Publications by authors named "Chan Shen"

88 Publications

Survival Benefit of Guideline-Concordant Postoperative Radiation for Local Merkel Cell Carcinoma.

J Surg Res 2021 May 17;266:168-179. Epub 2021 May 17.

Department of Surgery, Division of Outcomes Research and Quality, Penn State College of Medicine, Hershey, Pennsylvania; Department of Public Health Sciences, Division of Health Services and Behavioral Research, Penn State College of Medicine, Hershey, Pennsylvania. Electronic address:

Background: Postoperative radiation therapy (RT) for early-stage Merkel Cell Carcinoma (MCC) decreases the risk of locoregional recurrence and improve overall survival. However, concordance with RT guidelines is unknown.

Materials And Methods: The National Cancer Database was queried for stage I/II MCC patients receiving surgical intervention from 2006-2017. The cohort was stratified by patients who had and did not have indication(s) for adjuvant RT of the primary tumor site based on National Comprehensive Cancer Network guidelines. We captured the use of RT, patient demographics, socioeconomic characteristics, and clinical characteristics. Logistic regression, Kaplan-Meier method, and propensity score weighted Cox proportional hazards model examined associations and survival benefits of RT.

Results: 2,330 stage I/II MCC patients underwent surgical intervention. 1,858 (79.7%) met National Comprehensive Cancer Network criteria for RT of the primary tumor site, of which 1,062 (57.2%) received RT. 472 (20.3%) did not meet criteria for RT, of which 203 (43.0%) received RT. Five-year overall survival advantage was identified for patients who received RT when it was indicated (P < 0.003). There was no evidence of overall survival advantage when patients received guideline-discordant RT (P = 0.478).

Conclusions: Surgical resection with adjuvant RT of the primary tumor site has an overall survival benefit for local MCC when patients meet criteria for RT. This study found a group who received guideline-discordant RT with no survival advantage. Further investigation is warranted to identify the socio-demographic and oncologic reasons for guideline discordance in the treatment of MCC for both under- and over-treatment.
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http://dx.doi.org/10.1016/j.jss.2021.03.062DOI Listing
May 2021

Pathologic upstaging in resected pancreatic adenocarcinoma: Risk factors and impact on survival.

J Surg Oncol 2021 Jul 9;124(1):79-87. Epub 2021 Apr 9.

Section of Surgical Oncology, Division of Surgery, Baptist MD Anderson Cancer Center, Jacksonville, Florida, USA.

Background: Clinical and pathologic staging determine treatment of pancreatic cancer. Clinical stage has been shown to underestimate final pathologic stage in pancreatic cancer, resulting in upstaging.

Methods: National Cancer Database was used to identify clinical stage I pancreatic adenocarcinoma. Univariate, multivariable logistic regression, and Cox proportional hazard ratio were used to determine differences between upstaged and stage concordant patients.

Results: Upstaging was seen in 80.2% of patients. Factors found to be significantly associated with upstaging included pancreatic head tumors (OR 2.56), high-grade histology (OR 1.74), elevated Ca 19-9 (OR 2.09), and clinical stage T2 (OR 1.99). Upstaging was associated with a 45% increased risk of mortality compared to stage concordant disease (HR 1.44, p < .001).

Conclusion: A majority of clinical stage I pancreatic cancer is upstaged after resection. Factors including tumor location, grade, Ca 19-9, and tumor size can help identify those at high risk for upstaging.
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http://dx.doi.org/10.1002/jso.26481DOI Listing
July 2021

Gastric Cancer Treatments and Survival Trends in the United States.

Curr Oncol 2020 12 24;28(1):138-151. Epub 2020 Dec 24.

Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA 17036, USA.

Gastric cancer is the third most common cause of cancer deaths worldwide. Despite evidence-based recommendation for treatment, the current treatment patterns for all stages of gastric cancer remain largely unexplored. This study investigates trends in the treatments and survival of gastric cancer. The National Cancer Database was used to identify gastric adenocarcinoma patients from 2004-2016. Chi-square tests were used to examine subgroup differences between disease stages: Stage I, II/III and IV. Multivariate analyses identified factors associated with the receipt of guideline concordant care. The Kaplan-Meier method was used to assess three-year overall survival. The final cohort included 108,150 patients: 23,584 Stage I, 40,216 Stage II/III, and 44,350 Stage IV. Stage specific guideline concordant care was received in only 73% of patients with Stage I disease and 51% of patients with Stage II/III disease. Patients who received guideline consistent care had significantly improved survival compared to those who did not. Overall, we found only moderate improvement in guideline adherence and three-year overall survival during the 13-year study time period. This study showed underutilization of stage specific guideline concordant care for stage I and II/III disease.
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http://dx.doi.org/10.3390/curroncol28010017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816178PMC
December 2020

Factors associated with immune checkpoint inhibitor use among older adults with late-stage melanoma: A population-based study.

Medicine (Baltimore) 2021 Feb;100(7):e24782

Professor and Associate Dean of Health Outcomes Research, Department of Pharmacotherapy University of North Texas Health Sciences Center College of Pharmacy.

Abstract: Improvement in overall survival by immune checkpoint inhibitors (ICI) treatment in clinical trials encourages their use for late-stage melanoma. However, in the real-world, heterogeneity of population, such as older patients with multimorbidity, may lead to a slower diffusion of ICIs. The objective of this study was to examine the association of multimorbidity and other factors to ICI use among older patients with late-stage melanoma using real world data.A retrospective cohort study design with a 12-month baseline and follow-up period was adopted with data from the linked Surveillance, Epidemiology, and End Results cancer registry/Medicare database. Older patients (>65 years) with late-stage (stage III/IV) melanoma diagnosed between 2012 and 2015 were categorized as with or without multimorbidity (presence of 2 or more chronic conditions) and ICI use was identified in the post-index period. Chi-square tests and logistic regression were used to evaluate factors associated with ICI use.In the study cohort, 85% had multimorbidity, 18% received any treatment (chemotherapy, radiation, and/or ICI), and 6% received ICI. Only 5.5% of older patients with multimorbidity and 6% without multimorbidity received ICIs. Younger age, presence of social support, lower economic status, residence in northeastern regions, and recent year of diagnosis were significantly associated with ICI use; however, multimorbidity, sex, and race were not associated with ICI use.In the real-world clinical practice, only 1 in 18 older adults with late stage melanoma received ICI, suggesting slow pace of diffusion of innovation. However, multimorbidity was not a barrier to ICI use.
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http://dx.doi.org/10.1097/MD.0000000000024782DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899862PMC
February 2021

Adjuvant Chemotherapy After Neoadjuvant Chemotherapy for Pancreatic Cancer is Associated with Improved Survival for Patients with Low-Risk Pathology.

