Grant Number:	2R01CA081379-04 Interpret this number
Primary Investigator:	Nattinger, Ann
Organization:	Medical College Of Wisconsin
Project Title:	Outcomes of Older Women with Early Stage Breast Cancer
Fiscal Year:	2004

DESCRIPTION (provided by applicant): Breast cancer surgery in the U.S. exhibits little regionalization, with a large number of low volume providers. Several studies now show that higher surgeon volume of cases is associated with better 5-year survival. These studies suggest that the patients of surgeons performing at least 15-30 breast cancer operations annually have a 25% lower risk of all cause mortality. While these findings are important, the surgeon volume-outcome relationship requires further investigation before major policy initiatives are proposed. The possible contribution of selection bias to the observed relationship requires more study. Higher volume surgeons care for patients of higher socioeconomic status, the effect of which has been controlled for only ecologically. Disease recurrence, an outcome less subject to bias than is all-cause mortality, has not been studied. There is little understanding of what processes of care contribute to the volume-outcome association. This proposal aims: Specific Aim 1. To examine the relationship of surgeon volume and the 5-year outcomes of overall mortality and disease recurrence among women undergoing incident breast cancer surgery, controlling for age, ethnicity and race, patient-level SES and insurance coverage, extent of disease, and comorbidity. Specific Aim 2. To examine the effectiveness and cost-effectiveness of long-term hormonal adjuvant therapy (e.g. tamoxifen) among a population-based sample of older women with incident breast cancer, as well as the extent to which hormonal therapy accounts for any observed surgeon volume-outcome relationship. Specific Aim 3. To examine variations in care received by older women undergoing incident breast cancer surgery, and to examine the relationship between multiple initial processes of care and outcomes (death, recurrent disease, quality of life, functional status) at 18, 30, 48, and 60 months. Specific Aim 4. To describe the relationship between cost of alternative initial processes of breast cancer care and outcomes among older women, as well as the implications of these relationships for policy initiatives. These aims will be accomplished by studying a population-based sample of older women with incident breast cancer including measures derived from Medicare files, patient survey, and tumor registry data. The results will be critical to informing policy initiatives, including determination of how to best reduce socioeconomic disparities in breast cancer outcomes.




The interplay between hospital and surgeon factors and the use of sentinel lymph node biopsy for breast cancer.
Authors: Yen T.W. , Li J. , Sparapani R.A. , Laud P.W. , Nattinger A.B. .
Source: Medicine, 2016 Aug; 95(31), p. e4392.
PMID: 27495053
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Identifying patterns of breast cancer care provided at high-volume hospitals: a classification and regression tree analysis.
Authors: Kong A.L. , Pezzin L.E. , Nattinger A.B. .
Source: Breast Cancer Research And Treatment, 2015 Oct; 153(3), p. 689-98.
PMID: 26409836
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An algorithm to identify the development of lymphedema after breast cancer treatment.
Authors: Yen T.W. , Laud P.W. , Sparapani R.A. , Li J. , Nattinger A.B. .
Source: Journal Of Cancer Survivorship : Research And Practice, 2015 Jun; 9(2), p. 161-71.
PMID: 25187004
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Quality of life among a population-based cohort of older patients with breast cancer.
Authors: Neuner J.M. , Zokoe N. , McGinley E.L. , Pezzin L.E. , Yen T.W. , Schapira M.M. , Nattinger A.B. .
Source: Breast (edinburgh, Scotland), 2014 Oct; 23(5), p. 609-16.
PMID: 25034932
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Surgeon specialization and use of sentinel lymph node biopsy for breast cancer.
Authors: Yen T.W. , Laud P.W. , Sparapani R.A. , Nattinger A.B. .
Source: Jama Surgery, 2014 Feb; 149(2), p. 185-92.
PMID: 24369337
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Fracture risk and adjuvant hormonal therapy among a population-based cohort of older female breast cancer patients.
Authors: Neuner J.M. , Yen T.W. , Sparapani R.A. , Laud P.W. , Nattinger A.B. .
