564 results on '"Malin, Jennifer"'
Search Results
202. Outpatient cancer drug costs.
- Author
-
Halbert, R. J., Zaher, Carol, Wade, Sally, Malin, Jennifer, Lawless, Grant D., and Dubois, Robert W.
- Published
- 2002
- Full Text
- View/download PDF
203. Organizational systems used by California capitated medical groups and independent practice associations to increase cancer screening.
- Author
-
Malin, Jennifer L., Kahn, Katherine, Dulai, Gareth, Farmer, Melissa M., Rideout, Jeffrey, Payne Simon, Lisa, and Ganz, Patricia A.
- Published
- 2000
- Full Text
- View/download PDF
204. Evaluating the quality of cancer care.
- Author
-
Malin, Jennifer L., Asch, Steven M., Kerr, Eve A., and McGlynn, Elizabeth A.
- Published
- 2000
- Full Text
- View/download PDF
205. The Quality of Supportive Cancer Care in the Veterans Affairs Health System and Targets for Improvement
- Author
-
Walling, Anne M., Tisnado, Diana, Asch, Steven M., Malin, Jennifer M., Pantoja, Philip, Dy, Sydney M., Ettner, Susan L., Zisser, Ann P., Schreibeis-Baum, Hannah, Lee, Martin, and Lorenz, Karl A.
- Abstract
IMPORTANCE Characterizing the quality of supportive cancer care can guide quality improvement. OBJECTIVE To evaluate nonhospice supportive cancer care comprehensively in a national sample of veterans. DESIGN, SETTING, AND PARTICIPANTS Using a retrospective cohort study design, we measured evidence-based cancer care processes using previously validated indicators of care quality in patients with advanced cancer, addressing pain, nonpain symptoms, and information and care planning among 719 veterans with a 2008 Veterans Affairs Central Cancer Registry diagnosis of stage IV colorectal (37.0%), pancreatic (29.8%), or lung (33.2%) cancer. MAIN OUTCOMES AND MEASURES We abstracted medical records from diagnosis for 3 years or until death among eligible veterans (lived ≥30 days following diagnosis with ≥1 Veterans Affairs hospitalization or ≥2 Veterans Affairs outpatient visits). Each indicator identified a clinical scenario and an appropriate action. For each indicator for which a veteran was eligible, we determined whether appropriate care was provided. We also determined patient-level quality overall and by pain, nonpain symptoms, and information and care planning domains. RESULTS Most veterans were older (mean age, 66.2 years), male (97.2%), and white (74.3%). Eighty-five percent received both inpatient and outpatient care, and 92.5% died. Overall, the 719 veterans triggered a mean of 11.7 quality indicators (range, 1-22) and received a mean 49.5% of appropriate care. Notable gaps in care were that inpatient pain screening was common (96.5%) but lacking for outpatients (58.1%). With opioids, bowel prophylaxis occurred for only 52.2% of outpatients and 70.5% of inpatients. Few patients had a timely dyspnea evaluation (15.8%) or treatment (10.8%). Outpatient assessment of fatigue occurred for 31.3%. Of patients at high risk for diarrhea from chemotherapy, 24.2% were offered appropriate antidiarrheals. Only 17.7% of veterans had goals of care addressed in the month after a diagnosis of advanced cancer, and 63.7% had timely discussion of goals following intensive care unit admission. Most decedents (86.4%) were referred to palliative care or hospice before death. Single- vs multiple-fraction radiotherapy should have been considered in 28 veterans with bone metastasis, but none were offered this option. CONCLUSIONS AND RELEVANCE These care gaps reflect important targets for improving the patient and family experience of cancer care.
- Published
- 2013
- Full Text
- View/download PDF
206. Patient Centered Experiences in Breast Cancer
- Author
-
Kahn, Katherine L., Schneider, Eric C., Malin, Jennifer L., Adams, John L., and Epstein, Arnold M.
- Abstract
Among breast cancer patients, tamoxifen use is associated with reduced risk of disease relapse and death, but it is often difficult for women to sustain therapy during the 5 years required to obtain maximum benefit.
- Published
- 2007
- Full Text
- View/download PDF
207. Understanding cancer patients’ experience and outcomes: development and pilot study of the Cancer Care Outcomes Research and Surveillance patient survey
- Author
-
Malin, Jennifer, Ko, Clifford, Ayanian, John, Harrington, David, Nerenz, David, Kahn, Katherine, Ganther-Urmie, Julie, Catalano, Paul, Zaslavsky, Alan, Wallace, Robert, Guadagnoli, Edward, Arora, Neeraj, Roudier, Maryse, and Ganz, Patricia
- Abstract
The National Cancer Institute’s Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium is conducting a population-based study of newly diagnosed patients with lung and colorectal cancer to describe the experience of persons living with cancer and to understand which barriers present the most significant obstacles to their receipt of appropriate care. The keystone to this effort is the baseline patient survey administered approximately 4 months after diagnosis.We developed a survey to obtain information from patients newly diagnosed with lung and colorectal cancer about their personal characteristics, decision making, experience of care, and outcomes. We conducted a pilot study to evaluate the feasibility of a lengthy and clinically detailed interview in a convenience sample of patients within 8 months of diagnosis (n=71).The median length of the interviews was 75 min for patients with lung cancer (range 43–130) and 82 min for patients with colorectal cancer (range 46–119). Most patients had received some form of treatment for their cancer: 66.1% had undergone surgery, 28.2% had received radiation therapy, and 54.9% were treated with chemotherapy. In addition, 26.7% reported their overall health was less than 70 on a 0–100 scale, demonstrating that patients with substantial health impairment were able to complete the survey.A clinically detailed survey of newly diagnosed lung and colorectal cancer patients is feasible. A modified version of this survey is being fielded by the CanCORS Consortium and should provide much needed population-based data regarding patients’ experiences across the continuum of cancer care and their outcomes.
- Published
- 2006
- Full Text
- View/download PDF
208. Re: Personalized Medicine and Cancer Supportive Care: Appropriate Use of Colony-Stimulating Factor Support of Chemotherapy.
- Author
-
Potosky, Arnold L., Malin, Jennifer L., Kim, Benjamin, Chrischilles, Elizabeth A., and Weeks, Jane C.
- Subjects
- *
LETTERS to the editor , *COLONY-stimulating factors (Physiology) , *INDIVIDUALIZED medicine - Abstract
A letter to the editor is presented in response to the article on the appropriate use of colony-stimulating factors (CSFs) in personalized medicine and cancer supportive care.
- Published
- 2011
- Full Text
- View/download PDF
209. Early dissemination of bevacizumab for advanced colorectal cancer: a prospective cohort study
- Author
-
Provenzale, Dawn, Fouad, Mona N., Wallace, Robert, Grambow, Steven C., Abbott, David H., Zafar, S. Yousuf, Kolimaga, Jane T., Weeks, Jane C., Ganz, Patricia A., Malin, Jennifer L., Kahn, Katherine L., Zullig, Leah L., Catalano, Paul, West, Dee W., Ayanian, John Z., and Schrag, Deborah
- Subjects
genetic structures ,eye diseases ,3. Good health - Abstract
BackgroundWe describe early dissemination patterns for first-line bevacizumab given for metastatic colorectal cancer treatment.MethodsWe analyzed patient surveys and medical records for a population-based cohort with metastatic colorectal cancer treated in multiple regions and health systems in the United States (US). Eligible patients were diagnosed with metastatic colorectal cancer and initiated first-line chemotherapy after US Food & Drug Administration (FDA) bevacizumab approval in February 2004. First-line bevacizumab therapy was defined as receiving bevacizumab within 8 weeks of starting chemotherapy for metastatic colorectal cancer. We evaluated factors associated with first-line bevacizumab treatment using logistic regression.ResultsAmong 355 patients, 31% received first-line bevacizumab in the two years after FDA approval, including 26% of men, 41% of women, and 16% of those ≥ 75 years. Use rose sharply within 6 months after FDA approval, then plateaued. 20% of patients received bevacizumab in combination with irinotecan; 53% received it with oxaliplatin. Men were less likely than women to receive bevacizumab (adjusted OR 0.55; 95% CI 0.32-0.93; p = 0.026). Patients ≥ 75 years were less likely to receive bevacizumab than patients < 55 years (adjusted OR 0.13; 95% CI 0.04-0.46; p = 0.001).ConclusionsOne-third of eligible metastatic colorectal cancer patients received first-line bevacizumab shortly after FDA approval. Most patients did not receive bevacizumab as part of the regimen used in the pivotal study leading to FDA approval.
210. Providing Cancer Care: Individual or Team Sport?
- Author
-
Keating, Nancy L. and Malin, Jennifer L.
- Subjects
- *
LUNG cancer patients , *PHYSICIANS , *PRIMARY care , *MEDICAL specialties & specialists , *MEDICAL care - Abstract
The article presents the authors' comments on an article about patient, primary care, and specialist physicians' expectations about involvement in various phases of cancer care for a cohort of Canadian lung cancer patients, which appears in the current issue. The authors assert that coordination of care is one of the key roles of PCPs, and the PCPs surveyed in this study strongly supported their role in coordinating cancer care.
