subject:(SEER Medicare)

University of Washington

1. Chen, Lu. Hypertension and diabetes treatments and risk of adverse outcomes among breast cancer patients.

Degree: PhD, 2016, University of Washington

► Background: Management of comorbidities is a critical issue among 2.9 million breast cancer survivors in the U.S. Hypertension and diabetes are two common chronic conditions… (more)

▼ Background: Management of comorbidities is a critical issue among 2.9 million breast cancer survivors in the U.S. Hypertension and diabetes are two common chronic conditions affecting this patient population. Despite the generally good safety profile of widely used antihypertensive medications and diabetes treatments, few studies have examined their relationships with adverse breast cancer outcomes. In particular, metformin, a first line diabetes treatment, is hypothesized to lower the risk of incident breast cancer, but it is unclear whether metformin influences breast cancer progression. The purpose of this dissertation was to characterize how commonly prescribed classes of antihypertensive medications and diabetes treatments relate to adverse breast cancer outcomes. Methods: We conducted a retrospective cohort study of women between ages 66 and 80 years newly diagnosed with stage I or II breast cancer during 2007-2011. A total of 14,766 eligible women were identified in the linked Surveillance, Epidemiology and End-Results (SEER)-Medicare database. Medicare Part D Prescription Drug Event data were obtained to characterize women’s use of commonly used antihypertensive medications (angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), β-blockers, calcium channel blockers and diuretics) and diabetes treatments (metformin, sulfonylureas, insulin therapy and other diabetes treatments) after their breast cancer diagnosis. Primary outcomes were any second breast cancer events (SBCEs, recurrence or second primary breast cancer, n=791), recurrence per se (n=627), and breast cancer-specific mortality (n=327). Time varying Cox proportional hazard models, adjusted for demographic characteristics, tumor characteristics, first course treatment and a history of diabetes and hypertension, were used to estimate hazard ratios (HRs) and their associated 95% confidence intervals (CIs). Results: Use of diuretics (n=8,517) after breast cancer diagnosis was associated with 40% (95% CI: 1.20-1.64), 41% (95% CI: 1.18-1.67) and 78% (95% CI: 1.32-2.40) higher risks of a SBCE, recurrence and breast cancer death, respectively, compared to nonusers of diuretics. Use of β-blockers (n=7,145) was associated with a 1.63-fold (95% CI: 1.24-2.13) higher risk of breast cancer death compared to women who did not use this class of drug. Use of angiotensin II receptor blockers was associated with 1.26-fold (95% CI: 1.08-1.48) higher risk of a SBCE. Use of calcium channel blockers and angiotensin-converting enzyme inhibitors were generally not associated with an altered risk of adverse breast cancer outcomes. With respect to diabetes treatments, use of metformin after breast cancer (n=2,558) was associated with a 22% (95% CI: 0.62-0.98), 26% (95% CI: 0.57-0.96), and 40% (95% CI: 0.40-0.90) lower risk of a SBCE, breast cancer recurrence, and breast cancer death, respectively, compared to metformin nonusers. Use of sulfonylureas and insulin were associated with 1.58 (95% CI: 1.08-2.30) and 2.64-fold (95%CI: 1.78-3.92)… Advisors/Committee Members: Li, Christopher I (advisor).

Subjects/Keywords: breast cancer; diabetes; hypertension; pharmacoepidemiology; seer-medicare; Epidemiology; epidemiology

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6^th Edition):

Chen, L. (2016). Hypertension and diabetes treatments and risk of adverse outcomes among breast cancer patients. (Doctoral Dissertation). University of Washington. Retrieved from http://hdl.handle.net/1773/36675

Chicago Manual of Style (16^th Edition):

Chen, Lu. “Hypertension and diabetes treatments and risk of adverse outcomes among breast cancer patients.” 2016. Doctoral Dissertation, University of Washington. Accessed March 05, 2021. http://hdl.handle.net/1773/36675.

MLA Handbook (7^th Edition):

Chen, Lu. “Hypertension and diabetes treatments and risk of adverse outcomes among breast cancer patients.” 2016. Web. 05 Mar 2021.

Vancouver:

Chen L. Hypertension and diabetes treatments and risk of adverse outcomes among breast cancer patients. [Internet] [Doctoral dissertation]. University of Washington; 2016. [cited 2021 Mar 05]. Available from: http://hdl.handle.net/1773/36675.

