Grant Number:	1R01CA134964-01 Interpret this number
Primary Investigator:	Hershman, Dawn
Organization:	Columbia University Health Sciences
Project Title:	Determinants and Risks of Use and Overuse of Expensive Oncology Drugs
Fiscal Year:	2008

DESCRIPTION (provided by applicant): The past decade has witnessed the introduction of multiple new therapies for the treatment and supportive care of cancer patients. However, studies suggest that some cancer patients do not receive these newer, more effective treatments while others are offered these costly treatments without evidence of survival or quality-of-life benefit. While under-use has been evaluated to some degree in the setting of potentially life- saving surgery and chemotherapy, there has been very little evaluation of over-use. Our group has previously had extensive experience using the SEER-Medicare database to explore the utilization patterns of cancer treatments proven to be efficacious. We now propose to extend our studies to evaluate over-use of these newer, costly therapies. Because of the economc implications, issues concerning the appropriate use and over-use of expensive new cancer treatment and technology is of great interest. We propose to use the linked Surveillance, Epidemiology and End Results (SEER)-Medicare database to evaluate several important new costly therapies for their patterns of "appropriate use", over-use", benefits and toxicities. The treatments we will investigate have published evidence-based clinical guidelines advising appropriate use: (1) use of IV bisphosphonates (pamidronate/zoledronate) in patients with multiple myeloma or solid tumors with bone metastases; (2) use of erythrocyte stimulating agents (ESA's) in several common cancers; (3) use of the first anti-tumor antibody, rituximab (Rituxan), in patients with high and low grade lymphoma. In addition, for each of these agents we will identify the impact of patient (race, age, socioeconomic status), tumor (stage, grade), health system (teaching hospital, cancer center) and physician characteristics (specialty, age, gender) on the patterns of use, length of use and off-label use. This study will use a retrospective cohort design using the most updated SEER-Medicare and the American Medical Association Master file. In order to improve performance outcomes and quality of care while controlling health care costs, we need to understand patterns of care so that targeted interventions to improve quality can be implemented. The information obtained will help guide policy makers to improve the reglation of the use of the increasing cadre of treatment options for cancer treatments. PERFORMANCE SITE(S) Columbia University Medical Center, NY, NY. The past decade has witnessed the introduction of multiple new therapies for the treatment and supportive care of cancer patients. However, studies suggest that some cancer patients do not receive these newer, effective treatments while others are offered these costly treatments without evidence of benefit. We propose to use the linked Surveillance, Epidemiology and End Results (SEER)-Medicare database to evaluate several important new costly therapies for their patterns of "appropriate use", over-use", benefits and toxicities. PUBLIC HEALTH RELEVANCE: The past decade has witnessed the introduction of multiple new therapies for the treatment and supportive care of cancer patients. However, studies suggest that some cancer patients do not receive these newer, effective treatments while others are offered these costly treatments without evidence of benefit. We propose to use the linked Surveillance, Epidemiology and End Results (SEER)-Medicare database to evaluate several important new costly therapies for their patterns of "appropriate use", "over-use", benefits and toxicities




Association of Cardiovascular Risk Factors With Cardiac Events and Survival Outcomes Among Patients With Breast Cancer Enrolled in SWOG Clinical Trials.
Authors: Hershman D.L. , Till C. , Shen S. , Wright J.D. , Ramsey S.D. , Barlow W.E. , Unger J.M. .
Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2018-09-10 00:00:00.0; 36(26), p. 2710-2717.
EPub date: 2018-03-27 00:00:00.0.
PMID: 29584550
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History of Diabetes and Survival Outcome Among Participants 65 Years or Older in SWOG Clinical Trials.
Authors: Hershman D.L. , Till C. , Wright J.D. , Ramsey S. , Barlow W.E. , Unger J.M. .
Source: Jco Clinical Cancer Informatics, 2017 11; 1, p. 1-12.
PMID: 30657402
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Factors and Costs Associated With Delay in Treatment Initiation and Prolonged Length of Stay With Inpatient EPOCH Chemotherapy in Patients With Hematologic Malignancies.
Authors: Accordino M.K. , Wright J.D. , Vasan S. , Neugut A.I. , Hillyer G.C. , Hershman D.L. .
