National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
76 to 100 of 197 Research Studies DisplayedGibson DC, Chou LN, Raji MA
Opioid prescribing trends in women following mastectomy or breast-conserving surgery before and after the 2014 federal reclassification of hydrocodone.
This study compares changes in opioid prescribing among surgical breast cancer patients following the 2014 federal reclassification of hydrocodone. Data from 2009 to 2017 was used from a large nationally representative commercial insurance health program. Women aged 18 years and older who were diagnosed with carcinoma in-situ or malignant breast cancer and received breast-conserving surgery or a mastectomy from 2010 to 2016 were included. Patients in 2015 or 2016 who had surgery were less likely to receive a greater than 1-day supply of opioid prescriptions or 30 days or more supply than in 2013. However, only in 2016 were surgical breast cancer patients less likely to receive a 90-day supply than in 2013.
AHRQ-funded; HS026133.
Citation: Gibson DC, Chou LN, Raji MA .
Opioid prescribing trends in women following mastectomy or breast-conserving surgery before and after the 2014 federal reclassification of hydrocodone.
Oncologist 2020 Apr;25(4):281-89. doi: 10.1634/theoncologist.2019-0758..
Keywords: Opioids, Medication, Surgery, Cancer: Breast Cancer, Cancer, Women
Garcia-Albeniz X, Hernan MA, Logan RW
Continuation of annual screening mammography and breast cancer mortality in women older than 70 years.
This study examined whether discontinuing annual mammography screening in women older than 70 years results in an increased 8-year breast cancer mortality. The researchers used data from the Medicare program and looked at over 1 million beneficiaries aged 70 to 84 who had no previous breast cancer diagnosis, and who underwent screening mammography from 2000 to 20008. The 8-year risk difference for women aged 70 to 74 years was -1.0 death per 1000 women and for women aged 75 to 84 years it was 0.07. Neither of these show substantial reductions in 8-year breast cancer mortality compared with stopping screening.
AHRQ-funded; HS023128.
Citation: Garcia-Albeniz X, Hernan MA, Logan RW .
Continuation of annual screening mammography and breast cancer mortality in women older than 70 years.
Ann Intern Med 2020 Mar 17;172(6):381-89. doi: 10.7326/m18-1199..
Keywords: Cancer: Breast Cancer, Cancer, Screening, Prevention, Women, Elderly, Mortality
Fan T, Fakolade A
AHRQ Author: Fan T
Medication use to reduce risk of breast cancer.
In this case study, a 40-year-old woman comes to her doctor’s office for a routine gynecologic visit. She is not taking any medications and is generally healthy. She is sexually active, and her last menstrual period started 10 days ago. She states that her mother was diagnosed with bilateral breast cancer at 49 years of age and that she would like to discuss her options for reducing the risk of breast cancer. Three questions are posed about risk-reducing medications.
AHRQ-authored
Citation: Fan T, Fakolade A .
Medication use to reduce risk of breast cancer.
Am Fam Physician 2020 Mar 15;101(6):373-74..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer: Breast Cancer, Cancer, Medication, Risk, Prevention, Case Study, Women
Sprague BL, Coley RY, Kerlikowske K
Assessment of radiologist performance in breast cancer screening using digital breast tomosynthesis vs digital mammography.
Many US radiologists have screening mammography recall rates above the expert-recommended threshold of 12%. The influence of digital breast tomosynthesis (DBT) on the distribution of radiologist recall rates is uncertain. The objective of this study was to evaluate radiologists' recall and cancer detection rates before and after beginning interpretation of DBT examinations.
AHRQ-funded; HS018366.
Citation: Sprague BL, Coley RY, Kerlikowske K .
Assessment of radiologist performance in breast cancer screening using digital breast tomosynthesis vs digital mammography.
JAMA Netw Open 2020 Mar 2;3(3):e201759. doi: 10.1001/jamanetworkopen.2020.1759..
