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Walker G.V.,University of Houston | Giordano S.H.,University of Houston | Williams M.,Texas Cancer Registry | Jiang J.,Anderson University, South Carolina | And 9 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2013

Purpose: To evaluate, in the setting of breast cancer, the accuracy of registry radiation therapy (RT) coding compared with the gold standard of Medicare claims. Methods and Materials: Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified 73,077 patients aged ≥66 years diagnosed with breast cancer in the period 2001-2007. Underascertainment (1 - sensitivity), sensitivity, specificity, κ, and χ2 were calculated for RT receipt determined by registry data versus claims. Multivariate logistic regression characterized patient, treatment, and geographic factors associated with underascertainment of RT. Findings in the SEER-Medicare registries were compared with three non-SEER registries (Florida, New York, and Texas). Results: In the SEER-Medicare registries, 41.6% (n=30,386) of patients received RT according to registry coding, versus 49.3% (n=36,047) according to Medicare claims (P<.001). Underascertainment of RT was more likely if patients resided in a newer SEER registry (odds ratio [OR] 1.70, 95% confidence interval [CI] 1.60-1.80; P<.001), rural county (OR 1.34, 95% CI 1.21-1.48; P<.001), or if RT was delayed (OR 1.006/day, 95% CI 1.006-1.007; P<.001). Underascertainment of RT receipt in SEER registries was 18.7% (95% CI 18.6-18.8%), compared with 44.3% (95% CI 44.0-44.5%) in non-SEER registries. Conclusions: Population-based tumor registries are highly variable in ascertainment of RT receipt and should be augmented with other data sources when evaluating quality of breast cancer care. Future work should identify opportunities for the radiation oncology community to partner with registries to improve accuracy of treatment data. © 2013 Elsevier Inc. Source


Luke B.,Michigan State University | Brown M.B.,University of Michigan | Spector L.G.,University of Minnesota | Missmer S.A.,Harvard University | And 6 more authors.
Fertility and Sterility | Year: 2015

Objective To evaluate the risk of cancer after assisted reproductive technology (ART) therapy. Design Longitudinal cohort study. Setting Not applicable. Patient(s) New York, Texas, and Illinois residents between 2004 and 2009, treated with ART, comprising cycles of 113,226 women, including 53,859 women without prior ART treatment, who were linked to their respective state cancer registries and whose cycles were reported to the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System (SART CORS). Intervention(s) None. Main Outcome Measure(s) Diagnosis of cancer, as reported to the state cancer registry; standardized incidence ratios (SIR) and their 95% confidence intervals, comparing the observed to expected cancer cases based on age-specific cancer rates in the general population of each state. Result(s) Among the cohort of women without prior ART therapy, hazard ratios (HR) and 95% confidence intervals (CI) were calculated for treatment parameters and reproductive history factors. The mean follow-up period was 4.87 years; among women without prior ART, 450 women developed 460 cancers. Women treated with ART had a statistically significantly lower risk for all cancers (for all women: SIR 0.78; CI, 0.73-0.83; women without prior ART: SIR 0.75; CI, 0.68-0.82), breast cancer, and all female genital cancers; a non-statistically-significant lower risk for endocrine and uterine cancer; and a non-statistically-significant higher risk for melanoma and ovarian cancer. Among women without prior ART, we found no statistically significant increased HR by parity, number of cycles, cumulative follicle-stimulating hormone dosage, or cycle outcome. Conclusion(s) Women initiating ART treatment have no greater risk for developing cancer after nearly 5 years of follow-up compared with the general population and with other women treated with ART. © 2015 American Society for Reproductive Medicine. Source


Nogueira L.M.,Texas Cancer Registry | Thai C.L.,U.S. National Institutes of Health | Nelson W.,U.S. National Institutes of Health | Oh A.,U.S. National Institutes of Health
American Journal of Health Behavior | Year: 2016

