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Lewis D, Wong WWL, Lipscomb J, Horton S. An Exploratory Analysis of the Cost-Effectiveness of a Multi-cancer Early Detection Blood Test Compared with Standard of Care Screening in Ontario, Canada. Pharmacoeconomics 2024; 42:393-407. [PMID: 38150120 DOI: 10.1007/s40273-023-01345-9] [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] [Accepted: 12/06/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Determining whether multi-cancer early detection (MCED) tests are cost effective is important in deciding whether they should be included in the clinical path of cancer care, especially for cancers where screening tools do not exist. RESEARCH OBJECTIVE The main objective of this study is to determine the cost effectiveness of including a MCED screening regimen together with existing provincial screening protocols for selected cancers that are prevalent in Ontario, Canada, among average risk persons aged 50-75 years. The selected cancers include breast, colorectal, lung, esophageal, liver, pancreatic, stomach, and ovarian. METHODS Cost effectiveness was estimated from a provincial Ministry of Health perspective. A state-transition Markov model representing the decision path of both the proposed and existing screening strategies along the natural history of the selected types of cancers was implemented. The incremental cost-effectiveness ratio (ICER) was calculated using data from available literature and the guidelines published by the Canadian Agency for Drugs and Technologies in Health (CADTH) for conducting a cost-effectiveness analysis, which included a discount rate of 1.5% applied to all costs and outcomes. Costs were also converted to 2022 Canadian dollars. To test the robustness of the model, both univariate and probabilistic sensitivity analyses were conducted. RESULTS MCED screening resulted in more diagnosed cases of each type of cancer, even at an earlier stage of disease. This was also associated with fewer related deaths compared with standard of care. Notwithstanding, the analysis revealed that the MCED intervention was not cost effective [ICER: CAD$143,369 per quality-adjusted life year (QALY)], given a willingness to pay (WTP) threshold of $100,000 per QALY. The probabilistic sensitivity analyses revealed that the MCED intervention strategy was preferred to standard of care no more than 2% of the time at this WTP for both males and females. The model was most sensitive to the cost of MCED screening, and the levels of specificity of the MCED and colorectal cancer screening tests. CONCLUSION The main contribution of the study is to present and execute a methodological approach that can be adopted to test the cost effectiveness of an MCED tool in the Canadian setting. The model is also sufficiently generic that it could be adapted to other jurisdictions, and with consideration for increasing the WTP threshold beyond the common $100,000 per QALY limit, given the life-threatening nature of cancer, to ensure that MCED interventions are cost-effective.
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Affiliation(s)
- Diedron Lewis
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada.
| | - William W L Wong
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Joseph Lipscomb
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Cancer Prevention and Control Research Program, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Susan Horton
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Ji X, Hu X, Lipscomb J, Chow EJ, Mertens AC, Castellino SM. Utilization of cardiac tests in anthracycline-treated cancer survivors differs between young adults and children: A claims-based analysis. Cancer Med 2023; 12:22056-22061. [PMID: 38070180 PMCID: PMC10757126 DOI: 10.1002/cam4.6801] [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: 08/05/2023] [Revised: 11/01/2023] [Accepted: 11/28/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND The Children's Oncology Group Guidelines recommend a cardiacechocardiogram, or comparable functional imaging, following therapy completion in survivors of childhood/adolescent cancers exposed to anthracyclines. METHODS Using the 2009-2019 Merative™ MarketScan® Commercial Database, we examined real-world utilization of cardiac testing among 1609 anthracycline-treated survivors of childhood/adolescent cancers. RESULTS The cumulative incidence of receiving an initial cardiac test by 5.25 years from the index date (six months after end-of-therapy) was 62.3% (95% CI = 57.5%-66.7%), with median time to initial test being 2.7 years (95% CI = 2.5%-3.1%). Young adults (18-28 years) were less likely than children (≤17 years) to receive cardiac testing (hazard ratio [HR] = 0.42, 95% CI = 0.3%-0.49%). More likely to receive cardiac testing were survivors receiving hematopoietic stem cell transplantation versus chemotherapy only (HR = 2.23, 95% CI = 1.63%-3.03%), and survivors with bone or soft tissue versus hematologic cancer (HR = 1.64, 95% CI = 1.30%-2.07%). CONCLUSIONS Nearly 40% of anthracycline-treated survivors of childhood/adolescent cancers had not received cardiac testing within 5.25 years post-index date, with young adults least likely to receive a test.
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Affiliation(s)
- Xu Ji
- Department of PediatricsEmory University School of MedicineAtlantaGeorgiaUSA
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of AtlantaAtlantaGeorgiaUSA
| | - Xin Hu
- Department of Public Health SciencesUniversity of Virginia School of MedicineCharlottesvilleVirginiaUSA
| | - Joseph Lipscomb
- Department of Health Policy and Management, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
| | - Eric J. Chow
- University of Washington School of Medicine and Fred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | - Ann C. Mertens
- Department of PediatricsEmory University School of MedicineAtlantaGeorgiaUSA
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of AtlantaAtlantaGeorgiaUSA
| | - Sharon M. Castellino
- Department of PediatricsEmory University School of MedicineAtlantaGeorgiaUSA
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of AtlantaAtlantaGeorgiaUSA
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Guan Y, Haardörfer R, McBride CM, Escoffery C, Lipscomb J. Testing Theory-Based Messages to Encourage Women at Average Risk for Breast Cancer to Consider Biennial Mammography Screening. Ann Behav Med 2023; 57:696-707. [PMID: 37155576 DOI: 10.1093/abm/kaad018] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND The US Preventive Services Task Force does not recommend routine annual mammography screening for women aged 40-49 at average risk. Little research has been done to develop theory-based communication interventions to facilitate informed decision-making about reducing potentially low-value mammography screening. PURPOSE Evaluate the effects of theory-based persuasive messages on women's willingness to consider delaying screening mammography until age 50 or have mammograms biennially. METHODS We conducted a randomized controlled communication experiment online with a population-based sample of U.S. women aged 40-49 (N = 383) who screened to be at average risk for breast cancer. Women were randomly assigned to the following messaging summaries: annual mammography risks in 40s (Arm 1, n = 124), mammography risks plus family history-based genetic risk (Arm 2, n = 120), and mammography risks, genetic risk, and behavioral alternatives (Arm 3, n = 139). Willingness to delay screening or reduce screening frequency was assessed post-experiment by a set of 5-point Likert scale items. RESULTS Women in Arm 3 reported significantly greater willingness to delay screening mammography until age 50 (mean = 0.23, SD = 1.26) compared with those in Arm 1 (mean = -0.17, SD = 1.20; p = .04). There were no significant arm differences in willingness to reduce screening frequency. Exposure to the communication messages significantly shifted women's breast cancer-related risk perceptions without increasing unwarranted cancer worry across all three arms. CONCLUSIONS Providing women with screening information and options may help initiate challenging discussions with providers about potentially low-value screening.
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Affiliation(s)
- Yue Guan
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Regine Haardörfer
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Colleen M McBride
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Cam Escoffery
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Joseph Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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George PE, Maillis A, Zhu Y, Liu Y, Lane PA, Lam W, Lipscomb J, Ebelt S. Are children with sickle cell disease at particular risk from the harmful effects of air pollution? Evidence from a large, urban/peri-urban cohort. Pediatr Blood Cancer 2023; 70:e30453. [PMID: 37248172 PMCID: PMC10684822 DOI: 10.1002/pbc.30453] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Pathophysiologic pathways of sickle cell disease (SCD) and air pollution involve inflammation, oxidative stress, and endothelial damage. It is therefore plausible that children with SCD are especially prone to air pollution's harmful effects. METHODS Patient data were collected from a single-center, urban/peri-urban cohort of children with confirmed SCD. Daily ambient concentrations of particulate matter (PM2.5 ) were collected via satellite-derived remote-sensing technology, and carbon monoxide (CO), nitrogen dioxide (NO2 ), and ozone from local monitoring stations. We used multivariable regression to quantify associations of pollutant levels and daily counts of emergency department (ED) visits, accounting for weather and time trends. For comparison, we quantified the associations of pollutant levels with daily all-patient (non-SCD) ED visits to our center. RESULTS From 2010 to 2018, there were 17,731 ED visits by 1740 children with SCD (64.8% HbSS/HbSβ0 ). Vaso-occlusive events (57.8%), respiratory illness (17.1%), and fever (16.1%) were the most common visit diagnoses. Higher 3-day (lags 0-2) rolling mean PM2.5 and CO levels were associated with daily ED visits among those with SCD (PM2.5 incident rate ratio [IRR] 1.051 [95% confidence interval: 1.010-1.094] per 9.4 μg/m3 increase; CO 1.088 [1.045-1.132] per 0.5 ppm). NO2 showed positive associations in secondary analyses; ozone levels were not associated with ED visits. The comparison, all-patient ED visit analyses showed lower IRR for all pollutants. CONCLUSIONS Our results suggest short-term air pollution levels as triggers for SCD events and that children with SCD may be more vulnerable to air pollution than those without SCD. Targeted pollution-avoidance strategies could have significant clinical benefits in this population.
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Affiliation(s)
- Paul E. George
- Emory University School of Medicine, Department of Pediatrics, Atlanta GA
- Emory University Rollins School of Public Health, Department of Health Policy and Management, Atlanta GA
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta GA
| | - Alexander Maillis
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta GA
| | - Yijing Zhu
- Emory University Rollins School of Public Health, Gangarosa Department of Environmental Health, Atlanta GA
| | - Yang Liu
- Emory University Rollins School of Public Health, Gangarosa Department of Environmental Health, Atlanta GA
| | - Peter A. Lane
- Emory University School of Medicine, Department of Pediatrics, Atlanta GA
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta GA
| | - Wilbur Lam
- Emory University School of Medicine, Department of Pediatrics, Atlanta GA
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta GA
| | - Joseph Lipscomb
- Emory University Rollins School of Public Health, Department of Health Policy and Management, Atlanta GA
| | - Stefanie Ebelt
- Emory University Rollins School of Public Health, Gangarosa Department of Environmental Health, Atlanta GA
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Hu X, Lipscomb J, Jiang C, Graetz I. Vertical integration of oncologists and cancer outcomes and costs in metastatic castration-resistant prostate cancer. J Natl Cancer Inst 2023; 115:268-278. [PMID: 36583540 PMCID: PMC9996219 DOI: 10.1093/jnci/djac233] [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: 07/28/2022] [Revised: 10/13/2022] [Accepted: 11/29/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The share of oncology practices owned by hospitals (ie, vertically integrated) nearly doubled from 2007 to 2017. We examined how integration between hospitals and oncologists affected care quality, outcomes, and spending among metastatic castration-resistant prostate cancer (mCRPC) patients. METHODS Using Surveillance, Epidemiology, and End Results-Medicare linked data and the Medicare Data on Provider Practice and Specialty, we identified Medicare beneficiaries who initiated systemic therapy for mCRPC between 2008 and 2017 (n = 9172). Primary outcomes included 1) bone-modifying agents (BMA) use, 2) time on systemic therapy, 3) survival, and 4) Medicare spending for the first 3 months following therapy initiation. We used a differences-in-differences approach to estimate the impact of vertical integration on outcomes, adjusting for patient and provider characteristics. RESULTS The proportion of patients treated by integrated oncologists increased from 28% to 55% from 2008 to 2017. Vertical integration was associated with an 11.7 percentage point (95% confidence interval [CI] = 4.2 to 19.1) increased likelihood of BMA use. There were no satistically significant changes in time on systemic therapy, survival, or total per-patient Medicare spending. Further decomposition showed an increase in outpatient payment ($5190, 95% CI = $1451 to $8930) and decrease in professional service payment (-$4757, 95% CI = -$7644 to -$1870) but no statistically significant changes for other service types (eg, inpatient and prescription drugs). CONCLUSIONS Vertical integration was associated with statistically significant increased BMA use but not with other cancer outcomes among mCRPC patients. For oncologists who switched service billing from physician offices to outpatient departments, there was no statistically significant change in overall Medicare spending in the first 3 months of therapy initiation. Future studies should extend the investigation to other cancer types and patient outcomes.
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Affiliation(s)
- Xin Hu
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Joseph Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Changchuan Jiang
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ilana Graetz
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Lipscomb J, Switchenko JM, Flowers CR, Gillespie TW, Wortley PM, Bayakly AR, Almon L, Ward KC. Impact of multi-agent systemic therapy on all-cause and disease-specific survival for people living with HIV who are diagnosed with non-Hodgkin lymphoma: population-based analyses from the state of Georgia. Leuk Lymphoma 2023; 64:151-160. [PMID: 36308021 PMCID: PMC9905298 DOI: 10.1080/10428194.2022.2133539] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/29/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 01/12/2023]
Abstract
For people living with HIV (PLWH) who are subsequently diagnosed with non-Hodgkin lymphoma (NHL), we investigate the impact of standard-of-care (SoC) cancer treatment on all-cause, NHL-specific, and HIV-specific survival outcomes. The focus is on a registry-derived, population-based sample of HIV + adults diagnosed with NHL within 2004-2012 in the state of Georgia. SoC treatment is defined as receipt of multi-agent systemic therapy (MAST). In multivariable survival analyses, SoC cancer treatment is significantly associated with better all-cause and NHL-specific survival, but not better HIV-specific survival across 2004-2017. Having a CD4 count <200 near the time of cancer diagnosis and Ann Arbor stage III/IV disease are associated with worse all-cause and HIV-specific survival; the effects on NHL survival trend negative but are not significant. Future work should expand the geographic base and cancers examined, deepen the level of clinical detail brought to bear, and incorporate the perspectives and recommendations of patients and providers.
