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Lee JK, Roy A, Jensen CD, Chan JT, Zhao WK, Levin TR, Chubak J, Halm EA, Skinner CS, Schottinger JE, Ghai NR, Burnett-Hartman AN, Kamineni A, Udaltsova N, Corley DA. Surveillance Colonoscopy Findings in Older Adults With a History of Colorectal Adenomas. JAMA Netw Open 2024; 7:e244611. [PMID: 38564216 PMCID: PMC10988351 DOI: 10.1001/jamanetworkopen.2024.4611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/05/2024] [Indexed: 04/04/2024] Open
Abstract
Importance Postpolypectomy surveillance is a common colonoscopy indication in older adults; however, guidelines provide little direction on when to stop surveillance in this population. Objective To estimate surveillance colonoscopy yields in older adults. Design, Setting, and Participants This population-based cross-sectional study included individuals 70 to 85 years of age who received surveillance colonoscopy at a large, community-based US health care system between January 1, 2017, and December 31, 2019; had an adenoma detected 12 or more months previously; and had at least 1 year of health plan enrollment before surveillance. Individuals were excluded due to prior colorectal cancer (CRC), hereditary CRC syndrome, inflammatory bowel disease, or prior colectomy or if the surveillance colonoscopy had an inadequate bowel preparation or was incomplete. Data were analyzed from September 1, 2022, to February 22, 2024. Exposures Age (70-74, 75-79, or 80-85 years) at surveillance colonoscopy and prior adenoma finding (ie, advanced adenoma vs nonadvanced adenoma). Main Outcomes and Measures The main outcomes were yields of CRC, advanced adenoma, and advanced neoplasia overall (all ages) by age group and by both age group and prior adenoma finding. Multivariable logistic regression was used to identify factors associated with advanced neoplasia detection at surveillance. Results Of 9740 surveillance colonoscopies among 9601 patients, 5895 (60.5%) were in men, and 5738 (58.9%), 3225 (33.1%), and 777 (8.0%) were performed in those aged 70-74, 75-79, and 80-85 years, respectively. Overall, CRC yields were found in 28 procedures (0.3%), advanced adenoma in 1141 (11.7%), and advanced neoplasia in 1169 (12.0%); yields did not differ significantly across age groups. Overall, CRC yields were higher for colonoscopies among patients with a prior advanced adenoma vs nonadvanced adenoma (12 of 2305 [0.5%] vs 16 of 7435 [0.2%]; P = .02), and the same was observed for advanced neoplasia (380 of 2305 [16.5%] vs 789 of 7435 [10.6%]; P < .001). Factors associated with advanced neoplasia at surveillance were prior advanced adenoma (adjusted odds ratio [AOR], 1.65; 95% CI, 1.44-1.88), body mass index of 30 or greater vs less than 25 (AOR, 1.21; 95% CI, 1.03-1.44), and having ever smoked tobacco (AOR, 1.14; 95% CI, 1.01-1.30). Asian or Pacific Islander race was inversely associated with advanced neoplasia (AOR, 0.81; 95% CI, 0.67-0.99). Conclusions and Relevance In this cross-sectional study of surveillance colonoscopy yield in older adults, CRC detection was rare regardless of prior adenoma finding, whereas the advanced neoplasia yield was 12.0% overall. Yields were higher among those with a prior advanced adenoma than among those with prior nonadvanced adenoma and did not increase significantly with age. These findings can help inform whether to continue surveillance colonoscopy in older adults.
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Affiliation(s)
- Jeffrey K. Lee
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Abhik Roy
- Kaiser Permanente San Leandro Medical Center, San Leandro, California
| | | | - Jennifer T. Chan
- Kaiser Permanente San Leandro Medical Center, San Leandro, California
| | - Wei K. Zhao
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Theodore R. Levin
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Ethan A. Halm
- Rutgers Biological Health Sciences, Rutgers University, New Brunswick, New Jersey
| | - Celette S. Skinner
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas
- Peter O’Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas
| | - Joanne E. Schottinger
- Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena
- Department of Quality and Systems of Care, Kaiser Permanente Southern California, Pasadena
| | - Nirupa R. Ghai
- Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena
- Department of Quality and Systems of Care, Kaiser Permanente Southern California, Pasadena
| | | | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Natalia Udaltsova
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Douglas A. Corley
- Division of Research, Kaiser Permanente Northern California, Oakland
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White LL, Burnett-Hartman AN, Ichikawa LE, Goldberg SR, Chubak J, Spencer Feigelson H, Kamineni A. SARS-CoV-2 Infection and Related Hospitalization among Cancer Survivors. Cancer Epidemiol Biomarkers Prev 2024; 33:442-444. [PMID: 38126877 DOI: 10.1158/1055-9965.epi-23-1303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/30/2023] [Accepted: 12/19/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Little is known about SARS-CoV-2 infection and COVID-19 severity among a growing population of cancer survivors. We describe the association of infection and related hospitalization by recency of cancer diagnosis in a large U.S. cohort. METHODS Participants were sent electronic surveys between April 2020 and January 2021 to collect information on SARS-CoV-2 infection and potential COVID-19-related risk factors. SARS-CoV-2 infections were identified using survey report of a COVID-19-positive test and electronic health record data. Cumulative incidence of SARS-CoV-2 infection was estimated up to 365 days from baseline survey and stratified by recency of cancer diagnosis. Among those with SARS-CoV-2 infection, we used logistic regression to estimate the association between recency of cancer diagnosis and hospitalization within 30 days of infection. RESULTS Cumulative incidence of SARS-CoV-2 infection at 365 days was 3.3% [95% confidence interval (CI), 3.2%-3.5%] among those without cancer history and ranged from 2.8% (95% CI, 2.3%-3.5%) to 3.7% (95% CI, 2.9%-4.7%) among those with a history of cancer depending on recency. There was no statistically significant difference in odds of hospitalization within 30 days following SARS-CoV-2 infection by cancer diagnosis recency. CONCLUSIONS Our null findings are consistent with other studies on COVID-19 infection risk in cancer survivors, where COVID-19 severity and sequelae were independent of cancer history and were likely associated with factors such as intensive care unit admission, noncancer comorbid conditions, and long-term care residency. IMPACT This study can inform COVID-19 risk-counseling of cancer survivors and their caregivers as we continue to contend with COVID-19.
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Affiliation(s)
- Larissa L White
- Kaiser Permanente Colorado Institute for Health Research, Aurora, Colorado
| | | | - Laura E Ichikawa
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Shauna R Goldberg
- Kaiser Permanente Colorado Institute for Health Research, Aurora, Colorado
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | | | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
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Burnett-Hartman AN, Ton M, He Q, Malen RC, Potter JD, Reedy AM, Phipps AI, Newcomb PA. Dietary Factors Differ Between Young-Onset and Older-Onset Colorectal Cancer Patients. Nutr Cancer 2024; 76:352-355. [PMID: 38347682 PMCID: PMC10983792 DOI: 10.1080/01635581.2024.2316934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/05/2024] [Indexed: 03/02/2024]
Abstract
We aimed to evaluate differences in dietary factors between young-onset (diagnosed at ages <50) and older-onset colorectal cancer (CRC). CRC patients diagnosed from 1998 to 2018 reported to the Puget Sound Surveillance, Epidemiology, and End Results registry were recruited using mail and telephone. Consented patients completed questionnaires assessing demographics, medical history, and CRC risk factors, including dietary factors. We used multi-variable logistic regression to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) comparing dietary intake in young-onset vs. older-onset CRC. Analyses included 1,087 young- and 2,554 older-onset CRC patients. Compared to older-onset CRC, young-onset CRC patients had lower intake of vegetables (OR for highest intake vs. lowest = 0.59 CI: 0.55, 0.64) and fruit (OR for highest intake vs. lowest = 0.94 CI: 0.88, 0.99) and higher intake of processed meat (OR for highest intake vs. lowest = 1.82 CI: 1.11, 2.99) and spicy food (OR for highest intake vs. lowest = 1.69 CI: 1.09, 2.61). There was no statistically significant difference between young- and older-onset CRC patients for red meat consumption. Dietary patterns differed between young- and older-onset CRC; young-onset CRC patients had lower intake of vegetables and fruit and higher intakes of processed meat and spicy food.
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Affiliation(s)
| | - Mimi Ton
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
- University of Washington, School of Public Health, Seattle, Washington, USA
| | - Qianchuan He
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | | | - John D. Potter
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
- University of Washington, School of Public Health, Seattle, Washington, USA
- Research Centre for Hauora and Health, Massey University, Wellington, New Zealand
| | | | - Amanda I. Phipps
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
- University of Washington, School of Public Health, Seattle, Washington, USA
| | - Polly A. Newcomb
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
- University of Washington, School of Public Health, Seattle, Washington, USA
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Briggs NL, Ton M, Malen RC, Reedy AM, Cohen SA, Phipps AI, Burnett-Hartman AN, Newcomb PA. Colorectal cancer pre-diagnostic symptoms are associated with anatomic cancer site. BMC Gastroenterol 2024; 24:65. [PMID: 38317073 PMCID: PMC10845784 DOI: 10.1186/s12876-024-03152-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 01/29/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Signs and red flag symptoms in colorectal cancer (CRC) patients who are below the recommended screening age are often overlooked, leading to delayed diagnosis and worse prognosis. This study investigates how patient pre-diagnostic symptoms are associated with anatomic site of their cancer and whether the association varies by age at CRC diagnosis. METHODS We ascertained CRC patients' experienced symptoms and screening through medical abstractions from an ongoing population-based study of CRC patients identified through a SEER cancer registry (N = 626). We used logistic regression to estimate odds ratios and 95% confidence intervals for the association between symptoms and CRC anatomic site. Additional analyses were stratified by age at diagnosis. Early-onset was defined as less than 50 years of age at CRC diagnosis. RESULTS Participants who experienced blood in stool were more likely (odds ratio (95% confidence interval)) to have rectal (vs. colon) cancer (4.37 (3.02, 6.33)), as were patients who experienced changes to stool (1.78 (1.21, 2.60)). Patients diagnosed with colon cancer were more likely to present with abdominal pain (0.30 (0.19, 0.47)), anemia (0.40 (0.21, 0.75)), other symptoms (0.33 (0.19, 0.55)) and no symptoms (0.68 (0.44, 1.04)). When stratifying by age at diagnosis, we found that the association between blood in stool and rectal tumor location was particularly pronounced for patients with early-onset CRC (6.48 (2.73, 15.41)). CONCLUSIONS Common pre-diagnostic red flag symptoms are associated with CRC anatomic site. These findings can inform best practices for gastroenterologist triage of care and early evaluation of CRC and are of key importance given the rise of early-onset (pre-screening age) CRC. TRIAL REGISTRATION Not applicable to this study and analysis.
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Affiliation(s)
- Nicole L Briggs
- Department of Epidemiology, University of Washington School of Public Health, UW Box #351619, 3980 15th Ave NE, Seattle, WA, 98195, USA.
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA.
| | - Mimi Ton
- Department of Epidemiology, University of Washington School of Public Health, UW Box #351619, 3980 15th Ave NE, Seattle, WA, 98195, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
| | - Rachel C Malen
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
| | - Adriana M Reedy
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
| | - Stacey A Cohen
- Division of Oncology, University of Washington, 825 Eastlake Ave E, Seattle, WA, 98109, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
| | - Amanda I Phipps
- Department of Epidemiology, University of Washington School of Public Health, UW Box #351619, 3980 15th Ave NE, Seattle, WA, 98195, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
| | - Andrea N Burnett-Hartman
- Department of Epidemiology, University of Washington School of Public Health, UW Box #351619, 3980 15th Ave NE, Seattle, WA, 98195, USA
- Institute for Health Research, Kaiser Permanente, 2550 S Parker Rd, Aurora, CO, 80014, USA
| | - Polly A Newcomb
- Department of Epidemiology, University of Washington School of Public Health, UW Box #351619, 3980 15th Ave NE, Seattle, WA, 98195, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA, 98109, USA
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5
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Rendle KA, Saia CA, Vachani A, Burnett-Hartman AN, Doria-Rose VP, Beucker S, Neslund-Dudas C, Oshiro C, Kim RY, Elston-Lafata J, Honda SA, Ritzwoller D, Wainwright JV, Mitra N, Greenlee RT. Rates of Downstream Procedures and Complications Associated With Lung Cancer Screening in Routine Clinical Practice : A Retrospective Cohort Study. Ann Intern Med 2024; 177:18-28. [PMID: 38163370 DOI: 10.7326/m23-0653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Lung cancer screening (LCS) using low-dose computed tomography (LDCT) reduces lung cancer mortality but can lead to downstream procedures, complications, and other potential harms. Estimates of these events outside NLST (National Lung Screening Trial) have been variable and lacked evaluation by screening result, which allows more direct comparison with trials. OBJECTIVE To identify rates of downstream procedures and complications associated with LCS. DESIGN Retrospective cohort study. SETTING 5 U.S. health care systems. PATIENTS Individuals who completed a baseline LDCT scan for LCS between 2014 and 2018. MEASUREMENTS Outcomes included downstream imaging, invasive diagnostic procedures, and procedural complications. For each, absolute rates were calculated overall and stratified by screening result and by lung cancer detection, and positive and negative predictive values were calculated. RESULTS Among the 9266 screened patients, 1472 (15.9%) had a baseline LDCT scan showing abnormalities, of whom 140 (9.5%) were diagnosed with lung cancer within 12 months (positive predictive value, 9.5% [95% CI, 8.0% to 11.0%]; negative predictive value, 99.8% [CI, 99.7% to 99.9%]; sensitivity, 92.7% [CI, 88.6% to 96.9%]; specificity, 84.4% [CI, 83.7% to 85.2%]). Absolute rates of downstream imaging and invasive procedures in screened patients were 31.9% and 2.8%, respectively. In patients undergoing invasive procedures after abnormal findings, complication rates were substantially higher than those in NLST (30.6% vs. 17.7% for any complication; 20.6% vs. 9.4% for major complications). LIMITATION Assessment of outcomes was retrospective and was based on procedural coding. CONCLUSION The results indicate substantially higher rates of downstream procedures and complications associated with LCS in practice than observed in NLST. Diagnostic management likely needs to be assessed and improved to ensure that screening benefits outweigh potential harms. PRIMARY FUNDING SOURCE National Cancer Institute and Gordon and Betty Moore Foundation.
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Affiliation(s)
- Katharine A Rendle
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (K.A.R., C.A.S., A.V., S.B., R.Y.K., J.V.W., N.M.)
| | - Chelsea A Saia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (K.A.R., C.A.S., A.V., S.B., R.Y.K., J.V.W., N.M.)
| | - Anil Vachani
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (K.A.R., C.A.S., A.V., S.B., R.Y.K., J.V.W., N.M.)
| | | | - V Paul Doria-Rose
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (V.P.D.)
| | - Sarah Beucker
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (K.A.R., C.A.S., A.V., S.B., R.Y.K., J.V.W., N.M.)
| | | | - Caryn Oshiro
- Center for Integrated Healthcare Research, Kaiser Permanente Hawaii, Honolulu, Hawaii (C.O.)
| | - Roger Y Kim
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (K.A.R., C.A.S., A.V., S.B., R.Y.K., J.V.W., N.M.)
| | - Jennifer Elston-Lafata
- Henry Ford Health and Henry Ford Cancer Institute, Detroit, Michigan, and Eshelman School of Pharmacy and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (J.E.)
| | - Stacey A Honda
- Center for Integrated Health Care Research, Kaiser Permanente Hawaii, and Hawaii Permanente Medical Group, Honolulu, Hawaii (S.A.H.)
| | - Debra Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado (A.N.B., D.R.)
| | - Jocelyn V Wainwright
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (K.A.R., C.A.S., A.V., S.B., R.Y.K., J.V.W., N.M.)
| | - Nandita Mitra
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (K.A.R., C.A.S., A.V., S.B., R.Y.K., J.V.W., N.M.)
| | - Robert T Greenlee
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin (R.T.G.)