- Published
- 2012
- Full Text
- View/download PDF
211. Reconsidering the Veterans Health Administration: A Model and a Moment for Publicly Funded Health Care Delivery.
- Author
-
Ryoo, Joan J. and Malin, Jennifer L.
- Subjects
- *
CANCER treatment , *MEDICAL care for older people , *COMPARATIVE studies , *FEE for service (Medical fees) - Abstract
The author reflects on the Veterans Health Administration (VHA) performance in terms of cancer care in the U.S. According to the author, VHA has adhered to broadly accepted process measures in chronic disease management and preventive care including Medicare, commercial managed care, and various community health systems. The author also provides the findings of the comparative study between the treatment of older male veterans in the VHA system and fee-for-service Medicare patients.
- Published
- 2011
- Full Text
- View/download PDF
212. Hypofractionated whole breast irradiation for early-stage breast cancer--reply.
- Author
-
Bekelman, Justin E, Malin, Jennifer, and Emanuel, Ezekiel J
- Published
- 2015
- Full Text
- View/download PDF
213. Assessing the Impact of Transplant Case Management on Clinical Outcomes.
- Author
-
Crossman, Ashley, Krishnaswamy, Gita, Bannister, Wade, Bonagura, Anthony, and Malin, Jennifer
- Subjects
- *
RISK factors of pneumonia , *PATIENT aftercare , *LENGTH of stay in hospitals , *GRAFT rejection , *PATIENTS , *HEALTH outcome assessment , *RETROSPECTIVE studies , *CASE-control method , *PATIENT readmissions , *REGRESSION analysis , *HEALTH insurance reimbursement , *HEALTH insurance , *MEDICAL referrals , *CHI-squared test , *DESCRIPTIVE statistics , *RESEARCH funding , *MEDICAL case management , *DEATH , *TRANSPLANTATION of organs, tissues, etc. , *LONGITUDINAL method , *PROBABILITY theory , *DISCHARGE planning , *ORGAN donors , *EVALUATION - Abstract
OBJECTIVES: Case management is commonly used by health plans to attempt to improve the care received by their members who have complex needs, such as those who undergo transplantation. There are few observational studies evaluating the effects that transplant case management programs have on clinical outcomes following a solid organ transplant. This limits the understanding of the quantitative effectiveness of such programs. STUDY DESIGN: This retrospective cohort study of solid organ transplant recipients with access to a transplant case management program used a case-control study design. Propensity score 1:1 matching was used to balance the comparison groups on demographic and pretransplant clinical characteristics. METHODS: Health care claims data were used to determine whether program participation affected clinical outcomes following the transplant. A cohort of 1756 adults 18 years and older (878 cases and 878 controls) who had a solid organ transplant between 2018 and 2020 was followed beginning at the time of referral to transplant until 90 days following the transplant procedure. RESULTS: Transplant recipients who participated in the case management program had significantly lower 30-day and 90-day rejection rates, fewer 90-day readmissions, lower discharge mortality and 90-day mortality, and fewer bed days post transplant compared with those who did not participate in case management. CONCLUSIONS: Patients undergoing a solid organ transplant had improved clinical outcomes when they participated in a specialized case management program sponsored by their health plan. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
214. Developing a reliable, valid, and feasible plan for quality-of-care measurement for cancer: how should we measure?
- Author
-
Kahn KL, Malin JL, Adams J, Ganz PA, Kahn, Katherine L, Malin, Jennifer L, Adams, John, and Ganz, Patricia A
- Published
- 2002
- Full Text
- View/download PDF
215. Long-term follow-up of smokers following lung and colorectal cancer diagnosis.
- Author
-
Park, Elyse R., Skurla, Sarah E., Caballero, Grelda Yazmin Juarez, Friedman, Emily R., Ponzani, Colin, Wallace, Robert, Malin, Jennifer, and Keating, Nancy L.
- Abstract
Background: Continued smoking after a cancer diagnosis limits the effectiveness of treatment, increases the risk of cancer recurrence or secondary malignancies, and is associated with poorer quality of life and survival. A cancer diagnosis may provide a meaningful timepoint for quitting, but the prevalence and characteristics of continued smoking through survivorship are poorly understood. Methods: In the multi-regional Cancer Care Outcomes Research and Surveillance (CanCORS) cohort, we examined smoking rates and factors associated with continued smoking at long-term follow-up among lung and colorectal cancer patients. This paper builds upon previous CanCORS participant data addressing quit rates and associated characteristics at baseline and 5 months post-diagnosis. Results: At long-term follow-up (median 7.3 years post-diagnosis [IQR = 5.9–8.7]), 16.7% of lung cancer and 11.6% of colorectal cancer survivors continued to smoke combustible cigarettes. Factors independently associated with continued smoking at long-term follow-up included being male, younger, not married or partnered, having Medicare, Medicaid/other public or no insurance, more depression symptoms, smoking more cigarettes per day, and having a history of lung disease (p <.05). Continued smoking did not vary by lung vs. colorectal cancer diagnosis. Conclusion: Of active smokers at the time of diagnosis, an important minority of lung and colorectal cancer survivors continued to smoke well into survivorship. Understanding characteristics associated with continued smoking after a cancer diagnosis may help inform the development of tobacco treatment programs for cancer patients and survivors. Implications for survivors: While addressing smoking cessation at the time of diagnosis is critical to ensure better long-term treatment outcomes and quality of life, it is essential to continue smoking cessation discussions and efforts throughout care and survivorship. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
216. Is Race/Ethnicity Related to the Presence or Severity of Pain in Colorectal and Lung Cancer?
- Author
-
Martinez, Kathryn A., Snyder, Claire F., Malin, Jennifer L., and Dy, Sydney M.
- Subjects
- *
COLON cancer , *LUNG cancer , *CANCER pain , *HEALTH equity , *ETHNICITY , *QUALITY of life , *COHORT analysis - Abstract
Context Developing interventions to address racial/ethnic cancer pain disparities requires exploration of the role of socioeconomic status, health status, and pain severity from the time of diagnosis. Objectives To examine patterns of disparities in cancer pain by evaluating differences by race/ethnicity in the odds of reporting pain and in pain severity, controlling for key patient-level covariates. Methods This study used data from a nationally representative cohort of colorectal and lung cancer patients. Multivariable logistic regression was conducted to examine the relationship between race/ethnicity and reporting pain. Multivariable linear regression was then conducted, among those who reported pain, to determine differences in pain severity by race/ethnicity. Results The cohort included 5761 individuals (14% black, 7% Hispanic/Latino, 6% Asian or Pacific Islander, and 3% multiracial), among whom 48% reported pain. The adjusted odds of reporting differed only for multiracial patients, who were more likely to report pain than whites (odds ratio: 1.54; P = 0.036). However, among those with pain, severity was higher for black patients (β = 6.6; P ≤ 0.001) and multiracial patients (β = 4.5; P = 0.036) relative to white patients. Lower educational attainment, depressed affect, and lower levels of wealth also were associated with higher pain severity. Conclusion Although the odds of experiencing pain differed only for multiracial patients, among those reporting pain, both blacks and multiracial individuals reported higher pain severity than whites. Sociodemographic status, health status, and depression were associated with severity but did not explain the disparity. Interventions to address these disparities will need to focus on reported severity and patient-level factors. [ABSTRACT FROM AUTHOR]
- Published
- 2014
- Full Text
- View/download PDF
217. Use of Interpreters by Physicians Treating Limited English Proficient Women with Breast Cancer: Results from the Provider Survey of the Los Angeles Women's Health Study.
- Author
-
Rose, Danielle E., Tisnado, Diana M., Malin, Jennifer L., Tao, May L., Maggard, Melinda A., Adams, John, Ganz, Patricia A., and Kahn, Katherine L.
- Subjects
- *
PHYSICIANS , *BREAST cancer , *CANCER patients , *ENGLISH language - Abstract
Objective. Little is known about how cancer physicians communicate with limited English proficient (LEP) patients. We studied physician-reported use and availability of interpreters. Data Sources. A 2004 survey was fielded among physicians identified by a population-based sample of breast cancer patients. Three hundred and forty-eight physicians completed mailed surveys (response rate: 77 percent) regarding the structure and organization of care. Study Design and Settings. We used logistic regression to analyze use and availability of interpreters. Principal Findings. Most physicians reported treating LEP patients. Among physicians using interpreters within the last 12 months, 42 percent reported using trained medical interpreters, 21 percent telephone interpreter services, and 75 percent reported using untrained interpreters to communicate with LEP patients. Only one-third of physicians reported good availability of trained medical interpreters or telephone interpreter services when needed. Compared with HMO physicians, physicians in solo practice and single-specialty medical groups were less likely to report using trained medical interpreters or telephone interpreter services, and they were less likely to report good availability of these services. Conclusions. There were important practice setting differences predicting use and availability of trained medical interpreters and telephone interpretation services. These findings may have troubling implications for effective physician–patient communication critically needed during cancer treatment. [ABSTRACT FROM AUTHOR]
- Published
- 2010
- Full Text
- View/download PDF
218. Patterns of Use and Risks Associated With Erythropoiesis-Stimulating Agents Among Medicare Patients With Cancer.
- Author
-
Hershman, Dawn L., Buono, Donna L., Malin, Jennifer, McBride, Russell, Tsai, Wei Yann, and Neugut, Alfred I.