Ann Surg Oncol 2021 Jun 31;28(6):3111-3122. Epub 2021 Jan 31.

Section of Surgical Oncology, Baptist MD Anderson Cancer Center, 1301 Palm Avenue, Jacksonville, FL, 32207, USA.

Background: With limited evidence, the benefit of adjuvant chemotherapy (AT) after completion of neoadjuvant chemotherapy (NT) and surgical resection for patients with pancreatic adenocarcinoma is debated. Guidelines recommend 6 months of AT for patients receiving NT. However, the patient-derived benefit from additional AT remains unknown.

Methods: The National Cancer Database from 2006 to 2015 was used to identify patients undergoing NT. The chi-square test and multivariable logistic regression were used to identify differences between those receiving only NT and those receiving NT and AT. Survival analysis using the Kaplan-Meier method and the Cox proportional hazard ratio model was applied to the entire cohort and to subgroups with differing lymph node ratios (LNRs), tumor sizes, grades, and surgical margin statuses.

Results: Of the 3897 patients who received NT, 36.7 % received additional AT. Analysis of the entire cohort showed that associated survival was significantly improved with NT and AT compared with NT alone (hazard ratio [HR], 0.83; p < 0.001). In the subgroup analysis, the survival benefit of additional AT remained significant for those with negative nodal disease, an LNR lower than 0.15, low-grade histology, and negative margin status. Overall survival did not differ between those receiving NT only and those receiving NT and AT in the group with an LNR of 0.15 or higher, high-grade histology, and positive margins.

Conclusion: This study identified an increasing trend in the use of AT after NT and showed an associated survival benefit for subgroups with low-risk pathologic features. These results suggest that the addition of AT after NT likely beneficial for these subgroups.
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http://dx.doi.org/10.1245/s10434-020-09546-8DOI Listing
June 2021

Impact of COVID-19 related policy changes on filling of opioid and benzodiazepine medications.

Res Social Adm Pharm 2021 01 3;17(1):2005-2008. Epub 2020 Jun 3.

College of Pharmacy, Prescription Drug Misuse Education and Research (PREMIER) Center, University of Houston, TX, USA; College of Pharmacy, Department of Pharmaceutical Health Outcomes and Policy, University of Houston, TX, USA. Electronic address:

Background: Healthcare access has changed drastically during the COVID-19 pandemic. Elective medical procedures, including routine office visits, were restricted raising concerns regarding opioid and benzodiazepine provider and prescription availability.

Objective: To examine how the cancelation of elective medical procedures due to COVID-19 impacted the dispensing of opioid and benzodiazepine prescriptions in Texas.

Methods: Interrupted time series analyses were preformed to examine changes in prescription trends for opioids and benzodiazepines before and after the restriction on elective medical procedures. Samples of patients who filled an opioid or benzodiazepine prescription from January 5, 2020 to May 12, 2020 were identified from the Texas Prescription Monitoring Program. Elective medical procedures were restricted starting March 23, 2020 indicating the beginning of the intervention period.

Results: Restricting elective procedures was associated with a significant decrease in the number of patients (β = -6029, 95%CI = -8810.40, -3246.72) and prescribers (β = -2784, 95%CI = -3671.09, -1896.19) filling and writing opioid prescriptions, respectively. Also, the number of patients filling benzodiazepine prescriptions decreased significantly (β = -1982, 95%CI = -3712.43, -252.14) as did the number of prescribers (β = -708.62, 95%CI = -1190.54, -226.71).

Conclusion: Restricting elective procedures resulted in a large care gap for patients taking opioid or benzodiazepine prescriptions.
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http://dx.doi.org/10.1016/j.sapharm.2020.06.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7738763PMC
January 2021

Trends and patterns in the use of opioids among metastatic breast cancer patients.

Sci Rep 2020 12 10;10(1):21698. Epub 2020 Dec 10.

Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.

Opioid use among metastatic breast cancer (MBC) patients has not been well-studied. This study examined the trends and patterns of opioid use among working-age, privately insured patients diagnosed with MBC. Using MarketScan data, we identified female patients diagnosed with MBC in 2006-2015. We determined the proportion of patients who filled a prescription for an opioid and calculated days' supply and daily morphine milligram equivalents (MMEs) from 1 year prior to diagnosis till 1 year after. We assessed the trend in opioid use over the 10-year study period and examined opioid usage patterns after the diagnosis of MBC. Among 24,752 patients included, 11,579 (46.8%) had an opioid prescription within 1 year before diagnosis of MBC, and 20,416 (81.4%) had an opioid prescription within 1 year after diagnosis. The proportion of patients with opioid prescriptions after diagnosis was relatively stable from 2006 to 2015. However, both the median daily MME and median days' supply decreased over time with most of the decline from the subgroup of patients with prior prescription opioid use. Most patients received an opioid prescription in the first month after diagnosis (57.3%), dropping to approximately 20% from 3 to 12 months after diagnosis. Also, the median days' supply increased substantially during the year after diagnosis for patients who received opioids (from 7 to 19). Most women with MBC require opioid analgesia within the first month after diagnosis. Judicious, long-term management of pain after diagnosis of MBC will continue to be necessary for many patients.
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http://dx.doi.org/10.1038/s41598-020-78569-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7729956PMC
December 2020

Immune checkpoint inhibitor use, multimorbidity and healthcare expenditures among older adults with late-stage melanoma.

Immunotherapy 2021 Feb 5;13(2):103-112. Epub 2020 Nov 5.

Department of Pharmaceutical Systems & Policy, West Virginia University School of Pharmacy, Morgantown 26506, WV.

The objective of this study is to assess the impact of immune checkpoint inhibitors (ICIs) and multimorbidity on healthcare expenditures among older patients with late-stage melanoma. A retrospective longitudinal cohort study using Surveillance, Epidemiology and End Results linked with Medicare claims was conducted. Generalized linear mixed models were used to analyze adjusted relationships of ICI, multimorbidity and ICI-multimorbidity interaction on average healthcare expenditures. Patients who received ICI and those who had multimorbidity had significantly higher average total healthcare expenditures compared with ICI nonusers and no multimorbidity. In the fully adjusted model using ICI-multimorbidity interaction, no excess cost was added by multimorbidity. Use of ICIs, regardless of multimorbidity, is associated with increased healthcare expenditures.
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http://dx.doi.org/10.2217/imt-2020-0152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008205PMC
February 2021

Correlation between Venous Thromboembolism Risk and Venous Congestion in Microvascular Reconstruction of the Lower Extremity.

