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Eaglehouse YL, Darmon S, Gage MM, Shriver CD, Zhu K. Characteristics Associated With Survival in Surgically Nonresected Pancreatic Adenocarcinoma in the Military Health System. Am J Clin Oncol 2024; 47:64-70. [PMID: 37851358 PMCID: PMC10805355 DOI: 10.1097/coc.0000000000001057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVES Pancreatic cancer is often diagnosed at advanced stages with high-case fatality. Many tumors are not surgically resectable. We aimed to identify features associated with survival in patients with surgically nonresected pancreatic cancer in the Military Health System. METHODS We used the Military Cancer Epidemiology database to identify the Department of Defense beneficiaries aged 18 and older diagnosed with a primary pancreatic adenocarcinoma between January 1998 and December 2014 who did not receive oncologic surgery as treatment. We used Cox Proportional Hazard regression with stepwise procedures to select the sociodemographic and clinical characteristics related to 2-year overall survival, expressed as adjusted hazard ratios (aHR) and 95% CIs. RESULTS Among 1148 patients with surgically nonresected pancreatic cancer, sex, race-ethnicity, marital status, and socioeconomic indicators were not selected in association with survival. A higher comorbidity count (aHR 1.30, 95% CI: 1.06-1.59 for 5 vs. 0), jaundice at diagnosis (aHR 1.57, 95% CI: 1.33-1.85 vs. no), tumor grade G3 or G4 (aHR 1.32, 95% CI: 1.05-1.67 vs. G1/G2), tumor location in pancreas tail (aHR 1.49, 95% CI: 1.22-1.83 vs. head) or body (aHR 1.30, 95% CI: 1.04-1.62 vs. head), and metastases were associated with survival. Patients receiving chemotherapy (aHR 0.66, 95% CI: 0.57-0.76) had better survival compared with no treatment. CONCLUSIONS In a comprehensive health system, sociodemographic characteristics were not related to survival in surgically nonresected pancreatic cancer. This implicates access to care in reducing survival disparities in advanced pancreatic cancer and emphasizes the importance of treating patients based on clinical features.
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Affiliation(s)
- Yvonne L. Eaglehouse
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc
| | - Sarah Darmon
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc
| | - Michele M. Gage
- Departments of Surgery
- Division of Surgical Oncology, Walter Reed National Military Medical Center, Bethesda, MD
| | - Craig D. Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences
- Departments of Surgery
| | - Kangmin Zhu
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc
- Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences
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Eaglehouse YL, Darmon S, Park AB, Shriver CD, Zhu K. Treatment of pancreatic adenocarcinoma in relation to survival in the U.S. Military Health System. Cancer Epidemiol 2024; 88:102520. [PMID: 38184935 DOI: 10.1016/j.canep.2023.102520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Pancreatic cancer has a high case fatality and relatively short survival after diagnosis. Treatment is paramount to improving survival, but studies on the effects of standard treatment by surgery or chemotherapy on survival in U.S. healthcare settings is limited. Further, variability in access to care may impact treatment and outcomes for patients. We aimed to assess the relationship between standard treatment(s) and survival of pancreatic adenocarcinoma in a population with access to comprehensive healthcare. METHODS We used the Military Cancer Epidemiology (MilCanEpi) database, which includes data from the Department of Defense cancer registry and medical encounter data from the Military Health System (MHS), to study a cohort of 1408 men and women who were diagnosed with pancreatic adenocarcinoma between 1998 and 2014. Treatment with surgery or chemotherapy in relation to overall survival was examined in multivariable time-dependent Cox regression models. RESULTS Overall, 75 % of 441 patients with early-stage and 51 % of 967 patients with late-stage pancreatic adenocarcinoma received treatment. In early-stage disease, surgery alone or surgery with chemotherapy were both associated with statistically significant 52 % reduced risks of death, but chemotherapy alone was not. In late-stage disease, surgery alone, chemotherapy alone, or both surgery and chemotherapy significantly reduced the risk of death by 42 %, 25 %, and 52 %, respectively. CONCLUSIONS Our findings from the MHS demonstrate improved survival after treatment with surgery or surgery with chemotherapy for early- or late-stage pancreatic cancer and after chemotherapy for late-stage pancreatic cancer. In the era of immunotherapy and personalized medicine, further research on treatment and survival of pancreatic cancer in observational settings is needed.
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Affiliation(s)
- Yvonne L Eaglehouse
- Murtha Cancer Center Research Program, Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 310, Bethesda, MD 20817, USA.
| | - Sarah Darmon
- Murtha Cancer Center Research Program, Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 310, Bethesda, MD 20817, USA
| | - Amie B Park
- Murtha Cancer Center Research Program, Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 310, Bethesda, MD 20817, USA
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Department of Surgery, Walter Reed National Military Medical Center, 4494 Palmer Road North, Bethesda, MD 20814, USA
| | - Kangmin Zhu
- Murtha Cancer Center Research Program, Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 310, Bethesda, MD 20817, USA; Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
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Eaglehouse YL, Seabury SA, Aljehani M, Koehlmoos T, Lee JSH, Shriver CD, Zhu K. Chemotherapy Treatment Costs and Clinical Outcomes of Colon Cancer in the U.S. Military Health System's Direct and Private Sector Care Settings. Mil Med 2023; 188:e3439-e3446. [PMID: 37167011 DOI: 10.1093/milmed/usad132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/04/2023] [Accepted: 04/20/2023] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION Identifying low-value cancer care may be an important step in containing costs associated with treatment. Low-value care occurs when the medical services, tests, or treatments rendered do not result in clinical benefit. These may be impacted by care setting and patients' access to care and health insurance. We aimed to study chemotherapy treatment and the cost paid by the Department of Defense (DoD) for treatment in relation to clinical outcomes among patients with colon cancer treated within the U.S. Military Health System's direct and private sector care settings to better understand the value of cancer care. MATERIALS AND METHODS A cohort of patients aged 18 to 64 years with primary colon cancer diagnosed between January 1, 1999, and December 31, 2014, were identified in the Military Cancer Epidemiology database. Multivariable time-dependent Cox proportional hazards regression models were used to assess the relationship between chemotherapy treatment and the cost paid by the DoD (in quartiles, Q) and the outcomes of cancer progression, cancer recurrence, and all-cause death modeled as adjusted hazard ratios (aHRs) and 95% confidence intervals (95% CIs). The Military Cancer Epidemiology data were approved for research by the Uniformed Services University of the Health Sciences' Institutional Review Board. RESULTS The study included 673 patients using direct care and 431 patients using private sector care. The median per patient chemotherapy costs in direct care ($111,202) were lower than in private sector care ($350,283). In direct care, higher chemotherapy costs were associated with an increased risk of any outcome but not with all-cause death. In private sector care, higher chemotherapy costs were associated with a higher risk of any outcome and with all-cause death (aHR, 2.67; 95% CI, 1.20-5.92 for Q4 vs. Q1). CONCLUSIONS The findings in the private sector may indicate low-value care in terms of the cost paid by the DoD for chemotherapy treatment and achieving desirable survival outcomes for patients with colon cancer in civilian health care. Comprehensive evaluations of value-based care among patients treated for other tumor types may be warranted.