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Affiliation(s)
- Joseph Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jeffrey M Switchenko
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Christopher R Flowers
- Division of Cancer Medicine, Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX, USA
| | - Theresa W Gillespie
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Surgical Oncology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Lyn Almon
- Georgia Center for Cancer Statistics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kevin C Ward
- Georgia Center for Cancer Statistics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Hu X, Brock KE, Effinger KE, Zhang B, Graetz I, Lipscomb J, Ji X. Changes in Opioid Prescriptions and Potential Misuse and Substance Use Disorders Among Childhood Cancer Survivors Following the 2016 Opioid Prescribing Guideline. JAMA Oncol 2022; 8:1658-1662. [PMID: 36074473 PMCID: PMC9459898 DOI: 10.1001/jamaoncol.2022.3744] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/07/2022] [Indexed: 11/14/2022]
Abstract
Importance The Centers for Disease Control and Prevention (CDC) released an opioid-prescribing guideline in March 2016. Little is known about the guideline's potential effects on childhood cancer survivors, a population at high risk for pain. Objective To examine changes in opioid prescriptions and potential misuse/substance use disorders (SUD) among childhood cancer survivors and peers without cancer following the guideline release. Design, Setting, and Participants In this cohort study using the MarketScan Commercial Claims and Encounters Database, 8969 survivors who completed treatment for hematologic, central nervous system, bone, or gonadal cancers (aged ≤21 years at diagnosis) from 2009 to 2018 and 44 845 age-matched, sex-matched, and region-matched individuals without cancer were identified. With data aggregated based on the quarter-year of survivors' treatment completion, interrupted time series analyses were conducted in this cohort study to estimate the immediate (level) change and change in time trend (trend change) for each outcome after the guideline release, accounting for autocorrelation. Data were analyzed from September 2021 to April 2022. Exposures Release of the CDC opioid-prescribing guideline. Main Outcomes and Measures Outcomes included any opioid prescription and any indicator for potential misuse/SUD within 1 year following completion of treatment. Results This study included 8969 childhood cancer survivors (mean [SD] age, 13.7 [6.2] years old; 3814 [42.5%] female patients) and 44 845 peers without cancer (mean [SD] age, 13.7 [6.2] years old; 19 070 [42.5%] female patients). Before the guideline release, the opioid prescription rate (21.1% vs 7.2%) and rate of potential misuse/SUD (5.6% vs 1.9%) were higher among survivors than peers without cancer. After the guideline release, the trend in opioid prescription rate declined among survivors (trend change, -1.1 percentage points [ppt]; P < .001; 95% CI, -1.5 to -0.7). Survivors also experienced an immediate level decrease (-2.1 ppt; P = .04; 95% CI, -4.2 to -0.1) and a decreasing trend (trend change, -0.4 ppt; P = .009; 95% CI, -0.6 to -0.1) in rate of potential misuse/SUD. Peers without cancer experienced decreasing trends in opioid prescription rate (trend change, -0.3 ppt; P < .001; 95% CI, -0.5 to -0.1) and rate of potential misuse/SUD (trend change, -0.1 ppt; P = .03; 95% CI, -0.1 to -0.01). By 2 years after the guideline release, relative reductions in opioid prescription rate and rate of potential misuse/SUD among survivors were 36.7% and 65.4%, respectively, with peers without cancer experiencing smaller reductions (15.9% and 29.9%). Conclusions and Relevance In this cohort study, the opioid prescription rate and rate of potential misuse/SUD declined among both survivors and peers without cancer following the CDC guideline release, with survivors experiencing greater reductions. More research is needed to understand the guideline's potential effects on access to opioids required for pain control among childhood cancer survivors.
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Affiliation(s)
- Xin Hu
- Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Katharine E. Brock
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Aflac Cancer & Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Karen E. Effinger
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Aflac Cancer & Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Bo Zhang
- Department of Neurology and Institutional Centers for Clinical and Translational Research Biostatistics and Research Design Center, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ilana Graetz
- Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Joseph Lipscomb
- Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Xu Ji
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Aflac Cancer & Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
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Guan Y, Haardörfer R, McBride CM, Lipscomb J, Escoffery C. Factors Associated with Mammography Screening Choices by Women Aged 40-49 at Average Risk. J Womens Health (Larchmt) 2022; 31:1120-1126. [PMID: 35171027 DOI: 10.1089/jwh.2021.0232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/12/2022] Open
Abstract
Background: The U.S. Preventive Services Task Force (USPSTF) does not recommend routine mammogram screening for women aged 40-49 years at average risk for breast cancer. We aimed to assess the extent to which women were following guideline recommendations and to examine whether guideline awareness and other individual-level factors were associated with adherence. Materials and Methods: We surveyed a nationally representative panel of 383 U.S. women aged 40-49 years at low risk for hereditary breast cancer in October 2019. Results: Only 29% of women reported not having initiated screening mammography. Most women (80%) were unaware of the USPSTF screening guideline related to age of initiation and frequency of mammography. Being aware of the recommendation to initiate screening at age 50 increased the odds of not initiating screening (odds ratio [OR] = 6.70, p < 0.001), whereas being older than 45 years (OR = 0.22, p < 0.001) and having a primary care doctor decreased the odds of not initiating screening (OR = 0.25, p < 0.001). Conclusions: Mammogram screening in excess of USPSTF recommendations is prevalent among U.S. women aged 40-49 years. Efforts are needed to increase women's awareness of the rationale for guidelines and the opportunities to discuss with providers whether delaying mammograms is appropriate.
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Affiliation(s)
- Yue Guan
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Regine Haardörfer
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Colleen M McBride
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Joseph Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Cam Escoffery
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Shih YCT, Sabik LM, Stout NK, Halpern MT, Lipscomb J, Ramsey S, Ritzwoller DP. Health Economics Research in Cancer Screening: Research Opportunities, Challenges, and Future Directions. J Natl Cancer Inst Monogr 2022; 2022:42-50. [PMID: 35788368 PMCID: PMC9255920 DOI: 10.1093/jncimonographs/lgac008] [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] [Received: 09/30/2021] [Accepted: 03/03/2022] [Indexed: 01/26/2023] Open
Abstract
Cancer screening has long been considered a worthy public health investment. Health economics offers the theoretical foundation and research methodology to understand the demand- and supply-side factors associated with screening and evaluate screening-related policies and interventions. This article provides an overview of health economic theories and methods related to cancer screening and discusses opportunities for future research. We review 2 academic disciplines most relevant to health economics research in cancer screening: applied microeconomics and decision science. We consider 3 emerging topics: cancer screening policies in national as well as local contexts, "choosing wisely" screening practices, and targeted screening efforts for vulnerable subpopulations. We also discuss the strengths and weaknesses of available data sources and opportunities for methodological research and training. Recommendations to strengthen research infrastructure include developing novel data linkage strategies, increasing access to electronic health records, establishing curriculum and training programs, promoting multidisciplinary collaborations, and enhancing research funding opportunities.
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Affiliation(s)
- Ya-Chen Tina Shih
- Correspondence to: Ya-Chen Tina Shih, PhD, Department of Health Services Research, Unit 1444, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030-4009, USA.
| | - Lindsay M Sabik
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Michael T Halpern
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Joseph Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, and the Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Scott Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Institute, Seattle, WA, USA
| | - Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
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Halpern MT, Lipscomb J, Yabroff KR. Cancer Health Economics Research: The Future Is Now. J Natl Cancer Inst Monogr 2022; 2022:102-106. [PMID: 35788382 DOI: 10.1093/jncimonographs/lgac005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/28/2022] [Indexed: 11/14/2022] Open
Abstract
The goals of the "Future of Cancer Health Economics Research" virtual conference were to identify challenges, gaps, and unmet needs for conducting cancer health economics research; and develop suggestions and ideas to address these challenges and to support the development of this field. The conference involved multiple presentations and panels featuring several key themes, including data limitations and fragmentation; improving research methods; role and impacts of structural and policy factors; and the transdisciplinary nature of this field. The conference also highlighted emerging areas such as communicating results with nonresearchers; balancing data accessibility and data security; emphasizing the needs of trainees; and including health equity as a focus in cancer health economics research. From this conference, it is clear that cancer health economics research can have substantial impacts on how cancer care is delivered and how related health-care policies are developed and implemented. To support further growth and development, this field should continue to welcome individuals from multiple disciplines and enhance opportunities for training in economics and in analytic methods and perspectives from across the social and clinical sciences. Researchers should continue to engage with diverse stakeholders throughout the cancer community, building collaborations and focusing on the goal of improving health and well-being.
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Affiliation(s)
- Michael T Halpern
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Joseph Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
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Doria-Rose VP, Breen N, Brown ML, Feuer EJ, Geiger AM, Kessler L, Lipscomb J, Warren JL, Yabroff KR. A History of Health Economics and Healthcare Delivery Research at the National Cancer Institute. J Natl Cancer Inst Monogr 2022; 2022:21-27. [PMID: 35788380 DOI: 10.1093/jncimonographs/lgac003] [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] [Received: 11/01/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
With increased attention to the financing and structure of healthcare, dramatic increases in the cost of diagnosing and treating cancer, and corresponding disparities in access, the study of healthcare economics and delivery has become increasingly important. The Healthcare Delivery Research Program (HDRP) in the Division of Cancer Control and Population Sciences at the National Cancer Institute (NCI) was formed in 2015 to provide a hub for cancer-related healthcare delivery and economics research. However, the roots of this program trace back much farther, at least to the formation of the NCI Division of Cancer Prevention and Control in 1983. The creation of a division focused on understanding and explaining trends in cancer morbidity and mortality was instrumental in setting the direction of cancer-related healthcare delivery and health economics research over the subsequent decades. In this commentary, we provide a brief history of health economics and healthcare delivery research at NCI, describing the organizational structure and highlighting key initiatives developed by the division, and also briefly discuss future directions. HDRP and its predecessors have supported the growth and evolution of these fields through the funding of grants and contracts; the development of data, tools, and other research resources; and thought leadership including stimulation of research on previously understudied topics. As the availability of new data, methods, and computing capacity to evaluate cancer-related healthcare delivery and economics expand, HDRP aims to continue to support this growth and evolution.
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Affiliation(s)
- V Paul Doria-Rose
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Nancy Breen
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.,Office of Science Policy, Strategic Planning, Analysis, Reporting, and Data, National Institute of Minority Health and Health Disparities, Bethesda, MD, USA
| | - Martin L Brown
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Eric J Feuer
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Ann M Geiger
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Larry Kessler
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Joseph Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Joan L Warren
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - K Robin Yabroff
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
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12
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Hu X, Lipscomb J, Graetz I. The impact of vertical integration of oncologists on cancer outcomes and healthcare costs among metastatic prostate cancer patients. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18786] [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
e18786 Background: The share of oncology practices that were vertically integrated with hospitals more than doubled in the past decade. Vertical integration leads to higher spending, but evidence on quality and outcomes remains inconclusive. This study examines how integration between hospitals and oncologists affects patient outcomes and spending among patients with metastatic prostate cancer. Methods: Using the SEER-Medicare linkage with the Medicare Data on Provider Practice and Specialty file, we identified Medicare beneficiaries diagnosed with metastatic, castration-resistant prostate cancer who initiated chemotherapy between 2008-2017 (n = 9,167). We used a claims-based approach to identify treating oncologists and their integration status (as indexed by percent of total services billed to hospital outpatient departments). Outcomes included: 1) time on chemotherapy, 2) survival from chemotherapy initiation, 3) supportive care use (i.e. bone-modifying agents [BMA]), 4) Medicare payment for the first 3 months of chemotherapy initiation and last 3 months before end of life (EOL). The differences-in-differences approach was used to compare patient outcomes before and after oncologists became integrated versus those whose oncologists remained non-integrated or always integrated. Weibull survival and linear models were used for regression analysis, adjusting for sociodemographic, clinical, and market characteristics. Results: The proportion of patients treated by integrated oncologists increased from 28% in 2008 to 55% in 2017. Vertical integration was associated with 13.6 percentage points increase (95% CI = 6.1 to 21.1) in the likelihood of BMA use, but no significant changes for time on chemotherapy and survival. Average Medicare spending in the first 3 months of chemotherapy initiation and last 3 months of EOL was $34,324 and $42,624, respectively. Vertical integration did not have a significant effect on overall spending. Further decomposition showed decreases in professional service costs (-$4,264, 95% CI = -$6,642 to -$1,887) along with an increase in outpatient care costs ($3,941, 95% CI = $159 to $7,723) for the first 3 months of chemotherapy. A similar pattern was found for spending in the last 3 months of EOL. Conclusions: Vertical integration of oncologists was associated with increased use of supportive care, but not time on chemotherapy or survival among metastatic prostate cancer patients. Although oncologists switched service billing from physician offices to hospital outpatient departments, we did not detect significant increases in total Medicare spending after vertical integration. This suggests the potential for quality improvement following vertical integration without substantial increases in healthcare spending. Future studies should extend the investigation to other cancer types and patient outcomes.
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Affiliation(s)
- Xin Hu
- Emory University, Rollins School of Public Health, Atlanta, GA
| | - Joseph Lipscomb
- Emory University Rollins School of Public Health, Winship Cancer Institute, Atlanta, GA
| | - Ilana Graetz
- Emory University, Rollins School of Public Health, Atlanta, GA
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13
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Ji X, Hu X, Brock KE, Effinger KE, Zhang B, Lipscomb J. Changes in opioid prescription, potential misuse, and substance use disorder in pediatric cancer survivors following the 2016 CDC opioid prescribing guideline. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.6506] [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
6506 Background: The 2016 Centers for Disease Control and Prevention (CDC) guideline for prescribing opioids, despite not being intended for cancer-related pain, has been shown to be associated with declines in opioid prescriptions among adults with cancer. We examine the changes in opioid prescription, potential misuse, and substance use disorder (SUD) following the guideline release among pediatric cancer survivors, a population at high risk for chronic pain. Methods: Using nationwide private insurance claims data, we identified survivors (aged ≤21 years at cancer diagnosis) who completed treatment for leukemia, lymphoma, central nervous system, bone, or gonadal cancers in 2009-2018 (N=8,969). We also identified enrollees without cancer who were matched based on age, gender, and region as a control group (N=44,845). Outcomes included (1) any opioid prescription and (2) any indicator for potential misuse or SUD within 1-year post-therapy. We conducted interrupted time series analysis, where time period was assessed by quarters based on the quarter-year of patients’ therapy completion. Segmented linear regression was conducted to estimate the immediate change (“level” change) and the change in the time trend (“slope” change) in each outcome after the guideline release in March 2016, accounting for autocorrelation. Results: Before the guideline release, opioid prescription rate (21.1% vs. 7.2%) and rate of potential misuse or SUD (5.6% vs. 1.9%) were higher among survivors than controls ( p<0.05). Post guideline release, we found a declining trend in opioid prescription rate among survivors (slope change = -1.0 percentage point [ppt]; p<0.001). Survivors also experienced an immediate level decrease (-2.0 ppt; p=0.040) and a decreasing trend (slope change = -0.4 ppt; p=0.004) in the rate of potential misuse or SUD. Among controls, there were decreasing trends in opioid prescription rate (slope change = -0.3 ppt; p<0.001) and rate of potential misuse or SUD (slope change = -0.1 ppt; p=0.042). By three years post guideline release, relative reductions in opioid prescription rate and rate of potential misuse or SUD were 51.8% and 76.0%, respectively, among survivors ( p<0.05), with controls experiencing smaller relative reductions (29.4% and 36.5%; p<0.05). Conclusions: Following the release of the CDC opioid prescribing guideline in March 2016, there were reductions in opioid prescription rate and rate of potential opioid misuse or SUD among both pediatric cancer survivors and controls, with survivors experiencing greater reductions.
