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Allaire BT, Horvath ML, Lines LM, Davidoff AJ, Smith AW, Jensen RE. Do Contemporary Cancer Survivors Experience Better Quality of Life? Evaluating a Decade of SEER Medicare Health Outcomes Survey Data. Cancer Epidemiol Biomarkers Prev 2024; 33:593-599. [PMID: 38284816 DOI: 10.1158/1055-9965.epi-23-1114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/29/2023] [Accepted: 01/25/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND A cancer diagnosis may have deleterious effects on health-related quality of life (HRQOL) as adults age. This study examined differences in HRQOL between cancer and matched noncancer Medicare beneficiaries over 65, within and across two time periods. METHODS We used novel matching methods on data from the Surveillance, Epidemiology and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) data resource. We matched SEER-MHOS respondents with cancer from a recent period (2015-2019) to respondents with cancer from an earlier period (2008-2012). We then matched these two cohorts, without replacement, to contemporary cohorts without cancer diagnoses. We estimated Veteran's RAND 12-Item Short Form Survey Physical Component Summary (PCS) and Mental Component Summary (MCS) scores for all cohorts. RESULTS Our analysis found significantly higher mean MCS scores in the recent period for those with cancer relative to the recent noncancer control group. Breast and lung cancer presented positive and statistically significant trends. We found statistically insignificant differences in PCS scores between the two time periods. No cancer sites had different PCS scores over time compared with the comparison group. CONCLUSIONS Mental health for those with cancer improved more between 2008 and 2019 than a matched noncancer comparison group. Physical health remained stable across time. These findings highlight the importance of including a matched noncancer group when evaluating HRQOL outcomes. IMPACT SEER-MHOS respondents with cancer report stable PCS scores across 15 years of data and higher MCS scores relative to noncancer controls.
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Affiliation(s)
| | - Marc L Horvath
- RTI International, Research Triangle Park, North Carolina
| | - Lisa M Lines
- RTI International, Research Triangle Park, North Carolina
| | - Amy J Davidoff
- Outcomes Research Branch, Healthcare Delivery Research Program, DCCPS, National Cancer Institute, Bethesda, Maryland
| | - Ashley Wilder Smith
- Outcomes Research Branch, Healthcare Delivery Research Program, DCCPS, National Cancer Institute, Bethesda, Maryland
| | - Roxanne E Jensen
- Outcomes Research Branch, Healthcare Delivery Research Program, DCCPS, National Cancer Institute, Bethesda, Maryland
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Griffin JM, Kroner BL, Wong SL, Preiss L, Wilder Smith A, Cheville AL, Mitchell SA, Lancki N, Hassett MJ, Schrag D, Osarogiagbon RU, Ridgeway JL, Cella D, Jensen RE, Flores AM, Austin JD, Yanez B. Disparities in electronic health record portal access and use among patients with cancer. J Natl Cancer Inst 2024; 116:476-484. [PMID: 37930884 PMCID: PMC10919330 DOI: 10.1093/jnci/djad225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/12/2023] [Accepted: 10/18/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Electronic health record-linked portals may improve health-care quality for patients with cancer. Barriers to portal access and use undermine interventions that rely on portals to reduce cancer care disparities. This study examined portal access and persistence of portal use and associations with patient and structural factors before the implementation of 3 portal-based interventions within the Improving the Management of symPtoms during And following Cancer Treatment (IMPACT) Consortium. METHODS Portal use data were extracted from electronic health records for the 12 months preceding intervention implementation. Sociodemographic factors, mode of accessing portals (web vs mobile), and number of clinical encounters before intervention implementation were also extracted. Rurality was derived using rural-urban commuting area codes. Broadband access was estimated using the 2015-2019 American Community Survey. Multiple logistic regression models tested the associations of these factors with portal access (ever accessed or never accessed) and persistence of portal use (accessed the portal ≤20 weeks vs ≥21 weeks in the 35-week study period). RESULTS Of 28 942 eligible patients, 10 061 (35%) never accessed the portal. Male sex, membership in a racial and ethnic minority group, rural dwelling, not working, and limited broadband access were associated with lower odds of portal access. Younger age and more clinical encounters were associated with higher odds of portal access. Of those with portal access, 25% were persistent users. Using multiple modalities for portal access, being middle-aged, and having more clinical encounters were associated with persistent portal use. CONCLUSION Patient and structural factors affect portal access and use and may exacerbate disparities in electronic health record-based cancer symptom surveillance and management.
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Affiliation(s)
- Joan M Griffin
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
- Robert E. and Patricia D. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Barbara L Kroner
- Center for Clinical Research, RTI International, Research Triangle Park, NC, USA
| | - Sandra L Wong
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Liliana Preiss
- Center for Clinical Research, RTI International, Research Triangle Park, NC, USA
| | - Ashley Wilder Smith
- Outcomes Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Andrea L Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Sandra A Mitchell
- Outcomes Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Nicola Lancki
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael J Hassett
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Deborah Schrag
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Jennifer L Ridgeway
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
- Robert E. and Patricia D. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Roxanne E Jensen
- Outcomes Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Ann Marie Flores
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
- Department of Physical Therapy and Human Movement Science, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jessica D Austin
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Smith AW, DiMartino L, Garcia SF, Mitchell SA, Ruddy KJ, Smith JD, Wong SL, Cahue S, Cella D, Jensen RE, Hassett MJ, Hodgdon C, Kroner B, Osarogiagbon RU, Popovic J, Richardson K, Schrag D, Cheville AL. Systematic symptom management in the IMPACT Consortium: rationale and design for 3 effectiveness-implementation trials. JNCI Cancer Spectr 2023; 7:pkad073. [PMID: 37930033 PMCID: PMC10627528 DOI: 10.1093/jncics/pkad073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/30/2023] [Accepted: 09/13/2023] [Indexed: 11/07/2023] Open
Abstract
Cancer and its treatment produce deleterious symptoms across the phases of care. Poorly controlled symptoms negatively affect quality of life and result in increased health-care needs and hospitalization. The Improving the Management of symPtoms during And following Cancer Treatment (IMPACT) Consortium was created to develop 3 large-scale, systematic symptom management systems, deployed through electronic health record platforms, and to test them in pragmatic, randomized, hybrid effectiveness and implementation trials. Here, we describe the IMPACT Consortium's conceptual framework, its organizational components, and plans for evaluation. The study designs and lessons learned are highlighted in the context of disruptions related to the COVID-19 pandemic.
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Affiliation(s)
- Ashley Wilder Smith
- Outcomes Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Lisa DiMartino
- Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Austin, TX, USA
- RTI International, Washington, DC, USA
| | - Sofia F Garcia
- Department of Medical Social Sciences and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sandra A Mitchell
- Outcomes Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | | | - Justin D Smith
- Division of Health Systems Innovation and Research, Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Sandra L Wong
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - September Cahue
- American Academy of Allergy, Asthma and Immunology, Chicago, IL, USA
| | - David Cella
- Department of Medical Social Sciences and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Roxanne E Jensen
- Outcomes Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Michael J Hassett
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Christine Hodgdon
- Guiding Researchers and Advocates to Scientific Partnerships, Baltimore, MD, USA
| | | | | | | | | | - Deborah Schrag
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea L Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
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Dean D, Smith AW. Addressing sexual and gender minority disparities in cancer research. J Natl Cancer Inst 2023; 115:1125-1127. [PMID: 37682249 PMCID: PMC10560592 DOI: 10.1093/jnci/djad163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/07/2023] [Indexed: 09/09/2023] Open
Affiliation(s)
- David Dean
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Ashley Wilder Smith
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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Cella D, Garcia SF, Cahue S, Smith JD, Yanez B, Scholtens D, Lancki N, Bass M, Kircher S, Flores AM, Jensen RE, Smith AW, Penedo FJ. Implementation and evaluation of an expanded electronic health record-integrated bilingual electronic symptom management program across a multi-site Comprehensive Cancer Center: The NU IMPACT protocol. Contemp Clin Trials 2023; 128:107171. [PMID: 36990275 PMCID: PMC10164083 DOI: 10.1016/j.cct.2023.107171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 03/25/2023] [Accepted: 03/25/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND People with cancer experience symptoms that adversely affect quality of life. Despite existing interventions and clinical guidelines, timely symptom management remains uneven in oncology care. We describe a study to implement and evaluate an electronic health record (EHR)-integrated symptom monitoring and management program in adult outpatient cancer care. METHODS Our cancer patient-reported outcomes (cPRO) symptom monitoring and management program is a customized EHR-integrated installation. We will implement cPRO across all Northwestern Memorial HealthCare (NMHC) hematology/oncology clinics. We will conduct a cluster randomized modified stepped-wedge trial to evaluate patient and clinician engagement with cPRO. Further, we will embed a patient-level randomized clinical trial to evaluate the impact of an additional enhanced care (EC; cPRO plus web-based symptom self-management intervention) relative to usual care (UC; cPRO alone). The project uses a Type 2 hybrid effectiveness-implementation approach. The intervention will be implemented across seven regional clusters within the healthcare system comprising 32 clinic sites. A 6-month prospective pre-implementation enrollment period will be followed by a post-implementation enrollment period, during which newly enrolled, consenting patients will be randomly assigned (1:1) to EC or UC. We will follow patients for 12 months post-enrollment. Patients randomized to EC will receive evidence-based symptom-management content on cancer-related concerns and approaches to enhance quality of life, using a web-based tool ("MyNM Care Corner"). This design allows for within- and between-site evaluation of implementation plus a group-based comparison to demonstrate effectiveness on patient-level outcomes. DISCUSSION The project has potential to guide implementation of future healthcare system-level cancer symptom management programs. http://ClinicalTrials.gov # NCT03988543.
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Affiliation(s)
- David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States of America.
| | - Sofia F Garcia
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States of America.
| | - September Cahue
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
| | - Justin D Smith
- Department of Population Health Sciences, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT, United States of America.
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
| | - Denise Scholtens
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
| | - Nicola Lancki
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
| | - Michael Bass
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
| | - Sheetal Kircher
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
| | - Ann Marie Flores
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States of America; Department of Physical Therapy and Human Movement Science, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
| | - Roxanne E Jensen
- Outcomes Research Branch Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, United States of America.
| | - Ashley Wilder Smith
- Outcomes Research Branch Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, United States of America
| | - Frank J Penedo
- Departments of Psychology and Medicine, University of Miami, Coral Gables, FL, United States of America; Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, FL, United States of America.
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Sun V, Tuovinen P, Jacobsen PB, Smith AW. Healthcare delivery research in older adults with cancer: A review of National Institutes of Health-funded projects. J Am Geriatr Soc 2023. [PMID: 36896874 DOI: 10.1111/jgs.18317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/03/2023] [Accepted: 02/11/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Cancer is a disease of aging, and most people with cancer are older than 65. However, widespread uptake of evidence-based approaches that facilitate quality care delivery for older adults with cancer are lacking. This project aimed to review National Institutes of Health (NIH) grants funded in the last decade that focused on healthcare delivery in aging and older adults with cancer, and to examine grant-related characteristics, study designs, and scientific topics included. METHODS A search was conducted of all extramural NIH research grants awarded between fiscal year 2012 to 2021. We examined NIH terms; keyword searches of titles, abstracts, and specific aims were implemented to maximize search efficiency. Extraction criteria focused on grant-related and study characteristics. A priori scientific topics for coding included geriatric assessment, care decision-making, communication, care coordination, physical and psychosocial functioning/symptoms, and clinical outcomes. RESULTS A total of 48 funded grants met the inclusion criteria. A near-equal split was observed between R03, R21, and R01 grants. Most grants did not include family caregivers or focus on end-of-life care. Most grants included multiple cancers and were conducted during active treatment and in hospital/clinic settings. Common scientific topics included geriatric assessment, care decision-making, physical and psychosocial functioning/symptoms, communication, and care coordination. Few grants focused on cognitive functioning. CONCLUSIONS Several gaps in the portfolio were identified, including family caregiver inclusion, end-of-life care, and studies focusing on cognitive functioning.
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Affiliation(s)
- Virginia Sun
- Healthcare Delivery Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.,Department of Population Sciences, City of Hope, Duarte, California, USA.,Department of Surgery, City of Hope, Duarte, California, USA
| | - Priyanga Tuovinen
- Healthcare Delivery Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Paul B Jacobsen
- Healthcare Delivery Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ashley Wilder Smith
- Healthcare Delivery Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Griffin JM, Wong SL, Yanez B, Kroner B, Preiss L, Jensen RE, Wilder Smith A, Popovic J, Austin J, Flores AM, Mitchell S, Bian J, Hassett MJ, Osarogiagbon R, Cheville AL. Predictors of electronic health record (EHR) portal registration and frequency of portal use among patients with cancer prior to engagement in the IMPACT Consortium symptom management trials. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
419 Background: The patient portal is part of an electronic health record (EHR) that allows patients to communicate with their healthcare team. The portal also provides a platform for patients to receive and complete symptom surveys that can be directly integrated into the EHR, allowing clinical care teams to monitor symptoms and provide cancer symptom management. The Improving Management of symPtoms during And following Cancer Treatment (IMPACT) consortium, supported by the National Cancer Institute’s Cancer MoonshotSM, aims to improve symptom control for cancer patients through assessment and symptom management interventions deployed via the EHR. This initiative presents an opportunity to examine portal enrollment and variation in use, factors critical to successful implementation, especially among groups that have high cancer symptom burden. To this end, we examine: 1) relationships between portal enrollment prior to the launch of IMPACT interventions and neighborhood broadband access, demographic, and social characteristics; and 2) frequency of pre-intervention portal use for any purpose among enrollees. Methods: Data are derived from two of three IMPACT research centers. Enrollment in and frequency of portal use, mode of accessing the portal (web vs. phone), social, demographic, and cultural factors were extracted from the EHR. Rural Urban Commuting Area (RUCA) codes were used to classify population density and degree of rurality. Broadband access was estimated using 2015-2019 American Community Survey estimates matched to zip codes from enrolled IMPACT patients and classified as a patient’s residence being in a community with high (≥85% of households) or low (< 85% of households) access. Bivariate comparisons and adjusted odds ratios were used to describe all associations. Results: Forty-seven percent of patients (22,596/48,034) were enrolled in the portal prior to the intervention. Patients in zip codes with low broadband access and those who were men, > 65 years old, not White, of Hispanic ethnicity, or disabled or not employed had significantly lower odds of being enrolled in the portal. If enrolled, 21% (n = 4825) used the portal at least once a week. Less variation was found in the average frequency of portal use, but patients younger than 40, and those who were Black, disabled, unemployed, or those who used a mobile device to access the portal had the lowest odds of accessing it at least once a week. Conclusions: Significant disparities in portal enrollment exist across demographic groups and among those with limited broadband access. Among those enrolled, most used the portal less than once a week. Fewer differences in frequency of use were observed by sociodemographic factors. Improving portal enrollment and frequency of use may be critical for symptom management interventions deployed via patient portals.