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Schneider JL, Firemark AJ, Gille S, Davis J, Pawloski PA, Liang SY, Epstein MM, Lowery J, Lu CY, Sharaf RN, Burnett-Hartman AN, Schlieder V, Salvati ZM, Cragun D, Rahm AK, Hunter JE. "Go ahead and screen" - advice to healthcare systems for routine lynch syndrome screening from interviews with newly diagnosed colorectal cancer patients. Hered Cancer Clin Pract 2023; 21:24. [PMID: 37978552 PMCID: PMC10657118 DOI: 10.1186/s13053-023-00270-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Lynch syndrome (LS) is the most common cause of inherited colorectal cancer (CRC). Universal tumor screening (UTS) of newly diagnosed CRC cases is recommended to aid in diagnosis of LS and reduce cancer-related morbidity and mortality. However, not all health systems have adopted UTS processes and implementation may be inconsistent due to system and patient-level complexities. METHODS To identify barriers, facilitators, and suggestions for improvements of the UTS process from the patient perspective, we conducted in-depth, semi-structured interviews with patients recently diagnosed with CRC, but not screened for or aware of LS. Patients were recruited from eight regionally diverse US health systems. Interviews were conducted by telephone, 60-minutes, audio-recorded, and transcribed. An inductive, constant comparative analysis approach was employed. RESULTS: We completed 75 interviews across the eight systems. Most participants were white (79%), about half (52%) were men, and the mean age was 60 years. Most self-reported either no (60%) or minimal (40%) prior awareness of LS. Overall, 96% of patients stated UTS should be a routine standard of care for CRC tumors, consistently citing four primary motivations for wanting to know their LS status and engage in the process for LS identification: "knowledge is power"; "family knowledge"; "prevention and detection"; and "treatment and surveillance." Common concerns pertaining to the process of screening for and identifying LS included: creating anticipatory worry for patients, the potential cost and the accuracy of the genetic test, and possibly having one's health insurance coverage impacted by the LS diagnosis. Patients suggested health systems communicate LS results in-person or by phone from a trained expert in LS; offer proactive verbal and written education about LS, the screening steps, and any follow-up surveillance recommendations; and support patients in communicating their LS screening to any of their blood relatives. CONCLUSION Our qualitative findings demonstrate patients with CRC have a strong desire for healthcare systems to regularly implement and offer UTS. Patients offer key insights for health systems to guide future implementation and optimization of UTS and other LS screening programs and maximize diagnosis of individuals with LS and improve cancer-related surveillance and outcomes. TRIAL REGISTRATION Not available: not a clinical trial.
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Affiliation(s)
- Jennifer L Schneider
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, 97227, Portland, OR, USA.
| | - Alison J Firemark
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, 97227, Portland, OR, USA
| | - Sara Gille
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, 97227, Portland, OR, USA
| | - James Davis
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, 97227, Portland, OR, USA
| | | | - Su-Ying Liang
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - Mara M Epstein
- Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jan Lowery
- University of Colorado Cancer Center, Aurora, CO, USA
| | - Christine Y Lu
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Ravi N Sharaf
- Division of Gastroenterology, Department of Medicine, Division of Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | | | | | | | - Deborah Cragun
- University of South Florida, 3720 Spectrum Blvd, Suite 304, Tampa, Fl, USA
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Dalmat RR, Ziebell RA, Kamineni A, Phipps AI, Weiss NS, Breslau ES, Burnett-Hartman AN, Corley DA, Doria-Rose VP, Green BB, Halm EA, Levin TR, Schottinger JE, Chubak J. Risk of Colorectal Cancer and Colorectal Cancer Mortality Beginning One Year after a Negative Fecal Occult Blood Test, among Screen-Eligible 76- to 85-Year-Olds. Cancer Epidemiol Biomarkers Prev 2023; 32:1382-1390. [PMID: 37450838 PMCID: PMC10592334 DOI: 10.1158/1055-9965.epi-23-0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/05/2023] [Accepted: 07/13/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Colorectal cancer screening is universally recommended for adults ages 45 to 75 years. Noninvasive fecal occult blood tests are effective screening tests recommended by guidelines. However, empirical evidence to inform older adults' decisions about whether to continue screening is sparse, especially for individuals with prior screening. METHODS This study used a retrospective cohort of older adults at three Kaiser Permanente integrated healthcare systems (Northern California, Southern California, Washington) and Parkland Health. Beginning 1 year following a negative stool-based screening test, cumulative risks of colorectal cancer incidence, colorectal cancer mortality (accounting for deaths from other causes), and non-colorectal cancer mortality were estimated. RESULTS Cumulative incidence of colorectal cancer in screen-eligible adults ages 76 to 85 with a negative fecal occult blood test 1 year ago (N = 118,269) was 0.23% [95% confidence interval (CI), 0.20%-0.26%] after 2 years and 1.21% (95% CI, 1.13%-1.30%) after 8 years. Cumulative colorectal cancer mortality was 0.03% (95% CI, 0.02%-0.04%) after 2 years and 0.33% (95% CI, 0.28%-0.39%) after 8 years. Cumulative risk of death from non-colorectal cancer causes was 4.81% (95% CI, 4.68%-4.96%) after 2 years and 28.40% (95% CI, 27.95%-28.85%) after 8 years. CONCLUSIONS Among 76- to 85-year-olds with a recent negative stool-based test, cumulative colorectal cancer incidence and mortality estimates were low, especially within 2 years; death from other causes was over 100 times more likely than death from colorectal cancer. IMPACT These findings of low absolute colorectal cancer risk, and comparatively higher risk of death from other causes, can inform decision-making regarding whether and when to continue colorectal cancer screening beyond age 75 among screen-eligible adults.
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Affiliation(s)
- Ronit R. Dalmat
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Rebecca A. Ziebell
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Amanda I. Phipps
- Department of Epidemiology, University of Washington, Seattle, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Noel S. Weiss
- Department of Epidemiology, University of Washington, Seattle, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Erica S. Breslau
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | | | - Douglas A. Corley
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway Street, Oakland, CA, USA
- Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - V. Paul Doria-Rose
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Beverly B. Green
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Kaiser Permanente Bernard J Tyson School of Medicine, Department of Health Systems Science, Pasadena, CA
| | - Ethan A. Halm
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Theodore R. Levin
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway Street, Oakland, CA, USA
- Department of Gastroenterology, Kaiser Permanente Medical Center, Walnut Creek, CA USA
| | - Joanne E. Schottinger
- Kaiser Permanente Bernard J Tyson School of Medicine, Department of Health Systems Science, Pasadena, CA
| | - Jessica Chubak
- Department of Epidemiology, University of Washington, Seattle, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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8
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Burnett-Hartman AN, Powers JD, Hixon BP, Carroll NM, Frankland TB, Honda SA, Saia C, Rendle KA, Greenlee RT, Neslund-Dudas C, Zheng Y, Vachani A, Ritzwoller DP. Development of an Electronic Health Record-Based Algorithm for Predicting Lung Cancer Screening Eligibility in the Population-Based Research to Optimize the Screening Process Lung Research Consortium. JCO Clin Cancer Inform 2023; 7:e2300063. [PMID: 37910824 PMCID: PMC10642899 DOI: 10.1200/cci.23.00063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/21/2023] [Accepted: 09/14/2023] [Indexed: 11/03/2023] Open
Abstract
PURPOSE Lung cancer screening (LCS) guidelines in the United States recommend LCS for those age 50-80 years with at least 20 pack-years smoking history who currently smoke or quit within the last 15 years. We tested the performance of simple smoking-related criteria derived from electronic health record (EHR) data and developed and tested the performance of a multivariable model in predicting LCS eligibility. METHODS Analyses were completed within the Population-based Research to Optimize the Screening Process Lung Consortium (PROSPR-Lung). In our primary validity analyses, the reference standard LCS eligibility was based on self-reported smoking data collected via survey. Within one PROSPR-Lung health system, we used a training data set and penalized multivariable logistic regression using the Least Absolute Shrinkage and Selection Operator to select EHR-based variables into the prediction model including demographics, smoking history, diagnoses, and prescription medications. A separate test data set assessed model performance. We also conducted external validation analysis in a separate health system and reported AUC, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy metrics associated with the Youden Index. RESULTS There were 14,214 individuals with survey data to assess LCS eligibility in primary analyses. The overall performance for assigning LCS eligibility status as measured by the AUC values at the two health systems was 0.940 and 0.938. At the Youden Index cutoff value, performance metrics were as follows: accuracy, 0.855 and 0.895; sensitivity, 0.886 and 0.920; specificity, 0.896 and 0.850; PPV, 0.357 and 0.444; and NPV, 0.988 and 0.992. CONCLUSION Our results suggest that health systems can use an EHR-derived multivariable prediction model to aid in the identification of those who may be eligible for LCS.
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Affiliation(s)
| | - J. David Powers
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO
| | - Brian P. Hixon
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO
| | - Nikki M. Carroll
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO
| | | | - Stacey A. Honda
- Center for Integrated Healthcare Research, Kaiser Permanente Hawaii, Oahu, HI
- Hawaii Permanente Medical Group, Oahu, HI
| | - Chelsea Saia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Yingye Zheng
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA
| | - Anil Vachani
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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9
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Carroll NM, Burnett-Hartman AN, Rendle KA, Neslund-Dudas CM, Greenlee RT, Honda SA, Vachani A, Ritzwoller DP. Smoking status and the association between patient-level factors and survival among lung cancer patients. J Natl Cancer Inst 2023; 115:937-948. [PMID: 37228018 PMCID: PMC10407692 DOI: 10.1093/jnci/djad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Declines in the prevalence of cigarette smoking, advances in targeted therapies, and implementation of lung cancer screening have changed the clinical landscape for lung cancer. The proportion of lung cancer deaths is increasing in those who have never smoked cigarettes. To better understand contemporary patterns in survival among patients with lung cancer, a comprehensive evaluation of factors associated with survival, including differential associations by smoking status, is needed. METHODS Patients diagnosed with lung cancer between January 1, 2010, and September 30, 2019, were identified. We estimated all-cause and lung cancer-specific median, 5-year, and multivariable restricted mean survival time (RMST) to identify demographic, socioeconomic, and clinical factors associated with survival, overall and stratified by smoking status (never, former, and current). RESULTS Analyses included 6813 patients with lung cancer: 13.9% never smoked, 54.2% formerly smoked, and 31.9% currently smoked. All-cause RMST through 5 years for those who never, formerly, and currently smoked was 32.1, 25.9, and 23.3 months, respectively. Lung cancer-specific RMST was 36.3 months, 30.3 months, and 26.0 months, respectively. Across most models, female sex, younger age, higher socioeconomic measures, first-course surgery, histology, and body mass index were positively associated, and higher stage was inversely associated with survival. Relative to White patients, Black patients had increased survival among those who formerly smoked. CONCLUSIONS We identify actionable factors associated with survival between those who never, formerly, and currently smoked cigarettes. These findings illuminate opportunities to address underlying mechanisms driving lung cancer progression, including use of first-course treatment, and enhanced implementation of tailored smoking cessation interventions for individuals diagnosed with cancer.
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Affiliation(s)
- Nikki M Carroll
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA
| | - Andrea N Burnett-Hartman
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Katharine A Rendle
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Stacey A Honda
- Hawaii Permanente Medical Group, Center for Integrated Healthcare Research, Kaiser Permanente Hawaii, Honolulu, HI, USA
| | - Anil Vachani
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA
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10
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White LL, Goldberg SR, Spencer Feigelson H, Burnett-Hartman AN. Depression, anxiety, & loneliness among cancer survivors during the COVID-19 pandemic. J Psychosoc Oncol 2023; 42:242-255. [PMID: 37486169 DOI: 10.1080/07347332.2023.2238192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
PURPOSE To assess the impact of the COVID-19 pandemic on depression, anxiety, and loneliness between those with and without a history of cancer. DESIGN This prospective observational study used a quantitative approach. PARTICIPANTS Adult members of the Kaiser Permanente Research Bank (N = 104,640). METHODS Participants completed a series of surveys from May to December 2020. The difference in score of depression, anxiety, and loneliness were estimated using linear mixed regression. FINDINGS Among cancer survivors, 21% and 19% met the thresholds for increased risk of depression and anxiety. Among cancer survivors, younger age groups and females reported increased depression, anxiety, and loneliness scores. CONCLUSIONS This study highlights the continued necessity of addressing mental health needs and social support in cancer survivors during and after a public health emergency. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS Cancer survivors may need particular resources after cancer treatment to strengthen resilience and improve quality of life.
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Affiliation(s)
- Larissa Lee White
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Shauna R Goldberg
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
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11
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Carroll NM, Eisenstein J, Burnett-Hartman AN, Greenlee RT, Honda SA, Neslund-Dudas CM, Rendle KA, Vachani A, Ritzwoller DP. Uptake of novel systemic therapy: Real world patterns among adults with advanced non-small cell lung cancer. Cancer Treat Res Commun 2023; 36:100730. [PMID: 37352588 PMCID: PMC10528526 DOI: 10.1016/j.ctarc.2023.100730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/12/2023] [Indexed: 06/25/2023]
Abstract
INTRODUCTION/BACKGROUND Systemic treatment for advanced non-small cell lung cancer (NSCLC) is shifting from platinum-based chemotherapy to immunotherapy and targeted therapies associated with improved survival in clinical trials. As new therapies are approved for use, examining variations in use for treating patients in community practice can generate additional evidence as to the magnitude of their benefit. PATIENTS AND METHODS We identified 1,442 patients diagnosed with de novo stage IV NSCLC between 3/1/2012 and 12/31/2020. Patient characteristics and treatment patterns are described overall and by type of first- and second-line systemic therapy received. Prevalence ratios estimate the association of patient and tumor characteristics with receipt of first-line therapy. RESULTS Within 180 days of diagnosis, 949 (66%) patients received first-line systemic therapy, increasing from 53% in 2012 to 71% in 2020 (p = 0.0004). The proportion of patients receiving first-line immunotherapy+/-chemotherapy (IMO) increased from 14%-66% (p<0.0001). Overall, 380 (26%) patients received both first- and second-line treatment, varying by year between 16%-36% (p = 0.18). The proportion of patients receiving second-line IMO increased from 13%-37% (p<0.0001). Older age and current smoking status were inversely associated with receipt of first-line therapy. Higher BMI, receipt of radiation, and diagnosis year were positively associated with receipt of first-line therapy. No association was found for race, ethnicity, or socioeconomic status. CONCLUSION The proportion of advanced NSCLC patients receiving first- and second-line treatment increased over time, particularly for IMO treatments. Additional research is needed to better understand the impact of these therapies on patient outcomes, including short-term, long-term, and financial toxicities. MICROABSTRACT Systemic treatment for non-small cell lung cancer (NSCLC) is shifting from platinum-based therapies to immunotherapy and targeted therapies. Using de novo stage IV NSCLC patients identified from 4 healthcare systems, we examine trends in systemic therapy. We saw an increase in the portion of patients receiving any systemic therapy and a sharp increase in the proportion of patients receiving immunotherapy.
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Affiliation(s)
- Nikki M Carroll
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA.
| | - Jennifer Eisenstein
- Colorado Permanente Medical Group, Kaiser Permanente Colorado, Denver, CO, USA
| | - Andrea N Burnett-Hartman
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | | | - Stacey A Honda
- Hawaii Permanente Medical Group and Center for Integrated Healthcare Research, Kaiser Permanente Hawaii, Honolulu, HI, USA
| | | | - Katharine A Rendle
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anil Vachani
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA
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12
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Salvati ZM, Rahm AK, Williams MS, Ladd I, Schlieder V, Atondo J, Schneider JL, Epstein MM, Lu CY, Pawloski PA, Sharaf RN, Liang SY, Burnett-Hartman AN, Hunter JE, Burton-Akright J, Cragun D. A picture is worth a thousand words: advancing the use of visualization tools in implementation science through process mapping and matrix heat mapping. Implement Sci Commun 2023; 4:43. [PMID: 37098602 PMCID: PMC10127322 DOI: 10.1186/s43058-023-00424-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 04/03/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Identifying key determinants is crucial for improving program implementation and achieving long-term sustainment within healthcare organizations. Organizational-level complexity and heterogeneity across multiple stakeholders can complicate our understanding of program implementation. We describe two data visualization methods used to operationalize implementation success and to consolidate and select implementation factors for further analysis. METHODS We used a combination of process mapping and matrix heat mapping to systematically synthesize and visualize qualitative data from 66 stakeholder interviews across nine healthcare organizations, to characterize universal tumor screening programs of all newly diagnosed colorectal and endometrial cancers and understand the influence of contextual factors on implementation. We constructed visual representations of protocols to compare processes and score process optimization components. We also used color-coded matrices to systematically code, summarize, and consolidate contextual data using factors from the Consolidated Framework for Implementation Research (CFIR). Combined scores were visualized in a final data matrix heat map. RESULTS Nineteen process maps were created to visually represent each protocol. Process maps identified the following gaps and inefficiencies: inconsistent execution of the protocol, no routine reflex testing, inconsistent referrals after a positive screen, no evidence of data tracking, and a lack of quality assurance measures. These barriers in patient care helped us define five process optimization components and used these to quantify program optimization on a scale from 0 (no program) to 5 (optimized), representing the degree to which a program is implemented and optimally maintained. Combined scores within the final data matrix heat map revealed patterns of contextual factors across optimized programs, non-optimized programs, and organizations with no program. CONCLUSIONS Process mapping provided an efficient method to visually compare processes including patient flow, provider interactions, and process gaps and inefficiencies across sites, thereby measuring implementation success via optimization scores. Matrix heat mapping proved useful for data visualization and consolidation, resulting in a summary matrix for cross-site comparisons and selection of relevant CFIR factors. Combining these tools enabled a systematic and transparent approach to understanding complex organizational heterogeneity prior to formal coincidence analysis, introducing a stepwise approach to data consolidation and factor selection.