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Affiliation(s)
- Yvonne L Eaglehouse
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20817, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Seth A Seabury
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA 90089, USA
| | - Mayada Aljehani
- Lawrence J. Ellison Institute for Transformative Medicine, Los Angeles, CA 90064, USA
| | - Tracey Koehlmoos
- Center for Health Services Research, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Jerry S H Lee
- Lawrence J. Ellison Institute for Transformative Medicine, Los Angeles, CA 90064, USA
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- Department of Chemical Engineering and Material Sciences, Viterbi School of Engineering, University of Southern California, Los Angeles, CA 90089, USA
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20817, USA
| | - Kangmin Zhu
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20817, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
- Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Eaglehouse YL, Shriver CD, Lin J, Bytnar JA, Darmon S, McGlynn KA, Zhu K. MilCanEpi: Increased Capability for Cancer Care Research in the Department of Defense. JCO Clin Cancer Inform 2023; 7:e2300035. [PMID: 37582239 PMCID: PMC10569781 DOI: 10.1200/cci.23.00035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/23/2023] [Accepted: 06/29/2023] [Indexed: 08/17/2023] Open
Abstract
The Military Health System (MHS) of the US Department of Defense (DoD) provides comprehensive medical care to over nine million beneficiaries, including active-duty members, reservists, activated National Guard, military retirees, and their family members. The MHS generates an extensive database containing administrative claims and medical encounter data, while the DoD also maintains a cancer registry that collects information about the occurrence of cancer among its beneficiaries who receive care at military treatment facilities. Collating data from the two sources diminishes the limitations of using registry or medical claims data alone for cancer research and extends their usage. To facilitate cancer research using the unique military health resources, a computer interface linking the two databases has been developed, called Military Cancer Epidemiology, or MilCanEpi. The intent of this article is to provide an overview of the MilCanEpi data system, describing its components, structure, potential uses, and limitations.
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Affiliation(s)
- Yvonne L. Eaglehouse
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Craig D. Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD
| | - Jie Lin
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
- Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Julie A. Bytnar
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Sarah Darmon
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Katherine A. McGlynn
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Kangmin Zhu
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
- Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
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Kramer MK, Agee SC, Miller RG, Arena VC, Vanderwood KK, Eaglehouse YL, Venditti EM, Kriska AM. Translating the Diabetes Prevention Program Lifestyle Intervention to the Military Setting. Mil Med 2022; 188:1036-1045. [PMID: 35234887 DOI: 10.1093/milmed/usac037] [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] [Received: 10/09/2021] [Revised: 01/09/2022] [Accepted: 02/10/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Diabetes and obesity pose a significant burden for the U.S. military beneficiary population, creating a great need to provide evidence-based diabetes and obesity prevention services for military personnel, retirees, and their dependents. Despite increasing dissemination of the Diabetes Prevention Program (DPP) lifestyle intervention nationwide, formal evaluation of implementation of this highly successful program is limited in the military setting. The purpose of this study is to prospectively evaluate delivery of a direct adaptation of a 1-year DPP lifestyle intervention at a U.S. Air Force medical facility, Wright-Patterson Medical Center (WPMC), to determine the feasibility of delivery of the program in a group of at-risk active duty military, retirees, and family members, as well as assess effectiveness in improving weight and other risk factors for type 2 diabetes. MATERIALS AND METHODS A pre/post study design was utilized to evaluate feasibility and effectiveness of the DPP Group Lifestyle Balance (GLB), an up-to-date, 22-session direct adaptation of the DPP curriculum, at WPMC. Participants chose to complete the 1-year program either in coach-led face-to-face groups or via DVD with weekly telephonic coach contact. The study was approved by the University of Pittsburgh and WPMC Institutional Review Boards. RESULTS A total of 99 individuals enrolled in the study, with 83 (84%) and 77 (78%) completing 6- and 12-month follow-up assessments, respectively. The mean age of participants at baseline was 57 (range 20-85 years), with 63% being female. The group was comprised of individuals who were non-Hispanic White (73.7%), non-Hispanic Black (18.2%), and other race or Hispanic ethnicity (8.1%). Within this group, there were 10 active duty military, 37 retirees, and 52 family members. The DPP-GLB program was shown to be feasible to implement in this military healthcare setting as demonstrated by the high engagement over the course of the year-long program. Significant improvements were shown in the two main behavioral goals: mean weight (-12.8 lbs, -6.3%, P < .001) and mean physical activity (PA) (+18.9 Met-hrs/wk, P < .001). In addition, significant improvements in other diabetes and cardiovascular risk factors including low-density lipoprotein cholesterol, fasting insulin, diastolic blood pressure, and waist circumference were noted, as well as improvement in health-related quality of life. CONCLUSIONS These results demonstrate that the DPP-GLB program delivered via face-to-face groups or DVD was feasible and effective in improving weight, PA levels, and diabetes and cardiovascular risk factors in this group of active and retired military personnel and their family members. The program was well received by the program participants as well as the WPMC team. These findings offer a model for provision of the DPP-GLB program throughout the Military Health System.
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Affiliation(s)
- M Kaye Kramer
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15261, USA.,PeopleOne Health, Oakmont, PA 15139, USA
| | - Susan C Agee
- Wright Patterson Medical Center, Wright-Patterson AFB, OH 45433, USA
| | - Rachel G Miller
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15261, USA
| | - Vincent C Arena
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15261, USA
| | | | - Yvonne L Eaglehouse
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15261, USA.,Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
| | - Elizabeth M Venditti
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Andrea M Kriska
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15261, USA
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Bytnar JA, Lin J, Eaglehouse YL, Enewold L, Shriver CD, Zhu K. Brain cancer incidence: a comparison of active-duty military and general populations. Eur J Cancer Prev 2021; 30:328-333. [PMID: 32898014 DOI: 10.1097/cej.0000000000000625] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the USA, brain cancer disproportionately affects young adults. The US military has a younger age structure than the general population and may have differential exposures related to brain cancer. This study aimed to compare the incidence rates of brain cancer in the active-duty military and general populations to provide clues for future etiologic research. The rates between military service branches were also compared. METHODS The data for this study were from the Department of Defense's Automated Central Tumor Registry (ACTUR) and the National Cancer Institute's Surveillance, Epidemiology, and End Results 9 (SEER-9) registries. Age- and sex-adjusted incidence rates of malignant neuroepithelial brain cancer among adults 20-54 years of age from 1990-2013 were calculated and compared between the two populations, given as incidence rate ratios (IRRs) with 95% confidence intervals (CIs). RESULTS The age and sex-adjusted incidence rate for malignant neuroepithelial brain cancer was significantly lower in the active-duty population than in the US general population (IRR = 0.62, 95% CI, 0.56-0.68). The reduced incidence rate in the active-duty population was observed in men, all races, individuals 20-44 of age, and for all histological subtypes and time periods assessed. There were no significant differences in rates between the military service branches. CONCLUSION The incidence rates of neuroepithelial brain cancer were lower in the active-duty military population than the US general population. This study highlights the need for more research to enhance our understanding of variations in brain cancer incidence between these two populations.