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Affiliation(s)
| | | | - Betina Yanez
- Northwestern University Feinberg School of Medicine, Chicago, IL
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Lines LM, Cohen J, Kirschner J, Barch DH, Halpern MT, Kent EE, Mollica MA, Smith AW. Associations between illness burden and care experiences among Medicare beneficiaries before or after a cancer diagnosis. J Geriatr Oncol 2022; 13:731-737. [PMID: 35272981 PMCID: PMC9233114 DOI: 10.1016/j.jgo.2022.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 12/20/2021] [Accepted: 02/24/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION To understand associations between a new measure of illness burden and care experiences in a large, national sample of Medicare beneficiaries surveyed before or after a cancer diagnosis. MATERIALS AND METHODS The SEER-CAHPS Illness Burden Index (SCIBI) was previously developed using Surveillance, Epidemiology, and End Results (SEER)-Consumer Assessment of Healthcare Providers and Systems (CAHPS) linked data. The SCIBI provides a standardized morbidity score based on self- and other-reported information from 8 domains and proxies relative risk of 12-month, all-cause mortality among people surveyed before or after a cancer diagnosis. We analyzed a population of Medicare beneficiaries (n = 116,735; 49% fee-for-service and 51% Medicare Advantage [MA]; 73% post-cancer diagnosis) surveyed 2007-2013 to understand how their SCIBI scores were associated with 12 different care experience measures. Frequentist and Bayesian multivariable regression models adjusted for standard case-mix adjustors, enrollment type, timing of cancer diagnoses relative to survey, and survey year. RESULTS AND DISCUSSION SCIBl scores were associated (P < .001) in frequentist models with better ratings of Health Plan (coefficient ± standard error: 0.33 ± 0.08) and better Getting Care Quickly scores (0.51 ± 0.09). In Bayesian models, individuals with higher illness burden had similar results on the same two measures and also reported reliably worse Overall Care experiences (coefficient ± posterior SD: -0.17 ± 0.06). Illness burden may influence how people experience care or report those experiences. Individuals with greater illness burdens may need intensive care coordination and multilevel interventions before and after a cancer diagnosis.
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Affiliation(s)
- Lisa M Lines
- RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC 27709, United States of America; University of Massachusetts Chan Medical School, 55 Lake Ave., North Worcester, MA 01655, United States of America.
| | - Julia Cohen
- RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC 27709, United States of America
| | - Justin Kirschner
- RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC 27709, United States of America
| | - Daniel H Barch
- RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC 27709, United States of America; Psychology Department, Tufts University, Medford, MA, United States of America
| | - Michael T Halpern
- National Cancer Institute, Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, United States of America
| | - Erin E Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, United States of America; University of North Carolina Lineberger Comprehensive Cancer Center, United States of America
| | - Michelle A Mollica
- National Cancer Institute, Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, United States of America
| | - Ashley Wilder Smith
- National Cancer Institute, Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, United States of America
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Mollica MA, Smith AW, Tonorezos E, Castro K, Filipski KK, Guida J, Perna F, Green P, Jacobsen PB, Mariotto A, Tesauro G, Gallicchio L. Survivorship for Individuals Living with Advanced and Metastatic Cancers: National Cancer Institute Meeting Report. J Natl Cancer Inst 2021; 114:489-495. [PMID: 34878107 DOI: 10.1093/jnci/djab223] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/14/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
An important and often overlooked subpopulation of cancer survivors is individuals who are diagnosed with or progress to advanced or metastatic cancer. Living longer with advanced or metastatic cancer often comes with a cost of burdensome physical and psychosocial symptoms and complex care needs, however research is limited on this population. Thus, in May 2021, the National Cancer Institute convened subject matter experts, researchers, clinicians, survivors, and advocates a for a 2-day virtual meeting. The purpose of this report is to provide a summary of the evidence gaps identified by subject matter experts and attendees and key opportunities identified by NCI in five research areas: epidemiology and surveillance, symptom management, psychosocial research, healthcare delivery, and health behaviors. Identified gaps and opportunities include the need to develop new strategies to estimate the number of individuals living with advanced and metastatic cancers, understand and address emerging symptom trajectories, improve prognostic understanding and communication between providers, patients, and caregivers, develop and test models of comprehensive survivorship care tailored to these populations, and assess patient and provider preferences for health behavior discussions throughout the survivorship trajectory. To best address the needs of individuals living with advanced and metastatic cancer and to deliver comprehensive evidence-based quality care, research is urgently needed to fill evidence gaps, and it is essential to incorporate the survivor perspective. Developing such an evidence base is critical to inform policy and practice.
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Affiliation(s)
- Michelle A Mollica
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States
| | - Ashley Wilder Smith
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States
| | - Emily Tonorezos
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States
| | - Kathleen Castro
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States
| | - Kelly K Filipski
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States
| | - Jennifer Guida
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States
| | - Frank Perna
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States
| | - Paige Green
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States
| | - Paul B Jacobsen
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States
| | - Angela Mariotto
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States
| | - Gina Tesauro
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States
| | - Lisa Gallicchio
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States
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Lewis DR, Siembida EJ, Seibel NL, Smith AW, Mariotto AB. Survival outcomes for cancer types with the highest death rates for adolescents and young adults, 1975-2016. Cancer 2021; 127:4277-4286. [PMID: 34308557 DOI: 10.1002/cncr.33793] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/10/2021] [Accepted: 06/22/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Five-year relative survival for adolescent and young adult (AYA) patients with cancer diagnosed at the ages of 15 to 39 years is 85%. Survival rates vary considerably according to the cancer type. The purpose of this study was to analyze long-term survival trends for cancer types with the highest mortality among AYAs to determine where the greatest burden is and to identify areas for future research. METHODS Using data from the Surveillance, Epidemiology, and End Results cancer registry and the National Center for Health Statistics, the authors examined the incidence, mortality, and survival for the 9 cancer types with the highest mortality rates in this age group from 1975 to 2016. JPSurv, new survival trend software, was used in the analysis. RESULTS Results suggested significant improvements in 5-year relative survival for brain and other nervous system tumors, colon and rectum cancer, lung and bronchus cancer, acute myeloid leukemia, and non-Hodgkin lymphoma (all P values < .05). Limited or no improvement in survival was found for female breast cancer, cervical cancer, ovarian cancer, and bone and joint sarcomas. CONCLUSIONS Five-year relative survival for multiple cancer types in AYAs has improved, but some common cancer types in this group still show limited survival improvements (eg, ovarian cancer). Survival improvements in colorectal cancer have been overshadowed by its rising incidence, which suggests a substantial disease burden. Future research should focus on female breast, bone, ovarian, and cervical cancers, which have seen minimal or no improvements in survival. LAY SUMMARY Survival trends for adolescents and young adults with cancer are presented from a 40-year period. Although survival progress is noted for brain cancer, lung cancer, acute myeloid leukemia, and colon and rectum cancer, the incidence of colon and rectum cancer remains high. Minimal progress is evident for female breast, bone, ovarian, and cervical cancers, which are in need of renewed focus.
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Affiliation(s)
- Denise Riedel Lewis
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Elizabeth J Siembida
- Center for Health Innovation and Outcomes Research, Northwell Health, Manhasset, New York
| | - Nita L Seibel
- Division of Cancer Treatment and Detection, National Cancer Institute, Bethesda, Maryland
| | - Ashley Wilder Smith
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Angela B Mariotto
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
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11
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Togawa K, Ma H, Smith AW, Neuhouser ML, George SM, Baumgartner KB, McTiernan A, Baumgartner R, Ballard RM, Bernstein L. Self-reported symptoms of arm lymphedema and health-related quality of life among female breast cancer survivors. Sci Rep 2021; 11:10701. [PMID: 34021179 PMCID: PMC8139966 DOI: 10.1038/s41598-021-89055-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/31/2021] [Indexed: 12/24/2022] Open
Abstract
We examined cross-sectional associations between arm lymphedema symptoms and health-related quality of life (HRQoL) in the Health, Eating, Activity and Lifestyle (HEAL) Study. 499 women diagnosed with localized or regional breast cancer at ages 35-64 years completed a survey, on average 40 months after diagnosis, querying presence of lymphedema, nine lymphedema-related symptoms, e.g., tension, burning pain, mobility loss, and warmth/redness, and HRQoL. Analysis of covariance models were used to assess HRQoL scores in relation to presence of lymphedema and lymphedema-related symptoms. Lymphedema was self-reported by 137 women, of whom 98 were experiencing lymphedema at the time of the assessment. The most common symptoms were heaviness (52%), numbness (47%), and tightness (45%). Perceived physical health was worse for women reporting past or current lymphedema than those reporting no lymphedema (P-value < 0.0001). No difference was observed for perceived mental health (P-value = 0.31). Perceived physical health, stress, and lymphedema-specific HRQoL scores worsened as number of symptoms increased (P-values ≤ 0.01). Women reporting tension in the arm had lower physical health (P-value = 0.01), and those experiencing burning pain, tension, heaviness, or warmth/redness in the arm had lower lymphedema-specific HRQoL (P-values < 0.05). Treatment targeting specific lymphedema-related symptoms in addition to size/volume reduction may improve some aspects of HRQoL among affected women.
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Affiliation(s)
- Kayo Togawa
- Department of Population Sciences, Beckman Research Institute, City of Hope, Duarte, CA, USA.
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France.
| | - Huiyan Ma
- Department of Population Sciences, Beckman Research Institute, City of Hope, Duarte, CA, USA
| | - Ashley Wilder Smith
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Marian L Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Stephanie M George
- Office of Disease Prevention, Office of the Director, National Institutes of Health, Bethesda, MD, USA
- National Institute for Arthritis, Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Kathy B Baumgartner
- Department of Epidemiology and Population Health, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Anne McTiernan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Richard Baumgartner
- Department of Epidemiology and Population Health, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Rachel M Ballard
- Office of Disease Prevention, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Leslie Bernstein
- Department of Population Sciences, Beckman Research Institute, City of Hope, Duarte, CA, USA
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12
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Jacobsen PB, de Moor J, Doria-Rose VP, Geiger AM, Kobrin SC, Sampson A, Smith AW. The National Cancer Institute's Role in Advancing Health-care Delivery Research. J Natl Cancer Inst 2021; 114:20-24. [PMID: 33993284 DOI: 10.1093/jnci/djab096] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/26/2021] [Accepted: 05/13/2021] [Indexed: 01/12/2023] Open
Abstract
Improvements in cancer care delivery have the potential to reduce morbidity and mortality from cancer, however challenges to delivery of recommended care limit progress. These challenges include growing demands for care, increasing treatment complexity, inadequate care coordination, dramatic increases in costs, persistent disparities in care, and insufficient use of evidence-based guidelines. Recognizing the important role of research in understanding and addressing these challenges, the National Cancer Institute created the Healthcare Delivery Research Program (HDRP) in 2015 as a catalyst for expanding work in this area. Health-care delivery research is a multidisciplinary effort which recognizes that care delivery occurs in a multilevel system encompassing individuals, health-care systems, and communities. HDRP staff use a range of activities to fulfill the program's mission of advancing innovative research to improve delivery of care across the cancer control continuum. In addition to developing funding opportunities, HDRP staff support and facilitate the use of research infrastructure for conducting health-care delivery research, oversee publicly available data that can be used to evaluate patterns, costs, and patient experiences of care, contribute to development and dissemination of standardized health measurement tools for public use, and support professional development and training to build capacity within the field and grow the workforce. As HDRP enters its sixth year, we appreciate the opportunity to reflect on the program's progress in advancing the science of health-care delivery. At the same time, we recognize the need for the program to evolve and develop additional resources and opportunities to address new and emerging challenges.
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Affiliation(s)
- Paul B Jacobsen
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Janet de Moor
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - V Paul Doria-Rose
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Ann M Geiger
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Sarah C Kobrin
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Annie Sampson
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Ashley Wilder Smith
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
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13
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Mollica MA, Tesauro G, Tonorezos ES, Jacobsen PB, Smith AW, Gallicchio L. Current state of funded National Institutes of Health grants focused on individuals living with advanced and metastatic cancers: a portfolio analysis. J Cancer Surviv 2021; 15:370-374. [PMID: 33651327 DOI: 10.1007/s11764-021-01008-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/17/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE The National Cancer Institute has supported cancer survivorship science for many years, yet few funded studies have examined the needs of individuals living with cancer that is advanced or has metastasized. This report analyzes currently active National Institutes of Health (NIH) grants focused on survivorship for patients living with advanced or metastatic cancers to identify emerging research topics in this population and gaps in current science. METHODS A search of all NIH research grants that received funding in Fiscal Year 2020 focused on this population was conducted, excluding grants with a primary focus on end-of-life care, tumor progression or staging and grants for which the only outcome was survival. RESULTS A total of 25 active grants met the inclusion criteria. Most were funded using the R01 grant mechanism and included a range of cancer types and topics such as palliative/supportive care, psychosocial support, health services, and symptom sequelae. CONCLUSIONS Although currently funded grants focus on several important topics, gaps in the portfolio remain. There is a need to enhance the grant portfolio of research studies focused on the longitudinal examination of unmet needs, models of care delivery, impact of innovative therapies, and the impact of financial hardship for individuals living with advanced or metastatic cancer. IMPLICATIONS FOR CANCER SURVIVORS This review of current NIH studies suggests a need for expanded research on individuals living with advanced or metastatic cancer. Moving forward, enhancing research focused on key gap areas will be critical to improve care and outcomes for this growing population.