Source: Osteoporosis International : A Journal Established As Result Of Cooperation Between The European Foundation For Osteoporosis And The National Osteoporosis Foundation Of The Usa, 2011 Nov; 22(11), p. 2847-55.
PMID: 21170643
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Socioeconomic and racial differences in treatment for breast cancer at a low-volume hospital.
Authors: Kong A.L. , Yen T.W. , Pezzin L.E. , Miao H. , Sparapani R.A. , Laud P.W. , Nattinger A.B. .
Source: Annals Of Surgical Oncology, 2011 Oct; 18(11), p. 3220-7.
PMID: 21861226
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Socioeconomic factors associated with adjuvant hormone therapy use in older breast cancer survivors.
Authors: Yen T.W. , Czypinski L.K. , Sparapani R.A. , Guo C. , Laud P.W. , Pezzin L.E. , Nattinger A.B. .
Source: Cancer, 2011-01-15 00:00:00.0; 117(2), p. 398-405.
EPub date: 2011-01-15 00:00:00.0.
PMID: 20824718
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Heightened attention to medical privacy: challenges for unbiased sample recruitment and a possible solution.
Authors: Nattinger A.B. , Pezzin L.E. , Sparapani R.A. , Neuner J.M. , King T.K. , Laud P.W. .
Source: American Journal Of Epidemiology, 2010-09-15 00:00:00.0; 172(6), p. 637-44.
EPub date: 2010-09-15 00:00:00.0.
PMID: 20660123
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Elderly breast cancer survivors accurately self-report key treatment information.
Authors: Yen T.W. , Sparapani R.A. , Guo C. , Neuner J.M. , Laud P.W. , Nattinger A.B. .
Source: Journal Of The American Geriatrics Society, 2010 Feb; 58(2), p. 410-2.
PMID: 20370882
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The economic consequences of breast cancer adjuvant hormonal treatments.
Authors: Pezzin L.E. , O'Niel M.B. , Nattinger A.B. .
Source: Journal Of General Internal Medicine, 2009 Nov; 24 Suppl 2, p. S446-50.
PMID: 19838848
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A contemporary, population-based study of lymphedema risk factors in older women with breast cancer.
Authors: Yen T.W. , Fan X. , Sparapani R. , Laud P.W. , Walker A.P. , Nattinger A.B. .
Source: Annals Of Surgical Oncology, 2009 Apr; 16(4), p. 979-88.
PMID: 19194754
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Exploring the surgeon volume outcome relationship among women with breast cancer.
Authors: Nattinger A.B. , Laud P.W. , Sparapani R.A. , Zhang X. , Neuner J.M. , Gilligan M.A. .
Source: Archives Of Internal Medicine, 2007-10-08 00:00:00.0; 167(18), p. 1958-63.
PMID: 17923595
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Relationship between number of breast cancer operations performed and 5-year survival after treatment for early-stage breast cancer.
Authors: Gilligan M.A. , Neuner J. , Zhang X. , Sparapani R. , Laud P.W. , Nattinger A.B. .
Source: American Journal Of Public Health, 2007 Mar; 97(3), p. 539-44.
PMID: 17267725
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Surgeon characteristics and variations in treatment for early-stage breast cancer.
Authors: Gilligan M.A. , Neuner J. , Sparapani R. , Laud P.W. , Nattinger A.B. .
Source: Archives Of Surgery (chicago, Ill. : 1960), 2007 Jan; 142(1), p. 17-22.
PMID: 17224496
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Bone density testing in older women and its association with patient age.
Authors: Neuner J.M. , Binkley N. , Sparapani R.A. , Laud P.W. , Nattinger A.B. .
Source: Journal Of The American Geriatrics Society, 2006 Mar; 54(3), p. 485-9.
PMID: 16551317
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Decentralization of breast cancer surgery in the United States.
Authors: Neuner J.M. , Gilligan M.A. , Sparapani R. , Laud P.W. , Haggstrom D. , Nattinger A.B. .
Source: Cancer, 2004-09-15 00:00:00.0; 101(6), p. 1323-9.
PMID: 15368323
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