs) from 2 health care systems and the state registry. METHODS Diagnostic test and treatment data were extracted from the EMRs of all patients with breast cancer treated between 2000 and 2010 in 2 independent California institutions: a community-based practice (Palo Alto Medical Foundation; "Community") and an academic medical center (Stanford University; "University"). The authors incorporated records from the population-based California Cancer Registry and then linked EMR-California Cancer Registry data sets of Community and University patients. RESULTS The authors initially identified 8210 University patients and 5770 Community patients; linked data sets revealed a 16% patient overlap, yielding 12,109 unique patients. The percentage of all Community patients, but not University patients, treated at both institutions increased with worsening cancer prognostic factors. Before linking the data sets, Community patients appeared to receive less intervention than University patients (mastectomy: 37.6% vs 43.2%; chemotherapy: 35% vs 41.7%; magnetic resonance imaging: 10% vs 29.3%; and genetic testing: 2.5% vs 9.2%). Linked Community and University data sets revealed that patients treated at both institutions received substantially more interventions (mastectomy: 55.8%; chemotherapy: 47.2%; magnetic resonance imaging: 38.9%; and genetic testing: 10.9% [P < .001 for each 3-way institutional comparison]). CONCLUSIONS Data linkage identified 16% of patients who were treated in 2 health care systems and who, despite comparable prognostic factors, received far more intensive treatment than others. By integrating complementary data from EMRs and population-based registries, a more comprehensive understanding of breast cancer care and factors that drive treatment use was obtained.
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Affiliation(s)
- Allison W. Kurian
- Department of Medicine, Stanford University
- Department of Health Research & Policy, Stanford University
| | - Aya Mitani
- Department of Medicine, Stanford University
| | | | - Peter P. Yu
- Palo Alto Medical Foundation Research Institute
| | - Tina Seto
- Department of Medicine, Stanford University
| | | | - Cliff Olson
- Palo Alto Medical Foundation Research Institute
| | | | - Scarlett L. Gomez
- Department of Health Research & Policy, Stanford University
- Cancer Prevention Institute of California
| | | | | | - Jeffrey Belkora
- Palo Alto Medical Foundation Research Institute
- University of California, San Francisco
| | | | - Dominick L. Frosch
- Palo Alto Medical Foundation Research Institute
- Department of Medicine, University of California at Los Angeles
- Gordon and Betty Moore Foundation
| | | | - Harold S. Luft
- Palo Alto Medical Foundation Research Institute
- University of California, San Francisco
| | - Amar K. Das
- Department of Medicine, Stanford University
- Department of Psychiatry and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine
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65
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Ording AG, Garne JP, Nyström PMW, Frøslev T, Sørensen HT, Lash TL. Comorbid diseases interact with breast cancer to affect mortality in the first year after diagnosis--a Danish nationwide matched cohort study. PLoS One 2013; 8:e76013. [PMID: 24130755 PMCID: PMC3794020 DOI: 10.1371/journal.pone.0076013] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 08/19/2013] [Indexed: 11/23/2022] Open
Abstract
Background Survival of breast cancer patients with comorbidity, compared to those without comorbidity, has been well characterized. The interaction between comorbid diseases and breast cancer, however, has not been well-studied. Methods From Danish nationwide medical registries, we identified all breast cancer patients between 45 and 85 years of age diagnosed from 1994 to 2008. Women without breast cancer were matched to the breast cancer patients on specific comorbid diseases included in the Charlson comorbidity Index (CCI). Interaction contrasts were calculated as a measure of synergistic effect on mortality between comorbidity and breast cancer. Results The study included 47,904 breast cancer patients and 237,938 matched comparison women. In the first year, the strongest interaction between comorbidity and breast cancer was observed in breast cancer patients with a CCI score of ≥4, which accounted for 29 deaths per 1000 person-years. Among individual comorbidities, dementia interacted strongly with breast cancer and accounted for 148 deaths per 1000 person-years within one year of follow-up. There was little interaction between comorbidity and breast cancer during one to five years of follow-up. Conclusions There was substantial interaction between comorbid diseases and breast cancer, affecting mortality. Successful treatment of the comorbid diseases or the breast cancer can delay mortality caused by this interaction in breast cancer patients.
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Affiliation(s)
- Anne Gulbech Ording
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- * E-mail:
| | - Jens Peter Garne
- Breast Clinic, Aalborg Hospital, Aalborg University Hospital, Aalborg, Denmark
| | | | - Trine Frøslev
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Timothy L. Lash
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
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66
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Salani R. Survivorship planning in gynecologic cancer patients. Gynecol Oncol 2013; 130:389-97. [DOI: 10.1016/j.ygyno.2013.05.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 05/13/2013] [Accepted: 05/16/2013] [Indexed: 01/01/2023]
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