Source: Cancer Investigation, 2017-03-16 00:00:00.0; 35(3), p. 202-214.
EPub date: 2017-02-06 00:00:00.0.
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Utilization Of Sentinel Lymph Node Biopsy For Uterine Cancer
Authors: Wright J.D. , Cham S. , Chen L. , Burke W.M. , Hou J.Y. , Tergas A.I. , Desai V. , Hu J.C. , Ananth C.V. , Neugut A.I. , et al. .
Source: American Journal Of Obstetrics And Gynecology, 2017-02-16 00:00:00.0; , .
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Long-term Consequences of Finasteride vs Placebo in the Prostate Cancer Prevention Trial.
Authors: Unger J.M. , Till C. , Thompson I.M. , Tangen C.M. , Goodman P.J. , Wright J.D. , Barlow W.E. , Ramsey S.D. , Minasian L.M. , Hershman D.L. .
Source: Journal Of The National Cancer Institute, 2016 Dec; 108(12), .
EPub date: 2016-08-26 00:00:00.0.
PMID: 27565902
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Utilization and Outcomes of Sentinel Lymph Node Biopsy for Vulvar Cancer.
Authors: Cham S. , Chen L. , Burke W.M. , Hou J.Y. , Tergas A.I. , Hu J.C. , Ananth C.V. , Neugut A.I. , Hershman D.L. , Wright J.D. .
Source: Obstetrics And Gynecology, 2016 Oct; 128(4), p. 754-60.
PMID: 27607871
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Comorbidities And Risk Of Chemotherapy-induced Peripheral Neuropathy Among Participants 65 Years Or Older In Southwest Oncology Group Clinical Trials
Authors: Hershman D.L. , Till C. , Wright J.D. , Awad D. , Ramsey S.D. , Barlow W.E. , Minasian L.M. , Unger J. .
Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2016-09-01 00:00:00.0; 34(25), p. 3014-22.
PMID: 27325863
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Trends in Use and Outcomes of Women Undergoing Hysterectomy With Electric Power Morcellation.
Authors: Wright J.D. , Chen L. , Burke W.M. , Hou J.Y. , Tergas A.I. , Ananth C.V. , Hershman D.L. .
Source: Jama, 2016 Aug 23-30; 316(8), p. 877-8.
PMID: 27552622
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Overuse of external beam radiotherapy for stage I endometrial cancer.
Authors: Wright J.D. , Margolis B. , Hou J.Y. , Burke W.M. , Tergas A.I. , Huang Y. , Hu J.C. , Ananth C.V. , Neugut A.I. , Hershman D.L. .
Source: American Journal Of Obstetrics And Gynecology, 2016 Jul; 215(1), p. 75.e1-7.
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Utilization and Outcomes of Chemotherapy in Women With Intermediate-Risk, Early-Stage Ovarian Cancer.
Authors: Chatterjee S. , Chen L. , Tergas A.I. , Burke W.M. , Hou J.Y. , Hu J.C. , Ananth C.V. , Neugut A.I. , Hershman D.L. , Wright J.D. .
Source: Obstetrics And Gynecology, 2016 Jun; 127(6), p. 992-1002.
PMID: 27159756
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Natural history and outcome of neuroendocrine carcinoma of the cervix.
Authors: Margolis B. , Tergas A.I. , Chen L. , Hou J.Y. , Burke W.M. , Hu J.C. , Ananth C.V. , Neugut A.I. , Hershman D.L. , Wright J.D. .
Source: Gynecologic Oncology, 2016 May; 141(2), p. 247-54.
PMID: 26873865
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Psychosocial factors related to non-persistence with adjuvant endocrine therapy among women with breast cancer: the Breast Cancer Quality of Care Study (BQUAL).
Authors: Hershman D.L. , Kushi L.H. , Hillyer G.C. , Coromilas E. , Buono D. , Lamerato L. , Bovbjerg D.H. , Mandelblatt J.S. , Tsai W.Y. , Zhong X. , et al. .
Source: Breast Cancer Research And Treatment, 2016 May; 157(1), p. 133-43.
PMID: 27086286
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Adverse Health Events Following Intermittent and Continuous Androgen Deprivation in Patients With Metastatic Prostate Cancer.
