Underascertainment of radiotherapy receipt in Surveillance, Epidemiology, and End Results registry data

BACKGROUND: Surveillance, Epidemiology, and End Results (SEER) registry data have been used to suggest underuse and disparities in receipt of radiotherapy. Prior studies have cautioned that SEER may underascertain radiotherapy but lacked adequate representation to assess whether underascertainment varies by geography or patient sociodemographic characteristics. The authors sought to determine rates and correlates of underascertainment of radiotherapy in recent SEER data. METHODS: The authors evaluated data from 2290 survey respondents with nonmetastatic breast cancer, aged 20 to 79 years, diagnosed from June of 2005 to February 2007 in Detroit and Los Angeles and reported to SEER registries (73% response rate). Survey responses regarding treatment and sociodemographic factors were merged with SEER data. The authors compared radiotherapy receipt as reported by patients versus SEER records. The authors then assessed correlates of radiotherapy underascertainment in SEER. RESULTS: Of 1292 patients who reported receiving radiotherapy, 273 were coded as not receiving radiotherapy in SEER (underascertained). Underascertainment was more common in Los Angeles than in Detroit (32.0% vs 11.25%, P < .001). On multivariate analysis, radiotherapy underascertainment was significantly associated in each registry (Los Angeles, Detroit) with stage ( P = .008, P = .026), income ( P < .001, P = .050), mastectomy receipt ( P < .001, P < .001), chemotherapy receipt ( P < .001, P = .045), and diagnosis at a hospital that was not accredited by the American College of Surgeons ( P < .001, P < .001). In Los Angeles, additional significant variables included younger age ( P < .001), nonprivate insurance ( P < .001), and delayed receipt of radiotherapy ( P < .001). CONCLUSIONS: SEER registry data as currently collected may not be an appropriate source for documentation of rates of radiotherapy receipt or investigation of geographic variation in the radiation treatment of breast cancer. Cancer 2011;. © 2011 American Cancer Society. This study found that the Los Angeles Cancer Surveillance Program, among the largest Surveillance, Epidemiology, and End Results (SEER) registries, coded that radiation was not received in nearly a third of cases in which breast cancer patients themselves reported radiation receipt, whereas ascertainment of radiation receipt was much more complete in another large SEER registry, that of the Metropolitan Detroit Cancer Surveillance System. SEER registry data as currently collected may not be an appropriate source for documentation of rates of radiotherapy receipt or geographic disparities.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90319/1/26295_ftp.pd

Employment benefits and job retention: evidence among patients with colorectal cancer

A “health shock,” that is, a large, unanticipated adverse health event, can have long‐term financial implications for patients and their families. Colorectal cancer is the third most commonly diagnosed cancer among men and women and is an example of a specific health shock. We examined whether specific benefits (employer‐based health insurance, paid sick leave, extended sick leave, unpaid time off, disability benefits) are associated with job retention after diagnosis and treatment of colorectal cancer. In 2011–14, we surveyed patients with Stage III colorectal cancer from two representative SEER registries. The final sample was 1301 patients (68% survey response rate). For this study, we excluded 735 respondents who were not employed and 20 with unknown employment status. The final analytic sample included 546 respondents. Job retention in the year following diagnosis was assessed, and multivariable logistic regression was used to evaluate associations between job retention and access to specific employment benefits. Employer‐based health insurance (OR = 2.97; 95% CI = 1.56–6.01; P = 0.003) and paid sick leave (OR = 2.93; 95% CI = 1.23–6.98; P = 0.015) were significantly associated with job retention, after adjusting for sociodemographic, clinical, geographic, and job characteristics.A “health shock,” that is, a large, unanticipated adverse health event, can have long‐term financial implications for patients and their families. We examined whether specific benefits (employer‐based health insurance, paid sick leave, extended sick leave, unpaid time off, disability benefits) are associated with job retention after diagnosis and treatment of colorectal cancer, an example of a specific health shock. Employer‐based health insurance and paid sick leave were associated with job retention.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142914/1/cam41371_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142914/2/cam41371.pd

