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Wendt FR, Pathak GA, Vahey J, Qin X, Koller D, Cabrera-Mendoza B, Haeny A, Harrington KM, Rajeevan N, Duong LM, Levey DF, De Angelis F, De Lillo A, Bigdeli TB, Pyarajan S, Gaziano JM, Gelernter J, Aslan M, Provenzale D, Helmer DA, Hauser ER, Polimanti R. Modeling the longitudinal changes of ancestry diversity in the Million Veteran Program. Hum Genomics 2023; 17:46. [PMID: 37268996 PMCID: PMC10239111 DOI: 10.1186/s40246-023-00487-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 09/06/2022] [Accepted: 05/05/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND The Million Veteran Program (MVP) participants represent 100 years of US history, including significant social and demographic changes over time. Our study assessed two aspects of the MVP: (i) longitudinal changes in population diversity and (ii) how these changes can be accounted for in genome-wide association studies (GWAS). To investigate these aspects, we divided MVP participants into five birth cohorts (N-range = 123,888 [born from 1943 to 1947] to 136,699 [born from 1948 to 1953]). RESULTS Ancestry groups were defined by (i) HARE (harmonized ancestry and race/ethnicity) and (ii) a random-forest clustering approach using the 1000 Genomes Project and the Human Genome Diversity Project (1kGP + HGDP) reference panels (77 world populations representing six continental groups). In these groups, we performed GWASs of height, a trait potentially affected by population stratification. Birth cohorts demonstrate important trends in ancestry diversity over time. More recent HARE-assigned Europeans, Africans, and Hispanics had lower European ancestry proportions than older birth cohorts (0.010 < Cohen's d < 0.259, p < 7.80 × 10-4). Conversely, HARE-assigned East Asians showed an increase in European ancestry proportion over time. In GWAS of height using HARE assignments, genomic inflation due to population stratification was prevalent across all birth cohorts (linkage disequilibrium score regression intercept = 1.08 ± 0.042). The 1kGP + HGDP-based ancestry assignment significantly reduced the population stratification (mean intercept reduction = 0.045 ± 0.007, p < 0.05) confounding in the GWAS statistics. CONCLUSIONS This study provides a characterization of ancestry diversity of the MVP cohort over time and compares two strategies to infer genetically defined ancestry groups by assessing differences in controlling population stratification in genome-wide association studies.
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Affiliation(s)
- Frank R Wendt
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA CT Healthcare System, VA CT 116A2, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Gita A Pathak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA CT Healthcare System, VA CT 116A2, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Jacqueline Vahey
- Durham VA Medical Center, Durham, NC, USA
- Duke University, Carmichael Building, 300 N Duke St, Durham, NC, 27701, USA
| | - Xuejun Qin
- Durham VA Medical Center, Durham, NC, USA
- Duke University, Carmichael Building, 300 N Duke St, Durham, NC, 27701, USA
| | - Dora Koller
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA CT Healthcare System, VA CT 116A2, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Brenda Cabrera-Mendoza
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA CT Healthcare System, VA CT 116A2, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Angela Haeny
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Kelly M Harrington
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Nallakkandi Rajeevan
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA CT Healthcare System, VA CT 116A2, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Yale Center for Medical Informatics, Yale School of Medicine, New Haven, CT, USA
| | - Linh M Duong
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA CT Healthcare System, VA CT 116A2, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Daniel F Levey
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA CT Healthcare System, VA CT 116A2, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Flavio De Angelis
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA CT Healthcare System, VA CT 116A2, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | | | - Tim B Bigdeli
- SUNY Downstate Health Sciences University, Brooklyn, NY, USA
- VA New York Harbor Healthcare System, Brooklyn, NY, USA
| | - Saiju Pyarajan
- Massachusetts Area Veterans Epidemiology, Research, and Information Center (MAVERIC), Jamaica Plain, MA, USA
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital and Harvard School of Medicine, Boston, MA, USA
| | - John Michael Gaziano
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital and Harvard School of Medicine, Boston, MA, USA
| | - Joel Gelernter
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA
- Department of Neuroscience, Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA CT Healthcare System, West Haven, CT, USA
| | - Mihaela Aslan
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA CT Healthcare System, VA CT 116A2, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Dawn Provenzale
- Durham VA Medical Center, Durham, NC, USA
- Duke University, Carmichael Building, 300 N Duke St, Durham, NC, 27701, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Drew A Helmer
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Elizabeth R Hauser
- Durham VA Medical Center, Durham, NC, USA.
- Duke University, Carmichael Building, 300 N Duke St, Durham, NC, 27701, USA.
| | - Renato Polimanti
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
- VA Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA CT Healthcare System, VA CT 116A2, 950 Campbell Avenue, West Haven, CT, 06516, USA.
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Voils CI, Coffman CJ, Wu RR, Grubber JM, Fisher DA, Strawbridge EM, Sperber N, Wang V, Scheuner MT, Provenzale D, Nelson RE, Hauser E, Orlando LA, Goldstein KM. A Cluster Randomized Trial of a Family Health History Platform to Identify and Manage Patients at Increased Risk for Colorectal Cancer. J Gen Intern Med 2023; 38:1375-1383. [PMID: 36307642 PMCID: PMC10160317 DOI: 10.1007/s11606-022-07787-9] [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: 04/26/2022] [Accepted: 09/06/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Obtaining comprehensive family health history (FHH) to inform colorectal cancer (CRC) risk management in primary care settings is challenging. OBJECTIVE To examine the effectiveness of a patient-facing FHH platform to identify and manage patients at increased CRC risk. DESIGN Two-site, two-arm, cluster-randomized, implementation-effectiveness trial with primary care providers (PCPs) randomized to immediate intervention versus wait-list control. PARTICIPANTS PCPs treating patients at least one half-day per week; patients aged 40-64 with no medical conditions that increased CRC risk. INTERVENTIONS Immediate-arm patients entered their FHH into a web-based platform that provided risk assessment and guideline-driven decision support; wait-list control patients did so 12 months later. MAIN MEASURES McNemar's test examined differences between the platform and electronic medical record (EMR) in rates of increased risk documentation. General estimating equations using logistic regression models compared arms in risk-concordant provider actions and patient screening test completion. Referral for genetic consultation was analyzed descriptively. KEY RESULTS Seventeen PCPs were randomized to each arm. Patients (n = 252 immediate, n = 253 control) averaged 51.4 (SD = 7.2) years, with 83% assigned male at birth, 58% White persons, and 33% Black persons. The percentage of patients identified as increased risk for CRC was greater with the platform (9.9%) versus EMR (5.2%), difference = 4.8% (95% CI: 2.6%, 6.9%), p < .0001. There was no difference in PCP risk-concordant action [odds ratio (OR) = 0.7, 95% CI (0.4, 1.2; p = 0.16)]. Among 177 patients with a risk-concordant screening test ordered, there was no difference in test completion, OR = 0.8 [0.5,1.3]; p = 0.36. Of 50 patients identified by the platform as increased risk, 78.6% immediate and 68.2% control patients received a recommendation for genetic consultation, of which only one in each arm had a referral placed. CONCLUSIONS FHH tools could accurately assess and document the clinical needs of patients at increased risk for CRC. Barriers to acting on those recommendations warrant further exploration. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT02247336 https://clinicaltrials.gov/ct2/show/NCT02247336.
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Affiliation(s)
- Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
- Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA.
| | - Cynthia J Coffman
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - R Ryanne Wu
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | | | - Deborah A Fisher
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | | | - Nina Sperber
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Virginia Wang
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Maren T Scheuner
- San Francisco VA Health Care System, San Francisco, VA, USA
- Departments of Medicine and Pediatrics, University of California at San Francisco, San Francisco, CA, USA
| | - Dawn Provenzale
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Richard E Nelson
- Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Elizabeth Hauser
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Lori A Orlando
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Karen M Goldstein
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
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Kobe EA, Sullivan BA, Qin X, Redding TS, Hauser ER, Madison AN, Miller C, Efird JT, Gellad ZF, Weiss D, Sims KJ, Williams CD, Lieberman DA, Provenzale D. Longitudinal assessment of colonoscopy adverse events in the prospective Cooperative Studies Program no. 380 colorectal cancer screening and surveillance cohort. Gastrointest Endosc 2022; 96:553-562.e3. [PMID: 35533738 PMCID: PMC9531542 DOI: 10.1016/j.gie.2022.04.1343] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/30/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Data are limited regarding colonoscopy risk during long-term, programmatic colorectal cancer screening and follow-up. We aimed to describe adverse events during follow-up in a colonoscopy screening program after the baseline examination and examine factors associated with increased risk. METHODS Cooperative Studies Program no. 380 includes 3121 asymptomatic veterans aged 50 to 75 years who underwent screening colonoscopy between 1994 and 1997. Periprocedure adverse events requiring significant intervention were defined as major events (other events were minor) and were tracked during follow-up for at least 10 years. Multivariable odds ratios (ORs) were calculated for factors associated with risk of follow-up adverse events. RESULTS Of 3727 follow-up examinations in 1983 participants, adverse events occurred in 105 examinations (2.8%) in 93 individuals, including 22 major and 87 minor events (examinations may have had >1 event). Incidence of major events (per 1000 examinations) remained relatively stable over time, with 6.1 events at examination 2, 4.8 at examination 3, and 7.2 at examination 4. Examinations with major events included 1 perforation, 3 GI bleeds requiring intervention, and 17 cardiopulmonary events. History of prior colonoscopic adverse events was associated with increased risk of events (major or minor) during follow-up (OR, 2.7; 95% confidence interval, 1.6-4.6). CONCLUSIONS Long-term programmatic screening and surveillance was safe, as major events were rare during follow-up. However, serious cardiopulmonary events were the most common major events. These results highlight the need for detailed assessments of comorbid conditions during routine clinical practice, which could help inform individual decisions regarding the utility of ongoing colonoscopy follow-up.
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Affiliation(s)
- Elizabeth A Kobe
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC; School of Medicine, Duke University, Durham, NC
| | - Brian A Sullivan
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC; Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Xuejun Qin
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Thomas S Redding
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC
| | - Elizabeth R Hauser
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Ashton N Madison
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC
| | - Cameron Miller
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Jimmy T Efird
- Cooperative Studies Program Coordinating Center, Boston VA Health Care System, Boston, MA
| | - Ziad F Gellad
- Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC
| | - David Weiss
- Cooperative Studies Program Coordinating Center, Perry Point Veterans Affairs Medical Center, Perry Point, MD
| | - Kellie J Sims
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC
| | - Christina D Williams
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC; Department of Medicine, Duke University Medical Center, Durham, NC
| | - David A Lieberman
- Portland Veteran Affairs Medical Center, Portland, OR; Division of Gastroenterology and Hepatology, School of Medicine, Oregon Health and Science University, Portland, OR
| | - Dawn Provenzale
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC; Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC
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Sullivan BA, Redding TS, Qin X, Gellad ZF, Hauser ER, O'Leary MC, Williams CD, Musselwhite LW, Weiss D, Madison AN, Lieberman D, Provenzale D. Ten or More Cumulative Lifetime Adenomas Are Associated with Increased Risk for Advanced Neoplasia and Colorectal Cancer. Dig Dis Sci 2022; 67:2526-2534. [PMID: 34089135 DOI: 10.1007/s10620-021-07069-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/18/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) screening guidelines recommend frequent colonoscopies and consideration of genetic testing in individuals with ≥10 cumulative adenomas. However, it is unclear how these guidelines apply to routine practice. AIMS We estimated the proportion of participants found to have ≥10 cumulative adenomas in a screening population and described their outcomes of advanced neoplasia (AN), CRC, and extra-colonic malignancy. METHODS We performed a secondary analysis of VA CSP#380, which includes 3121 veterans aged 50-75 who were followed up to 10 years after screening colonoscopy. We calculated the cumulative risk of ≥10 cumulative adenomas by Kaplan-Meier method. We compared baseline risk factors in those with and without ≥10 cumulative adenomas as well as the risk for AN (adenoma ≥1 cm, villous adenoma or high-grade dysplasia, or CRC) and extra-colonic malignancy by multivariate logistic regression. RESULTS The cumulative risk of ≥10 cumulative adenomas over 10.5 years was 6.51% (95% CI 4.38%-9.62%). Age 60-69 or 70-75 at baseline colonoscopy was the only factors associated with the finding of ≥10 cumulative adenomas. Compared to those with 0-9 cumulative adenomas, participants with ≥10 cumulative adenomas were more likely to have had AN (OR 17.03; 95% CI 9.41-30.84), including CRC (OR 7.00; 95% CI 2.84-17.28), but not extra-colonic malignancies. CONCLUSIONS Approximately 6.5% of participants in this screening population were found to have ≥10 cumulative adenomas over 10.5 years, which was uncommon before age 60. These participants were found to have AN and CRC significantly more often compared to those with lower cumulative adenomas.
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Affiliation(s)
- Brian A Sullivan
- Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Medical Center, Durham, NC, USA.
- Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
| | - Thomas S Redding
- Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Xuejun Qin
- Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Ziad F Gellad
- Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Elizabeth R Hauser
- Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Meghan C O'Leary
- Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Christina D Williams
- Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Laura W Musselwhite
- Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Solid Tumor Oncology, Levine Cancer Institute, Charlotte, NC, USA
| | - David Weiss
- Cooperative Studies Program Coordinating Center, Perry Point Veterans Affairs Medical Center, Perry Point, MD, USA
| | - Ashton N Madison
- Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - David Lieberman
- Portland Veteran Affairs Medical Center, Portland, OR, USA
- Oregon Health and Science University, Portland, OR, USA
| | - Dawn Provenzale
- Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
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Sullivan BA, Qin X, Miller C, Hauser ER, Redding TS, Gellad ZF, Madison AN, Musselwhite LW, Efird JT, Sims KJ, Williams CD, Weiss D, Lieberman D, Provenzale D. Screening Colonoscopy Findings Are Associated With Noncolorectal Cancer Mortality. Clin Transl Gastroenterol 2022; 13:e00479. [PMID: 35333777 PMCID: PMC9038496 DOI: 10.14309/ctg.0000000000000479] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/15/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Controversy exists regarding the impact of various risk factors on noncolorectal cancer (CRC) mortality in healthy screening populations. We examined the impact of known CRC risk factors, including baseline colonoscopy findings, on non-CRC mortality in a screening population. METHODS Cooperative Studies Program (CSP) #380 is comprised of 3,121 veterans aged 50-75 years who underwent screening colonoscopy from 1994 to 97 and were then followed for at least 10 years or until death. Hazard ratios (HRs) for risk factors on non-CRC mortality were estimated by multivariate Cox proportional hazards. RESULTS Current smoking (HR 2.12, 95% confidence interval [CI] 1.78-2.52, compared with nonsmokers) and physical activity (HR 0.89, 95% CI 0.84-0.93) were the modifiable factors most associated with non-CRC mortality in CSP#380. In addition, compared with no neoplasia at baseline colonoscopy, non-CRC mortality was higher in participants with ≥3 small adenomas (HR 1.43, 95% CI 1.06-1.94), advanced adenomas (HR 1.32, 95% CI 0.99-1.75), and CRC (HR 2.95, 95% CI 0.98-8.85). Those with 1-2 small adenomas were not at increased risk for non-CRC mortality (HR 1.15, 95% CI 0.94-1.4). DISCUSSION In a CRC screening population, known modifiable risk factors were significantly associated with 10-year non-CRC mortality. Furthermore, those who died from non-CRC causes within 10 years were more likely to have had high-risk findings at baseline colonoscopy. These results suggest that advanced colonoscopy findings may be a risk marker of poor health outcomes. Integrated efforts are needed to motivate healthy lifestyle changes during CRC screening, particularly in those with high-risk colonoscopy findings and unaddressed risk factors.
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Affiliation(s)
- Brian A. Sullivan
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina, USA
- Duke University, Durham, North Carolina, USA
| | - Xuejun Qin
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina, USA
- Duke University, Durham, North Carolina, USA
| | - Cameron Miller
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina, USA
- Duke University, Durham, North Carolina, USA
| | - Elizabeth R. Hauser
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina, USA
- Duke University, Durham, North Carolina, USA
| | - Thomas S. Redding
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina, USA
| | - Ziad F. Gellad
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina, USA
- Duke University, Durham, North Carolina, USA
| | - Ashton N. Madison
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina, USA
| | - Laura W. Musselwhite
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Solid Tumor Oncology, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Jimmy T. Efird
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina, USA
| | - Kellie J. Sims
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina, USA
| | - Christina D. Williams
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina, USA
- Duke University, Durham, North Carolina, USA
| | - David Weiss
- Perry Point VA Medical Center, Perry Point, Maryland, USA
| | - David Lieberman
- VA Portland Health Care System, Portland, Oregon, USA
- Oregon Health & Science University, Portland, Oregon, USA
| | - Dawn Provenzale
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina, USA
- Duke University, Durham, North Carolina, USA
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Porto J, Ribeiro AG, Viza LH, Musselwhite LW, Talarico T, Costa M, Rocha DC, Oliveira MA, Fregnani JHT, Mauad E, Reis RM, Provenzale D, Guimaraes DP. Abstract PO-259: The impact of genetic ancestry and lifestyle factors on the risk of colorectal adenoma and adenocarcinoma in a Brazilian screening population. Cancer Epidemiol Biomarkers Prev 2022. [DOI: 10.1158/1538-7755.disp21-po-259] [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] Open
Abstract
Abstract
Background: Colorectal cancer (CRC) is the second most common cancer in Brazil. The Barretos Cancer Hospital (BCH) implemented a Fecal immunochemical test-based (FIT)-CRC screening program. Risk factors of the screening population and the prevalence of baseline colorectal neoplasia are important features for guiding a CRC screening strategy. This study aims to measure screening outcomes of the BCH program and associate with sociodemographic risk factors and genetic ancestry. Methods: This cross-sectional analysis included consecutive subjects between 50 and 65 years from the BCH (first round) CRC screening program. A REDCap database was built to track participants and measure clinical outcomes (adenoma, advanced adenoma (AA), and cancer). The ancestry components were analyzed using a multiplex PCR of 46 ancestry informative markers, based on insertion-deletion polymorphisms. A binary logistic regression model was used to examine the associations between sociodemographic factors and screening outcomes. Results: From Nov 2017 to Mar 2020, 2946 asymptomatic individuals were enrolled, being 83.0% females with a mean age of 57.1 ± 4.5 years, mainly from São Paulo State (79.1%). Self-reported skin color revealed 56.8% white, 36.6% brown, 5.8% black, and 0.7% yellow, and 69.9% had less than a high school diploma. The genetic ancestry revealed a mean proportion of 67.9% for European ancestry, 17.0% for African, 7.3% for East Asian, and 7.8% for Native American. A significant association was found between genetic ancestry proportions and self-reported skin colors (p<0.001). Current and former smokers comprised 41.9% of participants, 31.2% were alcohol drinkers, 73.3% reported exercise < 3x/week, and 71.9% had a BMI > 25kg/m². Of the 2946 participants, 80.7% completed and returned FIT kits. The inadequate FIT rate was 2.0%, and the positivity rate was 6.2%. The follow-up colonoscopy compliance rate was 90.5%, and the cecal intubation was successful in 99.0%. The PPV was 64.1% (86/134) for adenoma 20.1% (27/134) for AA, and 3.7% (5/134) for CRC. The five cancer patients had stage I (40.0%) or II (60.0%). The male gender (OR=2.94, 95% CI 1.06-8.17), BMI > 25kg/m² ≤ 30kg/m² (OR=5.40, 95% CI 1.42-20.52), alcohol consumption (OR=3.86, 95% CI 1.38-10.78), fried foods' consumption (OR=2.82, 95% CI 1.02-7.78) were associated to AA. Non-white skin color (OR=2.83, 95% CI 1.11-7.17), BMI > 25kg/m² ≤ 30kg/m² (OR=3.54, 95% CI 1.21-10.30), and eggs/milk consumption (OR=5.25, 95% CI 1.32-20.80) were associated to early adenoma. No association was found between genetic ancestry and screening outcomes. Conclusions: CRC detected in early stages corroborates the role of screening programs to increase the rate of early diagnosis. Further, lifestyle risk factors linked to colorectal cancer were significantly associated with the presence of a high and low-risk colorectal precursor lesion. Overall, our results in an admixed population can contribute to delineating preventive strategies and a targeted CRC screening program to improve CRC prevention and control in Brazil.