- Subjects
- *
ERYTHROPOIESIS , *ERYTHROPOIETIN , *DRUG approval , *BLOOD transfusion , *DRUG therapy , *THROMBOEMBOLISM , *THERAPEUTICS - Abstract
Background: Erythropoiesis-stimulating agents (erythropoietin and darbepoietin) have been approved to reduce the number of blood transfusions required during chemotherapy; however, concerns about the risks of venous thromboembolism and mortality exist. [ABSTRACT FROM PUBLISHER]
- Published
- 2009
- Full Text
- View/download PDF
219. Real-World Outcomes and Value of First-Line Therapy for Metastatic Non-Small Cell Lung Cancer†.
- Author
-
DaCosta Byfield, Stacey, Chastek, Benjamin, Korrer, Stephanie, Horstman, Thomas, Malin, Jennifer, and Newcomer, Lee
- Subjects
- *
LUNG cancer treatment , *HOSPITAL care , *EVALUATION of medical care , *MEDICAL care costs , *RETROSPECTIVE studies , *TREATMENT duration - Abstract
Although physicians rely on clinical trial data to guide cancer treatment decisions, patient characteristics and outcomes often differ between real-world and clinical trial populations. We analyzed retrospective clinical data collected from a prior authorization (PA) tool linked with payer claims data to describe outcomes of first-line treatment for metastatic non-small cell lung cancer among 2,108 patients. Duration of therapy was shorter than observed in clinical trials. Healthcare costs and hospitalizations varied substantially by regimen. PA clinical data linked with administrative claims enable head-to-head comparisons of contemporary cancer treatments used in routine clinical practice, which are not available from clinical trials. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
220. The Conflicted Language of Interracial Feedback.
- Author
-
Harber, Kent D., Reeves, Stephanie, Gorman, Jamie L., Williams, Christian H., Malin, Jennifer, and Pennebaker, James W.
- Subjects
- *
PSYCHOLOGICAL feedback , *NATURAL languages , *SELF-perception - Abstract
How is the natural language of feedback affected when instructors are White and learners are minorities? The present research addressed this question using a website called Feedback Forward through which White undergraduates provided extensive open-ended responses on a poorly written essay supposedly drafted by either a Black or a White fellow student. Results revealed a dissociation between the substance and style of feedback to the Black writer. The Black writer received selectively more overt praise for his or her writing and writing skills, and more encouragement to pursue a writing-related career, replicating past studies of the positive bias. However, this positively biased feedback was conveyed in a selectively more "lenient" style, marked by a simpler and less analytic vocabulary, more personal pronouns, more positive emotion words, and syntax that more closely mimicked that of the poorly written essay. Discomfort supplying feedback moderated these effects. Increased discomfort was associated with more substantive criticism to the White writer, and with a more lenient style to the Black writer. In sum, minority learners may be receiving open-ended feedback that is a perplexing blend of explicit praise conveyed in an implicitly diminishing manner. Additional results showed that manipulated self-image concerns produced positively biased copyedits to the Black writer, replicating Harber, Stafford, and Kennedy (2010). Direct queries from the fictive writer—in the form of rating-based questions—also favored the Black writer, whose essay, ability, and prospects were rated higher than those of the White writer. This research showed a marked dissociation between the content of White instructors' feedback to Black learners and the style in which this feedback is conveyed. Instructors, especially if uncomfortable supplying feedback, gave Black learners selectively more overt praise for their talents and for their work. However, they expressed these more positive evaluations in less sophisticated and more accommodating language. This dissociation between what White instructors said to Black learners and how they said it suggests that Black learners receive mixed messages about their performances and abilities. Secondary findings reconfirm and extend past research on the positive feedback bias. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
221. Smoking Status and Survival Among a National Cohort of Lung and Colorectal Cancer Patients.
- Author
-
Japuntich, Sandra J, Kumar, Pallavi, Pendergast, Jane F, Caballero, Grelda Yazmin Juarez, Malin, Jennifer L, Wallace, Robert B, Chrischilles, Elizabeth A, Keating, Nancy L, Park, Elyse R, and Juarez Caballero, Grelda Yazmin
- Subjects
- *
COLORECTAL cancer , *LUNG cancer , *SMOKING cessation , *CANCER patients , *CANCER patient care - Abstract
Introduction: The purpose of this study was to explore the association of smoking status and clinically relevant duration of smoking cessation with long-term survival after lung cancer (LC) or colorectal cancer (CRC) diagnosis. We compared survival of patients with LC and CRC who were never-smokers, long-term, medium-term, and short-term quitters, and current smokers around diagnosis.Methods: We studied 5575 patients in Cancer Care Outcomes Research and Surveillance (CanCORS), a national, prospective observational cohort study, who provided smoking status information approximately 5 months after LC or CRC diagnosis. Smoking status was categorized as: never-smoker, quit >5 years prior to diagnosis, quit between 1-5 years prior to diagnosis, quit less than 1 year before diagnosis, and current smoker. We examined the relationship between smoking status around diagnosis with mortality using Cox regression models.Results: Among participants with LC, never-smokers had lower mortality risk compared with current smokers (HR 0.71, 95% CI 0.57 to 0.89). Among participants with CRC, never-smokers had a lower mortality risk as compared to current smokers (HR 0.79, 95% CI 0.64 to 0.99).Conclusions: Among both LC and CRC patients, current smokers at diagnosis have higher mortality than never-smokers. This effect should be further studied in the context of tumor biology. However, smoking cessation around the time of diagnosis did not affect survival in this sample.Implications: The results from our analysis of patients in the CanCORS consortium, a large, geographically diverse cohort, show that both LC and CRC patients who were actively smoking at diagnosis have worse survival as compared to never-smokers. While current smoking is detrimental to survival, cessation upon diagnosis may not mitigate this risk. [ABSTRACT FROM AUTHOR]- Published
- 2019
- Full Text
- View/download PDF
222. The Symptom Experience in Rectal Cancer Survivors.
- Author
-
Gosselin, Tracy K., Beck, Susan, Abbott, David H., Grambow, Steven C., Provenzale, Dawn, Berry, Patricia, Kahn, Katherine L., and Malin, Jennifer L.
- Subjects
- *
RECTAL cancer patients , *RECTAL cancer treatment , *CLINICAL trials , *MEDICAL databases , *CANCER chemotherapy , *ANALYSIS of variance , *CANCER patient psychology , *CHI-squared test , *CLUSTER analysis (Statistics) , *SECONDARY analysis , *DESCRIPTIVE statistics , *SYMPTOMS ,RECTUM tumors - Abstract
Context As the number of rectal cancer survivors grows, it is important to understand the symptom experience after treatment. Although data show that rectal cancer survivors experience a variety of symptoms after diagnosis, little has been done to study the way these symptoms are grouped and associated. Objectives To determine symptom prevalence and intensity in rectal cancer survivors and if clusters of survivors exist, who share similar symptom-defined survivor subgroups that may vary based on antecedent variables. Methods A secondary analysis of the Cancer Care and Outcomes Research and Surveillance database was undertaken. Cluster analysis was performed on 15-month postdiagnosis data to form post-treatment survivor subgroups, and these were examined for differences in demographic and clinical characteristics. Data were analyzed using cluster analysis, chi-square, and analysis of variance. Results A total of 275 rectal cancer survivors were included who had undergone chemotherapy, radiation therapy, and surgery. Most frequently reported symptoms included feeling “worn out” (87%), feeling “tired” (85%), and “trouble sleeping” (66%). Four symptom-defined survivor subgroups (minimally symptomatic n = 40, tired and trouble sleeping n = 138, moderate symptoms n = 42, and highly symptomatic n = 55) were identified with symptom differences existing among each subgroup. Age and being married/partnered were the only two antecedents found to differ across subgroups. Conclusion This study documents differences in the symptom experience after treatment. The identification of survivor subgroups allows researchers to further investigate tailored, supportive care strategies to minimize ongoing symptoms in those with the greatest symptom burden. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
223. Palliative Care Specialist Consultation Is Associated With Supportive Care Quality in Advanced Cancer.
- Author
-
Walling, Anne M., Tisnado, Diana, Ettner, Susan L., Asch, Steven M., Dy, Sydney M., Pantoja, Philip, Lee, Martin, Ahluwalia, Sangeeta C., Schreibeis-Baum, Hannah, Malin, Jennifer L., and Lorenz, Karl A.