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Affiliation(s)
- Julie A Bytnar
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockledge Drive
| | - Jie Lin
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockledge Drive
- Department of Surgery, Uniformed Services University of the Health Sciences
| | - Yvonne L Eaglehouse
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockledge Drive
- Department of Surgery, Uniformed Services University of the Health Sciences
| | - Lindsey Enewold
- Division of Cancer Control and Population Sciences, National Cancer Institute, Medical Center Drive
| | - Craig D Shriver
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda
- Department of Surgery, Uniformed Services University of the Health Sciences
| | - Kangmin Zhu
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockledge Drive
- Department of Surgery, Uniformed Services University of the Health Sciences
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Eaglehouse YL, Park AB, Georg MW, Brown DW, Lin J, Shao S, Bytnar JA, Shriver CD, Zhu K. Consolidation of Cancer Registry and Administrative Claims Data on Cancer Diagnosis and Treatment in the US Military Health System. JCO Clin Cancer Inform 2020; 4:906-917. [PMID: 33074744 DOI: 10.1200/cci.20.00043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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
PURPOSE Linked cancer registry and medical claims data have increased the capacity for cancer research. However, few efforts have described methods to select information between data sources, which may affect data use. We developed a systematic process to evaluate and consolidate cancer diagnosis and treatment information between the linked Department of Defense Central Cancer Registry (CCR) and Military Health System Data Repository (MDR) administrative claims database, called Military Cancer Epidemiology Data System (MilCanEpi). METHODS MilCanEpi contains information on cancer diagnosis and treatment of patients receiving care from 1998 to 2014. We used an iterative process guided by knowledge of data features, current literature, and logical comparisons between the CCR and MDR data to evaluate and consolidate cancer diagnosis and treatment received (yes or no) and their dates. We applied the processes to breast cancer data as an example. Agreement between diagnosis and treatment dates in the two data sources was evaluated using Cohen's κ with 95% CIs. RESULTS In MilCanEpi, we identified 15,965 patients with a breast cancer diagnosis and 15,145 patients who underwent breast cancer surgery; 97.9% and 84.1% of patients had records in both CCR and MDR for diagnosis and surgery, respectively. Exact agreement was 13.7% for diagnosis dates (Cohen's κ = 0.14; 95% CI, 0.13 to 0.14) and 68.9% for surgery dates (Cohen's κ = 0.69; 95% CI, 0.68 to 0.70) between the two data sources. After applying systematic processes, 98.1% of patients with a breast cancer diagnosis and 99.7% of patients with surgery had information selected for analytic data sets. CONCLUSION The developed processes resulted in high consolidation rates of breast cancer data in MilCanEpi and may serve as a data selection template for other tumor sites and linked data sources.
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Affiliation(s)
- Yvonne L Eaglehouse
- Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Amie B Park
- Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Matthew W Georg
- Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Derek W Brown
- Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD.,Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Jie Lin
- Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Stephanie Shao
- Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD.,General Dynamics Information Technology Federal Health, Rockville, MD
| | - Julie A Bytnar
- Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Craig D Shriver
- Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD.,Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Kangmin Zhu
- Murtha Cancer Center/Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD.,Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
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Eaglehouse YL, Georg MW, Shriver CD, Zhu K. Racial Comparisons in Timeliness of Colon Cancer Treatment in an Equal-Access Health System. J Natl Cancer Inst 2020; 112:410-417. [PMID: 31271431 DOI: 10.1093/jnci/djz135] [Citation(s) in RCA: 13] [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] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 05/14/2019] [Accepted: 07/03/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Non-Hispanic black (NHB) adults with cancer may have longer time-to-treatment than non-Hispanic whites (NHW) in the United States. Unequal access to medical care may partially account for this racial disparity. This study aimed to investigate whether there were racial differences in time-to-treatment and in treatment delays for patients diagnosed with colon cancer in the equal-access Military Health System (MHS). METHODS Patients age 18-79 years diagnosed with colon adenocarcinoma between January 1, 1998, and December 31, 2014, were identified in the Department of Defense Central Cancer Registry and the MHS Data Repository-linked databases. Median time-to-treatment (surgery and chemotherapy) and 95% confidence intervals were compared between NHBs and NHWs in multivariable quantile regression models. Odds ratios and 95% confidence intervals of receiving delayed treatment defined by guidelines for NHBs relative to NHWs were estimated using multivariable logistic regression. RESULTS Patients (n = 3067) had a mean age at diagnosis of 58.4 (12.2) years and the racial distribution was 76.7% NHW and 23.3% NHB. Median adjusted time-to-treatment was similar for NHB compared to NHW patients. The likelihood of receiving delayed treatment was similar between NHB and NHW patients. CONCLUSIONS In the MHS, there was no evidence of treatment delays for NHBs compared to NHWs, suggesting the role of equal access to medical care and insurance coverage in reducing racial disparities in colon cancer treatment.
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Affiliation(s)
- Yvonne L Eaglehouse
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda.,Department of Surgery, Bethesda, MD.,F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda
| | - Matthew W Georg
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda.,F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda.,Department of Surgery, Bethesda, MD
| | - Kangmin Zhu
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda.,Department of Preventive Medicine and Biostatistics, Bethesda.,F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda
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Eaglehouse YL, Georg MW, Richard P, Shriver CD, Zhu K. Cost-Efficiency of Breast Cancer Care in the US Military Health System: An Economic Evaluation in Direct and Purchased Care. Mil Med 2020; 184:e494-e501. [PMID: 30839064 DOI: 10.1093/milmed/usz025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/07/2018] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION With the rising costs of cancer care, it is critical to evaluate the overall cost-efficiency of care in real-world settings. In the United States, breast cancer accounts for the largest portion of cancer care spending due to high incidence and prevalence. The purpose of this study is to assess the relationship between breast cancer costs in the first 6 months after diagnosis and clinical outcomes by care source (direct or purchased) in the universal-access US Military Health System (MHS). MATERIALS AND METHODS We conducted a retrospective analysis of data from the Department of Defense Central Cancer Registry and MHS Data Repository administrative records. The institutional review boards of the Walter Reed National Military Medical Center and the Defense Health Agency reviewed and approved the data linkage. We used the linked data to identify women aged 40-64 who were diagnosed with pathologically-confirmed breast cancer between 2003 and 2007 with at least 1 year of follow-up through December 31, 2008. We identified cancer treatment from administrative data using relevant medical procedure and billing codes and extracted costs paid by the MHS for each claim. Multivariable Cox proportional hazards models estimated hazards ratios (HR) and 95% confidence intervals (CI) for recurrence or all-cause death as a function of breast cancer cost in tertiles. RESULTS The median cost per patient (n = 2,490) for cancer care was $16,741 (interquartile range $9,268, $28,742) in the first 6 months after diagnosis. In direct care, women in the highest cost tertile had a lower risk for clinical outcomes compared to women in the lowest cost tertile (HR 0.58, 95% CI 0.35, 0.96). When outcomes were evaluated separately, there was a statistically significant inverse association between higher cost and risk of death (p-trend = 0.025) for women receiving direct care. These associations were not observed among women using purchased care or both care sources. CONCLUSIONS In the MHS, higher breast cancer costs in the first 6 months after diagnosis were associated with lower risk for clinical outcomes in direct care, but not in purchased care. Organizational, institutional, and provider-level factors may contribute to the observed differences by care source. Replication of our findings in breast and other tumor sites may have implications for informing cancer care financing and value-based reimbursement policy.