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Affiliation(s)
- Zachary M Salvati
- Geisinger Department of Genomic Health, 100 N. Academy Ave, Danville, PA, 17822, USA.
| | - Alanna Kulchak Rahm
- Geisinger Department of Genomic Health, 100 N. Academy Ave, Danville, PA, 17822, USA
| | - Marc S Williams
- Geisinger Department of Genomic Health, 100 N. Academy Ave, Danville, PA, 17822, USA
| | - Ilene Ladd
- Geisinger Department of Genomic Health, 100 N. Academy Ave, Danville, PA, 17822, USA
| | - Victoria Schlieder
- Geisinger Department of Genomic Health, 100 N. Academy Ave, Danville, PA, 17822, USA
| | - Jamie Atondo
- Geisinger Department of Genomic Health, 100 N. Academy Ave, Danville, PA, 17822, USA
| | - Jennifer L Schneider
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97202, USA
| | - Mara M Epstein
- Department of Medicine and the Meyers Primary Care Institute, University of Massachusetts Medical School, 365 Plantation St. Biotech 1, Suite 100, Worcester, MA, 01605, USA
| | - Christine Y Lu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA
| | | | - Ravi N Sharaf
- Division of Gastroenterology, Department of Medicine, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
| | - Su-Ying Liang
- Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Palo Alto, CA, 94301, USA
| | - Andrea N Burnett-Hartman
- Kaiser Permanente Colorado, Institute for Health Research, 2550 S. Parker Rd., Ste 200, Aurora, CO, 80014, USA
| | - Jessica Ezzell Hunter
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | | | - Deborah Cragun
- University of South Florida, 3720 Spectrum Blvd, Suite 304, Tampa, FL, 33612, USA
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13
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Kelly C, White LL, Scott SG, Feigelson HS, Burnett-Hartman AN. Social risk factors among individuals with a history of cancer during the COVID-19 pandemic. J Cancer Surviv 2023; 17:309-317. [PMID: 35921058 PMCID: PMC9362166 DOI: 10.1007/s11764-022-01235-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/08/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The coronavirus disease (COVID-19) pandemic and its economic consequences may disproportionately impact cancer survivors and their overall health-related quality of life. The objective of this study was to examine whether cancer survivors experienced higher levels of financial strain or food insecurity compared to those without a history of cancer. METHODS Kaiser Permanente Research Bank (KPRB) study participants were invited to complete a series of electronic surveys starting April 2020 to assess the impact of the COVID-19 pandemic. Participants who completed the initial survey and one follow-up survey were included. The odds of financial strain and food insecurity in those with and without a history of cancer were estimated using multinomial logistic regression. RESULTS Cancer survivors (n = 16,231) had lower odds of reporting "somewhat hard" (AOR = 0.77) and "very hard" (AOR = 0.67) financial strain, and food insecurity "sometimes" (AOR = 0.70) and "often" (AOR = 0.55) compared to those with no history of cancer (n = 88,409). Non-Hispanic (NH) Black and Hispanic cancer survivors had higher odds compared to NH Whites of reporting financial strain and food insecurity. Smokers and those with multiple comorbidities had higher odds of reporting financial strain and food insecurity among cancer survivors. CONCLUSIONS While cancer survivors overall did not report greater financial strain or food insecurity than individuals without a history of cancer, subsets of cancer survivors are experiencing greater social risks during the pandemic and should be prioritized for screening for social risk factors. IMPLICATIONS FOR CANCER SURVIVORS Incorporating screening for social risk factors into care coordination workflows for subsets of cancer survivors should be a priority.
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Affiliation(s)
- Cheryl Kelly
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S Parker Rd, Ste 200, Aurora, CO, 80014, USA.
| | - Larissa Lee White
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S Parker Rd, Ste 200, Aurora, CO, 80014, USA
| | - Shauna Goldberg Scott
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S Parker Rd, Ste 200, Aurora, CO, 80014, USA
| | - Heather Spencer Feigelson
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S Parker Rd, Ste 200, Aurora, CO, 80014, USA
| | - Andrea N Burnett-Hartman
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S Parker Rd, Ste 200, Aurora, CO, 80014, USA
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14
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Kim RY, Rendle KA, Mitra N, Saia CA, Neslund-Dudas C, Greenlee RT, Burnett-Hartman AN, Honda SA, Simoff MJ, Schapira MM, Croswell JM, Meza R, Ritzwoller DP, Vachani A. Socioeconomic Status as a Mediator of Racial Disparity in Annual Lung Cancer Screening Adherence. Am J Respir Crit Care Med 2023; 207:777-780. [PMID: 36306485 PMCID: PMC10037473 DOI: 10.1164/rccm.202208-1590le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Roger Y. Kim
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine
| | - Katharine A. Rendle
- Department of Family Medicine and Community Health
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | | | - Stacey A. Honda
- Center for Integrated Healthcare Research, Kaiser Permanente Hawaii, Oahu, Hawaii
- Hawaii Permanente Medical Group, Oahu, Hawaii
| | - Michael J. Simoff
- Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Marilyn M. Schapira
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs (VA) Medical Center, Philadelphia, Pennsylvania
| | - Jennifer M. Croswell
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, Maryland
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | | | - Anil Vachani
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine
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15
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Burnett-Hartman AN, Carroll NM, Croswell JM, Greenlee RT, Honda SA, Neslund-Dudas CM, Kim RY, Rendle KA, Vachani A, Ritzwoller DP. Percentage Up to Date With Chest Computed Tomography Among Those Eligible for Lung Cancer Screening. Am J Prev Med 2023:S0749-3797(23)00004-1. [PMID: 36707314 DOI: 10.1016/j.amepre.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/05/2023] [Accepted: 01/05/2023] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Authors aimed to calculate the percentage up-to-date with testing in the context of lung cancer screening across 5 healthcare systems and evaluate differences according to patient and health system characteristics. METHODS Lung cancer screening‒eligible individuals receiving care within the 5 systems in the Population-based Research to Optimize the Screening Process Lung consortium from October 1, 2018 to September 30, 2019 were included in analyses. Data collection was completed on June 15, 2021; final analyses were completed on April 1, 2022. Chest computed tomography scans and patient characteristics were obtained through electronic health records and used to calculate the percentage completing a chest computed tomography scan in the previous 12 months (considered up-to-date). The association of patient and healthcare system factors with being up-to-date was evaluated with adjusted prevalence ratios and 95% CIs using log-binomial regression models. RESULTS There were 29,417 individuals eligible for lung cancer screening as of September 30, 2019; 8,333 (28.3%) were up-to-date with testing. Those aged 65-74 years (prevalence ratio=1.19; CI=1.15, 1.24, versus ages 55-64), those with chronic obstructive pulmonary disease (prevalence ratio=2.05; CI=1.98, 2.13), and those in higher SES census tracts (prevalence ratio=1.22; CI=1.16, 1.30, highest quintile versus lowest) were more likely to be up-to-date. Currently smoking (prevalence ratio=0.91; CI=0.88, 0.95), having a BMI ≥30 kg/m2 (prevalence ratio=0.83; CI=0.77, 0.88), identifying as Native Hawaiian or other Pacific Islander (prevalence ratio=0.79; CI=0.68, 0.92), and having a decentralized lung cancer screening program (prevalence ratio=0.77; CI=0.74, 0.80) were inversely associated with being up-to-date. CONCLUSIONS The percentage up-to-date with testing among those eligible for lung cancer screening is well below up-to-date estimates for other types of cancer screening, and disparities in lung cancer screening participation remain.
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Affiliation(s)
| | - Nikki M Carroll
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - Jennifer M Croswell
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, Maryland
| | | | - Stacey A Honda
- Center for Integrated Healthcare Research, Kaiser Permanente Hawaii, Oahu, Hawaii; Hawaii Permanente Medical Group, Oahu, Hawaii
| | | | - Roger Y Kim
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Katharine A Rendle
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anil Vachani
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
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16
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Goldberg Scott S, Feigelson HS, Powers JD, Clennin MN, Lyons JA, Gray MT, Vachani A, Burnett-Hartman AN. Demographic, Clinical, and Behavioral Factors Associated With Electronic Nicotine Delivery Systems Use in a Large Cohort in the United States. Tob Use Insights 2023; 16:1179173X221134855. [PMID: 36636234 PMCID: PMC9829996 DOI: 10.1177/1179173x221134855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Introduction Our primary purpose is to understand comorbidities and health outcomes associated with electronic nicotine delivery systems (ENDS) use. Methods Study participants were Kaiser Permanente (KP) members from eight US regions who joined the Kaiser Permanente Research Bank (KPRB) from September 2015 through December 2019 and completed a questionnaire assessing demographic and behavioral factors, including ENDS and traditional cigarette use. Medical history and health outcomes were obtained from electronic health records. We used multinomial logistic regression to estimate odd ratios (ORs) and 95% confidence intervals (CIs) of current and former ENDS use according to member characteristics, behavioral factors, and clinical history. We used Cox regression to estimate hazard ratios (HRs) and 95% CIs comparing risk of health outcomes according to ENDS use. Results Of 119 593 participants, 1594 (1%) reported current ENDS use and 5603 (5%) reported past ENDS use. ENDS users were more likely to be younger, male, gay or lesbian, and American Indian / Alaskan Native or Asian. After adjustment for confounding, current ENDS use was associated with current traditional cigarette use (OR = 39.55; CI:33.44-46.77), current marijuana use (OR = 6.72; CI:5.61-8.05), history of lung cancer (OR = 2.64; CI:1.42-4.92), non-stroke cerebral vascular disease (OR = 1.55; CI:1.21-1.99), and chronic obstructive pulmonary disease (OR = 2.16; CI:1.77-2.63). Current ENDS use was also associated with increased risk of emergency room (ER) visits (HR = 1.17; CI: 1.05-1.30) and death (HR = 1.84; CI:1.02-3.32). Conclusions Concurrent traditional cigarette use, marijuana use, and comorbidities were prevalent among those who used ENDS, and current ENDS use was associated with an increased risk of ER visits and death. Additional research focused on health risks associated with concurrent ENDS and traditional cigarette use in those with underlying comorbidities is needed.
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Affiliation(s)
| | | | - John David Powers
- Institute for Health
Research, Kaiser Permanente Colorado,
Aurora, CO, USA
| | - Morgan N. Clennin
- Institute for Health
Research, Kaiser Permanente Colorado,
Aurora, CO, USA
| | - Jason A. Lyons
- Institute for Health
Research, Kaiser Permanente Colorado,
Aurora, CO, USA
| | - Mark T. Gray
- Institute for Health
Research, Kaiser Permanente Colorado,
Aurora, CO, USA
| | - Anil Vachani
- Perelman School of Medicine,
University
of Pennsylvania, Philadelphia, PA,
USA
| | - Andrea N. Burnett-Hartman
- Institute for Health
Research, Kaiser Permanente Colorado,
Aurora, CO, USA
- Department of Health Systems
Science, Kaiser
Permanente Bernard J. Tyson School of
Medicine, Pasadena, CA, USA
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17
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Pai RK, Banerjee I, Shivji S, Jain S, Hartman D, Buchanan DD, Jenkins MA, Schaeffer DF, Rosty C, Como J, Phipps AI, Newcomb PA, Burnett-Hartman AN, Marchand LL, Samadder NJ, Patel B, Swallow C, Lindor NM, Gallinger SJ, Grant RC, Westerling-Bui T, Conner J, Cyr DP, Kirsch R, Pai RK. Quantitative Pathologic Analysis of Digitized Images of Colorectal Carcinoma Improves Prediction of Recurrence-Free Survival. Gastroenterology 2022; 163:1531-1546.e8. [PMID: 35985511 PMCID: PMC9716432 DOI: 10.1053/j.gastro.2022.08.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/02/2022] [Accepted: 08/09/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND & AIMS To examine whether quantitative pathologic analysis of digitized hematoxylin and eosin slides of colorectal carcinoma (CRC) correlates with clinicopathologic features, molecular alterations, and prognosis. METHODS A quantitative segmentation algorithm (QuantCRC) was applied to 6468 digitized hematoxylin and eosin slides of CRCs. Fifteen parameters were recorded from each image and tested for associations with clinicopathologic features and molecular alterations. A prognostic model was developed to predict recurrence-free survival using data from the internal cohort (n = 1928) and validated on an internal test (n = 483) and external cohort (n = 938). RESULTS There were significant differences in QuantCRC according to stage, histologic subtype, grade, venous/lymphatic/perineural invasion, tumor budding, CD8 immunohistochemistry, mismatch repair status, KRAS mutation, BRAF mutation, and CpG methylation. A prognostic model incorporating stage, mismatch repair, and QuantCRC resulted in a Harrell's concordance (c)-index of 0.714 (95% confidence interval [CI], 0.702-0.724) in the internal test and 0.744 (95% CI, 0.741-0.754) in the external cohort. Removing QuantCRC from the model reduced the c-index to 0.679 (95% CI, 0.673-0.694) in the external cohort. Prognostic risk groups were identified, which provided a hazard ratio of 2.24 (95% CI, 1.33-3.87, P = .004) for low vs high-risk stage III CRCs and 2.36 (95% CI, 1.07-5.20, P = .03) for low vs high-risk stage II CRCs, in the external cohort after adjusting for established risk factors. The predicted median 36-month recurrence rate for high-risk stage III CRCs was 32.7% vs 13.4% for low-risk stage III and 15.8% for high-risk stage II vs 5.4% for low-risk stage II CRCs. CONCLUSIONS QuantCRC provides a powerful adjunct to routine pathologic reporting of CRC. A prognostic model using QuantCRC improves prediction of recurrence-free survival.
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Affiliation(s)
- Reetesh K. Pai
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Imon Banerjee
- Department of Radiology and Machine Intelligence in Medicine and Imaging Center (MI-2), Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Sameer Shivji
- Department of Pathology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Suchit Jain
- Department of Radiology and Machine Intelligence in Medicine and Imaging Center (MI-2), Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Douglas Hartman
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Daniel D. Buchanan
- Colorectal Oncogenomics Group, Department of Clinical Pathology, The University of Melbourne, Parkville, VIC, Australia
- University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia
- Genomic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Mark A. Jenkins
- University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - David F. Schaeffer
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, BC, Canada
| | - Christophe Rosty
- Colorectal Oncogenomics Group, Department of Clinical Pathology, The University of Melbourne, Parkville, VIC, Australia
- Envoi Specialist Pathologists, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Julia Como
- Colorectal Oncogenomics Group, Department of Clinical Pathology, The University of Melbourne, Parkville, VIC, Australia
- University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia
| | - Amanda I. Phipps
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Polly A. Newcomb
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Andrea N. Burnett-Hartman
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA
| | - Loic Le Marchand
- Department of Epidemiology, University of Hawaii, Seattle, Washington, USA
| | - Niloy J. Samadder
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Bhavik Patel
- Department of Radiology and Machine Intelligence in Medicine and Imaging Center (MI-2), Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Carol Swallow
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Department of Surgical Oncology, Princess Margaret Cancer Centre and Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Noralane M. Lindor
- Department of Health Sciences Research Mayo Clinic, Scottsdale, Arizona, USA
| | - Steven J. Gallinger
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Hepatobiliary/Pancreatic Surgical Oncology Program, University Health Network, Toronto, Ontario, Canada
| | - Robert C. Grant
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Vector Institute, Toronto, Ontario, Canada
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - James Conner
- Department of Pathology, Mount Sinai Hospital, Toronto, ON, Canada
| | - David P. Cyr
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Department of Surgical Oncology, Princess Margaret Cancer Centre and Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Richard Kirsch
- Department of Pathology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Rish K. Pai
- Department of Pathology and Laboratory Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
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18
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Sarma EA, Thompson MJ, Bowles EJA, Burnett-Hartman AN, Hubbard RA, Yu O, Chubak J. Patient and tumour characteristics of screening-age adults diagnosed with screen-detected versus symptomatic colon cancer. Colorectal Dis 2022; 24:1344-1351. [PMID: 35739634 PMCID: PMC10018485 DOI: 10.1111/codi.16232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 05/20/2022] [Accepted: 06/14/2022] [Indexed: 02/08/2023]
Abstract
AIM International studies have shown that most colon cancers are diagnosed among people with symptoms, but research is limited in the United States. Here, we conducted a retrospective study of adults aged 50-85 years diagnosed with stage I-IIIA colon cancer between 1995 and 2014 in two US healthcare systems. METHODS Mode of detection (screening or symptomatic) was ascertained from medical records. We estimated unadjusted odds ratios (OR) and 95% confidence intervals (CI) comparing detection mode by patient factors at diagnosis (year, age, sex, race, smoking status, body mass index [BMI], Charlson score), prediagnostic primary care utilization, and tumour characteristics (stage, location). RESULTS Of 1,675 people with colon cancer, 38.4% were screen-detected, while 61.6% were diagnosed following symptomatic presentation. Screen-detected cancer was more common among those diagnosed between 2010 and 2014 versus 1995-1999 (OR 1.65, 95% CI: 1.19-2.28), and those with a BMI of 25-<30 kg/m2 (OR 1.54, 95% CI: 1.21-1.98) or ≥30 kg/m2 (OR 1.52, 95% CI: 1.18-1.96) versus <25 kg/m2 . Screen-detected cancer was less common among people aged 76-85 (OR 0.50, 95% CI: 0.39-0.65) versus 50-64, those with comorbidity scores >0 (OR 0.71, 95% CI: 0.56-0.91 for score = 1, OR 0.34, 95% CI: 0.26-0.45 for score = 2+), and those with 2+ prediagnostic primary care visits (OR 0.53, 95% CI: 0.37-0.76) versus 0 visits. The odds of screen detection were lower among patients diagnosed with stage IIA (OR 0.33, 95% CI = 0.27-0.41) or IIB (OR 0.12, 95% CI: 0.06-0.24) cancers versus stage I. CONCLUSIONS Most colon cancers among screen-eligible adults were diagnosed following symptomatic presentation. Even with increasing screening rates over time, research is needed to better understand why specific groups are more likely to be diagnosed when symptomatic and identify opportunities for interventions.