Plast Reconstr Surg 2020 11;146(5):1177-1185

From the Penn State Health Milton S. Hershey Medical Center.

Background: Risk for venous thromboembolism formation and the relationship to postoperative free flap venous congestion and flap failure have not been adequately evaluated in a trauma population. The authors aim to use the Caprini Risk Assessment Model to evaluate the association between venous thromboembolism risk and postoperative flap venous congestion following lower extremity free tissue transfer.

Methods: A retrospective analysis was conducted of all patients who underwent lower extremity free flap reconstruction of traumatic defects at a single institution between 2007 and 2016. A Wilcoxon rank sum test was used for nonparametric analysis of aggregate Caprini Risk Assessment Model scores and flap outcomes. Flap venous congestion and failure rates as associated with the categorical variables underlying the Caprini Risk Assessment Model were further studied. Logistic regression was used to evaluate each of these outcomes and other flap-related covariates relative to the Caprini Risk Assessment Model categorical variables that had the greatest effect on our patient sample.

Results: One hundred twelve patients underwent lower extremity free flap reconstruction. One hundred eight free flaps were analyzed. Eight patients were excluded. The majority of patients were male (75.9 percent) and required reconstruction because of acute trauma (68.1 percent versus 31.9 percent for chronic wounds). There was no statistically significant association found between age, body mass index, or timing of trauma versus venous congestion, flap failure, or other flap-related covariates.

Conclusion: In patients with significantly elevated Caprini Risk Assessment Model scores, there was no significant association between venous thromboembolism risk and flap failure following free tissue reconstruction of lower extremities.

Clinical Question/level Of Evidence: Risk, III.
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http://dx.doi.org/10.1097/PRS.0000000000007273DOI Listing
November 2020

Benefits of Surgical Treatment of Stage IV Breast Cancer for Patients With Known Hormone Receptor and HER2 Status.

Ann Surg Oncol 2021 May 30;28(5):2646-2658. Epub 2020 Oct 30.

Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.

Background: For the 6% of breast cancer patients with a diagnosis of stage IV disease, systemic therapy is the cornerstone of treatment, with an unclear role for surgery. Limited evidence exists to delineate treatment methods with regard to hormone receptor and human epidermal growth factor receptor 2 (HER2) status.

Methods: The National Cancer Database was used to identify 12,838 stage IV breast cancer patients with known hormone receptor and HER2 status from 2010 to 2015. Chi square tests examined subgroup differences between the treatment methods received. Using the Kaplan-Meier method, 5-year overall survival (OS) was assessed. Multivariate Cox proportional hazard models examined factors associated with survival.

Results: A survival advantage was noted for patients who received either systemic therapy and surgery (ST + Surg: hazard ratio [HR] 0.723; 95% confidence interval [CI] 0.671-0.779) or systemic therapy, surgery, and radiation (Trimodality: HR 0.640; 95% CI 0.591-0.694) (both p < 0.0001) compared with systemic therapy alone (ST). The HER2+ patients who received Trimodality or ST + Surg had a better 5-year OS rate than those who received ST (Trimodality [48%], ST + Surg [41%], ST [29%]; p < 0.0001). The sequence of chemotherapy in relation to surgery is significant, with the greatest survival advantage noted for recipients of neoadjuvant chemotherapy (NAC) compared with patients who had adjuvant chemotherapy when they had positive hormone receptor and HER2 status (HER2 + NAC: HR 0.477; estrogen receptor-positive [ER+] NAC: HR 0.453; progesterone receptor-positive [PR+] NAC: HR 0.448; all p < 0.0001).

Conclusions: Surgery in addition to ST has a survival benefit for stage IV breast cancer patients with known hormone receptor and HER2 status and should be considered after NAC for patients with ER+, PR+, or HER2+ disease.
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http://dx.doi.org/10.1245/s10434-020-09244-5DOI Listing
May 2021

ASO Author Reflections: Surgery Offers Survival Advantage in Treatment-Responsive Metastatic Breast Cancer.

Ann Surg Oncol 2021 May 28;28(5):2659. Epub 2020 Oct 28.

College of Medicine, The Pennsylvania State University, Hershey, PA, USA.

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http://dx.doi.org/10.1245/s10434-020-09286-9DOI Listing
May 2021

Examining Older Adults' Attitudes and Perceptions of Cancer Screening and Overscreening: A Qualitative Study.

J Prim Care Community Health 2020 Jan-Dec;11:2150132720959234

Penn State College of Medicine, Hershey, PA, USA.

Introduction/objectives: Screening guidelines for breast, cervical, and colorectal cancer (CRC) are less clear for older adults due to the potential harms that may result from screening. Understanding older adults' attitudes and perceptions, especially racial/ethnic minority and underserved adults, of cancer screening can help health care providers determine how best to communicate with older adults about cancer screening and screening cessation. The objective of this study was to determine how older adults primarily from minority/underserved backgrounds perceive cancer screening and overscreening.

Methods: Four focus groups (n = 39) were conducted with adults (>=65 years of age) in 3 community settings in south-central Pennsylvania. Two focus groups were conducted in Spanish and translated to English upon transcription. Focus group data was managed and analyzed using QSR NVivo 12. Inductive thematic analysis was used to analyze the data where themes emerged following the coding process.

Results: The focus group participants had an average age of 74 years and were primarily female (74%) and Hispanic (69%), with 69% reporting having less than a high school degree. Four key themes were identified from the focus groups: (1) importance of tailored and targeted education/information; (2) impact of physician/patient communication; (3) impact of barriers and facilitators to screening on cancer screening cessation; and (4) awareness of importance of screening. Participants were more likely to be agreeable to screening cessation if they received specific information regarding their health status and previous medical history from their physician as to why screening should be stopped and told by their physician that the screening decision is up to them.

Conclusions: Older adults prefer individualized information from their physician in order to justify screening cessation but are against incorporating life expectancy into the discussion. Future research should focus on developing interventions to test the effectiveness of culturally tailored screening cessation messages for older adults.
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http://dx.doi.org/10.1177/2150132720959234DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7576932PMC
June 2021

Impact of COVID-19 Related Policy Changes on Buprenorphine Dispensing in Texas.