- Subjects
- *
RANDOMIZED controlled trials , *PALLIATIVE treatment , *CANCER of unknown primary origin , *CANCER diagnosis , *MEDICAL care of veterans , *COHORT analysis , *MEDICAL care research , *TUMOR treatment , *LONGITUDINAL method , *VETERANS , *MEDICAL quality control , *MEDICAL referrals , *MEDICAL specialties & specialists , *MULTIVARIATE analysis , *REGRESSION analysis , *TERMINAL care , *TIME , *TUMORS , *RETROSPECTIVE studies - Abstract
Context: Although recent randomized controlled trials support early palliative care for patients with advanced cancer, the specific processes of care associated with these findings and whether these improvements can be replicated in the broader health care system are uncertain.Objectives: The aim of this study was to evaluate the occurrence of palliative care consultation and its association with specific processes of supportive care in a national cohort of Veterans using the Cancer Quality ASSIST (Assessing Symptoms Side Effects and Indicators of Supportive Treatment) measures.Methods: We abstracted data from 719 patients' medical records diagnosed with advanced lung, colorectal, or pancreatic cancer in 2008 over a period of three years or until death who received care in the Veterans Affairs Health System to evaluate the association of palliative care specialty consultation with the quality of supportive care overall and by domain using a multivariate regression model.Results: All but 54 of 719 patients died within three years and 293 received at least one palliative care consult. Patients evaluated by a palliative care specialist at diagnosis scored seven percentage points higher overall (P < 0.001) and 11 percentage points higher (P < 0.001) within the information and care planning domain compared with those without a consult.Conclusion: Early palliative care specialist consultation is associated with better quality of supportive care in three advanced cancers, predominantly driven by improvements in information and care planning. This study supports the effectiveness of early palliative care consultation in three common advanced cancers within the Veterans Affairs Health System and provides a greater understanding of what care processes palliative care teams influence. [ABSTRACT FROM AUTHOR]- Published
- 2016
- Full Text
- View/download PDF
224. Lower Patient Ratings of Physician Communication Are Associated With Unmet Need for Symptom Management in Patients With Lung and Colorectal Cancer.
- Author
-
Walling, Anne M., Keating, Nancy L., Kahn, Katherine L., Mack, Jennifer W., Malin, Jennifer, Arora, Neeraj K., Adams, John L., Antonio, Anna Liza M., and Tisnado, Diana
- Subjects
- *
CANCER patients , *CANCER patient medical care , *CHI-squared test , *COLON tumors , *COMMUNICATION , *HEALTH surveys , *LONGITUDINAL method , *LUNG tumors , *PATIENT satisfaction , *PHYSICIAN-patient relations , *QUESTIONNAIRES , *RESEARCH funding , *LOGISTIC regression analysis , *SOCIOECONOMIC factors , *CROSS-sectional method , *DATA analysis software , *DESCRIPTIVE statistics , *BRIEF Pain Inventory , *SYMPTOMS , *PREVENTION ,RECTUM tumors - Abstract
Little is known about factors associated with unmet needs for symptom management in patients with cancer. Methods Patients with a new diagnosis of lung and colorectal cancer from the diverse nationally representative Cancer Care Outcomes Research and Surveillance cohort completed a survey approximately 5 months after diagnosis (N = 5,422). We estimated the prevalence of unmet need for symptom management, defined as patients who report that they wanted help for at least one common symptom (pain, fatigue, depression, nausea/vomiting, cough, dyspnea, diarrhea) during the 4 weeks before the survey but did not receive it. We identified patient factors associated with unmet need by using logistic regression with random effects to account for clustering within study sites. Results Overall, 15% (791 of 5,422) of patients had at least one unmet need for symptom management. Adjusting for sociodemographic and clinical factors, African American race, being uninsured or poor, having early-stage lung cancer, and the presence of moderate to severe symptoms were associated with unmet need (all P < .05). Furthermore, patients who rated their physician's communication score, 80 (on a 0 to 100 scale) had adjusted rates of an unmet need for symptom management that were more than twice as high as patients who rated their physicians with a perfect communication score (23.1% v 10.0%; P < .001). Conclusion A significant minority of patients with newly diagnosed lung and colorectal cancer report unmet needs for symptom management. Interventions to improve symptom management should consider the importance of physician communication to the patient's experience of disease. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
225. Correction to: Long-term follow-up of smokers following lung and colorectal cancer diagnosis.
- Author
-
Park, Elyse R., Skurla, Sarah E., Caballero, Grelda Yazmin Juarez, Friedman, Emily R., Ponzani, Colin, Wallace, Robert, Malin, Jennifer, and Keating, Nancy L.
- Abstract
A correction to the article "Long-Term Follow-up of Smokers Following Lung and Colorectal Cancer Diagnosis" that was published online on June 1, 2022 is presented.
- Published
- 2022
- Full Text
- View/download PDF
226. Symptom Prevalence in Lung and Colorectal Cancer Patients.
- Author
-
Walling, Anne M., Weeks, Jane C., Kahn, Katherine L., Tisnado, Diana, Keating, Nancy L., Dy, Sydney M., Arora, Neeraj K., Mack, Jennifer W., Pantoja, Philip M., and Malin, Jennifer L.
- Subjects
- *
COLON cancer , *LUNG cancer , *DISEASE prevalence , *SYMPTOMS , *SEVERITY of illness index , *HEALTH outcome assessment - Abstract
Context. Relatively few data are available about symptoms among cancer patients. Objectives To describe the prevalence and severity of symptoms among a large, representative cohort of newly diagnosed cancer patients. Methods We collected survey data about symptoms (pain, fatigue, depression, nausea/vomiting, cough, dyspnea, and diarrhea) from 5422 patients with incident lung and colorectal cancer from the diverse, nationally representative Cancer Care Outcomes Research and Surveillance Consortium cohort. We described the prevalence of any symptoms and moderate/severe symptoms approximately four to six months after diagnosis. We used logistic regression to identify patient and clinical characteristics associated with symptoms, and calculated adjusted proportions of patients with symptoms. Results In total, 5067 (93.5%) patients reported at least one symptom in the four weeks before their survey, with 51% reporting at least one moderate/severe symptom. Lung cancer patients reported more symptoms than colorectal cancer patients. Patients who received treatment or had more comorbidities were more likely to report symptoms. For example, after adjustment, patients who received chemotherapy during the six weeks before the survey were more likely than others to report at least one symptom (97.3% vs. 90.8%, P < 0.001), and at least one moderate/severe symptom (56.8% vs. 46.2%, P < 0.001). After adjustment, early- vs. late-stage patients did not differ in reports of at least one symptom (93.6% vs. 93.4%, P = 0.853) and differed only slightly in reports of at least one moderate/severe symptom (53.3% vs. 49.6%, P = 0.009). Conclusion Most recently diagnosed lung and colorectal cancer patients have cancer-related symptoms regardless of stage, and more than half have at least one moderate/severe symptom. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
227. Uptake and Costs of Hypofractionated vs Conventional Whole Breast Irradiation After Breast Conserving Surgery in the United States, 2008-2013.
- Author
-
Bekelman, Justin E., Sylwestrzak, Gosia, Barron, John, Liu, Jinan, Epstein, Andrew J., Freedman, Gary, Malin, Jennifer, and Emanuel, Ezekiel J.
- Subjects
- *
CANCER radiotherapy , *BREAST cancer treatment , *CANCER treatment , *MEDICAL care costs , *CANCER in women , *IRRADIATION , *BREAST surgery , *ECONOMICS , *THERAPEUTICS - Abstract
IMPORTANCE Based on randomized evidence, expert guidelines in 2011 endorsed shorter, hypofractionated whole breast irradiation (WBI) for selected patients with early-stage breast cancer and permitted hypofractionated WBI for other patients. OBJECTIVES To examine the uptake and costs of hypofractionated WBI among commercially insured patients in the United States. DESIGN, SETTING, AND PARTICIPANTS Retrospective, observational cohort study, using administrative claims data from 14 commercial health care plans covering 7.4%of US adult women in 2013, we classified patients with incident early-stage breast cancer treated with lumpectomy and WBI from 2008 and 2013 into 2 cohorts: (1) the hypofractionation-endorsed cohort (n = 8924) included patients aged 50 years or older without prior chemotherapy or axillary lymph node involvement and (2) the hypofractionation-permitted cohort (n = 6719) included patients younger than 50 years or those with prior chemotherapy or axillary lymph node involvement. EXPOSURES Hypofractionated WBI (3-5 weeks of treatment) vs conventional WBI (5-7 weeks of treatment). MAIN OUTCOMES AND MEASURES Use of hypofractionated and conventional WBI, total and radiotherapy-related health care expenditures, and patient out-of-pocket expenses. Patient and clinical characteristics included year of treatment, age, comorbid disease, prior chemotherapy, axillary lymph node involvement, intensity-modulated radiotherapy, practice setting, and other contextual variables. RESULTS Hypofractionated WBI increased from 10.6%(95%CI, 8.8%-12.5%) in 2008 to 34.5%(95%CI, 32.2%-36.8%) in 2013 in the hypofractionation-endorsed cohort and from 8.1% (95%CI, 6.0%-10.2%) in 2008 to 21.2%(95%CI, 18.9%-23.6%) in 2013 in the hypofractionation-permitted cohort. Adjusted mean total health care expenditures in the 1 year after diagnosis were $28 747 for hypofractionated and $31 641 for conventional WBI in the hypofractionation-endorsed cohort (difference, $2894; 95%CI, $1610-$4234; P < .001) and $64 273 for hypofractionated and $72 860 for conventional WBI in the hypofractionation-permitted cohort (difference, $8587; 95%CI, $5316-$12 017; P < .001). Adjusted mean total 1-year patient out-of-pocket expenses were not significantly different between hypofractionated vs conventional WBI in either cohort. CONCLUSIONS AND RELEVANCE Hypofractionated WBI after breast conserving surgery increased among women with early-stage breast cancer in 14 US commercial health care plans between 2008 and 2013. However, only 34.5%of patients with hypofractionationendorsed and 21.2%with hypofractionation-permitted early-stage breast cancer received hypofractionated WBI in 2013. [ABSTRACT FROM AUTHOR]
- Published
- 2014
- Full Text
- View/download PDF
228. Quality of Prostate Cancer Care Among Rural Men in the Veterans Health Administration.
- Author
-
Skolarus, Ted A., Chan, Stephanie, Shelton, Jeremy B., Antonio, Anna Liza, Sales, Anne E., Malin, Jennifer L., and Saigal, Christopher S.