Citation Format: Jun Porto, Adeylson G. Ribeiro, Lucas Henrique Viza, Laura W. Musselwhite, Thais Talarico, Maraisa Costa, Denise C. Rocha, Marco Antonio Oliveira, Jose Humberto T.G. Fregnani, Edmundo Mauad, Rui M. Reis, Dawn Provenzale, Denise P. Guimaraes. The impact of genetic ancestry and lifestyle factors on the risk of colorectal adenoma and adenocarcinoma in a Brazilian screening population [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-259.
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Affiliation(s)
- Jun Porto
- 1Barretos Cancer Hospital, Barretos, Brazil,
| | | | | | | | | | | | | | | | | | | | - Rui M. Reis
- 1Barretos Cancer Hospital, Barretos, Brazil,
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7
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Grewe ME, Khalil L, Felder K, Goldstein KM, McNeil RB, Sims KJ, Provenzale D, Voils CI. Gulf War Era Veterans' perspectives on research: a qualitative study. Life Sci 2021; 287:120113. [PMID: 34728229 DOI: 10.1016/j.lfs.2021.120113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/26/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
AIMS Many veterans of the 1990-1991 Gulf War Era (GWE) have experienced poorly understood health issues. In response to challenges recruiting this population for research, we conducted focus groups and semi-structured phone interviews with GWE veterans and subject matter experts (SMEs) to explore GWE veterans' perceptions about research. MAIN METHODS Transcribed discussions were content-analyzed. Participants discussed research-related motivators and barriers identified among other populations, and nuances that may be specific to GWE veterans. KEY FINDINGS Examples of motivating factors included: seeking answers about causes of and treatment for health issues; helping oneself; and helping other veterans. Examples of barriers included: distrust and dissatisfaction with federal entities; lack of research follow-through; and concerns about privacy and confidentiality. SIGNIFICANCE Researchers can use this information to better address GWE veterans' concerns and motivate them to participate in research. Inclusion of GWE veterans in research will allow researchers and clinicians to better understand and address health issues affecting this population.
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Affiliation(s)
- Mary E Grewe
- Durham Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina, United States of America
| | - Lara Khalil
- Durham Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina, United States of America
| | - Kristina Felder
- Durham Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina, United States of America
| | - Karen M Goldstein
- Durham Center for Health Services Research in Primary Care, Durham VA Health Care System, Durham, North Carolina, United States of America; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Rebecca B McNeil
- Durham Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina, United States of America; Center for Clinical Research Network Coordination, Division of Biostatistics and Epidemiology, RTI International, Durham, North Carolina, United States of America
| | - Kellie J Sims
- Durham Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina, United States of America.
| | - Dawn Provenzale
- Durham Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina, United States of America; Durham Center for Health Services Research in Primary Care, Durham VA Health Care System, Durham, North Carolina, United States of America; Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, Department of Veterans Affairs, Madison, WI, United States of America; Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
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8
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Radhakrishnan K, Hauser ER, Polimanti R, Helmer DA, Provenzale D, McNeil RB, Maffucci A, Quaden R, Zhao H, Whitbourne SB, Harrington KM, Vahey J, Gelernter J, Levey DF, Huang GD, Gaziano JM, Concato J, Aslan M. Genomics of Gulf War Illness in U.S. Veterans Who Served during the 1990-1991 Persian Gulf War: Methods and Rationale for Veterans Affairs Cooperative Study #2006. Brain Sci 2021; 11:brainsci11070845. [PMID: 34202057 PMCID: PMC8301942 DOI: 10.3390/brainsci11070845] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Received: 03/29/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 01/11/2023] Open
Abstract
Background: Approximately 697,000 members of the U.S. Armed Forces were deployed to the Persian Gulf in support of the 1990–1991 Persian Gulf War (GW). Subsequently, many deployed and some non-deployed veterans developed a chronic multi-symptom illness, now named Gulf War Illness (GWI). This manuscript outlines the methods and rationale for studying the genomics of GWI within the Million Veteran Program (MVP), a VA-based national research program that has linked medical records, surveys, and genomic data, enabling genome-wide association studies (GWASs). Methods: MVP participants who served in the military during the GW era were contacted by mail and invited to participate in the GWI study. A structured health questionnaire, based on a previously tested instrument, was also included in the mailing. Data on deployment locations and exposures, symptoms associated with GWI, clinical diagnoses, personal habits, and health care utilization were collected. Self-reported data will be augmented with chart reviews and structured international classification of disease codes, to classify participants by GWI case status. We will develop a phenotyping algorithm, based on two commonly used case definitions, to determine GWI status, and then conduct a nested case-control GWAS. Genetic variants associated with GWI will be investigated, and gene–gene and gene–environment interactions studied. The genetic overlap of GWI with, and causative mechanisms linking this illness to, other health conditions and the effects of genomic regulatory mechanisms on GWI risk will also be explored. Conclusions: The proposed initial GWAS described in this report will investigate the genomic underpinnings of GWI with a large sample size and state-of-the-art genomic analyses and phenotyping. The data generated will provide a rich and expansive foundation on which to build additional analyses.
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Affiliation(s)
- Krishnan Radhakrishnan
- Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD 20857, USA;
- College of Medicine, University of Kentucky, Lexington, KY 40536, USA
| | - Elizabeth R. Hauser
- VA Cooperative Studies Program Epidemiology Center—Durham, Department of Veterans Affairs, Durham, NC 27705, USA; (E.R.H.); (D.P.); (R.B.M.); (J.V.)
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC 27705, USA
| | - Renato Polimanti
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT 06516, USA; (R.P.); (A.M.); (H.Z.); (J.G.); (M.A.)
- School of Medicine, Yale University, New Haven, CT 06511, USA;
| | - Drew A. Helmer
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Correspondence:
| | - Dawn Provenzale
- VA Cooperative Studies Program Epidemiology Center—Durham, Department of Veterans Affairs, Durham, NC 27705, USA; (E.R.H.); (D.P.); (R.B.M.); (J.V.)
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC 27705, USA
| | - Rebecca B. McNeil
- VA Cooperative Studies Program Epidemiology Center—Durham, Department of Veterans Affairs, Durham, NC 27705, USA; (E.R.H.); (D.P.); (R.B.M.); (J.V.)
| | - Alysia Maffucci
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT 06516, USA; (R.P.); (A.M.); (H.Z.); (J.G.); (M.A.)
| | - Rachel Quaden
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (S.B.W.); (K.M.H.); (J.M.G.)
| | - Hongyu Zhao
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT 06516, USA; (R.P.); (A.M.); (H.Z.); (J.G.); (M.A.)
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06520, USA
| | - Stacey B. Whitbourne
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (S.B.W.); (K.M.H.); (J.M.G.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Kelly M. Harrington
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (S.B.W.); (K.M.H.); (J.M.G.)
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
| | - Jacqueline Vahey
- VA Cooperative Studies Program Epidemiology Center—Durham, Department of Veterans Affairs, Durham, NC 27705, USA; (E.R.H.); (D.P.); (R.B.M.); (J.V.)
- Computational Biology and Bioinformatics Program, Duke University, Durham, NC 27705, USA
| | - Joel Gelernter
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT 06516, USA; (R.P.); (A.M.); (H.Z.); (J.G.); (M.A.)
- School of Medicine, Yale University, New Haven, CT 06511, USA;
| | - Daniel F. Levey
- Division of Human Genetics, Department of Psychiatry, School of Medicine, Yale University, New Haven, CT 06511, USA;
- Department of Psychiatry, Veterans Affairs Connecticut Healthcare Center, West Haven, CT 06516, USA
| | - Grant D. Huang
- Cooperative Studies Program, VA Office of Research and Development, Washington, DC 20420, USA;
| | - John Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (S.B.W.); (K.M.H.); (J.M.G.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - John Concato
- School of Medicine, Yale University, New Haven, CT 06511, USA;
- Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Mihaela Aslan
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT 06516, USA; (R.P.); (A.M.); (H.Z.); (J.G.); (M.A.)
- School of Medicine, Yale University, New Haven, CT 06511, USA;
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9
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Hong JC, Hauser ER, Redding TS, Sims KJ, Gellad ZF, O'Leary MC, Hyslop T, Madison AN, Qin X, Weiss D, Bullard AJ, Williams CD, Sullivan BA, Lieberman D, Provenzale D. Characterizing chronological accumulation of comorbidities in healthy veterans: a computational approach. Sci Rep 2021; 11:8104. [PMID: 33854078 PMCID: PMC8046765 DOI: 10.1038/s41598-021-85546-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/13/2020] [Accepted: 12/14/2020] [Indexed: 12/13/2022] Open
Abstract
Understanding patient accumulation of comorbidities can facilitate healthcare strategy and personalized preventative care. We applied a directed network graph to electronic health record (EHR) data and characterized comorbidities in a cohort of healthy veterans undergoing screening colonoscopy. The Veterans Affairs Cooperative Studies Program #380 was a prospective longitudinal study of screening and surveillance colonoscopy. We identified initial instances of three-digit ICD-9 diagnoses for participants with at least 5 years of linked EHR history (October 1999 to December 2015). For diagnoses affecting at least 10% of patients, we calculated pairwise chronological relative risk (RR). iGraph was used to produce directed graphs of comorbidities with RR > 1, as well as summary statistics, key diseases, and communities. A directed graph based on 2210 patients visualized longitudinal development of comorbidities. Top hub (preceding) diseases included ischemic heart disease, inflammatory and toxic neuropathy, and diabetes. Top authority (subsequent) diagnoses were acute kidney failure and hypertensive chronic kidney failure. Four communities of correlated comorbidities were identified. Close analysis of top hub and authority diagnoses demonstrated known relationships, correlated sequelae, and novel hypotheses. Directed network graphs portray chronologic comorbidity relationships. We identified relationships between comorbid diagnoses in this aging veteran cohort. This may direct healthcare prioritization and personalized care.
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Affiliation(s)
- Julian C Hong
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA. .,Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA. .,Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA.
| | - Elizabeth R Hauser
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Thomas S Redding
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA
| | - Kellie J Sims
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA
| | - Ziad F Gellad
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA.,Department of Medicine, Duke University, Durham, NC, USA
| | - Meghan C O'Leary
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA
| | - Terry Hyslop
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Ashton N Madison
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA
| | - Xuejun Qin
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - David Weiss
- Cooperative Studies Program Coordinating Center, Perry Point VA Medical Center, Perry Point, MD, USA
| | - A Jasmine Bullard
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA
| | - Christina D Williams
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA.,Department of Medicine, Duke University, Durham, NC, USA
| | - Brian A Sullivan
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA.,Department of Medicine, Duke University, Durham, NC, USA
| | - David Lieberman
- VA Portland Health Care System, Portland, OR, USA.,Oregon Health and Science University, Portland, OR, USA
| | - Dawn Provenzale
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA. .,Department of Medicine, Duke University, Durham, NC, USA.
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10
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Jazowski SA, Sico IP, Lindquist JH, Smith VA, Bosworth HB, Danus S, Provenzale D, Kelley MJ, Zullig LL. Transportation as a barrier to colorectal cancer care. BMC Health Serv Res 2021; 21:332. [PMID: 33849524 PMCID: PMC8045363 DOI: 10.1186/s12913-021-06339-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 03/31/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Transportation barriers limit access to cancer care services and contribute to suboptimal clinical outcomes. Our objectives were to describe the frequency of Veterans reporting and the factors associated with transportation barriers to or from colorectal cancer (CRC) care visits. METHODS Between November 2015 and September 2016, Veterans with incident stage I, II, or III CRC completed a mailed survey to assess perceived barriers to recommended care. Participants who reported difficulty with transportation to or from CRC care appointments were categorized as experiencing transportation barriers. We assessed pairwise correlations between transportation barriers, transportation-related factors (e.g., mode of travel), and chaotic lifestyle (e.g., predictability of schedules), and used logistic regression to examine the association between the reporting of transportation difficulties, distance traveled to the nearest Veterans Affairs (VA) facility, and life chaos. RESULTS Of the 115 Veterans included in this analysis, 18% reported experiencing transportation barriers. Distance to the VA was not strongly correlated with the reporting of transportation barriers (Spearman's ρ = 0.12, p = 0.19), but chaotic lifestyle was both positively and significantly correlated with experiencing transportation barriers (Spearman's ρ = 0.22, p = 0.02). Results from the logistic regression model modestly supported the findings from the pairwise correlations, but were not statistically significant. CONCLUSIONS Transportation is an important barrier to or from CRC care visits, especially among Veterans who experience greater life chaos. Identifying Veterans who experience chaotic lifestyles would allow for timely engagement in behavioral interventions (e.g., organizational skills training) and with support services (e.g., patient navigation).
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Affiliation(s)
- Shelley A Jazowski
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, 27701, USA
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Isabelle P Sico
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, 27701, USA
| | - Jennifer H Lindquist
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Valerie A Smith
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, 27701, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - Hayden B Bosworth
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, 27701, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Division of General Internal Medicine, Duke University, Durham, NC, USA
- School of Nursing, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Susanne Danus
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Dawn Provenzale
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Medicine, Division of Gastroenterology, Duke University School of Medicine, Durham, NC, USA
- Cooperative Studies Program Epidemiology Center, Durham, NC, USA
| | - Michael J Kelley
- Department of Veterans Affairs, Specialty Care Services, Washington, DC, USA
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Division of Medical Oncology, Duke University School of Medicine, Durham, NC, USA
| | - Leah L Zullig
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, 27701, USA.
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA.
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11
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O'Leary MC, Whitley RL, Press A, Provenzale D, Williams CD, Chesnut B, Jones R, Redding TS, Sims KJ. Development of a Multi-Study Repository to Support Research on Veteran Health: The VA Cooperative Studies Program Epidemiology Center-Durham (CSPEC-Durham) Data and Specimen Repository. Front Public Health 2021; 9:612806. [PMID: 33681131 PMCID: PMC7925406 DOI: 10.3389/fpubh.2021.612806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/30/2020] [Accepted: 01/13/2021] [Indexed: 11/13/2022] Open
Abstract
Federal agencies, including the Department of Veterans Affairs (VA), have prioritized improved access to scientific data and results collected through federally funded research. Our VA Cooperative Studies Program Epidemiology Center in Durham, North Carolina (CSPEC-Durham) assembled a repository of data and specimens collected through multiple studies on Veteran health issues to facilitate future research in these areas. We developed a single protocol, request process that includes scientific and ethical review of all applications, and a database architecture using metadata (common variable descriptors) to securely store and share data across diverse studies. In addition, we created a mechanism to allow data and specimens collected through older studies in which re-use was not addressed in the study protocol or consent forms to be shared if the future research is within the scope of the original consent. Our CSPEC-Durham Data and Specimen Repository currently includes research data, genomic data, and study specimens (e.g., DNA, blood) for three content areas: colorectal cancer, amyotrophic lateral sclerosis, and Gulf War research. The linking of the study specimens and research data can support additional genetic analyses and related research to improve Veterans' health.
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Affiliation(s)
- Meghan C O'Leary
- Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Health Care System, Durham, NC, United States
| | | | - Ashlyn Press
- Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Health Care System, Durham, NC, United States
| | - Dawn Provenzale
- Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Health Care System, Durham, NC, United States.,Duke University Medical Center, Durham, NC, United States
| | - Christina D Williams
- Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Health Care System, Durham, NC, United States.,Duke University Medical Center, Durham, NC, United States
| | - Blair Chesnut
- Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Health Care System, Durham, NC, United States.,Duke Molecular Physiology Institute, School of Medicine, Duke University, Durham, NC, United States
| | - Rodney Jones
- Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Health Care System, Durham, NC, United States.,Duke Molecular Physiology Institute, School of Medicine, Duke University, Durham, NC, United States
| | - Thomas S Redding
- Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Health Care System, Durham, NC, United States
| | - Kellie J Sims
- Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Health Care System, Durham, NC, United States
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12
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Provenzale D, Ness RM, Llor X, Weiss JM, Abbadessa B, Cooper G, Early DS, Friedman M, Giardiello FM, Glaser K, Gurudu S, Halverson AL, Issaka R, Jain R, Kanth P, Kidambi T, Lazenby AJ, Maguire L, Markowitz AJ, May FP, Mayer RJ, Mehta S, Patel S, Peter S, Stanich PP, Terdiman J, Keller J, Dwyer MA, Ogba N. NCCN Guidelines Insights: Colorectal Cancer Screening, Version 2.2020. J Natl Compr Canc Netw 2020; 18:1312-1320. [PMID: 33022639 DOI: 10.6004/jnccn.2020.0048] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The NCCN Guidelines for Colorectal Cancer (CRC) Screening describe various colorectal screening modalities as well as recommended screening schedules for patients at average or increased risk of developing sporadic CRC. They are intended to aid physicians with clinical decision-making regarding CRC screening for patients without defined genetic syndromes. These NCCN Guidelines Insights focus on select recent updates to the NCCN Guidelines, including a section on primary and secondary CRC prevention, and provide context for the panel's recommendations regarding the age to initiate screening in average risk individuals and follow-up for low-risk adenomas.
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Affiliation(s)
| | | | | | | | | | - Gregory Cooper
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Dayna S Early
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | - Amy L Halverson
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - Rachel Issaka
- Fred Hutchinson Cancer Center/Seattle Cancer Care Alliance
| | | | | | | | | | | | | | | | - Robert J Mayer
- Dana-Farber/Brigham and Women's Cancer Center
- Massachusetts General Hospital Cancer Center
| | - Shivan Mehta
- Abramson Cancer Center at the University of Pennsylvania
| | | | | | - Peter P Stanich
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
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13
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Sullivan BA, Qin X, Redding TS, Gellad ZF, Stone A, Weiss D, Madison AN, Sims KJ, Williams CD, Lieberman D, Hauser ER, Provenzale D. Genetic Colorectal Cancer and Adenoma Risk Variants Are Associated with Increasing Cumulative Adenoma Counts. Cancer Epidemiol Biomarkers Prev 2020; 29:2269-2276. [PMID: 32928932 DOI: 10.1158/1055-9965.epi-20-0465] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/25/2020] [Accepted: 09/04/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The genetic basis for most individuals with high cumulative lifetime colonic adenomas is unknown. We investigated associations between known colorectal cancer-risk single-nucleotide polymorphisms (SNP) and increasing cumulative adenoma counts. METHODS The Cooperative Studies Program #380 screening colonoscopy cohort includes 612 selected participants age 50 to 75 with genotyped blood samples and 10 years of clinical follow-up. We evaluated 41 published "colorectal cancer-risk SNPs" for associations with individual cumulative adenoma counts or having ≥10 cumulative adenomas. SNPs were analyzed singly or combined in a polygenic risk score (PRS). The PRS was constructed from eight published SNPs associated with multiple adenomas, termed "adenoma-risk SNPs." RESULTS Four colorectal cancer-risk SNPs were associated with increasing cumulative adenoma counts (P < 0.05): rs12241008 (gene: VTI1A), rs2423279 (BMP2/HAO1), rs3184504 (SH2B3), and rs961253 (FERMT1/BMP2), with risk allele risk ratios of 1.31, 1.29, 1.24, and 1.23, respectively. Three colorectal cancer-risk SNPs were associated with ≥10 cumulative adenomas (P < 0.05), with risk allele odds ratios of 2.09 (rs3184504), 2.30 (rs961253), and 1.94 (rs3217901). A weighted PRS comprised of adenoma-risk SNPs was associated with higher cumulative adenomas (weighted rate ratio = 1.57; P = 0.03). CONCLUSIONS In this mostly male veteran colorectal cancer screening cohort, several known colorectal cancer-risk SNPs were associated with increasing cumulative adenoma counts and the finding of ≥10 cumulative adenomas. In addition, an increasing burden of adenoma-risk SNPs, measured by a weighted PRS, was associated with higher cumulative adenomas. IMPACT Future work will seek to validate these findings in different populations and then augment current colorectal cancer risk prediction tools with precancerous, adenoma genetic data.