J Addict Med 2020 12;14(6):e372-e374

College of Pharmacy, Department of Pharmaceutical Health Outcomes and Policy, University of Houston, Houston, TX (JDT, TJV, SSB); College of Pharmacy, Prescription Drug Misuse Education and Research (PREMIER) Center, University of Houston, Houston, TX (CGD); Division of Outcomes Research and Quality, Department of Surgery, Pennsylvania State College of Medicine, Hershey, PA (CS).

Objectives: To measure the change in the daily number of patients receiving buprenorphine and buprenorphine prescribers during the early phase of the COVID-19 (SARS-CoV-2) pandemic in Texas.

Methods: Counts of the number of patients filling and number of providers prescribing buprenorphine were calculated for each weekday between November 4, 2019 and May 12, 2020. The change in daily patients and prescribers between March 2, 2020 and May 12, 2020, was modeled as a change in slope compared to the baseline period using autoregressive, interrupted time series regression.

Results: The rate of change of daily buprenorphine prescriptions (β = -1.75, 95% CI = -5.8-2.34) and prescribers (β = -0.32, 95% CI = -1.47-0.82) declined insignificantly during the COVID-19 period compared to the baseline.

Conclusions: Despite a 57% decline in ambulatory care utilization in the south-central US during March and April of 2020, health services utilization related to buprenorphine in Texas remained robust. Protecting access to buprenorphine as the COVID-19 pandemic continues to unfold will require intensive efforts from clinicians and policy makers alike. While the presented results are promising, researchers must continue monitoring and exploring the clinical and humanistic impact of COVID-19 on the treatment of substance use disorders.
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http://dx.doi.org/10.1097/ADM.0000000000000756DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8194032PMC
December 2020

Prevalence and risk factors for multimorbidity in older US patients with late-stage melanoma.

J Geriatr Oncol 2021 Apr 25;12(3):388-393. Epub 2020 Sep 25.

Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV, United States.

Introduction: Presence of multimorbidity can affect prognosis, treatment, and outcomes of individuals with cancer. However, the prevalence and factors associated with multimorbidity among older late-stage melanoma is not well studied. We estimated the prevalence of any type of pre-existing multimorbidity (autoimmune disorder (AD), physical health conditions (PHC), and mental health conditions (MHC)) among older adults with late-stage melanoma in the United States. We further examined the association of patient-level factors to multimorbidity in late-stage melanoma.

Methods: We derived data on older fee-for-service Medicare beneficiaries (age ≥ 66 years) diagnosed with late-stage melanoma between 2011 and 2015 (N = 4,519) from the linked Surveillance, Epidemiology, and End Results cancer registry and Medicare claims. We defined multimorbidity as the prevalence of two or more chronic conditions prior to the diagnosis of melanoma. We used unadjusted and adjusted logistic regressions to examine the association of patient-level factors to multimorbidity.

Results: An overwhelming majority (85%) of older patients with late-stage melanoma had multimorbidity. Pre-existing PHC multimorbidity (84%) was the most prevalent, followed by AD (12%), and MHC (6%). Age and region were associated with any and PHC multimorbidity. Sex, marital status, and region were factors associated with pre-existing AD while sex, marital status, and dual eligibility were associated with MHC multimorbidity.

Conclusions: Pre-existing multimorbidity was highly prevalent among older individuals with late-stage melanoma; prevalence rates and factors associated with multimorbidity varied by type of chronic conditions. This highlights the need for developing systematic approaches to optimizing care of older patients with late-stage melanoma and multimorbidity.
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http://dx.doi.org/10.1016/j.jgo.2020.09.019DOI Listing
April 2021

ASO Author Reflections: Undertreatment of Pancreatic Cancer After Resection: Don't Get Fooled by Favorable Final Pathology.

Ann Surg Oncol 2021 Mar 28;28(3):1593-1594. Epub 2020 Aug 28.

Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.

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http://dx.doi.org/10.1245/s10434-020-09079-0DOI Listing
March 2021

Undertreatment of Pancreatic Cancer: Role of Surgical Pathology.

Ann Surg Oncol 2021 Mar 26;28(3):1581-1592. Epub 2020 Aug 26.

Department of Surgery, Division of Outcomes Research and Quality, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.

Background: Current guidelines recommend treatment of early-stage pancreatic cancer with surgical resection and chemotherapy. Undertreatment can occur after resection when patients fail to receive adjuvant chemotherapy. Final pathologic results have the potential to bias providers to omit adjuvant chemotherapy, however, the association of surgical pathology and adjuvant chemotherapy is unknown.

Methods: Data from the National Cancer Database identified patients who underwent surgery for stage I or II pancreatic cancer. Chi-square tests and logistic regression were used to determine differences between patients receiving surgery followed by chemotherapy and those who had resection alone. Survival analysis of subgroups with favorable pathology (node-negative disease, tumor size ≤ 2 cm, well-differentiated histology) was performed by the Kaplan-Meier method and the Cox proportional hazards model.

Results: Of the 22,131 patients included in this study, 28% were considered undertreated (surgery alone). Favorable pathologic traits of negative lymph nodes, tumor 2 cm in size or smaller, and well-differentiated histology were associated with a 15-35% lower probability that adjuvant chemotherapy would be given than less favorable pathologic results (p < 0.001). Multivariable survival analysis showed significantly lower odds of mortality for patients who received resection and chemotherapy than for those who were undertreated among two subgroups: patients with node-negative disease (hazard ratio [HR] 0.774) and those with a tumor 2 cm in size or smaller (HR 0.771).

Conclusion: The patients who had early-stage pancreatic cancer with favorable pathology after pancreatectomy were less likely than those with unfavorable pathology to receive adjuvant chemotherapy. This omission had significant survival consequences for subgroups with node-negative disease and tumors 2 cm in size or smaller. Recognition of patients with favorable pathology as an undertreated group is required for efforts to be directed toward encouraging guideline-concordant care and to combat undertreatment of pancreatic cancer.
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http://dx.doi.org/10.1245/s10434-020-09043-yDOI Listing
March 2021

Chronic prescription opioid use predicts stabilization on buprenorphine for the treatment of opioid use disorder.

J Subst Abuse Treat 2020 10 28;117:108073. Epub 2020 Jun 28.

Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, United States of America; Prescription Drug Misuse Education and Research Center, University of Houston College of Pharmacy, United States of America. Electronic address:

Introduction: Prescription opioid misuse is a risk factor for opioid use disorder (OUD). Patients who misuse prescribed opioids and those who misuse illicit opioids are demographically and medically distinct groups, and research has shown there is heterogeneity in treatment response between these groups. The objective of this study was to measure the adjusted odds of successful stabilization on buprenorphine in patients with baseline prescription opioid use compared to those not prescribed opioids.