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Affiliation(s)
- Xu Ji
- Emory University and Children's Healthcare of Atlanta, Atlanta, GA
| | - Xin Hu
- Emory University, Rollins School of Public Health, Atlanta, GA
| | | | | | - Bo Zhang
- Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Joseph Lipscomb
- Emory University, Rollins School of Public Health, Atlanta, GA
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Celtik K, Wallis CJD, Lo M, Lim K, Lipscomb J, Fleming S, Wu XC, Anderson RT, Thompson TD, Farach A, Hamilton AS, Miles BJ, Satkunasivam R. Localized prostate cancer: An analysis of the CDC Breast and Prostate Cancer Data Quality and Patterns of Care study (CDC PoC-BP). Can Urol Assoc J 2022; 16:E391-E398. [PMID: 35230935 DOI: 10.5489/cuaj.7580] [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: 11/19/2022]
Abstract
INTRODUCTION Limited evidence exists on the comparative effectiveness of local treatments for prostate cancer (PCa) due to the lack of generalizability. Using granular national data, we sought to examine the association between radical prostatectomy (RP) and intensity-modulated radiation therapy (IMRT) treatment and survival. METHODS Records were abstracted for localized PCa cases diagnosed in 2004 across seven state registries to identify patients undergoing RP (n=3019) or IMRT (n=667). Comorbidity was assessed by the Adult Comorbidity Evaluation-27 (ACE-27). Propensity score matching (PSM) was used to balance covariates between treatment groups. All-cause and PCa-specific mortality were primary endpoints. A subgroup analysis of patients with high-risk PCa (RP, n=89; IMRT, n=95) was conducted. RESULTS Following PSM, matched patients (n=502 pairs) treated with either RP or IMRT were well-balanced with respect to covariates. With a median followup of 10.5 years (interquartile range [IQR] 9.9-11.0), the 11-year overall survival (OS) was 71.2% (95% confidence interval [CI] 66.9-75.8) for RP and 62.3% (95% CI 57.4-67.6) for IMRT. IMRT was associated with a 41% increased risk of all-cause mortality (hazard ratio [HR] 1.41, 95% CI 1.13-1.76) but not PCa-specific mortality (HR 1.75, 95% CI 0.84-3.64), as compared to RP. In patients with high-risk PCa, IMRT, as compared to RP, was not associated with statistically significant difference in all-cause (HR 1.53, 95% CI 0.97-2.42) or PCa-specific mortality (HR 1.92, 95% CI 0.69-5.36). CONCLUSIONS Despite a low mortality rate at 10 years and possible residual confounding, we found a significantly increased risk of all-cause mortality, but no PCa-specific mortality associated with IMRT as compared to RP in this population-based study.
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Affiliation(s)
- Kenan Celtik
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
| | | | - Mary Lo
- Department of Preventive Medicine, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Kelvin Lim
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
| | - Joseph Lipscomb
- Rollins School of Public Health and Winship Cancer Institute, Emory University, Atlanta, GA, United States
| | - Steven Fleming
- University of Kentucky College of Public Health, Lexington, KY, United States
| | - Xiao-Cheng Wu
- Louisiana Tumor Registry, LSU Health Science Center, New Orleans, LA, United States
| | - Roger T Anderson
- Department of Public Health Sciences, UVA Cancer Center, University of Virginia, Charlottesville, VA, United States
| | - Trevor D Thompson
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Andrew Farach
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, United States
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Brian J Miles
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
| | - Raj Satkunasivam
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States.,Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States
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15
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Lipscomb J, Horton S, Kuo A, Tomasetti C. Evaluating the impact of multicancer early detection testing on health and economic outcomes: Toward a decision modeling strategy. Cancer 2022; 128 Suppl 4:892-908. [PMID: 35133662 DOI: 10.1002/cncr.33980] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 12/19/2022]
Abstract
Emerging data provide initial support for the concept that a single, minimally invasive liquid biopsy test, performed in conjunction with confirmatory radiologic or other diagnostic testing, when indicated, could be deployed on a broad scale to screen individuals for multiple types of cancer. Ideally, such a test could do this in a way that yields a clinically important percentage of true-positive indications of cancer while minimizing false-positive signals. Modern decision modeling approaches can and should be deployed to investigate the health and economic consequences of such multicancer early detection (MCED) testing within defined at-risk populations. In this paper, through small-scale analyses involving 3 hypothetical MCED-detectible cancers, the authors illustrate the potential for MCED testing to be cost-effective, along with the pivotal role of test-induced stage shift on results. The time is ripe for additional, prospective investigations of the clinical value of MCED testing, the benefits versus the risks for screened populations, and the overall projected impact on health outcomes and costs over time.
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Affiliation(s)
- Joseph Lipscomb
- Rollins School of Public Health, Emory University, Atlanta, Georgia.,Cancer Prevention and Control Program, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Susan Horton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Albert Kuo
- Division of Biostatistics and Bioinformatics, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Cristian Tomasetti
- Division of Biostatistics and Bioinformatics, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Gillespie TW, Mincey L, Liu Y, Ballard D, Scott KW, Knott R, Nguyen MLT, Chawla S, Lipscomb J, Wells JH. Abstract PO-024: Survivorship care plan for cancer prevention and screening for people living with HIV (PLWH). Cancer Epidemiol Biomarkers Prev 2022. [DOI: 10.1158/1538-7755.disp21-po-024] [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: 11/16/2022] Open
Abstract
Abstract
BACKGROUND. Over 1.2 million people living with HIV (PLWH) in the US are aging, many with the chance for normal or near-nomal life expectancy. Yet PLWH are at significantly increased risk for non-AIDS associated cancers due to immunocompromise, antiretroviral medications, lifestyle factors, and social determinants of health issues. HIV disproportionately affects Blacks, those from lower socioeconomic status, the uninsured, and the Southern US. Outcomes from PLWH diagnosed wtih cancer are consistently worse compared to those who are HIV negative, even when diagnosed at the same stage. However, PLWH are often unaware of their higher risk status and are infrequently referred for cancer prevention or screening by providers, despite these disparities in screening and outcomes. METHODS: To explore reasons why PLWH did not engage in cancer prevention or screening activities, we partnered with urban and rural community clinics with a mixed methods study design, including a quantitative survey and focus groups. RESULTS: In our sample (N=178), 90.4% Black, 57% female, significant differences were found between rural and urban settings related to guideline-concordant uptake of cancer screening and prevention. Only 37% subjects overall reported participating in regular cancer screening. Among women over 50 years who met criteria for breast cancer screening, 100% of women in the rural setting were screened while 55% of eligible women in the urban community received breast cancer screening (p=0.009). Participants from both settings demonstrated gaps in knowledge of their own cancer risk or need to pursue screening. Urban participants were more likely than rural to strongly disagree wtih the statement that HIV+ individuals are at higher risk for cancer (p<0.001). Qualitative data indicated the main reason why PLWH did not participate in prevention or screening activities was because participants were seldom referred for screening by their HIV clinic provider or informed of their risk status. Other qualitative data themes were shock and surprise at learning of their increased risk, or how certain behaviors might reduce cancer risk. DISCUSSION: Upon reviewing results with community partners, the suggestion was made that an HIV Survivorship Care Plan, similar to a Cancer Survivor Care Plan, be developed that could be part of the medical record. The HIV Survivorship Care Plan would incorporate cancer and other chronic disease screening, prevention interventions, and surveillance that would be important for aging PLWH to ensure both patients and providers adhered to evidence-based practices. CONCLUSIONS: PLWH are at increased risk for cancer incidence and mortality as they age, yet are often overlooked as a high-risk population that could greatly benefit from prevention and screening.The application of an HIV Survivorship Care Plan intervention is a novel approach to reduce disparities and improve quality of care and outcomes for PLWH. The tool will be tested and evaluated through additional community-engaged partnerships targeting PLWH.
Citation Format: Theresa W. Gillespie, Loree Mincey, Yuan Liu, Denise Ballard, Kimberly W. Scott, Robert Knott, Minh Ly T. Nguyen, Saurabh Chawla, Joseph Lipscomb, Jessica H. Wells. Survivorship care plan for cancer prevention and screening for people living with HIV (PLWH) [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-024.
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17
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Schwartz CE, Rohde G, Biletch E, Stuart RBB, Huang IC, Lipscomb J, Stark RB, Skolasky RL. If it's information, it's not "bias": a scoping review and proposed nomenclature for future response-shift research. Qual Life Res 2021; 31:2247-2257. [PMID: 34705159 DOI: 10.1007/s11136-021-03023-9] [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] [Accepted: 10/15/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The growth in response-shift methods has enabled a stronger empirical foundation to investigate response-shift phenomena in quality-of-life (QOL) research; but many of these methods utilize certain language in framing the research question(s) and interpreting results that treats response-shift effects as "bias," "noise," "nuisance," or otherwise warranting removal from the results rather than as information that matters. The present project will describe the various ways in which researchers have framed the questions for investigating response-shift issues and interpreted the findings, and will develop a nomenclature for such that highlights the important information about resilience reflected by response-shift findings. METHODS A scoping review was done of the QOL and response-shift literature (n = 1100 articles) from 1963 to 2020. After culling only empirical response-shift articles, raters characterized how investigators framed and interpreted study research questions (n = 164 articles). RESULTS Of 10 methods used, papers using four of them utilized terms like "bias" and aimed to remove response-shift effects to reveal "true change." Yet, the investigators' reflections on their own conclusions suggested that they do not truly believe that response shift is error to be removed. A structured nomenclature is proposed for discussing response-shift results in a range of research contexts and response-shift detection methods. CONCLUSIONS It is time for a concerted and focused effort to change the nomenclature of those methods that demonstrated this misinterpretation. Only by framing and interpreting response shift as information, not bias, can we improve our understanding and methods to help to distill outcomes with and without response-shift effects.
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Affiliation(s)
- Carolyn E Schwartz
- DeltaQuest Foundation, Inc., 31 Mitchell Road, Concord, MA, 01742, USA. .,Departments of Medicine and Orthopaedic Surgery, Tufts University Medical School, Boston, MA, USA.
| | - Gudrun Rohde
- Department of Clincal Research Sorlandet Hospital, Faculty of Health and Sport Sciences at University of Agder, Kristiansand, Norway
| | - Elijah Biletch
- DeltaQuest Foundation, Inc., 31 Mitchell Road, Concord, MA, 01742, USA
| | | | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Joseph Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, and the Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Roland B Stark
- DeltaQuest Foundation, Inc., 31 Mitchell Road, Concord, MA, 01742, USA
| | - Richard L Skolasky
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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18
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Shih YCT, Lipscomb J. Addressing Cancer Financial Hardship Begins With Comprehensive Assessment of Patient Economic Burden. J Natl Cancer Inst 2021; 113:1606-1607. [PMID: 34698844 PMCID: PMC8634529 DOI: 10.1093/jnci/djab193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 12/15/2022] Open
Affiliation(s)
- Ya-Chen Tina Shih
- Section of Cancer Economics and Policy, Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA,Correspondence to: Ya-Chen Tina Shih, PhD, Section of Cancer Economics and Policy, Department of Health Services Research, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1444, Houston, TX 77030, USA (e-mail: )
| | - Joseph Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, and the Winship Cancer Institute, Emory University, Atlanta, GA, USA
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19
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Collin LJ, Yan M, Jiang R, Gogineni K, Subhedar P, Ward KC, Switchenko JM, Lipscomb J, Miller-Kleinhenz J, Torres M, Lin J, McCullough LE. Receipt of Guideline-Concordant Care Does Not Explain Breast Cancer Mortality Disparities by Race in Metropolitan Atlanta. J Natl Compr Canc Netw 2021; 19:1242-1251. [PMID: 34399407 PMCID: PMC8847540 DOI: 10.6004/jnccn.2020.7694] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 12/02/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Racial disparities in breast cancer mortality in the United States are well documented. Non-Hispanic Black (NHB) women are more likely to die of their disease than their non-Hispanic White (NHW) counterparts. The disparity is most pronounced among women diagnosed with prognostically favorable tumors, which may result in part from variations in their receipt of guideline care. In this study, we sought to estimate the effect of guideline-concordant care (GCC) on prognosis, and to evaluate whether receipt of GCC modified racial disparities in breast cancer mortality. PATIENTS AND METHODS Using the Georgia Cancer Registry, we identified 2,784 NHB and 4,262 NHW women diagnosed with a stage I-III first primary breast cancer in the metropolitan Atlanta area, Georgia, between 2010 and 2014. Women were included if they received surgery and information on their breast tumor characteristics was available; all others were excluded. Receipt of recommended therapies (chemotherapy, radiotherapy, endocrine therapy, and anti-HER2 therapy) as indicated was considered GCC. We used Cox proportional hazards models to estimate the impact of receiving GCC on breast cancer mortality overall and by race, with multivariable adjusted hazard ratios (HRs). RESULTS We found that NHB and NHW women were almost equally likely to receive GCC (65% vs 63%, respectively). Failure to receive GCC was associated with an increase in the hazard of breast cancer mortality (HR, 1.74; 95% CI, 1.37-2.20). However, racial disparities in breast cancer mortality persisted despite whether GCC was received (HRGCC: 2.17 [95% CI, 1.61-2.92]; HRnon-GCC: 1.81 [95% CI, 1.28-2.91] ). CONCLUSIONS Although receipt of GCC is important for breast cancer outcomes, racial disparities in breast cancer mortality did not diminish with receipt of GCC; differences in mortality between Black and White patients persisted across the strata of GCC.
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Affiliation(s)
- Lindsay J. Collin
- Department of Epidemiology; Rollins School of Public Health, Emory University; Atlanta, GA, 30322, USA,Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112
| | - Ming Yan
- Department of Epidemiology; Rollins School of Public Health, Emory University; Atlanta, GA, 30322, USA
| | - Renjian Jiang
- Department of Epidemiology; Rollins School of Public Health, Emory University; Atlanta, GA, 30322, USA,Winship Cancer Institute of Emory University
| | - Keerthi Gogineni
- Winship Cancer Institute of Emory University,Emory University School of Medicine; Atlanta, GA, 30322, USA
| | - Preeti Subhedar
- Winship Cancer Institute of Emory University,Emory University School of Medicine; Atlanta, GA, 30322, USA
| | - Kevin C. Ward
- Department of Epidemiology; Rollins School of Public Health, Emory University; Atlanta, GA, 30322, USA,Winship Cancer Institute of Emory University
| | - Jeffrey M. Switchenko
- Winship Cancer Institute of Emory University,Department of Biostatistics and Bioinformatics; Rollins School of Public Health; Emory University; Atlanta, GA, 30322, USA
| | - Joseph Lipscomb
- Winship Cancer Institute of Emory University,Department of Health Policy and Management; Rollins School of Public Health, Emory University; Atlanta, GA, 30322, USA
| | - Jasmine Miller-Kleinhenz
- Department of Epidemiology; Rollins School of Public Health, Emory University; Atlanta, GA, 30322, USA
| | - Mylin Torres
- Winship Cancer Institute of Emory University,Emory University School of Medicine; Atlanta, GA, 30322, USA
| | - Jolinta Lin
- Winship Cancer Institute of Emory University,Emory University School of Medicine; Atlanta, GA, 30322, USA
| | - Lauren E. McCullough
- Department of Epidemiology; Rollins School of Public Health, Emory University; Atlanta, GA, 30322, USA,Winship Cancer Institute of Emory University
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20
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Halpern MT, Shih YCT, Yabroff KR, Ekwueme DU, Bradley CJ, Davidoff AJ, Sabik LM, Lipscomb J. A framework for cancer health economics research. Cancer 2020; 127:994-996. [PMID: 33237590 DOI: 10.1002/cncr.33343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 09/30/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 11/05/2022]
Abstract
LAY SUMMARY Cancer has substantial economic impacts for patients, their families and/or caregivers, employers, and the health care system. However, there is only limited understanding of how economic issues can affect access to cancer care services and the receipt of high-quality cancer care. Health economics research in cancer is particularly timely due to the large and increasing number of patients with cancer and cancer survivors, but there are many factors that may create barriers to performing cancer health economics research. This commentary has identified important topics and questions in cancer health economics research and will assist in the development of this critical field.