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Affiliation(s)
- Brian A Sullivan
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina.,Department of Medicine, Duke University, Durham, North Carolina
| | - Xuejun Qin
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina.,Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Thomas S Redding
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina
| | - Ziad F Gellad
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina.,Department of Medicine, Duke University, Durham, North Carolina
| | - Anjanette Stone
- Cooperative Studies Program Pharmacogenomics Analysis Laboratory, Central Arkansas Veterans Health System, Little Rock, Arkansas
| | - David Weiss
- Perry Point Cooperative Studies Program Coordinating Center, Perry Point VA Medical Center, Perry Point, Maryland
| | - Ashton N Madison
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina
| | - Kellie J Sims
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina
| | - Christina D Williams
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina.,Department of Medicine, Duke University, Durham, North Carolina
| | - David Lieberman
- Division of Gastroenterology and Hepatology, School of Medicine, Oregon Health & Science University, Portland, Oregon.,VA Portland Health Care System, Portland, Oregon
| | - Elizabeth R Hauser
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina.,Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Dawn Provenzale
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina. .,Department of Medicine, Duke University, Durham, North Carolina
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14
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Low EE, Demb J, Liu L, Earles A, Bustamante R, Williams CD, Provenzale D, Kaltenbach T, Gawron AJ, Martinez ME, Gupta S. Risk Factors for Early-Onset Colorectal Cancer. Gastroenterology 2020; 159:492-501.e7. [PMID: 31926997 PMCID: PMC7343609 DOI: 10.1053/j.gastro.2020.01.004] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [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: 05/31/2019] [Revised: 12/31/2019] [Accepted: 01/03/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND & AIMS Colorectal cancer (CRC) incidence and mortality are increasing among persons younger than 50 years old in the United States, but risk factors associated with early-onset CRC (EOCRC) have not been widely studied. METHODS We conducted a case-control study of US veterans 18 to 49 years old who underwent colonoscopy examinations from 1999 through 2014. EOCRC cases were identified from a national cancer registry; veterans who were free of CRC at their baseline colonoscopy through 3 years of follow-up were identified as controls. We collected data on age, sex, race/ethnicity, body weight, body mass index (BMI), diabetes, smoking status, and aspirin use. Multivariate-adjusted EOCRC odds were estimated for each factor, with corresponding 95% confidence interval (CI) values. RESULTS Our final analysis included 651 EOCRC cases and 67,416 controls. Median age was 45.3 years, and 82.3% were male. Higher proportions of cases were older, male, current smokers, nonaspirin users, and had lower BMIs, compared with controls (P < .05). In adjusted analyses, increasing age and male sex were significantly associated with increased risk of EOCRC, whereas aspirin use and being overweight or obese (relative to normal BMI) were significantly associated with decreased odds of EOCRC. In post hoc analyses, weight loss of 5 kg or more within the 5-year period preceding colonoscopy was associated with higher odds of EOCRC (odds ratio 2.23; 95% CI 1.76-2.83). CONCLUSIONS In a case-control study of veterans, we found increasing age and male sex to be significantly associated with increased risk of EOCRC, and aspirin use to be significantly associated with decreased risk; these factors also affect risk for CRC onset after age 50. Weight loss may be an early clinical sign of EOCRC. More intense efforts are required to identify the factors that cause EOCRC and signs that can be used to identify individuals at highest risk.
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Affiliation(s)
- Eric E Low
- Department of Internal Medicine, University of California San Diego, San Diego, California; Division of Gastroenterology, University of California San Diego, San Diego, California; Veteran Affairs San Diego Healthcare System, San Diego, California
| | - Joshua Demb
- Division of Gastroenterology, University of California San Diego, San Diego, California; Moores Cancer Center, University of California San Diego, La Jolla, California
| | - Lin Liu
- Veteran Affairs San Diego Healthcare System, San Diego, California; Moores Cancer Center, University of California San Diego, La Jolla, California; Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
| | - Ashley Earles
- Veterans Medical Research Foundation, San Diego, California
| | - Ranier Bustamante
- Veteran Affairs San Diego Healthcare System, San Diego, California; Moores Cancer Center, University of California San Diego, La Jolla, California
| | - Christina D Williams
- Cooperative Studies Program Epidemiology Center, Durham, North Carolina; Durham Veterans Affairs Medical Center, Durham, North Carolina; Duke Cancer Institute, Durham, North Carolina
| | - Dawn Provenzale
- Cooperative Studies Program Epidemiology Center, Durham, North Carolina; Durham Veterans Affairs Medical Center, Durham, North Carolina; Duke Cancer Institute, Durham, North Carolina
| | - Tonya Kaltenbach
- San Francisco Veterans Affairs Medical Center, San Francisco, California; University of California San Francisco, San Francisco, California
| | - Andrew J Gawron
- Salt Lake City VA Healthcare System, Salt Lake City, Utah; University of Utah, Salt Lake City, Utah
| | - Maria Elena Martinez
- Moores Cancer Center, University of California San Diego, La Jolla, California; Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
| | - Samir Gupta
- Department of Internal Medicine, University of California San Diego, San Diego, California; Division of Gastroenterology, University of California San Diego, San Diego, California; Veteran Affairs San Diego Healthcare System, San Diego, California; Moores Cancer Center, University of California San Diego, La Jolla, California.
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15
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Chapman M, Williams CD, Redding TI, Bartlett R, Chawla N, Provenzale D, Kelley MJ. Abstract PR11: Racial differences in characteristics of early- vs. late-onset colorectal cancer among veterans. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp18-pr11] [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] Open
Abstract
Abstract
Introduction: Colorectal cancer (CRC) accounts for approximately 8% of annual cancer cases in the Veterans Health Administration. While CRC incidence is decreasing, evidence suggests that the incidence among the subset of patients diagnosed before the age of 50 is increasing. The purpose of this work is to compare the clinical and demographic characteristics of veterans with early-onset CRC (age at diagnosis <50; EOC) and late-onset CRC (age at diagnosis ≥50; LOC) and assess racial differences within both groups.
Methods: We conducted a retrospective analysis of national cohort data in the Veterans Affairs Central Cancer Registry on patients diagnosed with CRC between 2001 and 2011. Descriptive statistics (frequencies, medians) were used to compare characteristics among EOC and LOC patients and evaluate black-white differences within both groups of CRC patients.
Results: In this cohort of 31,435 patients, 3% (N=966) had EOC, and this proportion was consistent each year. Statistically significant differences between EOC and LOC were noted for race, stage, and tumor location (all p<0.0001). The black/white race distribution was 33%/64% in EOC and 17%/80% in LOC. For stage, 56% of EOC and 44% of LOC were stage III/IV. Regarding tumor location, 39% of EOC was rectum whereas 30% of LOC was rectum. 5-year overall survival (OS) was 58% in EOC and 50% in LOC (p<0.0001); however, no difference in CRC-specific survival was noted (72% vs 74%, p=.13). We also observed significant differences by race when comparing demographic and clinical characteristics within EOC and LOC. Race-specific results for EOC patients were as follows: Median age was 46 for both blacks and whites; the proportion of blacks diagnosed with Stage III/IV disease was 51% compared to 58% of whites (p=0.001); tumor location was rectum for 31% of blacks and 43% of whites (p=0.0006); and overall and CRC-specific survival rates were similar for blacks and whites. The following was observed among patients with LOC: Blacks were slightly younger than whites (median age 66 vs 69, respectively); stage III/IV disease was noted for 47% of blacks and 43% of whites (p<0.0001); 24% of blacks and 31% of whites had rectum tumor location (p<0.0001); and overall and CRC-specific survival rates were lower among blacks compared to whites.
Conclusion: Although we did not find an increasing proportion of EOC over time, EOC was more common in blacks than whites and more common in the distal large bowel. EOC in blacks, however, was more commonly proximal, had less advanced stage at diagnosis but similar survival compared to whites. EOC has distinct clinical characteristics in blacks that may reflect differences in molecular etiology. Our findings emphasize the importance of distinguishing between EOC and LOC to better understand the unique characteristics of early-onset disease and how they might inform prevention and early detection efforts.
This abstract is also being presented as Poster C116.
Citation Format: Monalesia Chapman, Christina D. Williams, Thomas Ivey Redding, Robin Bartlett, Neeta Chawla, Dawn Provenzale, Michael J. Kelley. Racial differences in characteristics of early- vs. late-onset colorectal cancer among veterans [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr PR11.
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Affiliation(s)
- Monalesia Chapman
- 1University of North Carolina-Greensboro, Durham VA Healthcare System, Greensboro, NC,
| | | | | | | | - Neeta Chawla
- 5VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Dawn Provenzale
- 2Durham VA Healthcare System, Duke University Department of Medicine, Durham, NC,
| | - Michael J. Kelley
- 2Durham VA Healthcare System, Duke University Department of Medicine, Durham, NC,
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16
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Lieberman D, Sullivan BA, Hauser ER, Qin X, Musselwhite LW, O'Leary MC, Redding TS, Madison AN, Bullard AJ, Thomas R, Sims KJ, Williams CD, Hyslop T, Weiss D, Gupta S, Gellad ZF, Robertson DJ, Provenzale D. Baseline Colonoscopy Findings Associated With 10-Year Outcomes in a Screening Cohort Undergoing Colonoscopy Surveillance. Gastroenterology 2020; 158:862-874.e8. [PMID: 31376388 DOI: 10.1053/j.gastro.2019.07.052] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [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: 04/04/2019] [Revised: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Few studies have evaluated long-term outcomes of ongoing colonoscopic screening and surveillance in a screening population. We aimed to determine the 10-year risk for advanced neoplasia (defined as adenomas ≥10mm, adenomas with villous histology or high-grade dysplasia, or colorectal cancer [CRC]) and assessed whether baseline colonoscopy findings were associated with long-term outcomes. METHODS We collected data from the Department of Veterans Affairs Cooperative Studies Program Study on 3121 asymptomatic veterans (50-75 years old) who underwent a screening colonoscopy from 1994 through 1997 at 13 medical centers and were then followed for 10 years or until death. We included 1915 subjects with at least 1 surveillance colonoscopy and estimated cumulative incidence of advanced neoplasia by Kaplan-Meier curves. We then fit a longitudinal joint model to estimate risk of advanced neoplasia at each subsequent examination after baseline, adjusting for multiple colonoscopies within individuals. RESULTS Through 10 years of follow-up, there were 146 individuals among all baseline colonoscopy groups found to have at least 1 incident advanced neoplasia. The cumulative 10-year incidence of advanced neoplasia was highest among those with baseline CRC (43.7%; 95% CI 13.0%-74.4%), followed by those with baseline advanced adenoma (AA) (21.9%; 95% CI 15.7-28.1). The cumulative 10-year incidence of advanced neoplasia was 6.3% (95% CI 4.1%-8.5%) and 4.1% (95% CI 2.7%-5.4%) for baseline 1 to 2 small adenomas (<1cm, and without villous histology or high-grade dysplasia) and no neoplasia, respectively (log-rank P = .10). After adjusting for prior surveillance, the risk of advanced neoplasia at each subsequent examination was not significantly increased in veterans with 1 or 2 small adenomas at baseline (odds ratio 0.96; 95% CI 0.67-1.41) compared with veterans with no baseline neoplasia. CONCLUSIONS Baseline screening colonoscopy findings associate with advanced neoplasia within 10 years. Individuals with only 1 or 2 small adenomas at baseline have a low risk of advanced neoplasia over 10 years. Alternative surveillance strategies, could be considered for these individuals.
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Affiliation(s)
- David Lieberman
- VA Portland Health Care System, Portland, Oregon; Oregon Health & Science University, Portland, Oregon
| | - Brian A Sullivan
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina; Duke University, Durham, North Carolina
| | - Elizabeth R Hauser
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina; Duke University, Durham, North Carolina
| | - Xuejun Qin
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina; Duke University, Durham, North Carolina
| | - Laura W Musselwhite
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina; Duke University, Durham, North Carolina
| | - Meghan C O'Leary
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina
| | - Thomas S Redding
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina
| | - Ashton N Madison
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina
| | - A Jasmine Bullard
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina
| | - Reana Thomas
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina
| | - Kellie J Sims
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina
| | - Christina D Williams
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina; Duke University, Durham, North Carolina
| | - Terry Hyslop
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina; Duke University, Durham, North Carolina
| | - David Weiss
- Perry Point Cooperative Studies Program Coordinating Center, VA Maryland Health Care System, Perry Point, Maryland
| | - Samir Gupta
- San Diego VA Medical Center, San Diego, California; University of California San Diego, San Diego, California
| | - Ziad F Gellad
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina; Duke University, Durham, North Carolina
| | - Douglas J Robertson
- White River Junction VA Medical Center, White River Junction, Vermont; Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Dawn Provenzale
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina; Duke University, Durham, North Carolina.
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17
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Samadder NJ, Neklason D, Snow A, Samowitz W, Cessna MH, Rowe K, Sandhu I, Boucher K, Pappas L, Smith KR, Wong J, Curtin K, Provenzale D, Burt RW. Clinical and Molecular Features of Post-Colonoscopy Colorectal Cancers. Clin Gastroenterol Hepatol 2019; 17:2731-2739.e2. [PMID: 30930275 DOI: 10.1016/j.cgh.2019.02.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 11/16/2018] [Revised: 02/15/2019] [Accepted: 02/25/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Post-colonoscopy colorectal cancers (PCCRCs) may arise from missed lesions or due to molecular features of tumors that allow them to grow rapidly. We aimed to compare clinical, pathology, and molecular features of PCCRCs (those detected within 6-60 months of colonoscopy) and detected CRCs (those detected within 6 months of a colonoscopy). METHODS Within a population-based cross-sectional study of incident CRC cases in Utah (from 1995 through 2009), we identified PCCRCs (those cancers that developed within 5 years of a colonoscopy) and matched the patients by age, sex, and hospital site to patients with detected CRC. Archived specimens were retrieved and tested for microsatellite instability (MSI), CpG island methylation, and mutations in KRAS and BRAF. There were 2659 cases of CRC diagnosed within the study window; 6% of these (n = 159) were defined as PCCRCs; 84 of these cases had tissue available and were matched to 84 subjects with detected CRC. RESULTS Higher proportions of PCCRCs than detected CRCs formed in the proximal colon (64% vs 44%; P = .016) and were of an early stage (86% vs 69%; P = .040). MSI was observed in 32% of PCCRCs compared with 13% of detected CRCs (P = .005). The other molecular features were found in similar proportions of PCCRCs and detected CRCs. In a multivariable logistic regression, MSI (odds ratio, 4.20; 95% CI, 1.58-11.14) was associated with PCCRC. There was no difference in 5-year survival between patients with PCCRCs vs detected CRCs. CONCLUSION In this population-based cross-sectional study of incident CRC cases in Utah, we found PCCRCs to be more likely to arise in the proximal colon and demonstrate MSI, so PCCRCs and detected CRC appear to have different features or processes of tumorigenesis. Additional studies are needed to determine if post-colonoscopy cancers arise through a specific genetic pathway.
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Affiliation(s)
- N Jewel Samadder
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah; Department of Medicine (Gastroenterology), University of Utah, Salt Lake City, Utah; Department of Medicine (Gastroenterology), Mayo Clinic, Phoenix, Arizona.
| | - Deb Neklason
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah; Department of Medicine (Genetic Epidemiology), University of Utah, Salt Lake City, Utah
| | - Angela Snow
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Wade Samowitz
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah; Department of Pathology, University of Utah, Salt Lake City, Utah
| | - Melissa H Cessna
- Department of Pathology and Biorepository, Intermountain Healthcare, Salt Lake City, Utah
| | - Kerry Rowe
- Department of Medicine, Intermountain Healthcare, Salt Lake City, Utah
| | - Iqbal Sandhu
- Department of Bioinformatics, Intermountain Healthcare, Salt Lake City, Utah
| | - Kenneth Boucher
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Lisa Pappas
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Ken Robert Smith
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Jathine Wong
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Karen Curtin
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah; Department of Medicine (Genetic Epidemiology), University of Utah, Salt Lake City, Utah
| | - Dawn Provenzale
- Department of Medicine (Gastroenterology), Duke University, Durham, North Carolina; VA Cooperative Studies Program Epidemiology Center, Departments of Medicine (Gastroenterology) and Clinical Genomics, Mayo Clinic, Phoenix, Arizona
| | - Randall W Burt
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah; Department of Medicine (Gastroenterology), University of Utah, Salt Lake City, Utah; Department of Oncological Sciences, University of Utah, Salt Lake City, Utah
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18
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Musselwhite LW, Redding TS, Sims KJ, O'Leary MC, Hauser ER, Hyslop T, Gellad ZF, Sullivan BA, Lieberman D, Provenzale D. Advanced neoplasia in Veterans at screening colonoscopy using the National Cancer Institute Risk Assessment Tool. BMC Cancer 2019; 19:1097. [PMID: 31718588 PMCID: PMC6852743 DOI: 10.1186/s12885-019-6204-1] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 09/24/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Adapting screening strategy to colorectal cancer (CRC) risk may improve efficiency for all stakeholders however limited tools for such risk stratification exist. Colorectal cancers usually evolve from advanced neoplasms that are present for years. We applied the National Cancer Institute (NCI) CRC Risk Assessment Tool, which calculates future risk of CRC, to determine whether it could be used to predict current advanced neoplasia (AN) in a veteran cohort undergoing a baseline screening colonoscopy. METHODS This was a prospective assessment of the relationship between future CRC risk predicted by the NCI tool, and the presence of AN at screening colonoscopy. Family, medical, dietary and physical activity histories were collected at the time of screening colonoscopy and used to calculate absolute CRC risk at 5, 10 and 20 years. Discriminatory accuracy was assessed. RESULTS Of 3121 veterans undergoing screening colonoscopy, 94% had complete data available to calculate risk (N = 2934, median age 63 years, 100% men, and 15% minorities). Prevalence of AN at baseline screening colonoscopy was 11 % (N = 313). For tertiles of estimated absolute CRC risk at 5 years, AN prevalences were 6.54% (95% CI, 4.99, 8.09), 11.26% (95% CI, 9.28-13.24), and 14.21% (95% CI, 12.02-16.40). For tertiles of estimated risk at 10 years, the prevalences were 6.34% (95% CI, 4.81-7.87), 11.25% (95% CI, 9.27-13.23), and 14.42% (95% CI, 12.22-16.62). For tertiles of estimated absolute CRC risk at 20 years, current AN prevalences were 7.54% (95% CI, 5.75-9.33), 10.53% (95% CI, 8.45-12.61), and 12.44% (95% CI, 10.2-14.68). The area under the curve for predicting current AN was 0.60 (95% CI; 0.57-0.63, p < 0.0001) at 5 years, 0.60 (95% CI, 0.57-0.63, p < 0.0001) at 10 years and 0.58 (95% CI, 0.54-0.61, p < 0.0001) at 20 years. CONCLUSION The NCI tool had modest discriminatory function for estimating the presence of current advanced neoplasia in veterans undergoing a first screening colonoscopy. These findings are comparable to other clinically utilized cancer risk prediction models and may be used to inform the benefit-risk assessment of screening, particularly for patients with competing comorbidities and lower risk, for whom a non-invasive screening approach is preferred.
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Affiliation(s)
- Laura W Musselwhite
- VA Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA.,Levine Cancer Institute, Atrium Health, 100 Medical Park Drive, Suite 110 Concord, Charlotte, NC, 28025, USA
| | - Thomas S Redding
- VA Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
| | - Kellie J Sims
- VA Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
| | - Meghan C O'Leary
- VA Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
| | - Elizabeth R Hauser
- VA Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA.,Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, USA
| | - Terry Hyslop
- Duke University Medical Center, Duke University, 2424 Erwin Road, 8037 Hock Plaza, Durham, NC, 27705, USA
| | - Ziad F Gellad
- VA Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA.,Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Brian A Sullivan
- VA Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA.,Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - David Lieberman
- Veterans Affairs Portland Health Care System, 3710 Sw US Veterans Hospital Road, Portland, OR, 97239, USA.,Oregon Health & Science University, 3181 Sw Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Dawn Provenzale
- VA Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA. .,Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
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Provenzale D, Gupta S, Ahnen DJ, Markowitz AJ, Chung DC, Mayer RJ, Regenbogen SE, Blanco AM, Bray T, Cooper G, Early DS, Ford JM, Giardiello FM, Grady W, Hall MJ, Halverson AL, Hamilton SR, Hampel H, Klapman JB, Larson DW, Lazenby AJ, Llor X, Lynch PM, Mikkelson J, Ness RM, Slavin TP, Sugandha S, Weiss JM, Dwyer MA, Ogba N. NCCN Guidelines Insights: Colorectal Cancer Screening, Version 1.2018. J Natl Compr Canc Netw 2019; 16:939-949. [PMID: 30099370 DOI: 10.6004/jnccn.2018.0067] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The NCCN Guidelines for Colorectal Cancer (CRC) Screening outline various screening modalities as well as recommended screening strategies for individuals at average or increased-risk of developing sporadic CRC. The NCCN panel meets at least annually to review comments from reviewers within their institutions, examine relevant data, and reevaluate and update their recommendations. These NCCN Guidelines Insights summarize 2018 updates to the NCCN Guidelines, with a primary focus on modalities used to screen individuals at average-risk for CRC.