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Affiliation(s)
- Elizabeth A Sarma
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
| | - Matthew J Thompson
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Erin J A Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA
| | | | - Rebecca A Hubbard
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Onchee Yu
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA
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19
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Kamineni A, Doria-Rose VP, Chubak J, Inadomi JM, Corley DA, Haas JS, Kobrin SC, Winer RL, Elston Lafata J, Beaber EF, Yudkin JS, Zheng Y, Skinner CS, Schottinger JE, Ritzwoller DP, Croswell JM, Burnett-Hartman AN. Evaluation of Harms Reporting in U.S. Cancer Screening Guidelines. Ann Intern Med 2022; 175:1582-1590. [PMID: 36162112 PMCID: PMC9903969 DOI: 10.7326/m22-1139] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Cancer screening should be recommended only when the balance between benefits and harms is favorable. This review evaluated how U.S. cancer screening guidelines reported harms, within and across organ-specific processes to screen for cancer. OBJECTIVE To describe current reporting practices and identify opportunities for improvement. DESIGN Review of guidelines. SETTING United States. PATIENTS Patients eligible for screening for breast, cervical, colorectal, lung, or prostate cancer according to U.S. guidelines. MEASUREMENTS Information was abstracted on reporting of patient-level harms associated with screening, diagnostic follow-up, and treatment. The authors classified harms reporting as not mentioned, conceptual, qualitative, or quantitative and noted whether literature was cited when harms were described. Frequency of harms reporting was summarized by organ type. RESULTS Harms reporting was inconsistent across organ types and at each step of the cancer screening process. Guidelines did not report all harms for any specific organ type or for any category of harm across organ types. The most complete harms reporting was for prostate cancer screening guidelines and the least complete for colorectal cancer screening guidelines. Conceptualization of harms and use of quantitative evidence also differed by organ type. LIMITATIONS This review considers only patient-level harms. The authors did not verify accuracy of harms information presented in the guidelines. CONCLUSION The review identified opportunities for improving conceptualization, assessment, and reporting of screening process-related harms in guidelines. Future work should consider nuances associated with each organ-specific process to screen for cancer, including which harms are most salient and where evidence gaps exist, and explicitly explore how to optimally weigh available evidence in determining net screening benefit. Improved harms reporting could aid informed decision making, ultimately improving cancer screening delivery. PRIMARY FUNDING SOURCE National Cancer Institute.
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Affiliation(s)
- Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington (A.K., J.C.)
| | - V Paul Doria-Rose
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland (V.P.D., S.C.K., J.M.C.)
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington (A.K., J.C.)
| | - John M Inadomi
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah (J.M.I.)
| | - Douglas A Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, California (D.A.C.)
| | - Jennifer S Haas
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts (J.S.H.)
| | - Sarah C Kobrin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland (V.P.D., S.C.K., J.M.C.)
| | - Rachel L Winer
- Department of Epidemiology, University of Washington, Seattle, Washington (R.L.W.)
| | - Jennifer Elston Lafata
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, and Henry Ford Health System, Detroit, Michigan (J.E.L.)
| | - Elisabeth F Beaber
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (E.F.B., Y.Z.)
| | - Joshua S Yudkin
- University of Texas Health Science Center at Houston, Houston, Texas (J.S.Y.)
| | - Yingye Zheng
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (E.F.B., Y.Z.)
| | - Celette Sugg Skinner
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, and Simmons Comprehensive Cancer Center, Dallas, Texas (C.S.S.)
| | - Joanne E Schottinger
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California (J.E.S.)
| | - Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado (D.P.R., A.N.B.)
| | - Jennifer M Croswell
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland (V.P.D., S.C.K., J.M.C.)
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20
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Burnett-Hartman AN, Murphy CC, Lee JK. Novel, Emerging Risk Factors for Colorectal Cancer Remain Understudied. Gastroenterology 2022; 163:574-576. [PMID: 35809616 DOI: 10.1053/j.gastro.2022.06.085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 06/30/2022] [Indexed: 12/03/2022]
Affiliation(s)
| | - Caitlin C Murphy
- University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, Texas
| | - Jeffrey K Lee
- Department of Gastroenterology, Kaiser Permanente San Francisco, San Francisco, California, and, Division of Research Kaiser Permanente Northern California, Oakland, California
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21
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Kim RY, Rendle KA, Mitra N, Saia CA, Neslund-Dudas C, Greenlee RT, Burnett-Hartman AN, Honda SA, Simoff MJ, Schapira MM, Croswell JM, Meza R, Ritzwoller DP, Vachani A. Racial Disparities in Adherence to Annual Lung Cancer Screening and Recommended Follow-Up Care: A Multicenter Cohort Study. Ann Am Thorac Soc 2022; 19:1561-1569. [PMID: 35167781 PMCID: PMC9447384 DOI: 10.1513/annalsats.202111-1253oc] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/14/2022] [Indexed: 11/20/2022] Open
Abstract
Rationale: Black patients receive recommended lung cancer screening (LCS) follow-up care less frequently than White patients, but it is unknown if this racial disparity persists across both decentralized and centralized LCS programs. Objectives: To determine adherence to American College of Radiology Lung Imaging Reporting and Data System (Lung-RADS) recommendations among individuals undergoing LCS at either decentralized or centralized programs and to evaluate the association of race with LCS adherence. Methods: We performed a multicenter retrospective cohort study of patients receiving LCS at five heterogeneous U.S. healthcare systems. We calculated adherence to annual LCS among patients with a negative baseline screen (Lung-RADS 1 or 2) and recommended follow-up care among those with a positive baseline screen (Lung-RADS 3, 4A, 4B, or 4X) stratified by type of LCS program and evaluated the association between race and adherence using multivariable modified Poisson regression. Results: Of the 6,134 total individuals receiving LCS, 5,142 (83.8%) had negative baseline screens, and 992 (16.2%) had positive baseline screens. Adherence to both annual LCS (34.8% vs. 76.1%; P < 0.001) and recommended follow-up care (63.9% vs. 74.6%; P < 0.001) was lower at decentralized compared with centralized programs. Among individuals with negative baseline screens, a racial disparity in adherence was observed only at decentralized screening programs (interaction term, P < 0.001). At decentralized programs, Black race was associated with 27% reduced adherence to annual LCS (adjusted relative risk [aRR], 0.73; 95% confidence interval [CI], 0.63-0.84), whereas at centralized programs, no effect by race was observed (aRR, 0.98; 95% CI, 0.91-1.05). In contrast, among those with positive baseline screens, there was no significant difference by race for adherence to recommended follow-up care by type of LCS program (decentralized aRR, 0.95; 95% CI, 0.81-1.11; centralized aRR, 0.81; 95% CI, 0.71-0.93; interaction term, P = 0.176). Conclusions: In this large multicenter study of individuals screened for lung cancer, adherence to both annual LCS and recommended follow-up care was greater at centralized screening programs. Black patients were less likely to receive annual LCS than White patients at decentralized compared with centralized LCS programs. Our results highlight the need for further study of healthcare system-level mechanisms to optimize longitudinal LCS care.
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Affiliation(s)
- Roger Y. Kim
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine
| | - Katharine A. Rendle
- Department of Family Medicine and Community Health
- Department of Biostatistics, Epidemiology, and Informatics, and
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology, and Informatics, and
| | | | | | | | | | - Stacey A. Honda
- Center for Health Research, Kaiser Permanente Hawaii, Oahu, Hawaii
| | - Michael J. Simoff
- Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Marilyn M. Schapira
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer M. Croswell
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, Maryland; and
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | | | - Anil Vachani
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine
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22
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Beaber EF, Kamineni A, Burnett-Hartman AN, Hixon B, Kobrin SC, Li CI, Oliver M, Rendle KA, Skinner CS, Todd K, Zheng Y, Ziebell RA, Breslau ES, Chubak J, Corley DA, Greenlee RT, Haas JS, Halm EA, Honda S, Neslund-Dudas C, Ritzwoller DP, Schottinger JE, Tiro JA, Vachani A, Doria-Rose VP. Evaluating and Improving Cancer Screening Process Quality in a Multilevel Context: The PROSPR II Consortium Design and Research Agenda. Cancer Epidemiol Biomarkers Prev 2022; 31:1521-1531. [PMID: 35916603 PMCID: PMC9350927 DOI: 10.1158/1055-9965.epi-22-0100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/08/2022] [Accepted: 05/06/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Cancer screening is a complex process involving multiple steps and levels of influence (e.g., patient, provider, facility, health care system, community, or neighborhood). We describe the design, methods, and research agenda of the Population-based Research to Optimize the Screening Process (PROSPR II) consortium. PROSPR II Research Centers (PRC), and the Coordinating Center aim to identify opportunities to improve screening processes and reduce disparities through investigation of factors affecting cervical, colorectal, and lung cancer screening in U.S. community health care settings. METHODS We collected multilevel, longitudinal cervical, colorectal, and lung cancer screening process data from clinical and administrative sources on >9 million racially and ethnically diverse individuals across 10 heterogeneous health care systems with cohorts beginning January 1, 2010. To facilitate comparisons across organ types and highlight data breadth, we calculated frequencies of multilevel characteristics and volumes of screening and diagnostic tests/procedures and abnormalities. RESULTS Variations in patient, provider, and facility characteristics reflected the PROSPR II health care systems and differing target populations. PRCs identified incident diagnoses of invasive cancers, in situ cancers, and precancers (invasive: 372 cervical, 24,131 colorectal, 11,205 lung; in situ: 911 colorectal, 32 lung; precancers: 13,838 cervical, 554,499 colorectal). CONCLUSIONS PROSPR II's research agenda aims to advance: (i) conceptualization and measurement of the cancer screening process, its multilevel factors, and quality; (ii) knowledge of cancer disparities; and (iii) evaluation of the COVID-19 pandemic's initial impacts on cancer screening. We invite researchers to collaborate with PROSPR II investigators. IMPACT PROSPR II is a valuable data resource for cancer screening researchers.
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Affiliation(s)
- Elisabeth F. Beaber
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | | | - Brian Hixon
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO
| | - Sarah C. Kobrin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Christopher I. Li
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Malia Oliver
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Katharine A. Rendle
- Departments of Family Medicine and Community Health and of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Celette Sugg Skinner
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX,Simmons Comprehensive Cancer Center, Dallas, TX
| | - Kaitlin Todd
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Yingye Zheng
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Erica S. Breslau
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Douglas A. Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Robert T. Greenlee
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, WI
| | - Jennifer S. Haas
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Ethan A. Halm
- Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Stacey Honda
- Hawaii Permanente Medical Group, Kaiser Permanente Center for Integrated Health Care Research, Honolulu, HI
| | | | | | | | - Jasmin A. Tiro
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX,Simmons Comprehensive Cancer Center, Dallas, TX
| | - Anil Vachani
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - V. Paul Doria-Rose
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
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23
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Chubak J, Burnett-Hartman AN, Barlow WE, Corley DA, Croswell JM, Neslund-Dudas C, Vachani A, Silver MI, Tiro JA, Kamineni A. Estimating Cancer Screening Sensitivity and Specificity Using Healthcare Utilization Data: Defining the Accuracy Assessment Interval. Cancer Epidemiol Biomarkers Prev 2022; 31:1517-1520. [PMID: 35916602 PMCID: PMC9484579 DOI: 10.1158/1055-9965.epi-22-0232] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/29/2022] [Accepted: 05/23/2022] [Indexed: 11/16/2022] Open
Abstract
The effectiveness and efficiency of cancer screening in real-world settings depend on many factors, including test sensitivity and specificity. Outside of select experimental studies, not everyone receives a gold standard test that can serve as a comparator in estimating screening test accuracy. Thus, many studies of screening test accuracy use the passage of time to infer whether or not cancer was present at the time of the screening test, particularly for patients with a negative screening test. We define the accuracy assessment interval as the period of time after a screening test that is used to estimate the test's accuracy. We describe how the length of this interval may bias sensitivity and specificity estimates. We call for future research to quantify bias and uncertainty in accuracy estimates and to provide guidance on setting accuracy assessment interval lengths for different cancers and screening modalities.
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Affiliation(s)
- Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Andrea N. Burnett-Hartman
- Kaiser Permanente Colorado Institute for Health Research, Aurora, CO
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | | | - Christine Neslund-Dudas
- Department of Public Health Sciences and Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI
| | - Anil Vachani
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michelle I. Silver
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO
| | - Jasmin A. Tiro
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX
- Simmons Comprehensive Cancer Center, Dallas, TX
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
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24
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Lu CY, Jin R, Zhang F, Argetsinger S, Burnett-Hartman AN, Hao J, Honda SA, Neslund-Dudas C, Weinmann S. Tumor marker testing among Medicare beneficiaries with cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e13628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13628 Background: Precision medicine has changed treatment practices for patients with cancer. Clinical guidelines recommend tumor marker testing for many types of cancer given its benefits. Studies have demonstrated that tumor marker testing increases use of appropriate targeted therapies which is associated with improved survival, particularly among patients with advanced or metastatic cancer. In March 2018, Medicare issued a national coverage determination (NCD) for next-generation sequencing to facilitate tumor marker testing. Methods: We conducted a retrospective study to assess tumor marker testing among Medicare beneficiaries with cancer from 03/01/2016 through 02/28/2020. Data were obtained from the Virtual Data Warehouses of 6 United States (US) healthcare systems in the Cancer Research Network, a well-established distributed data network for cancer research. Together these systems provide care to a diverse population of over 5.5 million people in the US. The index date was the first observed cancer diagnosis date recorded in the tumor registry during the study period. Subgroup analyses included those with lung, breast, colorectal, or prostate cancers, or those with advanced, metastatic or recurrent cancer. This is part of a larger project that aims to advance methods for scalable and rigorous evaluation of outcomes of coverage policies for genetic tests. Results: We report results from one health system (03/01/2016-3/31/2018) including Medicare beneficiaries ≥65 years and ≥ 90 enrollment days after the index date. Among 2,277 Medicare beneficiaries with cancer, mean (SD) age was 74 (6.8) years, 1,065 (46.8%) were women, 199 (9.9%) had a tumor marker test within 90 days of the index date, and 1072 (47.1%) started a cancer drug therapy within 90 days of the index date. Among Medicare beneficiaries with lung (n=352), breast (n=361) colorectal (n=135) and prostate (n=326) cancers, proportions of patients having tumor marker tests ranged from 2.2% to 12.8% within 90 days of the index date. Among 572 Medicare beneficiaries with advanced, metastatic or recurrent cancer, 59 (10.3%) had a tumor marker test within 90 days of the index date. Conclusions: The relatively low tumor marker testing rate among Medicare beneficiaries with cancer in this health system is consistent with the literature. Analyses are underway to examine changes in tumor marker testing among Medicare beneficiaries after the implementation of the 2018 Medicare NCD.
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Affiliation(s)
- Christine Y. Lu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Robert Jin
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Fang Zhang
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Stephanie Argetsinger
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | | | | | - Stacey A. Honda
- Hawaii Permanente Medical Group and Center for Integrated Health Care Research, Kaiser Permanente, Honolulu, HI
| | | | - Sheila Weinmann
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
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Coronado GD, Dickerson JF, Burnett-Hartman AN, Carethers JM, Lee JK, McBurnie MA, Petrik A, Keast E, Hendren S, McMullen C, Mummadi R, Murphy CC, Rutter CM. Reduced Implementation and Completion of Average-Risk Annual Fecal Immunochemical Test Colorectal Cancer Screening in Black Patients Aged 45-49 Years. Clin Gastroenterol Hepatol 2022:S1542-3565(22)00519-5. [PMID: 35644342 DOI: 10.1016/j.cgh.2022.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 02/07/2023]
Affiliation(s)
| | | | | | - John M Carethers
- University of Michigan Department of Internal Medicine, Ann Arbor, Michigan
| | - Jeff K Lee
- Kaiser Permanente Division of Research, Oakland, California
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Madrid SD, Blum-Barnett E, Lemke AA, Pan V, Paolino V, McGlynn EA, Burnett-Hartman AN. "A Gift to My Family for Their Future": Attitudes about Genetic Research Participation. Public Health Genomics 2022; 25:1-10. [PMID: 35545013 DOI: 10.1159/000524462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 04/01/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Broad participation in genetic research is needed to promote equitable advances in disease treatment and prevention. OBJECTIVES The objective of the study was to assess motivations for, and concerns about, genetic research participation. METHODS The Genetics in Research and Health Care Survey was sent in winter 2017-2018 to 57,331 adult Kaiser Permanente (KP) members from 7 US regions to assess attitudes about genetic testing in health care and research. The survey included an open-ended question on why members would or would not participate in genetic research. Open text responses to this question were coded in the qualitative analysis software Dedoose and analyzed using a thematic analysis approach. Code summaries were organized by major themes, subthemes, and exemplary quotes. RESULTS Of the 10,369 participants who completed the survey, 2,645 (25%) provided a comment describing reasons they would or would not participate in research involving genetic testing. Respondents who provided a text comment were 64% female, 49% non-Hispanic (NH) White, 17% Asian/Pacific Islander, 20% Hispanic, and 14% NH Black. The primary themes identified were (1) altruism; (2) decision-making and planning; (3) data use; and (4) data security. These major themes were consistent across each race and ethnic group. CONCLUSIONS To promote broad participation in genetic research, it is important that recruitment materials address the primary motivators for genetic research participation, including altruism and the potential use of results for personal decision-making. Study materials should also address concerns about possible misuse of genetic information and fears over potential data breaches.