- Subjects
- *
PROSTATE cancer treatment , *COMPARATIVE studies , *RURAL geography , *MEDICAL quality control , *MEDICAL care costs - Abstract
BACKGROUND: Patient travel distances, coupled with variation in facility-level resources, create barriers for prostate cancer care in the Veterans Health Administration integrated delivery system. For these reasons, the authors investigated the degree to which these barriers impact the quality of prostate cancer care. METHODS: The Veterans Affairs Central Cancer Registry was used to identify all men who were diagnosed with prostate cancer in 2008. Patient residence was characterized using Rural Urban Commuting Area codes. The authors then examined whether rural residence, compared with urban residence, was associated with less access to cancer-related resources and worse quality of care for 5 prostate cancer quality measures. RESULTS: Approximately 25% of the 11,368 patients who were diagnosed with prostate cancer in 2008 lived in either a rural area or a large town. Rural patients tended to be white (62% urban vs 86% rural) and married (47% urban vs 63% rural), and they tended to have slightly higher incomes (all P<.01) but similar tumor grade (P = .23) and stage (P = .12) compared with urban patients. Rural patients were significantly less likely to be treated at facilities with comprehensive cancer resources, although they received a similar or better quality of care for 4 of the 5 prostate cancer quality measures. The time to prostate cancer treatment was similar (rural patients vs urban patients, 96.6 days vs 105.7 days). CONCLUSIONS: Rural patients with prostate cancer had less access to comprehensive oncology resources, although they received a similar quality of care, compared with their urban counterparts in the Veterans Health Administration integrated deliv-ery system. A better understanding of the degree to which facility factors contribute to the quality of cancer care may assist other organizations involved in rural health care delivery. [ABSTRACT FROM AUTHOR]
- Published
- 2013
- Full Text
- View/download PDF
229. Implementing a breast cancer registry and treatment plan/summary program in clinical practice: A pilot program.
- Author
-
Partridge, Ann H., Norris, Virginia W., Blinder, Victoria S., Cutter, Bruce A., Halpern, Michael T., Malin, Jennifer, Neuss, Michael N., and Wolff, Antonio C.
- Subjects
- *
BREAST cancer treatment , *TREATMENT effectiveness , *QUALITY of life , *MEDICAL practice , *LONGITUDINAL method , *DATA analysis , *HEALTH outcome assessment - Abstract
BACKGROUND: There is a need to better measure and improve the quality of oncology care and improve communication with patients and other providers. The American Society of Clinical Oncology Breast Cancer Registry (BCR) pilot evaluated the feasibility and acceptability of prospective data collection for quality assessment in daily clinical practice. Data were used to create and share treatment plans/summaries (TPSs) at the point of care. METHODS: Using a web-based tool, 20 diverse practices entered clinical data on each new early-stage breast cancer patient into the BCR for 14 months (September 2009 through November 2010). The tool created individual TPSs that were shared with patients. Practices received practice-specific and aggregate BCR quality measures data, participated in a survey, and received a participation stipend. RESULTS: Twenty practices entered 2014 patients into the BCR, collecting demographic, clinical, and treatment information. Fifty-two percent of practice participants replied to an end-of-pilot survey: 73% were satisfied with the BCR and web-based tool, 31% expressed concern regarding time and effort, and 52% reported additional practice costs during the pilot. Among those who created or shared the TPSs, 90% thought the documents improved oncologist-patient communication, and 95% favored using BCR data for practice quality improvement. CONCLUSIONS: Prospective data collection for quality assessment is feasible and allows sharing of TPSs with patients at the point of care. Future efforts should focus on decreasing implementation burden to practices, broadening participation, examining costs, and, most importantly, assessing its effects on patient outcomes. Cancer 2013. © 2012 American Cancer Society. [ABSTRACT FROM AUTHOR]
- Published
- 2013
- Full Text
- View/download PDF
230. The quality of supportive care among inpatients dying with advanced cancer.
- Author
-
Walling, Anne, Asch, Steven, Lorenz, Karl, Malin, Jennifer, Roth, Carol, Barry, Tod, and Wenger, Neil
- Subjects
- *
CANCER patients , *MEDICAL centers , *MEDICAL records , *HOSPITAL care , *CANCER treatment , *OPIOIDS - Abstract
Purpose: Managing symptoms and communicating effectively are essential aspects of providing high-quality cancer care, especially among patients with advanced cancer. The purpose of this study is to apply novel quality indicators to measure the quality of supportive care provided to patients with advanced cancer who died in a large university medical center. Methods: Cancer quality ASSIST is a comprehensive quality indicator (QI) set that includes 92 symptom and care planning indicators, of which we piloted 15 applicable to persons with advanced cancer who died in the hospital setting. We evaluated medical records of all adult terminal hospitalizations with lengths of stay ≥3 days at one university medical center between April 2005 and April 2006. Results: Of 496 decedents, 118 had advanced cancer (mean age 60, 54 % male). Forty-five percent received chemotherapy or radiation in the month prior to or during admission. During the hospitalization, 56 % of the patients spent time in the ICU (median length of stay 8 days), one in five received first-time hemodialysis, and 23 % had a ventilator withdrawn anticipating death. The 118 patients triggered 596 quality indicators of which 476 passed (QI level pass rate 80 %, range 50-100 %). Pain assessment and management were consistently performed; however, other cancer supportive care needed improvement: 26 % of patients not receiving cancer therapy who had nausea and vomiting received inadequate follow-up, more than one quarter of patients with dyspnea had this symptom inadequately addressed, and 29 % of patients taking long-acting opioids were not prescribed a bowel regimen. Timely discussion of patient preferences upon admission to the ICU or initiation of mechanical ventilation occurred in 64 and 69 % of cases, respectively. Conclusions: This set of quality indicators can evaluate the quality of supportive and end-of-life care provided to inpatients dying with advanced cancer and identify aspects of care that need improvement. [ABSTRACT FROM AUTHOR]
- Published
- 2012
- Full Text
- View/download PDF
231. A snapshot of smokers after lung and colorectal cancer diagnosis.
- Author
-
Park, Elyse R., Japuntich, Sandra J., Rigotti, Nancy A., Traeger, Lara, He, Yulei, Wallace, Robert B., Malin, Jennifer L., Zallen, Jennifer P., and Keating, Nancy L.
- Subjects
- *
LUNG cancer diagnosis , *COLON cancer diagnosis , *CIGARETTE smokers , *TREATMENT effectiveness , *CARDIOVASCULAR diseases , *CANCER chemotherapy , *CANCER risk factors , *DISEASES - Abstract
BACKGROUND: Continued smoking after a cancer diagnosis may adversely affect treatment effectiveness, subsequent cancer risk, and survival. The prevalence of continued smoking after cancer diagnosis is understudied. METHODS: In the multi-regional Cancer Care Outcomes Research and Surveillance cohort (lung cancer [N = 2456], colorectal cancer [N = 3063]), the authors examined smoking rates at diagnosis and 5 months after diagnosis and also study factors associated with continued smoking. RESULTS: Overall, 90.2% of patients with lung cancer and 54.8% of patients with colorectal cancer reported ever smoking. At diagnosis, 38.7% of patients with lung cancer and 13.7% of patients with colorectal cancer were smoking; whereas, 5 months after diagnosis, 14.2% of patients with lung cancer and 9.0% of patients with colorectal cancer were smoking. Factors that were associated independently with continued smoking among patients with nonmetastatic lung cancer were coverage by Medicare, other public/unspecified insurance, not receiving chemotherapy, not undergoing surgery, prior cardiovascular disease, lower body mass index, lower emotional support, and higher daily ever-smoking rates (all P < .05). Factors that were associated independently with continued smoking among patients with nonmetastatic colorectal cancer were male sex, high school education, being uninsured, not undergoing surgery, and higher daily ever-smoking rates (all P < .05). CONCLUSIONS: After diagnosis, a substantial minority of patients with lung and colorectal cancers continued smoking. Patients with lung cancer had higher rates of smoking at diagnosis and after diagnosis; whereas patients with colorectal cancer were less likely to quit smoking after diagnosis. Factors that were associated with continued smoking differed between lung and colorectal cancer patients. Future smoking-cessation efforts should examine differences by cancer type, particularly when comparing cancers for which smoking is a well established risk factor versus cancers for which it is not. Cancer 2012;118: 3153-64. © 2012 American Cancer Society. [ABSTRACT FROM AUTHOR]
- Published
- 2012
- Full Text
- View/download PDF
232. Prevalence, Predictors, and Patient Outcomes Associated with Physician Co-management: Findings from the Los Angeles Women's Health Study.