Understanding the engagement of key decision support persons in patient decision making around breast cancer treatment

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149329/1/cncr31956.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149329/2/cncr31956_am.pd

Characterizing and Propagating Modeling Uncertainties in Photometrically-Derived Redshift Distributions

The uncertainty in the redshift distributions of galaxies has a significant potential impact on the cosmological parameter values inferred from multi-band imaging surveys. The accuracy of the photometric redshifts measured in these surveys depends not only on the quality of the flux data, but also on a number of modeling assumptions that enter into both the training set and SED fitting methods of photometric redshift estimation. In this work we focus on the latter, considering two types of modeling uncertainties: uncertainties in the SED template set and uncertainties in the magnitude and type priors used in a Bayesian photometric redshift estimation method. We find that SED template selection effects dominate over magnitude prior errors. We introduce a method for parameterizing the resulting ignorance of the redshift distributions, and for propagating these uncertainties to uncertainties in cosmological parameters.Comment: 13 pages, 12 figures, version published in Ap

Development and psychometric properties of a brief measure of subjective decision quality for breast cancer treatment

Abstract Background Breast cancer patients face several preference-sensitive treatment decisions. Feelings such as regret or having had inadequate information about these decisions can significantly alter patient perceptions of recovery and recurrence. Numerous objective measures of decision quality (e.g., knowledge assessments, values concordance measures) have been developed; there are far fewer measures of subjective decision quality and little consensus regarding how the construct should be assessed. The current study explores the psychometric properties of a new subjective quality decision measure for breast cancer treatment that could be used for other preference sensitive decisions. Methods 320 women aged 20–79 diagnosed with AJCC stage 0 – III breast cancer were surveyed at two cancer specialty centers. Decision quality was assessed with single items representing six dimensions: regret, satisfaction, and fit as well as perceived adequacy of information, time, and involvement. Women rated decision quality for their overall treatment experience and surgery, chemotherapy, and radiation decisions separately. Principle components was used to explore factor structure. After scales were formed, internal consistency was computed using Cronbach’s alpha. The association of each of the four final scales with patient characteristics scores was examined by Pearson correlation. Results For overall breast cancer treatment as well as surgery, chemotherapy, and radiation decisions, the six items yielded a single factor solution. Factor loadings of the six decision items were all above .45 across the overall and treatment-specific scales, with the exception of “Right for You” for chemotherapy and radiation. Internal consistency was 0.77, 0.85, 0.82, and 0.78 for the overall, surgery, chemotherapy, and radiation decision quality scales, respectively. Conclusions Our measure of subjective appraisal of breast cancer treatment decisions includes 5 related elements; regret and satisfaction as well as perceived adequacy of information, time, and involvement. Future research is needed to establish norms for the measure as is further psychometric testing, particularly to examine how it is associated with outcomes such as quality of life, psychological coping and objective decision quality.http://deepblue.lib.umich.edu/bitstream/2027.42/109727/1/12911_2014_Article_110.pd

Association of Cumulative Social Risk and Social Support With Receipt of Chemotherapy Among Patients With Advanced Colorectal Cancer