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Affiliation(s)
- Michelle A Mollica
- Healthcare Delivery Research Program, Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, MSC 9712, Room 3E436, Bethesda, MD, 20892-9762, USA.
| | - Gina Tesauro
- Healthcare Delivery Research Program, Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, MSC 9712, Room 3E436, Bethesda, MD, 20892-9762, USA
| | - Emily S Tonorezos
- Healthcare Delivery Research Program, Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, MSC 9712, Room 3E436, Bethesda, MD, 20892-9762, USA
| | - Paul B Jacobsen
- Healthcare Delivery Research Program, Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, MSC 9712, Room 3E436, Bethesda, MD, 20892-9762, USA
| | - Ashley Wilder Smith
- Healthcare Delivery Research Program, Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, MSC 9712, Room 3E436, Bethesda, MD, 20892-9762, USA
| | - Lisa Gallicchio
- Healthcare Delivery Research Program, Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, MSC 9712, Room 3E436, Bethesda, MD, 20892-9762, USA
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14
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Siembida EJ, Smith AW, Potosky AL, Graves KD, Jensen RE. Examination of individual and multiple comorbid conditions and health-related quality of life in older cancer survivors. Qual Life Res 2021; 30:1119-1129. [PMID: 33447956 PMCID: PMC7808400 DOI: 10.1007/s11136-020-02713-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE Older cancer survivors (≥ 65 years at diagnosis) are at high-risk for multimorbidity (2 + comorbid conditions). However, few studies have utilized a generalizable sample of older cancer survivors to understand how individual comorbid conditions, as opposed to total comorbidity burden, are associated with health-related quality of life (HRQOL). We examined associations between HRQOL outcomes (pain, fatigue, physical function), individual comorbidities (cardiovascular disease [CVD], lung disease, diabetes, arthritis) and total comorbidity (cancer-only, cancer + 1 condition, cancer + 2 or more conditions). METHODS Utilizing a population-based sample of 2019 older cancer survivors, we tested associations between comorbid conditions and the HRQOL outcomes using generalized linear models. HRQOL domains were assessed using Patient-Reported Outcome Measurement Information System® (PROMIS®) measures. Comorbidity was assessed via self-report. RESULTS Cancer survivors with lung disease reported significantly worse physical functioning (β = - 4.96, p < 0.001), survivors with arthritis reported significantly higher pain (β = 4.37, p < 0.001), and survivors with CVD reported significantly higher fatigue (β = 3.45, p < 0.001) compared to survivors without each condition. Having cancer + 1 condition was not as strongly associated with all outcomes as when individual conditions were tested (e.g. pain: β = 3.09, p < 0.001). Having 2+ comorbidities had a stronger association with all outcomes (e.g. physical function: β = - 7.51, p < 0.001) than examining conditions individually. CONCLUSIONS Knowing the specific comorbid condition profile of an older cancer survivor provides insight into specific HRQOL outcomes that may be impaired in cancer survivorship, but understanding total comorbidity burden, regardless of the specific conditions, sheds light on survivors at-risk for multiple impairments in HRQOL. This information, taken together, can inform risk-stratified survivorship care.
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Affiliation(s)
- Elizabeth J. Siembida
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD USA ,Cancer Prevention Fellowship Program, National Cancer Institute, Rockville, MD USA ,Center for Health Innovation and Outcomes Research, Feinstein Institute for Medical Research, Northwell Health, 600 Community Drive, Suite 403, Manhasset, NY 11030 USA
| | | | - Arnold L. Potosky
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC USA
| | - Kristi D. Graves
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC USA
| | - Roxanne E. Jensen
- Outcomes Research Branch, National Cancer Institute, Rockville, MD USA
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15
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Lines LM, Cohen J, Kirschner J, Halpern MT, Kent EE, Mollica MA, Smith AW. Random survival forests using linked data to measure illness burden among individuals before or after a cancer diagnosis: Development and internal validation of the SEER-CAHPS illness burden index. Int J Med Inform 2021; 145:104305. [PMID: 33188949 PMCID: PMC7736519 DOI: 10.1016/j.ijmedinf.2020.104305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/03/2020] [Accepted: 10/16/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To develop and internally validate an illness burden index among Medicare beneficiaries before or after a cancer diagnosis. METHODS Data source: SEER-CAHPS, linking Surveillance, Epidemiology, and End Results (SEER) cancer registry, Medicare enrollment and claims, and Medicare Consumer Assessment of Healthcare Providers and Systems (Medicare CAHPS) survey data providing self-reported sociodemographic, health, and functional status information. To generate a score for everyone in the dataset, we tabulated 4 groups within each annual subsample (2007-2013): 1) Medicare Advantage (MA) beneficiaries or 2) Medicare fee-for-service (FFS) beneficiaries, surveyed before cancer diagnosis; 3) MA beneficiaries or 4) Medicare FFS beneficiaries surveyed after diagnosis. Random survival forests (RSFs) predicted 12-month all-cause mortality and drew predictor variables (mean per subsample = 44) from 8 domains: sociodemographic, cancer-specific, health status, chronic conditions, healthcare utilization, activity limitations, proxy, and location-based factors. Roughly two-thirds of the sample was held out for algorithm training. Error rates based on the validation ("out-of-bag," OOB) samples reflected the correctly classified percentage. Illness burden scores represented predicted cumulative mortality hazard. RESULTS The sample included 116,735 Medicare beneficiaries with cancer, of whom 73 % were surveyed after their cancer diagnosis; overall mean mortality rate in the 12 months after survey response was 6%. SEER-CAHPS Illness Burden Index (SCIBI) scores were positively skewed (median range: 0.29 [MA, pre-diagnosis] to 2.85 [FFS, post-diagnosis]; mean range: 2.08 [MA, pre-diagnosis] to 4.88 [MA, post-diagnosis]). The highest decile of the distribution had a 51 % mortality rate (range: 29-71 %); the bottom decile had a 1% mortality rate (range: 0-2 %). The error rate was 20 % overall (range: 9% [among FFS enrollees surveyed after diagnosis] to 36 % [MA enrollees surveyed before diagnosis]). CONCLUSIONS This new morbidity measure for Medicare beneficiaries with cancer may be useful to future SEER-CAHPS users who wish to adjust for comorbidity.
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Affiliation(s)
- Lisa M Lines
- Center for Advanced Methods Development, RTI International, Research Triangle Park, NC, United States; Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Ave. North, United States.
| | - Julia Cohen
- Center for Advanced Methods Development, RTI International, Research Triangle Park, NC, United States
| | - Justin Kirschner
- Center for Advanced Methods Development, RTI International, Research Triangle Park, NC, United States
| | - Michael T Halpern
- Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, United States
| | - Erin E Kent
- Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Michelle A Mollica
- Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, United States
| | - Ashley Wilder Smith
- Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, United States
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16
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Mollica MA, Chou WYS, Tonorezos ES, Smith AW. Young adult caregivers' perceptions of cancer misinformation on social media: Response to Warner et al. Cancer 2020; 127:1177-1179. [PMID: 33368152 DOI: 10.1002/cncr.33382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 01/21/2023]
Affiliation(s)
- Michelle A Mollica
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Wen-Ying Sylvia Chou
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Emily S Tonorezos
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Ashley Wilder Smith
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
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17
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Rincon MA, Smith AW, Yu M, Kent EE. Trends in Racial/Ethnic Disparity of Health-Related Quality of Life in Older Adults with and without Cancer (1998–2012). Cancer Epidemiol Biomarkers Prev 2020; 29:1188-1195. [DOI: 10.1158/1055-9965.epi-19-0819] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/14/2019] [Accepted: 03/09/2020] [Indexed: 11/16/2022] Open
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18
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Mollica MA, Smith AW, Kent EE. Caregiving tasks and unmet supportive care needs of family caregivers: A U.S. population-based study. Patient Educ Couns 2020; 103:626-634. [PMID: 31704030 DOI: 10.1016/j.pec.2019.10.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/08/2019] [Accepted: 10/18/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To describe the type of care provided by a nationally-representative sample of informal caregivers, the frequency of unmet supportive care needs, and examine characteristics associated with unmet needs. METHODS Using data from the Health Information National Trends Survey, we identified caregivers of an adult care recipient. Descriptive statistics examined support provided by caregivers for activities of daily living (ADLs) and instrumental activities of daily living (IADLs) and caregiver perceptions of their needs in five areas: medical/nursing tasks, accessing services, respite care, support groups, and counseling for caregivers. Bivariate statistics examined sociodemographic and caregiver characteristics associated with each need. RESULTS Among 316 caregivers, 30.9% reported at least one unmet supportive care need. Caregivers most often provided support for 0-2 ADLs and 5-7 IADLs. Younger age and longer duration of time caregiving were associated with unmet supportive care needs for medical/nursing training (p = 0.02 and 0.04, respectively). Caregivers providing assistance with more ADLs reported needs for respite care support (p=0.03). CONCLUSION Subgroups of caregivers that may be most vulnerable with greater unmet supportive care needs are those that are younger, have provided care for longer, and those assisting with more ADLs. Future research should explore these factors to inform intervention development.
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Affiliation(s)
- Michelle A Mollica
- National Cancer Institute, Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, USA.
| | - Ashley Wilder Smith
- National Cancer Institute, Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, USA
| | - Erin E Kent
- Department of Health Policy and Management, Gillings School of Global Public Health University of North Carolina, Chapel Hill, USA
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Coens C, Pe M, Dueck AC, Sloan J, Basch E, Calvert M, Campbell A, Cleeland C, Cocks K, Collette L, Devlin N, Dorme L, Flechtner HH, Gotay C, Griebsch I, Groenvold M, King M, Kluetz PG, Koller M, Malone DC, Martinelli F, Mitchell SA, Musoro JZ, O'Connor D, Oliver K, Piault-Louis E, Piccart M, Quinten C, Reijneveld JC, Schürmann C, Smith AW, Soltys KM, Taphoorn MJB, Velikova G, Bottomley A. International standards for the analysis of quality-of-life and patient-reported outcome endpoints in cancer randomised controlled trials: recommendations of the SISAQOL Consortium. Lancet Oncol 2020; 21:e83-e96. [PMID: 32007209 DOI: 10.1016/s1470-2045(19)30790-9] [Citation(s) in RCA: 168] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/12/2019] [Accepted: 11/18/2019] [Indexed: 02/03/2023]
Abstract
Patient-reported outcomes (PROs), such as symptoms, function, and other health-related quality-of-life aspects, are increasingly evaluated in cancer randomised controlled trials (RCTs) to provide information about treatment risks, benefits, and tolerability. However, expert opinion and critical review of the literature showed no consensus on optimal methods of PRO analysis in cancer RCTs, hindering interpretation of results. The Setting International Standards in Analyzing Patient-Reported Outcomes and Quality of Life Endpoints Data Consortium was formed to establish PRO analysis recommendations. Four issues were prioritised: developing a taxonomy of research objectives that can be matched with appropriate statistical methods, identifying appropriate statistical methods for PRO analysis, standardising statistical terminology related to missing data, and determining appropriate ways to manage missing data. This Policy Review presents recommendations for PRO analysis developed through critical literature reviews and a structured collaborative process with diverse international stakeholders, which provides a foundation for endorsement; ongoing developments of these recommendations are also discussed.
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Affiliation(s)
- Corneel Coens
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Madeline Pe
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium.
| | - Amylou C Dueck
- Alliance Statistics and Data Center, Mayo Clinic, Scottsdale, AZ, USA
| | - Jeff Sloan
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Ethan Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research and National Institute for Health Research Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
| | | | - Charles Cleeland
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kim Cocks
- Adelphi Values, Bollington, Cheshire, UK
| | - Laurence Collette
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Nancy Devlin
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Lien Dorme
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Hans-Henning Flechtner
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University of Magdeburg, Magdeburg, Germany
| | - Carolyn Gotay
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | | | - Mogens Groenvold
- Department of Public Health, Bispebjerg Hospital and University of Copenhagen, Copenhagen, Denmark
| | - Madeleine King
- School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Paul G Kluetz
- Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | | | | | - Sandra A Mitchell
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Jammbe Z Musoro
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Daniel O'Connor
- Medicines and Healthcare products Regulatory Agency, London, UK
| | | | | | - Martine Piccart
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Chantal Quinten
- European Centre for Disease Prevention and Control, Surveillance and Response Support Unit, Epidemiological Methods Section, Stockholm, Sweden
| | - Jaap C Reijneveld
- Department of Neurology and Brain Tumor Center, VU University Medical Center, Amsterdam, Netherlands
| | | | - Ashley Wilder Smith
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | | | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden; Department of Neurology, Haaglanden Medical Center, The Hague, Netherlands
| | - Galina Velikova
- Leeds Institute of Cancer and Pathology, University of Leeds, St James's Hospital, Leeds, UK; International Society for Quality of Life Research, Milwaukee, WI, USA
| | - Andrew Bottomley
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
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Kent EE, Wheldon CW, Smith AW, Srinivasan S, Geiger AM. Care delivery, patient experiences, and health outcomes among sexual and gender minority patients with cancer and survivors: A scoping review. Cancer 2019. [PMID: 31593319 DOI: 10.1002/cncr.32388:10.1002/cncr.32388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Sexual and gender minorities (SGMs) face a disproportionate burden of cancer, yet little is known about the experiences and specific needs of these underserved populations in cancer care delivery. The authors conducted a scoping review to characterize the literature on cancer care delivery, health outcomes, and health care experiences for patients with cancer and survivors identifying as SGM. In total, 1176 peer-reviewed citations were identified after a systematic search of the PubMed/Medline, PsycInfo, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Web of Sciences databases without restriction on publication date. The details captured included study aims, design, population, cancer site, and main findings. Thirty-seven studies published from 1998 to 2017 met the study criteria. Most studies were conducted in the post-treatment survivorship phase of the continuum (n = 30), and breast cancer was the most common cancer site (n = 20). There were only 2 intervention studies. The studies reviewed were classified under the following areas of focus: 1) disclosure of sexual orientation and gender identity, 2) quality of care, 3) psychosocial impact of/ adjustment to cancer, 4) social support, 5) sexual functioning, and 6) health risks/health behavior. Very little research reported an assessment of gender minority status or included a focus on gender minorities (n = 7). This review revealed substantial research gaps given a lack of population-based data and small sample sizes, likely related to the absence of systematic collection of sexual orientation and gender identity information in the cancer care context. Deficient research in this area likely perpetuates health disparities. Further research is needed to identify and remove the barriers to delivering high-quality care to SGM individuals with cancer.