Methods: A cohort of patients newly prescribed a buprenorphine product indicated for OUD between January 1 and November 30, 2018, were identified from the Texas Prescription Monitoring Program. We excluded those under the age of 15 and those who filled an opioid prescription after initiating buprenorphine to limit misclassification. We then stratified the cohort based on type of prescription opioid use in the pre-index period. We defined chronic opioid use as being prescribed opioids for a period of 90 out of 120 days, ending no sooner than 90 days prior to treatment initiation. We defined acute opioid use as filling any opioid prescription in the 90 days prior to initiating buprenorphine. The outcome of interest-stabilization on buprenorphine-was met by filling two prescriptions totaling 30-days' supply with no more than a six-day gap in therapy. We used multiple logistic regression to estimate the odds of stabilization in the prescription opioid use categories compared to those with no pre-index, opioid prescriptions.

Results: Among 6756 eligible patients, 44.1% used prescription opioids in the 90 days prior to buprenorphine initiation. Of these, 62.2% met the criteria for acute prescription opioid use and 37.8% for chronic prescription opioid use. Patients with prescription opioid use at baseline were more likely to be older and insured compared to those with no prescription opioid use. After adjustment for covariates, both prescription opioid use groups were significantly more likely to be successfully stabilized on therapy (Acute: aOR = 1.53, 95% CI = 1.37-1.72; Chronic: aOR = 2.43, 95% CI = 2.08-2.85). In a second model, those with chronic prescription opioid use were significantly more likely than those with acute prescription opioid use to be successfully stabilized (aOR = 1.60, 95% CI = 1.31-1.90).

Conclusion: Persistence to buprenorphine treatment for OUD is, in part, dependent on baseline prescription opioid use. This study suggests that patients with chronic prescription opioid use may be more likely than nonprescription opioid users to be successfully stabilized on treatment and may thus benefit more from pharmacotherapy with buprenorphine than those with no prescription opioid use. Failing to account for this variation in future studies of buprenorphine treatment persistence may lead to significant residual confounding and biased results. Extending access to buprenorphine among those with prescription OUD may have a significant impact on opioid related morbidity and mortality.
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http://dx.doi.org/10.1016/j.jsat.2020.108073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7451120PMC
October 2020

Relationship between smoking status and muscle strength in the United States older adults.

Epidemiol Health 2020 28;42:e2020055. Epub 2020 Jul 28.

Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV, USA.

Objectives: Muscle strength in older adults is associated with greater physical ability. Identifying interventions to maintain muscle strength can therefore improve quality of life. The purpose of this study was to evaluate whether current or former smoking status is associated with a decrease in muscle strength in older adults.

Methods: Data from the Health and Retirement Study from 2012-2014 were analyzed with regard to maximum dominant hand grip strength, maximum overall hand grip strength, and smoking status (current, former, or never). Unadjusted linear regression was conducted. Other factors known to be related to strength were included in the adjusted linear regression analyses.

Results: For maximum grip strength, the regression coefficient was 4.91 for current smoking (standard error [SE], 0.58; p<0.001), 3.58 for former smoking (SE, 0.43; p<0.001), and 28.12 for never smoking (SE, 0.34). Fully adjusted linear regression on the relationship between dominant hand grip strength and smoking did not yield a significant result. The factors significantly associated with dominant hand grip strength were male sex, younger age, a race/ethnicity of non-Hispanic White or non-Hispanic Black, higher income, morbidity of ≤1 condition, no pain, and moderate or vigorous exercise more than once a week.

Conclusions: Muscle strength in older adults was not associated with smoking status in the adjusted analysis.
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http://dx.doi.org/10.4178/epih.e2020055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871150PMC
January 2021

Geographic Variation in Overscreening for Colorectal, Cervical, and Breast Cancer Among Older Adults.

JAMA Netw Open 2020 07 1;3(7):e2011645. Epub 2020 Jul 1.

Penn State College of Medicine, Hershey, Pennsylvania.

Importance: National guidelines balance risks and benefits of population-level cancer screening among adults with average risk. Older adults are not recommended to receive routine screening, but many continue to be screened (ie, are overscreened).

Objective: To assess the prevalence of overscreening for colorectal, cervical, and breast cancers among older adults as well as differences in overscreening by metropolitan status.

Design, Setting, And Participants: The cross-sectional study examined responses to a telephone survey of 176 348 community-dwelling adults. Participants were included if they met age and sex criteria, and they were excluded from each cancer-specific subsample if they had a history of that cancer. Data came from the 2018 Behavioral Risk Factor Surveillance System, administered by the US Centers for Disease Control and Prevention.

Exposures: Metropolitan status, according to whether participants lived in a metropolitan statistical area.

Main Outcomes And Measures: Overscreening was assessed using US Preventive Services Task Force definitions, ie, whether participants self-reported having a screening after the recommended upper age limit for colorectal (75 years), cervical (65 years), or breast (74 years) cancer.

Results: Of 176 348 participants (155 411 [88.1%] women; mean [SE] age, 75.0 [0.04] years; 150 871 [85.6%] non-Hispanic white; 60 456 [34.3%] with nonmetropolitan residence) the cancer-specific subsamples contained 20 937 [11.9%] men and 34 244 [19.4%] women for colorectal cancer, 82 811 [47.0%] women for cervical cancer, and 38 356 [21.8%] women for breast cancer. Overall, 9461 men (59.3%; 95% CI, 57.6%-61.1%) were overscreened for colorectal cancer; 14 463 women (56.2%; 95% CI, 54.7%-57.6%), for colorectal cancer; 31 988 women (45.8%; 95% CI, 44.9%-46.7%), for cervical cancer; and 26 198 women (74.1%; 95% CI, 73.0%-75.3%), for breast cancer. Overscreening was more common in metropolitan than nonmetropolitan areas for colorectal cancer among women (adjusted odds ratio [aOR], 1.23; 95% CI, 1.08-1.39), cervical cancer (aOR, 1.20; 95% CI, 1.11-1.29), and breast cancer (aOR, 1.36; 95% CI, 1.17-1.57). Overscreening for cervical and breast cancers was also associated with having a usual source of care compared with not (eg, cervical cancer: aOR, 1.87; 95% CI, 1.56-2.25; breast cancer: aOR, 2.08; 95% CI, 1.58-2.76), good, very good, or excellent self-reported health compared with fair or poor self-reported health (eg, cervical cancer: aOR, 1.21; 95% CI, 1.11-1.32; breast cancer: aOR, 1.47; 95% CI, 1.28-1.69), an educational attainment greater than a high school diploma compared with a high school diploma or less (eg, cervical cancer: aOR, 1.14; 95% CI, 1.06-1.23; breast cancer: aOR, 1.30; 95% CI, 1.16-1.46), and being married or living as married compared with other marital status (eg, cervical cancer: OR, 1.36; 95% CI, 1.26-1.46; breast cancer: OR, 1.54; 95% CI, 1.34-1.77).