Authors: Hershman D.L. , Unger J.M. , Wright J.D. , Ramsey S. , Till C. , Tangen C.M. , Barlow W.E. , Blanke C. , Thompson I.M. , Hussain M. .
Source: Jama Oncology, 2016 Apr; 2(4), p. 453-61.
PMID: 26720308
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Comparative Effectiveness of Minimally Invasive Hysterectomy for Endometrial Cancer.
Authors: Wright J.D. , Burke W.M. , Tergas A.I. , Hou J.Y. , Huang Y. , Hu J.C. , Hillyer G.C. , Ananth C.V. , Neugut A.I. , Hershman D.L. .
Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2016-04-01 00:00:00.0; 34(10), p. 1087-96.
EPub date: 2016-04-01 00:00:00.0.
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Magnitude of risk for nodal metastasis associated with lymphvascular space invasion for endometrial cancer.
Authors: Jorge S. , Hou J.Y. , Tergas A.I. , Burke W.M. , Huang Y. , Hu J.C. , Ananth C.V. , Neugut A.I. , Hershman D.L. , Wright J.D. .
Source: Gynecologic Oncology, 2016 Mar; 140(3), p. 387-93.
PMID: 26768835
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Trends in Periodic Surveillance Testing for Early-Stage Uterine Cancer Survivors.
Authors: Wright J.D. , Tergas A.I. , Hou J.Y. , Burke W.M. , Huang Y. , Hu J.C. , Hillyer G.C. , Ananth C.V. , Neugut A.I. , Hershman D.L. .
Source: Obstetrics And Gynecology, 2016 Mar; 127(3), p. 449-58.
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Radiation Duration in Women with Cervical Cancer Treated with Primary Chemoradiation: A Population-Based Analysis.
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Source: Cancer Investigation, 2016; 34(3), p. 137-47.
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Economic and Survival Implications of Use of Electric Power Morcellation for Hysterectomy for Presumed Benign Gynecologic Disease.
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Source: Journal Of The National Cancer Institute, 2015 Nov; 107(11), .
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Use and duration of chemotherapy and its impact on survival in early-stage ovarian cancer.
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Uterine pathology in women undergoing minimally invasive hysterectomy using morcellation.
Authors: Wright J.D. , Tergas A.I. , Burke W.M. , Cui R.R. , Ananth C.V. , Chen L. , Hershman D.L. .
Source: Jama, 2014-09-24 00:00:00.0; 312(12), p. 1253-5.
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Erythropoiesis-stimulating agent use after changes in medicare reimbursement policies.
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Safety and tolerance of radical hysterectomy for cervical cancer in the elderly.
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An economic analysis of robotically assisted hysterectomy.
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Comparative effectiveness of upfront treatment strategies in elderly women with ovarian cancer.
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Patterns of use of hemostatic agents in patients undergoing major surgery.
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Source: The Journal Of Surgical Research, 2014 Jan; 186(1), p. 458-66.
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Use of guideline-based antibiotic prophylaxis in women undergoing gynecologic surgery.
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Source: Obstetrics And Gynecology, 2013 Dec; 122(6), p. 1145-53.
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Failure to rescue after major gynecologic surgery.
Authors: Wright J.D. , Ananth C.V. , Ojalvo L. , Herzog T.J. , Lewin S.N. , Lu Y.S. , Neugut A.I. , Hershman D.L. .
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Carcinosarcoma of the ovary: natural history, patterns of treatment, and outcome.
Authors: George E.M. , Herzog T.J. , Neugut A.I. , Lu Y.S. , Burke W.M. , Lewin S.N. , Hershman D.L. , Wright J.D. .
Source: Gynecologic Oncology, 2013 Oct; 131(1), p. 42-5.
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Contraindicated use of bevacizumab and toxicity in elderly patients with cancer.
Authors: Hershman D.L. , Wright J.D. , Lim E. , Buono D.L. , Tsai W.Y. , Neugut A.I. .
Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2013-10-01 00:00:00.0; 31(28), p. 3592-9.
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Utilization and safety of sodium hyaluronate-carboxymethylcellulose adhesion barrier.
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Source: Diseases Of The Colon And Rectum, 2013 Oct; 56(10), p. 1174-84.
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Prognostic significance of mucinous differentiation of endometrioid adenocarcinoma of the endometrium.