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Affiliation(s)
- Erin E Kent
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland.,ICF, Inc, Fairfax, Virginia
| | - Christopher W Wheldon
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Ashley Wilder Smith
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Shobha Srinivasan
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Ann M Geiger
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
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Kent EE, Wheldon CW, Smith AW, Srinivasan S, Geiger AM. Care delivery, patient experiences, and health outcomes among sexual and gender minority patients with cancer and survivors: A scoping review. Cancer 2019; 125:4371-4379. [PMID: 31593319 DOI: 10.1002/cncr.32388] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 11/07/2022]
Abstract
Sexual and gender minorities (SGMs) face a disproportionate burden of cancer, yet little is known about the experiences and specific needs of these underserved populations in cancer care delivery. The authors conducted a scoping review to characterize the literature on cancer care delivery, health outcomes, and health care experiences for patients with cancer and survivors identifying as SGM. In total, 1176 peer-reviewed citations were identified after a systematic search of the PubMed/Medline, PsycInfo, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Web of Sciences databases without restriction on publication date. The details captured included study aims, design, population, cancer site, and main findings. Thirty-seven studies published from 1998 to 2017 met the study criteria. Most studies were conducted in the post-treatment survivorship phase of the continuum (n = 30), and breast cancer was the most common cancer site (n = 20). There were only 2 intervention studies. The studies reviewed were classified under the following areas of focus: 1) disclosure of sexual orientation and gender identity, 2) quality of care, 3) psychosocial impact of/ adjustment to cancer, 4) social support, 5) sexual functioning, and 6) health risks/health behavior. Very little research reported an assessment of gender minority status or included a focus on gender minorities (n = 7). This review revealed substantial research gaps given a lack of population-based data and small sample sizes, likely related to the absence of systematic collection of sexual orientation and gender identity information in the cancer care context. Deficient research in this area likely perpetuates health disparities. Further research is needed to identify and remove the barriers to delivering high-quality care to SGM individuals with cancer.
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Affiliation(s)
- Erin E Kent
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
- ICF, Inc, Fairfax, Virginia
| | - Christopher W Wheldon
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Ashley Wilder Smith
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Shobha Srinivasan
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Ann M Geiger
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
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Mollica M, Lines LM, McNeel TS, Negoita S, Gaillot S, Elliott M, Halpern MT, Smith AW, Siembida E, Kent EE. Patient experiences of care in localized prostate cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.27_suppl.215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
215 Background: Over 161,000 new prostate cancer patients diagnosed annually, with 75% diagnosed at early stages. Limited evidence exists supporting choice of treatment (including radical prostatectomy, radiation therapy, hormonal therapy, active surveillance or watchful waiting) for localized prostate cancer. Treatments have varying side effects associated with impaired functional status and health-related quality of life. Patient care experiences are important quality indicators, but research examining patient experiences by prostate cancer treatment is limited. The purpose of this study was to examine the association between treatment received (surgery, radiation, or no treatment) and CAHPS ratings of overall care over the prior six months. Methods: This study used data from SEER-CAHPS, which links Surveillance, Epidemiology, and End Results (SEER) data with Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient experience survey and Medicare claims data. Medicare Fee-for-Service beneficiaries ≥65 years with a National Comprehensive Cancer Network (NCCN) low- or intermediate-risk prostate cancer diagnosis were assigned to surgery only, radiation only, and no treatment received groups for analysis. The outcome variable was a CAHPS rating of overall care (0 = worst; 10 = best). The analysis adjusted for case mix and other cancer-specific variables. Results: The final cohort included 507 prostate cancer survivors (surgery n = 109 [21%]; radiation n = 197 [39%]; no treatment n = 201 [40%]). Respondents who received radiation rated their overall care higher than those not receiving treatment (adjusted mean 8.9 vs 8.3; p= 0.02). Ratings did not differ significantly between the surgery and no treatment groups. Conclusions: This study represents a first look at patient experiences among localized prostate cancer survivors receiving surgery, radiation, or no treatment. It is not clear whether those who did not receive treatment chose active surveillance or watchful waiting, or whether they did not have access to care, which could have affected results. Future research should explore associations between receipt of treatment and patient care experiences in an adequately powered sample to inform future interventions.
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Affiliation(s)
| | | | | | - Serban Negoita
- National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Sarah Gaillot
- Centers for Medicare and Medicaid Services, Baltimore, MD
| | | | | | | | | | - Erin E Kent
- National Cancer Institute at the National Institutes of Health, Bethesda, MD
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Lines LM, Cohen J, Halpern MT, Smith AW, Kent EE. Care experiences among dually enrolled older adults with cancer: SEER-CAHPS, 2005-2013. Cancer Causes Control 2019; 30:1137-1144. [PMID: 31422490 DOI: 10.1007/s10552-019-01218-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 08/09/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Given the associations between poverty and poorer outcomes among older adults with cancer, we sought to understand the effects of dual enrollment in Medicare and Medicaid-as a marker of poverty-on self-reported care experiences among seniors diagnosed with cancer. METHODS Retrospective, observational study using cancer registry, Medicare claims, and care experience survey data (Surveillance, Epidemiology, and End Results [SEER]-Consumer Assessment of Healthcare Providers and Systems [CAHPS®]) for a national sample of fee-for-service (FFS) and Medicare Advantage (MA) enrollees aged 65 or older. We included people with one incident primary, malignant cancer diagnosed between 2005 and 2011, surveyed within 2 years after diagnosis (n = 9,800; 995 dual enrollees). Medicare CAHPS measures included 5 global ratings and 3 composite scores. RESULTS After adjustment for potential confounders, people with cancer histories who were dually enrolled were significantly more likely to report better experiences than non-duals on 2 measures (Medicare/their health plan: adjusted odds ratio [aOR]: 0.68, 95% confidence interval [CI] 0.53-0.87; prescription drug plan [PDP]: aOR: 0.54, 95% CI 0.40-0.73). CONCLUSIONS Dual enrollees with cancer reported better experiences than Medicare-only enrollees in terms of their health plan (Medicare FFS or Medicare Advantage) and their PDP. Better ratings among dually enrolled beneficiaries suggest possible divergence between health outcomes and care experiences, warranting additional investigation.
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Affiliation(s)
- Lisa M Lines
- RTI International, 307 Waverley Oaks Rd, Suite 101, Waltham, MA, 02452, USA. .,University of Massachusetts Medical School, 55 Lake Ave. North, Worcester, MA, 01655, USA.
| | - Julia Cohen
- RTI International, 307 Waverley Oaks Rd, Suite 101, Waltham, MA, 02452, USA
| | - Michael T Halpern
- Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Dr., Room 3E4342, Bethesda, MD, 20892-9762, USA
| | - Ashley Wilder Smith
- Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Dr., Room 3E4342, Bethesda, MD, 20892-9762, USA
| | - Erin E Kent
- Gillings School of Public Health, University of North Carolina - Chapel Hill, 135 Dauer Dr., Chapel Hill, NC, 27559, USA
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Rothrock NE, Cook KF, O'Connor M, Cella D, Smith AW, Yount SE. Establishing clinically-relevant terms and severity thresholds for Patient-Reported Outcomes Measurement Information System ® (PROMIS ®) measures of physical function, cognitive function, and sleep disturbance in people with cancer using standard setting. Qual Life Res 2019; 28:3355-3362. [PMID: 31410640 DOI: 10.1007/s11136-019-02261-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE Patient-Reported Outcomes Measurement Information System® (PROMIS®) physical function, cognitive function, and sleep disturbance measures are increasingly used in cancer care. However, there is limited guidance for interpreting the clinical meaning of scores. This study aimed to apply bookmarking, a standard setting methodology, to identify PROMIS score thresholds in the context of cancer care. METHODS Using item parameters, we constructed vignettes of five items covering the range of possible scores. Focus groups were held with cancer care providers and people with cancer. Terminology for categorizing levels of severity was explored. Participants rank ordered vignettes by severity and then placed bookmarks between vignettes representing different levels of severity. Group discussion was held until consensus on bookmark placement was reached. RESULTS Clinicians selected "within normal limits," "mild," "moderate," and "severe" to describe levels of severity. Both patients and clinicians were able to apply these labels, but there was not unanimous support for any set of descriptors. Clinicians and patients agreed on all severity thresholds for sleep disturbance. For cognitive and physical function, clinicians and patients agreed on the threshold between "within normal limits" and "mild." However, patients required greater dysfunction than clinicians before applying "moderate" and "severe" labels. CONCLUSIONS Bookmarking can be applied to develop provisional score interpretation for PROMIS measures. Patients and clinicians were frequently consistent in their bookmark placement. When there was variance, patients required more dysfunction before assigning more severity. Additional research with other cancer samples is needed to evaluate the replicability and generalizability of our findings.
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Affiliation(s)
- Nan E Rothrock
- Department of Medical Social Sciences, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA.
| | - Karon F Cook
- Department of Medical Social Sciences, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
| | - Mary O'Connor
- Department of Medical Social Sciences, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
| | - David Cella
- Department of Medical Social Sciences, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
| | | | - Susan E Yount
- Department of Medical Social Sciences, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
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Kent EE, Mollica MA, Buckenmaier S, Wilder Smith A. The Characteristics of Informal Cancer Caregivers in the United States. Semin Oncol Nurs 2019; 35:328-332. [DOI: 10.1016/j.soncn.2019.06.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Abstract
Patients' perspectives about their health are critical to improving health outcomes. Patient reported outcomes (PRO) are emerging as a standard way to capture patient perspectives in clinical research and care delivery. Conventionally, researchers used lengthy fixed instruments that were burdensome and had limited applicability across disease groups and the life course. To address these challenges, the National Institutes of Health invested in the development of an innovative, paradigm-shifting measurement system: The Patient-Reported Outcomes Measurement Information System® (PROMIS®). This article provides an overview of the vision, funding, development, and growth of PROMIS® over the last 15 years. We highlight current and future research needs given the expanding adoption of PROMIS® across a variety of health care contexts. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Ashley Wilder Smith
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
| | - Roxanne E Jensen
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute
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Siembida EJ, Kent EE, Bellizzi KM, Smith AW. Healthcare providers' discussions of physical activity with older survivors of cancer: Potential missed opportunities for health promotion. J Geriatr Oncol 2019; 11:437-443. [PMID: 31122873 DOI: 10.1016/j.jgo.2019.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 04/22/2019] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Physical activity (PA) promotes physical functioning and health-related quality of life in older survivors of cancer. Using a population-based sample of Medicare Advantage beneficiaries, we aimed to characterize the survivors who reported discussing PA with their healthcare provider. MATERIALS AND METHODS Data from the Surveillance, Epidemiology, and End Results (SEER) cancer registries was linked with the 2008-2014 Medicare Health Outcomes Survey (MHOS). Older survivors diagnosed with localized- or regional-stage female breast, prostate, or colorectal cancer ≥24 months prior to survey and had visited a healthcare provider in the previous year were included in the multiple logistic regression model. Best-fitting models were identified using the Hosmer and Lemeshow Goodness-of-Fit test. RESULTS The final sample (N = 5630) included 3006 survivors who reported discussing PA and 2624 survivors who did not report discussing PA. Older survivors of cancer were significantly more likely to report discussing PA if they had a history of cardiovascular disease (p < .001), diabetes (p < .001), or musculoskeletal disease (p < .001); had a history of fall(s) in the previous twelve months (p = .003); or were obese (p < .001). DISCUSSION PA is an important aspect of the management of cancer, other comorbid conditions, and maintenance of physical functioning in older adulthood. The results suggest that PA discussions are not occurring consistently across survivors, and key opportunities for health promotion are being missed. Future work should identify ways to encourage these conversations in all cancer follow-up appointments.
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Affiliation(s)
- Elizabeth J Siembida
- Outcomes Research Branch, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA.
| | - Erin E Kent
- Outcomes Research Branch, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA
| | - Keith M Bellizzi
- Department of Human Development and Family Studies, University of Connecticut, 348 Mansfield Road, U-1058, Storrs, CT 06269, USA
| | - Ashley Wilder Smith
- Outcomes Research Branch, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA
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Smith AW, Keegan T, Hamilton A, Lynch C, Wu XC, Schwartz SM, Kato I, Cress R, Harlan L. Understanding care and outcomes in adolescents and young adult with Cancer: A review of the AYA HOPE study. Pediatr Blood Cancer 2019; 66:e27486. [PMID: 30294882 PMCID: PMC7239374 DOI: 10.1002/pbc.27486] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 07/25/2018] [Accepted: 08/16/2018] [Indexed: 01/23/2023]
Abstract
Historically, adolescents and young adults (AYA) diagnosed with cancer have been an understudied population, and their unique care experiences, needs, and outcomes were not well understood. Thus, 10 years ago, the National Cancer Institute supported the fielding of the Adolescent and Young Adult Health Outcomes and Patient Experiences (AYA HOPE) study to address this gap. We recruited individuals diagnosed at ages 15 to 39 with germ cell, Hodgkin and non-Hodgkin lymphoma, acute lymphoblastic leukemia, and sarcoma from Surveillance, Epidemiology, and End Results cancer registries into the first multicenter population-based study of medical care, physical, and mental health outcomes for AYAs with cancer in the United States. This review of the 17 published manuscripts showed low awareness of clinical trials and substantial impact of cancer on financial burden, education and work, relationships and family planning, and physical and mental health. It highlights the feasibility of a longitudinal population-based study and key lessons learned for research on AYAs with cancer in and beyond the United States.