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Spechler SJ, Hunter JG, Jones KM, Lee R, Smith BR, Mashimo H, Sanchez VM, Dunbar KB, Pham TH, Murthy UK, Kim T, Jackson CS, Wallen JM, von Rosenvinge EC, Pearl JP, Laine L, Kim AW, Kaz AM, Tatum RP, Gellad ZF, Lagoo-Deenadayalan S, Rubenstein JH, Ghaferi AA, Lo WK, Fernando RS, Chan BS, Paski SC, Provenzale D, Castell DO, Lieberman D, Souza RF, Chey WD, Warren SR, Davis-Karim A, Melton SD, Genta RM, Serpi T, Biswas K, Huang GD. Randomized Trial of Medical versus Surgical Treatment for Refractory Heartburn. N Engl J Med 2019; 381:1513-1523. [PMID: 31618539 DOI: 10.1056/nejmoa1811424] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [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: 12/24/2022]
Abstract
BACKGROUND Heartburn that persists despite proton-pump inhibitor (PPI) treatment is a frequent clinical problem with multiple potential causes. Treatments for PPI-refractory heartburn are of unproven efficacy and focus on controlling gastroesophageal reflux with reflux-reducing medication (e.g., baclofen) or antireflux surgery or on dampening visceral hypersensitivity with neuromodulators (e.g., desipramine). METHODS Patients who were referred to Veterans Affairs (VA) gastroenterology clinics for PPI-refractory heartburn received 20 mg of omeprazole twice daily for 2 weeks, and those with persistent heartburn underwent endoscopy, esophageal biopsy, esophageal manometry, and multichannel intraluminal impedance-pH monitoring. If patients were found to have reflux-related heartburn, we randomly assigned them to receive surgical treatment (laparoscopic Nissen fundoplication), active medical treatment (omeprazole plus baclofen, with desipramine added depending on symptoms), or control medical treatment (omeprazole plus placebo). The primary outcome was treatment success, defined as a decrease of 50% or more in the Gastroesophageal Reflux Disease (GERD)-Health Related Quality of Life score (range, 0 to 50, with higher scores indicating worse symptoms) at 1 year. RESULTS A total of 366 patients (mean age, 48.5 years; 280 men) were enrolled. Prerandomization procedures excluded 288 patients: 42 had relief of their heartburn during the 2-week omeprazole trial, 70 did not complete trial procedures, 54 were excluded for other reasons, 23 had non-GERD esophageal disorders, and 99 had functional heartburn (not due to GERD or other histopathologic, motility, or structural abnormality). The remaining 78 patients underwent randomization. The incidence of treatment success with surgery (18 of 27 patients, 67%) was significantly superior to that with active medical treatment (7 of 25 patients, 28%; P = 0.007) or control medical treatment (3 of 26 patients, 12%; P<0.001). The difference in the incidence of treatment success between the active medical group and the control medical group was 16 percentage points (95% confidence interval, -5 to 38; P = 0.17). CONCLUSIONS Among patients referred to VA gastroenterology clinics for PPI-refractory heartburn, systematic workup revealed truly PPI-refractory and reflux-related heartburn in a minority of patients. For that highly selected subgroup, surgery was superior to medical treatment. (Funded by the Department of Veterans Affairs Cooperative Studies Program; ClinicalTrials.gov number, NCT01265550.).
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Affiliation(s)
- Stuart J Spechler
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - John G Hunter
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Karen M Jones
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Robert Lee
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Brian R Smith
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Hiroshi Mashimo
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Vivian M Sanchez
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Kerry B Dunbar
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Thai H Pham
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Uma K Murthy
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Taewan Kim
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Christian S Jackson
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Jason M Wallen
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Erik C von Rosenvinge
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Jonathan P Pearl
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Loren Laine
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Anthony W Kim
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Andrew M Kaz
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Roger P Tatum
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Ziad F Gellad
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Sandhya Lagoo-Deenadayalan
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Joel H Rubenstein
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Amir A Ghaferi
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Wai-Kit Lo
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Ronald S Fernando
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Bobby S Chan
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Shirley C Paski
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Dawn Provenzale
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Donald O Castell
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - David Lieberman
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Rhonda F Souza
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - William D Chey
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Stuart R Warren
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Anne Davis-Karim
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Shelby D Melton
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Robert M Genta
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Tracey Serpi
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Kousick Biswas
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
| | - Grant D Huang
- From the Department of Medicine and Center for Esophageal Diseases, Baylor University Medical Center at Dallas, Baylor Scott & White Health, and the Department of Medicine, Veterans Affairs (VA) North Texas Health Care System (S.J.S., R.F.S.), and the Departments of Medicine (K.B.D.), Surgery (T.H.P.), and Pathology (S.D.M.), VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, and the Department of Pathology, Baylor College of Medicine, Houston (R.M.G.); the Departments of Surgery (J.G.H.) and Medicine (D.L.), Oregon Health and Science University, and the Department of Medicine, VA Portland Health Care System (D.L.) - both in Portland; the VA Cooperative Studies Program Coordinating Center, Perry Point (K.M.J., T.S., K.B.), and the Departments of Medicine (E.C.R.) and Surgery (J.P.P.), VA Maryland Health Care System and University of Maryland School of Medicine, Baltimore - all in Maryland; the Departments of Medicine (R.L.) and Surgery (B.R.S.), VA Long Beach Healthcare System and University of California, Irvine, Irvine, the Departments of Medicine (C.S.J., R.S.F., B.S.C.) and Surgery (J.M.W.), VA Loma Linda Healthcare System and Loma Linda University Medical Center, Loma Linda, and the Department of Surgery, University of Southern California, Los Angeles (A.W.K.) - all in California; the Department of Medicine, VA Boston Healthcare System, Harvard Medical School (H.M., W.-K.L.), and the Department of Surgery, VA Boston Healthcare System, Boston University School of Medicine (V.M.S.), Boston; the Departments of Medicine (U.K.M.) and Surgery (T.K.), Syracuse VA Medical Center and SUNY Upstate Medical University, Syracuse, NY; the Department of Medicine, VA Connecticut Healthcare System and Yale University, New Haven, CT (L.L.); the Departments of Medicine (A.M.K., S.C.P.) and Surgery (R.P.T.), VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle; the Departments of Medicine (Z.F.G., D.P.) and Surgery (S.L.-D.), Durham VA Medical Center and Duke University Medical Center, Durham, NC; the Departments of Medicine (J.H.R.) and Surgery (A.A.G.), VA Ann Arbor Healthcare System, and the Departments of Medicine (J.H.R., W.D.C.) and Surgery (A.A.G.), University of Michigan - both in Ann Arbor; the Department of Medicine, Medical University of South Carolina, Charleston (D.O.C.); the VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM (S.R.W., A.D.-K.); and the VA Office of Research and Development, Washington, DC (G.D.H.)
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Goldstein KM, Fisher DA, Wu RR, Orlando LA, Coffman CJ, Grubber JM, Rakhra-Burris T, Wang V, Scheuner MT, Sperber N, Datta SK, Nelson RE, Strawbridge E, Provenzale D, Hauser ER, Voils CI. An electronic family health history tool to identify and manage patients at increased risk for colorectal cancer: protocol for a randomized controlled trial. Trials 2019; 20:576. [PMID: 31590688 PMCID: PMC6781340 DOI: 10.1186/s13063-019-3659-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 04/11/2019] [Accepted: 08/14/2019] [Indexed: 12/11/2022] Open
Abstract
Background Colorectal cancer is the fourth most commonly diagnosed cancer in the United States. Approximately 3–10% of the population has an increased risk for colorectal cancer due to family history and warrants more frequent or intensive screening. Yet, < 50% of that high-risk population receives guideline-concordant care. Systematic collection of family health history and decision support may improve guideline-concordant screening for patients at increased risk of colorectal cancer. We seek to test the effectiveness of a web-based, systematic family health history collection tool and decision support platform (MeTree) to improve risk assessment and appropriate management of colorectal cancer risk among patients in the Department of Veterans Affairs primary care practices. Methods In this ongoing randomized controlled trial, primary care providers at the Durham Veterans Affairs Health Care System and the Madison VA Medical Center are randomized to immediate intervention or wait-list control. Veterans are eligible if assigned to enrolled providers, have an upcoming primary care appointment, and have no conditions that would place them at increased risk for colorectal cancer (such as personal history, adenomatous polyps, or inflammatory bowel disease). Those with a recent lower endoscopy (e.g. colonoscopy, sigmoidoscopy) are excluded. Immediate intervention patients put their family health history information into a web-based platform, MeTree, which provides both patient- and provider-facing decision support reports. Wait-list control patients access MeTree 12 months post-consent. The primary outcome is the risk-concordant colorectal cancer screening referral rate obtained via chart review. Secondary outcomes include patient completion of risk management recommendations (e.g. colonoscopy) and referral for genetic consultation. We will also conduct an economic analysis and an assessment of providers’ experience with MeTree clinical decision support recommendations to inform future implementation efforts if the intervention is found to be effective. Discussion This trial will assess the feasibility and effectiveness of patient-collected family health history linked to decision support to promote risk-appropriate screening in a large healthcare system such as the Department of Veterans Affairs. Trial registration ClinicalTrials.gov, NCT02247336. Registered on 25 September 2014. Electronic supplementary material The online version of this article (10.1186/s13063-019-3659-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karen M Goldstein
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA. .,Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - Deborah A Fisher
- Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - R Ryanne Wu
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA.,Durham Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Health Care System, Durham, NC, USA.,Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Lori A Orlando
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA.,Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Cynthia J Coffman
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA.,Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Janet M Grubber
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
| | - Tejinder Rakhra-Burris
- Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Virginia Wang
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA.,Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Maren T Scheuner
- Division of Medical Genetics, University of California at San Francisco, San Francisco, CA, USA.,Division of Hematology-Oncology, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Nina Sperber
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Santanu K Datta
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA.,Health Services Research, Management and Policy, University of Florida College of Public Health and Health Professions, Gainesville, FL, USA
| | - Richard E Nelson
- IDEAS Center, VA Salt Lake City Healthcare System, Salt Lake City, UT, USA.,Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Elizabeth Strawbridge
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
| | - Dawn Provenzale
- Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Durham Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Elizabeth R Hauser
- Durham Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Health Care System, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Corrine I Voils
- William S Middleton Memorial Veterans Hospital, Madison, WI, USA.,Department of Surgery, University of Wisconsin, Madison, WI, USA
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22
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May FP, Yano EM, Provenzale D, Steers WN, Washington DL. Race, Poverty, and Mental Health Drive Colorectal Cancer Screening Disparities in the Veterans Health Administration. Med Care 2019; 57:773-780. [PMID: 31415338 DOI: 10.1097/mlr.0000000000001186] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Colorectal cancer (CRC) is a common but largely preventable malignancy. Screening is recommended for all adults aged 50-75 years; however, screening rates are low nationally and vary by patient factors and across health care systems. It is currently unknown whether there are inequities in CRC screening rates by patient sociodemographic and/or clinical factors in the Veterans Health Administration (VA) where the majority of patients are CRC screening-eligible age and CRC is the third most commonly diagnosed cancer. METHODS We performed a retrospective cohort study using VA national clinical performance and quality data to determine the overall CRC screening rate, rates by patient sociodemographic and clinical factors, and predictors of screening adjusting for patient and system factors. We also determined whether disparities in screening exist in VA. RESULTS The overall CRC screening rate in VA was 81.5%. Screening rates were lowest among American Indians/Alaska Natives [75.3%; adjusted odds ratio (aOR)=0.77, 95% confidence interval (CI)=0.65-0.90], those with serious mental illness (75.8%; aOR=0.65, 95% CI=0.61-0.69), those with substance abuse (76.9%; aOR=0.76, 95% CI=0.72-0.80), and those in the lowest socioeconomic status quintile (79.5%; aOR=1.10-1.31 for quintiles 2-5 vs. lowest quintile 1). Increasing age, Hispanic ethnicity, black race, Asian race, and high comorbidity were significant predictors of screening uptake. CONCLUSIONS Many racial/ethnic disparities in CRC screening documented in non-VA settings do not exist in VA. Nonetheless, overall high VA CRC screening rates have not reached American Indians/Alaska Natives, low socioeconomic status groups, and those with mental illness and substance abuse. These groups might benefit from additional targeted efforts to increase screening uptake.
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Affiliation(s)
- Folasade P May
- Department of Medicine, VA Greater Los Angeles Healthcare System
- Department of Medicine, The UCLA Vatche and Tamar Manoukian Division of Digestive Diseases, University of California David Geffen School of Medicine
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP)
| | - Elizabeth M Yano
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP)
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Dawn Provenzale
- VA Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Medical Center
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - William N Steers
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP)
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Donna L Washington
- Department of Medicine, VA Greater Los Angeles Healthcare System
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP)
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California Los Angeles, Los Angeles, CA
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23
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May FP, Yano EM, Provenzale D, Washington D. Reply. Clin Gastroenterol Hepatol 2019; 17:2138-2139. [PMID: 31004759 DOI: 10.1016/j.cgh.2019.04.032] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 04/15/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Folasade P May
- Department of Gastroenterology, University of California Los Angeles/ Veterans Affairs, Los Angeles, California
| | - Elizabeth M Yano
- Department of Gastroenterology, University of California Los Angeles/ Veterans Affairs, Los Angeles, California
| | - Dawn Provenzale
- Department of Gastroenterology, University of California Los Angeles/ Veterans Affairs, Los Angeles, California
| | - Donna Washington
- Department of Gastroenterology, University of California Los Angeles/ Veterans Affairs, Los Angeles, California
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24
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Gupta S, Provenzale D, Llor X, Halverson AL, Grady W, Chung DC, Haraldsdottir S, Markowitz AJ, Slavin Jr TP, Hampel H, Ness RM, Weiss JM, Ahnen DJ, Chen LM, Cooper G, Early DS, Giardiello FM, Hall MJ, Hamilton SR, Kanth P, Klapman JB, Lazenby AJ, Lynch PM, Mayer RJ, Mikkelson J, Peter S, Regenbogen SE, Dwyer MA, Ogba N. NCCN Guidelines Insights: Genetic/Familial High-Risk Assessment: Colorectal, Version 2.2019. J Natl Compr Canc Netw 2019; 17:1032-1041. [DOI: 10.6004/jnccn.2019.0044] [Citation(s) in RCA: 143] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Identifying individuals with hereditary syndromes allows for improved cancer surveillance, risk reduction, and optimized management. Establishing criteria for assessment allows for the identification of individuals who are carriers of pathogenic genetic variants. The NCCN Guidelines for Genetic/Familial High-Risk Assessment: Colorectal provide recommendations for the assessment and management of patients with high-risk colorectal cancer syndromes. These NCCN Guidelines Insights focus on criteria for the evaluation of Lynch syndrome and considerations for use of multigene testing in the assessment of hereditary colorectal cancer syndromes.
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Affiliation(s)
| | | | | | - Amy L. Halverson
- 4Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - William Grady
- 5Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | | | | | | | | | | | | | - Lee-may Chen
- 14UCSF Helen Diller Family Comprehensive Cancer Center
| | - Gregory Cooper
- 15Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Dayna S. Early
- 16Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
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25
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Zullig LL, Smith VA, Lindquist JH, Williams CD, Weinberger M, Provenzale D, Jackson GL, Kelley MJ, Danus S, Bosworth HB. Cardiovascular disease-related chronic conditions among Veterans Affairs nonmetastatic colorectal cancer survivors: a matched case-control analysis. Cancer Manag Res 2019; 11:6793-6802. [PMID: 31413631 PMCID: PMC6659791 DOI: 10.2147/cmar.s191040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 10/16/2018] [Accepted: 05/29/2019] [Indexed: 01/13/2023] Open
Abstract
Purpose The growing number of colorectal cancer (CRC) survivors often have multiple chronic conditions. Comparing nonmetastatic CRC survivors and matched noncancer controls, our objectives were to determine the odds of CRC survivors being diagnosed with cardiovascular disease (CVD)-related chronic conditions and their likelihood of control during the year after CRC diagnosis. Patients and methods We retrospectively identified patients diagnosed with nonmetastatic CRC in the Veterans Affairs health care system from fiscal years 2009 to 2012 and matched each with up to 3 noncancer control patients. We used logistic regression to assess differences in the likelihood of being diagnosed with CVD-related chronic conditions and control between nonmetastatic CRC survivors and noncancer controls. Results We identified 9,758 nonmetastatic CRC patients and matched them to 29,066 noncancer controls. At baseline, 69.4% of CRC survivors and their matched controls were diagnosed with hypertension, 52.4% with hyperlipidemia, and 36.7% with diabetes. Compared to matched noncancer controls, CRC survivors had 57% higher odds of being diagnosed with hypertension (OR=1.57, 95% CI=1.49–1.64) and 7% higher odds of controlled blood pressure (OR=1.07, 95% CI 1.02, 1.13) in the subsequent year. Compared to matched noncancer control patients, CRC survivors had half the odds of being diagnosed with hyperlipidemia (OR=0.50, 95% CI=0.48–0.52) and lower odds of low-density lipoprotein (LDL) control (OR 0.88, 95% CI 0.81–0.94). There were no significant differences between groups for diabetes diagnoses or control. Conclusion Compared to noncancer controls, nonmetastatic CRC survivors have 1) greater likelihood of being diagnosed with hypertension and worse blood pressure control in the year following diagnosis; 2) lower likelihood of being diagnosed with hyperlipidemia or LDL control; and 3) comparable diabetes diagnoses and control. There may be a need for hypertension control interventions targeting cancer survivors.
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Affiliation(s)
- Leah L Zullig
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, USA.,Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Valerie A Smith
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, USA.,Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Jennifer H Lindquist
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Christina D Williams
- Division of Medical Oncology, Department of Medicine, Duke University, Durham, NC, USA.,Cooperative Studies Program Epidemiology Center , Durham, NC, USA
| | - Morris Weinberger
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, USA.,Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC, USA
| | - Dawn Provenzale
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, USA.,Cooperative Studies Program Epidemiology Center , Durham, NC, USA
| | - George L Jackson
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, USA.,Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Michael J Kelley
- Office of Specialty Care Services, Department of Veterans Affairs , Washington, DC, USA.,Hematology-Oncology Service, Durham Veterans Affairs Medical Center , Durham, NC, USA.,Department of Medicine, Duke University, Durham, NC, USA
| | - Susanne Danus
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Hayden B Bosworth
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, USA.,Department of Population Health Sciences, Duke University, Durham, NC, USA.,Departments of Psychiatry and School of Nursing, Duke University, Durham, NC, USA
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26
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Finn RT, Lloyd B, Patel YA, Allen JT, Cornejo J, Davis A, McIntosh T, Ferguson S, Sims K, Sudaj S, Taheri J, Burr NA, Provenzale D, Gellad ZF. Decreasing Endoscopy No-Shows Using a Lean Improvement Framework. Clin Gastroenterol Hepatol 2019; 17:1224-1227.e3. [PMID: 30735786 DOI: 10.1016/j.cgh.2019.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Raymond T Finn
- Durham VA Medical Center, Durham, North Carolina; Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina
| | - Benjamin Lloyd
- Durham VA Medical Center, Durham, North Carolina; Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina
| | - Yuval A Patel
- Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina
| | | | | | - Andrea Davis
- Durham VA Medical Center, Durham, North Carolina
| | | | - Stephanie Ferguson
- Durham VA Medical Center, Durham, North Carolina; The Cooperative Studies Program Epidemiology Center-Durham, Durham, North Carolina
| | - Kellie Sims
- The Cooperative Studies Program Epidemiology Center-Durham, Durham, North Carolina
| | - Shawn Sudaj
- Durham VA Medical Center, Durham, North Carolina
| | - Javad Taheri
- Durham VA Medical Center, Durham, North Carolina; Department of Industrial Engineering, North Carolina State University, Raleigh, North Carolina
| | | | - Dawn Provenzale
- Durham VA Medical Center, Durham, North Carolina; Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina; The Cooperative Studies Program Epidemiology Center-Durham, Durham, North Carolina
| | - Ziad F Gellad
- Durham VA Medical Center, Durham, North Carolina; Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina; The Cooperative Studies Program Epidemiology Center-Durham, Durham, North Carolina.