Keywords: Cancer: Breast Cancer, Cancer, Diagnostic Safety and Quality, Imaging, Screening, Women, Prevention, Provider Performance
Mills J, Fakolade A
AHRQ Author: Mills J
Risk assessment, genetic counseling, and genetic testing for BRCA-related cancer.
In this case study, a 31-year-old woman presents for a well-woman examination. She indicates that her mother was diagnosed with tubal cancer at age 40, that her 42-year-old sister was recently diagnosed with breast cancer, and that her maternal aunt was diagnosed with breast cancer at age 45.
AHRQ-authored.
Citation: Mills J, Fakolade A .
Risk assessment, genetic counseling, and genetic testing for BRCA-related cancer.
Am Fam Physician 2020 Feb 15;101(4):239-40..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer: Breast Cancer, Cancer, Genetics, Screening, Women, Prevention, Case Study
Takvorian SU, Oganisian A, Mamtani R
Association of Medicaid expansion under the Affordable Care Act with insurance status, cancer stage, and timely treatment among patients with breast, colon, and lung cancer.
The effect of the Patient Protection and Affordable Care Act's Medicaid expansion on cancer care delivery and outcomes is unknown. Patients with cancer are a high-risk group for whom treatment delays are particularly detrimental. The objective of this study was to examine the association between Medicaid expansion and changes in insurance status, stage at diagnosis, and timely treatment among patients with incident breast, colon, and non-small cell lung cancer.
AHRQ-funded; HS026116.
Citation: Takvorian SU, Oganisian A, Mamtani R .
Association of Medicaid expansion under the Affordable Care Act with insurance status, cancer stage, and timely treatment among patients with breast, colon, and lung cancer.
JAMA Netw Open 2020 Feb 5;3(2):e1921653. doi: 10.1001/jamanetworkopen.2019.21653.
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Keywords: Cancer: Breast Cancer, Cancer: Colorectal Cancer, Cancer: Lung Cancer, Cancer, Health Insurance, Medicaid, Policy, Health Services Research (HSR)
Killelea BK, Evans SB, Mougalian SS
Association between perceived benefits and receipt of radiotherapy among older breast cancer patients.
This study examined perceptions of older women with stage I estrogen-receptor-positive breast cancer who underwent lumpectomy and were considering or receiving radiotherapy. Perceptions among 63 older women was that radiotherapy would reduce their 10-year-risk of local recurrent by an average of 18.7% although the literature showed only an 8% risk reduction. Participants who had the perception of a larger benefit were more likely to receive radiotherapy treatment.
AHRQ-funded; HS023900.
Citation: Killelea BK, Evans SB, Mougalian SS .
Association between perceived benefits and receipt of radiotherapy among older breast cancer patients.
Breast J 2020 Feb;26(2):231-34. doi: 10.1111/tbj.13518..
Keywords: Elderly, Cancer: Breast Cancer, Cancer, Women, Patient-Centered Outcomes Research, Shared Decision Making
Pembroke M, Nemeth LS
Instruments to evaluate self-management of radiation dermatitis in patients with breast cancer.
Radiation dermatitis (RD) is a side effect of radiation to the breast and chest wall. Healthcare providers routinely grade the severity of RD without assessing its impact on quality of life. This study investigates instruments to identify a patient's ability and confidence to self-manage RD. Findings showed that using a validated instrument to assess patients' needs and ability to self-manage RD will promote personalized care plans tailored to each patient. These findings can be used to implement a patient-reported outcome measure into clinical practice, to develop educational programs for RD management, and to create personalized care plans.
AHRQ-funded.
Citation: Pembroke M, Nemeth LS .
Instruments to evaluate self-management of radiation dermatitis in patients with breast cancer.
Oncol Nurs Forum 2020 Jan;47(1):101-11. doi: 10.1188/20.Onf.101-111..
Keywords: Patient Self-Management, Cancer: Breast Cancer, Cancer, Skin Conditions
Fuzesi S, Becetti K, Klassen AF
Expectations of breast-conserving therapy: a qualitative study.