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Affiliation(s)
- Ashley Wilder Smith
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Science, National Cancer Institute, Rockville, Maryland
| | - Theresa Keegan
- UC Davis Comprehensive Cancer Center, Sacramento, California
| | - Ann Hamilton
- Keck School of Medicine of USC, Los Angeles, California
| | | | - Xiao-Cheng Wu
- LSU Health Sciences Center School of Public Health, New Orleans, Louisiana
| | - Stephen M. Schwartz
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ikuko Kato
- Wayne State University, Detroit, Michigan
| | - Rosemary Cress
- Cancer Registry of Greater California, Sacramento, California
| | - Linda Harlan
- Special Volunteer, National Cancer Institute, Rockville, Maryland
| | - AYA HOPE Study Collaborative Group
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Science, National Cancer Institute, Rockville, Maryland
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Kent E, Mollica M, Klabunde CN, Arora NK, Elliott M, McNeel TS, Wilder Smith A. Examining the relative influence of multimorbidity on variations in older cancer patients’ experiences with care. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.30_suppl.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
14 Background: Cancer patients often have multiple chronic conditions and require complex care coordination. We compared older (ages 66+) cancer patients’ reports of their healthcare experiences based on level of multimorbidity. Methods: Data from the SEER-CAHPS combines cancer registry (Surveillance, Epidemiology, and End Results; SEER), patient experiences (Consumer Assessment of Healthcare Providers and Systems; CAHPS) and Medicare claims data. Multimorbidity was captured as: (1) the National Cancer Institute-Combined Comorbidity Index (NCCI, 16 Charlson conditions diagnosed ≤12 months prior to cancer); and (2) a Multimorbidity Burden Index (MBI), which categorizes conditions based on the impact to cancer treatment (no comorbidity, low/medium, and high). Outcomes were CAHPS patient experience measures: Doctor Communication, Getting Care Quickly, Getting Needed Care, Obtaining Prescription Drugs, Customer Service, and ratings of Overall Care, Personal Doctor, and Specialist. Multivariable linear regression provided associations of each multimorbidity measure with CAHPS measures controlling for standard case mix adjustors, years from diagnosis to survey and diagnostic stage. Results: The study cohort included 9305 cancer patients (53% male, 84% Non-Hispanic White, average age 77, average time from diagnosis 29 months), with a distribution of NCCI conditions as: 0 (cancer only), 73%; 1, 17%; ≥2, 10%. Cancer patients with NCCI = 0 and those with MBI = no comorbidity rated their Personal Doctor more negatively than those with any comorbidities ( p < 0.02). Those with NCCI ≥ 2 or MBI = low/medium reported better Doctor Communication ( p < 0.04). Those with high MBI rated their specialist physician better than those with no multimorbidity ( p = 0.04), and those with low/medium MBI reported better experiences Getting Care Quickly ( p = 0.02). No other associations were significant. Conclusions: Cancer patients with multimorbidity report better communication with their doctor and care = by = personal doctors and specialists. Increased attention to the care experiences of cancer patients with multimorbidity may lead to insights and interventions that benefit all cancer patients.
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Affiliation(s)
| | | | | | - Neeraj K. Arora
- Patient-Centered Outcomes Research Institute, Washington, DC
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Bottomley A, Pe M, Sloan J, Basch E, Bonnetain F, Calvert M, Campbell A, Cleeland C, Cocks K, Collette L, Dueck AC, Devlin N, Flechtner HH, Gotay C, Greimel E, Griebsch I, Groenvold M, Hamel JF, King M, Kluetz PG, Koller M, Malone DC, Martinelli F, Mitchell SA, Moinpour CM, Musoro JZ, O’Connor D, Oliver K, Piault-Louis E, Piccart M, Pimentel FL, Quinten C, Reijneveld JC, Schürmann C, Smith AW, Soltys KM, Sridhara R, Taphoorn MJB, Velikova G, Coens C. Moving forward toward standardizing analysis of quality of life data in randomized cancer clinical trials. Clin Trials 2018; 15:624-630. [DOI: 10.1177/1740774518795637] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background There is currently a lack of consensus on how health-related quality of life and other patient-reported outcome measures in cancer randomized clinical trials are analyzed and interpreted. This makes it difficult to compare results across randomized controlled trials (RCTs) synthesize scientific research, and use that evidence to inform product labeling, clinical guidelines, and health policy. The Setting International Standards in Analyzing Patient-Reported Outcomes and Quality of Life Endpoints Data for Cancer Clinical Trials (SISAQOL) Consortium aims to develop guidelines and recommendations to standardize analyses of patient-reported outcome data in cancer RCTs. Methods and Results Members from the SISAQOL Consortium met in January 2017 to discuss relevant issues. Data from systematic reviews of the current state of published research in patient-reported outcomes in cancer RCTs indicated a lack of clear reporting of research hypothesis and analytic strategies, and inconsistency in definitions of terms, including “missing data,”“health-related quality of life,” and “patient-reported outcome.” Based on the meeting proceedings, the Consortium will focus on three key priorities in the coming year: developing a taxonomy of research objectives, identifying appropriate statistical methods to analyze patient-reported outcome data, and determining best practices to evaluate and deal with missing data. Conclusion The quality of the Consortium guidelines and recommendations are informed and enhanced by the broad Consortium membership which includes regulators, patients, clinicians, and academics.
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Affiliation(s)
- Andrew Bottomley
- Quality of Life Department, European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Madeline Pe
- Quality of Life Department, European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Jeff Sloan
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Ethan Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Franck Bonnetain
- Methodology and Quality of Life Unit in Cancer, INSERM U1098, University Hospital of Besançon, Besançon, France
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Charles Cleeland
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Laurence Collette
- Quality of Life Department, European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Amylou C Dueck
- Alliance Statistics and Data Center, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Hans-Henning Flechtner
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University of Magdeburg, Magdeburg, Germany
| | - Carolyn Gotay
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Eva Greimel
- Department of Obstetrics and Gynecology, Medical University Graz, Graz, Austria
| | | | - Mogens Groenvold
- Department of Public Health, University of Copenhagen and Bispebjerg Hospital, Copenhagen, Denmark
| | - Jean-Francois Hamel
- Methodology and Biostatistics Department, University Hospital of Angers UNAM, Angers, France
| | - Madeleine King
- School of Psychology and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Paul G Kluetz
- US Food and Drug Administration, Silver Spring, MD, USA
| | - Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | | | - Francesca Martinelli
- Quality of Life Department, European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Sandra A Mitchell
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | | | - Jammbe Z Musoro
- Quality of Life Department, European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Daniel O’Connor
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | | | | | - Martine Piccart
- Internal Medicine/Oncology, Institut Jules Bordet, Brussels, Belgium
| | - Francisco L Pimentel
- Blueclinical Phase I, Porto, Portugal
- Centro de Estudos e Investigação em Saúde da Universidade de Coimbra, Coimbra, Portugal
| | - Chantal Quinten
- European Centre for Disease Prevention and Control, Surveillance and Response Support Unit, Epidemiological Methods Section, Stockholm, Sweden
| | - Jaap C Reijneveld
- VU University Medical Center, Department of Neurology & Brain Tumor Center, Amsterdam, The Netherlands
| | | | - Ashley Wilder Smith
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | | | | | - Martin J B Taphoorn
- Leiden University Medical Center/Haaglanden Medical Center, Leiden/The Hague, The Netherlands
| | - Galina Velikova
- Leeds Institute of Cancer and Pathology, University of Leeds, St James’s Hospital, Leeds, UK
| | - Corneel Coens
- Quality of Life Department, European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
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Smith AW, Mitchell SA, K De Aguiar C, Moy C, Riley WT, Wagster MV, M Werner E. News from the NIH: Person-centered outcomes measurement: NIH-supported measurement systems to evaluate self-assessed health, functional performance, and symptomatic toxicity. Transl Behav Med 2018; 6:470-4. [PMID: 27528535 DOI: 10.1007/s13142-015-0345-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Ashley Wilder Smith
- Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Rockville, MD, USA.
| | - Sandra A Mitchell
- Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Rockville, MD, USA
| | - Cheryl K De Aguiar
- Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Rockville, MD, USA
| | - Claudia Moy
- Office of Clinical Research, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | - William T Riley
- Office of Behavioral and Social Sciences Research, NIH, Bethesda, MD, USA
| | - Molly V Wagster
- Behavioral and Systems Neuroscience Branch, Division of Neuroscience, National Institute on Aging, NIH, Bethesda, MD, USA
| | - Ellen M Werner
- Blood Epidemiology and Clinical Therapeutics Branch, Division of Blood Diseases and Blood Resources, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD, USA
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Rincon MA, Kent E, Lines LM, Gaillot S, Schussler NC, Halpern MT, Mollica M, Smith AW. Measuring cancer care experiences: Introducing SEER-CAHPS. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.6595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6595 Background: Care experience ratings are recognized as measures of healthcare quality. Here we introduce a new, public data resource, SEER-CAHPS, which links cancer registry data from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) program with Medicare claims and the Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) survey. Methods: The SEER-CAHPS resource includes cancer registry data from 1973-2011 (diagnosis, incidence, mortality, and sociodemographic data), Medicare CAHPS survey data from 1998-2013 (sociodemographic, health status, and care experience ratings), and Medicare fee-for-service (FFS) claims data from 2002-2013. The survey includes global ratings of overall care, personal doctor, specialist, health plan, and prescription drug plans, and composite ratings of doctor communication, care coordination, getting needed care, and getting care quickly. Data also contain survey weights to account for the Medicare CAHPS sampling design. Cross-sectional and longitudinal analyses are possible. Results: Currently, SEER-CAHPS includes 205,339 individuals with a history of cancer documented in SEER (FFS: 26,802 with a survey before cancer diagnosis, and 55,231 with a survey after cancer diagnosis; Medicare Advantage [MA]: 57,227 with a survey before cancer diagnosis and 71,436 with a survey after cancer diagnosis). The data resource also includes 724,965 MCAHPS respondents without cancer in SEER regions (FFS: 282,592; MA: 447,358). The data provide insights on topics including experiences of cancer patients in their last year of life; experiences of cancer survivors; and the associations of guideline-concordant follow-up care with patient experiences among cancer survivors. We will demonstrate project sample-size estimation and present instructions for submitting data access applications. Conclusions: SEER-CAHPS, a new, publicly available resource, provides population-based, cancer-specific data on patient experiences, health outcomes and healthcare utilization.
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Affiliation(s)
| | - Erin Kent
- National Cancer Institute, Bethesda, MD
| | | | - Sarah Gaillot
- Centers for Medicare and Medicaid Services, Baltimore, MD
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Mollica MA, Lines LM, Halpern MT, Ramirez E, Schussler N, Urato M, Wilder Smith A, Kent EE. Patient experiences of cancer care: scoping review, future directions, and introduction of a new data resource: Surveillance Epidemiology and End Results-Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS). Patient Experience Journal 2017. [DOI: 10.35680/2372-0247.1167] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Jensen RE, Potosky AL, Moinpour CM, Lobo T, Cella D, Hahn EA, Thissen D, Smith AW, Ahn J, Luta G, Reeve BB. United States Population-Based Estimates of Patient-Reported Outcomes Measurement Information System Symptom and Functional Status Reference Values for Individuals With Cancer. J Clin Oncol 2017; 35:1913-1920. [PMID: 28426375 DOI: 10.1200/jco.2016.71.4410] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To estimate cancer population-based reference values in the United States for eight PROMIS (Patient-Reported Outcomes Measurement Information System) domains by age and stage of disease. Patients and Methods For the Measuring Your Health (MY-Health) study, persons newly diagnosed with cancer (prostate, colorectal, non-small-cell lung, non-Hodgkin lymphoma, breast, uterine, or cervical) from 2010 to 2012 (N = 5,284) were recruited through the National Cancer Institute's SEER Program. Participants were mailed surveys 6 to 13 months after diagnosis. Raking by race/ethnicity, age, and stage generated weighted average PROMIS scores for pain interference, fatigue, anxiety, depression, sleep disturbance, physical function, ability to participate in social roles, and cognitive function. PROMIS measures are standardized to a T-score metric, with a score of 50 representing the general US population mean. Clinically meaningful differences were defined as a 3-point difference in scores. Results Several reference values (means) for patients with cancer were worse than the general United States population norms of 50. These include pain interference (52.4), fatigue (52.2), and physical function (44.1). Reference values were highest (ie, showed greatest symptom burden) in lung cancer (pain interference, 55.5; fatigue, 57.3; depression, 51.4) and cervical cancer (anxiety, 53.2; sleep disturbance, 53.4). Reference values for patients age 65 to 84 years reported lower sleep disturbance, anxiety, and depression, and better cognitive function than younger patients. Cancer reference values were poorer among those with advanced disease compared with patients with limited or no evidence of disease, specifically physical function (41.1 v 46.6, respectively), fatigue (55.8 v 50.2, respectively), and pain interference (55.2 v 50.9, respectively). Conclusion In a large, population-based sample of patients with recently diagnosed cancer, we observed symptom severity and functional deficits by age, stage, and cancer type consistent with the expected impact of cancer diagnosis and treatment. These United States cancer reference values can help facilitate interpretation of the PROMIS domain scores in research studies or in clinical applications that measure and evaluate the symptom and functional burden patients with cancer experience after initial treatment.