Importance: Approximately 38% of patients with advanced colorectal cancer do not receive chemotherapy. Objective: To determine whether cumulative social risk (ie, multiple co-occurring sociodemographic risk factors) is associated with lower receipt of chemotherapy among patients with advanced colorectal cancer and whether social support would moderate this association. Design, Setting, and Participants: This cross-sectional, population-based, mailed survey study was conducted from 2012 to 2014. Participants were recruited between 2011 and 2014 from all adults within 1 year after diagnosis of stage III colorectal cancer in the Detroit, Michigan, and State of Georgia Surveillance, Epidemiology, End-Results cancer registries. Patients were eligible if they were aged 18 years or older, had undergone surgery 4 or more months ago, did not have stage IV cancer, and resided in the registry catchment areas. Data analyses were conducted from March 2017 to April 2021. Main Outcomes and Measures: The primary outcome was receipt of chemotherapy. Cumulative social risk represented a sum of 8 risk factors with the potential to drain resources from participants\u27 cancer treatment (marital status, employment, annual income, health insurance, comorbidities, health literacy, adult caregiving, and perceived discrimination). Social support was operationalized as emotional support related to colorectal cancer diagnosis. Results: Surveys were mailed to 1909 eligible patients; 1301 completed the survey (response rate, 68%). A total of 1087 participants with complete data for key variables were included in the sample (503 women [46%]; mean [SD] age, 64 [13] years). Participants with 3 or more risk factors were less likely to receive chemotherapy than participants with 0 risk factors (3 factors, odds ratio [OR], 0.48 [95% CI, 0.26-0.87]; 4 factors, OR, 0.41 [95% CI, 0.21-0.78]; 5 factors, OR, 0.42 [95% CI, 0.20-0.87]; ≥6 factors, OR, 0.22 [95% CI, 0.09-0.55]). Participants with 2 or more support sources had higher odds of undergoing chemotherapy than those without social support (2 sources, OR, 3.05 [95% CI, 1.36-6.85]; 3 sources, OR, 3.24 [95% CI, 1.48-7.08]; 4 sources, OR, 3.69 [95% CI, 1.71-7.97]; 5 sources, OR, 4.40 [95% CI, 1.98-9.75]; ≥6 sources, OR 5.95 [95% CI, 2.58-13.74]). Within each social support level, participants were less likely to receive chemotherapy as cumulative social risk increased. Conclusions and Relevance: Cumulative social risk was associated with reduced receipt of chemotherapy. These associations were mitigated by social support. Assessing cumulative social risk may identify patients with colorectal cancer who are at higher risk for omitting chemotherapy who can be targeted for support programs to address social disadvantage and increase social support

The accuracy of chemotherapy ascertainment among colorectal cancer patients in the surveillance, epidemiology, and end results registry program

Abstract Background Surveillance, Epidemiology, and End Results (SEER) public research database does not include chemotherapy data due to concerns for incomplete ascertainment. To compensate for perceived lack of data quality many researchers use SEER-Medicare linked data, limiting studies to persons over age 65. We sought to determine current SEER ascertainment of chemotherapy receipt in two relatively large SEER registries compared to patient-reported receipt and to assess patterns of under-ascertainment. Methods In 2011–14, we surveyed patients with Stage III colorectal cancer reported to the Georgia and Metropolitan Detroit SEER registries. 1301/1909 eligible patients responded (68% response rate). Survey responses regarding treatment and sociodemographic factors were merged with SEER data. We compared patient-reported chemotherapy receipt with SEER recorded chemotherapy receipt. We estimated multivariable regression models to assess associations of under-ascertainment in SEER. Results Eighty-five percent of patients reported chemotherapy receipt. Among those, 10% (n = 104) were under-ascertained in SEER (coded as not receiving chemotherapy). In unadjusted analyses, under-ascertainment was more common for older patients (11.8% age 76+ vs. < 9% for all other ages, p = 0.01) and varied with SEER registries (10.2% Detroit vs. 6.8% Georgia; p = 0.04). On multivariable analyses, chemotherapy under-ascertainment did not vary significantly by any patient attributes. Conclusion We found a 10% rate of under-ascertainment of adjuvant chemotherapy for resected, stage III colorectal cancer in two SEER registries. Chemotherapy under-ascertainment did not disproportionately affect any patient subgroups. Use of SEER data from select registries is an important resource for researchers investigating contemporary chemotherapy receipt and outcomes.https://deepblue.lib.umich.edu/bitstream/2027.42/143192/1/12885_2018_Article_4405.pd

Treatment experiences of Latinas after diagnosis of breast cancer

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138310/1/cncr30702.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138310/2/cncr30702_am.pd