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Affiliation(s)
- Sarah D Madrid
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Erica Blum-Barnett
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Amy A Lemke
- NorthShore University HealthSystem, Evanston, Illinois, USA
- Norton Children's Research Institute, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Vivian Pan
- University of Illinois Cancer Center, Chicago, Illinois, USA
| | - Valerie Paolino
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
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Burnett-Hartman AN, Goldberg Scott S, Powers JD, Clennin MN, Lyons JA, Gray M, Feigelson HS. The Association of Electronic Cigarette Use With SARS-CoV-2 Infection and COVID-19 Disease Severity. Tob Use Insights 2022; 15:1179173X221096638. [PMID: 35492220 PMCID: PMC9044777 DOI: 10.1177/1179173x221096638] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/06/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Although combustible cigarette use is an established risk factor for severe
COVID-19 disease, there is conflicting evidence for the association of
electronic cigarette use with SARS-CoV-2 infection and COVID-19 disease
severity. METHODS Study participants were from the Kaiser Permanente Research Bank (KPRB), a
biorepository that includes adult Kaiser Permanente members from across the
United States. Starting in April 2020, electronic surveys were sent to KPRB
members to assess the impact of the COVID-19 pandemic. These surveys
collected information on self-report of SARS-CoV-2 infection and
COVID-related risk factors, including electronic cigarette and combustible
cigarette smoking history. We also used electronic health records data to
assess COVID-19 diagnoses, positive PCR lab tests, hospitalizations, and
death. We used multivariable Cox proportional hazards regression to
calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs)
comparing the risk of SARS-CoV-2 infection between individuals by
e-cigarette use categories (never, former, and current). Among those with
SARS-CoV-2 infection, we used multivariable logistic regression to estimate
adjusted odds ratios (ORs) and 95% CIs comparing the odds of hospitalization
or death within 30 days of infection between individuals by e-cigarette use
categories. RESULTS There were 126,475 individuals who responded to the survey and completed
questions on e-cigarette and combustible cigarette use (48% response rate).
Among survey respondents, 819 (1%) currently used e-cigarettes, 3,691 (3%)
formerly used e-cigarettes, and 121,965 (96%) had never used e-cigarettes.
After adjustment for demographic, behavioral, and clinical factors, there
was no association with SARS-CoV-2 infection and former e-cigarette use
(hazard ratio (HR) = 0.99; CI: 0.83–1.18) or current e-cigarette use (HR =
1.08; CI: 0.76–1.52). Among those with SARS-CoV-2 infection, there was no
association with hospitalization or death within 30 days of infection and
former e-cigarette use (odds ratio (OR) = 1.19; CI: 0.59–2.43) or current
e-cigarette use (OR = 1.02; CI: 0.22–4.74). CONCLUSIONS Our results suggest that e-cigarette use is not associated with an increased
risk of SARS-CoV-2 infection or severe COVID-19 illness.
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Affiliation(s)
- Andrea N Burnett-Hartman
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | | | - J David Powers
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Morgan N Clennin
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Jason A Lyons
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Mark Gray
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
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Feigelson HS, Clarke CL, Van Den Eeden SK, Weinmann S, Burnett-Hartman AN, Rowell S, Scott SG, White LL, Ter-Minassian M, Honda SAA, Young DR, Kamineni A, Chinn T, Lituev A, Bauck A, McGlynn EA. The Kaiser Permanente Research Bank Cancer Cohort: a collaborative resource to improve cancer care and survivorship. BMC Cancer 2022; 22:209. [PMID: 35216576 PMCID: PMC8876075 DOI: 10.1186/s12885-022-09252-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/21/2022] [Indexed: 12/04/2022] Open
Abstract
Background The Kaiser Permanente Research Bank (KPRB) is collecting biospecimens and surveys linked to electronic health records (EHR) from approximately 400,000 adult KP members. Within the KPRB, we developed a Cancer Cohort to address issues related to cancer survival, and to understand how genetic, lifestyle and environmental factors impact cancer treatment, treatment sequelae, and prognosis. We describe the Cancer Cohort design and implementation, describe cohort characteristics after 5 years of enrollment, and discuss future directions. Methods Cancer cases are identified using rapid case ascertainment algorithms, linkage to regional or central tumor registries, and direct outreach to KP members with a history of cancer. Enrollment is primarily through email invitation. Participants complete a consent form, survey, and donate a blood or saliva sample. All cancer types are included. Results As of December 31, 2020, the cohort included 65,225 cases (56% female, 44% male) verified in tumor registries. The largest group was diagnosed between 60 and 69 years of age (31%) and are non-Hispanic White (83%); however, 10,076 (16%) were diagnosed at ages 18–49 years, 4208 (7%) are Hispanic, 3393 (5%) are Asian, and 2389 (4%) are Black. The median survival time is 14 years. Biospecimens are available on 98% of the cohort. Conclusions The KPRB Cancer Cohort is designed to improve our understanding of treatment efficacy and factors that contribute to long-term cancer survival. The cohort’s diversity - with respect to age, race/ethnicity and geographic location - will facilitate research on factors that contribute to cancer survival disparities.
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Affiliation(s)
- Heather Spencer Feigelson
- Institute for Health Research, Kaiser Permanente, 2550 S. Parker Rd, Suite 200, Aurora, CO, 80014, USA.
| | - Christina L Clarke
- Institute for Health Research, Kaiser Permanente, 2550 S. Parker Rd, Suite 200, Aurora, CO, 80014, USA
| | | | - Sheila Weinmann
- Center for Health Research, Kaiser Permanente, 3800 N. Interstate Ave, Portland, OR, 97227, USA
| | - Andrea N Burnett-Hartman
- Institute for Health Research, Kaiser Permanente, 2550 S. Parker Rd, Suite 200, Aurora, CO, 80014, USA
| | - Sarah Rowell
- Kaiser Permanente Program Office, 1800 Harrison, 16th floor, Oakland, CA, 94612, USA
| | - Shauna Goldberg Scott
- Institute for Health Research, Kaiser Permanente, 2550 S. Parker Rd, Suite 200, Aurora, CO, 80014, USA
| | - Larissa L White
- Institute for Health Research, Kaiser Permanente, 2550 S. Parker Rd, Suite 200, Aurora, CO, 80014, USA
| | - Monica Ter-Minassian
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente, 2101 East Jefferson St, 3 West, Rockville, MD, 20852, USA
| | - Stacey A A Honda
- Center for Integrated Healthcare Research and Hawai'i Permanente Medical Group, Kaiser Permanente, 501 Alakawa St Suite 201, Honolulu, HI, 96817, USA
| | - Deborah R Young
- Department of Research and Evaluation, Kaiser Permanente, 100 S. Los Robles Avenue, Pasadena, CA, 91101, USA
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave Suite 1600, Seattle, WA, 98101, USA
| | - Terrence Chinn
- Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA, 94612, USA
| | - Alexander Lituev
- Kaiser Permanente Research Bank, Kaiser Permanente, 1795 A Second St, Berkeley, CA, 94710, USA
| | - Alan Bauck
- Center for Health Research, Kaiser Permanente, 3800 N. Interstate Ave, Portland, OR, 97227, USA
| | - Elizabeth A McGlynn
- Kaiser Permanente Research & Quality Measurement and Kaiser Permanente Research Bank, 100 S. Los Robles, 3rd floor, Pasadena, CA, 91101, USA
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Newcomb PA, Ton M, Malen RC, Heffner JL, Labadie J, Phipps AI, Burnett-Hartman AN. Correction to: Cannabis use is associated with patient and clinical factors in a population-based sample of colorectal cancer survivors. Cancer Causes Control 2021; 32:1329-1331. [PMID: 34665364 DOI: 10.1007/s10552-021-01499-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- P A Newcomb
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA.
- Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | - M Ton
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - R C Malen
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA
| | - J L Heffner
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA
| | - J Labadie
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA
| | - A I Phipps
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - A N Burnett-Hartman
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA
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Ritzwoller DP, Meza R, Carroll NM, Blum-Barnett E, Burnett-Hartman AN, Greenlee RT, Honda SA, Neslund-Dudas C, Rendle KA, Vachani A. Evaluation of Population-Level Changes Associated With the 2021 US Preventive Services Task Force Lung Cancer Screening Recommendations in Community-Based Health Care Systems. JAMA Netw Open 2021; 4:e2128176. [PMID: 34636916 PMCID: PMC8511972 DOI: 10.1001/jamanetworkopen.2021.28176] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE The US Preventive Services Task Force (USPSTF) released updated lung cancer screening recommendations in 2021, lowering the screening age from 55 to 50 years and smoking history from 30 to 20 pack-years. These changes are expected to expand screening access to women and racial and ethnic minority groups. OBJECTIVE To estimate the population-level changes associated with the 2021 USPSTF expansion of lung cancer screening eligibility by sex, race and ethnicity, sociodemographic factors, and comorbidities in 5 community-based health care systems. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed data of patients who received care from any of 5 community-based health care systems (which are members of the Population-based Research to Optimize the Screening Process Lung Consortium, a collaboration that conducts research to better understand how to improve the cancer screening processes in community health care settings) from January 1, 2010, through September 30, 2019. Individuals who had complete smoking history and were engaged with the health care system for 12 or more continuous months were included. Those who had never smoked or who had unknown smoking history were excluded. EXPOSURES Electronic health record-derived age, sex, race and ethnicity, socioeconomic status (SES), comorbidities, and smoking history. MAIN OUTCOMES AND MEASURES Differences in the proportion of the newly eligible population by age, sex, race and ethnicity, Charlson Comorbidity Index, chronic obstructive pulmonary disease diagnosis, and SES as well as lung cancer diagnoses under the 2013 recommendations vs the expected cases under the 2021 recommendations were evaluated using χ2 tests. RESULTS As of September 2019, there were 341 163 individuals aged 50 to 80 years who currently or previously smoked. Among these, 34 528 had electronic health record data that captured pack-year and quit-date information and were eligible for lung cancer screening according to the 2013 USPSTF recommendations. The 2021 USPSTF recommendations expanded screening eligibility to 18 533 individuals, representing a 53.7% increase. Compared with the 2013 cohort, the newly eligible 2021 population included 5833 individuals (31.5%) aged 50 to 54 years, a larger proportion of women (52.0% [n = 9631]), and more racial or ethnic minority groups. The relative increases in the proportion of newly eligible individuals were 60.6% for Asian, Native Hawaiian, or Pacific Islander; 67.4% for Hispanic; 69.7% for non-Hispanic Black; and 49.0% for non-Hispanic White groups. The relative increase for women was 13.8% higher than for men (61.2% vs 47.4%), and those with a lower comorbidity burden and lower SES had higher relative increases (eg, 68.7% for a Charlson Comorbidity Index score of 0; 61.1% for lowest SES). The 2021 recommendations were associated with an estimated 30% increase in incident lung cancer diagnoses compared with the 2013 recommendations. CONCLUSIONS AND RELEVANCE This cohort study suggests that, in diverse health care systems, adopting the 2021 USPSTF recommendations will increase the number of women, racial and ethnic minority groups, and individuals with lower SES who are eligible for lung cancer screening, thus helping to minimize the barriers to screening access for individuals with high risk for lung cancer.
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Affiliation(s)
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor
| | - Nikki M. Carroll
- Institute for Health Research, Kaiser Permanente Colorado, Aurora
| | | | | | | | - Stacey A. Honda
- Center for Integrated Healthcare Research, Kaiser Permanente Hawaii, Oahu
| | | | | | - Anil Vachani
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Newcomb PA, Ton M, Malen RC, Heffner JL, Labadie J, Phipps AI, Burnett-Hartman AN. Cannabis use is associated with patient and clinical factors in a population-based sample of colorectal cancer survivors. Cancer Causes Control 2021; 32:1321-1327. [PMID: 34263391 DOI: 10.1007/s10552-021-01468-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 06/20/2021] [Indexed: 01/24/2023]
Abstract
PURPOSE This study aimed to characterize patient and clinical factors associated with cannabis (marijuana) use among patients diagnosed with colorectal cancer (CRC). METHODS We identified CRC patients, diagnosed from 2016 to 2018, using the Seattle-Puget Sound Surveillance, Epidemiology, and End Results (SEER) cancer registry. CRC patients were recruited via mail and telephone, and participants completed a questionnaire eliciting information on medical history, demographics, and lifestyle factors, including cannabis use. Cancer stage was obtained from SEER registry data. RESULTS Of 1,433 survey respondents, 339 (24%) were current cannabis users. Current cannabis use was associated with younger age at diagnosis, lower BMI, and a higher prevalence of cigarette smoking and alcohol consumption (p-value < 0.05). Cannabis use was also associated with lower quality of life scores (FACT-C) and advanced-stage cancer (p-value < 0.05). CONCLUSION Cannabis use among CRC patients was common. Patients with more advanced disease were more likely to report cannabis use. Use also varied by some personal factors, consistent with patterns in the general population. Given the high prevalence of cannabis use among CRC patients, research is needed to determine the benefits and harms of cannabis use for symptom management in cancer patients.
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Affiliation(s)
- P A Newcomb
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA. .,Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | - M Ton
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - R C Malen
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA
| | - J L Heffner
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA
| | - J Labadie
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA
| | - A I Phipps
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - A N Burnett-Hartman
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA.,Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA
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Bulkley JE, McMullen CK, Rawlings AM, Krouse RS, Francisco MC, Sterrett AT, Burnett-Hartman AN, Pawloski PA, Corley DA, Colwell JC, Feigelson HS. The association of bowel function, participation in life activities, and quality of life in rectal cancer survivors. Qual Life Res 2021; 31:487-495. [PMID: 34251589 DOI: 10.1007/s11136-021-02930-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate whether limited participation in life activities is associated with quality of life (QOL) in rectal cancer survivors, and if so, whether this association is independent of bowel function difficulties. METHODS We surveyed rectal cancer survivors from four healthcare systems about their QOL, bowel function, and participation in life activities. Additional demographic and clinical variables were extracted from the electronic health record. We examined independent associations between bowel function, participation in life activities, and QOL, controlling for potential confounders. We also identified factors, including ostomy status, that correlate with participation in life activities. RESULTS Of the 527 respondents, 52% were male, 80% were non-Hispanic white, and the mean age was 63. In fully adjusted models for all rectal cancer survivors, participation in life activities was positively associated with QOL, while bowel function was not. Bowel function retained an independent association with QOL for those who previously had an ostomy and were therefore more likely to have a low rectal anastomosis. Lower participation in life activities was correlated with lower self-reported physical and cognitive function, younger age, financial difficulty, and being non-Hispanic white. CONCLUSIONS Rectal cancer survivors' participation in life activities was strongly associated with QOL, even when controlling for numerous confounders, including bowel function. Identifying ways to improve participation in life activities may be critical to developing rehabilitative and other supportive interventions that optimize QOL among rectal cancer survivors.