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Affiliation(s)
- Roxanne E Jensen
- Roxanne E. Jensen, Arnold L. Potosky, Tania Lobo, and George Luta, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University; Jaeil Ahn and George Luta, Georgetown University, Washington, DC; Carol M. Moinpour, Fred Hutchinson Cancer Research Center, Seattle, WA; David Cella and Elizabeth A. Hahn, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; David Thissen and Bryce B. Reeve, University of North Carolina; Bryce B. Reeve, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; and Ashley Wilder Smith, National Cancer Institute, Bethesda, MD
| | - Arnold L Potosky
- Roxanne E. Jensen, Arnold L. Potosky, Tania Lobo, and George Luta, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University; Jaeil Ahn and George Luta, Georgetown University, Washington, DC; Carol M. Moinpour, Fred Hutchinson Cancer Research Center, Seattle, WA; David Cella and Elizabeth A. Hahn, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; David Thissen and Bryce B. Reeve, University of North Carolina; Bryce B. Reeve, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; and Ashley Wilder Smith, National Cancer Institute, Bethesda, MD
| | - Carol M Moinpour
- Roxanne E. Jensen, Arnold L. Potosky, Tania Lobo, and George Luta, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University; Jaeil Ahn and George Luta, Georgetown University, Washington, DC; Carol M. Moinpour, Fred Hutchinson Cancer Research Center, Seattle, WA; David Cella and Elizabeth A. Hahn, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; David Thissen and Bryce B. Reeve, University of North Carolina; Bryce B. Reeve, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; and Ashley Wilder Smith, National Cancer Institute, Bethesda, MD
| | - Tania Lobo
- Roxanne E. Jensen, Arnold L. Potosky, Tania Lobo, and George Luta, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University; Jaeil Ahn and George Luta, Georgetown University, Washington, DC; Carol M. Moinpour, Fred Hutchinson Cancer Research Center, Seattle, WA; David Cella and Elizabeth A. Hahn, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; David Thissen and Bryce B. Reeve, University of North Carolina; Bryce B. Reeve, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; and Ashley Wilder Smith, National Cancer Institute, Bethesda, MD
| | - David Cella
- Roxanne E. Jensen, Arnold L. Potosky, Tania Lobo, and George Luta, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University; Jaeil Ahn and George Luta, Georgetown University, Washington, DC; Carol M. Moinpour, Fred Hutchinson Cancer Research Center, Seattle, WA; David Cella and Elizabeth A. Hahn, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; David Thissen and Bryce B. Reeve, University of North Carolina; Bryce B. Reeve, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; and Ashley Wilder Smith, National Cancer Institute, Bethesda, MD
| | - Elizabeth A Hahn
- Roxanne E. Jensen, Arnold L. Potosky, Tania Lobo, and George Luta, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University; Jaeil Ahn and George Luta, Georgetown University, Washington, DC; Carol M. Moinpour, Fred Hutchinson Cancer Research Center, Seattle, WA; David Cella and Elizabeth A. Hahn, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; David Thissen and Bryce B. Reeve, University of North Carolina; Bryce B. Reeve, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; and Ashley Wilder Smith, National Cancer Institute, Bethesda, MD
| | - David Thissen
- Roxanne E. Jensen, Arnold L. Potosky, Tania Lobo, and George Luta, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University; Jaeil Ahn and George Luta, Georgetown University, Washington, DC; Carol M. Moinpour, Fred Hutchinson Cancer Research Center, Seattle, WA; David Cella and Elizabeth A. Hahn, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; David Thissen and Bryce B. Reeve, University of North Carolina; Bryce B. Reeve, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; and Ashley Wilder Smith, National Cancer Institute, Bethesda, MD
| | - Ashley Wilder Smith
- Roxanne E. Jensen, Arnold L. Potosky, Tania Lobo, and George Luta, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University; Jaeil Ahn and George Luta, Georgetown University, Washington, DC; Carol M. Moinpour, Fred Hutchinson Cancer Research Center, Seattle, WA; David Cella and Elizabeth A. Hahn, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; David Thissen and Bryce B. Reeve, University of North Carolina; Bryce B. Reeve, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; and Ashley Wilder Smith, National Cancer Institute, Bethesda, MD
| | - Jaeil Ahn
- Roxanne E. Jensen, Arnold L. Potosky, Tania Lobo, and George Luta, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University; Jaeil Ahn and George Luta, Georgetown University, Washington, DC; Carol M. Moinpour, Fred Hutchinson Cancer Research Center, Seattle, WA; David Cella and Elizabeth A. Hahn, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; David Thissen and Bryce B. Reeve, University of North Carolina; Bryce B. Reeve, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; and Ashley Wilder Smith, National Cancer Institute, Bethesda, MD
| | - George Luta
- Roxanne E. Jensen, Arnold L. Potosky, Tania Lobo, and George Luta, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University; Jaeil Ahn and George Luta, Georgetown University, Washington, DC; Carol M. Moinpour, Fred Hutchinson Cancer Research Center, Seattle, WA; David Cella and Elizabeth A. Hahn, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; David Thissen and Bryce B. Reeve, University of North Carolina; Bryce B. Reeve, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; and Ashley Wilder Smith, National Cancer Institute, Bethesda, MD
| | - Bryce B Reeve
- Roxanne E. Jensen, Arnold L. Potosky, Tania Lobo, and George Luta, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University; Jaeil Ahn and George Luta, Georgetown University, Washington, DC; Carol M. Moinpour, Fred Hutchinson Cancer Research Center, Seattle, WA; David Cella and Elizabeth A. Hahn, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL; David Thissen and Bryce B. Reeve, University of North Carolina; Bryce B. Reeve, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC; and Ashley Wilder Smith, National Cancer Institute, Bethesda, MD
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Kent E, Lines LM, Gaillot S, Schussler NC, Halpern M, Mollica M, Rincon M, Smith AW. Measuring experiences of patients with cancer with care: The SEER-CAHPS linked data resource. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.8_suppl.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
238 Background: Care experience ratings are recognized as measures of quality. We introduce a new resource, SEER-CAHPS, linking cancer registry data from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) program with Medicare claims and the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Methods: The SEER-CAHPS data resource includes registry data from 1973-2011 (diagnosis, incidence, mortality, and sociodemographic data), Medicare CAHPS survey data from 1998-2013 (sociodemographic, health status, and care experience ratings), and Medicare fee-for-service (FFS) claims data from 2002-2013. SEER-CAHPS includes global ratings of overall care, personal doctor, specialist, health plan, and prescription drug plan and composite ratings of doctor communication, care coordination, getting needed care, and getting care quickly. The data also contain optional survey weights to account for the Medicare CAHPS sampling design. Results: Currently, SEER-CAHPS includes 205,339 individuals with a history of cancer documented in SEER (FFS: 26,802 with a survey before cancer diagnosis, and 55,231 with a survey after cancer diagnosis; Medicare Advantage [MA]: 57,227 with a survey before cancer diagnosis and 71,436 with a survey after cancer diagnosis). The database also includes 724,965 MCAHPS respondents without cancer in SEER regions (FFS: 282,592; MA: 447,358). The data provide insights on topics including experiences of cancer patients in their last year of life; experiences of cancer survivors; experiences of dually eligible (Medicare-Medicaid) cancer patients; and the associations of guideline-concordant follow-up care with patient experiences among people with colorectal cancer. We will demonstrate project sample-size estimation and present instructions for submitting data access applications. Conclusions: SEER-CAHPS provides population-based, cancer-specific data on patient experiences and associations with both health outcomes and healthcare utilization.
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Affiliation(s)
- Erin Kent
- National Cancer Institute, Bethesda, MD
| | | | - Sarah Gaillot
- Centers for Medicare & Medicaid Services, Baltimore, MD
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Freyer DR, Smith AW, Wolfson JA, Barr RD. Making Ends Meet: Financial Issues from the Perspectives of Patients and Their Health-Care Team. Cancer in Adolescents and Young Adults 2017. [DOI: 10.1007/978-3-319-33679-4_27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Neuhouser ML, Smith AW, George SM, Gibson JT, Baumgartner KB, Baumgartner R, Duggan C, Bernstein L, McTiernan A, Ballard R. Use of complementary and alternative medicine and breast cancer survival in the Health, Eating, Activity, and Lifestyle Study. Breast Cancer Res Treat 2016; 160:539-546. [PMID: 27766453 DOI: 10.1007/s10549-016-4010-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 10/03/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE Use of complementary and alternative medicine (CAM) is common among breast cancer patients, but less is known about whether CAM influences breast cancer survival. METHODS Health Eating, Activity, and Lifestyle (HEAL) Study participants (n = 707) were diagnosed with stage I-IIIA breast cancer. Participants completed a 30-month post-diagnosis interview including questions on CAM use (natural products such as dietary and botanical supplements, alternative health practices, and alternative medical systems), weight, physical activity, and comorbidities. Outcomes were breast cancer-specific and total mortality, which were ascertained from the Surveillance Epidemiology and End Results registries in Western Washington, Los Angeles County, and New Mexico. Cox proportional hazards regression models were fit to data to estimate hazard ratios (HR) and 95 % confidence intervals (CI) for mortality. Models were adjusted for potential confounding by sociodemographic, health, and cancer-related factors. RESULTS Among 707 participants, 70 breast cancer-specific deaths and 149 total deaths were reported. 60.2 % of participants reported CAM use post-diagnosis. The most common CAM were natural products (51 %) including plant-based estrogenic supplements (42 %). Manipulative and body-based practices and alternative medical systems were used by 27 and 13 % of participants, respectively. No associations were observed between CAM use and breast cancer-specific (HR 1.04, 95 % CI 0.61-1.76) or total mortality (HR 0.91, 95 % CI 0.63-1.29). CONCLUSION Complementary and alternative medicine use was not associated with breast cancer-specific mortality or total mortality. Randomized controlled trials may be needed to definitively test whether there is harm or benefit from the types of CAM assessed in HEAL in relation to mortality outcomes in breast cancer survivors.
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Affiliation(s)
- Marian L Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave North, M4B402, Seattle, WA, 98109-1024, USA.
| | - Ashley Wilder Smith
- Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Stephanie M George
- Office of Disease Prevention, National Institutes of Health, Bethesda, MD, USA
| | - James T Gibson
- Information Management Services, Inc., Calverton, MD, USA
| | - Kathy B Baumgartner
- Department of Epidemiology and Population Health, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Richard Baumgartner
- Department of Epidemiology and Population Health, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Catherine Duggan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave North, M4B402, Seattle, WA, 98109-1024, USA
| | - Leslie Bernstein
- Division of Cancer Etiology, Department of Population Sciences, Beckman Research Institute of the City of Hope, Duarte, CA, USA
| | - Anne McTiernan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave North, M4B402, Seattle, WA, 98109-1024, USA
| | - Rachel Ballard
- Office of Disease Prevention, National Institutes of Health, Bethesda, MD, USA
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Parsons HM, Harlan LC, Schmidt S, Keegan THM, Lynch CF, Kent EE, Wu XC, Schwartz SM, Chu RL, Keel G, Smith AW. Who Treats Adolescents and Young Adults with Cancer? A Report from the AYA HOPE Study. J Adolesc Young Adult Oncol 2016; 4:141-50. [PMID: 26421222 DOI: 10.1089/jayao.2014.0041] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Physicians play a critical role in delivering effective treatment and enabling successful transition to survivorship among adolescent and young adult (AYA) cancer patients. However, with no AYA cancer medical specialty, information on where and by whom AYAs with cancer are treated is limited. METHODS Using the National Cancer Institute's population-based AYA HOPE Study, 464 AYAs aged 15-39 at diagnosis treated by 903 physicians were identified. Differences in physician and hospital characteristics were examined by age at diagnosis and cancer type (germ cell cancer, non-Hodgkin lymphoma, Hodgkin lymphoma, acute lymphocytic leukemia [ALL], and sarcoma) using chi-square tests. RESULTS Treating physicians were predominately 51-64 years old, male, United States-trained in non-pediatric specialties, and in group practices within large metropolitan areas. Older patients were less often treated by pediatric physicians (p < 0.01) and more likely to be treated by United States-trained physicians without research/teaching responsibilities and in hospitals without residency programs (p < 0.05). The majority of the few pediatricians (n = 44) treated ALL patients. Physicians with research/teaching responsibilities and those based in medical schools were more likely to treat patients with ALL and sarcoma compared with other cancer types (p < 0.01). Of HL patients, 73% were treated at a cancer center compared with 56% of patients with germ cell cancer (p < 0.01), while ALL (85%) and sarcoma (87%) patients were more likely to be treated in hospitals with residency programs (p < 0.01). CONCLUSIONS Most AYAs with cancer were treated by non-pediatric physicians in community settings, although physician characteristics varied significantly by patient cancer type and age at diagnosis.