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Affiliation(s)
- Yvonne L Eaglehouse
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Suite 1120, Rockville, MD.,Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
| | - Matthew W Georg
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Suite 1120, Rockville, MD
| | - Patrick Richard
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Suite 1120, Rockville, MD.,Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
| | - Kangmin Zhu
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Suite 1120, Rockville, MD.,Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
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10
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Eaglehouse YL, Georg MW, Richard P, Shriver CD, Zhu K. Costs for Colon Cancer Treatment Comparing Benefit Types and Care Sources in the US Military Health System. Mil Med 2020; 184:e847-e855. [PMID: 30941433 DOI: 10.1093/milmed/usz065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/13/2019] [Accepted: 03/11/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Cancer is one of the leading causes of morbidity and mortality in the USA, contributing largely to US healthcare spending. Provision of services (direct or purchased) and insurance benefit type may impact cost for cancer care. As a common cause of cancer in both men and women, we aim to compare colon cancer treatment costs between insurance benefit types and care sources in the US Military Health System (MHS) to better understand whether and to what extent these system factors impact cancer care costs. MATERIALS AND METHODS Department of Defense Central Cancer Registry records and MHS Data Repository administrative claims were used to identify MHS beneficiaries aged 18-64 who were diagnosed with primary colon adenocarcinoma and received treatment between 2003 and 2008. The data linkage was approved by the Institutional Review Boards of the Walter Reed National Military Medical Center, the Defense Health Agency, and the National Institutes of Health. Costs to the MHS for each claim related to cancer treatment were extracted from the linked data and adjusted to 2008 USD. We used quantile regression models to compare median cancer treatment costs between benefit types and care sources (direct, purchased, or both), adjusted for demographic, tumor, and treatment characteristics. RESULTS The median per capita (n = 801) costs for colon cancer care were $60,321 (interquartile range $24,625, $159,729) over a median follow-up of 1.7 years. The model-estimated treatment costs were similar between benefit types. Patients using direct care had significantly lower estimated median costs [$34,145 (standard error $4,326)] than patients using purchased care [$106,395 ($10,559)] or both care sources [$82,439 ($13,330)], controlled for patient demographic, tumor, and treatment characteristics. Differences in cost by care source were noted for patients with later stage tumors and by treatment type. Relative costs were 2-3 times higher for purchased care compared to direct care for patients with late-stage tumors and for patients receiving chemotherapy or radiation treatment. CONCLUSIONS In the MHS, median cost for colon cancer treatment was lower in direct care compared to purchased care or patients using a combination of direct and purchased care. The variation in cancer treatment costs between care sources may be due to differences in treatment incentives or capabilities. Additional studies on cost differences between direct and purchased services are needed to understand how provision of care affects cancer treatment costs and to identify possible targets for cost reduction.
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Affiliation(s)
- Yvonne L Eaglehouse
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Suite 1120, Rockville, MD 20852.,Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Matthew W Georg
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Suite 1120, Rockville, MD 20852
| | - Patrick Richard
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Suite 1120, Rockville, MD 20852.,Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Kangmin Zhu
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Suite 1120, Rockville, MD 20852.,Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
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11
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Eaglehouse YL, Georg MW, Jatoi I, Shriver CD, Zhu K. Factors related to re-excision procedures following primary breast-conserving surgery for women with breast cancer in the U.S. Military Health System. J Surg Oncol 2020; 121:200-209. [PMID: 31784990 DOI: 10.1002/jso.25788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/17/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND OBJECTIVES Re-excision surgery is undertaken to obtain clear margins after breast-conserving surgery (BCS) for localized breast cancer. This study examines patient and tumor characteristics related to re-excision surgery in the universal-access Military Health System (MHS). METHODS Retrospective analysis of patients with pathologically confirmed stage I-III breast cancer between 1998 and 2014 in the Department of Defense Central Cancer Registry and MHS Data Repository-linked databases who received primary BCS. Multivariable stepwise logistic regression methods identified characteristics associated with re-excision surgery (lumpectomy and mastectomy) and conversion to mastectomy, given as adjusted odds ratios (AOR) and 95% confidence intervals (CIs). RESULTS Of 7637 women receiving BCS, 26.3% had a re-excision and 9.9% converted to mastectomy. Tumor location, larger tumor size (≥4 cm), and regional lymph node involvement were associated with a greater likelihood of re-excision and mastectomy conversion. Pathology before BCS (AOR, 0.39; 95% CI, 0.35, 0.44 for re-excision) and neoadjuvant treatment (AOR, 0.50; 95% CI, 0.36, 0.69 for re-excision) were associated with a decreased likelihood of these outcomes. Additionally, age, tumor histology, and military-specific variables were associated with mastectomy conversion. CONCLUSION Comprehensive preoperative workup, including tumor pathology, may better inform surgical decision-making and reduce re-excision rates.
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Affiliation(s)
- Yvonne L Eaglehouse
- Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Matthew W Georg
- Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Ismail Jatoi
- Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Kangmin Zhu
- Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland.,Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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12
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Lovejoy LA, Eaglehouse YL, Hueman MT, Mostoller BJ, Shriver CD, Ellsworth RE. Evaluation of Surgical Disparities Between African American and European American Women Treated for Breast Cancer Within an Equal-Access Military Hospital. Ann Surg Oncol 2019; 26:3838-3845. [PMID: 31410609 DOI: 10.1245/s10434-019-07706-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Survival disparities between African American women (AAW) and European American women (EAW) with invasive breast cancer may be attributable, in part, to access to or quality of medical care. In this study, we evaluated surgical disparities between AAW and EAW treated within an equal-access military treatment facility (MTF). METHODS All AAW (N = 271) and EAW (N = 628) with Stage I-III breast cancer who had their initial diagnosis performed at Murtha Cancer Center at Walter Reed National Military Medical Center were identified. Differences in surgical interval (time between diagnosis and definitive breast surgery) and surgical procedures were evaluated using χ2 and Student t-tests while survival was analyzed using Kaplan-Meier survival estimates and log-rank tests. A P value < 0.05 was used to define significance. RESULTS Surgical intervals did not differ significantly between populations with an average of 36.3 days in AAW and 33.9 days in EAW. Frequency of the percentage of women undergoing reexcision, mastectomy, and prophylactic removal of the contralateral breast did not differ significantly between populations. Likewise, frequency of sentinel lymph node biopsy and 5-year survival were not significantly different between AAW compared to EAW. DISCUSSION Surgical intervals and procedures were similar between AAW and EAW treated within an equal-access MTF. These data demonstrate that the availability of quality surgical care to all patients with stage I-III breast cancer may eliminate survival disparities between AAW and EAW, emphasizing the importance of equalizing access to breast care.
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Affiliation(s)
- Leann A Lovejoy
- Chan Soon-Shiong Institute of Molecular Medicine, Windber, PA, USA
| | - Yvonne L Eaglehouse
- Clinical Breast Care Project, Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, and Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Matthew T Hueman
- Clinical Breast Care Project, Murtha Cancer Center Research Program, Uniformed Services University and Walter Reed National Military Medical Center, Bethesda, MD, USA
| | | | - Craig D Shriver
- Clinical Breast Care Project, Murtha Cancer Center Research Program, Uniformed Services University and Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Rachel E Ellsworth
- Clinical Breast Care Project, Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, and Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA. .,Clinical Breast Care Project, Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, and Henry M. Jackson Foundation for the Advancement of Military Medicine, Windber, PA, USA.