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Affiliation(s)
- Joanna E Bulkley
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227-1110, USA.
| | - Carmit K McMullen
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227-1110, USA
| | - Andreea M Rawlings
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227-1110, USA
| | - Robert S Krouse
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Melanie C Francisco
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227-1110, USA
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Kim R, Rendle KA, Neslund-Dudas C, Greenlee RT, Burnett-Hartman AN, Honda SA, Simoff MJ, Croswell JM, Ritzwoller DP, Vachani A. Community-based lung cancer screening adherence to Lung-RADS recommendations. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.10540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10540 Background: In the NLST and NELSON trials, most low-dose CT (LDCT) screen-detected lung cancers were not diagnosed during the first round of screening, suggesting that longitudinal adherence to lung cancer screening (LCS) recommendations is key. Adherence was as high as 95% in clinical trials, but limited data exist regarding LCS adherence in clinical practice. We aimed to determine adherence to Lung-RADS recommendations among community-based patients undergoing LCS. Methods: We performed a multicenter retrospective cohort study of patients screened for lung cancer at healthcare systems within the Lung Population-based Research to Optimize the Screening Process (PROSPR) Consortium. We included 55-80 year-old current or former smokers who received a baseline (T0) LDCT with a Lung-RADS score between January 1, 2015 and September 30, 2017 and excluded patients who were diagnosed with lung cancer prior to the T0 scan. Over a 24-month period, we calculated the proportion of patients adherent to Lung-RADS recommendations and evaluated associations with patient-level (age, sex, race, ethnicity, smoking status, body mass index, Elixhauser comorbidities, year of T0 scan, and Lung-RADS score) and census tract (median family income, level of education) data, using multivariable logistic regression with mixed effects to account for site variability. Results: Of the 6,723 patients in our cohort (median age 65 years [IQR 60-69]; 45.1% female; 73.0% white; 59.0% current smokers), 5,583 (83.0%) had Lung-RADS 1 or 2 T0 scans, 733 (10.9%) Lung-RADS 3, 274 (4.1%) Lung-RADS 4A, and 133 (2.0%) Lung-RADS 4B or 4X. Overall, 55.2% (3,709/6,723) of patients were adherent (Table). In the final multivariable model, Black patients had reduced adherence compared to white patients (adjusted odds ratio [aOR] 0.79, 95% CI 0.66-0.94), while greater adherence was observed in former smokers compared to current smokers (aOR 1.33, 95% 1.19-1.49). Compared to individuals with a negative T0 scan (Lung-RADS 1 or 2), those with Lung-RADS 3 (aOR 1.56, 95% CI 1.31-1.86), 4A (aOR 1.63, 95% CI 1.24-2.15), or 4B/4X (aOR 3.59, 95% CI 2.30-5.60) T0 scans had greater odds of adherence. Conclusions: In the largest study of real-world patients receiving LCS to date, adherence to Lung-RADS recommendations is lower than previously observed in clinical trials. Our results highlight the need for further study of system-level mechanisms to improve longitudinal LCS adherence rates.[Table: see text]
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Affiliation(s)
- Roger Kim
- University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | - Stacey A. Honda
- Hawaii Permanente Medical Group and Center for Integrated Health Care Research, Kaiser Permanente, Honolulu, HI
| | | | | | | | - Anil Vachani
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Burnett-Hartman AN, Lee JK, Demb J, Gupta S. An Update on the Epidemiology, Molecular Characterization, Diagnosis, and Screening Strategies for Early-Onset Colorectal Cancer. Gastroenterology 2021; 160:1041-1049. [PMID: 33417940 PMCID: PMC8273929 DOI: 10.1053/j.gastro.2020.12.068] [Citation(s) in RCA: 102] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/22/2020] [Accepted: 12/26/2020] [Indexed: 12/15/2022]
Abstract
Rising trends in the incidence and mortality of early-onset colorectal cancer (CRC) in those who are younger than 50 years have been well established. These trends have spurred intense investigation focused on elucidating the epidemiology and characteristics of early-onset CRC, as well as on identifying strategies for early detection and prevention. In this review, we provide a contemporary update on early-onset CRC with a particular focus on epidemiology, molecular characterization, red flag signs and symptoms, and screening for early-onset CRC.
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Affiliation(s)
| | - Jeffrey K Lee
- Division of Research, Kaiser Permanente Northern California; Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California.
| | - Joshua Demb
- Division of Gastroenterology, Department of Internal Medicine, University of California, San Diego, La Jolla, California
| | - Samir Gupta
- Division of Gastroenterology, Department of Internal Medicine, University of California, San Diego, La Jolla, California; VA San Diego Healthcare System, San Diego, California
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Burnett-Hartman AN, Ton M(T, He C(Q, Malen RC, Phipps AI, Labadie JD, Feigelson HS, Newcomb PA. Abstract LB-161: A comparison of dietary factors between early-onset and late-onset colorectal cancer patients. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-lb-161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: Despite declines in the overall incidence and mortality of colorectal cancer (CRC), there have been increases in the incidence and mortality of CRC among those < 50 years old (early-onset CRC). Although the reasons for the increases in early-onset CRC are unknown, one hypothesis is that temporal changes in dietary patterns has led to changes in the consumption of foods that are associated with increased CRC risk, in particular red and processed meats. Thus, the purpose of our analyses was to evaluate differences in dietary factors between early-onset and late-onset CRC patients. Methods: We used the Puget Sound SEER cancer registry to identify a population-based sample of patients diagnosed with CRC from 4/1/2016 through 12/31/2018. CRC patients were recruited to the study via mail and telephone, and consented patients completed a questionnaire assessing patient demographics, medical history, and CRC risk factors, including diet. For dietary factors, we ascertained information on the average number of servings per week of fruits, vegetables, red meat, processed meat, and “spicy” foods two years prior to CRC diagnosis. We used logistic regression to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) comparing dietary intake in early-onset vs. late-onset CRC. ORs were adjusted for sex, race/ethnicity, cigarette smoking history, diabetes, hyperlipidemia, and alcohol consumption. Results: There were 304 early-onset and 1,150 late-onset CRC patients in our analyses. Compared to late-onset patients, those with early-onset CRC were less likely to be current smokers or to have a history of diabetes or hyperlipidemia. After adjustment for these differences, compared to late-onset CRC, early-onset CRC patients had higher intake of red meat (OR for quartile 4 vs. quartile 1 = 1.49 CI: 1.02 - 2.17), processed meat (OR for quartile 4 vs. quartile 1 = 1.63 CI: 1.16 -2 .29), and spicy food (OR for quartile 4 vs. quartile 1 = 1.80 CI: 1.25 - 2.58). However, there was not a statistically significant difference between early- and late-onset CRC patients with regard to fruit (OR for quartile 4 vs. quartile 1 = 1.07 CI: 0.73 - 1.57) or vegetable (OR for quartile 4 vs. quartile 1 = 0.87 CI: 0.62 - 1.22) consumption. Conclusion: Our results suggest that dietary patterns differ between early- and late-onset CRC patients; in particular, early-onset CRC patients had higher intake of red meat, processed meat, and spicy food. This may reflect differences is dietary patterns by age; additional research with population-based controls is needed to determine the association between diet and early-onset colorectal cancer.
Citation Format: Andrea N. Burnett-Hartman, Mimi (Trucmai) Ton, Chad (Qianchuan) He, Rachel C. Malen, Amanda I. Phipps, Julia D. Labadie, Heather Spencer Feigelson, Polly A. Newcomb. A comparison of dietary factors between early-onset and late-onset colorectal cancer patients [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr LB-161.
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Burnett-Hartman AN, Udaltsova N, Kushi LH, Neslund-Dudas C, Rahm AK, Pawloski PA, Corley DA, Knerr S, Feigelson HS, Hunter JE, Tabano DC, Epstein MM, Honda SA, Ter-Minassian M, Lynch JA, Lu CY. Clinical Molecular Marker Testing Data Capture to Promote Precision Medicine Research Within the Cancer Research Network. JCO Clin Cancer Inform 2020; 3:1-10. [PMID: 31487201 DOI: 10.1200/cci.19.00026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To evaluate health care systems for the availability of population-level data on the frequency of use and results of clinical molecular marker tests to inform precision cancer care. METHODS We assessed cancer-related molecular marker test data availability across 12 US health care systems in the Cancer Research Network. Overall, these systems provide care to a diverse population of more than 12 million people in the United States. We performed qualitative analyses of test data availability for five blood-based protein, nine germline, and 14 tissue-based tumor marker tests in each health care system's electronic health record and tumor registry using key informants, test code lists, and manual review of data types and output. We then performed quantitative analyses to estimate the proportion of patients with cancer with test utilization data and results for specific molecular marker tests. RESULTS Health systems were able to systematically capture population-level data on all five blood protein markers, six of 14 tissue-based tumor markers, and none of the nine germline markers. Successful, systematic data capture was achievable for tests with electronic data feeds for test results (blood protein markers) or through prior manual abstraction by tumor registrars (select tumor-based markers). For test results stored in scanned image files (particularly germline and tumor marker tests), information on which test was performed and test results was not readily accessible in an electronic format. CONCLUSION Even in health care systems with sophisticated electronic health records, there were few codified data elements available for evaluating precision cancer medicine test use and results at the population level. Health care organizations should establish standards for electronic reporting of precision medicine tests to expedite cancer research and facilitate the implementation of precision medicine approaches.
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Affiliation(s)
| | | | | | | | | | | | | | - Sarah Knerr
- University of Washington and Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | | | | | - David C Tabano
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO
| | - Mara M Epstein
- University of Massachusetts Medical School, Worcester, MA
| | | | | | - Julie A Lynch
- Department of Veterans Affairs Salt Lake City Health System, Salt Lake City, UT
| | - Christine Y Lu
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
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Calcaterra SL, Burnett-Hartman AN, Powers JD, Corley DA, McMullen CM, Pawloski PA, Feigelson HS. A population-based survey to assess the association between cannabis and quality of life among colorectal cancer survivors. BMC Cancer 2020; 20:373. [PMID: 32362277 PMCID: PMC7197173 DOI: 10.1186/s12885-020-06887-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 04/22/2020] [Indexed: 02/05/2023] Open
Abstract
Background As more states legalize cannabis for medical and recreational use, people increasingly use cannabis to treat medical conditions and associated symptoms. The prevalence and utility of cannabis for cancer-related symptoms may be clarified by examining cannabis use among patients with a common cancer diagnosis. We aimed to determine the prevalence of cannabis use among colorectal cancer (CRC) survivors and its associations with quality of life (QoL) and cancer-related symptomatology. Methods A cross-sectional survey of patient-reported QoL outcomes and behaviors, including cannabis use, was conducted within the Patient Outcomes To Advance Learning network’s (PORTAL) CRC Cohort. The cohort included a population-based sample of healthcare system members ≥18 years old diagnosed with adenocarcinoma of the colon or rectum from 2010 through 2016. We assessed the association between cannabis use and QoL using the European Organization for Research and Treatment of Cancer QLQ-C30 summary score. Results Of the 1784 respondents, 293 (16.4%) reported cannabis use following CRC diagnosis. Current tobacco smokers were more likely to use cannabis compared to former or never tobacco smokers (adjusted odds ratio [aOR] 2.71, 95% confidence interval [CI] 1.56 to 4.70). Greater alcohol use (> 4 drinks per month versus ≤4 drinks per month) was associated with cannabis use (aOR 2.17, 95% CI 1.65 to 2.85). There was an association between cannabis use and cancer stage at diagnosis, with stage 3 or 4 CRC patients more likely to use cannabis than stage 1 or 2 CRC patients (aOR 1.68, 95% CI 1.25 to 2.25). After adjusting for demographics, medical comorbidities, stage and site of CRC diagnosis, and prescription opioid use, people who used cannabis had significantly lower QoL than people who did not use cannabis (difference of − 6.14, 95% CI − 8.07 to − 4.20). Conclusion Among CRC survivors, cannabis use was relatively common, associated with more advanced stages of disease, associated with tobacco and alcohol use, and not associated with better QoL. Clinicians should inquire about cannabis use among their patients and provide evidence-based recommendations for cancer-related symptoms.
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Affiliation(s)
- Susan L Calcaterra
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, 8th Floor, Academic Office 1 Mailstop B180, 12631 E 17th Ave, Aurora, CO, 80045, USA.
| | | | - J David Powers
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA
| | - Douglas A Corley
- Department of Gastroenterology, Kaiser Permanente San Francisco, San Francisco, California, USA.,Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Carmit M McMullen
- Center for Health Research, Kaiser Permanente, Portland, Oregon, USA
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Hua X, Newcomb PA, Chubak J, Malen RC, Ziebell R, Kamineni A, Zhu LC, Upton MP, Wurscher MA, Thomas SS, Newman H, Hardikar S, Burnett-Hartman AN. Associations between molecular characteristics of colorectal serrated polyps and subsequent advanced colorectal neoplasia. Cancer Causes Control 2020; 31:631-640. [PMID: 32358694 DOI: 10.1007/s10552-020-01304-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/24/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE BRAF mutation and DNA hypermethylation have linked sessile serrated adenomas/polyps (SSA/Ps) to serrated colorectal cancer (CRC) in cross-sectional studies, but they have not been evaluated in a longitudinal study. We aimed to evaluate the associations between molecular markers of serrated polyps and subsequent advanced colorectal neoplasia. METHODS Study subjects included Kaiser Permanente Washington members aged 20-75 years who received an index colonoscopy between 1/1/1998 and 12/31/2007 and had hyperplastic polyps (HPs) or SSA/Ps according to study pathology review. Polyps from index colonoscopies were removed and assayed for BRAF mutation, CpG island methylator phenotype (CIMP), and MLH1 methylation. Pathology reports and biopsies from the subsequent lower gastrointestinal endoscopy through 1/1/2013 were reviewed for advanced colorectal neoplasia. We identified additional incident CRC cases through linkage to the Seattle-Puget Sound Surveillance Epidemiology and End Results registry. We used generalized estimating equations to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) for subsequent advanced colorectal neoplasia, comparing index serrated polyps with different molecular markers. RESULTS We included 553 individuals with index serrated polyps (420 HPs and 133 SSA/Ps) and 795 subsequent endoscopies. The prevalence of BRAF-mutant, CIMP-high, and MLH1-methylated serrated polyps were 51%, 4%, and 2%, respectively. BRAF and CIMP were not associated with subsequent advanced colorectal neoplasia. MLH1-methylated SSP/As were significantly more likely to have subsequent advanced neoplasia (OR = 4.66, 95% CI 1.06-20.51). CONCLUSION Our results suggest that BRAF-mutant and CIMP-high serrated polyps are not associated with subsequent advanced colorectal neoplasia. Among SSA/Ps, MLH1 methylation may be an important marker to identify high-risk CRC precursors.
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Affiliation(s)
- Xinwei Hua
- School of Public Health, University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Polly A Newcomb
- School of Public Health, University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jessica Chubak
- School of Public Health, University of Washington, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Rachel C Malen
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Rebecca Ziebell
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Lee-Ching Zhu
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Melissa P Upton
- Department of Pathology, University of Washington, Seattle, WA, USA
| | | | | | - Hana Newman
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Sheetal Hardikar
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Andrea N Burnett-Hartman
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
- Kaiser Permanente Colorado, Institute for Health Research, 2550 S Parker Rd, Suite 200, Waterpark III, 2nd floor, Aurora, CO, 80014, USA.
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Burnett-Hartman AN, Wiener RS. Lessons Learned to Promote Lung Cancer Screening and Preempt Worsening Lung Cancer Disparities. Am J Respir Crit Care Med 2020; 201:892-893. [PMID: 31905007 PMCID: PMC7159416 DOI: 10.1164/rccm.201912-2398ed] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
| | - Renda Soylemez Wiener
- Center for Healthcare Organization and Implementation ResearchEdith Nourse Rogers Memorial VA HospitalBedford, Massachusettsand.,The Pulmonary CenterBoston University School of MedicineBoston, Massachusetts
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Burnett-Hartman AN, Blum-Barnett E, Carroll NM, Madrid SD, Jonas C, Janes K, Alvarado M, Bedoy R, Paolino V, Aziz N, McGlynn EA. Return of Research-Related Genetic Test Results and Genetic Discrimination Concerns: Facilitators and Barriers of Genetic Research Participation in Diverse Groups. Public Health Genomics 2020; 23:59-68. [PMID: 32289795 DOI: 10.1159/000507056] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 03/08/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Most genetics studies lack the diversity necessary to ensure that all groups benefit from genetic research. OBJECTIVES To explore facilitators and barriers to genetic research participation. METHODS We conducted a survey on genetics in research and healthcare from November 15, 2017 to February 28, 2018 among adult Kaiser Permanente (KP) members who had been invited to participate in the KP biobank (KP Research Bank). We used logistic regression to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) comparing the willingness to participate in genetic research under different return of results scenarios and genetic discrimination concerns between groups, according to their demographic characteristics. RESULTS A total of 57,331 KP members were invited to participate, and 10,369 completed the survey (18% response rate). Respondents were 65% female, 44% non-Hispanic White (NH White), 22% Asian/Native Hawaiian or other Pacific Islander (Asian/PI), 19% non-Hispanic Black (NH Black), and 16% Hispanic. Respondents willing to participate in genetic research ranged from 22% with no results returned to 87% if health-related genetic results were returned. We also found variation by race/ethnicity; when no results were to be returned, Asian/PIs, Hispanics, and NH Blacks were less likely to want to participate than NH Whites (p < 0.05). However, when results were returned, disparities in the willingness to participate disappeared for NH Blacks and Hispanics. Genetic discrimination concerns were more prevalent in Asian/PIs, Hispanics, and NH Blacks than in NH Whites (p < 0.05). CONCLUSIONS Policies that prohibit the return of results and do not address genetic discrimination concerns may contribute to a greater underrepresentation of diverse groups in genetic research.