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Affiliation(s)
- Michael T Halpern
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, Maryland
| | - Ya-Chen Tina Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - K Robin Yabroff
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Donatus U Ekwueme
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cathy J Bradley
- Population Health Sciences, University of Colorado Cancer Center, University of Colorado, Aurora, Colorado
| | - Amy J Davidoff
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, School of Medicine, Yale University, New Haven, Connecticut
| | - Lindsay M Sabik
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Joseph Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, Georgia
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Lipscomb J, Switchenko JM, Flowers CR, Gillespie TW, Wortley PM, Bayakly AR, Almon L, Fernando R, Ward KC. Biologic, clinical, and sociodemographic predictors of multi-agent systemic therapy for non-Hodgkin lymphoma in people living with HIV: a population-based investigation in the state of Georgia. Leuk Lymphoma 2020; 61:896-904. [PMID: 31852329 PMCID: PMC7082188 DOI: 10.1080/10428194.2019.1702176] [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: 06/03/2019] [Revised: 11/15/2019] [Accepted: 11/29/2019] [Indexed: 02/07/2023]
Abstract
We conducted a population-based study of biologic, clinical, and sociodemographic factors associated with receipt of multi-agent systemic therapy (MAST) by people living with HIV (PLWH) who were diagnosed with non-Hodgkin lymphoma (NHL). Building on recent registry-based analyses, we linked records from the Georgia Cancer Registry, Georgia HIV/AIDS Surveillance Registry, and the Georgia Hospital Discharge Database to identify 328 PLWH adults (age ≥ 18) diagnosed with NHL within 2004-2012. Through logistic regression modeling, we examined factors associated with patients receiving MAST for NHL. Robust predictors included CD4 count ≥200 cells/mm3 around the time of cancer diagnosis, an advanced stage (III or IV) diagnosis of NHL, MSM HIV transmission, and having private health insurance. The strongest single predictor of MAST was CD4 count. Because there is now guideline-integrated evidence that PLWH receiving standard-of-care cancer therapy can achieve substantially improved outcomes, it is vital they have access to regimens routinely provided to HIV-negative cancer patients.
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Affiliation(s)
- Joseph Lipscomb
- Department of Health Policy and Management, Rollins School
of Public Health, Emory University, Atlanta GA
- Winship Cancer Institute of Emory University
| | - Jeffrey M. Switchenko
- Winship Cancer Institute of Emory University
- Department of Biostatistics & Bioinformatics, Rollins
School of Public Health
| | | | - Theresa W. Gillespie
- Winship Cancer Institute of Emory University
- Department of Surgical Oncology, Emory University School of
Medicine
- Department of Hematology & Medical Oncology, Emory
University School of Medicine
| | | | | | - Lyn Almon
- Georgia Center for Cancer Statistics, Rollins School of
Public Health
| | - Robyn Fernando
- Department of Epidemiology, Rollins School of Public
Health
| | - Kevin C. Ward
- Winship Cancer Institute of Emory University
- Georgia Center for Cancer Statistics, Rollins School of
Public Health
- Department of Epidemiology, Rollins School of Public
Health
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22
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Lipscomb J, Escoffery C, Gillespie TW, Henley SJ, Smith RA, Chociemski T, Almon L, Jiang R, Sheng X, Goodman M, Ward KC. Improving Screening Uptake among Breast Cancer Survivors and Their First-Degree Relatives at Elevated Risk to Breast Cancer: Results and Implications of a Randomized Study in the State of Georgia. Int J Environ Res Public Health 2020; 17:ijerph17030977. [PMID: 32033227 PMCID: PMC7037204 DOI: 10.3390/ijerph17030977] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/20/2020] [Accepted: 01/24/2020] [Indexed: 11/24/2022]
Abstract
Women diagnosed with breast cancer at a relatively early age (≤45 years) or with bilateral disease at any age are at elevated risk for additional breast cancer, as are their female first-degree relatives (FDRs). We report on a randomized trial to increase adherence to mammography screening guidelines among survivors and FDRs. From the Georgia Cancer Registry, breast cancer survivors diagnosed during 2000–2009 at six Georgia cancer centers underwent phone interviews about their breast cancer screening behaviors and their FDRs. Nonadherent survivors and FDRs meeting all inclusion criteria were randomized to high-intensity (evidence-based brochure, phone counseling, mailed reminders, and communications with primary care providers) or low-intensity interventions (brochure only). Three and 12-month follow-up questionnaires were completed. Data analyses used standard statistical approaches. Among 1055 survivors and 287 FDRs who were located, contacted, and agreed to participate, 59.5% and 62.7%, respectively, reported breast cancer screening in the past 12 months and were thus ineligible. For survivors enrolled at baseline (N = 95), the proportion reporting adherence to guideline screening by 12 months post-enrollment was similar in the high and low-intensity arms (66.7% vs. 79.2%, p = 0.31). Among FDRs enrolled at baseline (N = 83), screening was significantly higher in the high-intensity arm at 12 months (60.9% vs. 32.4%, p = 0.03). Overall, about 72% of study-eligible survivors (all of whom were screening nonadherent at baseline) reported screening within 12 months of study enrollment. For enrolled FDRs receiving the high-intensity intervention, over 60% reported guideline screening by 12 months. A major conclusion is that using high-quality central cancer registries to identify high-risk breast cancer survivors and then working closely with these survivors to identify their FDRs represents a feasible and effective strategy to promote guideline cancer screening.
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Affiliation(s)
- Joseph Lipscomb
- Rollins School of Public Health, Emory University; Atlanta, GA 30322, USA; (C.E.); (R.A.S.); (T.C.); (L.A.); (R.J.); (X.S.); (M.G.); (K.C.W.)
- Winship Cancer Institute of Emory University; Atlanta, GA 30322, USA;
- Correspondence: ; Tel.: +404-727-4513; Fax: +404-727-9198
| | - Cam Escoffery
- Rollins School of Public Health, Emory University; Atlanta, GA 30322, USA; (C.E.); (R.A.S.); (T.C.); (L.A.); (R.J.); (X.S.); (M.G.); (K.C.W.)
- Winship Cancer Institute of Emory University; Atlanta, GA 30322, USA;
| | - Theresa W. Gillespie
- Winship Cancer Institute of Emory University; Atlanta, GA 30322, USA;
- Department of Surgery and Department of Hematology and Medical Oncology, Emory University School of Medicine; Atlanta, GA 30322, USA
| | - S. Jane Henley
- Division of Cancer Prevention and Control, U.S. Centers for Disease Control and Prevention; Atlanta, GA 30341, USA;
| | - Robert A. Smith
- Rollins School of Public Health, Emory University; Atlanta, GA 30322, USA; (C.E.); (R.A.S.); (T.C.); (L.A.); (R.J.); (X.S.); (M.G.); (K.C.W.)
- Cancer Control Program, American Cancer Society; Atlanta, GA 30303, USA
| | - Toni Chociemski
- Rollins School of Public Health, Emory University; Atlanta, GA 30322, USA; (C.E.); (R.A.S.); (T.C.); (L.A.); (R.J.); (X.S.); (M.G.); (K.C.W.)
| | - Lyn Almon
- Rollins School of Public Health, Emory University; Atlanta, GA 30322, USA; (C.E.); (R.A.S.); (T.C.); (L.A.); (R.J.); (X.S.); (M.G.); (K.C.W.)
| | - Renjian Jiang
- Rollins School of Public Health, Emory University; Atlanta, GA 30322, USA; (C.E.); (R.A.S.); (T.C.); (L.A.); (R.J.); (X.S.); (M.G.); (K.C.W.)
| | - Xi Sheng
- Rollins School of Public Health, Emory University; Atlanta, GA 30322, USA; (C.E.); (R.A.S.); (T.C.); (L.A.); (R.J.); (X.S.); (M.G.); (K.C.W.)
| | - Michael Goodman
- Rollins School of Public Health, Emory University; Atlanta, GA 30322, USA; (C.E.); (R.A.S.); (T.C.); (L.A.); (R.J.); (X.S.); (M.G.); (K.C.W.)
- Winship Cancer Institute of Emory University; Atlanta, GA 30322, USA;
| | - Kevin C. Ward
- Rollins School of Public Health, Emory University; Atlanta, GA 30322, USA; (C.E.); (R.A.S.); (T.C.); (L.A.); (R.J.); (X.S.); (M.G.); (K.C.W.)
- Winship Cancer Institute of Emory University; Atlanta, GA 30322, USA;
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Johnson J, Anderson D, Li J, Santos Tino A, Politch J, Lipscomb J, Defelice J, Gelman M, Mayer K. HIV particles expressed in semen under INSTI-based suppressive therapy are largely myeloid cell-derived and exhibit widely diverse genotypes. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30172-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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24
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Smith TG, Troeschel AN, Castro KM, Arora NK, Stein K, Lipscomb J, Brawley OW, McCabe RM, Clauser SB, Ward E. Perceptions of Patients With Breast and Colon Cancer of the Management of Cancer-Related Pain, Fatigue, and Emotional Distress in Community Oncology. J Clin Oncol 2019; 37:1666-1676. [PMID: 31100037 PMCID: PMC6804889 DOI: 10.1200/jco.18.01579] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [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] [Accepted: 04/02/2019] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Pain, fatigue, and distress are common among patients with cancer but are often underassessed and undertreated. We examine the prevalence of pain, fatigue, and emotional distress among patients with cancer, as well as patient perceptions of the symptom care they received. PATIENTS AND METHODS Seventeen Commission on Cancer-accredited cancer centers across the United States sampled patients with local/regional breast (82%) or colon (18%) cancer. We received 2,487 completed surveys (61% response rate). RESULTS Of patients, 76%, 78%, and 59% reported talking to a clinician about pain, fatigue, and distress, respectively, and 70%, 61%, and 54% reported receiving advice. Sixty-one percent of patients experienced pain, 74% fatigue, and 46% distress. Among those patients experiencing each symptom, 58% reported getting the help they wanted for pain, 40% for fatigue, and 45% for distress. Multilevel logistic regression models revealed that patients experiencing symptoms were significantly more likely to have talked about and received advice on coping with these symptoms. In addition, patients who were receiving or recently completed curative treatment reported more symptoms and better symptom care than did those who were further in time from curative treatment. CONCLUSION In our sample, 30% to 50% of patients with cancer in community cancer centers did not report discussing, getting advice, or receiving desired help for pain, fatigue, or emotional distress. This finding suggests that there is room for improvement in the management of these three common cancer-related symptoms. Higher proportions of talk and advice among those experiencing symptoms imply that many discussions may be patient initiated. Lower rates of talk and advice among those who are further in time from treatment suggest the need for more assessment among longer-term survivors, many of whom continue to experience these symptoms. These findings seem to be especially important given the high prevalence of these symptoms in our sample.
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Affiliation(s)
| | | | | | - Neeraj K. Arora
- Patient‐Centered Outcomes Research Institute, Washington, DC
| | - Kevin Stein
- Emory University, Atlanta, GA
- Cancer Support Community, Washington, DC
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25
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Gamboa AC, Zaidi MY, Lee RM, Speegle S, Switchenko JM, Lipscomb J, Cloyd JM, Ahmed A, Grotz T, Leiting J, Fournier K, Lee AJ, Dineen S, Powers BD, Lowy AM, Kotha NV, Clarke C, Gamblin TC, Patel SH, Lee TC, Lambert L, Hendrix RJ, Abbott DE, Vande Walle K, Lafaro K, Lee B, Johnston FM, Greer J, Russell MC, Staley CA, Maithel SK. Optimal Surveillance Frequency After CRS/HIPEC for Appendiceal and Colorectal Neoplasms: A Multi-institutional Analysis of the US HIPEC Collaborative. Ann Surg Oncol 2019; 27:134-146. [PMID: 31243668 DOI: 10.1245/s10434-019-07526-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND No guidelines exist for surveillance following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for appendiceal and colorectal cancer. The primary objective was to define the optimal surveillance frequency after CRS/HIPEC. METHODS The U.S. HIPEC Collaborative database (2000-2017) was reviewed for patients who underwent a CCR0/1 CRS/HIPEC for appendiceal or colorectal cancer. Radiologic surveillance frequency was divided into two categories: low-frequency surveillance (LFS) at q6-12mos or high-frequency surveillance (HFS) at q2-4mos. Primary outcome was overall survival (OS). RESULTS Among 975 patients, the median age was 55 year, 41% were male: 31% had non-invasive appendiceal (n = 301), 45% invasive appendiceal (n = 435), and 24% colorectal cancer (CRC; n = 239). With a median follow-up time of 25 mos, the median time to recurrence was 12 mos. Despite less surveillance, LFS patients had no decrease in median OS (non-invasive appendiceal: 106 vs. 65 mos, p < 0.01; invasive appendiceal: 120 vs. 73 mos, p = 0.02; colorectal cancer [CRC]: 35 vs. 30 mos, p = 0.8). LFS patients had lower median PCI scores compared with HFS (non-invasive appendiceal: 10 vs. 19; invasive appendiceal: 10 vs. 14; CRC: 8 vs. 11; all p < 0.01). However, on multivariable analysis, accounting for PCI score, LFS was still not associated with decreased OS for any histologic type (non-invasive appendiceal: hazard ratio [HR]: 0.28, p = 0.1; invasive appendiceal: HR: 0.73, p = 0.42; CRC: HR: 1.14, p = 0.59). When estimating annual incident cases of CRS/HIPEC at 375 for non-invasive appendiceal, 375 invasive appendiceal and 4410 colorectal, LFS compared with HFS for the initial two post-operative years would potentially save $13-19 M/year to the U.S. healthcare system. CONCLUSIONS Low-frequency surveillance after CRS/HIPEC for appendiceal or colorectal cancer is not associated with decreased survival, and when considering decreased costs, may optimize resource utilization.