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13
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Eaglehouse YL, Aljehani M, Georg MW, Castellanos O, Lee JSH, Seabury SA, Shriver CD, Zhu K. Contribution Of Care Source To Cancer Treatment Cost Variation In The US Military Health System. Health Aff (Millwood) 2019; 38:1335-1342. [PMID: 31381409 DOI: 10.1377/hlthaff.2019.00283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The US Military Health System (MHS) provides universal access to health care for more than nine million eligible beneficiaries through direct care in military treatment facilities or purchased care in civilian facilities. Using information from linked cancer registry and administrative databases, we examined how care source contributed to cancer treatment cost variation in the MHS for patients ages 18-64 who were diagnosed with colon, female breast, or prostate cancer in the period 2003-14. After accounting for patient, tumor, and treatment characteristics, we found the independent contribution of care source to total variation in cost to be 8 percent, 12 percent, and 2 percent for colon, breast, and prostate cancer treatment, respectively. About 20-50 percent of the total cost variance remained unexplained and may be related to organizational and administrative factors.
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Affiliation(s)
- Yvonne L Eaglehouse
- Yvonne L. Eaglehouse is a health services researcher in the Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences (USUHS); is an assistant professor in the Department of Surgery at USUHS; and is employed by the Henry M. Jackson Foundation for the Advancement of Military Medicine, all in Bethesda, Maryland
| | - Mayada Aljehani
- Mayada Aljehani is a biostatistician in the Lawrence J. Ellison Institute for Transformative Medicine, University of Southern California (USC), in Los Angeles
| | - Matthew W Georg
- Matthew W. Georg is a research associate in the Murtha Cancer Center Research Program, Department of Surgery, USUHS; and is employed by the Henry M. Jackson Foundation for the Advancement of Military Medicine
| | - Olga Castellanos
- Olga Castellanos is a clinical research program manager in the Lawrence J. Ellison Institute for Transformative Medicine, USC
| | - Jerry S H Lee
- Jerry S. H. Lee is the chief science and innovation officer in the Lawrence J. Ellison Institute for Transformative Medicine, USC; is an associate professor in the Departments of Clinical Medicine and Chemical Engineering, both at USC; and is employed by the Henry M. Jackson Foundation for the Advancement of Military Medicine
| | - Seth A Seabury
- Seth A. Seabury is the director of the Keck-Schaeffer Initiative for Population Health Policy at the Leonard D. Schaeffer Center for Health Policy and Economics and an associate professor in the Department of Pharmaceutical and Health Economics at the School of Pharmacy, both at USC
| | - Craig D Shriver
- Craig D. Shriver is the director of the Murtha Cancer Center Research Program, Department of Surgery, USUHS; director of the Murtha Cancer Center at Walter Reed National Military Medical Center; and a professor in the Department of Surgery at USUHS
| | - Kangmin Zhu
- Kangmin Zhu ( ) is the director of Military Epidemiology and Population Science in the Murtha Cancer Center Research Program, Department of Surgery, USUHS; is a professor in the Department of Preventive Medicine and Biostatistics at USUHS; and is employed by the Henry M. Jackson Foundation for the Advancement of Military Medicine
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14
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Wang LF, Eaglehouse YL, Poppenberg JT, Brufsky J, Geramita E, Zhai S, Davis K, Gibbs B, Metz J, Van Londen GJ. Effects of a personal trainer led exercise intervention on physical activity and physical function of breast cancer survivors. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e23053] [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
e23053 Background: Regular exercise is an important tool to address physical and emotional effects of breast cancer treatment. However, many breast cancer survivors do not meet minimum recommended levels of physical activity. This study examines effects of a personal trainer led exercise intervention on physical activity levels and physical function in breast cancer survivors. Methods: Women who completed active treatment for breast cancer were recruited from oncology clinics and survivorship programs from September 2015-to September 2017. Subjects were randomized to an immediate exercise or a wait-list control group. The intervention included 3 personal training sessions over a period of up to 30 weeks. Physical activity and function were assessed before and after intervention by pedometer (7-day record) and endurance step test (steps in 2 minutes). Results: 60 women were randomized to immediate intervention (n = 31) or wait-list control (n = 29). Subjects were an average of (mean ± SD) 56 ± 10 years old and 2 ± 1 years since breast cancer diagnosis. At baseline, the exercise group averaged (mean ± SD) 5236 ± 2214 steps/day and 101 ± 23 steps on 2-minute step test while the control group averaged 5856 ± 2916 steps/day and 106 ± 23 steps on 2-minute step test. After intervention, change (mean ∆ ± SD) was 143 ± 1842 steps/day in the exercise group and 79 ± 1862 steps/day in the control group ( p= 0.9). On the 2-minute step test, the exercise group increased 18 ± 20 steps and the control group increased 9 ± 12 steps ( p= 0.07). Conclusions: While there was some improvement in physical function after the personal-trainer led intervention, the short duration and intensity of the intervention may have diminished the effects. Our results suggest a multi-faceted approach may be needed to support significant changes in breast cancer survivors’ physical activity. Future efforts employing a multidisciplinary team, which includes a certified personal trainer, and with larger patient samples may help address this possibility. Clinical trial information: NCT02770781.
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Affiliation(s)
- Linda F. Wang
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | | | | | | | - Shuyan Zhai
- University of Pittsburgh Hillman Cancer Center, Pittsburgh, PA
| | - Kelliann Davis
- University of Pittsburgh School of Education, Pittsburgh, PA
| | - Bethany Gibbs
- University of Pittsburgh School of Education, Pittsburgh, PA
| | - Jason Metz
- West Liberty University, West Liberty, WV
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Eaglehouse YL, Georg MW, Shriver CD, Zhu K. Time to surgery and overall survival after breast cancer diagnosis in a universal health system. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e12063] [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
e12063 Background: It is unclear whether time between breast cancer diagnosis and surgical treatment is associated with survival. In the general U.S. population, timing of treatment and clinical outcomes may be related to access to care. We aimed to evaluate the relationship between time-to-surgery (TTS) and overall survival among women with a breast cancer diagnosis in the universal-access U.S. Military Health System (MHS). Methods: Women aged 18-64 who had a pathologic diagnosis of stages I-III breast cancer between 1998 and 2007 and who received breast cancer surgery during the primary course of treatment were identified in the Department of Defense’s Central Cancer Registry and MHS Data Repository linked databases containing records through December 31, 2008. The time in days between diagnosis and breast cancer surgery was calculated as TTS. Cox regression models were used to estimate hazards ratios (HR) and 95% confidence intervals (CIs) of all-cause death associated with TTS intervals of 0 days (diagnosis and surgery on the same day), 1-21 days (≤3 weeks), 22-35 days ( > 3-5 weeks), and 36 days or more ( > 5 weeks), controlling for potential confounders. Results: Women (n = 6,033) had a mean age of 50.1 (SD 9.3) years at diagnosis and an average follow-up of 3.8 (SD 2.1) years. The multivariable HRs (95% CIs) of all-cause death associated with TTS intervals were 1.26 (0.97, 1.63) for 0 days, 1.22 (0.94, 1.57) for 22-35 days, and 1.55 (1.18, 2.03) for ≥36 days compared to 1-21 days as the reference. The higher risk of mortality for TTS ≥36 days was observed among patient subgroups stratified by surgery type, age at diagnosis, and tumor stage. It was also shown that women with same-day surgery (TTS 0 days) had a significantly higher risk of all-cause mortality compared to the reference group among those age 18-49 at diagnosis (HR 1.52, 95% CI 1.03, 2.26). Conclusions: In the MHS, we found that longer TTS is associated with poorer overall survival after breast cancer while same-day surgery may also have a higher risk of mortality in some patient groups. Our findings suggest the importance of timeliness in receiving surgical treatment and the need for future research on factors related to TTS and its potential effects on clinical outcomes.