Authors: Galic V. , Schiavone M.B. , Herzog T.J. , Holcomb K. , Lewin S.N. , Lu Y.S. , Neugut A.I. , Hershman D.L. , Wright J.D. .
Source: Cancer Investigation, 2013 Aug; 31(7), p. 500-4.
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Nationwide trends in the performance of inpatient hysterectomy in the United States.
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Source: Obstetrics And Gynecology, 2013 Aug; 122(2 Pt 1), p. 233-41.
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Uptake And Outcomes Of Intensity-modulated Radiation Therapy For Uterine Cancer
Authors: Wright J.D. , Deutsch I. , Wilde E.T. , Ananth C.V. , Neugut A.I. , Lewin S.N. , Siddiq Z. , Herzog T.J. , Hershman D.L. .
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Trends in hospital volume and patterns of referral for women with gynecologic cancers.
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Source: Obstetrics And Gynecology, 2013 Jun; 121(6), p. 1217-25.
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Deviations from guideline-based therapy for febrile neutropenia in cancer patients and their effect on outcomes.
Authors: Wright J.D. , Neugut A.I. , Ananth C.V. , Lewin S.N. , Wilde E.T. , Lu Y.S. , Herzog T.J. , Hershman D.L. .
Source: Jama Internal Medicine, 2013-04-08 00:00:00.0; 173(7), p. 559-68.
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Variation In Ovarian Conservation In Women Undergoing Hysterectomy For Benign Indications
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Robotically Assisted Vs Laparoscopic Hysterectomy Among Women With Benign Gynecologic Disease
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Influence Of Health Insurance, Hospital Factors And Physician Volume On Receipt Of Immediate Post-mastectomy Reconstruction In Women With Invasive And Non-invasive Breast Cancer
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Source: Breast Cancer Research And Treatment, 2012 Nov; 136(2), p. 535-45.
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Effect Of Radical Cytoreductive Surgery On Omission And Delay Of Chemotherapy For Advanced-stage Ovarian Cancer
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Source: Obstetrics And Gynecology, 2012 Oct; 120(4), p. 871-81.
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Use And Benefits Of Laparoscopic Hysterectomy For Stage I Endometrial Cancer Among Medicare Beneficiaries
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Source: Journal Of Oncology Practice / American Society Of Clinical Oncology, 2012 Sep; 8(5), p. e89-99.
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Uptake Of Oxaliplatin And Bevacizumab For Treatment Of Node-positive And Metastatic Colon Cancer
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Source: Journal Of Oncology Practice / American Society Of Clinical Oncology, 2012 May; 8(3), p. 156-63.
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Comparative Effectiveness Of Robotic Versus Laparoscopic Hysterectomy For Endometrial Cancer
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Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2012-03-10 00:00:00.0; 30(8), p. 783-91.
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Uptake And Economic Impact Of First-cycle Colony-stimulating Factor Use During Adjuvant Treatment Of Breast Cancer
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Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2012-03-10 00:00:00.0; 30(8), p. 806-12.
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Physician Characteristics And Variability Of Erythropoiesis-stimulating Agent Use Among Medicare Patients With Cancer
Authors: Wright,J.D. , Neugut,A.I. , Wilde,E.T. , Buono,D.L. , Malin,J. , Tsai,W.Y. , Hershman,D.L. .
Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2011-09-01 00:00:00.0; 29(25), p. 3408-18.
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Comparative Effectiveness Of Screening And Prevention Strategies Among Brca1/2-affected Mutation Carriers
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Source: Breast Cancer Research And Treatment, 2011 Feb; 125(3), p. 837-47.
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Influence Of Private Practice Setting And Physician Characteristics On The Use Of Breast Cancer Adjuvant Chemotherapy For Elderly Women
Authors: Hershman,D.L. , Buono,D. , McBride,R.B. , Tsai,W.Y. , Neugut,A.I. .
Source: Cancer, 2009-09-01 00:00:00.0; 115(17), p. 3848-57.
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Surgeon Characteristics And Use Of Breast Conservation Surgery In Women With Early Stage Breast Cancer
Authors: Hershman,D.L. , Buono,D. , Jacobson,J.S. , McBride,R.B. , Tsai,W.Y. , Joseph,K.A. , Neugut,A.I. .
Source: Annals Of Surgery, 2009 May; 249(5), p. 828-33.
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