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27
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Scheuner MT, Russell MM, Chanfreau-Coffinier C, Peredo J, Yano EM, Hamilton AB, Lerner B, Provenzale D, Knight SJ, Voils CI. Stakeholders' views on the value of outcomes from clinical genetic and genomic interventions. Genet Med 2018; 21:1371-1380. [PMID: 30377384 DOI: 10.1038/s41436-018-0344-6] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/09/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Robust evidence about the value of clinical genomic interventions (CGIs), such as genetic/genomic testing or clinical genetic evaluation, is limited. We obtained stakeholders' perspectives on outcomes from CGIs to help inform their value. METHODS We used an adapted Delphi expert panel process. Two anonymous survey rounds assessed the value of 44 CGI outcomes and whether a third party should pay for them, with discussion in between rounds. RESULTS Sixty-six panelists responded to the first-round survey and 60 to the second. Policy-makers/payers gave the lowest ratings for value and researchers gave the highest. Patients/consumers had the most uncertainty about value and payment by a third party. Uncertainty about value was observed when evidence of proven health benefit was lacking, potential harms outweighed benefits for reproductive outcomes, and outcomes had only personal utility for individuals or family members. Agreement about outcomes for which a third party should not pay included prevention through surgery with unproven health benefits, establishing ancestry, parental consanguinity, and paternity. CONCLUSION Research is needed to understand factors contributing to uncertainty and stakeholder differences about the value of CGI outcomes. Reaching consensus will accelerate the creation of metrics to generate the evidence needed to inform value and guide policies that promote availability, uptake, and coverage of CGIs.
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Affiliation(s)
- Maren T Scheuner
- Department of Pediatrics, Division of Medical Genetics, University of California-San Francisco, San Francisco, CA, USA. .,San Francisco VA Healthcare System, San Francisco, CA, USA. .,VA HSR&D Center for the Study of Healthcare Innovation Implementation and Policy, Los Angeles, CA, USA.
| | - Marcia M Russell
- VA HSR&D Center for the Study of Healthcare Innovation Implementation and Policy, Los Angeles, CA, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Catherine Chanfreau-Coffinier
- VA HSR&D Center for the Study of Healthcare Innovation Implementation and Policy, Los Angeles, CA, USA.,VA Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | - Jane Peredo
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Elizabeth M Yano
- VA HSR&D Center for the Study of Healthcare Innovation Implementation and Policy, Los Angeles, CA, USA.,Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Alison B Hamilton
- VA HSR&D Center for the Study of Healthcare Innovation Implementation and Policy, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Dawn Provenzale
- VA Cooperative Studies Program Epidemiology Center, Durham, NC, USA.,Duke University School of Medicine, Durham, NC, USA
| | - Sara J Knight
- VA Salt Lake City Healthcare System, Salt Lake City, UT, USA.,Department of Medicine, Division of Epidemiology, University of Utah, Salt Lake City, UT, USA
| | - Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.,Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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28
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Chanfreau-Coffinier C, Peredo J, Russell MM, Yano EM, Hamilton AB, Lerner B, Provenzale D, Knight SJ, Voils CI, Scheuner MT. A logic model for precision medicine implementation informed by stakeholder views and implementation science. Genet Med 2018; 21:1139-1154. [DOI: 10.1038/s41436-018-0315-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 09/10/2018] [Indexed: 01/22/2023] Open
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29
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Patel YA, Gifford EJ, Glass LM, Turner MJ, Han B, Moylan CA, Choi S, Suzuki A, Provenzale D, Hunt CM. Correction to: Identifying Nonalcoholic Fatty Liver Disease Advanced Fibrosis in the Veterans Health Administration. Dig Dis Sci 2018; 63:2813-2814. [PMID: 30043282 DOI: 10.1007/s10620-018-5213-2] [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] [Indexed: 12/09/2022]
Abstract
The original version of the article unfortunately contained errors in Table 3, Risk Factor column headings "Age > 50 (n = 115)," "Age > 50-64 (n = 154)," and "Age > 65 + (n = 60)."
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Affiliation(s)
- Yuval A Patel
- Department of Medicine, Duke University Medical Center, Durham Veterans Administration Medical Center, Box 3913, Durham, NC, 27710, USA.
| | | | - Lisa M Glass
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA.,VA Ann Arbor Healthcare Systems, Ann Arbor, MI, USA
| | - Marsha J Turner
- Cooperative Studies Program Epidemiology Center, Durham Veterans Administration Medical Center, Durham, NC, USA
| | - Byungjoo Han
- Cooperative Studies Program Epidemiology Center, Durham Veterans Administration Medical Center, Durham, NC, USA
| | - Cynthia A Moylan
- Department of Medicine, Duke University Medical Center, Durham Veterans Administration Medical Center, Box 3913, Durham, NC, 27710, USA
| | - Steve Choi
- Department of Medicine, Duke University Medical Center, Durham Veterans Administration Medical Center, Box 3913, Durham, NC, 27710, USA
| | - Ayako Suzuki
- Department of Medicine, Duke University Medical Center, Durham Veterans Administration Medical Center, Box 3913, Durham, NC, 27710, USA
| | - Dawn Provenzale
- Department of Medicine, Duke University Medical Center, Durham Veterans Administration Medical Center, Box 3913, Durham, NC, 27710, USA.,Cooperative Studies Program Epidemiology Center, Durham Veterans Administration Medical Center, Durham, NC, USA
| | - Christine M Hunt
- Department of Medicine, Duke University Medical Center, Durham Veterans Administration Medical Center, Box 3913, Durham, NC, 27710, USA.,Cooperative Studies Program Epidemiology Center, Durham Veterans Administration Medical Center, Durham, NC, USA
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30
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Patel YA, Gifford EJ, Glass LM, Turner MJ, Han B, Moylan CA, Choi S, Suzuki A, Provenzale D, Hunt CM. Identifying Nonalcoholic Fatty Liver Disease Advanced Fibrosis in the Veterans Health Administration. Dig Dis Sci 2018; 63:2259-2266. [PMID: 29779083 DOI: 10.1007/s10620-018-5123-3] [Citation(s) in RCA: 18] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/10/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease. Severe NAFLD with advanced fibrosis results in substantial morbidity and mortality. Associated with metabolic syndrome, NAFLD is often initially clinically silent, yet intensive lifestyle intervention with 7% or greater weight loss can improve or resolve NAFLD. Using a Veterans Health Administration (VHA) liver biopsy cohort, we evaluated simple noninvasive fibrosis scoring systems to identify NAFLD with advanced fibrosis (or severe disease) to assist providers. METHODS In our retrospective study of a national VHA sample of patients with biopsy-proven NAFLD or normal liver (2005-2015), we segregated patients by fibrosis stage (0-4). Non-NAFLD liver disease was excluded. We evaluated the diagnostic accuracy of the NAFLD fibrosis score (NFS), fibrosis-4 calculator (FIB-4), aspartate aminotransferase-to-alanine aminotransferase ratio (AST/ALT ratio), AST-to-platelet ratio index (APRI), and body mass index, AST/ALT ratio, and diabetes (BARD) score by age groups. RESULTS We included 329 patients with well-defined liver histology (296 NAFLD and 33 normal controls without fibrosis), in which 92 (28%) had advanced (stage 3-4) fibrosis. Across all age groups, NFS and FIB-4 best predicted advanced fibrosis (NFS with 0.676 threshold: AUROC 0.71-0.76, LR + 2.30-22.05, OR 6.00-39.58; FIB-4 with 2.67 threshold: AUROC of 0.62-0.80, LR + 4.70-27.45, OR 16.34-59.65). CONCLUSIONS While NFS and FIB-4 scores exhibit good diagnostic accuracy, FIB-4 is optimal in identifying NAFLD advanced fibrosis in the VHA. Easily implemented as a point-of-care clinical test, FIB-4 can be useful in directing patients that are most likely to have advanced fibrosis to GI/hepatology consultation and follow-up.
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Affiliation(s)
- Yuval A Patel
- Department of Medicine, Duke University Medical Center, Durham Veterans Administration Medical Center, Box 3913, Durham, NC, 27710, USA.
| | | | - Lisa M Glass
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA.,VA Ann Arbor Healthcare Systems, Ann Arbor, MI, USA
| | - Marsha J Turner
- Cooperative Studies Program Epidemiology Center, Durham Veterans Administration Medical Center, Durham, NC, USA
| | - Byungjoo Han
- Cooperative Studies Program Epidemiology Center, Durham Veterans Administration Medical Center, Durham, NC, USA
| | - Cynthia A Moylan
- Department of Medicine, Duke University Medical Center, Durham Veterans Administration Medical Center, Box 3913, Durham, NC, 27710, USA
| | - Steve Choi
- Department of Medicine, Duke University Medical Center, Durham Veterans Administration Medical Center, Box 3913, Durham, NC, 27710, USA
| | - Ayako Suzuki
- Department of Medicine, Duke University Medical Center, Durham Veterans Administration Medical Center, Box 3913, Durham, NC, 27710, USA
| | - Dawn Provenzale
- Department of Medicine, Duke University Medical Center, Durham Veterans Administration Medical Center, Box 3913, Durham, NC, 27710, USA.,Cooperative Studies Program Epidemiology Center, Durham Veterans Administration Medical Center, Durham, NC, USA
| | - Christine M Hunt
- Department of Medicine, Duke University Medical Center, Durham Veterans Administration Medical Center, Box 3913, Durham, NC, 27710, USA.,Cooperative Studies Program Epidemiology Center, Durham Veterans Administration Medical Center, Durham, NC, USA
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Gupta S, Provenzale D, Regenbogen SE, Hampel H, Slavin TP, Hall MJ, Llor X, Chung DC, Ahnen DJ, Bray T, Cooper G, Early DS, Ford JM, Giardiello FM, Grady W, Halverson AL, Hamilton SR, Klapman JB, Larson DW, Lazenby AJ, Lynch PM, Markowitz AJ, Mayer RJ, Ness RM, Samadder NJ, Shike M, Sugandha S, Weiss JM, Dwyer MA, Ogba N. NCCN Guidelines Insights: Genetic/Familial High-Risk Assessment: Colorectal, Version 3.2017. J Natl Compr Canc Netw 2018; 15:1465-1475. [PMID: 29223984 DOI: 10.6004/jnccn.2017.0176] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Genetic/Familial High-Risk Assessment: Colorectal provide recommendations for the management of patients with high-risk syndromes associated with an increased risk of colorectal cancer (CRC). The NCCN Panel for Genetic/Familial High-Risk Assessment: Colorectal meets at least annually to assess comments from reviewers within their institutions, examine relevant data, and reevaluate and update their recommendations. These NCCN Guidelines Insights focus on genes newly associated with CRC risk on multigene panels, the associated evidence, and currently recommended management strategies.
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Zullig LL, Goldstein KM, Sims KJ, Williams CD, Chang M, Provenzale D, Kelley MJ. Cancer Among Women Treated in the Veterans Affairs Healthcare System. J Womens Health (Larchmt) 2018; 28:268-275. [PMID: 29920139 DOI: 10.1089/jwh.2018.6936] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The Veterans Affairs (VA) healthcare system is a high-volume provider of cancer care. Women are the fastest growing patient population using VA healthcare services. Quantifying the types of cancers diagnosed among women in the VA is a critical step toward identifying needed healthcare resources for women Veterans with cancer. MATERIALS AND METHODS We obtained data from the VA Central Cancer Registry for cancers newly diagnosed in calendar year 2010. Our analysis was limited to women diagnosed with invasive cancers (e.g., stages I-IV) between January 1, 2010, and December 31, 2010, in the VA healthcare system. We evaluated frequency distributions of incident cancer diagnoses by primary anatomical site, race, and geographic region. For commonly occurring cancers, we reported distribution by stage. RESULTS We identified 1,330 women diagnosed with invasive cancer in the VA healthcare system in 2010. The most commonly diagnosed cancer among women Veterans was breast (30%), followed by cancers of the respiratory (16%), gastrointestinal (12%), and gynecological systems (12%). The most commonly diagnosed cancers were similar for white and minority women, except white women were significantly more likely to be diagnosed with respiratory cancers (p < 0.01) and minority women were significantly more likely to be diagnosed with gastrointestinal cancers (p = 0.03). CONCLUSIONS Understanding cancer incidence among women Veterans is important for healthcare resource planning. While cancer incidence among women using the VA healthcare system is similar to U.S civilian women, the geographic dispersion and small incidence relative to male cancers raise challenges for high quality, well-coordinated cancer care within the VA.
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Affiliation(s)
- Leah L Zullig
- 1 Center for Health Services Research in Primary Care , Durham Veterans Affairs Health Care System, Durham, North Carolina.,2 Department of Population Health Sciences, Duke University Medical Center , Durham, North Carolina
| | - Karen M Goldstein
- 1 Center for Health Services Research in Primary Care , Durham Veterans Affairs Health Care System, Durham, North Carolina.,3 Division of General Internal Medicine, Duke University Medical Center , Durham, North Carolina
| | - Kellie J Sims
- 4 VA Cooperative Studies Program Epidemiology Center , Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Christina D Williams
- 4 VA Cooperative Studies Program Epidemiology Center , Durham Veterans Affairs Health Care System, Durham, North Carolina.,5 Division of Medical Oncology, Duke University Medical Center , Durham, North Carolina
| | - Michael Chang
- 6 Radiation Oncology Service, Richmond Veterans Affairs Medical Center , Richmond, Virginia
| | - Dawn Provenzale
- 4 VA Cooperative Studies Program Epidemiology Center , Durham Veterans Affairs Health Care System, Durham, North Carolina.,7 Division of Gastroenterology, Duke University Medical Center , Durham, North Carolina
| | - Michael J Kelley
- 5 Division of Medical Oncology, Duke University Medical Center , Durham, North Carolina.,8 Departments of Psychiatry and School of Nursing Duke University , Durham, North Carolina.,9 Department of Veterans Affairs, Specialty Care Services , Washington, District of Columbia.,10 Hematology-Oncology Service, Durham Veterans Affairs Health Care System , Durham, North Carolina
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Zullig LL, Goldstein KM, Bosworth HB, Andrews SM, Danus S, Jackson GL, Provenzale D, Weinberger M, Kelley MJ, Voils CI. Chronic disease management perspectives of colorectal cancer survivors using the Veterans Affairs healthcare system: a qualitative analysis. BMC Health Serv Res 2018. [PMID: 29523146 PMCID: PMC5845139 DOI: 10.1186/s12913-018-2975-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the third most commonly diagnosed cancer in the US. CRC survivors may have complex healthcare needs requiring care from both specialists and primary care. Our objective was to understand how CRC survivors perceive their survivorship care, especially management of their cardiovascular-related chronic diseases. METHODS We identified patients diagnosed with non-metastatic CRC between 10/1/2007 and 12/31/2015 at Veterans Affairs Medical Centers in North Carolina or Virginia. In 2016, we conducted telephone-based, semi-structured interviews to assess survivors' experiences with cancer survivorship and changes in health priorities. Interviews were conducted until thematic saturation was reached. Interviews were audio-recorded, transcribed, and coded. RESULTS The 25 participants were, on average, 64 years old and approximately 4 years post-CRC diagnosis at the time of interview; most were white (60%), male (92%), and diagnosed with colon cancer (64%) as opposed to rectal cancer. CRC survivors reported: (1) a shift in focus from surviving cancer to reducing cardiovascular disease risk (e.g., by managing weight); (2) challenges with taking medications for CVD-related conditions; (3) new recognition of the importance of engaging with primary care providers. CONCLUSIONS Experiences with cancer shapes how survivors view their health. Management of cardiovascular-related chronic disease is important to veteran CRC survivors. There is a need to deliver cardiovascular disease risk reduction programs tailored for CRC survivors.
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Affiliation(s)
- Leah L Zullig
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27701, USA. .,Department of Population Health Sciences, Duke University Medical Center, Durham, USA.
| | - Karen M Goldstein
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27701, USA.,Department of Medicine, Duke University Medical Center, Durham, USA
| | - Hayden B Bosworth
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27701, USA.,Department of Population Health Sciences, Duke University Medical Center, Durham, USA.,Department of Psychiatry and Behavioral Sciences and School of Nursing, Duke University, Durham, USA
| | - Sara M Andrews
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27701, USA
| | - Susanne Danus
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27701, USA
| | - George L Jackson
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27701, USA.,Department of Population Health Sciences, Duke University Medical Center, Durham, USA
| | - Dawn Provenzale
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27701, USA.,Department of Medicine, Duke University Medical Center, Durham, USA.,Cooperative Studies Program Epidemiology Center-Durham, Durham, NC, USA
| | - Morris Weinberger
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27701, USA.,Department of Health Policy and Management, University of North Carolina, Chapel Hill, USA
| | - Michael J Kelley
- Department of Veterans Affairs, Washington, DC, USA.,Hematology-Oncology Service, Durham Veterans Affairs Health Care System, Durham, USA
| | - Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, Madison, USA.,Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, USA
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Zullig LL, Smith V, Lindquist J, Williams CD, Weinberger M, Provenzale D, Jackson GL, Kelley MJ, Danus S, Bosworth HB. Cardiovascular disease-related chronic conditions among Veterans Affairs colorectal cancer survivors: A matched case-control analysis. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.7_suppl.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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4 Background: The growing number of colorectal cancer (CRC) survivors often have multiple chronic conditions. Comparing CRC survivors and matched non-cancer controls, our objectives were to determine the odds of CRC survivors being diagnosed with CVD-related chronic conditions and their likelihood of control during the year after CRC diagnosis. Methods: We retrospectively identified patients diagnosed with non-metastatic CRC in the Veterans Affairs (VA) healthcare system from fiscal years 2009-2012 and matched each with up to 3 non-cancer control patients. We used logistic regression to assess differences in the likelihood of being diagnosed with CVD-related chronic conditions and control between CRC survivors and non-cancer controls. Results: We identified 9,758 CRC patients and matched them to 29,066 non-cancer controls. At baseline, 69.4% of CRC survivors and their matched controls were diagnosed with hypertension, 52.4% with hyperlipidemia, and 36.7% with diabetes. Compared to matched non-cancer controls, CRC survivors had 57% higher odds of being diagnosed with hypertension (OR = 1.57, 95% CI = 1.49-1.64) and 12% higher odds of poor blood pressure control (OR = 1.12, 95% CI 1.06-1.18) in the subsequent year. Compared to matched non-cancer control patients, CRC survivors had half the odds of being diagnosed with hyperlipidemia (OR = 0.50, 95% CI = 0.48-0.52) and higher odds of LDL control (OR 1.14, 95% CI 1.06-1.23). There were no significant differences between groups for diabetes diagnoses or control. Conclusions: Compared to non-cancer controls, CRC survivors have: 1) greater likelihood of being diagnosed with hypertension and worse blood pressure control in the year following diagnosis; 2) lower likelihood of being diagnosed with hyperlipidemia or LDL control; and 3) comparable diabetes diagnoses and control. There may be a need for hypertension control interventions targeting cancer survivors.