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Affiliation(s)
- Yvonne L Eaglehouse
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
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16
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Eaglehouse YL, Georg MW, Shriver CD, Zhu K. Racial comparisons in receipt of timely guideline-based colon cancer treatment in an equal-access health system. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.6563] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6563 Background: Non-Hispanic Black (NHB) adults with colon cancer may have longer time-to-treatment and be less likely to receive guideline-based therapy than Whites (NHW) in the U.S. This may be largely related to racial differences in access to care and insurance coverage. This study aimed to determine whether there were racial differences in receipt of timely guideline-based colon cancer treatment in the equal-access Military Health System (MHS). Methods: Patients age 18-79 years diagnosed with colon adenocarcinoma between January 1, 1998 and December 31, 2007 were identified in linked databases from the Department of Defense Central Cancer Registry and MHS Data Repository. Odds ratios (ORs) and 95% confidence intervals (CIs) of receiving stage-specific treatment within recommended timeframes [surgery within 6 weeks of diagnosis (stages I-III); adjuvant chemotherapy within 8 weeks of surgery (stages II-III); treatment within 4 weeks of diagnosis (stage IV)] for NHB relative to NHW patients were estimated using multivariable logistic regression. Results: Patients (n = 2,170) had a mean age at diagnosis of 59.6 (SD 11.8) years and the racial distribution was 78.6% NHW and 21.4% NHB. The likelihood of receiving timely surgery between races was similar across the stage groups (I-III). NHB patients were equally likely to receive adjuvant chemotherapy as NHW patients (OR 0.90, 95% CI 0.57, 1.41) and to receive it within 8 weeks of surgery (OR 1.19, 95% CI 0.75, 1.87). The likelihood of receiving timely treatment for patients with stage IV disease was similar between races (OR 0.82, 95% CI 0.39, 1.69). The overall likelihood of receiving treatment adherent to stage-specific guidelines in the study sample was similar between NHB and NHW patients (OR 1.00, 95% CI 0.77 to 1.31). Conclusions: In the MHS population, the likelihood of receiving timely treatment adherent to recommended guidelines was similar between races. Our results support the role of equal access to medical care and insurance coverage in reducing racial disparities in colon cancer treatment.
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Affiliation(s)
- Yvonne L Eaglehouse
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
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17
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Eaglehouse YL, Georg MW, Shriver CD, Zhu K. Racial Differences in Time to Breast Cancer Surgery and Overall Survival in the US Military Health System. JAMA Surg 2019; 154:e185113. [PMID: 30673075 DOI: 10.1001/jamasurg.2018.5113] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Importance Racial disparities in time to surgery (TTS) after a breast cancer diagnosis and whether these differences account for disparities in overall survival have been understudied in the US population. Objectives To compare TTS in non-Hispanic black (NHB) and non-Hispanic white (NHW) women with breast cancer and to examine whether racial differences in TTS may explain possible racial disparities in overall survival in a universal health care system. Design, Setting, and Participants Retrospective cohort identified from the Department of Defense Central Cancer Registry and Military Health System Data Repository linked databases containing records between January 1, 1998, and December 31, 2008, of 998 NHB women and 3899 NHW women who received a diagnosis of stages I to III breast cancer and underwent breast-conserving surgery (BCS) or mastectomy in the US Military Health System during the study period. Data analyses were conducted from July 5, 2017, to December 29, 2017. Main Outcomes and Measures The main outcome was time to breast cancer surgery. Non-Hispanic black and NHW women were compared at the 25th, 50th (median), 75th, and 90th percentiles of TTS by using multivariable quantile regression. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs for all-cause death in NHB compared with NHW women after controlling for potential confounders first without and then with TTS. Results Among the 4887 NHB and NHW women in the cohort, the mean (SD) age was 50.0 (9.4) years. The median TTS was 21 days (95% CI, 20.6-21.4 days) among NHW women and 22 days (95% CI, 20.6-23.4 days) among NHB women. Non-Hispanic black women had a significantly greater estimated TTS at the 75th (3.6 days; 95% CI, 1.6-5.5 days) and 90th (8.9 days; 95% CI, 5.1-12.6 days) percentiles than NHW women in multivariable models. The estimated differences were similar by surgery type. Non-Hispanic black women had a higher adjusted risk for death (HR, 1.45; 95% CI, 1.06-2.01) compared with NHW women among patients receiving breast-conserving surgery. The risks were similar between races among those receiving mastectomy (HR, 1.06; 95% CI, 0.76-1.48). The HRs remained similar after adding TTS to the Cox proportional hazards regression models. Conclusions and Relevance This study's results indicate that time to breast cancer surgery was delayed for NHB compared with NHW women in the Military Health System. However, the racial differences in TTS did not explain the observed racial differences in overall survival among women who received breast-conserving surgery.