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Affiliation(s)
| | - Erica Blum-Barnett
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Nikki M Carroll
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Sarah D Madrid
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Cabell Jonas
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland, USA
| | - Kristen Janes
- Kaiser Permanente Care Management Institute, Oakland, California, USA
| | - Monica Alvarado
- Southern California Permanente Medical Group, Pasadena, California, USA
| | - Ruth Bedoy
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Valerie Paolino
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Nazneen Aziz
- Variant Genomics, Inc., Oakland, California, USA
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Carroll NM, Burnett-Hartman AN, Joyce CA, Kinnard W, Harker EJ, Hall V, Steiner JS, Blum-Barnett E, Ritzwoller DP. Real-world Clinical Implementation of Lung Cancer Screening-Evaluating Processes to Improve Screening Guidelines-Concordance. J Gen Intern Med 2020; 35:1143-1152. [PMID: 31974902 PMCID: PMC7174472 DOI: 10.1007/s11606-019-05539-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 10/18/2019] [Accepted: 10/18/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Lung cancer screening (LCS) requires complex processes to identify eligible patients, provide appropriate follow-up, and manage findings. It is unclear whether LCS in real-world clinical settings will realize the same benefits as the National Lung Screening Trial (NLST). OBJECTIVE To evaluate the impact of process modifications on compliance with LCS guidelines during LCS program implementation, and to compare patient characteristics and outcomes with those in NLST. DESIGN Retrospective cohort study. SETTING Kaiser Permanente Colorado (KPCO), a non-profit integrated healthcare system. PATIENTS A total of 3375 patients who underwent a baseline lung cancer screening low-dose computed tomography (S-LDCT) scan between May 2014 and June 2017. MEASUREMENTS Among those receiving an S-LDCT, proportion who met guidelines-based LCS eligibility criteria before and after LCS process modifications, differences in patient characteristics and outcomes between KPCO LCS patients and the NLST cohort, and factors associated with a positive screen. RESULTS After modifying LCS eligibility confirmation processes, patients receiving S-LDCT who met guidelines-based LCS eligibility criteria increased from 45.6 to 92.7% (P < 0.001). Prior to changes, patients were older (68 vs. 67 years; P = 0.001), less likely to be current smokers (51.3% vs. 52.5%; P < 0.001), and less likely to have a ≥ 30-pack-year smoking history (50.0% vs. 95.3%; P < 0.001). Compared with NLST participants, KPCO LCS patients were older (67 vs. 60 years; P < 0.001), more likely to currently smoke (52.3% vs. 48.1%; P < 0.001), and more likely to have pulmonary disease. Among those with a positive baseline S-LDCT, the lung cancer detection rate was higher at KPCO (9.4% vs. 3.8%; P < 0.001) and was positively associated with prior pulmonary disease. CONCLUSION Adherence to LCS guidelines requires eligibility confirmation procedures. Among those with a positive baseline S-LDCT, comorbidity burden and lung cancer detection rates were notably higher than in NLST, suggesting that the study of long-term outcomes in patients undergoing LCS in real-world clinical settings is warranted.
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Affiliation(s)
- Nikki M Carroll
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA.
| | | | - Caroline A Joyce
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - William Kinnard
- Colorado Permanente Medical Group, Kaiser Permanente Colorado, Denver, CO, USA
| | - Eric J Harker
- Colorado Permanente Medical Group, Kaiser Permanente Colorado, Denver, CO, USA
| | - Virginia Hall
- Kaiser Foundation Health Plan, Kaiser Permanente Colorado, Denver, CO, USA
| | - Julie S Steiner
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Erica Blum-Barnett
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
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Archambault AN, Su YR, Jeon J, Thomas M, Lin Y, Conti DV, Win AK, Sakoda LC, Lansdorp-Vogelaar I, Peterse EFP, Zauber AG, Duggan D, Holowatyj AN, Huyghe JR, Brenner H, Cotterchio M, Bézieau S, Schmit SL, Edlund CK, Southey MC, MacInnis RJ, Campbell PT, Chang-Claude J, Slattery ML, Chan AT, Joshi AD, Song M, Cao Y, Woods MO, White E, Weinstein SJ, Ulrich CM, Hoffmeister M, Bien SA, Harrison TA, Hampe J, Li CI, Schafmayer C, Offit K, Pharoah PD, Moreno V, Lindblom A, Wolk A, Wu AH, Li L, Gunter MJ, Gsur A, Keku TO, Pearlman R, Bishop DT, Castellví-Bel S, Moreira L, Vodicka P, Kampman E, Giles GG, Albanes D, Baron JA, Berndt SI, Brezina S, Buch S, Buchanan DD, Trichopoulou A, Severi G, Chirlaque MD, Sánchez MJ, Palli D, Kühn T, Murphy N, Cross AJ, Burnett-Hartman AN, Chanock SJ, de la Chapelle A, Easton DF, Elliott F, English DR, Feskens EJM, FitzGerald LM, Goodman PJ, Hopper JL, Hudson TJ, Hunter DJ, Jacobs EJ, Joshu CE, Küry S, Markowitz SD, Milne RL, Platz EA, Rennert G, Rennert HS, Schumacher FR, Sandler RS, Seminara D, Tangen CM, Thibodeau SN, Toland AE, van Duijnhoven FJB, Visvanathan K, Vodickova L, Potter JD, Männistö S, Weigl K, Figueiredo J, Martín V, Larsson SC, Parfrey PS, Huang WY, Lenz HJ, Castelao JE, Gago-Dominguez M, Muñoz-Garzón V, Mancao C, Haiman CA, Wilkens LR, Siegel E, Barry E, Younghusband B, Van Guelpen B, Harlid S, Zeleniuch-Jacquotte A, Liang PS, Du M, Casey G, Lindor NM, Le Marchand L, Gallinger SJ, Jenkins MA, Newcomb PA, Gruber SB, Schoen RE, Hampel H, Corley DA, Hsu L, Peters U, Hayes RB. Cumulative Burden of Colorectal Cancer-Associated Genetic Variants Is More Strongly Associated With Early-Onset vs Late-Onset Cancer. Gastroenterology 2020; 158:1274-1286.e12. [PMID: 31866242 PMCID: PMC7103489 DOI: 10.1053/j.gastro.2019.12.012] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/22/2019] [Accepted: 12/09/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Early-onset colorectal cancer (CRC, in persons younger than 50 years old) is increasing in incidence; yet, in the absence of a family history of CRC, this population lacks harmonized recommendations for prevention. We aimed to determine whether a polygenic risk score (PRS) developed from 95 CRC-associated common genetic risk variants was associated with risk for early-onset CRC. METHODS We studied risk for CRC associated with a weighted PRS in 12,197 participants younger than 50 years old vs 95,865 participants 50 years or older. PRS was calculated based on single nucleotide polymorphisms associated with CRC in a large-scale genome-wide association study as of January 2019. Participants were pooled from 3 large consortia that provided clinical and genotyping data: the Colon Cancer Family Registry, the Colorectal Transdisciplinary Study, and the Genetics and Epidemiology of Colorectal Cancer Consortium and were all of genetically defined European descent. Findings were replicated in an independent cohort of 72,573 participants. RESULTS Overall associations with CRC per standard deviation of PRS were significant for early-onset cancer, and were stronger compared with late-onset cancer (P for interaction = .01); when we compared the highest PRS quartile with the lowest, risk increased 3.7-fold for early-onset CRC (95% CI 3.28-4.24) vs 2.9-fold for late-onset CRC (95% CI 2.80-3.04). This association was strongest for participants without a first-degree family history of CRC (P for interaction = 5.61 × 10-5). When we compared the highest with the lowest quartiles in this group, risk increased 4.3-fold for early-onset CRC (95% CI 3.61-5.01) vs 2.9-fold for late-onset CRC (95% CI 2.70-3.00). Sensitivity analyses were consistent with these findings. CONCLUSIONS In an analysis of associations with CRC per standard deviation of PRS, we found the cumulative burden of CRC-associated common genetic variants to associate with early-onset cancer, and to be more strongly associated with early-onset than late-onset cancer, particularly in the absence of CRC family history. Analyses of PRS, along with environmental and lifestyle risk factors, might identify younger individuals who would benefit from preventive measures.
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Affiliation(s)
- Alexi N Archambault
- Division of Epidemiology, Department of Population Health, New York University School of Medicine, New York, New York
| | - Yu-Ru Su
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | - Minta Thomas
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Yi Lin
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - David V Conti
- Department of Preventive Medicine, USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Aung Ko Win
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lori C Sakoda
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Elisabeth F P Peterse
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Ann G Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David Duggan
- Translational Genomics Research Institute, An Affiliate of City of Hope, Phoenix, Arizona
| | - Andreana N Holowatyj
- Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Jeroen R Huyghe
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michelle Cotterchio
- Population Health and Prevention, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Stéphane Bézieau
- Service de Génétique Médicale, Centre Hospitalier Universitaire (CHU) Nantes, Nantes, France
| | - Stephanie L Schmit
- Department of Preventive Medicine, USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Christopher K Edlund
- Department of Preventive Medicine, USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Melissa C Southey
- Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Melbourne, Australia
| | - Robert J MacInnis
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia; Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Peter T Campbell
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; University Medical Centre Hamburg-Eppendorf, University Cancer Centre Hamburg (UCCH), Hamburg, Germany
| | - Martha L Slattery
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Andrew T Chan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Broad Institute of Harvard and MIT, Cambridge, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Amit D Joshi
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Mingyang Song
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Yin Cao
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Michael O Woods
- Memorial University of Newfoundland, Discipline of Genetics, St. John's, Newfoundland, Canada
| | - Emily White
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
| | - Stephanie J Weinstein
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Cornelia M Ulrich
- Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stephanie A Bien
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Tabitha A Harrison
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jochen Hampe
- Department of Medicine I, University Hospital Dresden, Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Christopher I Li
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Clemens Schafmayer
- Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Kenneth Offit
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Paul D Pharoah
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Victor Moreno
- Cancer Prevention and Control Program, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Annika Lindblom
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Alicja Wolk
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Anna H Wu
- Department of Preventive Medicine, USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Li Li
- Department of Family Medicine, University of Virginia, Charlottesville, Virginia
| | - Marc J Gunter
- Nutrition and Metabolism Section, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Andrea Gsur
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Temitope O Keku
- Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, North Carolina
| | - Rachel Pearlman
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - D Timothy Bishop
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Sergi Castellví-Bel
- Gastroenterology Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Leticia Moreira
- Gastroenterology Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Pavel Vodicka
- Department of Molecular Biology of Cancer, Institute of Experimental Medicine of the Czech Academy of Sciences, Prague, Czech Republic; Institute of Biology and Medical Genetics, First Faculty of Medicine, Charles University, Prague, Czech Republic; Faculty of Medicine and Biomedical Center in Pilsen, Charles University, Pilsen, Czech Republic
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Graham G Giles
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia; Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Demetrius Albanes
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
| | - John A Baron
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Sonja I Berndt
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
| | - Stefanie Brezina
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Stephan Buch
- Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Daniel D Buchanan
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia; Colorectal Oncogenomics Group, Department of Clinical Pathology, The University of Melbourne, Parkville, Victoria, Australia; Genomic Medicine and Family Cancer Clinic, The Royal Melbourne Hospital, Parkville, Victoria, Australia; University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia
| | | | - Gianluca Severi
- Centre de Recherche en Épidémiologie et Santé des Populations (CESP, Inserm U1018), Facultés de Médecine, Université Paris-Saclay, Gustave Roussy, Villejuif, France
| | - María-Dolores Chirlaque
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, Murcia, Spain
| | - Maria-José Sánchez
- Escuela Andaluza de Salud Pública, CIBER de Epidemiología y Salud Pública, Granada, Spain
| | - Domenico Palli
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy
| | - Tilman Kühn
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Neil Murphy
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France
| | - Amanda J Cross
- School of Public Health, Imperial College London, London, UK
| | | | - Stephen J Chanock
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
| | - Albert de la Chapelle
- Department of Cancer Biology and Genetics, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Douglas F Easton
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Faye Elliott
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Dallas R English
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia; Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Edith J M Feskens
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Liesel M FitzGerald
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Phyllis J Goodman
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia; Department of Epidemiology, School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, South Korea
| | - Thomas J Hudson
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - David J Hunter
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts; Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Eric J Jacobs
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia
| | - Corinne E Joshu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sébastien Küry
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Sanford D Markowitz
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Roger L Milne
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia; Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Elizabeth A Platz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Gad Rennert
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Clalit National Cancer Control Center, Haifa, Israel
| | - Hedy S Rennert
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Clalit National Cancer Control Center, Haifa, Israel
| | - Fredrick R Schumacher
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Robert S Sandler
- Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, North Carolina
| | - Daniela Seminara
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Catherine M Tangen
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Stephen N Thibodeau
- Division of Laboratory Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Amanda E Toland
- Department of Cancer Biology and Genetics, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | | | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ludmila Vodickova
- Department of Molecular Biology of Cancer, Institute of Experimental Medicine of the Czech Academy of Sciences, Prague, Czech Republic; Institute of Biology and Medical Genetics, First Faculty of Medicine, Charles University, Prague, Czech Republic; Faculty of Medicine and Biomedical Center in Pilsen, Charles University, Pilsen, Czech Republic
| | - John D Potter
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Satu Männistö
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Korbinian Weigl
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Jane Figueiredo
- Department of Preventive Medicine, USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Vicente Martín
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Biomedicine Institute (IBIOMED), University of León, León, Spain
| | - Susanna C Larsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Patrick S Parfrey
- The Clinical Epidemiology Unit, Memorial University Medical School, St. John's, Newfoundland, Canada
| | - Wen-Yi Huang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Heinz-Josef Lenz
- Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jose E Castelao
- Instituto de Investigación Sanitaria Galicia Sur (IISGS), Xerencia de Xestion Integrada de Vigo-SERGAS, Oncology and Genetics Unit, Vigo, Spain
| | - Manuela Gago-Dominguez
- Genomic Medicine Group, Galician Foundation of Genomic Medicine, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain; Moores Cancer Center, University of California San Diego, La Jolla, California
| | - Victor Muñoz-Garzón
- Radiotherapy Department, Complejo Hospitalario Universitario de Vigo, SERGAS, Vigo, Spain
| | | | - Christopher A Haiman
- Department of Preventive Medicine, USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Lynne R Wilkens
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Erin Siegel
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Elizabeth Barry
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Ban Younghusband
- Memorial University of Newfoundland, Discipline of Genetics, St. John's, Newfoundland, Canada
| | - Bethany Van Guelpen
- Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden; Department of Radiation Sciences, Oncology Unit, Umeå University, Umeå, Sweden
| | - Sophia Harlid
- Department of Radiation Sciences, Oncology Unit, Umeå University, Umeå, Sweden
| | - Anne Zeleniuch-Jacquotte
- Division of Epidemiology, Department of Population Health, New York University School of Medicine, New York, New York
| | - Peter S Liang
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Mengmeng Du
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Graham Casey
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia
| | - Noralane M Lindor
- Department of Health Science Research, Mayo Clinic, Scottsdale, Arizona
| | - Loic Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Steven J Gallinger
- Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mark A Jenkins
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Polly A Newcomb
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; School of Public Health, University of Washington, Seattle, Washington
| | - Stephen B Gruber
- Center for Precision Medicine & Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, California
| | - Robert E Schoen
- Department of Medicine and Epidemiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Heather Hampel
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Douglas A Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Li Hsu
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Biostatistics, University of Washington, Seattle, Washington
| | - Ulrike Peters
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Memorial University of Newfoundland, Discipline of Genetics, St. John's, Newfoundland, Canada.
| | - Richard B Hayes
- Division of Epidemiology, Department of Population Health, New York University School of Medicine, New York, New York.
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Rendle KA, Burnett-Hartman AN, Neslund-Dudas C, Greenlee RT, Honda S, Elston Lafata J, Marcus PM, Cooley ME, Vachani A, Meza R, Oshiro C, Simoff MJ, Schnall MD, Beaber EF, Doria-Rose VP, Doubeni CA, Ritzwoller DP. Evaluating Lung Cancer Screening Across Diverse Healthcare Systems: A Process Model from the Lung PROSPR Consortium. Cancer Prev Res (Phila) 2020; 13:129-136. [PMID: 31871221 PMCID: PMC7010351 DOI: 10.1158/1940-6207.capr-19-0378] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/18/2019] [Accepted: 12/18/2019] [Indexed: 02/07/2023]
Abstract
Numerous organizations, including the United States Preventive Services Task Force, recommend annual lung cancer screening (LCS) with low-dose CT for high risk adults who meet specific criteria. Despite recommendations and national coverage for screening eligible adults through the Centers for Medicare and Medicaid Services, LCS uptake in the United States remains low (<4%). In recognition of the need to improve and understand LCS across the population, as part of the larger Population-based Research to Optimize the Screening PRocess (PROSPR) consortium, the NCI (Bethesda, MD) funded the Lung PROSPR Research Consortium consisting of five diverse healthcare systems in Colorado, Hawaii, Michigan, Pennsylvania, and Wisconsin. Using various methods and data sources, the center aims to examine utilization and outcomes of LCS across diverse populations, and assess how variations in the implementation of LCS programs shape outcomes across the screening process. This commentary presents the PROSPR LCS process model, which outlines the interrelated steps needed to complete the screening process from risk assessment to treatment. In addition to guiding planned projects within the Lung PROSPR Research Consortium, this model provides insights on the complex steps needed to implement, evaluate, and improve LCS outcomes in community practice.