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Affiliation(s)
- Adriana C Gamboa
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Mohammad Y Zaidi
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Rachel M Lee
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Shelby Speegle
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jeffrey M Switchenko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Joseph Lipscomb
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jordan M Cloyd
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ahmed Ahmed
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Travis Grotz
- Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jennifer Leiting
- Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA
| | - Keith Fournier
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew J Lee
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sean Dineen
- Department of Surgery, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | | | - Andrew M Lowy
- Division of Surgical Oncology, Department of Surgery, University of California, San Diego, CA, USA
| | - Nikhil V Kotha
- Division of Surgical Oncology, Department of Surgery, University of California, San Diego, CA, USA
| | - Callisia Clarke
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - T Clark Gamblin
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sameer H Patel
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Tiffany C Lee
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Laura Lambert
- Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Ryan J Hendrix
- Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Daniel E Abbott
- Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Kara Vande Walle
- Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Kelly Lafaro
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Byrne Lee
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | | | - Jonathan Greer
- Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Maria C Russell
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Charles A Staley
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Shishir K Maithel
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
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26
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Moore AH, Trentham-Dietz A, Burns M, Gangnon RE, Greenberg CC, Vanness DJ, Hampton J, Wu XC, Anderson RT, Lipscomb J, Kimmick GG, Cress R, Wilson JF, Sabatino SA, Fleming ST. Obesity and mortality after locoregional breast cancer diagnosis. Breast Cancer Res Treat 2018; 172:647-657. [PMID: 30159788 DOI: 10.1007/s10549-018-4932-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 03/03/2018] [Accepted: 08/20/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE Higher mortality after a breast cancer diagnosis has been observed among women who are obese. We investigated the relationships between body mass index (BMI) and all-cause or breast cancer-specific mortality after a diagnosis of locoregional breast cancer. METHODS Women diagnosed in 2004 with AJCC Stage I, II, or III breast cancer (n = 5394) were identified from a population-based National Program of Cancer Registries (NPCR) patterns of care study (POC-BP) drawing from registries in seven U.S. states. Differences in overall and breast cancer-specific mortality were investigated using Cox proportional hazards regression models adjusting for demographic and clinical covariates, including age- and stage-based subgroup analyses. RESULTS In women 70 or older, higher BMI was associated with lower overall mortality (HR for a 5 kg/m2 difference in BMI = 0.85, 95% CI 0.75-0.95). There was no significant association between BMI and overall mortality for women under 70. BMI was not associated with breast cancer death in the full sample, but among women with Stage I disease; those in the highest BMI category had significantly higher breast cancer mortality (HR for BMI ≥ 35 kg/m2 vs. 18.5-24.9 kg/m2 = 4.74, 95% CI 1.78-12.59). CONCLUSIONS Contrary to our hypothesis, greater BMI was not associated with higher overall mortality. Among older women, BMI was inversely related to overall mortality, with a null association among younger women. Higher BMI was associated with breast cancer mortality among women with Stage I disease, but not among women with more advanced disease.
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Affiliation(s)
- A Holliston Moore
- Department of Population Health Sciences, University of Wisconsin, Madison, WI, USA. .,University of Wisconsin, 307 WARF Building, 610 Walnut St, Madison, WI, 53726, USA. .,Smith Cardiovascular Research Building, University of California San Francisco, 555 Mission Bay Blvd S, Suite 161, San Francisco, CA, 94158, USA.
| | - Amy Trentham-Dietz
- Department of Population Health Sciences, University of Wisconsin, Madison, WI, USA.,University of Wisconsin Paul P. Carbone Comprehensive Cancer Center, Madison, WI, USA
| | - Marguerite Burns
- Department of Population Health Sciences, University of Wisconsin, Madison, WI, USA
| | - Ronald E Gangnon
- Department of Population Health Sciences, University of Wisconsin, Madison, WI, USA.,Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, USA
| | - Caprice C Greenberg
- Department of Surgery, University of Wisconsin, Madison, WI, USA.,University of Wisconsin Paul P. Carbone Comprehensive Cancer Center, Madison, WI, USA
| | - David J Vanness
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA, USA
| | - John Hampton
- University of Wisconsin Paul P. Carbone Comprehensive Cancer Center, Madison, WI, USA
| | - Xiao-Cheng Wu
- Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Roger T Anderson
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Joseph Lipscomb
- Rollins School of Public Health and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | | | - Rosemary Cress
- Public Health Institute, Cancer Registry of Greater California, Sacramento, USA
| | | | | | - Steven T Fleming
- University of Kentucky College of Public Health, Lexington, KY, USA
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27
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Kimmick GG, Li X, Fleming ST, Sabatino SA, Wilson JF, Lipscomb J, Cress R, Bergom C, Anderson RT, Wu XC. Risk of cancer death by comorbidity severity and use of adjuvant chemotherapy among women with locoregional breast cancer. J Geriatr Oncol 2018; 9:214-220. [DOI: 10.1016/j.jgo.2017.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/11/2017] [Accepted: 11/09/2017] [Indexed: 11/28/2022]
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Kim H, Filson C, Joski P, von Esenwein S, Lipscomb J. Association Between Online Information-Seeking and Adherence to Guidelines for Breast and Prostate Cancer Screening. Prev Chronic Dis 2018; 15:E45. [PMID: 29679480 PMCID: PMC5912925 DOI: 10.5888/pcd15.170147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction From 2012 through 2014, the US Preventive Services Task Force (USPSTF) recommended biennial mammography for women aged 50 to 75 and recommended against the prostate specific antigen (PSA) test for men of any age, emphasizing informed decision making for patients. Because of time constraints and other patient health priorities, health care providers often do not discuss benefits and risks associated with cancer screening. We analyzed the association between seeking information online about breast and prostate cancer and undergoing mammography and PSA screening. Methods We assessed guideline concordance in mammogram and PSA screening, according to USPSTF guidelines for those at average risk for disease. We used data on 4,537 survey respondents from the National Cancer Institute’s Health Information National Trends Survey (HINTS) for 2012 through 2014 to assess online information-seeking, defined as whether people searched for cancer-related information online in the past 12 months. We used HINTS data to construct multivariable logistic regression models to isolate the effect of exposure to online information on the incidence of cancer screening. Results After controlling for available covariates, we found no significant association between online information-seeking and guideline-concordant screening for breast or prostate cancer. Significant covariate values suggest that factors related to access to care were significantly associated with conformance to mammography guidelines for women recommended for screening and that physician discussion was significantly associated with nonconformance to guidelines for prostate-specific antigen screening (ie, having a PSA test in spite of the recommendation not to have it). Decomposition of differences between those who sought online information and those who did not indicated that uncontrolled confounders probably had little effect on findings. Conclusion We found little evidence that online information-seeking significantly affected screening for breast or prostate cancer in accordance with USPSTF guidelines among people at average risk.
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Affiliation(s)
- Hankyul Kim
- Rollins School of Public Health,1518 Clifton Rd, NE, Atlanta, GA 30322.
| | - Christopher Filson
- Emory University School of Medicine, Atlanta, Georgia.,Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Peter Joski
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Joseph Lipscomb
- Rollins School of Public Health, Emory University, Atlanta, Georgia.,Winship Cancer Institute of Emory University, Atlanta, Georgia
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29
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Hanlon A, Fleming S, Hamilton AS, Dinan MA, Melloni C, Harrison MR, Khouri M, Wu XC, Wilson JF, Lipscomb J, Cress RD, Anderson RT, Kimmick GG. Androgen deprivation therapy (ADT) and cardiovascular mortality (CVD) in men with early-stage prostate cancer (PC) receiving curative radiation therapy (RT). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.7_suppl.127] [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
127 Background: Combined with RT, ADT is a highly effective and utilized treatment for men with localized PC, but some studies suggest that use of ADT leads to increased CVD. We explored the association between ADT and CVD in men receiving RT for localized PC in the National Program for Cancer Registry’s (NPCR) Breast and Prostate Cancer Patterns of Care (POC) study. Methods: From 7 population-based cancer registries, we constructed a sample of men with localized PC treated with definitive RT, stratified by race/ethnicity. Cases diagnosed in 2004 were followed through 2009. Comorbidity, at or before diagnosis, was quantified using the Adult Comorbidity Evaluation 27; subcategories were combined into CV disease (CVD = myocardial infarction, coronary artery disease, congestive heart failure, arrhythmia), CVD-equivalents (CVE = peripheral artery disease and stroke) and CV-risk factors (CVRF = hypertension, diabetes, obesity). Cause of death was determined from the National Death Index data and linkage with vital statistics data. Rates of CV death, in those receiving RT alone versus RT+ADT, were compared in univariate and multivariable analyses. Results: The sample included 2,413 men with mean age 67.7 years (range 39-94), 54.5% white non-Hispanic, 997 received RT alone and 1,416 received RT+ADT. Five-year CVD was 2.3% with RT alone and 3.4% with RT+ADT. In univariate analysis, the following predicted higher CVD with ADT: age < 60 (OR 1.42, p = 0.04), white (OR 2.06, p = 0.001), divorced/separated/widowed (OR 1.29, p = 0.02), insured by Medicare (OR 1.64, p = 0.04), living in mixed urban-rural area (OR 1.87, p = 0.03), higher education level (OR 1.56, p = 0.05), high socioeconomic status (OR 1.70, p = 0.03), no or mild comorbidity level (OR 2.14, p = 0.05 and OR 1.66, p = 0.02, respectively), low PSA (OR 5.44, p = 0,02), and Gleason score 3 (OR 2.12, p = 0.02). In multivariate analysis, use of ADT did not significantly predict hazard of death from heart disease (HR 1.21, p = 0.28) or PC (HR 0.76, p = 0.34). Conclusions: After controlling for confounding variables, use of ADT was not associated with increased risk of CVD in men receiving radiation as definitive therapy for localized PC.
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Affiliation(s)
| | | | | | | | | | | | | | - Xiao-cheng Wu
- LSU Health Sciences Center School of Public Health, Baton Rouge, LA
| | - J. Frank Wilson
- Medical College of Wisconsin, Department of Radiation Oncology, Milwaukee, WI
| | - Joseph Lipscomb
- Rollins School of Public Health, Winship Cancer Institute, Atlanta, GA
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Arnold SD, Brazauskas R, He N, Li Y, Aplenc R, Jin Z, Hall M, Atsuta Y, Dalal J, Hahn T, Khera N, Bonfim C, Majhail NS, Diaz MA, Freytes CO, Wood WA, Savani BN, Kamble RT, Parsons S, Ahmed I, Sullivan K, Beattie S, Dandoy C, Munker R, Marino S, Bitan M, Abdel-Azim H, Aljurf M, Olsson RF, Joshi S, Buchbinder D, Eckrich MJ, Hashmi S, Lazarus H, Marks DI, Steinberg A, Saad A, Gergis U, Krishnamurti L, Abraham A, Rangarajan HG, Walters M, Lipscomb J, Saber W, Satwani P. Clinical risks and healthcare utilization of hematopoietic cell transplantation for sickle cell disease in the USA using merged databases. Haematologica 2017; 102:1823-1832. [PMID: 28818869 PMCID: PMC5664386 DOI: 10.3324/haematol.2017.169581] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 08/10/2017] [Indexed: 12/11/2022] Open
Abstract
Advances in allogeneic hematopoietic cell transplantation for sickle cell disease have improved outcomes, but there is limited analysis of healthcare utilization in this setting. We hypothesized that, compared to late transplantation, early transplantation (at age <10 years) improves outcomes and decreases healthcare utilization. We performed a retrospective study of children transplanted for sickle cell disease in the USA during 2000-2013 using two large databases. Univariate and Cox models were used to estimate associations of demographics, sickle cell disease severity, and transplant-related variables with mortality and chronic graft-versus-host disease, while Wilcoxon, Kruskal-Wallis, or linear trend tests were applied for the estimates of healthcare utilization. Among 161 patients with a 2-year overall survival rate of 90% (95% confidence interval [CI] 85-95%) mortality was significantly higher in those who underwent late transplantation versus early (hazard ratio (HR) 21, 95% CI 2.8-160.8, P=0.003) and unrelated compared to matched sibling donor transplantation (HR 5.9, 95% CI 1.7-20.2, P=0.005). Chronic graftversus host disease was significantly more frequent among those translanted late (HR 1.9, 95% CI 1.0-3.5, P=0.034) and those who received an unrelated graft (HR 2.5, 95% CI 1.2-5.4; P=0.017). Merged data for 176 patients showed that the median total adjusted transplant cost per patient was $467,747 (range: $344,029-$799,219). Healthcare utilization was lower among recipients of matched sibling donor grafts and those with low severity disease compared to those with other types of donor and disease severity types (P<0.001 and P=0.022, respectively); no association was demonstrated with late transplantation (P=0.775). Among patients with 2-year pre- and post-transplant data (n=41), early transplantation was associated with significant reductions in admissions (P<0.001), length of stay (P<0.001), and cost (P=0.008). Early transplant outcomes need to be studied prospectively in young children without severe disease and an available matched sibling to provide conclusive evidence for the superiority of this approach. Reduced post-transplant healthcare utilization inpatient care indicates that transplantation may provide a sustained decrease in healthcare costs over time.
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Affiliation(s)
| | - Ruta Brazauskas
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Naya He
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Yimei Li
- University of Pennsylvania, Philadelphia, PA, USA
| | | | - Zhezhen Jin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Matt Hall
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan.,Nagoya University Graduate School of Medicine, Japan
| | - Jignesh Dalal
- Rainbow Babies & Children's Hospital, Cleveland, OH, USA
| | - Theresa Hahn
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Nandita Khera
- Department of Hematology/Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Carmem Bonfim
- Hospital de Clinicas-Federal University of Parana, Curitiba, Brazil
| | - Navneet S Majhail
- Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Miguel Angel Diaz
- Department of Hematology/Oncology, Hospital Infantil Universitario Nino Jesus, Madrid, Spain
| | | | - William A Wood
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rammurti T Kamble
- Divsion of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | | | - Ibrahim Ahmed
- Rainbow Babies & Children's Hospital, Cleveland, OH, USA
| | | | | | | | - Reinhold Munker
- Section of Hematology/Oncology, Department of Internal Medicine, Louisiana State University Health Shreveport, LA, USA
| | | | - Menachem Bitan
- Department of Pediatric Hematology/Oncology, Tel-Aviv Sourasky Medical Center, Israel
| | - Hisham Abdel-Azim
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital of Los Angeles, University of Southern California Keck School of Medicine, CA, USA
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riydah, Saudi Arabia
| | - Richard F Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinksa Institutet, Stockholm, Sweden.,Centre for Clinical Research Sormland, Uppsala University, Sweden
| | - Sarita Joshi
- Pediatric Hematology, Oncology and BMT, Nationwide Children's Hospital and Ohio State University Wexner, Columbus, OH, USA
| | - Dave Buchbinder
- Division of Pediatrics Hematology, Children's Hospital of Orange County, Orange, CA, USA
| | | | - Shahrukh Hashmi
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riydah, Saudi Arabia.,Department of Internal Medicine, Mayo Clinic, Minneapolis, MN, USA
| | - Hillard Lazarus
- Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - David I Marks
- Adult Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Amir Steinberg
- Department of Hematology-Oncology, Mount Saini Hospital, New York, NY, USA
| | - Ayman Saad
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Usama Gergis
- Hematologic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, NY, USA
| | | | - Allistair Abraham
- Division of Blood and Marrow Transplantation, Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC, USA
| | - Hemalatha G Rangarajan
- Pediatric Hematology, Oncology and BMT, Nationwide Children's Hospital and Ohio State University Wexner, Columbus, OH, USA
| | - Mark Walters
- Children's Hospital & Research Center Oakland, Oakland, NY, USA
| | - Joseph Lipscomb
- Health Policy and Management, Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Wael Saber
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Prakash Satwani
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
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Rai A, Nastoupil LJ, Williams JN, Lipscomb J, Ward KC, Howard DH, Lee D, Flowers CR. Patterns of use and survival outcomes of positron emission tomography for initial staging in elderly follicular lymphoma patients. Leuk Lymphoma 2017; 58:1570-1580. [PMID: 27830968 PMCID: PMC5726977 DOI: 10.1080/10428194.2016.1253836] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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] [Indexed: 01/24/2023]
Abstract
The role of positron emission tomography (PET) in the initial assessment of follicular lymphoma (FL) has been a topic of debate. We examined the patterns of utilization of PET staging in FL and assessed the association of PET with survival. Using the SEER-Medicare database, we identified 5712 patients diagnosed with first primary FL between 2000 and 2009. Older age, African-American race, poor performance status, B-symptoms and history of anemia were negatively associated with PET staging. Receipt of PET staging was positively associated with treatment at institutions affiliated with research networks and with residence in areas with higher concentrations of nuclear medicine specialists. PET was associated with improved lymphoma-related (HR 0.69, 95% CI: 0.58-0.82) and overall (HR 0.75, 95% CI: 0.68-0.83) survival. Our findings substantiate the use of PET as the standard of care for imaging in FL patients. Further investigation is warranted to identify mechanisms underlying the apparent survival advantage associated with PET staging in FL.