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Affiliation(s)
- Yvonne L Eaglehouse
- John P. Murtha Cancer Center, Uniformed Services University and Walter Reed National Military Medical Center, Bethesda, Maryland.,Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland
| | - Matthew W Georg
- John P. Murtha Cancer Center, Uniformed Services University and Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Craig D Shriver
- John P. Murtha Cancer Center, Uniformed Services University and Walter Reed National Military Medical Center, Bethesda, Maryland.,Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland
| | - Kangmin Zhu
- John P. Murtha Cancer Center, Uniformed Services University and Walter Reed National Military Medical Center, Bethesda, Maryland.,Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland
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18
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Eaglehouse YL, Manjelievskaia J, Shao S, Brown D, Hofmann K, Richard P, Shriver CD, Zhu K. Costs for Breast Cancer Care in the Military Health System: An Analysis by Benefit Type and Care Source. Mil Med 2018; 183:e500-e508. [DOI: 10.1093/milmed/usy052] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Indexed: 12/22/2022] Open
Affiliation(s)
- Yvonne L Eaglehouse
- John P. Murtha Cancer Center, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, 11300 Rockville Pike, Suite 1120, Rockville, MD
- Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
| | - Janna Manjelievskaia
- John P. Murtha Cancer Center, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, 11300 Rockville Pike, Suite 1120, Rockville, MD
| | - Stephanie Shao
- John P. Murtha Cancer Center, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, 11300 Rockville Pike, Suite 1120, Rockville, MD
| | - Derek Brown
- John P. Murtha Cancer Center, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, 11300 Rockville Pike, Suite 1120, Rockville, MD
| | - Keith Hofmann
- Kennell and Associates, Inc., 3130 Fairview Park Drive, Suite 450, Falls Church, VA
| | - Patrick Richard
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
| | - Craig D Shriver
- John P. Murtha Cancer Center, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, 11300 Rockville Pike, Suite 1120, Rockville, MD
- Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
| | - Kangmin Zhu
- John P. Murtha Cancer Center, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, 11300 Rockville Pike, Suite 1120, Rockville, MD
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
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Kramer MK, Vanderwood KK, Arena VC, Miller RG, Meehan R, Eaglehouse YL, Schafer G, Venditti EM, Kriska AM. Evaluation of a Diabetes Prevention Program Lifestyle Intervention in Older Adults: A Randomized Controlled Study in Three Senior/Community Centers of Varying Socioeconomic Status. Diabetes Educ 2018. [PMID: 29514568 DOI: 10.1177/0145721718759982] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose The purpose of this study is to evaluate the feasibility and effectiveness of an adapted Diabetes Prevention Program (DPP) lifestyle program, DPP Group Lifestyle Balance (GLB), delivered in 3 economically diverse senior/community centers. Methods The DPP-GLB was implemented in 3 senior/community centers in Allegheny County, PA. A 6-month delayed control intervention design was used. Participants were randomized to begin the DPP-GLB immediately (immediate) or after a 6-month delay (delayed). Adults (n = 134; mean age = 62.8 years) with BMI ≥24 kg/m2 and prediabetes and/or the metabolic syndrome took part. Weight, physical activity (PA), and diabetes and cardiovascular disease (CVD) risk factors were assessed at 6, 12, and 18 months from baseline. Results At 6 months, the immediate group demonstrated greater mean weight loss than the delayed control group as well as significantly greater improvements in PA, A1C, fasting insulin, and waist circumference. In pre-post analyses, both randomized groups showed similar success that was maintained at 18 months. Conclusions The DPP-GLB delivered in economically diverse community centers was effective in this group of older adults. These findings support provision of coverage for prevention programs in older adults at risk for diabetes/CVD, which is important considering the large number of individuals who will be Medicare eligible in the near future.
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Affiliation(s)
- M Kaye Kramer
- University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, Pennsylvania
| | | | - Vincent C Arena
- University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, Pennsylvania
| | - Rachel G Miller
- University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, Pennsylvania
| | - Rebecca Meehan
- University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, Pennsylvania
| | - Yvonne L Eaglehouse
- John P. Murtha Cancer Center, Division of Military Epidemiology and Population Sciences, Uniformed Services University and Walter Reed National Military Medical Center
| | - Gerald Schafer
- Carroll College, Department of Health Sciences, Helena, Montana
| | | | - Andrea M Kriska
- University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, Pennsylvania
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Eaglehouse YL, Venditti EM, Kramer MK, Arena VC, Vanderwood KK, Rockette-Wagner B, Kriska AM. Factors related to lifestyle goal achievement in a diabetes prevention program dissemination study. Transl Behav Med 2017; 7:873-880. [PMID: 28397158 PMCID: PMC5634908 DOI: 10.1007/s13142-017-0494-0] [Citation(s) in RCA: 14] [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] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The U.S. Diabetes Prevention Program (DPP) showed that lifestyle participants who achieved ≥7% weight loss and ≥150 min/week physical activity experienced the greatest reduction in type 2 diabetes incidence. Demographic, clinical, and program factors that are related to achieving both these lifestyle goals have seldom been explored in community-delivered DPP programs. The purpose of this investigation is to examine factors associated with concurrent achievement of weight loss and physical activity goals in a 12-month community DPP lifestyle intervention. Adults [n = 223; age = 58.4 (SD = 11.5); BMI = 33.8 (SD = 6.0)] with glucose or HbA1c values in the pre-diabetes range and/or metabolic syndrome risk factors enrolled from one worksite and three community centers in the Pittsburgh, PA metropolitan area between January 2011 and January 2014. Logistic regression analyses determined the demographic, clinical and program adherence factors related to goal achievement at 6, 12, and 18 months. Participants achieving both intervention goals at 6 months (n = 57) were more likely to attend sessions [Adjusted Odds Ratio (AOR) =1.48], self-weigh (AOR = 1.19), and self-monitor behaviors (AOR = 1.18) than those meeting neither goal (n = 35; all p < 0.05). Baseline BMI (AOR = 0.87, p < 0.01), elevated glycemic status (AOR = 0.49, p < 0.05), and female sex (AOR = 0.52, p < 0.05) were inversely related to goal achievement at 6 months. Meeting either lifestyle goal at 6 months had the strongest association with meeting both goals at 12 and 18 months. Our study supports the importance of early engagement, regular attendance, self-monitoring, and self-weighing for goal achievement. Dissemination efforts should consider alternative approaches for those not meeting goals by 6 months to enhance long-term success.
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Affiliation(s)
- Yvonne L Eaglehouse
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA.
- Division of Cancer Prevention and Population Sciences, University of Pittsburgh Cancer Institute, 5150 Centre Avenue, Pittsburgh, PA, 15232, USA.
- , 11300 Rockville Pike, Suite 1120, Rockville, MD, 20852, USA.
| | - Elizabeth M Venditti
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA, 15261, USA
| | - M Kaye Kramer
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Vincent C Arena
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Karl K Vanderwood
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
- Montana Department of Public Health and Human Services, 111 North Sanders, Helena, MT, 59601, USA
| | - Bonny Rockette-Wagner
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Andrea M Kriska
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
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Eaglehouse YL, Schafer GL, Arena VC, Kramer MK, Miller RG, Kriska AM. Impact of a community-based lifestyle intervention program on health-related quality of life. Qual Life Res 2016; 25:1903-12. [PMID: 26896960 PMCID: PMC5496447 DOI: 10.1007/s11136-016-1240-7] [Citation(s) in RCA: 24] [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] [Accepted: 01/30/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND The presence of risk factors for type 2 diabetes and cardiovascular disease, or the conditions themselves, contributes to lower health-related quality of life (HRQoL) among adults. Although community-based lifestyle intervention programs have been shown to be effective for improving risk factors for these diseases, the impact of these interventions on HRQoL has rarely been described. PURPOSE To examine changes in HRQoL following participation in the Group Lifestyle Balance program, a community translation of the Diabetes Prevention Program lifestyle intervention for adults with prediabetes and/or the metabolic syndrome. METHODS Participants enrolled in the 12-month, 22-session intervention program (N = 223) completed the EuroQol Health Questionnaire (EQ-5D-3L) at baseline, 6, and 12 months. Linear mixed-effects regression models determined change in EQ-5D-visual analog scale (VAS) and Index scores post-intervention. RESULTS Mean EQ-5D-VAS was improved by +7.38 (SE = 1.03) at 6 months and by +6.73 (SE = 1.06) at 12 months post-intervention (both; p < 0.0001). Mean changes in EQ-5D index values were +0.00 (SE = 0.01; NS) and +0.01 (SE = 0.01; p < 0.05), respectively. Adjusted for age, baseline score, and achieving intervention goals, mean change in EQ-5D-VAS was +11.83 (SE = 1.61) at 6 months and +11.23 (SE = 1.54) at 12 months (both; p < 0.0001). Adjusted mean change in EQ-5D index value was +0.04 (SE = 0.01) at 6 months and +0.05 (SE = 0.01) at 12 months (both; p < 0.01). CONCLUSION Participation in a community lifestyle intervention program resulted in improved HRQoL among adults with prediabetes and/or the metabolic syndrome. These benefits to HRQoL, together with improved clinical and behavioral outcomes, should increase the appeal of such programs for improving health.