- Author
-
Rose, Danielle E., Tisnado, Diana M., Tao, May L., Malin, Jennifer L., Adams, John L., Ganz, Patricia A., and Kahn, Katherine L.
- Subjects
- *
WOMEN'S health , *BREAST cancer patients , *MEDICAL quality control - Abstract
Background Physician co-management, representing joint participation in the planning, decision-making, and delivery of care, is often cited in association with coordination of care. Yet little is known about how physicians manage tasks and how their management style impacts patient outcomes. Objectives To describe physician practice style using breast cancer as a model. We characterize correlates and predictors of physician practice style for 10 clinical tasks, and then test for associations between physician practice style and patient ratings of care. Methods We queried 347 breast cancer physicians identified by a population-based cohort of women with incident breast cancer regarding care using a clinical vignette about a hypothetical 65-year-old diabetic woman with incident breast cancer. To test the association between physician practice style and patient outcomes, we linked medical oncologists' responses to patient ratings of care (physician n = 111; patient n = 411). Results After adjusting for physician and practice setting characteristics, physician practice style varied by physician specialty, practice setting, financial incentives, and barriers to referrals. Patients with medical oncologists who co-managed tasks had higher patient ratings of care. Conclusion Physician practice style for breast cancer is influenced by provider and practice setting characteristics, and it is an important predictor of patient ratings. We identify physician and practice setting factors associated with physician practice style and found associations between physician co-management and patient outcomes (e.g., patient ratings of care). [ABSTRACT FROM AUTHOR]
- Published
- 2012
- Full Text
- View/download PDF
233. Novel adverse events of bevacizumab in the US FDA adverse event reporting system database: a disproportionality analysis.
- Author
-
Shamloo BK, Chhabra P, Freedman AN, Potosky A, Malin J, Weiss Smith S, Shamloo, Behrooz K, Chhabra, Pankdeep, Freedman, Andrew N, Potosky, Arnold, Malin, Jennifer, and Weiss Smith, Sheila
- Abstract
Background: Bevacizumab is the first in its class, vascular endothelial growth factor (VEGF) inhibitor that was initially approved by the US FDA in 2004 for the treatment of metastatic colon cancer and other solid tumors. Preapproval clinical trials, particularly for oncology drugs, are limited in their ability to detect certain adverse effects and, therefore, the FDA and pharmaceutical sponsors collect and monitor reports of adverse events (AEs) following approval.Objective: The purpose of this study was to screen the FDA's Adverse Event Reporting System (AERS) database for novel AEs that may be attributed to bevacizumab.Methods: The FDA AERS database was used to identify all AE reports for bevacizumab from February 2004 to September 2009. Disproportionality analysis was conducted for bevacizumab against all other drugs in the background by setting statistical significance at proportional reporting ratio (PRR) ≥2, observed case count ≥3 and chi-square ≥4. Subsequent clinical evaluation was performed to determine the clinical relevance of the findings and to group related events.Results: A total of 523 Preferred Terms (PTs) were disproportionally reported; following clinical review 63 (12%) were found to be both unlabelled and of clinical importance. These PTs were grouped into 15 clinical disorder groups. Among the clinical disorders, electrolyte abnormalities had the greatest number of reports (n = 426) followed by cardiovascular events (n = 421), gastrointestinal events (n = 345), nervous system disorders (n = 106) and pneumonitis (n = 96). On sensitivity analysis, a number of clinically important unlabelled disorders, such as necrotizing fasciitis, vessel wall disorders, arrhythmia and conduction disorder and autoimmune thrombocytopenia still met the statistical significance criteria.Conclusions: During the study period, out of 12 010 AE reports mentioning bevacizumab, it was listed as the suspect drug in 94.2% of the reports. Our disproportionality analysis identified many events that are already recognized as AEs of bevacizumab, but it also identified a number of clinically important unlabelled terms, which if confirmed in future studies would have potential implications for use of bevacizumab in clinical practice. [ABSTRACT FROM AUTHOR]- Published
- 2012
- Full Text
- View/download PDF
234. End-of-life care discussions among patients with advanced cancer: a cohort study.
- Author
-
Mack JW, Cronin A, Taback N, Huskamp HA, Keating NL, Malin JL, Earle CC, Weeks JC, Mack, Jennifer W, Cronin, Angel, Taback, Nathan, Huskamp, Haiden A, Keating, Nancy L, Malin, Jennifer L, Earle, Craig C, and Weeks, Jane C
- Abstract
Background: National guidelines recommend that physicians discuss end-of-life (EOL) care planning with patients with cancer whose life expectancy is less than 1 year.Objective: To evaluate the incidence of EOL care discussions for patients with stage IV lung or colorectal cancer and where, when, and with whom these discussions take place.Design: Prospective cohort study of patients diagnosed with lung or colorectal cancer from 2003 to 2005.Setting: Participants lived in Northern California, Los Angeles County, North Carolina, Iowa, or Alabama or received care in 1 of 5 large HMOs or 1 of 15 Veterans Health Administration sites.Patients: 2155 patients with stage IV lung or colorectal cancer.Measurements: End-of-life care discussions reported in patient and surrogate interviews or documented in medical records through 15 months after diagnosis.Results: 73% of patients had EOL care discussions identified by at least 1 source. Among the 1470 patients who died during follow-up, 87% had EOL care discussions, compared with 41% of the 685 patients who were alive at the end of follow-up. Of the 1081 first EOL care discussions documented in records, 55% occurred in the hospital. Oncologists documented EOL care discussions with only 27% of their patients. Among 959 patients with documented EOL care discussions who died during follow-up, discussions took place a median of 33 days before death.Limitations: The depth and quality of EOL care discussions was not evaluated. Much of the information about discussions came from surrogates of patients who died before baseline interviews could be obtained.Conclusion: Although most patients with stage IV lung or colorectal cancer discuss EOL care planning with physicians before death, many discussions occur during acute hospital care, with providers other than oncologists, and late in the course of illness.Primary Funding Source: National Cancer Institute and Department of Veterans Affairs. [ABSTRACT FROM AUTHOR]- Published
- 2012
- Full Text
- View/download PDF
235. Colony-Stimulating Factor Use and Impact on Febrile Neutropenia Among Patients with Newly Diagnosed Breast, Colorectal, or Non-Small Cell Lung Cancer Who Were Receiving Chemotherapy.
- Author
-
McCune, Jeannine S., Sullivan, Sean D., Blough, David K., Clarke, Lauren, McDermott, Cara, Malin, Jennifer, and Ramsey, Scott
- Subjects
- *
COLONY-stimulating factors (Physiology) , *FEBRILE neutropenia , *DRUG therapy , *BREAST cancer patients , *COLON cancer patients , *PHARMACISTS - Abstract
Study Objective To determine the impact of primary prophylactic colony-stimulating 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 guideline-directed prescribing of primary prophylactic CSFs can improve clinical outcomes. [ABSTRACT FROM AUTHOR]
- Published
- 2012
- Full Text
- View/download PDF
236. Using breast cancer quality indicators in a vulnerable population.
- Author
-
Chen, Formosa, Puig, Melissa, Yermilov, Irina, Malin, Jennifer, Schneider, Eric C., Epstein, Arnold M., Kahn, Katherine L., Ganz, Patricia A., and Gibbons, Melinda Maggard
- Subjects
- *
BREAST cancer , *MEDICAL care , *SICK people , *MEDICAL quality control , *LEGAL compliance , *PUBLIC hospitals - Abstract
BACKGROUND: [ABSTRACT FROM AUTHOR]
- Published
- 2011
- Full Text
- View/download PDF
237. Development and validation of a prediction model for the risk of developing febrile neutropenia in the first cycle of chemotherapy among elderly patients with breast, lung, colorectal, and prostate cancer.
- Author
-
Hosmer W, Malin J, Wong M, Hosmer, Wylie, Malin, Jennifer, and Wong, Mitchell
- Abstract
Purpose: Current guidelines recommend prophylactic use of granulocyte-colony stimulating factors (G-CSF) when febrile neutropenia (FN) risk is greater than 20%. Advanced age is a risk factor for FN; however, little is known about the impact of other factors on the incidence of FN in an older population.Patients and Methods: We analyzed SEER-Medicare data (1994-2005) to develop and validate a prediction model for hospitalization with fever, infection, or neutropenia occurring after chemotherapy initiation for patients with breast, colorectal, prostate, and lung cancer.Results: In multivariate analysis (N = 58,053) independent predictors of FN included advanced stage at diagnosis [stage 2 (OR 1.29; 95% CI: 1.09-1.53), stage 3 (1.38; 95% CI: 1.19-1.60), and stage 4 (1.57; 95% CI: 1.35-1.83)], number of associated comorbid conditions [one condition (1.13; 95% CI: 1.02-1.28), two conditions (1.39; 95% CI: 1.22-1.57), and three or more conditions (1.81; 95% CI: 1.61-2.04)], receipt of myelosuppressive chemotherapy (1.11; 95% CI: 0.94-1.32), and receipt of chemotherapy within 1 month of diagnosis [1 to 3 months (0.70; 95% CI: 0.62-0.80) and greater than 3 months (0.63; 95% CI: 0.55-0.73)].Conclusion: We created a prediction model for febrile neutropenia with first cycle of chemotherapy in a large population of elderly patients with common malignancies. [ABSTRACT FROM AUTHOR]- Published
- 2011
- Full Text
- View/download PDF
238. Cancer Quality-ASSIST Supportive Oncology Quality Indicator Set.
- Author
-
Dy, Sydney M., Lorenz, Karl A., ONeill, Sean M., Asch, Steven M., Walling, Anne M., Tisnado, Diana, Antonio, Anna Liza, and Malin, Jennifer L.