The goal of this study was to describe expectations of breast-conserving therapy (BCT) among patients with early breast cancer and aimed to inform preoperative patient education and improve the patient experience through knowledge. The researchers identified themes related to patient expectations of BCT and found that patients had a clear knowledge gap regarding BCT. This data may be used to enhance preoperative discussions aimed at preparing patients for surgery and treatment.
AHRQ-funded; T32HS00066.
Citation: Fuzesi S, Becetti K, Klassen AF .
Expectations of breast-conserving therapy: a qualitative study.
J Patient Rep Outcomes 2019 Dec 27;3(1):73. doi: 10.1186/s41687-019-0167-5..
Keywords: Cancer: Breast Cancer, Cancer, Education: Patient and Caregiver, Surgery
Kunst NR, Alarid-Escudero F, Paltiel AD
A value of information analysis of research on the 21-gene assay for breast cancer management.
The authors aimed to quantify the value of conducting further research to reduce decision uncertainty in the use of the 21-gene assay Oncotype DX (21-GA). They found that current evidence strongly supports the use of the 21-GA in intermediate- and high-risk women and recommended that further research focus on low-risk women.
AHRQ-funded; HS023900.
Citation: Kunst NR, Alarid-Escudero F, Paltiel AD .
A value of information analysis of research on the 21-gene assay for breast cancer management.
Value Health 2019 Oct;22(10):1102-10. doi: 10.1016/j.jval.2019.05.004..
Keywords: Genetics, Cancer: Breast Cancer, Cancer, Shared Decision Making, Research Methodologies
Nelson HD, Fu R, Zakher B
Medication use for the risk reduction of primary breast cancer in women: updated evidence report and systematic review for the US Preventive Services Task Force.
The purpose of this paper was to update the 2013 US Preventive Services Task Force systematic review on medications to reduce risk of primary (first diagnosis) invasive breast cancer in women. Investigators abstracted data on methods, participant characteristics, eligibility criteria, outcome ascertainment, and follow-up; individual trial results were combined using a profile likelihood random-effects model. Results showed that tamoxifen, raloxifene, and aromatase inhibitors were associated with lower risk of primary invasive breast cancer in women but also were associated with adverse effects that differed between medications. Risk stratification methods to identify patients with increased breast cancer risk demonstrated low accuracy.
AHRQ-funded; 290201500009I.
Citation: Nelson HD, Fu R, Zakher B .
Medication use for the risk reduction of primary breast cancer in women: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2019 Sep 3;322(9):868-86. doi: 10.1001/jama.2019.5780..
Keywords: Cancer: Breast Cancer, Cancer, Medication, U.S. Preventive Services Task Force (USPSTF), Evidence-Based Practice, Guidelines, Prevention, Primary Care
Rosenberg SM, Vaz-Luis I, Gong J
Employment trends in young women following a breast cancer diagnosis.
This cohort study examined employment trends in young women (age 40 or less) following a breast cancer diagnosis and treatment. The participants were 911 women who were enrolled in the Young Women’s Breast Cancer Study with non-metastatic breast cancer who were surveyed about employment-related outcomes 1 year post-diagnosis. Most women (80%) were employed 1 year after diagnosis. Among employed women, 7% said treatment affected their job performance. Seven percent of women reported unemployment at 1 year, with half of them reporting health reasons for their unemployment. Women with Stage 3 disease, and those who reporting having money to pay bills after cutting back or difficulty paying bills at baseline were more likely to be unemployed.
AHRQ-funded; HS023680.
Citation: Rosenberg SM, Vaz-Luis I, Gong J .
Employment trends in young women following a breast cancer diagnosis.
Breast Cancer Res Treat 2019 Aug;177(1):207-14. doi: 10.1007/s10549-019-05293-x..
Keywords: Cancer: Breast Cancer, Cancer, Women, Young Adults
Sepucha KR, Langford AT, Belkora JK
Impact of timing on measurement of decision quality and shared decision making: longitudinal cohort study of breast cancer patients.
Med Decis Making 2019 Aug;39(6):642-50. doi: 10.1177/0272989x19862545.
AHRQ-funded; HS025718.
