Publications by authors named "Rebeca Franco"

Oncologists routinely have opportunities for goals-of-care (GoC) discussions with patients. GoC discussions increase the likelihood that patients receive care consistent with their values. However, oncologists often feel ill-equipped to discuss end-of-life care.

View Article and Find Full Text PDF

Purpose: To describe the length of encounter during visits where goals-of-care (GoC) discussions were expected to take place.

Methods: Oncologists from community, academic, municipal, and rural hospitals were randomly assigned to receive a coaching model of communication skills to facilitate GoC discussions with patients with newly diagnosed advanced solid-tumor cancer with a prognosis of < 2 years. Patients were surveyed after the first restaging visit regarding the quality of the GoC discussion on a scale of 0-10 (0 = worst; 10 = best), with ≥ 8 indicating a high-quality GoC discussion.

View Article and Find Full Text PDF

Background: Racial disparities in breast cancer survival between Black and White women persist across all stages of breast cancer. The metabolic syndrome (MetS) of insulin resistance disproportionately affects more Black than White women. It has not been discerned if insulin resistance mediates the link between race and poor prognosis in breast cancer.

View Article and Find Full Text PDF

Purpose: To study factors that have an impact on the conduct of high-quality goals of care (GoC) discussions and productivity of oncologists among four different practice settings in patients with advanced cancer.

Methods: Solid-tumor oncologists from community, academic, municipal, and rural hospitals were randomly assigned to receive a coaching model of communication skills to help them facilitate a GoC discussion with newly diagnosed patients with advanced cancer who had a less-than-2-year prognosis. Patients were surveyed after the first restaging visit regarding the quality of the GoC discussion on a scale of 0 to 10 (0, worst; 10, best) with a score of 8 or better indicating a high-quality GoC discussion.

View Article and Find Full Text PDF

Introduction: Although breast cancer incidence is higher among white women, black women are more likely to have aggressive tumors with less favorable histology, and to have a worse prognosis. Obesity and alcohol consumption have been identified as two modifiable risk factors for breast cancer, while physical activity may offer protection. Little however is known about the association of these factors with race on the severity of breast cancer.

View Article and Find Full Text PDF

Purpose: Cancer, with readmission rates as high as 27%, has thus far been excluded from most readmission reduction efforts. However, some readmissions for patients with advanced disease may be avoidable. We assessed the prevalence of potentially preventable readmissions and associated factors in patients with metastatic cancer.

View Article and Find Full Text PDF

Purpose: To implement and test a Web-based tracking and feedback (T&F) tool to close referral loops and reduce adjuvant breast cancer treatment underuse in safety-net hospitals (SNHs).

Patient And Methods: We randomly assigned 10 SNHs, identified patients with new stage 1 to stage 3 breast cancer, assessed their connection with the oncologist, and relayed this information to surgeons for follow-up. We interviewed key informants about the tool's usefulness.

View Article and Find Full Text PDF

Under the Affordable Care Act (ACA), more women are insured with Medicaid, which should improve healthcare access. We sought to determine whether there are survival differences among patients with breast cancer undergoing surgery at facilities with varying proportions of Medicaid patients. We used New York State (NYS) Vital Statistics death records data linked with NYS discharge inpatient and ambulatory surgery databases to examine 90-day survival after surgery from 2008 to 2013.

View Article and Find Full Text PDF
Article Synopsis
  • Studies indicate that while statin use may lower the risk of breast cancer recurrence and improve survival, there is insufficient data on racial disparities in prognosis related to statin use.
  • The research consisted of a comparison between 587 women (487 White and 100 Black) recently diagnosed with primary invasive breast cancer, focusing on factors like statin use and tumor characteristics.
  • Findings revealed that although Black women had higher statin usage compared to White women, they also experienced worse prognosis, which was not linked to the differences in pre-diagnosis statin use.
View Article and Find Full Text PDF

Objective: Administrative claims data offer an alternative to chart abstraction to assess ovarian cancer recurrence, treatment and outcomes. Such analyses have been hindered by lack of valid recurrence and treatment algorithms. In this study, we sought to develop claims-based algorithms to identify ovarian cancer recurrence and secondary debulking surgery, and to validate them against the gold-standard of chart abstraction.

View Article and Find Full Text PDF

Objective: To identify key organizational approaches associated with underuse of breast cancer care.

Setting: Nine New York City area safety-net hospitals.

Study Design: Mixed qualitative-quantitative, cross-sectional cohort.

View Article and Find Full Text PDF

Objective: The best course of treatment for recurrent ovarian cancer is uncertain. We sought to determine whether secondary cytoreductive surgery for first recurrence of ovarian cancer improves overall survival compared with other treatments.

Materials And Methods: We assessed survival using Surveillance, Epidemiology and End Results-Medicare data for advanced stage ovarian cancer cases diagnosed from January 1, 1997 to December 31, 2007 with survival data through 2010 using multinomial propensity weighted finite mixture survival regression models to distinguish true from misclassified recurrences.