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Affiliation(s)
- Katharine A Rendle
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | | | | | | | - Stacey Honda
- Center for Health Research, Hawaii Permanente Medical Group, Kaiser Permanente Hawaii, Oahu, Hawaii
| | - Jennifer Elston Lafata
- Henry Ford Health System and Henry Ford Cancer Institute, Detroit, Michigan
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina
| | - Pamela M Marcus
- Division of Cancer Control and Population Sciences, NCI, Bethesda, Maryland
| | | | - Anil Vachani
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Rafael Meza
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Caryn Oshiro
- Center for Health Research, Hawaii Permanente Medical Group, Kaiser Permanente Hawaii, Oahu, Hawaii
| | - Michael J Simoff
- Henry Ford Health System and Henry Ford Cancer Institute, Detroit, Michigan
| | - Mitchell D Schnall
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - V Paul Doria-Rose
- Division of Cancer Control and Population Sciences, NCI, Bethesda, Maryland
| | - Chyke A Doubeni
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
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Burnett-Hartman AN, Newcomb PA, Peters U. Challenges With Colorectal Cancer Family History Assessment-Motivation to Translate Polygenic Risk Scores Into Practice. Gastroenterology 2020; 158:433-435. [PMID: 31682850 DOI: 10.1053/j.gastro.2019.10.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 10/29/2019] [Indexed: 12/14/2022]
Affiliation(s)
| | - Polly A Newcomb
- Member, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ulrike Peters
- Member and Associate Director, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Clarke CL, Kushi LH, Chubak J, Pawloski PA, Bulkley JE, Epstein MM, Burnett-Hartman AN, Powell B, Pearce CL, Feigelson HS. Abstract DP-004: DESCRIBING THE ODDS OF LONG-TERM SURVIVAL AMONG WOMEN DIAGNOSED WITH HIGH-GRADE SEROUS OVARIAN CANCER USING ELECTRONIC MEDICAL RECORDS. Clin Cancer Res 2019. [DOI: 10.1158/1557-3265.ovcasymp18-dp-004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Relatively little is known about factors associated with long-term survival (LTS) following a diagnosis of ovarian cancer. We conducted a retrospective observational study of high-grade serous ovarian cancer (HGSOC) to explore predictors of LTS, defined as >= 7 years of survivorship, using data from five participating health plans in the Cancer Research Network (CRN, http:\\crn.cancer.gov). Our primary data source was the Virtual Data Warehouse (VDW), a common data model which includes standardized, individual-level data extracted from the electronic data systems of each study site. We included 642 women with incident HGSOC diagnosed between 2000 and 2008 to allow for at least 7 years of follow-up. We conducted a multivariable logistic regression analysis to compare characteristics of women who survived >=7 years after diagnosis (n=148) to those who died within 7 years of diagnosis (n=494). In addition to stage and grade, predictors considered for the model included age, race, smoking status at time of diagnosis, body mass index (BMI) within the year prior to diagnosis, and CA-125 level prior to cancer treatment. We examined estrogen and hormonal contraceptive use, as well as the prevalence of comorbidities in the year prior to diagnosis of ovarian cancer. We also included variables for receipt of surgery, radiation, and chemotherapy. We used forward selection to include variables, and retained them in the final model if they had a p-value of <= 0.3. Our final model included CRN study site, age, stage at diagnosis, CA-125 (categorized as <35 or >=35 units/ml), Charlson comorbidity score, receipt of chemotherapy, BMI, and five separate comorbid conditions: weight loss, hypothyroidism, liver disease, chronic pulmonary disease and hypertension. Of these, only younger age, lower stage, and receipt of chemotherapy were statistically significantly associated with LTS. The OR for LTS was 2.9 (95% CI: 1.2-6.3) for ages 18-49 years at diagnosis compared to >=70 years of age. Those who were diagnosed at stage IV had statistically significantly lower odds of surviving >=7 years than any other stage of disease. The OR for LTS for stage I vs. stage IV was 46.6 (95% CI: 46.7 – 15.9), stage II vs. stage IV was 14.1 (95% CI: 5.3-37.0) and stage III vs. stage IV was 5.3 (95% CI: 2.7-10.4). The OR was 2.9 (95% CI: 1.0-8.4) for receipt of chemotherapy versus no chemotherapy after adjusting for all other covariates. Our analysis of data from electronic medical records did not identify any new characteristics that may be associated with ovarian cancer LTS.
Citation Format: Christina L. Clarke, Lawrence H. Kushi, Jessica Chubak, Pamala A. Pawloski, Joanna E. Bulkley, Mara M. Epstein, Andrea N. Burnett-Hartman, Bethan Powell, C. Leigh Pearce, Heather Spencer Feigelson. DESCRIBING THE ODDS OF LONG-TERM SURVIVAL AMONG WOMEN DIAGNOSED WITH HIGH-GRADE SEROUS OVARIAN CANCER USING ELECTRONIC MEDICAL RECORDS [abstract]. In: Proceedings of the 12th Biennial Ovarian Cancer Research Symposium; Sep 13-15, 2018; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2019;25(22 Suppl):Abstract nr DP-004.
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Affiliation(s)
| | | | | | | | | | - Mara M. Epstein
- 6Meyers Primary Care Institute, MA,
- 7University of Massachusetts Medical School,
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Chen L, Chubak J, Yu O, Pocobelli G, Ziebell RA, Aiello Bowles EJ, Fujii MM, Sterrett AT, Boggs JM, Burnett-Hartman AN, Ritzwoller DP, Hubbard RA, Boudreau DM. Changes in use of opioid therapy after colon cancer diagnosis: a population-based study. Cancer Causes Control 2019; 30:1341-1350. [PMID: 31667710 DOI: 10.1007/s10552-019-01236-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 09/28/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To describe patterns of opioid use in cancer survivors. METHODS In a cohort study of colon cancer patients diagnosed during 1995-2014 and enrolled at two Kaiser Permanente regions, we constructed quarterly measures of opioid use from 1 year before cancer diagnosis through 5 years after diagnosis to examine changes in use. Measures included any use, incident use, regular use (use ≥ 45 days in a 91-day quarter), and average daily dose (converted to morphine milligram equivalent, MME). We also assessed temporal trends of opioid use. RESULTS Of 2,039 colon cancer patients, 11-15% received opioids in the four pre-diagnosis quarters, 68% in the first quarter after diagnosis, and 15-17% in each subsequent 19 quarters. Regular opioid use increased from 3 to 5% pre-diagnosis to 5-7% post diagnosis. Average dose increased from 15 to 17 MME/day pre-diagnosis to 14-22 MME/day post diagnosis (excluding the quarter in which cancer was diagnosed). Among post-diagnosis opioid users, 73-95% were on a low dose (< 20 MME/day). Over years, regular use of opioids increased in survivorship with no change in dosage. CONCLUSION Opioid use slightly increased following a colon cancer diagnosis, but high-dose use was rare. Research is needed to differentiate under- versus over-treatment of cancer pain.
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Affiliation(s)
- Lu Chen
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA.
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA.,Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Onchee Yu
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA
| | - Gaia Pocobelli
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA
| | - Rebecca A Ziebell
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA
| | - Erin J Aiello Bowles
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA
| | - Monica M Fujii
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA
| | - Andrew T Sterrett
- Kaiser Permanente Colorado Institute for Health Research, Denver, CO, USA
| | - Jennifer M Boggs
- Kaiser Permanente Colorado Institute for Health Research, Denver, CO, USA
| | | | - Debra P Ritzwoller
- Kaiser Permanente Colorado Institute for Health Research, Denver, CO, USA
| | - Rebecca A Hubbard
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Denise M Boudreau
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA.,Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA.,Department of Pharmacy, University of Washington, Seattle, WA, USA
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Burnett-Hartman AN, Kamineni A, Corley DA, Singal AG, Halm EA, Rutter CM, Chubak J, Lee JK, Doubeni CA, Inadomi JM, Doria-Rose VP, Zheng Y. Colonoscopy Indication Algorithm Performance Across Diverse Health Care Systems in the PROSPR Consortium. EGEMS (Wash DC) 2019; 7:37. [PMID: 31531383 PMCID: PMC6676916 DOI: 10.5334/egems.296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 06/21/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Despite the importance of characterizing colonoscopy indication for quality monitoring and cancer screening program evaluation, there is no standard approach to documenting colonoscopy indication in medical records. METHODS We applied two algorithms in three health care systems to assign colonoscopy indication to persons 50-89 years old who received a colonoscopy during 2010-2013. Both algorithms used standard procedure, diagnostic, and laboratory codes. One algorithm, the KPNC algorithm, used a hierarchical approach to classify exam indication into: diagnostic, surveillance, or screening; whereas the other, the SEARCH algorithm, used a logistic regression-based algorithm to provide the probability that colonoscopy was performed for screening. Gold standard assessment of indication was from medical records abstraction. RESULTS There were 1,796 colonoscopy exams included in analyses; age and racial/ethnic distributions of participants differed across health care systems. The KPNC algorithm's sensitivities and specificities for screening indication ranged from 0.78-0.82 and 0.78-0.91, respectively; sensitivities and specificities for diagnostic indication ranged from 0.78-0.89 and 0.74-0.82, respectively. The KPNC algorithm had poor sensitivities (ranging from 0.11-0.67) and high specificities for surveillance exams. The Area Under the Curve (AUC) of the SEARCH algorithm for screening indication ranged from 0.76-0.84 across health care systems. For screening indication, the KPNC algorithm obtained higher specificities than the SEARCH algorithm at the same sensitivity. CONCLUSION Despite standardized implementation of these indication algorithms across three health care systems, the capture of colonoscopy indication data was imperfect. Thus, we recommend that standard, systematic documentation of colonoscopy indication should be added to medical records to ensure efficient and accurate data capture.
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Affiliation(s)
- Andrea N. Burnett-Hartman
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, US
- Fred Hutchinson Cancer Research Center, Seattle, WA, US
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, US
| | - Douglas A. Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, US
| | - Amit G. Singal
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, US
| | - Ethan A. Halm
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, US
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, US
| | | | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, US
| | - Jeffrey K. Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, US
| | - Chyke A. Doubeni
- Center for Health Equity and Community Engagement Research, Rochester, MN, US
- Department of Family Medicine, Mayo Clinic, Rochester, MN, US
| | - John M. Inadomi
- Division of Gastroenterology, University of Washington, School of Medicine, Seattle, WA, US
| | - V. Paul Doria-Rose
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, US
| | - Yingye Zheng
- Fred Hutchinson Cancer Research Center, Seattle, WA, US
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Clarke CL, Kushi LH, Chubak J, Pawloski PA, Bulkley JE, Epstein MM, Burnett-Hartman AN, Powell B, Pearce CL, Spencer Feigelson H. Predictors of Long-Term Survival among High-Grade Serous Ovarian Cancer Patients. Cancer Epidemiol Biomarkers Prev 2019; 28:996-999. [PMID: 30967418 DOI: 10.1158/1055-9965.epi-18-1324] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/05/2019] [Accepted: 02/15/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Relatively little is known about factors associated with long-term survival (LTS) following a diagnosis of ovarian cancer. METHODS We conducted a retrospective study of high-grade serous ovarian cancer (HGSOC) to explore predictors of LTS (defined as ≥7 years of survival) using electronic medical record data from a network of integrated health care systems. Multivariable logistic regression with forward selection was used to compare characteristics of women who survived ≥7 years after diagnosis (n = 148) to those who died within 7 years of diagnosis (n = 494). RESULTS Our final model included study site, age, stage at diagnosis, CA-125, comorbidity score, receipt of chemotherapy, BMI, and four separate comorbid conditions: weight loss, depression, hypothyroidism, and liver disease. Of these, only younger age, lower stage, and depression were statistically significantly associated with LTS. CONCLUSIONS We did not identify any new characteristics associated with HGSOC survival. IMPACT Prognosis of ovarian cancer generally remains poor. Large, pooled studies of ovarian cancer are needed to identify characteristics that may improve survival.
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Affiliation(s)
- Christina L Clarke
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado.
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Jessica Chubak
- Health Research Institute, Kaiser Permanente Washington, Seattle, Washington
| | | | - Joanna E Bulkley
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Mara M Epstein
- Meyers Primary Care Institute, Worcester, Massachusetts
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Bethan Powell
- Gynecologic Oncology Program, Kaiser Permanente Northern California, San Francisco, California
| | - Celeste L Pearce
- School of Public Health, University of Michigan, Ann Arbor, Michigan
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Bowles EJA, Yu O, Ziebell R, Chen L, Boudreau DM, Ritzwoller DP, Hubbard RA, Boggs JM, Burnett-Hartman AN, Sterrett A, Fujii M, Chubak J. Cardiovascular medication use and risks of colon cancer recurrences and additional cancer events: a cohort study. BMC Cancer 2019; 19:270. [PMID: 30917783 PMCID: PMC6437861 DOI: 10.1186/s12885-019-5493-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/19/2019] [Indexed: 12/12/2022] Open
Abstract
Background Cardiovascular medications may be associated with cancer development, but little is known about their association with cancer recurrence. Medications such as statins and antihypertensives may be commonly used among colon cancer survivors, who are, on average, diagnosed in their mid-60s. We described the associations between statins and antihypertensive medications and colon cancer recurrence in a large, population-based study. Methods We conducted a cohort study among adults with stage I-IIIA colon cancer diagnosed in 1995–2014 in two Kaiser Permanente regions, Colorado and Washington. Statin and antihypertensive use were obtained from electronic pharmacy dispensing data. People were classified as medication users on the date of their first dispensing after cohort entry, which started 90 days after completing cancer treatment, continuing through the earliest of death, health plan disenrollment, or chart abstraction. We collected outcome information from medical record abstraction and tumor registries on colon cancer recurrences and second primary cancers. Using Cox proportional hazards multivariable models, we estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for colon cancer recurrences and any cancer event (recurrences and new primaries at any anatomic site) comparing medication users to non-users. Results Among 2039 people, 937 (46%) used statins and 1425 (70%) used antihypertensives at any point during a median of 4.9 years of follow-up; 460 people had any additional cancer event, including 152 with a colon cancer recurrence. Statin use was not associated with colon cancer recurrence (HR = 1.09, 95%CI = 0.65–1.85) or any cancer event (HR = 1.12, 95%CI = 0.85–1.47), nor was antihypertensive use associated with recurrence (HR = 0.73, 95%CI = 0.44–1.21) or any cancer event (HR = 0.93, 95%CI = 0.70–1.24). Conclusions Our results suggest no association between cardiovascular medication use and the risk of recurrence or any additional cancer, and may provide reassurance to colon cancer survivors.
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Affiliation(s)
- Erin J A Bowles
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA.
| | - Onchee Yu
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA
| | - Rebecca Ziebell
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA
| | - Lu Chen
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA
| | - Denise M Boudreau
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA.,School of Pharmacy, University of Washington, Seattle, Washington, 98195, USA.,Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Debra P Ritzwoller
- Kaiser Permanente Colorado Institute for Health Research, 2550 S Parker Rd Suite 200, Aurora, Colorado, 80014, USA
| | - Rebecca A Hubbard
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, 604 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA
| | - Jennifer M Boggs
- Kaiser Permanente Colorado Institute for Health Research, 2550 S Parker Rd Suite 200, Aurora, Colorado, 80014, USA
| | - Andrea N Burnett-Hartman
- Kaiser Permanente Colorado Institute for Health Research, 2550 S Parker Rd Suite 200, Aurora, Colorado, 80014, USA
| | - Andrew Sterrett
- Kaiser Permanente Colorado Institute for Health Research, 2550 S Parker Rd Suite 200, Aurora, Colorado, 80014, USA
| | - Monica Fujii
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA.,Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
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Burnett-Hartman AN, Hua X, Rue TC, Golchin N, Kessler L, Rowhani-Rahbar A. Risk interval analysis of emergency room visits following colonoscopy in patients with inflammatory bowel disease. PLoS One 2019; 14:e0210262. [PMID: 30625217 PMCID: PMC6326490 DOI: 10.1371/journal.pone.0210262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 12/04/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND AIMS Prior studies suggest that colonoscopy may exacerbate inflammatory bowel disease (IBD) symptoms. Thus, our study aimed to determine risk of emergency room (ER) visits associated with colonoscopy among IBD patients and evaluate potential modifiers of this risk. METHODS The study population included IBD patients in the Multi-Payer Claims Database who were >20 years old and had a colonoscopy from 2007-2010. We used a self-controlled risk interval design and mixed-effects Poisson regression models to calculate risk ratios (RR) and 95% confidence intervals (CI) comparing the incidence of ER visits in the 1-4 weeks following colonoscopy (risk interval) to the incidence of ER visits in the 7-10 weeks after colonoscopy (control interval). We also conducted stratified analyses by patient characteristics, bowel preparation type, and medication. RESULTS There were 212,205 IBD patients with at least 1 colonoscopy from 2007-2010, and 3,699 had an ER visit during the risk and/or control interval. The risk of an ER visit was higher in the 4-week risk interval following colonoscopy compared to the control interval (RR = 1.24; 95% CI: 1.17-1.32). The effect was strongest in those <41 years old (RR = 1.60; 95% CI: 1.21-2.11), in women (RR = 1.32; 95% CI: 1.21-1.44), and in those with sodium phosphate bowel preparation (RR = 2.09; 95% CI: 1.02-4.29). Patients using immunomodulators had no increased risk of ER visits (RR = 0.75; 95% CI: 0.35-1.59). CONCLUSIONS Our results suggest that there is an increased risk of ER visits following colonoscopy among IBD patients, but that immunomodulators and mild bowel preparation agents may mitigate this risk.
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Affiliation(s)
- Andrea N. Burnett-Hartman
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, United States of America
- School of Public Health, University of Washington, Seattle, Washington, United States of America
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- * E-mail:
| | - Xinwei Hua
- School of Public Health, University of Washington, Seattle, Washington, United States of America
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Tessa C. Rue
- School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Negar Golchin
- School of Pharmacy, University of Washington, Seattle, Washington, United States of America
| | - Larry Kessler
- School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Ali Rowhani-Rahbar
- School of Public Health, University of Washington, Seattle, Washington, United States of America
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