Citation: Sepucha KR, Langford AT, Belkora JK .
Impact of timing on measurement of decision quality and shared decision making: longitudinal cohort study of breast cancer patients.
Med Decis Making 2019 Aug;39(6):642-50. doi: 10.1177/0272989x19862545..
Keywords: Shared Decision Making, Cancer: Breast Cancer, Cancer, Surgery
Knerr S, Bowles EJA, Leppig KA
Trends in BRCA test utilization in an integrated health system, 2005-2015.
The authors reported 10-year trends in BRCA testing in an integrated health-care system with long-standing access to genetic services. They found that many eligible women did not receive BRCA testing despite having insurance coverage and access to specialty genetic services, thus underscoring challenges to primary and secondary hereditary cancer prevention.
AHRQ-funded; HS022982.
Citation: Knerr S, Bowles EJA, Leppig KA .
Trends in BRCA test utilization in an integrated health system, 2005-2015.
J Natl Cancer Inst 2019 Aug;111(8):795-802. doi: 10.1093/jnci/djz008..
Keywords: Cancer: Breast Cancer, Cancer: Ovarian Cancer, Cancer, Genetics, Screening, Prevention, Healthcare Utilization, Healthcare Delivery, Women
Bateni SB, Davidson AJ, Arora M
Is breast-conserving therapy appropriate for male breast cancer patients? A national cancer database analysis.
The purpose of this study was to compare overall survival rates among male breast cancer patients who underwent breast-conserving therapy (BCT) versus mastectomy. A retrospective analysis identified 8445 stage I-II male breast cancer patients from the National Cancer Database and grouped them according to surgical and radiation therapy (RT). Most of the patients underwent total mastectomy, while 18.2% underwent BCT, 12.4% underwent total mastectomy with RT, and 8.2% underwent partial mastectomy alone. Partial mastectomy alone, total mastectomy alone, and total mastectomy with RT were associated with worse overall survival rates compared with BCT. The authors conclude that BCT is associated with greater survival, but the underlying mechanisms of this association warrant further study.
AHRQ-funded; HS022236.
Citation: Bateni SB, Davidson AJ, Arora M .
Is breast-conserving therapy appropriate for male breast cancer patients? A national cancer database analysis.
Ann Surg Oncol 2019 Jul;26(7):2144-53. doi: 10.1245/s10434-019-07159-4..
Keywords: Cancer, Cancer: Breast Cancer, Shared Decision Making, Mortality, Outcomes, Patient-Centered Outcomes Research
Rotter J, Wilson L, Greiner MA
Shared-patient physician networks and their impact on the uptake of genomic testing in breast cancer.
This study examined the impact of physician networks have on the adoption of genomic testing for women with early stage breast cancer. The genomic assay discussed in this paper is Oncotype DX (ODX) which stratifies risk. The study used retrospective data from the SEER-Medicare database from 2008 to 2012. Early adoption was more likely if the oncologists shared two or more patients during that period. There was a 1.7-fold increase in providers’ adoption of ODX in 2008-2009, and a 1.5-fold increase in their patients receiving ODX in 2010-2012.
AHRQ-funded; HS022189.
Citation: Rotter J, Wilson L, Greiner MA .
Shared-patient physician networks and their impact on the uptake of genomic testing in breast cancer.
Breast Cancer Res Treat 2019 Jul;176(2):445-51. doi: 10.1007/s10549-019-05248-2..
Keywords: Cancer, Cancer: Breast Cancer, Genetics, Screening
Miglioretti DL, Abraham L, Lee CI
Digital breast tomosynthesis: radiologist learning curve.
This study examined if detect rates and lower recall rates occurred with the adoption of digital breast tomosynthesis (DBT) than for traditional breast mammography. Performance was compared before and after DBT adoption using data from the Breast Cancer Surveillance Consortium cohort. There was a small improvement in recall rates, with more improvement in women with nondense breasts. Cancer detection rates were similar.
AHRQ-funded; HS018366.
Citation: Miglioretti DL, Abraham L, Lee CI .