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Affiliation(s)
- Helen M Parsons
- Department of Epidemiology and Biostatistics, The University of Texas Health Science Center , San Antonio, Texas
| | - Linda C Harlan
- Applied Research Program, National Cancer Institute , Bethesda, Maryland
| | - Susanne Schmidt
- Department of Epidemiology and Biostatistics, The University of Texas Health Science Center , San Antonio, Texas
| | | | - Charles F Lynch
- Department of Epidemiology, University of Iowa , Iowa City, Iowa
| | - Erin E Kent
- Applied Research Program, National Cancer Institute , Bethesda, Maryland
| | - Xiao-Cheng Wu
- Louisiana Tumor Registry, Louisiana State University Health Sciences Center , New Orleans, Louisiana
| | - Stephen M Schwartz
- Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center , Seattle, Washington
| | - Roland L Chu
- Department of Pediatrics, Wayne State University , Detroit, Michigan
| | - Gretchen Keel
- Information Management Services , Calverton, Maryland
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Jensen RE, Moinpour CM, Potosky AL, Lobo T, Hahn EA, Hays RD, Cella D, Smith AW, Wu XC, Keegan THM, Paddock LE, Stroup AM, Eton DT. Responsiveness of 8 Patient-Reported Outcomes Measurement Information System (PROMIS) measures in a large, community-based cancer study cohort. Cancer 2016; 123:327-335. [PMID: 27696377 DOI: 10.1002/cncr.30354] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 08/23/2016] [Accepted: 08/24/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND The Patient-Reported Outcomes Measurement Information System (PROMIS) was a National Institutes of Health-funded initiative to develop measures of symptoms and function. Responsiveness is the degree to which a measure can detect underlying changes over time. The objective of the current study was to document the responsiveness of 8 PROMIS measures in a large, population-based cancer cohort. METHODS The Measuring Your Health study recruited 2968 patients who were diagnosed with 1 of 7 cancers between 2010 and 2012 through 4 Surveillance, Epidemiology, and End Results registries. Participants completed a baseline survey (6-13 months after diagnosis) and a 6-month follow-up survey. Changes in 8 PROMIS scores were compared with global ratings of transition, changes in performance status, and clinical events. RESULTS Measures were responsive to 6-month declines and improvements in performance status with small to large effect sizes (ES) (Cohen d = 0.34-0.71; P < .01). Mean changes and effect sizes were larger for participants who reported declines compared with those who reported improvements. Small-to-medium ES were observed in patients who reported being "a little" worse (d = 0.31-0.56), and medium-to-large ES were observed in those who reported being "a lot" worse (d = 0.53-0.72). Hospitalized participants reported significant score increases, resulting in worsening of pain (d = 0.51), fatigue (d = 0.35), and depression (d = 0.57; all P < .01). Cancer recurrence and progression were associated with smaller increases in pain, fatigue, and sleep disturbance (d = 0.22-0.27). CONCLUSIONS The current results indicated that all 8 PROMIS measures were sensitive to patient-perceived worsening and improvement and to major clinical events. These findings will be able to inform the design and interpretation of future research studies and clinical initiatives administering PROMIS measures. Cancer 2017;123:327-335. © 2016 American Cancer Society.
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Affiliation(s)
- Roxanne E Jensen
- Department of Oncology, Georgetown University, Washington, DC.,Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | | | - Arnold L Potosky
- Department of Oncology, Georgetown University, Washington, DC.,Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - Tania Lobo
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - Elizabeth A Hahn
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ron D Hays
- University of California-Los Angeles Department of Medicine, Los Angeles, California
| | - David Cella
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ashley Wilder Smith
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Xiao-Cheng Wu
- Lousiana State University Health Sciences Center School of Public Health, Louisiana Tumor Registry, New Orleans, Louisiana
| | - Theresa H M Keegan
- Department of Internal Medicine, Division of Hematology and Oncology, University of California-Davis School of Medicine, Sacramento, California
| | - Lisa E Paddock
- Cancer Epidemiology Services, New Jersey Department of Health, Trenton, New Jersey.,Rutgers School of Public Health and Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Antoinette M Stroup
- Cancer Epidemiology Services, New Jersey Department of Health, Trenton, New Jersey
| | - David T Eton
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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Moinpour CM, Donaldson GW, Davis KM, Potosky AL, Jensen RE, Gralow JR, Back AL, Hwang JJ, Yoon J, Bernard DL, Loeffler DR, Rothrock NE, Hays RD, Reeve BB, Smith AW, Hahn EA, Cella D. The challenge of measuring intra-individual change in fatigue during cancer treatment. Qual Life Res 2016; 26:259-271. [PMID: 27469506 DOI: 10.1007/s11136-016-1372-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate how well three different patient-reported outcomes (PROs) measure individual change. METHODS Two hundred and fourteen patients (from two sites) initiating first or new chemotherapy for any stage of breast or gastrointestinal cancer participated. The 13-item FACIT Fatigue scale, a 7-item PROMIS® Fatigue Short Form (PROMIS 7a), and the PROMIS® Fatigue computer adaptive test (CAT) were administered monthly online for 6 months. Reliability of measured change was defined, under a population mixed effects model, as the ratio of estimated systematic variance in rate of change to the estimated total variance of measured individual differences in rate of change. Precision of individual measured change, the standard error of measurement of change, was given by the square root of the rate-of-change sampling variance. Linear and quadratic models were examined up to 3 and up to 6 months. RESULTS A linear model for measured change showed the following by 6 and 3 months, respectively: PROMIS CAT (0.363 and 0.342); PROMIS SF (0.408 and 0.533); FACIT (0.459 and 0.473). Quadratic models offered no noteworthy improvement over linear models. Both reliability and precision results demonstrate the need to improve the measurement of intra-individual change. CONCLUSIONS These results illustrate the challenge of reliably measuring individual change in fatigue with a level of confidence required for intervention. Optimizing clinically useful measurement of intra-individual differences over time continues to pose a challenge for PROs.
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Affiliation(s)
- Carol M Moinpour
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center [Emerita], Seattle, WA, USA.
| | - Gary W Donaldson
- Pain Research Center, Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
| | - Kimberly M Davis
- Health Services Research, Georgetown University Medical Center, and Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Arnold L Potosky
- Health Services Research, Georgetown University Medical Center, and Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Roxanne E Jensen
- Health Services Research, Georgetown University Medical Center, and Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Julie R Gralow
- Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Anthony L Back
- Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jimmy J Hwang
- Hematology/Oncology, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA
| | - Jihye Yoon
- Cancer Prevention Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Debra L Bernard
- Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Nan E Rothrock
- Department of Medical Social Sciences and Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ron D Hays
- Departments of Medicine and Health Services Research, University of California Los Angeles, Los Angeles, CA, USA
| | - Bryce B Reeve
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Elizabeth A Hahn
- Department of Medical Social Sciences and Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David Cella
- Department of Medical Social Sciences and Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Wettergren L, Kent EE, Mitchell SA, Zebrack B, Lynch CF, Rubenstein MB, Keegan THM, Wu XC, Parsons HM, Smith AW. Cancer negatively impacts on sexual function in adolescents and young adults: The AYA HOPE study. Psychooncology 2016; 26:1632-1639. [PMID: 27240019 DOI: 10.1002/pon.4181] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 04/16/2016] [Accepted: 05/22/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This cohort study examined the impact of cancer on sexual function and intimate relationships in adolescents and young adults (AYAs). We also explored factors predicting an increased likelihood that cancer had negatively affected these outcomes. METHODS Participants (n = 465, ages 15-39) in the Adolescent and Young Adult Health Outcomes and Patient Experience (AYA HOPE) study completed two surveys approximately 1 and 2 years post-cancer diagnosis. We used multivariable logistic regression to determine factors negatively affected by perceptions of sexual function at 2 years post-diagnosis. RESULTS Forty-nine percent of AYAs reported negative effects on sexual function at 1 year post-cancer diagnosis and 70% of those persisted in their negative perceptions 2 years after diagnosis. Those reporting a negative impact at 2 years were more likely to be 25 years or older (OR, 2.53; 95% CI, 1.44-4.42), currently not raising children (OR, 1.81; 95% CI, 1.06-3.08), experiencing fatigue (OR, 0.99; 95% CI, 0.975-0.998) and more likely to report that their diagnosis has had a negative effect on physical appearance (OR, 3.08; 95% CI, 1.97-4.81). Clinical factors and mental health were not significant predictors of negative effects on sexual function. CONCLUSIONS Many AYAs diagnosed with cancer experience a persistent negative impact on sexual life up to 2 years following diagnosis. The findings underscore the need to develop routine protocols to assess sexual function in AYAs with cancer and to provide comprehensive management in the clinical setting. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Lena Wettergren
- Outcomes Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Erin E Kent
- Outcomes Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Sandra A Mitchell
- Outcomes Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Brad Zebrack
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
| | - Charles F Lynch
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | | | - Theresa H M Keegan
- Division of Hematology and Oncology, UC Davis Comprehensive Cancer Center, CA, USA
| | - Xiao-Cheng Wu
- Epidemiology Program/Louisiana Tumor Registry, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Helen M Parsons
- Department of Epidemiology and Biostatistics, University of Texas Health Sciences Center, San Antonio, TX, USA
| | - Ashley Wilder Smith
- Outcomes Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
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- The AYA HOPE Study Collaborative Group, National Cancer Institute, Bethesda, MD, USA
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Kent EE, Mollica M, Gaillot S, Halpern MT, Hays RD, Lines LM, Topor MA, Yuan G, Schussler NC, Ramirez E, Wilder Smith A. Cancer registry-survey data linkages to measure patient-centered quality of care: SEER-MHOS and SEER-CAHPS. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.7_suppl.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
303 Background: Limited opportunities exist to conduct population-based surveillance of cancer patient-reported outcomes. Data from the National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) program has recently been linked with data from two Centers for Medicare & Medicaid Services quality improvement surveys: the Medicare Health Outcomes Survey (MHOS) and the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. We provide an overview of the data available, recent findings, and priority areas for future research. Methods: Since 1998, the MHOS has conducted 2-wave/biennial surveys of individuals ages 65+ and individuals with disabilities enrolled in Medicare Advantage (MA) health plans on aspects of health-related quality of life, functional status, comorbidities, and symptoms. Fourteen cohorts are available, representing over 126K patients with cancer and over 1.9 million MA enrollees without a history of cancer. The SEER-MHOS publicly available data resource has produced over 40 data use agreements and 19 publications. SEER-CAHPS links cancer registry data with cross-sectional survey data of Medicare beneficiaries (both fee-for-service and MA) that contain information on patient experiences with care, including access to needed and timely care, doctor communication, health plan customer service, and care coordination. The current linkage contains survey data from 1998 to 2010 and includes over 150K and 570K respondents with and without a history of cancer, respectively. Plans to launch the publicly available resource are underway. Results: Recent findings include the impact of diagnosis and treatment on health-related quality of life in older cancer survivors, physical health impairments and variation of treatment received, the impact of cancer on activities of daily living, and variations in care ratings between participants with and without cancer across the cancer control continuum. Conclusions: The SEER-MHOS and SEER-CAHPS linked data resources provide population-based surveillance data on cancer patient-reported outcomes which allow unprecedented opportunities to evaluate national quality improvement activities.
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Affiliation(s)
- Erin E. Kent
- National Cancer Institute at the National Institutes of Health, Rockville, MD
| | | | - Sarah Gaillot
- Centers for Medicare & Medicaid Services, Baltimore, MD
| | | | - Ron D. Hays
- University of California, Los Angeles, Los Angeles, CA
| | | | | | - Gigi Yuan
- Information Management Services, Inc., Rockville, MD
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Smith AW, Seibel NL, Lewis DR, Albritton KH, Blair DF, Blanke CD, Bleyer WA, Freyer DR, Geiger AM, Hayes-Lattin B, Tricoli JV, Wagner LI, Zebrack BJ. Next steps for adolescent and young adult oncology workshop: An update on progress and recommendations for the future. Cancer 2016; 122:988-99. [PMID: 26849003 DOI: 10.1002/cncr.29870] [Citation(s) in RCA: 135] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 09/18/2015] [Accepted: 09/21/2015] [Indexed: 12/14/2022]
Abstract
Each year, 70,000 adolescents and young adults (AYAs) between ages 15 and 39 years in the United States are diagnosed with cancer. In 2006, a National Cancer Institute (NCI) Progress Review Group (PRG) examined the state of science associated with cancer among AYAs. To assess the impact of the PRG and examine the current state of AYA oncology research, the NCI, with support from the LIVESTRONG Foundation, sponsored a workshop entitled "Next Steps in Adolescent and Young Adult Oncology" on September 16 and 17, 2013, in Bethesda, Maryland. This report summarizes the findings from the workshop, opportunities to leverage existing data, and suggestions for future research priorities. Multidisciplinary teams that include basic scientists, epidemiologists, trialists, biostatisticians, clinicians, behavioral scientists, and health services researchers will be essential for future advances for AYAs with cancer.
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Affiliation(s)
- Ashley Wilder Smith
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Nita L Seibel
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - Denise R Lewis
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Karen H Albritton
- Cook Children's Medical Center and University of North Texas Health Science Center, Houston, Texas
| | - Donald F Blair
- Division of Cancer Biology, National Cancer Institute, Bethesda, Maryland
| | - Charles D Blanke
- Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland, Oregon
| | - W Archie Bleyer
- Radiation Medicine Department, Oregon Health and Science University, Portland, Oregon
| | - David R Freyer
- Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Ann M Geiger
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Brandon Hayes-Lattin
- Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland, Oregon
| | - James V Tricoli
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - Lynne I Wagner
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Barile JP, Mitchell SA, Thompson WW, Zack MM, Reeve BB, Cella D, Smith AW. Patterns of Chronic Conditions and Their Associations With Behaviors and Quality of Life, 2010. Prev Chronic Dis 2015; 12:E222. [PMID: 26679491 PMCID: PMC5241639 DOI: 10.5888/pcd12.150179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Co-occurring chronic health conditions elevate the risk of poor health outcomes such as death and disability, are associated with poor quality of life, and magnify the complexities of self-management, care coordination, and treatment planning. This study assessed patterns of both singular and multiple chronic conditions, behavioral risk factors, and quality of life in a population-based sample. METHODS In a national survey, adults (n = 4,184) answered questions about the presence of 27 chronic conditions. We used latent class analysis to identify patterns of chronic conditions and to explore associations of latent class membership with sociodemographic characteristics, behavioral risk factors, and health. RESULTS Latent class analyses indicated 4 morbidity profiles: a healthy class (class 1), a class with predominantly physical health conditions (class 2), a class with predominantly mental health conditions (class 3), and a class with both physical and mental health conditions (class 4). Class 4 respondents reported significantly worse physical health and well-being and more days of activity limitation than those in the other latent classes. Class 4 respondents were also more likely to be obese and sedentary, and those with predominantly mental health conditions were most likely to be current smokers. CONCLUSIONS Subgroups with distinct patterns of chronic conditions can provide direction for screening and surveillance, guideline development, and the delivery of complex care services.