- Subjects
- *
ONCOLOGY , *CLINICAL indications , *CANCER diagnosis , *CANCER treatment , *THERAPEUTICS - Abstract
The article focuses on a study which evaluated a comprehensive set of 92 supportive oncology quality indicators called Cancer Quality-ASSIST. Cancer Quality is composed of outpatient and hospital indicators for symptoms commonly related to cancer and its treatment. The study found that of the 92 Cancer Quality-ASSIST quality indicators for symptoms, treatment toxicity and information and care planning, 41 are sufficiently feasible, reliable and valid for application in cancer settings.
- Published
- 2010
- Full Text
- View/download PDF
239. The Value of Specialty Oncology Drugs.
- Author
-
Goldman, Dana P., Jena, Anupam B., Lakdawalla, Darius N., Malin, Jennifer L., Malkin, Jesse D., and Sun, Eric
- Subjects
- *
HEALTH insurance , *ONCOLOGY , *CANCER treatment , *HEALTH planning , *ANTINEOPLASTIC agents - Abstract
Objective. To estimate patients' elasticity of demand, willingness to pay, and consumer surplus for five high-cost specialty medications treating metastatic disease or hematologic malignancies. Data Source/Study Setting. Claims data from 71 private health plans from 1997 to 2005. Study Design. This is a revealed preference analysis of the demand for specialty drugs among cancer patients. We exploit differences in plan generosity to examine how utilization of specialty oncology drugs varies with patient out-of-pocket costs. Data Collection/Extraction Methods. We extracted key variables from administrative health insurance claims records. Principal Findings. A 25 percent reduction in out-of-pocket costs leads to a 5 percent increase in the probability that a patient initiates specialty cancer drug therapy. Among patients who initiate, a 25 percent reduction in out-of-pocket costs reduces the number of treatments (claims) by 1–3 percent, depending on the drug. On average, the value of these drugs to patients who use them is about four times the total cost paid by the patient and his or her insurer, although this ratio may be lower for oral specialty therapies. Conclusions. The decision to initiate therapy with specialty oncology drugs is responsive to price, but not highly so. Among patients who initiate therapy, the amount of treatment is equally responsive. The drugs we examine are highly valued by patients in excess of their total costs, although oral agents warrant further scrutiny as copayments increase. [ABSTRACT FROM AUTHOR]
- Published
- 2010
- Full Text
- View/download PDF
240. Cost-Effectiveness of Primary versus Secondary Prophylaxis with Pegfilgrastim in Women with Early-Stage Breast Cancer Receiving Chemotherapy.
- Author
-
Ramsey, Scott D., Liu, Zhimei, Boer, Rob, Sullivan, Sean D., Malin, Jennifer, Doan, Quan V., Dubois, Robert W., and Lyman, Gary H.
- Subjects
- *
COST effectiveness , *MEDICAL care costs , *BREAST cancer patients , *DRUG therapy , *FILGRASTIM , *FEBRILE neutropenia - Abstract
Objective: Prophylaxis with granulocyte colony-stimulating factor (G-CSF) reduces the risk of febrile neutropenia (FN) in patients receiving myelosuppressive chemotherapy. We estimated the incremental cost-effectiveness of G-CSF pegfilgrastim primary (starting in cycle 1 and continuing in subsequent cycles of chemotherapy) versus secondary (only after an FN event) prophylaxis in women with early-stage breast cancer receiving myelosuppressive chemotherapy with a ≥20% FN risk. Methods: A decision-analytic model was constructed from a health insurer's perspective with a lifetime study horizon. The model considers direct medical costs and outcomes related to reduced FN and potential survival benefits because of reduced FN-related mortality. Inputs for the model were obtained from the medical literature. Sensitivity analyses were conducted across plausible ranges in parameter values. Results: The incremental cost-effectiveness ratio (ICER) of pegfilgrastim as primary versus secondary prophylaxis was $48,000/FN episode avoided. Adding survival benefit from avoiding FN mortality yielded an ICER of $110,000/life-year gained (LYG) or $116,000/quality-adjusted life-year (QALY) gained. The most influential factors included FN case-fatality, FN relative risk reduction from primary prophylaxis, and age at diagnosis. Conclusions: Compared with secondary prophylaxis, the cost-effectiveness of pegfilgrastim as primary prophylaxis may be equivalent or superior to other commonly used supportive care interventions for women with breast cancer. Further assessment of the direct impact of G-CSF on short- and long-term survival is needed to substantiate these findings. [ABSTRACT FROM AUTHOR]
- Published
- 2009
- Full Text
- View/download PDF
241. Do Variations in Provider Discussions Explain Socioeconomic Disparities in Postmastectomy Breast Reconstruction?
- Author
-
Greenberg, Caprice C., Schneider, Eric C., Lipsitz, Stuart R., Ko, Clifford Y., Malin, Jennifer L., Epstein, Arnold M., Weeks, Jane C., and Kahn, Katherine L.
- Subjects
- *
SOCIAL status , *ETIOLOGY of cancer , *MEDICAL records , *SURVEYS - Abstract
Background: The use of postmastectomy reconstruction varies with socioeconomic status, but the etiology of these variations is not understood. We investigated whether these differences reflect variations in the rate or qualitative aspects of the provider's discussion of reconstruction as an option.Study Design: Data were collected through chart review and patient survey for stages I to III breast cancer patients during the National Initiative on Cancer Care Quality. Multivariable logistic regression was used to identify predictors of reconstruction and discussion of reconstruction as an option. Predictors of not receiving reconstruction despite a documented discussion were also determined.Results: There were 253 of 626 patients who received reconstruction (40.4%). Younger, more educated Caucasian women who were not overweight or receiving postmastectomy radiation were more likely to receive reconstruction. Patients who were younger, more educated, and not receiving postmastectomy radiation were more likely to have a documented discussion of reconstruction. If a discussion was documented, patients who were older, Hispanic, not born in the US, and received postmastectomy radiation were less likely to receive reconstruction. The greatest predictor of reconstruction was medical record documentation of a discussion about reconstruction.Conclusions: We observed disparities in the likelihood of reconstruction that were at least partially explained by differences in the likelihood that reconstruction was discussed. But there were also differences in the likelihood of reconstruction based on age, race, and radiation once discussions occurred. Efforts to increase and improve discussions about reconstruction may decrease disparities for this procedure. [ABSTRACT FROM AUTHOR]- Published
- 2008
- Full Text
- View/download PDF
242. Spatial patterning controls neuron numbers in the Drosophila visual system.
- Author
-
Malin JA, Chen YC, Simon F, Keefer E, and Desplan C
- Subjects
- Animals, Optic Lobe, Nonmammalian metabolism, Optic Lobe, Nonmammalian cytology, Signal Transduction, Visual Pathways metabolism, Apoptosis, Bone Morphogenetic Proteins metabolism, Body Patterning, Interneurons metabolism, Interneurons cytology, Gene Expression Regulation, Developmental, Cell Count, Cell Proliferation, Neurogenesis physiology, Drosophila Proteins metabolism, Drosophila Proteins genetics, Neurons metabolism, Neurons cytology, Drosophila melanogaster metabolism
- Abstract
Neurons must be made in the correct proportions to communicate with the appropriate synaptic partners and form functional circuits. In the Drosophila visual system, multiple subtypes of distal medulla (Dm) inhibitory interneurons are made in distinct, reproducible numbers-from 5 to 800 per optic lobe. These neurons are born from a crescent-shaped neuroepithelium called the outer proliferation center (OPC), which can be subdivided into specific domains based on transcription factor and growth factor expression. We fate mapped Dm neurons and found that more abundant neural types are born from larger neuroepithelial subdomains, while less abundant subtypes are born from smaller ones. Additionally, morphogenetic Dpp/BMP signaling provides a second layer of patterning that subdivides the neuroepithelium into smaller domains to provide more granular control of cell proportions. Apoptosis appears to play a minor role in regulating Dm neuron abundance. This work describes an underappreciated mechanism for the regulation of neuronal stoichiometry., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
243. High-throughput identification of the spatial origins of Drosophila optic lobe neurons using single-cell mRNA-sequencing.
