Medicare/Medicaid Insurance, Rurality, and Black Race Associated With Provision of Hepatocellular Carcinoma Treatment and Survival.

Background: Early treatment of hepatocellular carcinoma (HCC) is associated with improved survival, but many patients with HCC do not receive therapy. We aimed to examine factors associated with HCC treatment and survival among incident patients with HCC in a statewide cancer registry.

Materials And Methods: All patients with HCC from 2003 through 2013 were identified in the North Carolina cancer registry.

A Refined Model of Stress-Diathesis Relationships in Mothers With Significant Depressive Symptom Severity.

Mothers' depressive symptoms affect their children's growth as well as physical and mental well-being. Moreover, mothers of young children with developmental delay or disability (DD) tend to have higher depressive symptoms. The purpose of this study was to examine associations between maternal depressive symptoms and number of children with DD among mothers with significant levels of depressive symptoms, while accounting for maternal diathesis factors and family stress factors.

Geriatric Assessment Predicts Hospitalization Frequency and Long-Term Care Use in Older Adult Cancer Survivors.

Purpose: The association between geriatric assessment (GA)-identified impairments and long-term health care use in older cancer survivors remains unknown. Our objective was to evaluate whether a GA performed at cancer diagnosis was predictive of hospitalizations and long-term care (LTC) use in older adult cancer survivors.

Methods: Older adults with GA performed between 3 months before through 6 months after diagnosis were included (N = 125).

Care Coordination and Multispecialty Teams in the Care of Colorectal Cancer Patients.

Objectives: To estimate the association between provider and team experience and adherence to guidelines, survival, and utilization among colorectal cancer patients in North Carolina.

Subjects: The analysis cohort included 7295 patients diagnosed with incident stage II/III colorectal cancer between 2004 and 2013 who received surgery.

Methods: Primary outcomes included adherence to guidelines: consultation with a medical oncologist (stage III), receipt of adjuvant chemotherapy (stage III), and receipt of surveillance colonoscopy posttreatment.

Patient-Reported Comorbidity and Survival in Older Adults with Cancer.

Background: Our ability to optimize the care of older adults with cancer and comorbid illnesses is insufficient because most clinical trials lack systematic measurement. The primary purpose of this study was to evaluate the association between patient-reported comorbidity and all-cause mortality using various comorbidity scoring algorithms.

Materials And Methods: The Carolina Senior Registry was linked with the North Carolina Central Cancer Registry to obtain mortality data.

Frailty Index Developed From a Cancer-Specific Geriatric Assessment and the Association With Mortality Among Older Adults With Cancer.

An objective measure is needed to identify frail older adults with cancer who are at increased risk for poor health outcomes. The primary objective of this study was to develop a frailty index from a cancer-specific geriatric assessment (GA) and evaluate its ability to predict all-cause mortality among older adults with cancer. Using a unique and novel data set that brings together GA data with cancer-specific and long-term mortality data, we developed the Carolina Frailty Index (CFI) from a cancer-specific GA based on the principles of deficit accumulation.

Data Linkage to Improve Geriatric Oncology Research: A Feasibility Study.

Older adults (aged 65 years and older) diagnosed with cancer account for most cancer-related morbidity and mortality in the United States but are often underrepresented on clinical trials. Recent attention from a variety of professional, research, regulatory, and patient advocacy groups has centered on data linkage and data sharing as a means to capture patient information and outcomes outside of clinical trials to accelerate progress in the fight against cancer. The development of a more robust observational research data infrastructure would help to address gaps in the evidence base regarding optimal approaches to treating cancer among the growing and complex population of older adults.

Hospice Utilization and Its Effect on Acute Care Needs at the End of Life in Medicare Beneficiaries With Hepatocellular Carcinoma.

Introduction: Hepatocellular carcinoma (HCC) is a poor-prognosis cancer with a high symptom burden. Multidisciplinary HCC care is complex and unique in cancer medicine. We sought to determine whether the distinct process affects hospice use and how hospice affects end-of-life acute care utilization.

Impact of Location of Readmission on Outcomes After Major Cancer Surgery.

Background: The burden of readmissions after major cancer surgery is high. Prior work suggests that one-third of readmitted patients are readmitted to a different hospital than where the surgery was performed. The impact of this location of readmission needs to be more thoroughly understood.

Sorafenib Effectiveness in Advanced Hepatocellular Carcinoma.

Background: Phase III trials show sorafenib improves survival in advanced hepatocellular carcinoma (HCC). Because of narrow trial eligibility, results may not be generalizable to a broader HCC population. We sought to evaluate the effectiveness of initial sorafenib versus no treatment among Medicare beneficiaries with advanced HCC.

Effectiveness of Initial Transarterial Chemoembolization for Hepatocellular Carcinoma Among Medicare Beneficiaries.