Conclusions And Relevance: In this study, overscreening for cancer among older adults was high, particularly for women living in metropolitan areas. Overscreening could be associated with health care access and patient-clinician relationships. Additional research on why overscreening persists and how to reduce overscreening is needed to minimize risks associated with cancer screening among older adults.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.11645DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8127072PMC
July 2020

Associations of multimorbidity and patient-reported experiences of care with conservative management among elderly patients with localized prostate cancer.

Cancer Med 2020 08 6;9(16):6051-6061. Epub 2020 Jul 6.

West Virginia University School of Pharmacy, Pharmaceutical Systems & Policy, Morgantown, WV, USA.

Background: Many elderly localized prostate cancer patients could benefit from conservative management (CM). This retrospective cohort study examined the associations of patient-reported access to care and multimorbidity on CM use patterns among Medicare Fee-for-Service (FFS) beneficiaries with localized prostate cancer.

Methods: We used linked Surveillance, Epidemiology, and End Results cancer Registry, Medicare Claims, and the Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) survey files. We identified FFS Medicare Beneficiaries (age ≥ 66; continuous enrollment in Parts A & B) with incident localized prostate cancer from 2003 to 2013 and a completed MCAHPS survey measuring patient-reported experiences of care within 24 months after diagnosis (n = 496). We used multivariable models to examine MCAHPS measures (getting needed care, timeliness of care, and doctor communication) and multimorbidity on CM use.

Results: Localized prostate cancer patients with multimorbidity were less likely to use CM (adjusted odds ratio (AOR)=0.42 (0.27- 0.66), P < .001); those with higher scores on timeliness of care (AOR = 1.21 (1.09, 1.35), P < .001), higher education attainment (3.21 = AOR (1.50,6.89), P = .003), and impaired mental health status (4.32 = AOR (1.86, 10.1) P < .001) were more likely to use CM.

Conclusion(s): Patient-reported experience with timely care was significantly and positively associated with CM use. Multimorbidity was significantly and inversely associated with CM use. Addressing specific modifiable barriers to timely care along the cancer continuum for elderly localized prostate cancer patients with limited life expectancy could reduce the adverse effects of overtreatment on health outcomes and costs.
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http://dx.doi.org/10.1002/cam4.3274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7433828PMC
August 2020

Human papillomavirus (HPV) vaccine utilization among adults (18-29 years), BRFSS 2015.

Vaccine 2020 07 19;38(33):5119-5122. Epub 2020 Jun 19.

Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV 26506-9510 USA. Electronic address:

Human papillomavirus (HPV) vaccination acceptance is hampered by fears and conflicting attitudes about the need for and safety of vaccine. There are also ethical dilemmas associated with vaccinating adolescents for a sexually transmitted disease despite future cancer risk. The purpose of this research was to determine HPV vaccination acceptance/hesitancy among young adults. Behavioral Risk Factor Surveillance System 2015 data were used. During 2015, 83.1% of adults ages 25-29 years did not receive any HPV vaccination; the UOR was 3.47; 95% CI = 2.11, 5.70) compared to adults 18-24 years. There is a need to accelerate public health messaging/campaigns to increase HPV vaccination rates.
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http://dx.doi.org/10.1016/j.vaccine.2020.05.056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7367495PMC
July 2020

Prolonged Opioid Use After Surgery for Early-Stage Breast Cancer.

Oncologist 2020 10 2;25(10):e1574-e1582. Epub 2020 Jun 2.

Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.

Introduction: This study examined the patterns of prolonged opioid use and the factors associated with higher risk of prolonged opioid use among opioid-naïve working-age patients with early-stage breast cancer.

Methods: Using MarketScan data, the study identified 23,440 opioid-naïve patients who received surgery for breast cancer between January 2000 and December 2014 and filled at least one opioid prescription attributable to surgery. Prolonged opioid use was defined as one or more prescriptions for opioids within 90 to 180 days after surgery and defined extra-prolonged opioid use as one or more opioid prescriptions between 181 and 365 days after surgery. Multivariable logistic regressions were performed to ascertain factors associated with prolonged and extra-prolonged use of opioids.

Findings: Of the 23,440 patients, 4,233 (18%) had prolonged opioid use, and 2,052 (9%) had extra-prolonged opioid use. Patients who received mastectomy plus reconstruction had the highest rate of prolonged opioid use (38%) followed by mastectomy alone (15%). A multivariable logistic regression confirmed that patients with mastectomy and reconstruction had the highest odds ratio of prolonged opioid use compared to lumpectomy and whole breast irradiation (adjusted odds ratio, 5.6; 95% confidence interval, 5.1-6.1). Mean daily opioid dose was consistently high without any obvious dosage reduction among patients with opioid use.

Interpretation: This large observational study showed a high rate of prolonged opioid use among patients who received surgery for early-stage breast cancer and found significant difference in prolonged opioid use by treatment type.

Implications For Practice: This large observational study found a high rate of prolonged opioid use among working-age patients with early-stage breast cancer who received curative surgery, especially among patients who received mastectomy. Among patients with opioid use, the mean daily opioid dose was consistently high without any obvious dosage tapering. This study highlights the need to emphasize appropriate opioid therapy and potential dosage reduction or discontinuation among patients with early-stage breast cancer who received surgical interventions.
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http://dx.doi.org/10.1634/theoncologist.2019-0868DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7543235PMC
October 2020

Association between depression and healthcare expenditures among elderly cancer patients.

BMC Psychiatry 2020 03 23;20(1):131. Epub 2020 Mar 23.

Division of Outcomes Research and Quality, Department of Surgery, College of Medicine, Pennsylvania State University, Hershey, PA, USA.

Background: Both depression and cancer are economically burdensome. However, how depression affects the healthcare expenditures of elderly cancer patients from payers' and patients' perspectives is largely unknown. This study investigated whether depression resulted in higher healthcare expenditures among these patients from both payers' and patients' perspectives and identified health service use categories associated with increased expenditures.

