Biomedical subjects

Jean Freeman

Publications and source records attributed to Jean Freeman.

5 recordsLinked to original sources

PubMed2006

Late gastrointestinal toxicity after radiation for prostate cancer.

BACKGROUND: The current study was designed to determine rates and predictors of late, lower gastrointestinal toxicity after radiation therapy in a population-based cohort of older men with prostate cancer. METHODS: The study population consisted of men with localized or regional stage prostate cancer who were age > or =66 years and were diagnosed between 1992 and 1999 who were identified in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Gastrointestinal diagnoses were ascertained through claims from 6 to 60 months after diagnosis. The relative rates of diagnoses in the radiation group versus the nonradiation group were used as a means of estimating toxicity from radiotherapy. Cox modeling was used to determine factors associated with gastrointestinal diagnoses. RESULTS: A total of 57,955 men were included, 24,130 of whom were treated with radiation therapy. Among patients with 5 years of follow-up, the rates of gastrointestinal diagnoses were 19.4% higher in irradiated patients than among patients who did not have local therapy. Hemorrhage was the most common diagnosis, and was increased by 18.9% among patients treated with radiation (39.6% of irradiated patients vs. comparison rates of 18.2% in patients treated with radical prostatectomy and 20.7% in patients with no local therapy). Diagnostic lower endoscopies were performed in an additional 20.9% of men (32.4% of men treated with radiation vs. 12.7% of men who underwent prostatectomy). In all, 4.4% of irradiated men were hospitalized with a gastrointestinal diagnosis versus comparison rates of 3.2% among men with no local therapy. In multivariate models, increasing patient age, hormonal therapy, comorbidity, diabetes, peripheral vascular disease, and hemorrhoids were all associated with gastrointestinal diagnoses consistent with toxicity, whereas tumor stage and grade were not predictors. CONCLUSIONS: Lower gastrointestinal toxicity after radiation therapy for prostate cancer continues for at least 5 years and may be more common than previously reported.

Adult↗

PubMed2006

Impact of a scientific presentation on community treatment patterns for primary breast cancer.

BACKGROUND: The publication of results from randomized clinical trials can have a dramatic effect on treatment patterns, but the impact of oral presentations at national scientific meetings is unknown. We investigated the temporal association between the oral presentation of the results from the Cancer and Leukemia Group B (CALGB) Study 9344 at the May 1998 meeting of the American Society of Clinical Oncology, which showed that paclitaxel improves survival of women with lymph node-positive breast cancer, and use of taxane chemotherapy for breast cancer. METHODS: We studied chemotherapy use in 3341 women identified through the Surveillance, Epidemiology, and End Results-Medicare database who were diagnosed with stage I-III breast cancer in 1994-1999 at age 65 years or older and received adjuvant chemotherapy, as identified through claims data, within 1 year of diagnosis. We assessed the temporal association between the CALBG presentation and taxane use with piecewise regression analysis. Multivariable logistic regression analysis was used to determine which patient characteristics were associated with taxane use. RESULTS: The use of taxanes increased substantially after the CALGB presentation, with absolute rates of taxane use of 5.2% before May 1998 and 23.6% in May 1998 and later. Initially, this increase was confined to patients with lymph node-positive disease (40% of whom were receiving taxanes by the end of 1999), but over time it extended to patients with lymph node-negative disease (15% of whom were receiving taxanes by the end of 1999). In multivariable analysis, patients who were treated in May 1998 or later were statistically significantly more likely to have received a taxane than patients treated before this date (estimated relative risk = 6.84, 95% confidence interval = 5.71 to 8.07). Younger patient age, larger number of lymph nodes involved, higher tumor grade, and larger tumor size were also independently associated with adjuvant taxane use. CONCLUSIONS: The oral presentation of a single study at a national conference was temporally associated with an increase in the use of taxanes for primary breast cancer, even before study publication or Food and Drug Administration approval.

Aged↗

PubMed2005

Relationship of depression to patient satisfaction: findings from the barriers to breast cancer study.