Background: Optimal administration of transarterial chemoembolization (TACE), the standard approach for intermediate-stage hepatocellular carcinoma (HCC), requires clinical and technical expertise. We sought to evaluate whether TACE retains its effectiveness when administered across a broad range of health care settings. Furthermore, as the use of yttrium(90) (Y(90)) radioembolization has been increasing, we explored the comparative effectiveness of Y(90) as an alternative to TACE.

Exploring the burden of inpatient readmissions after major cancer surgery.

Purpose: Travel distances to care have increased substantially with centralization of complex cancer procedures at high-volume centers. We hypothesize that longer travel distances are associated with higher rates of postoperative readmission and poorer outcomes.

Methods: SEER-Medicare patients with bladder, lung, pancreas, or esophagus cancer who were diagnosed in 2001 to 2007 and underwent extirpative surgery were included.

Using Procedure Codes to Define Radiation Toxicity in Administrative Data: The Devil is in the Details.

Background: Systematic coding systems are used to define clinically meaningful outcomes when leveraging administrative claims data for research. How and when these codes are applied within a research study can have implications for the study validity and their specificity can vary significantly depending on treatment received.

Subjects: Data are from the Surveillance, Epidemiology, and End Results-Medicare linked dataset.

Provider-based research networks may improve early access to innovative colon cancer treatment for African Americans treated in the community.

Background: African American (AA) patients with colon cancer (CC) experience worse outcomes than whites partly due to differential treatment. The National Cancer Institute's Community Clinical Oncology Program (CCOP), a provider-based research network, adopts and diffuses innovative CC treatments quickly. The authors hypothesized that CCOP participation would lessen racial differences in the receipt of oxaliplatin, an innovative treatment for CC, among patients with stage III CC in the community.

Improving our understanding of the surgical oncology workforce.

Objective: This study characterizes the surgical oncology workforce as a baseline for future workforce projections.

Background: Measuring the capacity of the surgical oncology workforce is difficult due to the wide variety of surgeons who contribute to surgical cancer care. We hypothesize that the bulk of surgical oncology care is provided by general surgeons.

Quality and strength of patient safety climate on medical-surgical units.

Background: Describing the safety climate in hospitals is an important first step in creating work environments where safety is a priority. Yet, little is known about the patient safety climate on medical-surgical units.

Purposes: Study purposes were to describe quality and strength of the patient safety climate on medical-surgical units and explore hospital and unit characteristics associated with this climate.

Informing the dosing of interventions in randomized trials.

Dosing is potentially the most important decision that must be made when building or refining behavioral interventions. In this paper, we propose standardized terminology and reporting of dosing information, which would inform intervention development, refinement for dissemination, and systematic reviews of dose-response relationships. Dosing of interventions may be characterized by duration, frequency, and amount.

Intensity-modulated radiation therapy, proton therapy, or conformal radiation therapy and morbidity and disease control in localized prostate cancer.

Context: There has been rapid adoption of newer radiation treatments such as intensity-modulated radiation therapy (IMRT) and proton therapy despite greater cost and limited demonstrated benefit compared with previous technologies.

Objective: To determine the comparative morbidity and disease control of IMRT, proton therapy, and conformal radiation therapy for primary prostate cancer treatment.

Design, Setting, And Patients: Population-based study using Surveillance, Epidemiology, and End Results-Medicare-linked data from 2000 through 2009 for patients with nonmetastatic prostate cancer.

Effects of learning climate and registered nurse staffing on medication errors.

Background: Despite increasing recognition of the significance of learning from errors, little is known about how learning climate contributes to error reduction.

Objectives: The purpose of this study was to investigate whether learning climate moderates the relationship between error-producing conditions and medication errors.

Methods: A cross-sectional descriptive study was done using data from 279 nursing units in 146 randomly selected hospitals in the United States.

Bayesian data augmentation methods for the synthesis of qualitative and quantitative research findings.

The possible utility of Bayesian methods for the synthesis of qualitative and quantitative research has been repeatedly suggested but insufficiently investigated. In this project, we developed and used a Bayesian method for synthesis, with the goal of identifying factors that influence adherence to HIV medication regimens. We investigated the effect of 10 factors on adherence.

A mixed-methods approach to synthesizing evidence on mediators of intervention effects.

Greater understanding of the mechanisms (mediators) by which behavioral-change interventions work is critical to developing theory and refining interventions. Although systematic reviews have been advocated as a method for exploring mediators, this is rarely done. One challenge is that intervention researchers typically test only two paths of the mediational model: the effect of the intervention on mediators and on outcomes.

Effects of learning climate and registered nurse staffing on medication errors.

Background: Despite increasing recognition of the significance of learning from errors, little is known about how learning climate contributes to error reduction.

Objectives: The purpose of this study was to investigate whether learning climate moderates the relationship between error-producing conditions and medication errors.

Methods: A cross-sectional descriptive study was done using data from 279 nursing units in 146 randomly selected hospitals in the United States.