Objective: We investigated the relative importance of nutrition label numeracy and sociodemographic characteristics in predicting health behaviors. Methods: Secondary data analysis of data collected from the National Cancer Institute's Health Information National Trends Survey (HINTS 4, cycle 3, 2013). Weighted age-adjusted ordinal logistical regression was used to evaluate sociodemographic characteristics among individuals with different nutrition label numeracy levels. Dominance analysis was conducted to rank nutrition label numeracy and sociodemographic characteristics in order of importance as predictors of health behavior. Results: Lower levels of nutrition label numeracy were associated with older age, black and Hispanic race/ethnicity, unemployment, being born outside of the United States, lower English proficiency, lower education achievement, lower income, and living in the South. Nutrition label numeracy and income were the most important predictors of health behaviors, accounting for about 50% of the variance in fruit consumption and level of effort, frustration, concern, and confusion experienced while seeking health information. Conclusions: Nutrition label numeracy differed significantly among sociodemographic groups and was a strong predictor of health behaviors. When developing health interventions targeting dietary behaviors, disparities in nutrition label numeracy comprehension should be considered. Copyright © PNG Publications. All rights reserved. Source


Luke B.,Michigan State University | Brown M.B.,University of Michigan | Spector L.G.,University of Minnesota | Smith Y.R.,University of Michigan | And 3 more authors.
Journal of Assisted Reproduction and Genetics | Year: 2016

Purpose: The purpose of the present study is to estimate the proportion of women with cancer who return to use the embryos that they have banked and to compare this proportion to that of women without cancer who bank embryos. Methods: This is a cohort study of three groups of women from New York, Texas, and Illinois who used embryo banking in their first assisted reproductive technology (ART) treatment cycle: two groups with cancer (222 women without an infertility diagnosis and 48 women with an infertility diagnosis) and a control group without cancer (68 women with the infertility diagnosis of male factor only). Women were included only if their first ART cycle reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) occurred between 2004 and 2009. Cancer cases were identified from each State Cancer Registry from 5 years prior to initiation of ART treatment to 6 months post-initiation; mean follow-up after the first ART cycle was 2.0 years. Results: Women with cancer without an infertility diagnosis returned for a subsequent ART cycle at a lower rate (10.8 %) than those with an infertility diagnosis (31.3 %, p = 0.0010) or the control group (85.3 %, p < 0.0001). Among those who returned for a subsequent cycle, women with cancer waited a longer time to return (14.3 months without an infertility diagnosis and 8.3 months with an infertility diagnosis, p = 0.13) compared to the control group (2.8 months, p = 0.0007). The live birth rate among women who did not utilize embryo banking in their second cycle did not differ significantly across the three study groups, ranging from 25.0 and 42.9 % for women with cancer with and without an infertility diagnosis, respectively, to 36.2 % for women in the control group. Conclusions: Women with cancer without an infertility diagnosis are either less likely to return for subsequent treatment or will wait a longer time to return than women with an infertility diagnosis or those that do not have cancer. A longer-term study is necessary to assess whether these women return to use their frozen embryos after cancer treatment or are able to spontaneously conceive and if those subsequent pregnancies are adversely affected by the cancer diagnosis or therapy. © 2016 Springer Science+Business Media New York Source


Luke B.,Michigan State University | Brown M.B.,University of Michigan | Missmer S.A.,Harvard University | Spector L.G.,University of Minnesota | And 6 more authors.
Human Reproduction | Year: 2016