Digital breast tomosynthesis: radiologist learning curve.
Radiology 2019 Apr;291(1):34-42. doi: 10.1148/radiol.2019182305..
Keywords: Cancer, Cancer: Breast Cancer, Diagnostic Safety and Quality, Imaging, Screening, Women
Sprague BL, Kerlikowske K, Bowles EJA
Trends in clinical breast density assessment from the Breast Cancer Surveillance Consortium.
Changes to mammography practice, including revised Breast Imaging Reporting and Data System (BI-RADS) density classification guidelines and implementation of digital breast tomosynthesis (DBT), may impact clinical breast density assessment. In this study, the authors investigated temporal trends in clinical breast density assessment among 2 990 291 digital mammography (DM) screens and 221 063 DBT screens interpreted by 722 radiologists from 144 facilities in the Breast Cancer Surveillance Consortium.
AHRQ-funded; HS018366.
Citation: Sprague BL, Kerlikowske K, Bowles EJA .
Trends in clinical breast density assessment from the Breast Cancer Surveillance Consortium.
J Natl Cancer Inst 2019 Jun;111(6):629-32. doi: 10.1093/jnci/djy210..
Keywords: Cancer: Breast Cancer, Cancer, Screening, Imaging, Women
Hoover DS, Pappadis MR, Housten AJ
Preferences for communicating about breast cancer screening among racially/ethnically diverse older women.
The purpose of this study was to examine preferences for communicating about screening mammography among racially/ethnically diverse older women. Through in-depth interviews, findings revealed that older women desire information about the benefits and harms of screening mammography and would prefer to learn this information through discussions with healthcare providers and multiple other formats. Results were consistent regardless of participants' age, race/ethnicity, or education.
AHRQ-funded; HS022134.
Citation: Hoover DS, Pappadis MR, Housten AJ .
Preferences for communicating about breast cancer screening among racially/ethnically diverse older women.
Health Commun 2019 Jun;34(7):702-06. doi: 10.1080/10410236.2018.1431026..
Keywords: Cancer, Cancer: Breast Cancer, Clinician-Patient Communication, Communication, Elderly, Women, Prevention, Racial and Ethnic Minorities, Screening
Tice JA, Bissell MCS, Miglioretti DL
Validation of the breast cancer surveillance consortium model of breast cancer risk.
This study evaluated the breast cancer surveillance consortium (BCSC) model of breast cancer risk. The accuracy of the model was assessed using a racially diverse population followed for up to 10 years. An independent cohort of 252,997 women in the Chicago area was used to validate the model. The model was found to be well-calibrated, but underestimated the incidence of invasive breast cancer in younger women and in women with low mammographic density.
AHRQ-funded; HS018366.
Citation: Tice JA, Bissell MCS, Miglioretti DL .
Validation of the breast cancer surveillance consortium model of breast cancer risk.
Breast Cancer Res Treat 2019 Jun;175(2):519-23. doi: 10.1007/s10549-019-05167-2..
Keywords: Cancer, Cancer: Breast Cancer, Risk
Pisu M, Schoenberger YM, Herbey I
Perspectives on conversations about costs of cancer care of breast cancer survivors and cancer center staff: a qualitative study.
Despite recommendations to discuss the cost of care (CoC) with patients with cancer, little formal guidance is available on how to conduct these sensitive conversations in ways that are acceptable to both patients and providers. The objective of this study was to explore the perspectives of patients and medical and nonmedical cancer center staff on CoC conversations.
ARHQ-funded; HS023009.
Citation: Pisu M, Schoenberger YM, Herbey I .
Perspectives on conversations about costs of cancer care of breast cancer survivors and cancer center staff: a qualitative study.
Ann Intern Med 2019 May 7;170(9_Supplement):S54-s61. doi: 10.7326/m18-2117..
Keywords: Cancer: Breast Cancer, Cancer, Healthcare Costs, Clinician-Patient Communication, Communication
Arasu VA, Miglioretti DL, Sprague BL
Population-based assessment of the association between magnetic resonance imaging background parenchymal enhancement and future primary breast cancer risk.