View Article and Find Full Text PDF

Background: Women with obesity and type 2 diabetes (T2D) are at greater risk of dying from breast cancer than women without these conditions. Obesity and T2D are associated with insulin resistance and endogenous hyperinsulinemia and are more common in Black women. There is increasing disparity in breast cancer mortality between Black and White women in the USA.

View Article and Find Full Text PDF

Background: Despite the survival benefit associated with adjuvant chemotherapy in early-stage breast cancer, many do not complete treatment. This study identified factors associated with noncompletion of adjuvant chemotherapy among a select population of women with early-stage breast cancer.

Methods: The study sample was obtained from a multicenter study designed to evaluate patient-assistance program usage among early-stage breast cancer patients requiring adjuvant therapy.

View Article and Find Full Text PDF

Objective: To evaluate whether overall survival is improving among women in the United States with advanced ovarian cancer.

Methods: This retrospective cohort study evaluated trends in treatment and overall survival for women older than 65 years diagnosed with stage III and IV epithelial ovarian cancer between 1995 and 2008 using Surveillance, Epidemiology, and End Results-Medicare data. Parametric and semiparametric multivariate survival analyses were used to assess comparative treatment survival rates and factors affecting survival and recurrence.

View Article and Find Full Text PDF

Oncotype DX, a 21-gene-array analysis, can guide chemotherapy treatment decisions for women with ER+ tumors. Of 225 ER+ women participating in a patient assistance trial, 23% underwent Oncotype DX testing: 31% of whites, 21% of blacks, and 14% of Hispanics (P = 0.04) were tested.

View Article and Find Full Text PDF

Objective: To examine whether treatment with guideline-recommended care (surgery and chemotherapy) is associated with mortality differences between black and white women with advanced epithelial ovarian cancer.

Methods: We conducted an observational cohort study using the Surveillance, Epidemiology, and End Results (SEER) linked to Medicare claims for 1995-2007. We evaluated long-term survival for 4,695 black and white women with stage III or stage IV epithelial ovarian cancer with Kaplan-Meier analysis and Cox regression, and then in patients matched by propensity score to create two similar cohorts for comparison.

View Article and Find Full Text PDF

Purpose: Patients with breast cancer who need adjuvant treatments often fail to receive them. High-quality, community-based patient-assistance programs are an underused, inexpensive resource to help patients with cancer obtain needed therapy. We sought to determine whether connecting women to patient-assistance programs would reduce underuse of adjuvant therapies.

View Article and Find Full Text PDF

Background: As adjuvant treatment moves to outpatient settings, required reporting is problematic. We undertook a solutions-focused exercise to identify reporting barriers and devise a pilot improvement intervention.

Methods: We convened a multidisciplinary group of community-based oncologists, tumor registry (TR) staff, and hospital leadership.

View Article and Find Full Text PDF

Existing comprehensive patient assistance programs can help cancer patients overcome needs and barriers to care: yet the costs of such programs and who utilizes them is not well described. 333 women with primary early stage breast cancer in New York City either chose to attend or abstain from attending one of these programs. We obtained the operating costs of the most utilized patient assistance program.

View Article and Find Full Text PDF

Objective: Physicians are mandated to offer treatment choices to patients, yet not all patients may want the responsibility that entails. We evaluated predisposing factors for, and long-term consequences of, too much and not enough perceived decision-making responsibility among breast cancer patients.

Design: Longitudinal assessment, with measurements collected just after surgical treatment (baseline) and 6-month follow-up.

View Article and Find Full Text PDF

Purpose: Because insurers use performance and quality metrics to inform reimbursement, identifying remediable causes of poor-quality cancer care is imperative. We undertook this descriptive cohort study to assess key predictors of women's perceived quality of their breast cancer care and actual guideline-concordant quality of care received.

Patients And Methods: We surveyed inner-city women with newly diagnosed and surgically treated early-stage breast cancer requiring adjuvant treatment who were enrolled onto a randomized controlled trial (RCT) of patient assistance to reduce disparities in care.

View Article and Find Full Text PDF

Background: Healthcare accrediting organizations and insurers increasingly require reporting of clinical data, and cancer treatment is one area of enhanced scrutiny.

Objectives: To compare rates of received versus reported adjuvant breast cancer treatments, and to assess barriers to measuring and reporting treatments to the tumor registry (TR) of a high-volume medical center with both hospital-based and community-based oncologists.

Research Design: We calculated rates of received treatments using data collected using chart abstraction (N=115) and compared these with rates of reported treatments from the TR (N=535).

View Article and Find Full Text PDF

Background: The objective of this study was to assess factors that affect breast cancer patients' recall of patient assistance services.

Methods: We surveyed newly-diagnosed breast cancer patients and compared recall of receiving patient assistance services at 2 weeks and 6 months in a patient-assistance randomized controlled trial aimed to connect women to such programs. The intervention group received information about assistance programs targeted to their practical, psychosocial, and/or informational needs; the control group received a Department of Health pamphlet about breast cancer and its treatment, including a list of patient assistance services.

View Article and Find Full Text PDF