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Affiliation(s)
| | | | | | | | | | | | - George L. Jackson
- Health Services Research and Development, Durham VA Medical Center, Durham, NC
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Patel YA, Gifford EJ, Glass LM, McNeil R, Turner MJ, Han B, Provenzale D, Choi SS, Moylan CA, Hunt CM. Risk factors for biopsy-proven advanced non-alcoholic fatty liver disease in the Veterans Health Administration. Aliment Pharmacol Ther 2018; 47:268-278. [PMID: 29115682 PMCID: PMC5861349 DOI: 10.1111/apt.14411] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 08/02/2017] [Revised: 08/26/2017] [Accepted: 10/17/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND With its increasing incidence, nonalcoholic fatty liver disease (NAFLD) is of particular concern in the Veterans Health Administration (VHA). AIMS To evaluate risk factors for advanced fibrosis in biopsy-proven NAFLD in the VHA, to identify patients at risk for adverse outcomes. METHODS In randomly selected cases from VHA databases (2005-2015), we performed a retrospective case-control study in adults with biopsy-defined NAFLD or normal liver. RESULTS Of 2091 patients reviewed, 399 met inclusion criteria. Normal controls (n = 65) had normal liver function. The four NAFLD cohorts included: NAFL steatosis (n = 76), nonalcoholic steatohepatitis (NASH) without fibrosis (n = 68), NAFLD/NASH stage 1-3 fibrosis (n = 82), and NAFLD/NASH cirrhosis (n = 70). NAFLD with hepatocellular carcinoma (HCC) was separately identified (n = 38). Most patients were older White men. NAFLD patients with any fibrosis were on average severely obese (BMI>35 kg/m2 ). Diabetes (54.4%-79.6%) and hypertension (85.8%-100%) were more common in NAFLD with fibrosis or HCC. Across NAFLD, 12.3%-19.5% were enrolled in diet/exercise programs and 0%-2.6% had bariatric surgery. Hispanics exhibited higher rates of NASH (20.6%), while Blacks had low NAFLD rates (1.4%-11.8%), particularly NAFLD cirrhosis and HCC (1.4%-2.6%). Diabetes (OR 11.8, P < .001) and BMI (OR 1.4, P < .001) were the most significant predictors of advanced fibrosis. CONCLUSIONS In the VHA, diabetes and severe obesity increased risk for advanced fibrosis in NAFLD. Of these patients, only a small proportion (~20%) had enrolled in diet/exercise programs or had bariatric surgery (~2%). These results suggest that providers should focus/tailor interventions to improve outcomes, particularly in those with diabetes and severe obesity.
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Dominitz JA, Robertson DJ, Ahnen DJ, Allison JE, Antonelli M, Boardman KD, Ciarleglio M, Del Curto BJ, Huang GD, Imperiale TF, Larson MF, Lieberman D, O'Connor T, O'Leary TJ, Peduzzi P, Provenzale D, Shaukat A, Sultan S, Voorhees A, Wallace R, Guarino PD. Colonoscopy vs. Fecal Immunochemical Test in Reducing Mortality From Colorectal Cancer (CONFIRM): Rationale for Study Design. Am J Gastroenterol 2017; 112:1736-1746. [PMID: 29016565 DOI: 10.1038/ajg.2017.286] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [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: 05/09/2017] [Accepted: 07/08/2017] [Indexed: 12/11/2022]
Abstract
RATIONALE Colorectal cancer (CRC) is preventable through screening, with colonoscopy and fecal occult blood testing comprising the two most commonly used screening tests. Given the differences in complexity, risk, and cost, it is important to understand these tests' comparative effectiveness. STUDY DESIGN The CONFIRM Study is a large, pragmatic, multicenter, randomized, parallel group trial to compare screening with colonoscopy vs. the annual fecal immunochemical test (FIT) in 50,000 average risk individuals. CONFIRM examines whether screening colonoscopy will be superior to a FIT-based screening program in the prevention of CRC mortality measured over 10 years. Eligible individuals 50-75 years of age and due for CRC screening are recruited from 46 Veterans Affairs (VA) medical centers. Participants are randomized to either colonoscopy or annual FIT. Results of colonoscopy are managed as per usual care and study participants are assessed for complications. Participants testing FIT positive are referred for colonoscopy. Participants are surveyed annually to determine if they have undergone colonoscopy or been diagnosed with CRC. The primary endpoint is CRC mortality. The secondary endpoints are (1) CRC incidence (2) complications of screening colonoscopy, and (3) the association between colonoscopists' characteristics and neoplasia detection, complications and post-colonoscopy CRC. CONFIRM leverages several key characteristics of the VA's integrated healthcare system, including a shared medical record with national databases, electronic CRC screening reminders, and a robust national research infrastructure with experience in conducting large-scale clinical trials. When completed, CONFIRM will be the largest intervention trial conducted within the VA (ClinicalTrials.gov identifier: NCT01239082).
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Affiliation(s)
- Jason A Dominitz
- VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle, Washington, USA
| | - Douglas J Robertson
- VA Medical Center, White River Junction, Vermont and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Dennis J Ahnen
- VA Eastern Colorado Health Care System, Denver, Colorado, USA
| | - James E Allison
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, Kaiser Division of Research, San Francisco, California, USA
| | - Margaret Antonelli
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Kathy D Boardman
- Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico, USA
| | - Maria Ciarleglio
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
| | - Barbara J Del Curto
- Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico, USA
| | - Grant D Huang
- Cooperative Studies Program Central Office, Office of Research and Development, Washington, DC, USA
| | - Thomas F Imperiale
- Center for Innovation, Health Services Research and Development, Richard L. Roudebush VA Medical Center and Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | | | - Theresa O'Connor
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Timothy J O'Leary
- Office of Research and Development Veterans Health Administration Washington DC and Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Peter Peduzzi
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
| | - Dawn Provenzale
- VA Cooperative Studies Epidemiology Center-Durham and Duke University Medical Center, Durham, North Carolina, USA
| | - Aasma Shaukat
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Healthcare System, Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - Shahnaz Sultan
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Healthcare System, Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - Amy Voorhees
- White River Junction VA Medical Center, White River Junction, Vermont, USA
| | - Robert Wallace
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Peter D Guarino
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, CT and the Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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Provenzale D, Gupta S, Ahnen DJ, Bray T, Cannon JA, Cooper G, David DS, Early DS, Erwin D, Ford JM, Giardiello FM, Grady W, Halverson AL, Hamilton SR, Hampel H, Ismail MK, Klapman JB, Larson DW, Lazenby AJ, Lynch PM, Mayer RJ, Ness RM, Regenbogen SE, Samadder NJ, Shike M, Steinbach G, Weinberg D, Dwyer M, Darlow S. Genetic/Familial High-Risk Assessment: Colorectal Version 1.2016, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2017; 14:1010-30. [PMID: 27496117 DOI: 10.6004/jnccn.2016.0108] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This is a focused update highlighting the most current NCCN Guidelines for diagnosis and management of Lynch syndrome. Lynch syndrome is the most common cause of hereditary colorectal cancer, usually resulting from a germline mutation in 1 of 4 DNA mismatch repair genes (MLH1, MSH2, MSH6, or PMS2), or deletions in the EPCAM promoter. Patients with Lynch syndrome are at an increased lifetime risk, compared with the general population, for colorectal cancer, endometrial cancer, and other cancers, including of the stomach and ovary. As of 2016, the panel recommends screening all patients with colorectal cancer for Lynch syndrome and provides recommendations for surveillance for early detection and prevention of Lynch syndrome-associated cancers.
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Zullig LL, Sims KJ, McNeil R, Williams CD, Jackson GL, Provenzale D, Kelley MJ. Cancer Incidence Among Patients of the U.S. Veterans Affairs Health Care System: 2010 Update. Mil Med 2017; 182:e1883-e1891. [PMID: 28810986 PMCID: PMC5650119 DOI: 10.7205/milmed-d-16-00371] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [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] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Nearly 50,000 incident cancer cases are reported in Veterans Affairs (VA) Central Cancer Registry (VACCR) annually. This article provides an updated report of cancer incidence recorded in VACCR. MATERIALS AND METHODS Data were obtained from VACCR for incident cancers diagnosed in the VA health care system, focusing on 2010 data. Cancer incidence among VA patients is described by anatomical site, sex, race, stage, and geographic location, and was compared to the general U.S. cancer population. RESULTS In 2010, among 46,170 invasive cancers, 97% were diagnosed among men. Approximately 80% of newly diagnosed patients were white, 19% black, and less than 2% were other minority races. Median age at diagnosis was 65 years. The three most frequently diagnosed cancers among VA were prostate (29%), lung/bronchus (18%), and colon/rectum (8%). Melanoma and kidney/renal pelvis tied for fourth (4%), and urinary bladder tied for sixth with liver and intrahepatic bile duct (3.4%). Approximately 23% of prostate, 21% of lung/bronchus, and 31% of colon/rectum cancers were diagnosed with Stage I disease. The overall invasive cancer incidence rate among VA users was 505.8 per 100,000 person-years. CONCLUSIONS Although the composition of the VA population is shifting and includes a larger number of women, registry data indicate that incident cancers in VA in 2010 were most similar to those observed among U.S. men. Consistent reporting of VACCR data is important to provide accurate estimates of VA cancer incidence. This information can be used to plan efforts to improve quality of cancer care and access to services.
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Affiliation(s)
- Leah L. Zullig
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC 27705
- Division of General Internal Medicine, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710
| | - Kellie J. Sims
- Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Health Care System, Durham, NC, 508 Fulton Street, Durham, NC 27705
| | - Rebecca McNeil
- Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Health Care System, Durham, NC, 508 Fulton Street, Durham, NC 27705
| | - Christina D. Williams
- Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Health Care System, Durham, NC, 508 Fulton Street, Durham, NC 27705
- Division of Medical Oncology, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710
| | - George L. Jackson
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC 27705
- Division of General Internal Medicine, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710
| | - Dawn Provenzale
- Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Health Care System, Durham, NC, 508 Fulton Street, Durham, NC 27705
- Division of Gastroenterology, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710
| | - Michael J. Kelley
- Division of Medical Oncology, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710
- Specialty Care Services, Department of Veterans Affairs, 810 Vermont Ave., Washington, DC 20420
- Hematology-Oncology Service, Durham Veterans Affairs Health Care System, Durham, NC, 508 Fulton Street, Durham, NC 27705
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Kinsinger LS, Anderson C, Kim J, Larson M, Chan SH, King HA, Rice KL, Slatore CG, Tanner NT, Pittman K, Monte RJ, McNeil RB, Grubber JM, Kelley MJ, Provenzale D, Datta SK, Sperber NS, Barnes LK, Abbott DH, Sims KJ, Whitley RL, Wu RR, Jackson GL. Implementation of Lung Cancer Screening in the Veterans Health Administration. JAMA Intern Med 2017; 177:399-406. [PMID: 28135352 DOI: 10.1001/jamainternmed.2016.9022] [Citation(s) in RCA: 241] [Impact Index Per Article: 34.4] [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: 12/14/2022]
Abstract
IMPORTANCE The US Preventive Services Task Force recommends annual lung cancer screening (LCS) with low-dose computed tomography for current and former heavy smokers aged 55 to 80 years. There is little published experience regarding implementing this recommendation in clinical practice. OBJECTIVES To describe organizational- and patient-level experiences with implementing an LCS program in selected Veterans Health Administration (VHA) hospitals and to estimate the number of VHA patients who may be candidates for LCS. DESIGN, SETTING, AND PARTICIPANTS This clinical demonstration project was conducted at 8 academic VHA hospitals among 93 033 primary care patients who were assessed on screening criteria; 2106 patients underwent LCS between July 1, 2013, and June 30, 2015. INTERVENTIONS Implementation Guide and support, full-time LCS coordinators, electronic tools, tracking database, patient education materials, and radiologic and nodule follow-up guidelines. MAIN OUTCOMES AND MEASURES Description of implementation processes; percentages of patients who agreed to undergo LCS, had positive findings on results of low-dose computed tomographic scans (nodules to be tracked or suspicious findings), were found to have lung cancer, or had incidental findings; and estimated number of VHA patients who met the criteria for LCS. RESULTS Of the 4246 patients who met the criteria for LCS, 2452 (57.7%) agreed to undergo screening and 2106 (2028 men and 78 women; mean [SD] age, 64.9 [5.1] years) underwent LCS. Wide variation in processes and patient experiences occurred among the 8 sites. Of the 2106 patients screened, 1257 (59.7%) had nodules; 1184 of these patients (56.2%) required tracking, 42 (2.0%) required further evaluation but the findings were not cancer, and 31 (1.5%) had lung cancer. A variety of incidental findings, such as emphysema, other pulmonary abnormalities, and coronary artery calcification, were noted on the scans of 857 patients (40.7%). CONCLUSIONS AND RELEVANCE It is estimated that nearly 900 000 of a population of 6.7 million VHA patients met the criteria for LCS. Implementation of LCS in the VHA will likely lead to large numbers of patients eligible for LCS and will require substantial clinical effort for both patients and staff.
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Affiliation(s)
- Linda S Kinsinger
- Veterans Health Administration National Center for Health Promotion and Disease Prevention, Durham, North Carolina
| | - Charles Anderson
- Veterans Health Administration National Radiology Program Office, Durham, North Carolina
| | - Jane Kim
- Veterans Health Administration National Center for Health Promotion and Disease Prevention, Durham, North Carolina
| | - Martha Larson
- Veterans Health Administration National Center for Health Promotion and Disease Prevention, Durham, North Carolina
| | - Stephanie H Chan
- Veterans Health Administration National Center for Health Promotion and Disease Prevention, Durham, North Carolina
| | - Heather A King
- Durham Veterans Affairs Health Services Research and Development Center of Innovation, Durham, North Carolina.,Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Kathryn L Rice
- Department of Medicine, Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota
| | - Christopher G Slatore
- Department of Medicine, Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Nichole T Tanner
- Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
| | - Kathleen Pittman
- Veterans Health Administration National Center for Health Promotion and Disease Prevention, Durham, North Carolina
| | - Robert J Monte
- Pittsburgh Veterans Engineering Resource Center, Pittsburgh, Pennsylvania
| | - Rebecca B McNeil
- Durham Veterans Affairs Health Services Research and Development Center of Innovation, Durham, North Carolina.,Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Janet M Grubber
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Michael J Kelley
- Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Veterans Health Administration National Oncology Program, Durham, North Carolina
| | - Dawn Provenzale
- Durham Veterans Affairs Health Services Research and Development Center of Innovation, Durham, North Carolina.,Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Santanu K Datta
- Durham Veterans Affairs Health Services Research and Development Center of Innovation, Durham, North Carolina.,Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Nina S Sperber
- Durham Veterans Affairs Health Services Research and Development Center of Innovation, Durham, North Carolina.,Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Lottie K Barnes
- Durham Veterans Affairs Health Services Research and Development Center of Innovation, Durham, North Carolina
| | - David H Abbott
- Durham Veterans Affairs Health Services Research and Development Center of Innovation, Durham, North Carolina
| | - Kellie J Sims
- Durham Veterans Affairs Health Services Research and Development Center of Innovation, Durham, North Carolina
| | - Richard L Whitley
- Durham Veterans Affairs Health Services Research and Development Center of Innovation, Durham, North Carolina
| | - R Ryanne Wu
- Durham Veterans Affairs Health Services Research and Development Center of Innovation, Durham, North Carolina.,Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - George L Jackson
- Durham Veterans Affairs Health Services Research and Development Center of Innovation, Durham, North Carolina.,Department of Medicine, Duke University Medical Center, Durham, North Carolina
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Zullig LL, Smith VA, Jackson GL, Danus S, Schnell M, Lindquist J, Provenzale D, Weinberger M, Kelley MJ, Bosworth HB. Colorectal Cancer Statistics From the Veterans Affairs Central Cancer Registry. Clin Colorectal Cancer 2016; 15:e199-e204. [PMID: 27301717 PMCID: PMC5099105 DOI: 10.1016/j.clcc.2016.04.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 12/23/2015] [Revised: 03/29/2016] [Accepted: 04/27/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) is a common and potentially deadly disease. Although the United States has robust cancer data reporting, information from the Department of Veterans Affairs (VA) healthcare system has often been underrepresented in national cancer data sources. We describe veterans with incident CRC in terms of their patient and tumor characteristics and mortality. PATIENTS AND METHODS Patients diagnosed or treated with CRC at any VA institution in the fiscal years 2009 to 2012 were identified using 3 data sources: (1) VA Central Cancer Registry (VACCR); (2) VA Corporate Data Warehouse; and (3) VA Reports and Measures Portal. The CRC frequencies within the VA population and survival curves were examined descriptively and compared with the national projections using Surveillance, Epidemiology, and End Results program data. RESULTS A total of 12,551 veterans with CRC were included in the present analysis. The median age at diagnosis was 65.5 years. Approximately 97% (n = 12,229) of the CRC cases were diagnosed among men. Approximately 44% (n = 5517) of the patients were diagnosed with localized disease. The 3-year survival rate was associated with age (P < .01) and stage (P < .01) at diagnosis. We identified a possible decrease in VA CRC incidence over time. CONCLUSION Although the VA CRC patient population was heavily skewed toward the male gender, the patient and tumor characteristics were similar between the incident CRC cases reported by the VACCR and those reported to the Surveillance, Epidemiology, and End Results program. This suggests that research findings resulting from the VACCR might have applicability beyond the VA healthcare system setting.
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Affiliation(s)
- Leah L Zullig
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC; Division of General Internal Medicine, Duke University Medical Center, Durham, NC.
| | - Valerie A Smith
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC; Division of General Internal Medicine, Duke University Medical Center, Durham, NC
| | - George L Jackson
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC; Division of General Internal Medicine, Duke University Medical Center, Durham, NC
| | - Susanne Danus
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC
| | - Merritt Schnell
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC
| | - Jennifer Lindquist
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC
| | - Dawn Provenzale
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC; Cooperative Studies Program Epidemiology Center, Durham, NC; Division of Gastroenterology, Duke University Medical Center, Durham, NC
| | - Morris Weinberger
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC
| | - Michael J Kelley
- Office of Patient Care Services, Department of Veterans Affairs, Washington, DC; Hematology-Oncology Service, Durham Veterans Affairs Medical Center, Durham, NC; Division of Medical Oncology, Duke University Medical Center, Durham, NC
| | - Hayden B Bosworth
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC; Division of General Internal Medicine, Duke University Medical Center, Durham, NC; Department of Psychiatry and Behavioral Sciences, School of Nursing, Duke University, Durham, NC
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Gosselin TK, Beck S, Abbott DH, Grambow SC, Provenzale D, Berry P, Kahn KL, Malin JL. The Symptom Experience in Rectal Cancer Survivors. J Pain Symptom Manage 2016; 52:709-718. [PMID: 27697567 DOI: 10.1016/j.jpainsymman.2016.05.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 07/19/2015] [Revised: 05/15/2016] [Accepted: 05/24/2016] [Indexed: 11/12/2022]
Abstract
CONTEXT As the number of rectal cancer survivors grows, it is important to understand the symptom experience after treatment. Although data show that rectal cancer survivors experience a variety of symptoms after diagnosis, little has been done to study the way these symptoms are grouped and associated. OBJECTIVES To determine symptom prevalence and intensity in rectal cancer survivors and if clusters of survivors exist, who share similar symptom-defined survivor subgroups that may vary based on antecedent variables. METHODS A secondary analysis of the Cancer Care and Outcomes Research and Surveillance database was undertaken. Cluster analysis was performed on 15-month postdiagnosis data to form post-treatment survivor subgroups, and these were examined for differences in demographic and clinical characteristics. Data were analyzed using cluster analysis, chi-square, and analysis of variance. RESULTS A total of 275 rectal cancer survivors were included who had undergone chemotherapy, radiation therapy, and surgery. Most frequently reported symptoms included feeling "worn out" (87%), feeling "tired" (85%), and "trouble sleeping" (66%). Four symptom-defined survivor subgroups (minimally symptomatic n = 40, tired and trouble sleeping n = 138, moderate symptoms n = 42, and highly symptomatic n = 55) were identified with symptom differences existing among each subgroup. Age and being married/partnered were the only two antecedents found to differ across subgroups. CONCLUSION This study documents differences in the symptom experience after treatment. The identification of survivor subgroups allows researchers to further investigate tailored, supportive care strategies to minimize ongoing symptoms in those with the greatest symptom burden.