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Affiliation(s)
- Ashish Rai
- Surveillance & Health Services Research Program, American Cancer Society, Atlanta, GA, USA
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | - Joseph Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kevin C. Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - David H. Howard
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Daniel Lee
- Emory University School of Medicine, Atlanta, GA, USA
| | - Christopher R. Flowers
- Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
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Khullar OV, Rajaei MH, Force SD, Binongo JN, Lasanajak Y, Robertson S, Pickens A, Sancheti MS, Lipscomb J, Gillespie TW, Fernandez FG. Pilot Study to Integrate Patient Reported Outcomes After Lung Cancer Operations Into The Society of Thoracic Surgeons Database. Ann Thorac Surg 2017; 104:245-253. [DOI: 10.1016/j.athoracsur.2017.01.110] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 01/26/2017] [Accepted: 01/30/2017] [Indexed: 12/20/2022]
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Mukamel D, Wenzel L, Havrilesky L, Osann K, Ladd H, Walker J, Wright A, Alvarez R, Bristow R, DiSilvestro P, Morgan R, Lipscomb J, Cohn D. Variations in patient preferences over side effects of treatments for ovarian cancer: Baseline results of a randomized controlled clinical trial. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wenzel L, Mukamel D, Osann K, Havrilesky L, Sparks L, Lipscomb J, Wright AA, Walker J, Alvarez R, Van Le L, Robison K, Bristow R, Morgan R, Rimel BJ, Ladd H, Hsieh S, Wahi A, Cohn D. Rationale and study protocol for the Patient-Centered Outcome Aid (PCOA) randomized controlled trial: A personalized decision tool for newly diagnosed ovarian cancer patients. Contemp Clin Trials 2017; 57:29-36. [PMID: 28330753 PMCID: PMC6198815 DOI: 10.1016/j.cct.2017.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/04/2017] [Accepted: 03/13/2017] [Indexed: 01/23/2023]
Affiliation(s)
- L Wenzel
- University of California, Irvine, United States.
| | - D Mukamel
- University of California, Irvine, United States
| | - K Osann
- University of California, Irvine, United States
| | | | - L Sparks
- Chapman University, United States
| | | | - A A Wright
- Dana Farber Cancer Institute, United States
| | - J Walker
- University of Oklahoma, United States
| | - R Alvarez
- Vanderbilt University, United States
| | - L Van Le
- University of North Carolina at Chapel Hill, United States
| | | | - R Bristow
- University of California, Irvine, United States
| | | | | | - H Ladd
- University of California, Irvine, United States
| | - S Hsieh
- University of California, Irvine, United States
| | - A Wahi
- University of California, Irvine, United States
| | - D Cohn
- Ohio State University, United States
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Wenzel LB, Mukamel DB, Osann K, Sparks L, Havrilesky LJ, Wright AA, Walker JL, Robison K, Alvarez RD, Van Le L, Wakabayashi MT, Randall LM, Wahi A, Hsieh S, Lipscomb J, Cohn DE. Shared decision-making in ovarian cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.5549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
5549 Background: The value of shared decision-making in ovarian cancer is relatively unexplored. The goal of this study was to test a new decision aid, Patient Centered Outcome Aid (PCOA), that facilitates shared decision-making and helps ovarian cancer patients assimilate information and identify quality of life (QOL), toxicity and survival trade-offs between IP/IV therapy and IV therapy alone, based on their preferences and personal clinical characteristics. Methods: Participants were randomized to either PCOA (N=64) or usual care (N=59). Patient characteristics, QOL and shared decision-making data were collected at baseline and treatment initiation. Primary outcomes included satisfaction with treatment decision and decisional regret. Comparisons were made using t-tests and multivariate methods, adjusting for patient covariates. Multivariate linear models were used to investigate predictors of the primary outcomes. Results: Although satisfaction and decisional regret did not differ significantly by arm at any time point, the majority of PCOA patients indicated that the aid helped them understand treatment options and side effects. Notably, low shared decision-making and low QOL, were significant predictors of low satisfaction at treatment initiation (multiple r=0.76), six months (multiple r=0.48) and nine months (r=0.58). They were also significant predictors of decisional regret (multiple r=0.48 and 0.36 at 6 and 9 months). Patient covariates including age, stage, treatment and neoadjuvant status were not associated with differences in satisfaction or decisional regret. Conclusions: There were no clinically meaningful differences in satisfaction with the treatment decision, or decisional regret between the study arms. The absence of a difference may reflect the high degree of shared decision-making in both arms and greater disease severity in PCOA patients, who were more likely to report low baseline QOL and declining QOL over time. Both shared decision-making and quality of life were robust, independent predictors of satisfaction with the treatment decision over time. This implies that women who perceive themselves as less engaged in the decision process, and report poor QOL may benefit from a decision aid, in addition to physician counseling. Clinical trial information: NCT02259699.
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Affiliation(s)
| | | | | | | | - Laura Jean Havrilesky
- Division of Gynecologic Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, NC
| | | | - Joan L. Walker
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Katina Robison
- Women and Infants Hospital in Rhode Island, Providence, RI
| | | | - Linda Van Le
- The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Aditi Wahi
- University of California Irvine, Irvine, CA
| | - Susie Hsieh
- University of California, Irvine, Irvine, CA
| | - Joseph Lipscomb
- Rollins School of Public Health, Winship Cancer Institute, Atlanta, GA
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Jackson SL, Safo SE, Staimez LR, Olson DE, Narayan KMV, Long Q, Lipscomb J, Rhee MK, Wilson PWF, Tomolo AM, Phillips LS. Glucose challenge test screening for prediabetes and early diabetes. Diabet Med 2017; 34:716-724. [PMID: 27727467 PMCID: PMC5388592 DOI: 10.1111/dme.13270] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 08/15/2016] [Accepted: 10/06/2016] [Indexed: 12/29/2022]
Abstract
AIMS To test the hypothesis that a 50-g oral glucose challenge test with 1-h glucose measurement would have superior performance compared with other opportunistic screening methods. METHODS In this prospective study in a Veterans Health Administration primary care clinic, the following test performances, measured by area under receiver-operating characteristic curves, were compared: 50-g oral glucose challenge test; random glucose; and HbA1c level, using a 75-g oral glucose tolerance test as the 'gold standard'. RESULTS The study population was comprised of 1535 people (mean age 56 years, BMI 30.3 kg/m2 , 94% men, 74% black). By oral glucose tolerance test criteria, diabetes was present in 10% and high-risk prediabetes was present in 22% of participants. The plasma glucose challenge test provided area under receiver-operating characteristic curves of 0.85 (95% CI 0.78-0.91) to detect diabetes and 0.76 (95% CI 0.72-0.80) to detect high-risk dysglycaemia (diabetes or high-risk prediabetes), while area under receiver-operating characteristic curves for the capillary glucose challenge test were 0.82 (95% CI 0.75-0.89) and 0.73 (95% CI 0.69-0.77) for diabetes and high-risk dysglycaemia, respectively. Random glucose performed less well [plasma: 0.76 (95% CI 0.69-0.82) and 0.66 (95% CI 0.62-0.71), respectively; capillary: 0.72 (95% CI 0.65-0.80) and 0.64 (95% CI 0.59-0.68), respectively], and HbA1c performed even less well [0.67 (95% CI 0.57-0.76) and 0.63 (95% CI 0.58-0.68), respectively]. The cost of identifying one case of high-risk dysglycaemia with a plasma glucose challenge test would be $42 from a Veterans Health Administration perspective, and $55 from a US Medicare perspective. CONCLUSIONS Glucose challenge test screening, followed, if abnormal, by an oral glucose tolerance test, would be convenient and more accurate than other opportunistic tests. Use of glucose challenge test screening could improve management by permitting earlier therapy.
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Affiliation(s)
- S L Jackson
- Atlanta VA Medical Center, Decatur, GA, USA
- Nutrition and Health Sciences, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, USA
| | - S E Safo
- Atlanta VA Medical Center, Decatur, GA, USA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - L R Staimez
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - D E Olson
- Atlanta VA Medical Center, Decatur, GA, USA
- Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - K M V Narayan
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Q Long
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - J Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - M K Rhee
- Atlanta VA Medical Center, Decatur, GA, USA
- Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | | | - A M Tomolo
- Atlanta VA Medical Center, Decatur, GA, USA
- Division of General Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - L S Phillips
- Atlanta VA Medical Center, Decatur, GA, USA
- Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Wenzel LB, Mukamel DB, Cohn DE, Havrilesky L, Wright AA, Lipscomb J, Sparks L, Ladd H, Osann K. Time trade-offs in advanced ovarian cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.26_suppl.20] [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
20 Background: Most women with advanced ovarian cancer develop recurrence and die within five years of diagnosis. This creates a clinical imperative to discuss tradeoffs between the risks and benefits of treatment options. The purpose of this study is to examine the experience of ovarian cancer patients presented with a decision aid leading them through a time-tradeoff (TTO) exercise to guide choice of therapy. Methods: Newly diagnosed advanced ovarian cancer patients (N = 64) participated in a study evaluating the effectiveness and usefulness of a Patient-Centered Outcome Aid (PCOA). This i-Pad based interactive aid included an exercise during which patients evaluated personal tradeoffs between longer survival and adverse events associated with chemotherapy, in consultation with providers. Patients were educated about potential side effects, asked to rank their concerns about each side effect, and then asked: “Now that you have thought about and ranked the side effects, we ask you to think about the worst side effect for you as it relates to survival in good health. Would you be willing to go through 6 months of your worst side effect, if it gave you 5 years of good health?” There was a forced choice (Yes vs. No); then the tradeoff question was repeated with decreasing survival times: i.e. 3 years, 1 year, and 9, 6, 5, 4, 3, 2, and 1 months. Results: Of the 61 patients who responded to the TTO question, 52% required 1 or more years of good health to endure 6 months of their worst side effect. Among the non-neoadjuvant patients (N = 50), 18% indicated they would trade 6 months of the worst side effect for 1-2 months of additional life in good health, however 56% would require 9 months or more. While 95% of patients found it easy to rank order concerns about side effects, 75% considered the TTO question difficult to answer. Conclusions: Decisions aids which incorporate tradeoffs must be designed with sensitivity to differential health literacy levels, and the extremely personal nature of this decision.
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Affiliation(s)
| | | | | | | | | | - Joseph Lipscomb
- Rollins School of Public Health; Winship Cancer Institute, Atlanta, GA
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Bian J, Bennett C, Cooper G, D'Alfonso A, Fisher D, Lipscomb J, Qian CN. Assessing Colorectal Cancer Screening Adherence of Medicare Fee-for-Service Beneficiaries Age 76 to 95 Years. J Oncol Pract 2016; 12:e670-80. [PMID: 27189357 DOI: 10.1200/jop.2015.009118] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION There are concerns about potential overuse of colorectal cancer (CRC) screening services among average-risk individuals older than age 75 years. MATERIALS AND METHODS Using a 5% random noncancer sample of Medicare beneficiaries who resided in the SEER areas, we examined rates of CRC screening adherence, defined by the Medicare coverage policy, among average-risk fee-for-service beneficiaries age 76 to 95 years from 2002 to 2010. The two outcomes are the status of overall CRC screening adherence, and the status of adherence to colonoscopy (v other modalities) conditional on patient adherence. RESULTS Overall CRC screening adherence rates of Medicare beneficiaries age 76 to 95 years increased from 13.0% to 21.4% from 2002 to 2010. In 2002, 2.2% of beneficiaries were adherent to colonoscopy, and 10.7%, by other modalities; the corresponding rates were 19.5% and 1.9%, respectively, in 2010. Specifically, rates of adherence to colonoscopy were 1.1% for those age 86 to 90 years and almost nil for those age 91 to 95 years in 2002, but the rates became 13.5% and 8.2%, respectively, in 2010. Compared with white beneficiaries, black beneficiaries age 76 to 95 years had a 7-percentage-point lower adherence rate. However, overall adherence rates among blacks increased by 168.6% from 2002 to 2010, whereas rates among whites increased by 63.0%. Logistic regressions showed that blacks age 86 to 95 years were less likely than whites to be adherent (odds ratio, 0.56; 95% CI, 0.47 to 0.59) but were more likely to be adherent to colonoscopy (odds ratio, 2.34; 95% CI, 1.47 to 3.91). CONCLUSION High proportions of average-risk Medicare fee-for-service beneficiaries screened by colonoscopy may represent opportunities for improving appropriateness and allocative efficiency of CRC screening by Medicare.