- Author
-
Simon F, Holguera I, Chen YC, Malin J, Valentino P, Erclik T, and Desplan C
- Abstract
The medulla is the largest neuropil of the Drosophila optic lobe. It contains about 100 neuronal types that have been comprehensively characterized morphologically and molecularly. These neuronal types are specified from a larval neuroepithelium called the Outer Proliferation Center (OPC) via the integration of temporal, spatial, and Notch-driven mechanisms. Although we recently characterized the temporal windows of origin of all medulla neurons, as well as their Notch status, their spatial origins remained unknown. Here, we isolated cells from different OPC spatial domains and performed single-cell mRNA-sequencing to identify the neuronal types produced in these domains. This allowed us to characterize in a high-throughput manner the spatial origins of all medulla neurons and to identify two new spatial subdivisions of the OPC. Moreover, our work shows that the most abundant neuronal types are produced from epithelial domains of different sizes despite being present in a similar number of copies. Combined with our previously published scRNA-seq developmental atlas of the optic lobe, our work opens the door for further studies on how specification factor expression in progenitors impacts gene expression in developing and adult neurons., Competing Interests: Declaration of Interests: The authors declare no competing interests.
- Published
- 2024
- Full Text
- View/download PDF
244. Neural specification, targeting, and circuit formation during visual system assembly.
- Author
-
Malin J and Desplan C
- Subjects
- Animals, Cell Adhesion Molecules metabolism, Cell Movement, Mammals embryology, Neuroglia cytology, Receptors, Notch metabolism, Signal Transduction, Time Factors, Body Patterning, Drosophila melanogaster embryology, Nerve Net embryology, Neurons physiology, Visual Pathways embryology
- Abstract
Like other sensory systems, the visual system is topographically organized: Its sensory neurons, the photoreceptors, and their targets maintain point-to-point correspondence in physical space, forming a retinotopic map. The iterative wiring of circuits in the visual system conveniently facilitates the study of its development. Over the past few decades, experiments in Drosophila have shed light on the principles that guide the specification and connectivity of visual system neurons. In this review, we describe the main findings unearthed by the study of the Drosophila visual system and compare them with similar events in mammals. We focus on how temporal and spatial patterning generates diverse cell types, how guidance molecules distribute the axons and dendrites of neurons within the correct target regions, how vertebrates and invertebrates generate their retinotopic map, and the molecules and mechanisms required for neuronal migration. We suggest that basic principles used to wire the fly visual system are broadly applicable to other systems and highlight its importance as a model to study nervous system development., Competing Interests: The authors declare no competing interest.
- Published
- 2021
- Full Text
- View/download PDF
245. Defining Quality Metrics for Active Surveillance: The Michigan Urological Surgery Improvement Collaborative Experience. Letter.
- Author
-
Gaylis FD, Cooperberg MR, Chen RC, Malin J, Loeb S, Witte JS, Carroll PR, Cohen ES, Dato PE, Lin DW, Zheng Y, Seibert TM, Setzler C, Wilt W, Gomez SL, Chan JML, and Catalona WJ
- Subjects
- Benchmarking, Humans, Michigan, Quality Improvement, Urology, Watchful Waiting
- Published
- 2021
- Full Text
- View/download PDF
246. Measure Scan and Synthesis of Palliative and End-of-Life Process Quality Measures for Advanced Cancer.
- Author
-
O'Hanlon CE, Lindvall C, Lorenz KA, Giannitrapani KF, Garrido M, Asch SM, Wenger N, Malin J, Dy SM, Canning M, Gamboa RC, and Walling AM
- Subjects
- Death, Humans, Palliative Care, Quality Indicators, Health Care, United States, Advance Care Planning, Neoplasms therapy, Terminal Care
- Abstract
Purpose: Monitoring and improving the quality of palliative and end-of-life cancer care remain pressing needs in the United States. Among existing measures that assess the quality of palliative and end-of-life care, many operationalize similar concepts. We identified existing palliative care process measures and synthesized these measures to aid stakeholder prioritization that will facilitate health system implementation in patients with advanced cancer., Methods: We reviewed MEDLINE/PubMed-indexed articles for process quality measures related to palliative and end-of-life care for patients with advanced cancer, supplemented by expert input. Measures were inductively grouped into "measure concepts" and higher-level groups., Results: Literature review identified 226 unique measures from 23 measure sources, which we grouped into 64 measure concepts within 12 groups. Groups were advance care planning (11 measure concepts), pain (7), dyspnea (9), palliative care-specific issues (6), other specific symptoms (17), comprehensive assessment (2), symptom assessment (1), hospice/palliative care referral (1), spiritual care (2), mental health (5), information provision (2), and culturally appropriate care (1)., Conclusion: Measure concepts covered the spectrum of care from acute symptom management to advance care planning and psychosocial needs, with variability in the number of measure concepts per group. This taxonomy of process quality measure concepts can be used by health systems seeking stakeholder input to prioritize targets for improving palliative and end-of-life care quality in patients with advanced cancer.
- Published
- 2021
- Full Text
- View/download PDF
247. Neuronal diversity and convergence in a visual system developmental atlas.
- Author
-
Özel MN, Simon F, Jafari S, Holguera I, Chen YC, Benhra N, El-Danaf RN, Kapuralin K, Malin JA, Konstantinides N, and Desplan C
- Subjects
- Anatomy, Artistic, Animals, Apoptosis, Atlases as Topic, Gene Expression Regulation, Developmental, Male, Neurons cytology, Pupa cytology, Pupa growth & development, Single-Cell Analysis, Synapses metabolism, Transcriptome genetics, Visual Pathways, Wnt Signaling Pathway, Drosophila melanogaster cytology, Drosophila melanogaster growth & development, Neurons classification, Neurons metabolism, Optic Lobe, Nonmammalian cytology, Optic Lobe, Nonmammalian growth & development
- Abstract
Deciphering how neuronal diversity is established and maintained requires a detailed knowledge of neuronal gene expression throughout development. In contrast to mammalian brains
1,2 , the large neuronal diversity of the Drosophila optic lobe3 and its connectome4-6 are almost completely characterized. However, a molecular characterization of this neuronal diversity, particularly during development, has been lacking. Here we present insights into brain development through a nearly complete description of the transcriptomic diversity of the optic lobes of Drosophila. We acquired the transcriptome of 275,000 single cells at adult and at five pupal stages, and built a machine-learning framework to assign them to almost 200 cell types at all time points during development. We discovered two large neuronal populations that wrap neuropils during development but die just before adulthood, as well as neuronal subtypes that partition dorsal and ventral visual circuits by differential Wnt signalling throughout development. Moreover, we show that the transcriptomes of neurons that are of the same type but are produced days apart become synchronized shortly after their production. During synaptogenesis we also resolved neuronal subtypes that, although differing greatly in morphology and connectivity, converge to indistinguishable transcriptomic profiles in adults. Our datasets almost completely account for the known neuronal diversity of the Drosophila optic lobes, and serve as a paradigm to understand brain development across species.- Published
- 2021
- Full Text
- View/download PDF
248. Real-World Outcomes and Value of First-Line Therapy for Metastatic Non-Small Cell Lung Cancer † .
- Author
-
DaCosta Byfield S, Chastek B, Korrer S, Horstman T, Malin J, and Newcomer L
- Subjects
- Carcinoma, Non-Small-Cell Lung drug therapy, Carcinoma, Non-Small-Cell Lung secondary, Female, Follow-Up Studies, Humans, Lung Neoplasms drug therapy, Lung Neoplasms pathology, Lymphatic Metastasis, Male, Middle Aged, Prognosis, Retrospective Studies, Survival Rate, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Carcinoma, Non-Small-Cell Lung mortality, Lung Neoplasms mortality
- Abstract
Although physicians rely on clinical trial data to guide cancer treatment decisions, patient characteristics and outcomes often differ between real-world and clinical trial populations. We analyzed retrospective clinical data collected from a prior authorization (PA) tool linked with payer claims data to describe outcomes of first-line treatment for metastatic non-small cell lung cancer among 2,108 patients. Duration of therapy was shorter than observed in clinical trials. Healthcare costs and hospitalizations varied substantially by regimen. PA clinical data linked with administrative claims enable head-to-head comparisons of contemporary cancer treatments used in routine clinical practice, which are not available from clinical trials.
- Published
- 2020
- Full Text
- View/download PDF
249. Charting the Course: Use of Clinical Pathways to Improve Value in Cancer Care.
- Author
-
Malin JL
- Subjects
- Antineoplastic Agents therapeutic use, Cost-Benefit Analysis, Drug Costs, Health Care Costs, Humans, Neoplasms drug therapy, United States, Antineoplastic Agents economics, Neoplasms economics, Neoplasms therapy
- Published
- 2020
- Full Text
- View/download PDF
250. Cherub versus brat .
- Author
-
Malin JA and Desplan C
- Subjects
- Animals, DNA-Binding Proteins genetics, Drosophila melanogaster genetics, Stem Cells, Transcription Factors genetics, Drosophila Proteins genetics, RNA, Long Noncoding
- Abstract
A long non-coding RNA molecule called cherub is a driver of tumor development., Competing Interests: JM, CD No competing interests declared, (© 2018, Malin et al.)
- Published
- 2018
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.