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Affiliation(s)
- Tracy K Gosselin
- Duke University Health System, Duke Cancer Institute, Durham, North Carolina, USA.
| | - Susan Beck
- University of Utah, College of Nursing, Salt Lake City, Utah, USA
| | - David H Abbott
- Durham Veterans Affairs Epidemiologic Research and Information Center, Durham, North Carolina, USA
| | - Steven C Grambow
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Dawn Provenzale
- Durham Veterans Affairs Epidemiologic Research and Information Center, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA
| | - Patricia Berry
- School of Nursing, Oregon Health and Science University, Portland, Oregon, USA
| | - Katherine L Kahn
- Division of General Internal Medicine, University of California, Los Angeles, Los Angeles, California, USA; RAND Corporation, Santa Monica, California, USA
| | - Jennifer L Malin
- Division of General Internal Medicine, University of California, Los Angeles, Los Angeles, California, USA; Anthem, Thousand Oaks, California, USA; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
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Sullivan DR, Forsberg CW, Ganzini L, Au DH, Gould MK, Provenzale D, Slatore CG. Longitudinal Changes in Depression Symptoms and Survival Among Patients With Lung Cancer: A National Cohort Assessment. J Clin Oncol 2016; 34:3984-3991. [PMID: 27996350 DOI: 10.1200/jco.2016.66.8459] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose Depression symptoms are common among patients with lung cancer; however, longitudinal changes and their impact on survival are understudied. Methods This was a prospective, observational study from the Cancer Care Outcomes Research and Surveillance Consortium from five US geographically defined regions from September 2003 through December 2005. Patients enrolled within 3 months of their lung cancer diagnosis were eligible. The eight-item Center for Epidemiologic Studies Depression scale was administered at diagnosis and 12 months' follow-up. The main outcome was survival, which was evaluated using Kaplan-Meyer curves and adjusted Cox proportional hazards modeling. Results Among 1,790 participants, 681 (38%) had depression symptoms at baseline and an additional 105 (14%) developed new-onset depression symptoms during treatment. At baseline, depression symptoms were associated with increased mortality (hazard ratio [HR], 1.17; 95% CI, 1.03 to 1.32; P = .01). Participants were classified into the following four groups based on longitudinal changes in depression symptoms from baseline to follow-up: never depression symptoms (n = 640), new-onset depression symptoms (n = 105), depression symptom remission (n = 156), and persistent depression symptoms (n = 254) and HRs were calculated. Using the never-depression symptoms group as a reference group, HRs were as follows: new-onset depression symptoms, 1.50 (95% CI, 1.12 to 2.01; P = .006); depression symptom remission, 1.02 (95% CI, 0.79 to 1.31; P = .89), and persistent depression symptoms, 1.42 (95% CI, 1.15 to 1.75; P = .001). At baseline, depression symptoms were associated with increased mortality among participants with early-stage disease (stages I and II; HR, 1.61; 95% CI, 1.26 to 2.04), but not late-stage disease (stages III and IV; HR, 1.05; 95% CI, 0.91 to 1.22). At follow-up, depression symptoms were associated with increased mortality among participants with early-stage disease (HR, 1.71; 95% CI, 1.27 to 2.31) and those with late-stage disease (HR, 1.32; 95% CI, 1.04 to 1.69). Conclusion Among patients with lung cancer, longitudinal changes in depression symptoms are associated with differences in mortality, particularly among patients with early-stage disease. Symptom remission is associated with a similar mortality rate as never having had depression.
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Affiliation(s)
- Donald R Sullivan
- Donald R. Sullivan, Christopher G. Slatore, and Linda Ganzini, Oregon Health & Science University; Donald R. Sullivan, Christopher W. Forsberg, Linda Ganzini, and Christopher G. Slatore, Veterans Affairs Portland Health Care System, Portland, OR; David H. Au, Veterans Affairs Puget Sound Health Care System David H. Au, University of Washington, Seattle, WA; Michael K. Gould, Kaiser Permanente Southern California, Pasadena; Michael K. Gould, University of Southern California, Los Angeles, CA; Dawn Provenzale, Durham VA Medical Center; and Dawn Provenzale, Duke University, Durham, NC
| | - Christopher W Forsberg
- Donald R. Sullivan, Christopher G. Slatore, and Linda Ganzini, Oregon Health & Science University; Donald R. Sullivan, Christopher W. Forsberg, Linda Ganzini, and Christopher G. Slatore, Veterans Affairs Portland Health Care System, Portland, OR; David H. Au, Veterans Affairs Puget Sound Health Care System David H. Au, University of Washington, Seattle, WA; Michael K. Gould, Kaiser Permanente Southern California, Pasadena; Michael K. Gould, University of Southern California, Los Angeles, CA; Dawn Provenzale, Durham VA Medical Center; and Dawn Provenzale, Duke University, Durham, NC
| | - Linda Ganzini
- Donald R. Sullivan, Christopher G. Slatore, and Linda Ganzini, Oregon Health & Science University; Donald R. Sullivan, Christopher W. Forsberg, Linda Ganzini, and Christopher G. Slatore, Veterans Affairs Portland Health Care System, Portland, OR; David H. Au, Veterans Affairs Puget Sound Health Care System David H. Au, University of Washington, Seattle, WA; Michael K. Gould, Kaiser Permanente Southern California, Pasadena; Michael K. Gould, University of Southern California, Los Angeles, CA; Dawn Provenzale, Durham VA Medical Center; and Dawn Provenzale, Duke University, Durham, NC
| | - David H Au
- Donald R. Sullivan, Christopher G. Slatore, and Linda Ganzini, Oregon Health & Science University; Donald R. Sullivan, Christopher W. Forsberg, Linda Ganzini, and Christopher G. Slatore, Veterans Affairs Portland Health Care System, Portland, OR; David H. Au, Veterans Affairs Puget Sound Health Care System David H. Au, University of Washington, Seattle, WA; Michael K. Gould, Kaiser Permanente Southern California, Pasadena; Michael K. Gould, University of Southern California, Los Angeles, CA; Dawn Provenzale, Durham VA Medical Center; and Dawn Provenzale, Duke University, Durham, NC
| | - Michael K Gould
- Donald R. Sullivan, Christopher G. Slatore, and Linda Ganzini, Oregon Health & Science University; Donald R. Sullivan, Christopher W. Forsberg, Linda Ganzini, and Christopher G. Slatore, Veterans Affairs Portland Health Care System, Portland, OR; David H. Au, Veterans Affairs Puget Sound Health Care System David H. Au, University of Washington, Seattle, WA; Michael K. Gould, Kaiser Permanente Southern California, Pasadena; Michael K. Gould, University of Southern California, Los Angeles, CA; Dawn Provenzale, Durham VA Medical Center; and Dawn Provenzale, Duke University, Durham, NC
| | - Dawn Provenzale
- Donald R. Sullivan, Christopher G. Slatore, and Linda Ganzini, Oregon Health & Science University; Donald R. Sullivan, Christopher W. Forsberg, Linda Ganzini, and Christopher G. Slatore, Veterans Affairs Portland Health Care System, Portland, OR; David H. Au, Veterans Affairs Puget Sound Health Care System David H. Au, University of Washington, Seattle, WA; Michael K. Gould, Kaiser Permanente Southern California, Pasadena; Michael K. Gould, University of Southern California, Los Angeles, CA; Dawn Provenzale, Durham VA Medical Center; and Dawn Provenzale, Duke University, Durham, NC
| | - Christopher G Slatore
- Donald R. Sullivan, Christopher G. Slatore, and Linda Ganzini, Oregon Health & Science University; Donald R. Sullivan, Christopher W. Forsberg, Linda Ganzini, and Christopher G. Slatore, Veterans Affairs Portland Health Care System, Portland, OR; David H. Au, Veterans Affairs Puget Sound Health Care System David H. Au, University of Washington, Seattle, WA; Michael K. Gould, Kaiser Permanente Southern California, Pasadena; Michael K. Gould, University of Southern California, Los Angeles, CA; Dawn Provenzale, Durham VA Medical Center; and Dawn Provenzale, Duke University, Durham, NC
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Provenzale D, Jasperson K, Ahnen DJ, Aslanian H, Bray T, Cannon JA, David DS, Early DS, Erwin D, Ford JM, Giardiello FM, Gupta S, Halverson AL, Hamilton SR, Hampel H, Ismail MK, Klapman JB, Larson DW, Lazenby AJ, Lynch PM, Mayer RJ, Ness RM, Rao MS, Regenbogen SE, Shike M, Steinbach G, Weinberg D, Dwyer MA, Freedman-Cass DA, Darlow S. Colorectal Cancer Screening, Version 1.2015. J Natl Compr Canc Netw 2016; 13:959-68; quiz 968. [PMID: 26285241 DOI: 10.6004/jnccn.2015.0116] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Colorectal Cancer Screening provide recommendations for selecting individuals for colorectal cancer screening, and for evaluation and follow-up of colon polyps. These NCCN Guidelines Insights summarize major discussion points of the 2015 NCCN Colorectal Cancer Screening panel meeting. Major discussion topics this year were the state of evidence for CT colonography and stool DNA testing, bowel preparation procedures for colonoscopy, and guidelines for patients with a positive family history of colorectal cancer.
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Affiliation(s)
- Dawn Provenzale
- From Duke Cancer Institute; Huntsman Cancer Institute at the University of Utah; University of Colorado Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; Hereditary Colon Cancer Foundation; University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Roswell Park Cancer Institute; Stanford Cancer Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UC San Diego Moores Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Moffitt Cancer Center; Mayo Clinic Cancer Center; Fred & Pamela Buffett Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Fox Chase Cancer Center; and National Comprehensive Cancer Network
| | - Kory Jasperson
- From Duke Cancer Institute; Huntsman Cancer Institute at the University of Utah; University of Colorado Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; Hereditary Colon Cancer Foundation; University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Roswell Park Cancer Institute; Stanford Cancer Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UC San Diego Moores Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Moffitt Cancer Center; Mayo Clinic Cancer Center; Fred & Pamela Buffett Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Fox Chase Cancer Center; and National Comprehensive Cancer Network
| | - Dennis J Ahnen
- From Duke Cancer Institute; Huntsman Cancer Institute at the University of Utah; University of Colorado Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; Hereditary Colon Cancer Foundation; University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Roswell Park Cancer Institute; Stanford Cancer Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UC San Diego Moores Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Moffitt Cancer Center; Mayo Clinic Cancer Center; Fred & Pamela Buffett Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Fox Chase Cancer Center; and National Comprehensive Cancer Network
| | - Harry Aslanian
- From Duke Cancer Institute; Huntsman Cancer Institute at the University of Utah; University of Colorado Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; Hereditary Colon Cancer Foundation; University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Roswell Park Cancer Institute; Stanford Cancer Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UC San Diego Moores Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Moffitt Cancer Center; Mayo Clinic Cancer Center; Fred & Pamela Buffett Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Fox Chase Cancer Center; and National Comprehensive Cancer Network
| | - Travis Bray
- From Duke Cancer Institute; Huntsman Cancer Institute at the University of Utah; University of Colorado Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; Hereditary Colon Cancer Foundation; University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Roswell Park Cancer Institute; Stanford Cancer Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UC San Diego Moores Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Moffitt Cancer Center; Mayo Clinic Cancer Center; Fred & Pamela Buffett Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Fox Chase Cancer Center; and National Comprehensive Cancer Network
| | - Jamie A Cannon
- From Duke Cancer Institute; Huntsman Cancer Institute at the University of Utah; University of Colorado Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; Hereditary Colon Cancer Foundation; University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Roswell Park Cancer Institute; Stanford Cancer Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UC San Diego Moores Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Moffitt Cancer Center; Mayo Clinic Cancer Center; Fred & Pamela Buffett Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Fox Chase Cancer Center; and National Comprehensive Cancer Network
| | - Donald S David
- From Duke Cancer Institute; Huntsman Cancer Institute at the University of Utah; University of Colorado Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; Hereditary Colon Cancer Foundation; University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Roswell Park Cancer Institute; Stanford Cancer Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UC San Diego Moores Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Moffitt Cancer Center; Mayo Clinic Cancer Center; Fred & Pamela Buffett Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Fox Chase Cancer Center; and National Comprehensive Cancer Network
| | - Dayna S Early
- From Duke Cancer Institute; Huntsman Cancer Institute at the University of Utah; University of Colorado Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; Hereditary Colon Cancer Foundation; University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Roswell Park Cancer Institute; Stanford Cancer Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UC San Diego Moores Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Moffitt Cancer Center; Mayo Clinic Cancer Center; Fred & Pamela Buffett Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Fox Chase Cancer Center; and National Comprehensive Cancer Network
| | - Deborah Erwin
- From Duke Cancer Institute; Huntsman Cancer Institute at the University of Utah; University of Colorado Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; Hereditary Colon Cancer Foundation; University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Roswell Park Cancer Institute; Stanford Cancer Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UC San Diego Moores Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Moffitt Cancer Center; Mayo Clinic Cancer Center; Fred & Pamela Buffett Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Fox Chase Cancer Center; and National Comprehensive Cancer Network
| | - James M Ford
- From Duke Cancer Institute; Huntsman Cancer Institute at the University of Utah; University of Colorado Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; Hereditary Colon Cancer Foundation; University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Roswell Park Cancer Institute; Stanford Cancer Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UC San Diego Moores Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Moffitt Cancer Center; Mayo Clinic Cancer Center; Fred & Pamela Buffett Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Fox Chase Cancer Center; and National Comprehensive Cancer Network
| | - Francis M Giardiello
- From Duke Cancer Institute; Huntsman Cancer Institute at the University of Utah; University of Colorado Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; Hereditary Colon Cancer Foundation; University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Roswell Park Cancer Institute; Stanford Cancer Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UC San Diego Moores Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Moffitt Cancer Center; Mayo Clinic Cancer Center; Fred & Pamela Buffett Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Fox Chase Cancer Center; and National Comprehensive Cancer Network
| | - Samir Gupta
- From Duke Cancer Institute; Huntsman Cancer Institute at the University of Utah; University of Colorado Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; Hereditary Colon Cancer Foundation; University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Roswell Park Cancer Institute; Stanford Cancer Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UC San Diego Moores Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Moffitt Cancer Center; Mayo Clinic Cancer Center; Fred & Pamela Buffett Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Fox Chase Cancer Center; and National Comprehensive Cancer Network
| | - Amy L Halverson
- From Duke Cancer Institute; Huntsman Cancer Institute at the University of Utah; University of Colorado Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; Hereditary Colon Cancer Foundation; University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Roswell Park Cancer Institute; Stanford Cancer Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UC San Diego Moores Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Moffitt Cancer Center; Mayo Clinic Cancer Center; Fred & Pamela Buffett Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Fox Chase Cancer Center; and National Comprehensive Cancer Network
| | - Stanley R Hamilton
- From Duke Cancer Institute; Huntsman Cancer Institute at the University of Utah; University of Colorado Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; Hereditary Colon Cancer Foundation; University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Roswell Park Cancer Institute; Stanford Cancer Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UC San Diego Moores Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Moffitt Cancer Center; Mayo Clinic Cancer Center; Fred & Pamela Buffett Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Fox Chase Cancer Center; and National Comprehensive Cancer Network
| | - Heather Hampel
- From Duke Cancer Institute; Huntsman Cancer Institute at the University of Utah; University of Colorado Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; Hereditary Colon Cancer Foundation; University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Roswell Park Cancer Institute; Stanford Cancer Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UC San Diego Moores Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Moffitt Cancer Center; Mayo Clinic Cancer Center; Fred & Pamela Buffett Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Fox Chase Cancer Center; and National Comprehensive Cancer Network
| | - Mohammad K Ismail
- From Duke Cancer Institute; Huntsman Cancer Institute at the University of Utah; University of Colorado Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; Hereditary Colon Cancer Foundation; University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Roswell Park Cancer Institute; Stanford Cancer Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UC San Diego Moores Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Moffitt Cancer Center; Mayo Clinic Cancer Center; Fred & Pamela Buffett Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Fox Chase Cancer Center; and National Comprehensive Cancer Network
| | - Jason B Klapman
- From Duke Cancer Institute; Huntsman Cancer Institute at the University of Utah; University of Colorado Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; Hereditary Colon Cancer Foundation; University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Roswell Park Cancer Institute; Stanford Cancer Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UC San Diego Moores Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Moffitt Cancer Center; Mayo Clinic Cancer Center; Fred & Pamela Buffett Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Fox Chase Cancer Center; and National Comprehensive Cancer Network
| | - David W Larson
- From Duke Cancer Institute; Huntsman Cancer Institute at the University of Utah; University of Colorado Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; Hereditary Colon Cancer Foundation; University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Roswell Park Cancer Institute; Stanford Cancer Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UC San Diego Moores Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Moffitt Cancer Center; Mayo Clinic Cancer Center; Fred & Pamela Buffett Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Fox Chase Cancer Center; and National Comprehensive Cancer Network
| | - Audrey J Lazenby
- From Duke Cancer Institute; Huntsman Cancer Institute at the University of Utah; University of Colorado Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; Hereditary Colon Cancer Foundation; University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Roswell Park Cancer Institute; Stanford Cancer Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UC San Diego Moores Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Moffitt Cancer Center; Mayo Clinic Cancer Center; Fred & Pamela Buffett Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Fox Chase Cancer Center; and National Comprehensive Cancer Network
| | - Patrick M Lynch
- From Duke Cancer Institute; Huntsman Cancer Institute at the University of Utah; University of Colorado Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; Hereditary Colon Cancer Foundation; University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Roswell Park Cancer Institute; Stanford Cancer Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UC San Diego Moores Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Moffitt Cancer Center; Mayo Clinic Cancer Center; Fred & Pamela Buffett Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Fox Chase Cancer Center; and National Comprehensive Cancer Network
| | - Robert J Mayer
- From Duke Cancer Institute; Huntsman Cancer Institute at the University of Utah; University of Colorado Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; Hereditary Colon Cancer Foundation; University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Roswell Park Cancer Institute; Stanford Cancer Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UC San Diego Moores Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Moffitt Cancer Center; Mayo Clinic Cancer Center; Fred & Pamela Buffett Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Fox Chase Cancer Center; and National Comprehensive Cancer Network
| | - Reid M Ness
- From Duke Cancer Institute; Huntsman Cancer Institute at the University of Utah; University of Colorado Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; Hereditary Colon Cancer Foundation; University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Roswell Park Cancer Institute; Stanford Cancer Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UC San Diego Moores Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Moffitt Cancer Center; Mayo Clinic Cancer Center; Fred & Pamela Buffett Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Fox Chase Cancer Center; and National Comprehensive Cancer Network
| | - M Sambasiva Rao
- From Duke Cancer Institute; Huntsman Cancer Institute at the University of Utah; University of Colorado Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; Hereditary Colon Cancer Foundation; University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Roswell Park Cancer Institute; Stanford Cancer Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UC San Diego Moores Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Moffitt Cancer Center; Mayo Clinic Cancer Center; Fred & Pamela Buffett Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Fox Chase Cancer Center; and National Comprehensive Cancer Network
| | - Scott E Regenbogen
- From Duke Cancer Institute; Huntsman Cancer Institute at the University of Utah; University of Colorado Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; Hereditary Colon Cancer Foundation; University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Roswell Park Cancer Institute; Stanford Cancer Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UC San Diego Moores Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Moffitt Cancer Center; Mayo Clinic Cancer Center; Fred & Pamela Buffett Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Fox Chase Cancer Center; and National Comprehensive Cancer Network
| | - Moshe Shike
- From Duke Cancer Institute; Huntsman Cancer Institute at the University of Utah; University of Colorado Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; Hereditary Colon Cancer Foundation; University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Roswell Park Cancer Institute; Stanford Cancer Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UC San Diego Moores Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Moffitt Cancer Center; Mayo Clinic Cancer Center; Fred & Pamela Buffett Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Fox Chase Cancer Center; and National Comprehensive Cancer Network
| | - Gideon Steinbach
- From Duke Cancer Institute; Huntsman Cancer Institute at the University of Utah; University of Colorado Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; Hereditary Colon Cancer Foundation; University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Roswell Park Cancer Institute; Stanford Cancer Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UC San Diego Moores Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Moffitt Cancer Center; Mayo Clinic Cancer Center; Fred & Pamela Buffett Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Fox Chase Cancer Center; and National Comprehensive Cancer Network
| | - David Weinberg
- From Duke Cancer Institute; Huntsman Cancer Institute at the University of Utah; University of Colorado Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; Hereditary Colon Cancer Foundation; University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Roswell Park Cancer Institute; Stanford Cancer Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UC San Diego Moores Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Moffitt Cancer Center; Mayo Clinic Cancer Center; Fred & Pamela Buffett Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Fox Chase Cancer Center; and National Comprehensive Cancer Network
| | - Mary A Dwyer
- From Duke Cancer Institute; Huntsman Cancer Institute at the University of Utah; University of Colorado Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; Hereditary Colon Cancer Foundation; University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Roswell Park Cancer Institute; Stanford Cancer Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UC San Diego Moores Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Moffitt Cancer Center; Mayo Clinic Cancer Center; Fred & Pamela Buffett Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Fox Chase Cancer Center; and National Comprehensive Cancer Network
| | - Deborah A Freedman-Cass
- From Duke Cancer Institute; Huntsman Cancer Institute at the University of Utah; University of Colorado Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; Hereditary Colon Cancer Foundation; University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Roswell Park Cancer Institute; Stanford Cancer Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UC San Diego Moores Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Moffitt Cancer Center; Mayo Clinic Cancer Center; Fred & Pamela Buffett Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Fox Chase Cancer Center; and National Comprehensive Cancer Network
| | - Susan Darlow
- From Duke Cancer Institute; Huntsman Cancer Institute at the University of Utah; University of Colorado Cancer Center; Yale Cancer Center/Smilow Cancer Hospital; Hereditary Colon Cancer Foundation; University of Alabama at Birmingham Comprehensive Cancer Center; City of Hope Comprehensive Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Roswell Park Cancer Institute; Stanford Cancer Institute; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UC San Diego Moores Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; The University of Texas MD Anderson Cancer Center; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; Moffitt Cancer Center; Mayo Clinic Cancer Center; Fred & Pamela Buffett Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; Vanderbilt-Ingram Cancer Center; University of Michigan Comprehensive Cancer Center; Memorial Sloan Kettering Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Fox Chase Cancer Center; and National Comprehensive Cancer Network
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Hunt CM, Beste LA, Lowy E, Suzuki A, Moylan CA, Tillmann HL, Ioannou GN, Lim JK, Kelley MJ, Provenzale D. Veterans health administration hepatitis B testing and treatment with anti-CD20 antibody administration. World J Gastroenterol 2016; 22:4732-4740. [PMID: 27217704 PMCID: PMC4870079 DOI: 10.3748/wjg.v22.i19.4732] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/16/2016] [Accepted: 03/30/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate pretreatment hepatitis B virus (HBV) testing, vaccination, and antiviral treatment rates in Veterans Affairs patients receiving anti-CD20 Ab for quality improvement.
