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Quek R.G.W.,Emory University | Master V.A.,Emory University | Ward K.C.,Emory University | Lin C.C.,Surveillance and Health Services Research Program | And 3 more authors.
Cancer | Year: 2013

BACKGROUND Prostate cancer treatment choices have been shown to vary by physician and patient characteristics. For patients with low-risk, clinically localized prostate cancer, the authors examined the impact of their clinical, sociodemographic, and radiation oncologists' (RO) characteristics on the likelihood that the patients would receive combined external beam radiotherapy and brachytherapy, a treatment regimen that is at variance with clinical guidelines. METHODS The Surveillance, Epidemiology and End Results (SEER)-Medicare linked database and the American Medical Association Physician Masterfile were used in a retrospective analysis of 5531 patients with low-risk, clinically localized prostate cancer who were diagnosed between 2004 and 2007, and the 708 ROs who treated them. Hierarchical logistic regression analyses were used to evaluate the relationship between patient and RO characteristics and the use of combined therapy within 6 months of diagnosis. RESULTS Overall, 356 patients (6.4%) received combined therapy. Nonclinical factors were found to be associated with combined therapy. After adjusting for patient and RO characteristics, the odds of receiving combined therapy for patients residing in Georgia were found to be significantly greater than for all other SEER regions. Black patients were significantly less likely to receive combined therapy (odds ratio, 0.62; 95% confidence interval, 0.40-0.96 [P =.03]) compared with white patients. In addition, ROs accounted for 36.6% of the variation in patients receiving combined therapy. CONCLUSIONS Geographic and sociodemographic factors were found to be significantly associated with guideline-discordant combined therapy for patients diagnosed with low-risk, clinically localized prostate cancer. Which RO a patient consults is important in determining whether they receive combined therapy. Cancer 2013;119:3619-3628. © 2013 American Cancer Society. Source

Lin C.C.,Surveillance and Health Services Research Program | Virgo K.S.,Emory University
Medical Care | Year: 2014

BACKGROUND:: A prior assessment of concordance between the diagnosis month in SEER records and Medicare claims found reasonable agreement; however, no assessment of the impact of discordance on cancer treatment ascertainment was conducted. OBJECTIVES:: The aim of this study was to assess the concordance between the SEER diagnosis date (Sdx) and Medicare claim-derived diagnosis date and the impact of discordance on identification of treatment received. METHODS:: The first Medicare claim date with a cancer diagnosis (Mdx) was compared with the Sdx among patients diagnosed with breast, colorectal, or lung cancer. The Mdx was considered concordant with the Sdx if the Mdx was within 16 days. Claims within 4 months after both the Mdx and Sdx were examined to collect treatment information. Treatment rate agreement was measured by κ-statistics. RESULTS:: Among 50,731 breast, 51,025 colorectal, and 61,384 lung cancer patients, the Sdx and Mdx were concordant in 79%, 86%, and 73% of cases, respectively. Most discordant Mdx cases were identified in the month after the SEER diagnosis month. A small proportion of cases (7%-12%) preceded the SEER diagnosis month. Agreement for receipt of surgery was very good across all 3 cancer sites (κ>0.88) and was excellent for radiation therapy (κ>0.96). CONCLUSIONS:: Although most cases were concordant for both diagnosis date and treatment ascertainment, there was still a small proportion of cases discordant for both diagnosis date and treatment identification. This study underscores the importance of examining claims in the months preceding diagnosis in the SEER-Medicare dataset to ensure patients are appropriately selected for analysis. Copyright © 2013 by Lippincott Williams & Wilkins. Source

Mullins C.D.,University of Maryland, Baltimore | Vandigo J.,University of Maryland, Baltimore | Zheng Z.,University of Maryland, Baltimore | Zheng Z.,Surveillance and Health Services Research Program | Wicks P.,PatientsLikeMe Inc.
Value in Health | Year: 2014

