|Grant Number:||5UC2CA148185-02 Interpret this number|
|Primary Investigator:||Weeks, Jane|
|Organization:||Dana-Farber Cancer Inst|
|Project Title:||Building Cer Capacity: Aligning Crn, Cms, and State Resources to Map Cancer Care|
DESCRIPTION (Provided by the applicant): Through a partnership between investigators in the Cancer Research Network (CRN) and Dana-Farber/Harvard Cancer Center, we propose to develop a resource with sufficient depth and breadth to support high quality cancer comparative effectiveness research (CER) addressing two key knowledge gaps. First, we will focus on treatment of advanced disease. Advanced cancer results in the bulk of deaths, morbidity, and expenditures. Moreover, the evidence base for treatment of advanced disease is often thin and based on expert consensus achieved through extrapolation from small efficacy studies in highly selected cohorts. The second key gap we will address is the relative dearth of population-based research on patterns and outcomes of cancer care for patients who aren't represented in SEER-Medicare, the dominant data source in the field, namely, patients younger than 65, those receiving their care in an HMO, and the poor. We will capitalize on pre-existing infrastructure with focused activities aimed at selective enhancement of resources to support CER studies in patients with advanced cancer. Specifically, we will: Aim 1. Build broad capacity by assembling national data sets (CRN, SEER-Medicare, Medicaid, and NCCN) to support studies of patterns of care and outcomes among patients with advanced cancer and developing, validating, and implementing strategies to enhance the accuracy of key data elements; Aim 2. In one region (California) augment the patient level data from the national sources in Aim 1 with regional data on supply to build a comprehensive cancer "map" of the region; Aim 3. Test capacity and understand limitations of the data systems assembled in Specific Aims 1 and 2 by conducting 5 "use case" analyses that describe patterns of care for select decisions in advanced cancer that span the major treatment modalities, have significant clinical or economic ramifications, and are likely influenced by patient, provider, and/or health system factors; and Aim 4. Launch CE analyses that capitalize on the resources developed and tested in Aims 1-3 by (a) conducting analyses to fully determine the CE of two interventions for advanced cancer, (b) designing and vetting a CE trial appropriate for the CRN, and (c) partnering with NCI to convene a national stakeholders meeting where project data will be presented and strategies for future CER research in cancer discussed. This project will create a sustainable resource for cancer CER, generate new and improved methods to help advance the field of cancer CER, and provide insights into the nature and causes of variation in important patterns of cancer care. It will also lay the groundwork for future cancer CER research by exploring the feasibility of CE trials in the CRN and engaging national stakeholders in a discussion of future research directions. PUBLIC HEALTH RELEVANCE: Advanced cancer is an ideal topic for comparative effectiveness research because the existing evidence base is less well-developed than for early disease, and the potential impact of CER therefore greater. The primary beneficiaries of this work will be cancer patients, since a better understanding of the most effective strategies of care could lead to meaningful improvements in the length and quality of their lives. But policy-makers and taxpayers could benefit as well, if this research reveals that patients at the end of life are receiving care that is not only ineffective, but also costly.
Changes in body mass index and stoma related problems in the elderly.
Authors: Skeps R, McMullen CK, Wendel CS, Bulkley J, Grant M, Mohler J, Hornbrook MC, Krouse RS, Herrinton LJ
Source: J Geriatr Oncol, 2013 Jan;4(1), p. 84-9.
EPub date: 2012 Oct 27.
A standardized relative resource cost model for medical care: application to cancer control programs.
Authors: O'Keeffe-Rosetti MC, Hornbrook MC, Fishman PA, Ritzwoller DP, Keast EM, Staab J, Lafata JE, Salloum R
Source: J Natl Cancer Inst Monogr, 2013;2013(46), p. 106-16.
The challenge of conducting comparative effectiveness research in cancer: the impact of a fragmented U.S. health-care system.
Authors: Fishman PA, Hornbrook MC, Ritzwoller DP, O'Keeffe-Rosetti MC, Lafata JE, Salloum RG
Source: J Natl Cancer Inst Monogr, 2013;2013(46), p. 99-105.
A meta-analysis of randomized trials: immediate stent placement vs. surgical bypass in the palliative management of malignant biliary obstruction.
Authors: Glazer ES, Hornbrook MC, Krouse RS
Source: J Pain Symptom Manage, 2014 Feb;47(2), p. 307-14.
EPub date: 2013 Jul 3.
Underuse of hospice care by Medicaid-insured patients with stage IV lung cancer in New York and California.
Authors: Mack JW, Chen K, Boscoe FP, Gesten FC, Roohan PJ, Weeks JC, Schymura MJ, Schrag D
Source: J Clin Oncol, 2013 Jul 10;31(20), p. 2569-79.
EPub date: 2013 Jun 3.
Validating Billing/Encounter Codes as Indicators of Lung, Colorectal, Breast, and Prostate Cancer Recurrence Using 2 Large Contemporary Cohorts.
Authors: Hassett MJ, Ritzwoller DP, Taback N, Carroll N, Cronin AM, Ting GV, Schrag D, Warren JL, Hornbrook MC, Weeks JC
Source: Med Care, 2012 Dec 6;null, p. null.
EPub date: 2012 Dec 6.
When does an episode of care for cancer begin?
Authors: Hornbrook MC, Fishman PA, Ritzwoller DP, Elston-Lafata J, O'Keeffe-Rosetti MC, Salloum RG
Source: Med Care, 2013 Apr;51(4), p. 324-9.
Patterns and predictors of first-line chemotherapy use among adults with advanced non-small cell lung cancer in the cancer research network.
Authors: Ritzwoller DP, Carroll NM, Delate T, Hornbrook MC, Kushi L, Aiello Bowles EJ, Freml JM, Huang K, Loggers ET
Source: Lung Cancer, 2012 Dec;78(3), p. 245-52.
EPub date: 2012 Sep 27.
Validation of AJCC TNM staging for breast tumors diagnosed before 2004 in cancer registries.
Authors: Kwan ML, Haque R, Lee VS, Joanie Chung WL, Avila CC, Clancy HA, Quinn VP, Kushi LH
Source: Cancer Causes Control, 2012 Sep;23(9), p. 1587-91.
EPub date: 2012 Jul 14.
Evidence gaps in advanced cancer care: community-based clinicians' perspectives and priorities for CER.
Authors: Lowry SJ, Loggers ET, Bowles EJ, Wagner EH
Source: Am J Manag Care, 2012 May;18(5 Spec No. 2), p. SP77-83.
Validation of electronic data on chemotherapy and hormone therapy use in HMOs.
Authors: Ritzwoller DP, Carroll N, Delate T, O'Keeffe-Rossetti M, Fishman PA, Loggers ET, Aiello Bowles EJ, Elston-Lafata J, Hornbrook MC
Source: Med Care, 2013 Oct;51(10), p. e67-73.
Carboplatin and paclitaxel with vs without bevacizumab in older patients with advanced non-small cell lung cancer.
Authors: Zhu J, Sharma DB, Gray SW, Chen AB, Weeks JC, Schrag D
Source: JAMA, 2012 Apr 18;307(15), p. 1593-601.