METHODS: We performed a retrospective cohort study using a national repository of Veterans Health Administration (VHA) electronic health record data. We identified all patients receiving anti-CD20 Ab treatment (2002-2014). We ascertained patient demographics, laboratory results, HBV vaccination status (from vaccination records), pharmacy data, and vital status. The high risk period for HBV reactivation is during anti-CD20 Ab treatment and 12 mo follow up. Therefore, we analyzed those who were followed to death or for at least 12 mo after completing anti-CD20 Ab. Pretreatment serologic tests were used to categorize chronic HBV (hepatitis B surface antigen positive or HBsAg+), past HBV (HBsAg-, hepatitis B core antibody positive or HBcAb+), resolved HBV (HBsAg-, HBcAb+, hepatitis B surface antibody positive or HBsAb+), likely prior vaccination (isolated HBsAb+), HBV negative (HBsAg-, HBcAb-), or unknown. Acute hepatitis B was defined by the appearance of HBsAg+ in the high risk period in patients who were pretreatment HBV negative. We assessed HBV antiviral treatment and the incidence of hepatitis, liver failure, and death during the high risk period. Cumulative hepatitis, liver failure, and death after anti-CD20 Ab initiation were compared by HBV disease categories and differences compared using the χ2 test. Mean time to hepatitis peak alanine aminotransferase, liver failure, and death relative to anti-CD20 Ab administration and follow-up were also compared by HBV disease group.
RESULTS: Among 19304 VHA patients who received anti-CD20 Ab, 10224 (53%) had pretreatment HBsAg testing during the study period, with 49% and 43% tested for HBsAg and HBcAb, respectively within 6 mo pretreatment in 2014. Of those tested, 2% (167/10224) had chronic HBV, 4% (326/7903) past HBV, 5% (427/8110) resolved HBV, 8% (628/8110) likely prior HBV vaccination, and 76% (6022/7903) were HBV negative. In those with chronic HBV infection, ≤ 37% received HBV antiviral treatment during the high risk period while 21% to 23% of those with past or resolved HBV, respectively, received HBV antiviral treatment. During and 12 mo after anti-CD20 Ab, the rate of hepatitis was significantly greater in those HBV positive vs negative (P = 0.001). The mortality rate was 35%-40% in chronic or past hepatitis B and 26%-31% in hepatitis B negative. In those pretreatment HBV negative, 16 (0.3%) developed acute hepatitis B of 4947 tested during anti-CD20Ab treatment and follow-up.
CONCLUSION: While HBV testing of Veterans has increased prior to anti-CD20 Ab, few HBV+ patients received HBV antivirals, suggesting electronic health record algorithms may enhance health outcomes.
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Sherer EA, Fisher DA, Barnd J, Jackson GL, Provenzale D, Haggstrom DA. The accuracy and completeness for receipt of colorectal cancer care using Veterans Health Administration administrative data. BMC Health Serv Res 2016; 16:50. [PMID: 26869265 PMCID: PMC4751682 DOI: 10.1186/s12913-016-1294-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 02/05/2016] [Indexed: 12/02/2022] Open
Abstract
Background The National Comprehensive Cancer Network and the American Society of Clinical Oncology have established guidelines for the treatment and surveillance of colorectal cancer (CRC), respectively. Considering these guidelines, an accurate and efficient method is needed to measure receipt of care. Methods The accuracy and completeness of Veterans Health Administration (VA) administrative data were assessed by comparing them with data manually abstracted during the Colorectal Cancer Care Collaborative (C4) quality improvement initiative for 618 patients with stage I-III CRC. Results The VA administrative data contained gender, marital, and birth information for all patients but race information was missing for 62.1 % of patients. The percent agreement for demographic variables ranged from 98.1–100 %. The kappa statistic for receipt of treatments ranged from 0.21 to 0.60 and there was a 96.9 % agreement for the date of surgical resection. The percentage of post-diagnosis surveillance events in C4 also in VA administrative data were 76.0 % for colonoscopy, 84.6 % for physician visit, and 26.3 % for carcinoembryonic antigen (CEA) test. Conclusions VA administrative data are accurate and complete for non-race demographic variables, receipt of CRC treatment, colonoscopy, and physician visits; but alternative data sources may be necessary to capture patient race and receipt of CEA tests.
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Affiliation(s)
- Eric A Sherer
- Department of Chemical Engineering, Louisiana Tech University, Ruston, LA, USA. .,Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA.
| | - Deborah A Fisher
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Jeffrey Barnd
- Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA
| | - George L Jackson
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Dawn Provenzale
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Duke Cancer Institute, Durham, NC, USA
| | - David A Haggstrom
- Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, IN, USA.,Indiana University Cancer Center, Indianapolis, IN, USA
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Samadder NJ, Curtin K, Pappas L, Boucher K, Mineau GP, Smith K, Fraser A, Wan Y, Provenzale D, Kinney AY, Ulrich C, Burt RW. Risk of Incident Colorectal Cancer and Death After Colonoscopy: A Population-based Study in Utah. Clin Gastroenterol Hepatol 2016; 14:279-86.e1-2. [PMID: 26343183 PMCID: PMC7416738 DOI: 10.1016/j.cgh.2015.08.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 02/10/2015] [Revised: 08/24/2015] [Accepted: 08/27/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Colonoscopy is widely recommended for colorectal (CRC) screening in the United States, but evidence of effectiveness is limited. We examined whether exposure to colonoscopy decreases the odds of incident CRC and death from CRC in Utah. METHODS We performed a case-control study of Utah residents, 54 to 90 years old, who received a CRC diagnosis from 2000 through 2010 (cases). Age- and sex-matched controls with no history of CRC (controls) were selected for each case. We determined receipt of colonoscopy 6 months to 10 years before the reference date for each case and control through administrative claims data. Colonoscopy exposure was compared by using conditional logistic regression. RESULTS We identified 5128 cases and 20,512 controls; 741 cases (14%) and 5715 controls (28%) received a colonoscopy. Exposure to colonoscopy reduced the odds for a diagnosis of CRC; the odds ratios (ORs) were 0.41 for any CRC (95% confidence interval [CI], 0.38-0.44), 0.58 for proximal colon cancer (95% CI, 0.51-0.65), and 0.29 for distal colon or rectal cancer (95% CI, 0.25-0.33). This finding was consistent among sexes, age groups, and cancer stages. Similarly, in a subgroup analysis, colonoscopy was associated with decreased odds of death from CRC (OR, 0.33; 95% CI, 0.28-0.39) in both the proximal colon (OR, 0.43; 95% CI, 0.34-0.55) and distal colon or rectum (OR, 0.23; 95% CI, 0.18-0.30). CONCLUSIONS In the population of Utah, colonoscopy is associated with a large reduction in risk of new-onset CRC and death from CRC. This reduction in risk for CRC was greatest for the distal colon and rectum, with a more modest reduction for proximal colon cancer.
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Affiliation(s)
- N. Jewel Samadder
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT,Medicine (Gastroenterology), University of Utah, Salt Lake City, UT
| | - Karen Curtin
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT,Medicine (Genetic Epidemiology), University of Utah, Salt Lake City, UT,Utah Population Database all at University of Utah, Salt Lake City, UT
| | - Lisa Pappas
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Ken Boucher
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT,Population Sciences, University of Utah, Salt Lake City, UT
| | - Geraldine P. Mineau
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT,Departments of Oncological Sciences, University of Utah, Salt Lake City, UT,Utah Population Database all at University of Utah, Salt Lake City, UT
| | - Ken Smith
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT,Departments of Oncological Sciences, University of Utah, Salt Lake City, UT,Family and Consumer Studies, University of Utah, Salt Lake City, UT,Utah Population Database all at University of Utah, Salt Lake City, UT
| | - Alison Fraser
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT,Utah Population Database all at University of Utah, Salt Lake City, UT
| | - Yuan Wan
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT,Utah Population Database all at University of Utah, Salt Lake City, UT
| | - Dawn Provenzale
- Durham Epidemiologic Research and Information Center (ERIC), Durham VAMC, Durham, NC, Department of Medicine (Gastroenterology), Duke University, Durham, NC, USA
| | - Anita Y. Kinney
- Department of Medicine (Epidemiology) and Cancer Center, University of New Mexico, Albuquerque, NM, USA
| | - Cornelia Ulrich
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT,Population Sciences, University of Utah, Salt Lake City, UT,National Center for Tumor Disease, German Cancer Research Center, Heidelberg, Germany
| | - Randall W. Burt
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT,Departments of Oncological Sciences, University of Utah, Salt Lake City, UT,Medicine (Gastroenterology), University of Utah, Salt Lake City, UT
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Johnson MR, Grubber J, Grambow SC, Maciejewski ML, Dunn-Thomas T, Provenzale D, Fisher DA. Physician Non-adherence to Colonoscopy Interval Guidelines in the Veterans Affairs Healthcare System. Gastroenterology 2015; 149:938-51. [PMID: 26122143 DOI: 10.1053/j.gastro.2015.06.026] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [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: 10/24/2014] [Revised: 06/17/2015] [Accepted: 06/19/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND & AIMS Colonoscopy can decrease colorectal cancer (CRC) mortality, although performing this procedure more frequently than recommended could increase costs and risks to patients. We aimed to determine rates and correlates of physician non-adherence to guidelines for repeat colonoscopy screening and polyp surveillance intervals. METHODS We performed a multi-center, retrospective, observational study using administrative claims, physician databases, and electronic medical records (EMR) from 1455 patients (50-64 y old) who underwent colonoscopy in the Veterans Affairs healthcare system in fiscal year 2008. Patients had no prior diagnosis of CRC or inflammatory bowel disease, and had not undergone colonoscopy examinations in the previous 10 years. We compared EMR-documented, endoscopist-recommended intervals for colonoscopies with intervals recommended by the 2008 Multi-Society Task Force guidelines. RESULTS The overall rate of non-adherence to guideline recommendations was 36% and ranged from 3% to 80% among facilities. Non-adherence was 28% for patients who underwent normal colonoscopies, but 45%-52% after colonoscopies that identified hyperplastic or adenomatous polyps. Most of all recommendations that were not followed recommended a shorter surveillance interval. In adjusted analyses, non-adherence was significantly higher for patients whose colonoscopies identified hyperplastic (odds ratio [OR] = 3.1; 95% CI, 1.7-5.5) or high-risk adenomatous polyps (OR = 3.0; 95% CI, 1.2-8.0), compared to patients with normal colonoscopy examinations, but not for patients with low-risk adenomatous polyps (OR = 1.8; 95% CI, 0.9-3.7). Nonadherence was also associated with bowel preparation quality, geographic region, Charlson comorbidity score, and colonoscopy indication. CONCLUSIONS In a managed care setting with salaried physicians, endoscopists recommend repeat colonoscopy sooner than guidelines for more than one third of patients. Factors associated with non-adherence to guideline recommendations were colonoscopy findings, quality of bowel preparation, and geographic region. Targeting endoscopist about non-adherence to colonoscopy guidelines could reduce overuse of colonoscopy and associated healthcare costs.
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Affiliation(s)
- Marcus R Johnson
- Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Medical Center, Durham, North Carolina; Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Janet Grubber
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Steven C Grambow
- Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Medical Center, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Matthew L Maciejewski
- Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Medical Center, Durham, North Carolina; Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Tyra Dunn-Thomas
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Dawn Provenzale
- Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Medical Center, Durham, North Carolina; Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina; Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Deborah A Fisher
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina; Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
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Jackson GL, Zullig LL, Phelan SM, Provenzale D, Griffin JM, Clauser SB, Haggstrom DA, Jindal RM, van Ryn M. Patient characteristics associated with the level of patient-reported care coordination among male patients with colorectal cancer in the Veterans Affairs health care system. Cancer 2015; 121:2207-13. [PMID: 25782082 DOI: 10.1002/cncr.29341] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 09/25/2014] [Revised: 12/12/2014] [Accepted: 01/06/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND The current study was performed to determine whether patient characteristics, including race/ethnicity, were associated with patient-reported care coordination for patients with colorectal cancer (CRC) who were treated in the Veterans Affairs (VA) health care system, with the goal of better understanding potential goals of quality improvement efforts aimed at improving coordination. METHODS The nationwide Cancer Care Assessment and Responsive Evaluation Studies survey involved VA patients with CRC who were diagnosed in 2008 (response rate, 67%). The survey included a 4-item scale of patient-reported frequency ("never," "sometimes," "usually," and "always") of care coordination activities (scale score range, 1-4). Among 913 patients with CRC who provided information regarding care coordination, demographics, and symptoms, multivariable logistic regression was used to examine odds of patients reporting optimal care coordination. RESULTS VA patients with CRC were found to report high levels of care coordination (mean scale score, 3.50 [standard deviation, 0.61]). Approximately 85% of patients reported a high level of coordination, including the 43% reporting optimal/highest-level coordination. There was no difference observed in the odds of reporting optimal coordination by race/ethnicity. Patients with early-stage disease (odds ratio [OR], 0.60; 95% confidence interval [95% CI], 0.45-0.81), greater pain (OR, 0.97 for a 1-point increase in pain scale; 95% CI, 0.96-0.99), and greater levels of depression (OR, 0.97 for a 1-point increase in depression scale; 95% CI, 0.96-0.99) were less likely to report optimal coordination. CONCLUSIONS Patients with CRC in the VA reported high levels of care coordination. Unlike what has been reported in settings outside the VA, there appears to be no racial/ethnic disparity in reported coordination. However, challenges remain in ensuring coordination of care for patients with less advanced disease and a high symptom burden. Cancer 2015;121:2207-2213. © 2015 American Cancer Society.
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Affiliation(s)
- George L Jackson
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina.,Division of General Internal Medicine, Duke University, Durham, North Carolina
| | - Leah L Zullig
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina.,Division of General Internal Medicine, Duke University, Durham, North Carolina
| | - Sean M Phelan
- Division of Health Care Policy & Research, Mayo Clinic, Rochester, Minnesota
| | - Dawn Provenzale
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina.,Division of Gastroenterology, Duke University, Durham, North Carolina
| | - Joan M Griffin
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | | | - David A Haggstrom
- Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana.,Division of General Internal Medicine and Geriatrics, Indiana University, Indianapolis, Indiana
| | - Rahul M Jindal
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Michelle van Ryn
- Division of Health Care Policy & Research, Mayo Clinic, Rochester, Minnesota
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Abstract
The present issue of Epidemiologic Reviews is dedicated to better understanding the health of men and women who have served in the military. There are 13 articles that discuss a range of physical and mental health concerns among both military personnel who are currently serving and those who served in the past. The corresponding research provides insight into issues that are directly relevant and of keen interest to clinicians and investigators. The articles illustrate some of the obstacles to conducting rigorous epidemiologic research when seeking to inform the health issues of those who serve in the military and of veterans. Within the United States, they point to opportunities for the Department of Defense and Department of Veterans Affairs (VA) to address existing gaps in knowledge. The VA in particular can take advantage of its research infrastructure, altruistic veteran population, and clinical and administrative databases. In the era of multinational military interventions, international counterparts of the Department of Defense and VA should collaborate in the collection of data on relevant military exposures and also in the characterization of short- and long-term health effects related to service to better inform health needs. The work included in this issue is a call to the global research community to continue to invest resources to better characterize military service and its impact on health. Finally, these articles serve as a testament to the additional health burden carried by many of the women and men who have provided service to their country.
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Zafar SY, McNeil RB, Thomas CM, Lathan CS, Ayanian JZ, Provenzale D. Population-based assessment of cancer survivors' financial burden and quality of life: a prospective cohort study. J Oncol Pract 2014; 11:145-50. [PMID: 25515717 DOI: 10.1200/jop.2014.001542] [Citation(s) in RCA: 231] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE The impact of financial burden among patients with cancer has not yet been measured in a way that accounts for inter-relationships between quality of life, perceived quality of care, disease status, and sociodemographic characteristics. PATIENTS AND METHODS In a national, prospective, observational, population- and health care systems-based cohort study, patients with colorectal or lung cancer were enrolled from 2003 to 2006 within 3 months of diagnosis. For this analysis, surviving patients who were either disease free or had advanced disease were resurveyed a median 7.3 years from diagnosis. Structural equation modeling was used to investigate relationships between financial burden, quality of life, perceived quality of care, and sociodemographic characteristics. RESULTS Among 1,000 participants enrolled from five geographic regions, five integrated health care systems, or 15 Veterans Administration Hospitals, 89% (n = 889) were cancer free, and 11% (n = 111) had advanced cancer. Overall, 48% (n = 482) reported difficulties living on their household income, and 41% (n = 396) believed their health care to be "excellent." High financial burden was associated with lower household income (adjusted odds ratio [OR] = 0.61 per $20k per year, P < .001) and younger age (adjusted OR = 0.63 per 10 years; P < .001). High financial burden was also associated with poorer quality of life (adjusted beta = -0.06 per burden category; P < .001). Better quality of life was associated with fewer perceptions of poorer quality of care (adjusted OR = 0.85 per 0.10 EuroQol units; P < .001). CONCLUSION Financial burden is prevalent among cancer survivors and is related to patients' health-related quality of life. Future studies should consider interventions to improve patient education and engagement with regard to financial burden.
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Affiliation(s)
- S Yousuf Zafar
- Duke Cancer Institute; Center for Learning Health Care, Duke Clinical Research Institute; Duke University Medical Center; Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Medical Center Durham, Durham, NC; Medical University of South Carolina, Charleston, SC; Harvard Medical School; Dana-Farber Cancer Institute; and Brigham and Women's Hospital, Boston, MA
| | - Rebecca B McNeil
- Duke Cancer Institute; Center for Learning Health Care, Duke Clinical Research Institute; Duke University Medical Center; Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Medical Center Durham, Durham, NC; Medical University of South Carolina, Charleston, SC; Harvard Medical School; Dana-Farber Cancer Institute; and Brigham and Women's Hospital, Boston, MA
| | - Catherine M Thomas
- Duke Cancer Institute; Center for Learning Health Care, Duke Clinical Research Institute; Duke University Medical Center; Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Medical Center Durham, Durham, NC; Medical University of South Carolina, Charleston, SC; Harvard Medical School; Dana-Farber Cancer Institute; and Brigham and Women's Hospital, Boston, MA
| | - Christopher S Lathan
- Duke Cancer Institute; Center for Learning Health Care, Duke Clinical Research Institute; Duke University Medical Center; Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Medical Center Durham, Durham, NC; Medical University of South Carolina, Charleston, SC; Harvard Medical School; Dana-Farber Cancer Institute; and Brigham and Women's Hospital, Boston, MA
| | - John Z Ayanian
- Duke Cancer Institute; Center for Learning Health Care, Duke Clinical Research Institute; Duke University Medical Center; Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Medical Center Durham, Durham, NC; Medical University of South Carolina, Charleston, SC; Harvard Medical School; Dana-Farber Cancer Institute; and Brigham and Women's Hospital, Boston, MA
| | - Dawn Provenzale
- Duke Cancer Institute; Center for Learning Health Care, Duke Clinical Research Institute; Duke University Medical Center; Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Medical Center Durham, Durham, NC; Medical University of South Carolina, Charleston, SC; Harvard Medical School; Dana-Farber Cancer Institute; and Brigham and Women's Hospital, Boston, MA
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