Council of Science Editors:

Chen L. Hypertension and diabetes treatments and risk of adverse outcomes among breast cancer patients. [Doctoral Dissertation]. University of Washington; 2016. Available from: http://hdl.handle.net/1773/36675

University of Minnesota

2. Longacre, Colleen. Travel And Treatment Among Breast Cancer Patients: A Population-Based Analysis.

Degree: PhD, Health Services Research, Policy and Administration, 2020, University of Minnesota

URL: http://hdl.handle.net/11299/215208

► Treatment choices for patients with breast cancer require balancing a variety of considerations, but travel distance may create barriers to accessing specific treatments and impact… (more)

▼ Treatment choices for patients with breast cancer require balancing a variety of considerations, but travel distance may create barriers to accessing specific treatments and impact patient choices and outcomes. This dissertation uses novel methods to explore travel burden and evaluate the relationship between travel distance and: 1) surgical choice (mastectomy or breast-conserving surgery (BCS), 2) optimal receipt of radiation, and 3) breast reconstruction among a population-based national sample of newly diagnosed breast cancer patients. We use data from the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database. Our study cohort consists of breast cancer patients newly diagnosed between 2004 and 2013. We use Google Maps and ArcGIS to calculate driving distances and driving times to the nearest available treatment facility. We find that patients living in rural areas traveled on average nearly three times as far for radiation treatment as those from urban areas (40.8 miles vs. 15.4 miles), and their nearest facility was more than four times farther away (21.9 miles vs. 4.8 miles). Disease severity (stage, grade, etc.) was not significantly associated with actual or minimum travel distance. We also find that women living farther from radiation facilities (>50 miles vs. <10 miles) were more likely to undergo mastectomy vs. BCS (OR: 1.48, 95% CI: 1.22, 1.79). Among those who underwent BCS, women living farther from radiation facilities were less likely to complete any RT (OR: 1.72, 95% CI: 1.32, 2.23) or the full recommended course of RT (OR: 1.79, 95% CI: 1.24, 2.60), and were thus more likely to receive guideline-discordant treatment. Women receiving guideline-discordant treatment had worse overall (HR: 1.50, 95% CI: 1.42, 1.57) and breast-cancer specific survival (HR: 1.44, 95% CI: 1.29, 1.60) compared to women receiving guideline-concordant treatment. Finally, we find that increased distance to the nearest reconstruction provider was associated with decreased odds of reconstruction (p<0.001) among mastectomy patients and increased odds of delayed vs. immediate reconstruction among reconstruction patients (p=0.0003). Women living >50 miles away from a reconstruction provider had 51% lower odds of immediate reconstruction (OR: 0.49, 95% CI: 0.39, 0.62) and 93% higher odds of delayed reconstruction (OR: 1.93, 95% CI: 1.03, 3.60) compared to women living within 10 miles of a reconstruction provider. Method of reconstruction was also highly correlated with geography. Increases in reconstruction rates were greater among urban patients, widening the disparity in reconstruction rates among urban vs. rural patients. Taken together, these results suggest that travel burden may be contributing to patients making suboptimal treatment decisions, which in turn contribute to suboptimal survival and patient-centered (quality of life) outcomes. Clinicians, policymakers, and patient advocates should explore social support models, such as lodging and transportation support, and service delivery models, such as…

Subjects/Keywords: breast cancer; breast reconstruction; patient travel distance; radiation treatment; SEER-Medicare

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6^th Edition):

Longacre, C. (2020). Travel And Treatment Among Breast Cancer Patients: A Population-Based Analysis. (Doctoral Dissertation). University of Minnesota. Retrieved from http://hdl.handle.net/11299/215208

Chicago Manual of Style (16^th Edition):

Longacre, Colleen. “Travel And Treatment Among Breast Cancer Patients: A Population-Based Analysis.” 2020. Doctoral Dissertation, University of Minnesota. Accessed March 05, 2021. http://hdl.handle.net/11299/215208.

MLA Handbook (7^th Edition):

Longacre, Colleen. “Travel And Treatment Among Breast Cancer Patients: A Population-Based Analysis.” 2020. Web. 05 Mar 2021.