Methods: From the Medicare Current Beneficiary Survey (MCBS)-Medicare database, we identified breast, lung and prostate cancer patients aged 65 years and over who were newly diagnosed between 2007 and 2012. Presence of depression was based on self-reports from the surveys. We used generalized linear models (GLM) and two-part models to examine the impact of depression on healthcare expenditures during the first two years of cancer diagnosis controlling for a vast array of covariates. We stratified the analyses of total healthcare expenditures by healthcare services and payers.

Results: Out of the 710 elderly breast, lung and prostate cancer patients in our study cohort, 128 (17.7%) reported depression. Individuals with depression had $11,454 higher total healthcare expenditures, $8213 higher medical provider expenditures and $405 higher other services expenditures compared to their counterparts without depression. Also, they were significantly more likely to have inpatient services. For payers, they incurred $8280 and $1270 higher expenditures from Medicare's and patients' perspectives, respectively.

Conclusions: Elderly cancer patients with depression have significantly higher healthcare expenditures from both payers' and patients' perspectives and over different expenditure types. More research is needed in depression screening, diagnosis and treatment for this population.
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http://dx.doi.org/10.1186/s12888-020-02527-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7092441PMC
March 2020

Extending epidural analgesia for intrapartum cesarean section following epidural labor analgesia: a retrospective cohort study.

J Matern Fetal Neonatal Med 2020 Mar 23:1-7. Epub 2020 Mar 23.

Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, Wuchang, China.

: To determine the effectiveness of extending epidural analgesia following epidural labor analgesia for intrapartum cesarean section, and provide a reference for clinical practice. Data of 1254 singleton parturient who failed trial of epidural labor analgesia and underwent intrapartum cesarean section were retrospectively included. After entering the operating room, parturient were given 3 ml of 1.5% lidocaine with 1:200,000 epinephrine 15 µg as a test dose, followed by a dose of 10 ml 0.75% ropivacaine plus 5 ml of 2% lidocaine mixed solution was administered the epidural catheter. Case data were reviewed and analyzed of cesarean section anesthesia implementation methods, results and maternal and neonatal outcomes. Of the 1254 parturient, 4.7% (59 of 1254) underwent general anesthesia directly, 7.1% (89 of 1254) were given combined spinal and epidural anesthesia, and the other 88.2% (1106 of 1254) underwent extending epidural anesthesia, 3.5% (39 of 1106) of them were given general anesthesia after extending epidural anesthesia failed, and 96.5% (1067 of 1106) parturient have a successful extending epidural anesthesia. Adverse reactions of extending epidural anesthesia: 6.7% (72 of 1067) parturient experienced hypotension and 12.1% (129 of 1067) of nausea and vomiting occurred. For the neonatal Apgar scores at 1 min, eleven of 1254 (0.9%) newborns were between 0 and 3 points, 107 (8.5%) newborns between 4 and 7 points, and 1136 (90.6%) newborns Apgar scores between 8 and 10 point. 24 (1.9%) newborns with Apgar scores between 4 to 7 points at 5 min transferred to the department of neonatology, and the rest 1230 (98.1%) newborns with Apgar scores 8-10 points. Extending epidural analgesia using the well-functioning epidural catheter for epidural labor analgesia might be a reliable and effective anesthetic method for intrapartum cesarean section.
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http://dx.doi.org/10.1080/14767058.2020.1743661DOI Listing
March 2020

Factors Associated With Hospital Decisions to Purchase Robotic Surgical Systems.

MDM Policy Pract 2020 Jan-Jun;5(1):2381468320904364. Epub 2020 Feb 2.

Department of Surgery, Division of Outcomes Research and Quality, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvani.

Robotic surgical systems are expensive to own and operate, and the purchase of such technology is an important decision for hospital administrators. Most prior literature focuses on the comparison of clinical outcomes between robotic surgery and other laparoscopic or open surgery. There is a knowledge gap about what drives hospitals' decisions to purchase robotic systems. To identify factors associated with a hospital's acquisition of advanced surgical systems. We used 2002 to 2011 data from the State of California Office of Statewide Health Planning and Development to examine robotic surgical system purchase decisions of 476 hospitals. We used a probit estimation allowing heteroscedasticity in the error term including a set of two equations: one binary response equation and one heteroscedasticity equation. During the study timeframe, there were 78 robotic surgical systems purchased by hospitals in the sample. Controlling for hospital characteristics such as number of available beds, teaching status, nonprofit status, and patient mix, the probit estimation showed that market-level directly relevant surgery volume in the previous year (excluding the hospital's own volume) had the largest impact. More specifically, hospitals in high volume (>50,000 surgeries v. 0) markets were 12 percentage points more likely to purchase robotic systems. We also found that hospitals in less competitive markets (i.e., Herfindahl index above 2500) were 2 percentage points more likely to purchase robotic systems. This study has limitations common to observational database studies. Certain characteristics such as cultural factors cannot be accurately quantified. Our findings imply that potential market demand is a strong driver for hospital purchase of robotic surgical systems. Market competition does not significantly increase the adoption of new expensive surgical technologies.
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http://dx.doi.org/10.1177/2381468320904364DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6997967PMC
February 2020

Renal Replacement Therapy in Patients With Stage IV Cancer Admitted to the Intensive Care Unit With Acute Kidney Injury at a Comprehensive Cancer Center Was Not Associated With Survival.

Am J Hosp Palliat Care 2020 Sep 27;37(9):707-715. Epub 2020 Jan 27.

Sections of Nephrology and Supportive Care, West Virginia University School of Medicine, Morgantown, WV, USA.

Introduction: In patients with advanced cancer, prolongation of life with treatment often incurs substantial emotional and financial expense. Among hospitalized patients with cancer since acute kidney injury (AKI) is known to be associated with much higher odds for hospital mortality, we investigated whether renal replacement therapy (RRT) use in the intensive care unit (ICU) was a significant independent predictor of worse outcomes.

Methods: We retrospectively reviewed patients admitted in 2005 to 2014 who were diagnosed with stage IV solid tumors, had AKI, and a nephrology consult. The main outcomes were survival times from the landmark time points, inpatient mortality, and longer term survival after hospital discharge. Logistic regression and Cox proportional regression were used to compare inpatient mortality and longer term survival between RRT and non-RRT groups. Propensity score-matched landmark survival analyses were performed with 2 landmark time points chosen at day 2 and at day 7 from ICU admission.

