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Lynden, WA, United States

Holford T.R.,The New School | Clark L.,Cornerstone Systems Northwest Inc.
Risk Analysis

Publication of the Surgeon General's Report in 1964 marshaled evidence of the harm to public health caused by cigarette smoking, including lung cancer mortality, and provided an impetus for introducing control programs. The purpose of this article is to develop estimates of their effect on basic smoking exposure input parameters related to introduction of the report. Fundamental inputs used to generate exposure to cigarettes are initiation and cessation rates for men and women, as well as the distribution of the number of cigarettes smoked per day. These fundamental quantities are presented for three scenarios: actual tobacco control in the United States; no tobacco control in which the experience before 1955 was assumed to continue; and complete tobacco control in which all smoking ceased following publication of the report. These results were derived using data from National Health Interview Surveys, and they provide basic input parameters for the Smoking History Generator used by each of the lung cancer models developed by the Cancer Intervention and Surveillance Modeling Network. © 2012 Society for Risk Analysis. Source

Jeon J.,Fred Hutchinson Cancer Research Center | Meza R.,University of Michigan | Krapcho M.,Management Information Services Inc. | Clarke L.D.,Cornerstone Systems Northwest Inc. | And 3 more authors.
Risk Analysis

The smoking history generator (SHG) developed by the National Cancer Institute simulates individual life/smoking histories that serve as inputs for the Cancer Intervention and Surveillance Modeling Network (CISNET) lung cancer models. In this chapter, we review the SHG inputs, describe its outputs, and outline the methodology behind it. As an example, we use the SHG to simulate individual life histories for individuals born between 1890 and 1984 for each of the CISNET smoking scenarios and use those simulated histories to compute the corresponding smoking prevalence over the period 1975-2000. © 2012 Society for Risk Analysis. Source

McCune J.S.,University of Washington | McCune J.S.,Fred Hutchinson Cancer Research Center | Sullivan S.D.,University of Washington | Blough D.K.,University of Washington | And 6 more authors.

Study Objective. To determine the impact of primary prophylactic colonystimulating factor (CSF) use on febrile neutropenia in a large patient population receiving contemporary chemotherapy regimens to treat breast cancer, colorectal cancer, or non-small cell lung cancer (NSCLC). Design. Retrospective claims analysis. Data Sources. The Surveillance, Epidemiology, and End Results (SEER)-Puget Sound cancer registry and insurance claims records. Patients. A total of 2728 patients aged 25 years or older who received a diagnosis of breast cancer (998 patients), colorectal cancer (688 patients), or NSCLC (1042 patients) between January 1, 2002, and December 31, 2005, and received chemotherapy. Measurements and Main Results. Initial chemotherapy regimen, CSF use (filgrastim or pegfilgrastim), and febrile neutropenia events were evaluated after the first chemotherapy administration. Subsequently, febrile neutropenia rates in patients receiving primary prophylactic CSF were compared with febrile neutropenia rates in patients receiving CSF in settings other than primary prophylaxis or not at all. The impact of primary prophylactic CSF could not be assessed for patients with colorectal cancer or NSCLC because only 1 and 18 febrile neutropenia events, respectively, occurred in those receiving primary prophylactic CSF. Of the 998 patients with breast cancer, 72 (7.2%) experienced febrile neutropenia, 28 of whom received primary prophylactic CSF. In the patients with breast cancer, we observed that primary prophylactic CSF use was associated with reduced febrile neutropenia rates; however, the analysis may have been confounded by unmeasured factors associated with febrile neutropenia. Conclusion. The impact of primary prophylactic CSFs on febrile neutropenia rates could not be demonstrated. Given the substantive cost of CSFs to pharmacy budgets, there are numerous opportunities for pharmacists to optimize CSF use. Research studies are needed to evaluate if guidelinedirected prescribing of primary prophylactic CSFs can improve clinical outcomes. Source

Sullivan S.D.,Fred Hutchinson Cancer Research Center | Sullivan S.D.,University of Washington | Ramsey S.D.,Fred Hutchinson Cancer Research Center | Blough D.K.,University of Washington | And 4 more authors.
Value in Health

Objectives: We examined health care use in conjunction with primary prophylaxis use of colony stimulating factors (CSF) during patients' initial course of chemotherapy. Methods: This retrospective cohort study identified adults aged 25 years and older with a diagnosis of breast, colorectal, or nonsmall cell lung cancer between 2002 and 2005 from the Western Washington Surveillance Epidemiology and End Results Puget Sound registry. We linked these records to health insurance claims from four payers representing 75% of those insured in the state. Claims records were used to determine chemotherapy regimen type, CSF use, febrile neutropenia occurrences, and supportive care. Chemotherapy regimens were categorized as conferring high, intermediate, or low risk of myelosuppression according to the National Comprehensive Cancer Network guidelines. CSF use was described as primary prophylaxis, other, or none. Antibiotics and antifungal and antiviral agents per National Comprehensive Cancer Network guidelines for supportive care for cancer infection were categorized using Healthcare Common Procedure Coding System and National Drug Code assignments. Results: Use of CSF as primary prophylaxis is not significantly associated with a reduction in antibiotic use or inpatient or outpatient visits. Primary prophylactic CSF use was associated with less use of antiviral drugs. Conclusions: CSF use is not associated with a reduction in health care use, with the exception of antiviral drug use. Given the expense associated with CSF use, pragmatic trials and additional research are needed to further assess the affects of CSF on health care use. Copyright © 2011, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Source

Mcmahon P.M.,Massachusetts General Hospital | Hazelton W.D.,Fred Hutchinson Cancer Research Center | Kimmel M.,Rice University | Clarke L.D.,Cornerstone Systems Northwest Inc.
Risk Analysis

Sophisticated modeling techniques can be powerful tools to help us understand the effects of cancer control interventions on population trends in cancer incidence and mortality. Readers of journal articles are, however, rarely supplied with modeling details. Six modeling groups collaborated as part of the National Cancer Institute's Cancer Intervention and Surveillance Modeling Network (CISNET) to investigate the contribution of U.S. tobacco-control efforts toward reducing lung cancer deaths over the period 1975-2000. The six models included in this monograph were developed independently and use distinct, complementary approaches toward modeling the natural history of lung cancer. The models used the same data for inputs, and agreed on the design of the analysis and the outcome measures. This article highlights aspects of the models that are most relevant to similarities of or differences between the results. Structured comparisons can increase the transparency of these complex models. © 2011 Society for Risk Analysis. Source

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