Adjuvant endocrine therapy initiation and persistence in a diverse sample of patients with breast cancer

Abstract Adjuvant endocrine therapy for breast cancer reduces recurrence and improves survival rates. Many patients never start treatment or discontinue prematurely. A better understanding of factors associated with endocrine therapy initiation and persistence could inform practitioners how to support patients. We analyzed data from a longitudinal study of 2,268 women diagnosed with breast cancer and reported to the Metropolitan Detroit and Los Angeles SEER cancer registries in 2005–2007. Patients were surveyed approximately both 9 months and 4 years after diagnosis. At the 4-year mark, patients were asked if they had initiated endocrine therapy, terminated therapy, or were currently taking therapy (defined as persistence). Multivariable logistic regression models examined factors associated with initiation and persistence. Of the 743 patients eligible for endocrine therapy, 80 (10.8 %) never initiated therapy, 112 (15.1 %) started therapy but discontinued prematurely, and 551 (74.2 %) continued use at the second time point. Compared with whites, Latinas (OR 2.80, 95 % CI 1.08–7.23) and black women (OR 3.63, 95 % CI 1.22–10.78) were more likely to initiate therapy. Other factors associated with initiation included worry about recurrence (OR 3.54, 95 % CI 1.31–9.56) and inadequate information about side effects (OR 0.24, 95 % CI 0.10–0.55). Factors associated with persistence included two or more medications taken weekly (OR 4.19, 95 % CI 2.28–7.68) and increased age (OR 0.98, 95 % CI 0.95–0.99). Enhanced patient education about potential side effects and the effectiveness of adjuvant endocrine therapy in improving outcomes may improve initiation and persistence rates and optimize breast cancer survival. Keywords Breast neoplasms Aromatase inhibitors Selective estrogen receptor modulators Medication taking Health services researchhttp://deepblue.lib.umich.edu/bitstream/2027.42/97045/1/Adjuvant endocrine therapy initiation and persistence in a diverse sample of patients with breast cancer.pd

A benzimidazole-based new fluorogenic differential/sequential chemosensor for Cu2+, Zn2+, CN-, P2O74-, DNA, its live-cell imaging and pyrosequencing applications

Differential chemosensors have emerged as next-generation systems due to their simplicity and favourable responsive properties to produce different signals upon selective binding of various analytes simultaneously. Nevertheless, given their inadequate fluorescence response and laborious synthetic procedures, only a few differential chemosensors have been developed so far. In this work, we have employed a single pot synthesis strategy to establish a new benzimidazole-based Schiff base type fluorogenic chemosensor (DFB) which differentially detects Cu2+ (detection limit (LOD) = 24.4 ± 0.5 nM) and Zn2+ (LOD = 2.18 ± 0.1 nM) through fluorescence “off-on” manner over the library of other metal cations in an aqueous medium. The DFB-derived ‘in situ’ complexes DFB-Cu2+ and DFB-Zn2+ showed fluorescence revival “on-off” responses toward cyanide (CN−) and bio-relevant pyrophosphate (P2O7 4--PPi) ions with a significantly low LOD of 9.43 ± 0.2 and 2.9 ± 0.1 nM, respectively, in water. We have demonstrated the phosphate group-specific binding capability of DFB-Zn2+ , by testing it with both ssDNA and dsDNA samples which displayed fluorescence “turn-off” response (LOD ∼10-7 M), similar to the PPi binding in an aqueous medium, indicating that it interacts explicitly with the phosphate backbone of DNA. We have also harnessed the DFB as a sequential fluorescent probe to detect Cu2+, Zn2+, CN− and P2O7 4- ions in human cervical (HeLa) and breast (MCF-7 and MDA-MB-231 (aggressive and invasive)) cancer cell lines. Moreover, we have explored the PPi recognition capability of DFB-Zn2+ in the polymerase-chain-reaction (PCR) products where PPi is one of the primary by-products during amplification of DNA