Results: Of the 465 patients with stage IV cancer admitted to the ICU with AKI, 176 needed RRT. In the multivariate logistic regression model after adjusting for baseline serum albumin and baseline maximum Sequential Organ Failure Assessment (SOFA), the patients who received RRT were not significantly different from non-RRT patients in inpatient mortality (odds ratio: 1.004 [95% confidence interval: 0.598-1.684], = .9892). In total, 189 patients were evaluated for the impact of RRT on long-term survival and concluded that RRT was not significantly associated with long-term survival after discharge for patients who discharged alive. Landmark analyses at day 2 and day 7 confirmed the same findings.

Conclusions: Our study found that receiving RRT in the ICU was not significantly associated with inpatient mortality, survival times from the landmark time points, and long-term survival after discharge for patients with stage IV cancer with AKI.
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http://dx.doi.org/10.1177/1049909120902115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7363512PMC
September 2020

Asthma, chronic obstructive pulmonary disease, tooth loss, and edentulism among adults in the United States: 2016 Behavioral Risk Factor Surveillance System survey.

J Am Dent Assoc 2020 Oct 13;151(10):735-744.e1. Epub 2019 Nov 13.

Background: Adults with chronic respiratory conditions, specifically asthma or chronic obstructive pulmonary disease (COPD), may be at risk of experiencing poor oral health due to systemic inflammation, challenges in routine oral health care, and adverse effects of medications used to treat these conditions. The authors examined the association of asthma, COPD, and coexisting asthma and COPD (asthma-COPD overlap syndrome [ACOS]) with tooth loss among US adults.

Methods: The authors conducted a cross-sectional study using 2016 Behavioral Risk Factor Surveillance System data (N = 387,217). The authors categorized the participants with missing permanent teeth into 4 groups: asthma only (n = 38,817), COPD only (n = 19,819), ACOS (n = 13,494), no asthma, no COPD (n = 315,087). The authors used adjusted multinomial logistic regressions to examine the associations between asthma and COPD categories and tooth loss.

Results: According to the authors, 5.3% of study participants reported they were edentulous; 10.7% reported 6 or fewer missing teeth. Participants with asthma only, COPD only, and ACOS had higher odds of reporting tooth loss (6 or more teeth) than those in the no asthma, no COPD group; adjusted odds ratios were 1.12 (95% confidence interval, 1.00 to 1.26) to 2.04 (95% confidence interval, 1.85 to 2.26). A lower percentage of participants with COPD and ACOS visited dentists in the past year than those with no asthma and no COPD. Interactive associations suggested participants with asthma or COPD with dental visits were less likely to report edentulism than those with neither asthma nor COPD and no dental visits.

Conclusions: Participants with asthma or COPD had higher odds of tooth loss compared with those with neither asthma nor COPD.

Practical Implications: People with asthma or COPD should maintain routine dental visits to reduce the risk of experiencing tooth loss.
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http://dx.doi.org/10.1016/j.adaj.2019.07.032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7531763PMC
October 2020

Racial Differences in the Incidence and Survival of Patients With Neuroendocrine Tumors.

Pancreas 2019 Nov/Dec;48(10):1373-1379

Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.

Objectives: The incidence of neuroendocrine tumors (NETs) has been steadily increasing. Racial differences in the incidence and survival are mostly unknown. This study examines the racial differences and the underlying causes.

Methods: We conducted a retrospective, population-based study using datasets from Surveillance, Epidemiology, and End Results (SEER) cancer registry and SEER data linked with Medicare claims (SEER-Medicare). We examined the incidence rates and the effects of patient demographics, clinical characteristics, and socioeconomic factors on survival.

Results: Of the 15,786 and 1731 cases from SEER and SEER-Medicare, 1991 and 163 were blacks, respectively. We found that blacks had higher NET incidence for all stages, with the largest difference noted in the local stage (4.3 vs 2.6 per 100,000 in whites). We found worse survival for distant-stage black patients, although they more often had clinical factors typically associated with better prognosis in NETs. However, they were also found to have significant unfavorable differences in socioeconomic and sociodemographic factors.

Conclusions: Blacks have higher incidence of NETs and worse survival compared with other races, especially whites. The influences of neighborhood socioeconomic, sociodemographic, and marital status suggest that social determinants, support mechanisms, and access to health care may be contributing factors.
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http://dx.doi.org/10.1097/MPA.0000000000001431DOI Listing
September 2020

Assessing the Importance of Factors Associated with Cost-Related Nonadherence to Medication for Older US Medicare Beneficiaries.

Authors:
Dian Gu Chan Shen

Drugs Aging 2019 12;36(12):1111-1121

Division of Outcomes Research and Quality, Department of Surgery, College of Medicine, Penn State University, Hershey, PA, USA.

Background: Prescription drug costs have been rising rapidly in the USA, contributing to the persistent problem of cost-related medication nonadherence (CRN) among older Medicare beneficiaries. Given the importance of CRN and the negative outcomes associated with it, it is important to examine the factors that affect CRN. This study aims to estimate the factors influencing CRN among older Medicare beneficiaries and to rank their relative contribution in explaining CRN.

Methods: We used a 2015 Medicare Current Beneficiary Survey linked to Medicare claims data to identify older Medicare beneficiaries aged 65 years and over. Multivariate logistic regression was performed to identify factors associated with CRN. Factors included in the regression analyses were based on a conceptual framework adapted from Piette et al., including main effects (financial factors and regimen complexity) and contextual factors (sociodemographic, lifestyle and health factors). Dominance analysis was conducted to determine their relative importance in predicting CRN.

Results: Our study sample included 4427 older Medicare beneficiaries, 13.43% of whom reported CRN. For main effects, drug coverage and regimen complexity were significantly associated with CRN. Compared to beneficiaries with public coverage, those with private drug coverage were less likely to report CRN while those without drug coverage were more likely to report CRN. Having more than two monthly prescriptions was also associated with higher CRN. Significant contextual factors included age, activities of daily living limitations, perceived health status, cancer, rheumatoid arthritis, non-rheumatoid arthritis, depression, and lung disease. Dominance analysis showed drug coverage was the most influential factor in explaining CRN, after which age, ADL limitations, and depression ranked in sequence.

Conclusions: These findings can help policy makers understand the relative importance of factors affecting CRN and identify the most important areas for intervention to improve CRN.
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http://dx.doi.org/10.1007/s40266-019-00715-3DOI Listing
December 2019