Vancouver:

Longacre C. Travel And Treatment Among Breast Cancer Patients: A Population-Based Analysis. [Internet] [Doctoral dissertation]. University of Minnesota; 2020. [cited 2021 Mar 05]. Available from: http://hdl.handle.net/11299/215208.

Council of Science Editors:

Longacre C. Travel And Treatment Among Breast Cancer Patients: A Population-Based Analysis. [Doctoral Dissertation]. University of Minnesota; 2020. Available from: http://hdl.handle.net/11299/215208

University of Minnesota

3. Joseph, Jennifer. Timeliness and Equity as Overlooked Quality Domains: Racial/Ethnic Disparities in Timeliness of Adjuvant Chemotherapy Receipt for Stage III Colon Cancer.

Degree: PhD, Health Services Research, Policy and Administration, 2018, University of Minnesota

URL: http://hdl.handle.net/11299/218707

► Consensus and evidence-based guidelines or quality measures provide treatment recommendations to promote standardized, high-quality health care. This research focused on a specific guideline which recommends… (more)

Subjects/Keywords: Adjuvant Chemotherapy; Colon Cancer; Health Equity; Quality of Care; SEER-Medicare; Timeliness/Delayed Care

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6^th Edition):

Joseph, J. (2018). Timeliness and Equity as Overlooked Quality Domains: Racial/Ethnic Disparities in Timeliness of Adjuvant Chemotherapy Receipt for Stage III Colon Cancer. (Doctoral Dissertation). University of Minnesota. Retrieved from http://hdl.handle.net/11299/218707

Chicago Manual of Style (16^th Edition):

Joseph, Jennifer. “Timeliness and Equity as Overlooked Quality Domains: Racial/Ethnic Disparities in Timeliness of Adjuvant Chemotherapy Receipt for Stage III Colon Cancer.” 2018. Doctoral Dissertation, University of Minnesota. Accessed March 05, 2021. http://hdl.handle.net/11299/218707.

MLA Handbook (7^th Edition):

Joseph, Jennifer. “Timeliness and Equity as Overlooked Quality Domains: Racial/Ethnic Disparities in Timeliness of Adjuvant Chemotherapy Receipt for Stage III Colon Cancer.” 2018. Web. 05 Mar 2021.

Vancouver:

Joseph J. Timeliness and Equity as Overlooked Quality Domains: Racial/Ethnic Disparities in Timeliness of Adjuvant Chemotherapy Receipt for Stage III Colon Cancer. [Internet] [Doctoral dissertation]. University of Minnesota; 2018. [cited 2021 Mar 05]. Available from: http://hdl.handle.net/11299/218707.

Council of Science Editors:

Joseph J. Timeliness and Equity as Overlooked Quality Domains: Racial/Ethnic Disparities in Timeliness of Adjuvant Chemotherapy Receipt for Stage III Colon Cancer. [Doctoral Dissertation]. University of Minnesota; 2018. Available from: http://hdl.handle.net/11299/218707

University of Illinois – Chicago

4. Monberg, Matthew J. Evaluation of the Patterrns and Risks of Erythropoietin Stimulating Agents in Head and Neck Cancers.

Degree: 2016, University of Illinois – Chicago

URL: http://hdl.handle.net/10027/20886

► Background: Although head and neck cancer (HNC) is the sixth most common cancer type by incidence globally, few studies have focused on real world treatment… (more)