Study question: How do the assisted reproductive technology (ART) outcomes of women presenting for ART after cancer diagnosis compare to women without cancer? summaryanswer: The likelihood of a live birth afterARTamongwomenwith prior cancer using autologous oocytes is reduced and varies by cancer diagnosis but is similar to women without cancer when donor oocytes are used. what is known already: Premenopausal patients faced with a cancer diagnosis frequently present for fertility preservation. study design, size, duration: Population-based cohort study of women treated with ART in NY, TX and IL, USA. participants/materials, setting, methods: Women with their first ART treatment between 2004 and 2009 were identified from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System database and linked to their respective State Cancer Registries based on name, date of birth and social security number. Years were rounded, i.e. year 1 = 6-18 months before treatment. This study used reports of cancer from5 years, 6 months prior to treatment until 6 months after firstARTtreatment.Women who only presented for embryo bankingwere omitted from the analysis. The likelihood of pregnancy and of live birth withARTusing autologous oocyteswas modeled using logistic regression, with women without prior cancer as the reference group, adjusted for woman's age, parity, cumulative FSH dosage, infertility diagnosis, number of diagnoses, numberofARTcycles, State of residency and year ofARTtreatment. Results of the modeling are reported as adjusted odds ratios (AORs) and (95% confidence intervals). main results and the role of chance: The study population included 53 426 women; 441 womenwere diagnosed with cancer within 5 years prior toARTcycle start.Mean(±SD) age at cancer diagnosiswas 33.4±5.7 years; age at start ofARTtreatmentwas34.9±5.8 for women with cancer compared with 35.3±5.3 years for women without cancer (P = 0.03). Live birth rates among women using autologous oocytes differed substantially by cancer status (47.7% without cancer versus 24.7% with cancer, P < 0.0001), and cancer diagnosis (ranging from53.5% for melanomato 14.3% for breast cancer, P < 0.0001. The live birth rates amongwomenusing donor oocytes did not vary significantly by cancer status (60.4% forwomenwith any cancer versus64.5%forwomenwithout cancer), or by cancer diagnosis (ranging from57.9%for breast cancer to 63.6% for endocrine cancer).Women with breast cancer make up about one-third of all cancers in this cohort. Among women with breast cancer, 2.8% of the 106 women who underwent ART within 6 months of being diagnosed with cancer used donor oocytes compared with 34.8% of the 46 women who received ART treatment a longer time after being diagnosed with cancer (P < 0.0001).We conjecture that the former group were either unaware that they had cancer or decided to undergo ART therapy prior to cancer treatment. However, their live birth rate was only 11.7% compared with 28.8%, the overall live birth rate for all women with cancer using autologous oocytes (P < 0.0001). The live birth rate for women diagnosed with breast cancer more than 6 months before ART (23.3%) did not differ significantly from the overall live birth rate for cancer (P = 0.49). If this difference is substantiated by a larger study, it would indicate a negative effect of severe recent illness itself on ART success, rather than the poor outcomebeing only related to the destructive effects of chemotherapies on ovarian follicles. Alternatively, because of the short time difference between cancer diagnosis and ART treatment, these pre-existing cancers may have been detected due to the increased medical surveillance during ART therapy. In women who only used autologous oocytes, women with prior cancers were significantly less likely to become pregnant and to have a live birth than those without cancer (adjusted odds ratio (AOR): 0.34, [95% confidence interval (CI): 0.27, 0.42] and 0.36 [0.28, 0.46], respectively). This was also evident with specific cancer diagnoses: breast cancer (0.20 [0.13, 0.32] and 0.19 [0.11, 0.30], respectively), cervical cancer (0.36 [0.15, 0.87] and 0.33 [0.13, 0.84], respectively) and all female genital cancers (0.49 [0.27, 0.87] and 0.47 [0.25, 0.86], respectively). Of note,amongwomenwith cancerwhobecame pregnant, their likelihood of having a live birth did not differ significantly from women without cancer (85.8 versus 86.7% for women using autologous oocytes, and 85.3 versus 86.9% for women using donor oocytes). limitations, reasons for caution: Women may not have been residents of the individual States for the entire 5-year pre-ART period, and therefore somecancersmaynot havebeen identified through this linkage.As a result, the actual observed numberof cancersmay be an underestimate. In addition, the overall prevalence is low due to the age distributions. Also, because we restricted the pre-ART period to 5 years prior,wewould not have identifiedwomenwhowere survivors of early childhood cancers (younger than age 13 years at cancer diagnosis), orwho had ART more than 5 years after being diagnosed with cancer. Additional analyses are currently underway evaluating live birth outcomes after embryo banking among women with cancer prior to ART, cycles which were excluded from the analyses in this paper. Future studies are planned which will include more States, as well as linkages to vital records to obtain information on spontaneous conceptions and births, to further clarify some of the issues raised in this analysis. wider implications of the findings: Since the live birth rates using donor oocytes were not reduced in women with a prior cancer, but were reduced with autologous cycles, this suggests that factors acting in the pre- or peri-conceptional periods may be responsible for the decline. study funding/competing interests: The study was funded by grant R01 CA151973 from the National Cancer Institute, National Institutes of Health, USA. B.L. is a research consultant for the Society for Assisted Reproductive Technology. All other authors report no conflict of interest. © The Author 2015. 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