The purpose of this study was to evaluate comparative associations of breast magnetic resonance imaging (MRI) background parenchymal enhancement (BPE) and mammographic breast density with subsequent breast cancer risk. The investigators concluded that BPE was associated with future invasive breast cancer risk independent of breast density. They suggest that BPE should be considered for risk prediction models for women undergoing breast MRI.
AHRQ-funded; HS018366.
Citation: Arasu VA, Miglioretti DL, Sprague BL .
Population-based assessment of the association between magnetic resonance imaging background parenchymal enhancement and future primary breast cancer risk.
J Clin Oncol 2019 Apr 20;37(12):954-63. doi: 10.1200/jco.18.00378..
Keywords: Cancer, Cancer: Breast Cancer, Imaging, Patient-Centered Outcomes Research, Risk, Women
Giess CS, Wang A, Ip IK
Patient, radiologist, and examination characteristics affecting screening mammography recall rates in a large academic practice.
This retrospective study examined patient, radiologist and examination characteristics affecting screening mammography recall rates. This study used 61,198 examinations from an academic center and two outpatient centers from October 1, 2012 to May 31, 2015. Radiologists’ risk aversion, stress from uncertainty, and malpractice concerns and cancer detection rates were derived from the survey. Their annual screening volumes, clinical experience, and concentration in breast imaging was calculated. About 9.3% of screening examinations were recalled. There was no association found with radiologists’ risk aversion, stress from uncertainty, malpractice concerns and cancer detection rates and high recall rates. The most variation was found with radiologists’ annual reading volume and experience.
AHRQ-funded; HS24722.
Citation: Giess CS, Wang A, Ip IK .
Patient, radiologist, and examination characteristics affecting screening mammography recall rates in a large academic practice.
J Am Coll Radiol 2019 Apr;16(4 Pt A):411-18. doi: 10.1016/j.jacr.2018.06.016..
Keywords: Cancer, Cancer: Breast Cancer, Diagnostic Safety and Quality, Imaging, Prevention, Screening, Women
Perez S, Greenzang KA
Completion of adolescent cancer treatment: excitement, guilt, and anxiety.
The completion of cancer treatment in adolescents and young adults is a time that many patients and families approach with hope and excitement but is often tinged with anxiety and fear. In this paper, the authors present a young man’s personal experience moving from treatment to survivorship as well as that of his oncologist, and together we offer recommendations for supporting children and teenagers with serious illness at the completion of therapy.
AHRQ-funded; HS022986.
Citation: Perez S, Greenzang KA .
Completion of adolescent cancer treatment: excitement, guilt, and anxiety.
Pediatrics 2019 Mar;143(3). doi: 10.1542/peds.2018-3073..
Keywords: Children/Adolescents, Young Adults, Cancer: Breast Cancer, Anxiety, Clinician-Patient Communication
Dinan MA, Wilson LE, Reed SD
Chemotherapy costs and 21-gene recurrence score genomic testing among Medicare beneficiaries with early-stage breast cancer, 2005 to 2011.
This study examined whether associations between 21-gene recurrence score (RS) genomic testing and lower costs among patients with early-stage, estrogen receptor-positive breast cancer were observable in real-world data from the Medicare population. The investigators found that RS testing was associated with lower overall and chemotherapy-related costs in patients with high-risk disease, consistent with lower chemotherapy use among these patients. Higher overall costs for patients with intermediate-risk and low-risk disease were driven largely by non-treatment-related costs.
AHRQ-funded; HS022189.
Citation: Dinan MA, Wilson LE, Reed SD .
Chemotherapy costs and 21-gene recurrence score genomic testing among Medicare beneficiaries with early-stage breast cancer, 2005 to 2011.
J Natl Compr Canc Netw 2019 Mar;17(3):245-54. doi: 10.6004/jnccn.2018.7097..
Keywords: Cancer, Cancer: Breast Cancer, Treatments, Genetics, Healthcare Costs, Medicare, Women