▼ Background: Although head and neck cancer (HNC) is the sixth most common cancer type by incidence globally, few studies have focused on real world treatment patterns of this disease. A large, randomized study of erythropoietin stimulating agents (ESAs) produced worsened outcomes in patients with HNC. Real-world data on the treatment patterns HNC, and the use and outcomes of ESAs in this population is currently lacking. Methods: SEER Medicare was used to evaluate patients aged ≥65 years with a first diagnosis of HNC between 2002 and 2007. Logistic regression was used to evaluate predictors of treatment. An interrupted time series was used to estimate the changes in ESA use among patients receiving chemotherapy over time. Propensity weighted models predicted survival, thromboembolism (TEE), and disease recurrence outcomes associated with ESA exposure. Results: Characteristics associated with no treatment for HNC included being unmarried (adjusted OR=2.00, 95% CI: 1.75, 2.27) or African American (adjusted OR=1.65, 95% CI: 1.37, 1.98). ESA use was 50.0% among patients receiving chemotherapy and 3.1% among patients not receiving chemotherapy. ESA use was 50.0% among patients receiving chemotherapy and 3.1% among patients not receiving chemotherapy. Combination regimens such as cetuximab+taxane+platinum (63.8%) and taxane+platinum (56.0%) were associated with the highest rates of ESA use, while single-agent cetuximab was associated with the lowest rate of ESA use (22.3%). Use of ESAs significantly declined from 40.3% of patients receiving chemotherapy in January 2007 to 16.7% in August 2007. Patients receiving an ESA were more likely to have a TEE (adjusted HR=1.19 [95% CI: 1.31, 1.81), experience disease recurrence (adjusted HR=1.09 [95% CI: 1.00, 1.16]), or die (adjusted HR=1.17 [95% CI: 1.06, 1.30]). Discussion: Disparities in the diagnosis and treatment of patients with HNC were present, despite the uniform insurance status of patients in the database. Significant declines in ESA occurred following FDA action in January 2007. ESA use increased among HNC patients in the immediate aftermath of previous disclosure of negative trial data (June 2003). ESAs may be associated with modestly worsened outcomes in HNC. Advisors/Committee Members: Stayner, Leslie T. (advisor), Lee, Todd A. (committee member), Rauscher, Garth H. (committee member), Reda, Domenic J. (committee member), Schumock, Glen T. (committee member), Zinner, Ralph G. (committee member).

Subjects/Keywords: SEER Medicare; head and neck cancer; HNC; erythropoietin stimulating agents; anemia; supportive care; ESAs; cetuximab; disparities; chemotherapy; radiation

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6^th Edition):

Monberg, M. J. (2016). Evaluation of the Patterrns and Risks of Erythropoietin Stimulating Agents in Head and Neck Cancers. (Thesis). University of Illinois – Chicago. Retrieved from http://hdl.handle.net/10027/20886

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Chicago Manual of Style (16^th Edition):

Monberg, Matthew J. “Evaluation of the Patterrns and Risks of Erythropoietin Stimulating Agents in Head and Neck Cancers.” 2016. Thesis, University of Illinois – Chicago. Accessed March 05, 2021. http://hdl.handle.net/10027/20886.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

MLA Handbook (7^th Edition):

Monberg, Matthew J. “Evaluation of the Patterrns and Risks of Erythropoietin Stimulating Agents in Head and Neck Cancers.” 2016. Web. 05 Mar 2021.

Vancouver:

Monberg MJ. Evaluation of the Patterrns and Risks of Erythropoietin Stimulating Agents in Head and Neck Cancers. [Internet] [Thesis]. University of Illinois – Chicago; 2016. [cited 2021 Mar 05]. Available from: http://hdl.handle.net/10027/20886.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Council of Science Editors:

Monberg MJ. Evaluation of the Patterrns and Risks of Erythropoietin Stimulating Agents in Head and Neck Cancers. [Thesis]. University of Illinois – Chicago; 2016. Available from: http://hdl.handle.net/10027/20886

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

5. Osterbur, Elaina. Case-control studies of vaginal and vulvar cancers and gynecologic screening: A SEER-Medicare analysis.

Degree: PhD, 0349, 2013, University of Illinois – Urbana-Champaign

URL: http://hdl.handle.net/2142/42206

► The efficacy of performing pelvic examinations and Pap smears screening (gynecologic screening) in older women has been strongly debated among researchers and policymakers. Because of… (more)