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Affiliation(s)
- John Bian
- South Carolina College of Pharmacy, Columbia, SC; University Hospitals Case Medical Center, Cleveland, OH; Duke University Medical Center, Durham, NC; Emory Rollins School of Public Health, Atlanta, GA; Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Charles Bennett
- South Carolina College of Pharmacy, Columbia, SC; University Hospitals Case Medical Center, Cleveland, OH; Duke University Medical Center, Durham, NC; Emory Rollins School of Public Health, Atlanta, GA; Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Gregory Cooper
- South Carolina College of Pharmacy, Columbia, SC; University Hospitals Case Medical Center, Cleveland, OH; Duke University Medical Center, Durham, NC; Emory Rollins School of Public Health, Atlanta, GA; Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Alessandra D'Alfonso
- South Carolina College of Pharmacy, Columbia, SC; University Hospitals Case Medical Center, Cleveland, OH; Duke University Medical Center, Durham, NC; Emory Rollins School of Public Health, Atlanta, GA; Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Deborah Fisher
- South Carolina College of Pharmacy, Columbia, SC; University Hospitals Case Medical Center, Cleveland, OH; Duke University Medical Center, Durham, NC; Emory Rollins School of Public Health, Atlanta, GA; Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Joseph Lipscomb
- South Carolina College of Pharmacy, Columbia, SC; University Hospitals Case Medical Center, Cleveland, OH; Duke University Medical Center, Durham, NC; Emory Rollins School of Public Health, Atlanta, GA; Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Chao-Nan Qian
- South Carolina College of Pharmacy, Columbia, SC; University Hospitals Case Medical Center, Cleveland, OH; Duke University Medical Center, Durham, NC; Emory Rollins School of Public Health, Atlanta, GA; Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
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Goldstein DA, Chen Q, Ayer T, Howard DH, Lipscomb J, Ramalingam SS, Khuri FR, Flowers CR. Necitumumab in Metastatic Squamous Cell Lung Cancer: Establishing a Value-Based Cost. JAMA Oncol 2016; 1:1293-300. [PMID: 26313558 DOI: 10.1001/jamaoncol.2015.3316] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The SQUIRE trial demonstrated that adding necitumumab to chemotherapy for patients with metastatic squamous cell lung cancer (mSqCLC) increased median overall survival by 1.6 months (hazard ratio, 0.84). However, the costs and value associated with this intervention remains unclear. Value-based pricing links the price of a drug to the benefit that it provides and is a novel method to establish prices for new treatments. OBJECTIVE To evaluate the range of drug costs for which adding necitumumab to chemotherapy could be considered cost-effective. DESIGN, SETTING, AND PARTICIPANTS We developed a Markov model using data from multiple sources, including the SQUIRE trial, which compared standard chemotherapy with and without necitumumab as first-line treatment of mSqCLC, to evaluate the costs and patient life expectancies associated with each regimen. In the analysis, patients were modeled to receive gemcitabine and cisplatin for 6 cycles or gemcitabine, cisplatin, and necitumumab for 6 cycles followed by maintenance necitumumab. Our model's clinical inputs were the survival estimates and frequency of adverse events (AEs) described in the SQUIRE trial. Log-logistic models were fitted to the survival distributions in the SQUIRE trial. The cost inputs included drug costs, based on the Medicare average sale prices, and costs for drug administration and management of AEs, based on Medicare reimbursement rates (all in 2014 US dollars). MAIN OUTCOMES AND MEASURES We evaluated incremental cost-effectiveness ratios (ICERs) for the use of necitumumab across a range of values for its cost. Model robustness was assessed by probabilistic sensitivity analyses, based on 10 000 Monte Carlo simulations, sampling values from the distributions of all model parameters. RESULTS In the base case analysis, the addition of necitumumab to the treatment regimen produced an incremental survival benefit of 0.15 life-years and 0.11 quality-adjusted life-years (QALYs). The probabilistic sensitivity analyses established that when necitumumab cost less than $563 and less than $1309 per cycle, there was 90% confidence that the ICER for adding necitumumab would be less than $100 000 per QALY and less than $200 000 per QALY, respectively. CONCLUSIONS AND RELEVANCE These findings provide a value-based range for the cost of necitumumab from $563 to $1309 per cycle. This study provides a framework for establishing value-based pricing for new oncology drugs entering the US marketplace.
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Affiliation(s)
- Daniel A Goldstein
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Qiushi Chen
- H. Milton Stewart School of Industrial & Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Turgay Ayer
- H. Milton Stewart School of Industrial & Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - David H Howard
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia3Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Joseph Lipscomb
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia3Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Suresh S Ramalingam
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Fadlo R Khuri
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Christopher R Flowers
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
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Jegadeesh N, Liu Y, Gillespie T, Fernandez F, Ramalingam S, Mikell J, Lipscomb J, Curran WJ, Higgins KA. Evaluating Intensity-Modulated Radiation Therapy in Locally Advanced Non-Small-Cell Lung Cancer: Results From the National Cancer Data Base. Clin Lung Cancer 2016; 17:398-405. [PMID: 26936682 DOI: 10.1016/j.cllc.2016.01.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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: 09/24/2015] [Revised: 01/26/2016] [Accepted: 01/26/2016] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Reports have suggested improvements in dosimetry, toxicity, and quality of life with intensity-modulated radiation therapy (IMRT) in locally advanced non-small-cell lung cancer (NSCLC). The selection criteria for those patients who may benefit is unclear. This study sought to identify subgroups of patients who may derive survival benefit from intensity modulated radiation therapy (IMRT) compared with 3D conformal radiation therapy (3DCRT). METHODS AND MATERIALS The National Cancer Data Base was queried for stage III NSCLC treated with radiation and chemotherapy alone with curative intent. All received ≥ 58 Gy. Kaplan-Meier and log-rank test were performed to compare overall survival (OS) by treatment modality. A multivariable Cox proportional hazards model was used to assess association with OS. Propensity score matching was also implemented. RESULTS A total of 2543 patients treated between 2003 and 2006 were eligible; 422 (16.6%) received IMRT, 2121 (83.4%) received 3DCRT. In patients with T3 and T4 disease, IMRT was associated with an improvement in median OS and 5-year survival rate (17.2 vs. 14.6 months; 19.9% vs. 13.4%, P = .021.) In multivariable analysis, there was an interaction between treatment type and T stage that was found to be significant (P = .03). In the propensity matched cohort of T3 and T4 patients, the use of IMRT remained associated with improved OS (hazard ratio, 0.80; 95% confidence interval, 0.64-1.00; P = .048). CONCLUSIONS Use of IMRT in patients with T3 and T4 tumors was associated with improved overall survival in this large population-based analysis. This is a novel finding that is in concordance with the well-described dosimetric benefits of IMRT in NSCLC.
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Affiliation(s)
- Naresh Jegadeesh
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA.
| | - Yuan Liu
- Department of Biostatistics and Bioinformatics, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Theresa Gillespie
- Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Felix Fernandez
- Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Suresh Ramalingam
- Department of Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - John Mikell
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Joseph Lipscomb
- Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Walter J Curran
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Kristin A Higgins
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
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Lipscomb J, Fleming ST, Trentham-Dietz A, Kimmick G, Wu XC, Morris CR, Zhang K, Smith RA, Anderson RT, Sabatino SA. What Predicts an Advanced-Stage Diagnosis of Breast Cancer? Sorting Out the Influence of Method of Detection, Access to Care, and Biologic Factors. Cancer Epidemiol Biomarkers Prev 2016; 25:613-23. [PMID: 26819266 DOI: 10.1158/1055-9965.epi-15-0225] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 12/11/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Multiple studies have yielded important findings regarding the determinants of an advanced-stage diagnosis of breast cancer. We seek to advance this line of inquiry through a broadened conceptual framework and accompanying statistical modeling strategy that recognize the dual importance of access-to-care and biologic factors on stage. METHODS The Centers for Disease Control and Prevention-sponsored Breast and Prostate Cancer Data Quality and Patterns of Care Study yielded a seven-state, cancer registry-derived population-based sample of 9,142 women diagnosed with a first primary in situ or invasive breast cancer in 2004. The likelihood of advanced-stage cancer (American Joint Committee on Cancer IIIB, IIIC, or IV) was investigated through multivariable regression modeling, with base-case analyses using the method of instrumental variables (IV) to detect and correct for possible selection bias. The robustness of base-case findings was examined through extensive sensitivity analyses. RESULTS Advanced-stage disease was negatively associated with detection by mammography (P < 0.001) and with age < 50 (P < 0.001), and positively related to black race (P = 0.07), not being privately insured [Medicaid (P = 0.01), Medicare (P = 0.04), uninsured (P = 0.07)], being single (P = 0.06), body mass index > 40 (P = 0.001), a HER2 type tumor (P < 0.001), and tumor grade not well differentiated (P < 0.001). This IV model detected and adjusted for significant selection effects associated with method of detection (P = 0.02). Sensitivity analyses generally supported these base-case results. CONCLUSIONS Through our comprehensive modeling strategy and sensitivity analyses, we provide new estimates of the magnitude and robustness of the determinants of advanced-stage breast cancer. IMPACT Statistical approaches frequently used to address observational data biases in treatment-outcome studies can be applied similarly in analyses of the determinants of stage at diagnosis. Cancer Epidemiol Biomarkers Prev; 25(4); 613-23. ©2016 AACR.
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Affiliation(s)
- Joseph Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, Georgia.
| | - Steven T Fleming
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, Kentucky
| | | | - Gretchen Kimmick
- Department of Internal Medicine, Medical Oncology, Duke University Medical Center and Multidisciplinary Breast Cancer Program, Duke Cancer Institute, Durham, North Carolina
| | - Xiao-Cheng Wu
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Cyllene R Morris
- California Cancer Registry, Institute for Population Health Improvement, UC Davis Health System, Sacramento, California
| | - Kun Zhang
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Roger T Anderson
- Department of Public Health Sciences, University of Virginia School of Medicine, and UVA Cancer Center, Charlottesville, Virginia
| | - Susan A Sabatino
- Division of Cancer Prevention and Control, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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Medbery RL, Gillespie TW, Liu Y, Nickleach DC, Lipscomb J, Sancheti MS, Pickens A, Force SD, Fernandez FG. Nodal Upstaging Is More Common with Thoracotomy than with VATS During Lobectomy for Early-Stage Lung Cancer: An Analysis from the National Cancer Data Base. J Thorac Oncol 2016; 11:222-33. [PMID: 26792589 DOI: 10.1016/j.jtho.2015.10.007] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [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: 08/20/2015] [Revised: 09/22/2015] [Accepted: 10/13/2015] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Questions remain regarding differences in nodal evaluation and upstaging between thoracotomy (open) and video-assisted thoracic surgery (VATS) approaches to lobectomy for early-stage lung cancer. Potential differences in nodal staging based on operative approach remain the final significant barrier to widespread adoption of VATS lobectomy. The current study examines differences in nodal staging between open and VATS lobectomy. METHODS The National Cancer Data Base was queried for patients with clinical stage T2N0M0 or lower lung cancer who underwent lobectomy in 2010-2011. Propensity score matching was performed to compare the rate of nodal upstaging in VATS with that in open approaches. Additional subgroup analysis was performed to assess whether rates of upstaging differed by specific clinical setting. RESULTS A total of 16,983 lobectomies were analyzed; 4935 (29.1%) were performed using VATS. Nodal upstaging was more frequent in the open group (12.8% versus 10.3%; p < 0.001). In 4437 matched pairs, nodal upstaging remained more common for open approaches. For a subgroup of patients who had seven lymph or more nodes examined, propensity matching revealed that nodal upstaging remained more common after an open approach than after VATS (14.0% versus 12.1%; p = 0.03). For patients who were treated in an academic/research facility, however, the difference in nodal upstaging between an open and VATS approach was no longer significant (12.2% versus 10.5%, p = 0.08). CONCLUSIONS For early-stage lung cancer, nodal upstaging was observed more frequently with thoracotomy than with VATS. However, nodal upstaging appears to be affected by facility type, which may be a surrogate for expertise in minimally invasive surgical procedures.
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Affiliation(s)
- Rachel L Medbery
- Section of General Thoracic Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Theresa W Gillespie
- Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Yuan Liu
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Dana C Nickleach
- Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Joseph Lipscomb
- Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA; Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Manu S Sancheti
- Section of General Thoracic Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Allan Pickens
- Section of General Thoracic Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Seth D Force
- Section of General Thoracic Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Felix G Fernandez
- Section of General Thoracic Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA.
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Smith TG, Castro KM, Troeschel AN, Arora NK, Lipscomb J, Jones SM, Treiman KA, Hobbs C, McCabe RM, Clauser SB. The rationale for patient-reported outcomes surveillance in cancer and a reproducible method for achieving it. Cancer 2015; 122:344-51. [DOI: 10.1002/cncr.29767] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 07/27/2015] [Accepted: 07/29/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Tenbroeck G. Smith
- Behavioral Research Center, Intramural Research Department; American Cancer Society; Atlanta Georgia
| | - Kathleen M. Castro
- Division of Cancer Control and Population Sciences; National Cancer Institute; Bethesda Maryland
| | - Alyssa N. Troeschel
- Behavioral Research Center, Intramural Research Department; American Cancer Society; Atlanta Georgia
| | | | - Joseph Lipscomb
- Health Policy and Management, Rollins School of Public Health; Emory University; Atlanta Georgia
- Population Sciences, Winship Cancer Institute; Emory University; Atlanta Georgia
| | | | | | - Connie Hobbs
- RTI International, Research Triangle Park; North Carolina
| | - Ryan M. McCabe
- National Cancer Data Base; American College of Surgeons; Chicago Illinois
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Quek RGW, Ward KC, Master VA, Lin CC, Portier KM, Virgo KS, Lipscomb J. Association between urologist characteristics and radiation oncologist consultation for patients with locoregional prostate cancer. J Natl Compr Canc Netw 2015; 13:303-9. [PMID: 25736007 DOI: 10.6004/jnccn.2015.0042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Physicians managing patients with prostate cancer play a critical role in subsequent specialist consultations and initial treatment choice, especially in cases for which no consensus exists regarding optimal treatment strategy. The NCCN Guidelines for Prostate Cancer recommend radiation as a therapy option for patients with locoregional prostate cancer. PURPOSE The authors examined the association of urologist characteristics with the likelihood that patients would consult radiation oncologists. METHODS A retrospective cohort of 39,934 patients aged 66 years or older who were diagnosed with locoregional prostate cancer between 2004 and 2007, and the 2405 urologists who performed the patient diagnostic biopsies were constructed using the SEER-Medicare linked database and the American Medical Association Physician Masterfile. Logistic multilevel regression analysis was used to evaluate the influence of urologists' characteristics on radiation oncologist consultation within 9 months of locoregional prostate cancer diagnosis. RESULTS Overall, 24,549 (61.5%) patients consulted a radiation oncologist. After adjusting for patient and urologist characteristics, patients diagnosed by urologists in noninstitutional settings (eg, physician office) were significantly more likely to consult a radiation oncologist (odds ratio [OR], 1.40; 95% CI, 1.17-1.67; P=.0002) compared with those diagnosed by urologists in institutional settings with a major medical school affiliation. In addition, patients diagnosed by urologists older than 57 years were significantly more likely to consult a radiation oncologist (OR, 1.21; 95% CI, 1.07-1.38, P=.003).