Evidence from clinical trials should contribute to informed decision making and a learning health care system. People frequently, however, find participating in clinical trials meaningless or disempowering. Moreover, people often do not incorporate trial results directly into their decision making. The lack of patient centeredness in clinical trials may be partially addressed through trial design. For example, Bayesian adaptive trials designed to adjust in a prespecified manner to changes in clinical practice could motivate people and their health care providers to view clinical trials as more applicable to real-world clinical decisions. The way in which clinical trials are designed can transform the evidence generation process to be more patient centered, providing people with an incentive to participate or continue participating in clinical trials. To achieve the transformation to patient-centeredness in clinical trial decisions, however, there is a need for transparent and reliable methods and education of trial investigators and site personnel. © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Source

Chen W.,National Cancer Center | Zheng R.,National Cancer Center | Baade P.D.,Cancer Council Queensland | Zhang S.,National Cancer Center | And 6 more authors.
CA Cancer Journal for Clinicians | Year: 2016

With increasing incidence and mortality, cancer is the leading cause of death in China and is a major public health problem. Because of China's massive population (1.37 billion), previous national incidence and mortality estimates have been limited to small samples of the population using data from the 1990s or based on a specific year. With high-quality data from an additional number of population-based registries now available through the National Central Cancer Registry of China, the authors analyzed data from 72 local, population-based cancer registries (2009-2011), representing 6.5% of the population, to estimate the number of new cases and cancer deaths for 2015. Data from 22 registries were used for trend analyses (2000-2011). The results indicated that an estimated 4292,000 new cancer cases and 2814,000 cancer deaths would occur in China in 2015, with lung cancer being the most common incident cancer and the leading cause of cancer death. Stomach, esophageal, and liver cancers were also commonly diagnosed and were identified as leading causes of cancer death. Residents of rural areas had significantly higher age-standardized (Segi population) incidence and mortality rates for all cancers combined than urban residents (213.6 per 100,000 vs 191.5 per 100,000 for incidence; 149.0 per 100,000 vs 109.5 per 100,000 for mortality, respectively). For all cancers combined, the incidence rates were stable during 2000 through 2011 for males (+0.2% per year; P =.1), whereas they increased significantly (+2.2% per year; P <.05) among females. In contrast, the mortality rates since 2006 have decreased significantly for both males (-1.4% per year; P <.05) and females (-1.1% per year; P <.05). Many of the estimated cancer cases and deaths can be prevented through reducing the prevalence of risk factors, while increasing the effectiveness of clinical care delivery, particularly for those living in rural areas and in disadvantaged populations. © 2016 American Cancer Society. Source

Siegel R.L.,Surveillance and Health Services Research Program | Fedewa S.A.,Surveillance and Health Services Research Program | Miller K.D.,Surveillance and Health Services Research Program | Goding-Sauer A.,Surveillance and Health Services Research Program | And 3 more authors.
CA Cancer Journal for Clinicians | Year: 2015

Cancer is the leading cause of death among Hispanics/Latinos, who represent the largest racial/ethnic minority group in the United States, accounting for 17.4% (55.4 million/318 million) of the total US population in 2014. Every 3 years, the American Cancer Society reports on cancer statistics for Hispanics based on incidence data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data from the National Center for Health Statistics. Among Hispanics in 2015, there will be an estimated 125,900 new cancer cases diagnosed and 37,800 cancer deaths. For all cancers combined, Hispanics have 20% lower incidence rates and 30% lower death rates compared with non-Hispanic whites (NHWs); however, death rates are slightly higher among Hispanics during adolescence (aged 15-19 years). Hispanic cancer rates vary by country of origin and are generally lowest in Mexicans, with the exception of infection-associated cancers. Liver cancer incidence rates in Hispanic men, which are twice those in NHW men, doubled from 1992 to 2012; however, rates in men aged younger than 50 years declined by 43% since 2003, perhaps a bellwether of future trends for this highly fatal cancer. Variations in cancer risk between Hispanics and NHWs, as well as between subpopulations, are driven by differences in exposure to cancer-causing infectious agents, rates of screening, and lifestyle patterns. Strategies for reducing cancer risk in Hispanic populations include increasing the uptake of preventive services (eg, screening and vaccination) and targeted interventions to reduce obesity, tobacco use, and alcohol consumption. © 2015 American Cancer Society. Source

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