▼ The efficacy of performing pelvic examinations and Pap smears screening (gynecologic screening) in older women has been strongly debated among researchers and policymakers. Because of the rare nature of invasive vaginal and vulvar cancers, few epidemiological studies have been performed on this group (Mabuchi, et al. 1985, Brinton, et al. 1990a, Brinton, et al. 1990b) to determine if gynecologic screening reduces the risk of invasive vaginal and vulvar cancers. Previous studies, that have been published, utilized simulated mathematical models and small case-control designs to determine the etiology of vaginal and vulvar cancers, rather than to determine the efficacy of gynecologic screening. This study utilized two large national population-based linked databases: the Medicare data set supported by the Centers for Medicare and Medicaid (CMS) and the Surveillance Epidemiology and End Results Registries (SEER) data set sponsored by the National Cancer Institute (NCI). The study cases included female Medicare beneficiaries with invasive vaginal and vulvar cancers diagnosed between 1991 and 1999 by the SEER Registries (representing approximately 14% of the United States population) who were 65 years or over and Medicare eligible. The age and residence matched controls were selected from a five-percent (5%) Medicare sample of female beneficiaries 65 years or older, who received care between 1991 and 1999, had not been diagnosed with cancer, and resided in the SEER areas. This matched case-control design utilized incident vaginal (N=328) and vulvar (N=1,103) cancer cases, respectively from the Surveillance, Epidemiology and End Results (SEER). The study identified vaginal (N=2,624) and vulvar (N=8,825) cancer controls that were matched on age and geographical location to the cases. This study included women, covered by Medicare, who were enrolled in both Parts A and B coverage. These two matched case-control studies compared cases of persons diagnosed with invasive vaginal or vulvar cancers with non-cancer controls who had not been diagnosed with cancer. The purpose was to investigate whether they had a history of gynecologic screening during the estimated combined duration of the pre-invasive detectable phase (PIDP) when screening is most beneficial, which occurs prior to the occult invasive phase (OIP) (Weiss, 1999). Stratified analysis suggested that Pap smear and pelvic examination screenings have a stronger negative association among regional (odds ratio (OR) 0.78, 95% CI 0.40-1.51), distant (OR 0.31, 95% CI 0.09-1.03) and unstaged (OR 0.86, 95% CI 0.43-1.70) invasive vaginal cancers. Similar findings were observed for vulvar cancers suggesting that gynecological screening reduced the risk of regional (OR 0.71, 95% CI 0.51-1.00), distant (OR 0.68, 95% CI 0.27-1.70) and unstaged (OR 0.77, 95% CI 0.37-1.59) cancer stages. Borderline significant results were observed among women with invasive vaginal distant stage disease, as well as invasive vulvar regional stage disease. These findings suggest that… Advisors/Committee Members: Rosenblatt, Karin (advisor), Rosenblatt, Karin (Committee Chair), Douglas, Jeffrey A. (committee member), Rich, Robert F. (committee member), Armstrong, Jocelyn (committee member).

Subjects/Keywords: Vaginal cancer; vulvar cancer; gynecologic cancers; Pap smear; pelvic examinations; Surveillance Epidemiology and End Results Registries (SEER-Medicare)

…Centers for Medicare and Medicaid (CMS)) should be consistent in age… …study This study utilized two large national population-based linked databases: the Medicare… …data set supported by the Centers for Medicare and Medicaid (CMS) and the… …Surveillance Epidemiology and End Results (SEER) data set funded by the National Cancer… …vaginal and vulvar cancers diagnosed between 1991 and 1999 by the SEER Registries (…

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6^th Edition):

Osterbur, E. (2013). Case-control studies of vaginal and vulvar cancers and gynecologic screening: A SEER-Medicare analysis. (Doctoral Dissertation). University of Illinois – Urbana-Champaign. Retrieved from http://hdl.handle.net/2142/42206

Chicago Manual of Style (16^th Edition):

Osterbur, Elaina. “Case-control studies of vaginal and vulvar cancers and gynecologic screening: A SEER-Medicare analysis.” 2013. Doctoral Dissertation, University of Illinois – Urbana-Champaign. Accessed March 05, 2021. http://hdl.handle.net/2142/42206.

MLA Handbook (7^th Edition):

Osterbur, Elaina. “Case-control studies of vaginal and vulvar cancers and gynecologic screening: A SEER-Medicare analysis.” 2013. Web. 05 Mar 2021.

Vancouver:

Osterbur E. Case-control studies of vaginal and vulvar cancers and gynecologic screening: A SEER-Medicare analysis. [Internet] [Doctoral dissertation]. University of Illinois – Urbana-Champaign; 2013. [cited 2021 Mar 05]. Available from: http://hdl.handle.net/2142/42206.

Council of Science Editors:

Osterbur E. Case-control studies of vaginal and vulvar cancers and gynecologic screening: A SEER-Medicare analysis. [Doctoral Dissertation]. University of Illinois – Urbana-Champaign; 2013. Available from: http://hdl.handle.net/2142/42206

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