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Affiliation(s)
- John P Barile
- Department of Psychology, University of Hawai'i at Mānoa, 2530 Dole St, Sakamaki C400, Honolulu, HI 96822.
| | | | | | - Matthew M Zack
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bryce B Reeve
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Abstract
Adolescent and young adults (AYAs) face challenges in having their cancers recognized, diagnosed, treated, and monitored. Monitoring AYA cancer survival is of interest because of the lack of improvement in outcome previously documented for these patients as compared with younger and older patient outcomes. AYA patients 15-39 years old, diagnosed during 2000-2008 with malignant cancers were selected from the SEER 17 registries data. Selected cancers were analyzed for incidence and five-year relative survival by histology, stage, and receptor subtypes. Hazard ratios were estimated for cancer death risk among younger and older ages relative to the AYA group. AYA survival was worse for female breast cancer (regardless of estrogen receptor status), acute lymphoid leukemia (ALL), and acute myeloid leukemia (AML). AYA survival for AML was lowest for a subtype associated with a mutation of the nucleophosmin 1 gene (NPM1). AYA survival for breast cancer and leukemia remain poor as compared with younger and older survivors. Research is needed to address disparities and improve survival in this age group.
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Affiliation(s)
- Denise Riedel Lewis
- Division of Cancer Control and Population Sciences (DRL, AWS, MRS), Division of Cancer Treatment and Diagnosis (NLS), National Cancer Institute, National Institutes of Health, Bethesda, MD.
| | - Nita L Seibel
- Division of Cancer Control and Population Sciences (DRL, AWS, MRS), Division of Cancer Treatment and Diagnosis (NLS), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Ashley Wilder Smith
- Division of Cancer Control and Population Sciences (DRL, AWS, MRS), Division of Cancer Treatment and Diagnosis (NLS), National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Margaret R Stedman
- Division of Cancer Control and Population Sciences (DRL, AWS, MRS), Division of Cancer Treatment and Diagnosis (NLS), National Cancer Institute, National Institutes of Health, Bethesda, MD
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Guy GP, Yabroff KR, Ekwueme DU, Smith AW, Dowling EC, Rechis R, Nutt S, Richardson LC. Estimating the health and economic burden of cancer among those diagnosed as adolescents and young adults. Health Aff (Millwood) 2015; 33:1024-31. [PMID: 24889952 DOI: 10.1377/hlthaff.2013.1425] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Adolescent and young adult cancer survivors-those who were ages 15-39 at their first cancer diagnosis-have important health limitations. These survivors are at risk for higher health care expenditures and lost productivity, compared to adults without a history of cancer. Using Medical Expenditure Panel Survey data, we present nationally representative estimates of the economic burden among people who were diagnosed with cancer in adolescence or young adulthood. Our findings demonstrate that surviving cancer at this age is associated with a substantial economic burden. Compared to adults without a history of cancer, adolescent and young adult cancer survivors had excess annual medical expenditures of $3,170 per person and excess annual productivity losses of $2,250 per person. Multifaceted prevention strategies, including education and sustained intervention programs to ensure access to lifelong risk-based follow-up care, may be effective ways to improve the economic outcomes associated with cancer survivorship in this population.
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Affiliation(s)
- Gery P Guy
- Gery P. Guy Jr. is a health economist in the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention (CDC), in Atlanta, Georgia
| | - K Robin Yabroff
- K. Robin Yabroff is an epidemiologist in the Division of Cancer Control and Population Sciences, National Cancer Institute (NCI), in Bethesda, Maryland
| | - Donatus U Ekwueme
- Donatus U. Ekwueme is a senior health economist in the Division of Cancer Prevention and Control, CDC
| | - Ashley Wilder Smith
- Ashley Wilder Smith is a behavioral scientist in the Division of Cancer Control and Population Sciences, NCI
| | - Emily C Dowling
- Emily C. Dowling is program manager for the Institute for Technology Assessment, Massachusetts General Hospital, in Boston, Massachusetts
| | - Ruth Rechis
- Ruth Rechis is vice president of Programs and Strategy at the LIVESTRONG Foundation, in Austin, Texas
| | - Stephanie Nutt
- Stephanie Nutt is a program manager on the Research and Evaluation Team, LIVESTRONG Foundation
| | - Lisa C Richardson
- Lisa C. Richardson is director of the Division of Blood Disorders, CDC
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Weinfurt KP, Lin L, Bruner DW, Cyranowski JM, Dombeck CB, Hahn EA, Jeffery DD, Luecht RM, Magasi S, Porter LS, Reese JB, Reeve BB, Shelby RA, Smith AW, Willse JT, Flynn KE. Development and Initial Validation of the PROMIS(®) Sexual Function and Satisfaction Measures Version 2.0. J Sex Med 2015; 12:1961-74. [PMID: 26346418 DOI: 10.1111/jsm.12966] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The Patient-Reported Outcomes Measurement Information System (PROMIS)(®) Sexual Function and Satisfaction measure (SexFS) version 1.0 was developed with cancer populations. There is a need to expand the SexFS and provide evidence of its validity in diverse populations. AIM The aim of this study was to describe the development of the SexFS v2.0 and present preliminary evidence for its validity. METHODS Development built on version 1.0, plus additional review of extant items, discussions with 15 clinical experts, 11 patient focus groups (including individuals with diabetes, heart disease, anxiety, depression, and/or are lesbian, gay, bisexual, or aged 65 or older), 48 cognitive interviews, and psychometric evaluation in a random sample of U.S. adults plus an oversample for specific sexual problems (2281 men, 1686 women). We examined differential item functioning (DIF) by gender and sexual activity. We examined convergent and known-groups validity. RESULTS The final set of domains includes 11 scored scales (interest in sexual activity, lubrication, vaginal discomfort, clitoral discomfort, labial discomfort, erectile function, orgasm ability, orgasm pleasure, oral dryness, oral discomfort, satisfaction), and six nonscored item pools (screeners, sexual activities, anal discomfort, therapeutic aids, factors interfering with sexual satisfaction, bother). Domains from version 1.0 were reevaluated and improved. Domains considered applicable across gender and sexual activity status, namely interest, orgasm, and satisfaction, were found to have significant DIF. We identified subsets of items in each domain that provided consistent measurement across these important respondent groups. Convergent and known-groups validity was supported. CONCLUSIONS The SexFS version 2.0 has several improvements and enhancements over version 1.0 and other extant measures, including expanded evidence for validity, scores centered around norms for sexually active U.S. adults, new domains, and a final set of items applicable for both men and women and those sexually active with a partner and without. The SexFS is customizable, allowing users to select relevant domains and items for their study.
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Affiliation(s)
- Kevin P Weinfurt
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Li Lin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | - Jill M Cyranowski
- Departments of Psychiatry and Psychology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Carrie B Dombeck
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Elizabeth A Hahn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Diana D Jeffery
- Department of Defense-Health Affairs, TRICARE Management Activity, Falls Church, VA, USA
| | - Richard M Luecht
- Department of Educational Research Methodology, School of Education, University of North Carolina at Greensboro, Chicago, IL, USA
| | - Susan Magasi
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Laura S Porter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jennifer Barsky Reese
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Bryce B Reeve
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Ashley Wilder Smith
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - John T Willse
- Department of Educational Research Methodology, School of Education, University of North Carolina at Greensboro, Chicago, IL, USA
| | - Kathryn E Flynn
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, USA
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Shnorhavorian M, Harlan LC, Smith AW, Keegan THM, Lynch CF, Prasad PK, Cress RD, Wu XC, Hamilton AS, Parsons HM, Keel G, Charlesworth SE, Schwartz SM. Fertility preservation knowledge, counseling, and actions among adolescent and young adult patients with cancer: A population-based study. Cancer 2015. [PMID: 26214755 DOI: 10.1002/cncr.29328] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The fertility of adolescent and young adult (AYA) patients with cancer can be threatened by treatments, but to the authors' knowledge little is known regarding the extent to which providers discuss this with patients or recommend fertility preservation, or the patient and physician characteristics associated with these interactions. METHODS Questionnaires from 459 AYA patients with cancer who were diagnosed between 2007 and 2008 and recruited through 7 US population-based cancer registries were analyzed using sex-specific multivariable models. The authors assessed characteristics associated with not discussing therapy effects on fertility or fertility preservation options, and not making fertility preservation arrangements. RESULTS Males without a medical oncologist were more likely not to be told that therapy might affect fertility than those with a medical oncologist (male odds ratio [OR], 2.28; 95% confidence interval [95% CI], 1.03-5.00). Individuals without insurance (male OR, 2.91 [95% CI, 1.41-5.91] and female OR, 5.46 [95% CI, 1.59-18.72]); those raising children aged <18 years; and, among males only, those who received treatment posing no or a low fertility risk (OR, 3.39; 95% CI, 1.60-7.16) were more likely not to discuss fertility preservation with providers. Finally, among males, those without a college degree (OR, 1.98; 95% CI, 1.00-3.97), lacking private insurance (OR, 2.97; 95% CI, 1.16-7.63), and raising children aged <18 years (OR, 3.53; 95% CI, 1.63-7.65) were more likely to not make fertility preservation arrangements; too few females had made fertility preservation arrangements for similar analyses to be performed. CONCLUSIONS Discussion and action surrounding fertility preservation for AYA patients with cancer are associated with medical factors, patient socioeconomic data, and child-rearing status. These results highlight the need for insurance coverage for fertility preservation and increased awareness of fertility preservation options.
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Affiliation(s)
- Margarett Shnorhavorian
- Division of Pediatric Urology, Department of Urology, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Linda C Harlan
- Applied Research Program, National Cancer Institute, Bethesda, Maryland
| | | | - Theresa H M Keegan
- Cancer Prevention Institute of California, Fremont, California.,Department of Health Research and Policy, School of Medicine, Stanford University, Stanford, California
| | - Charles F Lynch
- Department of Epidemiology, University of Iowa, Iowa City, Iowa
| | - Pinki K Prasad
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Rosemary D Cress
- Department of Public Health Sciences, School of Medicine, University of California, Davis, California
| | - Xiao-Cheng Wu
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Helen M Parsons
- Department of Epidemiology and Biostatistics, School of Medicine, The University of Texas Health Science Center, San Antonio, Texas
| | - Gretchen Keel
- Information Management Services Inc, Silver Spring, Maryland
| | - Sarah E Charlesworth
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | - Stephen M Schwartz
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington.,Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Proctor JE, Smith AW, Jung TM, Woods SI. High-gain cryogenic amplifier assembly employing a commercial CMOS operational amplifier. Rev Sci Instrum 2015; 86:073102. [PMID: 26233351 DOI: 10.1063/1.4923277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We have developed a cryogenic amplifier for the measurement of small current signals (10 fA-100 nA) from cryogenic optical detectors. Typically operated with gain near 10(7) V/A, the amplifier performs well from DC to greater than 30 kHz and exhibits noise level near the Johnson limit. Care has been taken in the design and materials to control heat flow and temperatures throughout the entire detector-amplifier assembly. A simple one-board version of the amplifier assembly dissipates 8 mW to our detector cryostat cold stage, and a two-board version can dissipate as little as 17 μW to the detector cold stage. With current noise baseline of about 10 fA/(Hz)(1/2), the cryogenic amplifier is generally useful for cooled infrared detectors, and using blocked impurity band detectors operated at 10 K, the amplifier enables noise power levels of 2.5 fW/(Hz)(1/2) for detection of optical wavelengths near 10 μm.
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Affiliation(s)
- J E Proctor
- Jung Research and Development Corp., 3807 Porter St. NW #304, Washington, DC 20016, USA
| | - A W Smith
- L-1 Standards and Technology, Inc., 209 High Street, New Windsor, Maryland 21776, USA
| | - T M Jung
- Jung Research and Development Corp., 3807 Porter St. NW #304, Washington, DC 20016, USA
| | - S I Woods
- National Institute of Standards and Technology, 100 Bureau Drive, Gaithersburg, Maryland 20899, USA
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50
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Kent EE, Breen N, Lewis DR, de Moor JS, Smith AW, Seibel NL. US trends in survival disparities among adolescents and young adults with non-Hodgkin lymphoma. Cancer Causes Control 2015; 26:1153-62. [PMID: 26084209 DOI: 10.1007/s10552-015-0609-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 05/30/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Improvement in US survival rates among adolescents and young adults (AYAs, ages 15 through 39 years inclusive) diagnosed with non-Hodgkin lymphoma (NHL) has been documented over the last two decades. We examined national trends in survival disparities for AYAs with NHL by race/ethnicity and socioeconomic status (SES, county-level poverty) to further understand NHL and to begin monitoring health outcome disparities for this disease. METHODS Surveillance Epidemiology and End Results data were used to calculate 5-year relative survival rates of AYAs diagnosed with NHL from 1992 to 2007 and followed through 2011. Absolute and relative disparities were computed using HD*Calc. Whether a significant linear trend was present was evaluated using Joinpoint. Analyses were replicated after excluding individuals with known HIV infection. RESULTS The study sample included 9,573 total and 7,121 non-HIV cases of NHL. Five-year survival rates improved for all groups over time. Significant decreases were found in absolute disparities for race/ethnicity (non-HIV), in relative disparities for SES (total) and race/ethnicity (total and non-HIV) (all p < 0.05). Survival rates of non-Hispanic Blacks and Hispanics remained below than those of non-Hispanic Whites throughout the time period. CONCLUSION Absolute and relative disparities in 5-year survival narrowed for AYAs with NHL over the time period. To continue to promote this trend, future research should investigate factors, particularly diagnostic delays and barriers to care, which continue to contribute to SES and racial/ethnic differences in survival. These factors may be particularly relevant to identify given the recent Affordable Care Act, which is designed to increase access to medical services, particularly for young adults.
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Affiliation(s)
- Erin E Kent
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA,
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