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Affiliation(s)
- Yvonne L Eaglehouse
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.
- University of Pittsburgh Cancer Institute, 5150 Centre Avenue, Suite 4C-464, Pittsburgh, PA, 15232, USA.
| | - Gerald L Schafer
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
- Department of Health Sciences, Carroll College, Helena, MT, USA
| | - Vincent C Arena
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - M Kaye Kramer
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Rachel G Miller
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Andrea M Kriska
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
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Eaglehouse YL, Rockette-Wagner B, Kramer MK, Arena VC, Miller RG, Vanderwood KK, Kriska AM. Physical Activity Levels in a Community Lifestyle Intervention: A Randomized Trial. Transl J Am Coll Sports Med 2016; 1:45-51. [PMID: 27551690 PMCID: PMC4991779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND A behavioral lifestyle intervention program with goals of increasing physical activity (PA) and losing weight was shown to be efficacious for preventing type 2 diabetes and decreasing risk for cardiovascular disease in the U.S. Diabetes Prevention Program (DPP). Modified versions of the DPP lifestyle intervention are being translated into diverse community settings and have been successful in decreasing weight and improving metabolic markers. However, comprehensive evaluations of PA levels within these community translation intervention efforts are rare. PURPOSE To evaluate the effectiveness of a DPP-based community lifestyle intervention for improving PA levels. METHODS 223 overweight adults at-risk for type 2 diabetes and/or cardiovascular disease were randomized (immediate or 6-month delayed-start) to a 12-month DPP-based lifestyle intervention. Past-month PA level was assessed at baseline and post-intervention with the Modifiable Activity Questionnaire. Simple and mixed-effects regression models were used to determine changes in PA level between and within groups over time. RESULTS The between-group mean difference for change in PA levels from baseline to 6 months indicated significantly greater improvement in the intervention compared to the delayed-start group [+6.72 (SE=3.01) MET-hrs/week; p=0.03]. Examining combined within-group change from baseline to post-intervention, mean PA levels significantly increased by +14.69 (SE=1.43) and +9.50 (SE= 1.40) MET-hrs/week at 6 and 12 months post-intervention, respectively. This PA change offset to approximately +10 MET-hrs/week at both 6 and 12 months after adjusting for baseline PA level and season (all; p<0.01). Other than season, sex impacted on change in PA level. CONCLUSIONS This community-based lifestyle intervention significantly increased PA levels among overweight adults at risk for type 2 diabetes and cardiovascular disease, even after adjusting for key variables. CLINICALTRIALSGOV IDENTIFIER NCT01050205.
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Affiliation(s)
- Yvonne L. Eaglehouse
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Bonny Rockette-Wagner
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - M. Kaye Kramer
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Vincent C. Arena
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Rachel G. Miller
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Karl K. Vanderwood
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Andrea M. Kriska
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
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Eaglehouse YL, Rockette-Wagner BJ, Kramer MK, Arena VC, Miller RG, Vanderwood KK, Kriska AM. Physical Activity Levels in a Community Lifestyle Intervention. Translational Journal of the American College of Sports Medicine 2016. [DOI: 10.1249/tjx.0000000000000004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Eaglehouse YL, Talbott EO, Chang Y, Kuller LH. Participation in Physical Activity and Risk for Amyotrophic Lateral Sclerosis Mortality Among Postmenopausal Women. JAMA Neurol 2016; 73:329-36. [PMID: 26783702 PMCID: PMC6044440 DOI: 10.1001/jamaneurol.2015.4487] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 12/11/2022]
Abstract
IMPORTANCE Amyotrophic lateral sclerosis (ALS) is a progressive, fatal disease with no known cause. Case studies primarily of athletes and several case-control studies have suggested that high levels of strenuous physical activity (PA) may increase the risk for ALS. This relationship has yet to be evaluated among women in population-based cohort studies. OBJECTIVE To evaluate the relationship between PA and risk for ALS mortality in a large cohort of postmenopausal women. DESIGN, SETTING, AND PARTICIPANTS The Women's Health Initiative (WHI) enrolled 161 809 postmenopausal women, aged 50 to 79 years (mean [SD] age, 63.6 [7.24] years), between 1993 and 1998 into either a clinical trial or an observational study at 40 clinical research centers across the United States. We conducted a cohort study from November 2014 to September 2015 using baseline and mortality data during an average of 9.6 years of follow-up from the entire WHI cohort, through September 1, 2013 (with 1.1% lost to follow-up), to address whether there is a relationship between PA and ALS mortality. EXPOSURES The WHI assessed frequency and duration of mild, moderate, and strenuous PA at baseline via self-administered questionnaire. MAIN OUTCOMES AND MEASURES Underlying cause of death from ALS collected from death certificates. RESULTS The WHI enrolled 161 809 women, of whom 165 died of ALS; women who died of ALS were older (median age, 66 years; interquartile range, 61-69 years) compared with the total WHI study population (median age, 63 years; interquartile range, 57-69 years). Age-adjusted ALS mortality rates varied from 7.4 (95% CI, 5.5-9.9)/100 000 person-years for no strenuous PA to 10.6 (95% CI, 5.6-20.0)/100 000 person-years for strenuous PA 3 or more days per week (P = .07). Adjusted for age and body mass index (calculated as weight in kilograms divided by height in meters squared), the odds ratio for death from ALS for participants with strenuous PA 3 or more days per week compared with no reported strenuous PA was 1.56 (95% CI, 1.02-2.37; P = .04). CONCLUSIONS AND RELEVANCE To our knowledge, this is the first cohort study to report an increased risk for ALS mortality associated with strenuous PA in postmenopausal women. The association between strenuous PA and ALS risk observed does not compromise the overall benefit of strenuous PA for total mortality, coronary heart disease, and breast cancer reported in other WHI investigations, but it may provide an important clue to the etiology of ALS, if replicated by other studies.
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Affiliation(s)
- Yvonne L Eaglehouse
- Division of Cancer Prevention and Population Science, Cancer Institute, University of Pittsburgh, Pittsburgh, Pennsylvania2Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Evelyn O Talbott
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yuefang Chang
- Department of Neurological Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lewis H Kuller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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Eaglehouse YL, Vanderwood KK, Kramer MK, Kriska AM. Can a Lifestyle Program Aimed at Preventing Diabetes Increase Physical Activity Levels Across Diverse Settings? Med Sci Sports Exerc 2014. [DOI: 10.1249/01.mss.0000493497.78979.f9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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26
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Kriska AM, Eaglehouse YL, Vanderwood KK, Kaye Kramer M. Evaluation of a Flexibly-delivered Lifestyle Program Designed To Prevent Diabetes and Provided Via DVD. Med Sci Sports Exerc 2014. [DOI: 10.1249/01.mss.0000495253.28573.7a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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