OBJECTIVE: Examine the association between depressive symptoms and patient satisfaction for older women with a diagnosis of breast cancer. METHODS: Prospective study of 210 women aged 65 or older from southeast Texas newly diagnosed with breast cancer. Baseline (<2 months after diagnosis) and 12 month follow-up interviews were conducted face-to-face to collect information on sociodemographic characteristics, physical and emotional health, use of health services and satisfaction with medical care. Data analyses included descriptive statistics, chi2 analysis, and multivariate logistic regression analysis. RESULTS: Average age at baseline interview was 71.8 years (SD 6.6). The sample was 70.5% non-Hispanic white, 61.0% were unmarried, and 85.2% reported no ADL limitations. Logistic regression analysis showed a significant association between increasing depressive symptoms at baseline and lower patient satisfaction at follow-up. Each unit increase in depressive symptoms at baseline was associated with a 6% decrease in the predicted odds of being "very satisfied" with medical care at follow up (OR = 0.94, 95% CI = 0.89, 0.99), after adjusting for age, marital status, race/ethnicity, stage of diagnosis and other relevant factors. Similarly, patients who had an increase in CES-D score between baseline and follow-up interview were less likely to be satisfied with their medical care at follow up. CONCLUSION: Increasing depressive symptoms are associated with lower patient satisfaction. Early recognition and treatment of depressive symptoms may improve patients' well being and perception about quality of medical care.

Aged↗

PubMed2002

Use of SEER-Medicare data for measuring cancer surgery.

BACKGROUND: The accuracy and completeness of the SEER-Medicare data for measuring cancer-related therapy have not been extensively evaluated. OBJECTIVES: To investigate the best method for measuring cancer-related surgery among patients in the SEER-Medicare database. SUBJECTS: A total of 149,970 incident cases of breast, colorectal, endometrial, lung, pancreatic, and prostate cancer diagnosed between 1991 and 1993.MEASURES The most invasive surgical procedure identified through Medicare's inpatient, physician, and hospital outpatient claims was compared with corresponding data from the SEER files. RESULTS: Agreement between the SEER and Medicare files was generally highest for resection and radical surgery (eg, kappa 0.70-0.90). While there was less agreement regarding no surgical therapy and biopsy individually, the concordance of the two sources in excluding cancer-directed surgery was high. Compared with inpatient data alone, using the combined inpatient, physician, and outpatient data increased concordance between SEER and Medicare for less invasive procedures. CONCLUSIONS: The agreement of SEER and Medicare data appears to be good for major surgical procedures and for excluding persons who did not undergo cancer-directed surgery. Both the SEER and the Medicare data captured a small number of surgeries not reported in the other file. Therefore, where possible, using both data sources will enhance identification of surgeries. Because the analysis was performed with linked data, the accuracy of surgical claims in Medicare data alone cannot be assessed.

Health Services Research↗

PubMed2002

Studying radiation therapy using SEER-Medicare-linked data.

BACKGROUND: Numerous studies have used the SEER or Medicare data to assess the use of radiation therapy. However, the completeness of these data has not been evaluated. METHODS: Using linked SEER-Medicare data, a cohort was created that included incident cases of breast, endometrial, lung, prostate, or rectal cancer from 1991 to 1996 in persons 65 years and older. For each of these cases, use of radiation therapy as an initial course of treatment reported from the SEER data was compared with use of radiation therapy in the months following diagnosis, as determined from the Medicare claims. RESULTS: Overall, there was a high agreement between SEER and Medicare sources for use of radiation therapy. Agreement was 88% for lung cancer, 93% for prostate cancer, 94% for rectal and breast cancers, and 95% for endometrial cancer. Within the Medicare files, radiation claims were found in MedPAR Physician Supplier Part B and Outpatient files. CONCLUSIONS: There is a high level of agreement between SEER and Medicare reporting of radiation treatments after a cancer diagnosis, suggesting that either source can be used to assess radiation-related treatment patterns. However, for the most complete ascertainment of radiation use, both SEER and Medicare sources should be used.

Aged↗