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Affiliation(s)
- Ruben G W Quek
- From the Department of Health Policy and Management, Department of Epidemiology, Winship Cancer Institute, and Department of Urology, Emory University; Surveillance and Health Services Research Program, and Statistics and Evaluation Center, Intramural Research Department, American Cancer Society; and Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
| | - Kevin C Ward
- From the Department of Health Policy and Management, Department of Epidemiology, Winship Cancer Institute, and Department of Urology, Emory University; Surveillance and Health Services Research Program, and Statistics and Evaluation Center, Intramural Research Department, American Cancer Society; and Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
| | - Viraj A Master
- From the Department of Health Policy and Management, Department of Epidemiology, Winship Cancer Institute, and Department of Urology, Emory University; Surveillance and Health Services Research Program, and Statistics and Evaluation Center, Intramural Research Department, American Cancer Society; and Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia. From the Department of Health Policy and Management, Department of Epidemiology, Winship Cancer Institute, and Department of Urology, Emory University; Surveillance and Health Services Research Program, and Statistics and Evaluation Center, Intramural Research Department, American Cancer Society; and Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
| | - Chun Chieh Lin
- From the Department of Health Policy and Management, Department of Epidemiology, Winship Cancer Institute, and Department of Urology, Emory University; Surveillance and Health Services Research Program, and Statistics and Evaluation Center, Intramural Research Department, American Cancer Society; and Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
| | - Kenneth M Portier
- From the Department of Health Policy and Management, Department of Epidemiology, Winship Cancer Institute, and Department of Urology, Emory University; Surveillance and Health Services Research Program, and Statistics and Evaluation Center, Intramural Research Department, American Cancer Society; and Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia. From the Department of Health Policy and Management, Department of Epidemiology, Winship Cancer Institute, and Department of Urology, Emory University; Surveillance and Health Services Research Program, and Statistics and Evaluation Center, Intramural Research Department, American Cancer Society; and Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
| | - Katherine S Virgo
- From the Department of Health Policy and Management, Department of Epidemiology, Winship Cancer Institute, and Department of Urology, Emory University; Surveillance and Health Services Research Program, and Statistics and Evaluation Center, Intramural Research Department, American Cancer Society; and Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
| | - Joseph Lipscomb
- From the Department of Health Policy and Management, Department of Epidemiology, Winship Cancer Institute, and Department of Urology, Emory University; Surveillance and Health Services Research Program, and Statistics and Evaluation Center, Intramural Research Department, American Cancer Society; and Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia. From the Department of Health Policy and Management, Department of Epidemiology, Winship Cancer Institute, and Department of Urology, Emory University; Surveillance and Health Services Research Program, and Statistics and Evaluation Center, Intramural Research Department, American Cancer Society; and Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
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Goldstein DA, Ahmad BB, Chen Q, Ayer T, Howard DH, Lipscomb J, El-Rayes BF, Flowers CR. Cost-Effectiveness Analysis of Regorafenib for Metastatic Colorectal Cancer. J Clin Oncol 2015; 33:3727-32. [PMID: 26304904 PMCID: PMC4737857 DOI: 10.1200/jco.2015.61.9569] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [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] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Regorafenib is a standard-care option for treatment-refractory metastatic colorectal cancer that increases median overall survival by 6 weeks compared with placebo. Given this small incremental clinical benefit, we evaluated the cost-effectiveness of regorafenib in the third-line setting for patients with metastatic colorectal cancer from the US payer perspective. METHODS We developed a Markov model to compare the cost and effectiveness of regorafenib with those of placebo in the third-line treatment of metastatic colorectal cancer. Health outcomes were measured in life-years and quality-adjusted life-years (QALYs). Drug costs were based on Medicare reimbursement rates in 2014. Model robustness was addressed in univariable and probabilistic sensitivity analyses. RESULTS Regorafenib provided an additional 0.04 QALYs (0.13 life-years) at a cost of $40,000, resulting in an incremental cost-effectiveness ratio of $900,000 per QALY. The incremental cost-effectiveness ratio for regorafenib was > $550,000 per QALY in all of our univariable and probabilistic sensitivity analyses. CONCLUSION Regorafenib provides minimal incremental benefit at high incremental cost per QALY in the third-line management of metastatic colorectal cancer. The cost-effectiveness of regorafenib could be improved by the use of value-based pricing.
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Affiliation(s)
- Daniel A Goldstein
- Daniel A. Goldstein, Bilal B. Ahmad, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA.
| | - Bilal B Ahmad
- Daniel A. Goldstein, Bilal B. Ahmad, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA
| | - Qiushi Chen
- Daniel A. Goldstein, Bilal B. Ahmad, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA
| | - Turgay Ayer
- Daniel A. Goldstein, Bilal B. Ahmad, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA
| | - David H Howard
- Daniel A. Goldstein, Bilal B. Ahmad, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA
| | - Joseph Lipscomb
- Daniel A. Goldstein, Bilal B. Ahmad, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA
| | - Bassel F El-Rayes
- Daniel A. Goldstein, Bilal B. Ahmad, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA
| | - Christopher R Flowers
- Daniel A. Goldstein, Bilal B. Ahmad, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers, Emory University; and Qiushi Chen and Turgay Ayer, Georgia Institute of Technology, Atlanta, GA
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Jegadeesh N, Liu Y, Gillespie T, Fernandez F, Suresh R, Mikell J, Lipscomb J, Curran W, Higgins K. Intensity Modulated Radiation Therapy is Associated With Improved Survival in Non-Small Cell Lung Cancer With Advanced T Stage: Results From the National Cancer Data Base. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nanda RH, Liu Y, Gillespie TW, Mikell JL, Ramalingam SS, Fernandez FG, Curran WJ, Lipscomb J, Higgins KA. Stereotactic body radiation therapy versus no treatment for early stage non-small cell lung cancer in medically inoperable elderly patients: A National Cancer Data Base analysis. Cancer 2015; 121:4222-30. [DOI: 10.1002/cncr.29640] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/07/2015] [Accepted: 07/20/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Ronica H. Nanda
- Department of Radiation Oncology; Emory University; Atlanta Georgia
- Winship Cancer Institute; Emory University; Atlanta Georgia
| | - Yuan Liu
- Winship Cancer Institute; Emory University; Atlanta Georgia
- Department of Biostatistics and Bioinformatics Shared Resource; Emory University; Atlanta Georgia
- Rollins School of Public Health; Emory University; Atlanta Georgia
| | - Theresa W. Gillespie
- Winship Cancer Institute; Emory University; Atlanta Georgia
- Department of Biostatistics and Bioinformatics Shared Resource; Emory University; Atlanta Georgia
| | - John L. Mikell
- Department of Radiation Oncology; Emory University; Atlanta Georgia
- Winship Cancer Institute; Emory University; Atlanta Georgia
| | - Suresh S. Ramalingam
- Winship Cancer Institute; Emory University; Atlanta Georgia
- Department of Hematology and Oncology; Emory University; Atlanta Georgia
| | - Felix G. Fernandez
- Winship Cancer Institute; Emory University; Atlanta Georgia
- Department of Surgery; Emory University; Atlanta Georgia
| | - Walter J. Curran
- Department of Radiation Oncology; Emory University; Atlanta Georgia
- Winship Cancer Institute; Emory University; Atlanta Georgia
| | - Joseph Lipscomb
- Winship Cancer Institute; Emory University; Atlanta Georgia
- Rollins School of Public Health; Emory University; Atlanta Georgia
| | - Kristin A. Higgins
- Department of Radiation Oncology; Emory University; Atlanta Georgia
- Winship Cancer Institute; Emory University; Atlanta Georgia
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Denu RA, Hampton JM, Currey A, Anderson RT, Cress RD, Fleming ST, Lipscomb J, Sabatino SA, Wu XC, Wilson JF, Trentham-Dietz A. Abstract 3727: Influence of patient, physician, and hospital characteristics on the receipt of guideline-concordant care for inflammatory breast cancer. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-3727] [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: 11/16/2022]
Abstract
Abstract
Introduction: Inflammatory breast cancer (IBC) is an aggressive and lethal form of locally advanced breast cancer that makes up 1-6% of all breast cancers and has a median overall survival of less than 4 years. Physically, IBC is characterized by erythema, edema, and fine dimpling, so treatment can be delayed due to misdiagnosis as mastitis or dermatitis. Therapy for IBC tends to vary since no treatments are highly effective. Because IBC is such a rare subtype, studies have been challenged to demonstrate patterns of IBC treatment and analyze factors affecting differences in treatment. In this study we examined factors affecting the receipt of guideline-concordant care and survival for IBC patients.
Methods: Patients diagnosed with non-metastatic IBC in 2004 were identified from the Breast and Prostate Cancer Data Quality and Patterns of Care Study, containing information from cancer registry reports in seven states supplemented through medical record re-abstraction and physician verification. Variation in guideline-concordant care for IBC, based on 2003 National Comprehensive Cancer Network (NCCN) guidelines, was assessed according to patient, physician, and hospital characteristics. Additionally, survival based on receipt of guideline-concordant care was analyzed using Kaplan-Meier curves and log-rank tests.
Results: Of the 107 IBC patients in the study, only 25.8% of them received treatment that was fully concordant with guidelines. The majority of patients received guideline-concordant surgery (90.4%), with percentages lower for chemotherapy (51.9%), radiation (40.7%), and hormone therapy (78.0%). Guideline-concordant care was less common among patients with extreme categories of patient age (under 40 or over 80 years; P = 0.19), non-white race (P = 0.03), lower body mass index (BMI<25 kg/m2, P = 0.003), a surgeon graduating from medical school more than 15 years prior (P = 0.02), and smaller hospital size (<200 beds, P = 0.02).
Results suggested that IBC patients experienced longer breast cancer-specific survival if they received guideline-concordant treatment based on 2003 (P = 0.06) and 2013 (P = 0.06) NCCN guidelines.
Conclusion: Targeting factors associated with receipt of care that is not guideline-concordant may reduce survival disparities in IBC patients. Further research is needed to identify approaches to ensure that physicians are adhering to NCCN guidelines for IBC cases and to identify reasons for non-adherence to guidelines.
Citation Format: Ryan A. Denu, John M. Hampton, Adam Currey, Roger T. Anderson, Rosemary D. Cress, Steven T. Fleming, Joseph Lipscomb, Susan A. Sabatino, Xiao-Cheng Wu, J F. Wilson, Amy Trentham-Dietz. Influence of patient, physician, and hospital characteristics on the receipt of guideline-concordant care for inflammatory breast cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3727. doi:10.1158/1538-7445.AM2015-3727
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Affiliation(s)
- Ryan A. Denu
- 1University of Wisconsin School of Medicine & Public Health, Madison, WI
| | - John M. Hampton
- 1University of Wisconsin School of Medicine & Public Health, Madison, WI
| | - Adam Currey
- 2Medical College of Wisconsin, Milwaukee, WI
| | | | | | | | | | | | - Xiao-Cheng Wu
- 8LSU Health Sciences Center School of Public Health, New Orleans, LA
| | - J F. Wilson
- 2Medical College of Wisconsin, Milwaukee, WI
| | - Amy Trentham-Dietz
- 1University of Wisconsin School of Medicine & Public Health, Madison, WI
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Cohn DE, Havrilesky LJ, Osann K, Lipscomb J, Hsieh S, Walker JL, Wright AA, Alvarez RD, Karlan BY, Bristow RE, DiSilvestro PA, Wakabayashi MT, Morgan R, Mukamel DB, Wenzel L. Consensus in controversy: The modified Delphi method applied to Gynecologic Oncology practice. Gynecol Oncol 2015; 138:712-6. [PMID: 26177553 DOI: 10.1016/j.ygyno.2015.07.014] [Citation(s) in RCA: 3] [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: 06/02/2015] [Revised: 07/07/2015] [Accepted: 07/09/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine the degree of consensus regarding the probabilities of outcomes associated with IP/IV and IV chemotherapy. METHODS A survey was administered to an expert panel using the Delphi method. Ten ovarian cancer experts were asked to estimate outcomes for patients receiving IP/IV or IV chemotherapy. The clinical estimates were: 1) probability of completing six cycles of chemotherapy, 2) probability of surviving five years, 3) median survival, and 4) probability of ER/hospital visits during treatment. Estimates for two patients, one with a low comorbidity index (patient 1) and the other with a moderate index (patient 2), were included. The survey was administered in three rounds, and panelists could revise their subsequent responses based on review of the anonymous opinions of their peers. RESULTS The ranges were smaller for IV compared with IP/IV therapy. Ranges decreased with each round. Consensus converged around outcomes related to IP/IV chemotherapy for: 1) completion of 6 cycles of therapy (type 1 patient, 62%, type 2 patient, 43%); 2) percentage of patients surviving 5 years (type 1 patient, 66%, type 2 patient, 47%); and 3) median survival (type 1 patient, 83 months, type 2 patient, 58 months). The group required three rounds to achieve consensus on the probabilities of ER/hospital visits (type 1 patient, 24%, type 2 patient, 35%). CONCLUSIONS Initial estimates of survival and adverse events associated with IP/IV chemotherapy differ among experts. The Delphi process works to build consensus and may be a pragmatic tool to inform patients of their expected outcomes.
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Affiliation(s)
- David E Cohn
- The Ohio State University, Columbus, OH, United States.
| | | | - Kathryn Osann
- University of California at Irvine, Irvine, CA, United States
| | - Joseph Lipscomb
- Emory University Rollins School of Public Health and Winship Cancer Institute, Atlanta, GA, United States
| | - Susie Hsieh
- University of California at Irvine, Irvine, CA, United States
| | - Joan L Walker
- The University of Oklahoma, Oklahoma City, OK, United States
| | - Alexi A Wright
- Dana-Farber Cancer Institute/Harvard Medical School, Boston, MA, United States
| | - Ronald D Alvarez
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - Beth Y Karlan
- Cedars Sinai Medical Center, Los Angeles, CA, United States
| | | | - Paul A DiSilvestro
- Women & Infants Hospital, Brown University, Providence, RI, United States
| | | | | | - Dana B Mukamel
- University of California Irvine, School of Medicine, Orange, CA, United States
| | - Lari Wenzel
- University of California at Irvine, Irvine, CA, United States
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50
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Olson DE, Zhu M, Long Q, Barb D, Haw JS, Rhee MK, Mohan AV, Watson-Williams PI, Jackson SL, Tomolo AM, Wilson PWF, Narayan KMV, Lipscomb J, Phillips LS. Increased cardiovascular disease, resource use, and costs before the clinical diagnosis of diabetes in veterans in the southeastern U.S. J Gen Intern Med 2015; 30:749-57. [PMID: 25608739 PMCID: PMC4441670 DOI: 10.1007/s11606-014-3075-7] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 08/26/2014] [Accepted: 09/28/2014] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Screening for diabetes might be more widespread if adverse associations with cardiovascular disease (CVD), resource use, and costs were known to occur earlier than conventional clinical diagnosis. OBJECTIVE The purpose of this study was to determine whether adverse effects associated with diabetes begin prior to clinical diagnosis. DESIGN Veterans with diabetes were matched 1:2 with controls by follow-up, age, race/ethnicity, gender, and VA facility. CVD was obtained from ICD-9 codes, and resource use and costs from VA datasets. SETTING VA facilities in SC, GA, and AL. PARTICIPANTS Patients with and without diagnosed diabetes. MAIN OUTCOME MEASURES Diagnosed CVD, resource use, and costs. RESULTS In this study, the 2,062 diabetic patients and 4,124 controls were 63 years old on average, 99 % male, and 29 % black; BMI was 30.8 in diabetic patients vs. 27.8 in controls (p<0.001). CVD prevalence was higher and there were more outpatient visits in Year -4 before diagnosis through Year +4 after diagnosis among diabetic vs. control patients (all p<0.01); in Year -2, CVD prevalence was 31 % vs. 24 %, and outpatient visits were 22 vs. 19 per year, respectively. Total VA costs/year/veteran were higher in diabetic than control patients from Year -4 ($4,083 vs. $2,754) through Year +5 ($8,347 vs. $5,700) (p<0.003) for each, reflecting underlying increases in outpatient, inpatient, and pharmacy costs (p<0.05 for each). Regression analysis showed that diabetes contributed an average of $1,748/year to costs, independent of CVD (p<0.001). CONCLUSIONS AND RELEVANCE VA costs per veteran are higher--over $1,000/year before and $2,000/year after diagnosis of diabetes--due to underlying increases in outpatient, inpatient, and pharmacy costs, greater number of outpatient visits, and increased CVD. Moreover, adverse associations with veterans' health and the VA healthcare system occur early in the natural history of the disease, several years before diabetes is diagnosed. Since adverse associations begin before diabetes is recognized, greater consideration should be given to systematic screening in order to permit earlier detection and initiation of preventive management. Keeping frequency of CVD and marginal costs in line with those of patients before diabetes is currently diagnosed has the potential to save up to $2 billion a year.
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