Quality of Cancer Care

CanSORT has had a strong track record of population-based research in collaboration with selected Surveillance, Epidemiology and End Results (SEER) registries in the U.S. to evaluate patterns and quality of breast cancer treatment in racially/ethnically diverse patients. These projects evaluate patterns of breast cancer care and resulting quality of life during the survivorship period in patients across clinical subgroups and potentially vulnerable populations including Latinas, African Americans, and low-income women living in urban and rural areas. The research aims to examine the role of clinician and health system factors that contribute to treatment decision-making and patient outcomes in cancer treatment. Additional NCI-funded projects evaluate patterns of systemic treatment and the quality of evaluative tests for women with breast cancer.

Representative Projects

Clinical subgroups

National Cancer Institute: Determinants and Outcomes of Surgical Treatment Choices for Early Stage Breast Cancer. (R01 CA088370, P.I. Steven Katz, MD, MPH) The major goals of this project and supplemental activity were to evaluate patterns of treatment and decision making among breast cancer patients in Detroit and Los Angeles with early stage breast cancer and to survey the patients’ treating surgeons.

National Cancer Institute: Understanding Decision-Making in Breast Cancer Reconstruction. (1R21CA122467, P.I. Steven Katz, MD, MPH) The goal of this study is to examine the decision-making process of breast cancer reconstruction after the initial diagnosis and treatment period. The specific aims of the proposed study are: 1) to perform a survey of a population-based cohort of women diagnosed with breast cancer from August 2005 to June 2006 in the metropolitan area of Los Angeles who received a mastectomy, and to measure the proportion of women undergoing delayed breast reconstruction; 2) to describe correlates of receipt of immediate and delayed breast reconstruction compared to those women who have not been reconstructed; 3) to evaluate decisional satisfaction and health-related quality of life (HRQL) in women who did and did not receive immediate or delayed breast reconstruction and 4) to develop measures and describe the stages in the decision- making process for breast reconstruction.

American Cancer Society. Patient and Provider Influences on Disparities in Colorectal Cancer Care (RSG-11-097-01-CPHPS; P.I. Arden Morris, MD, MPH) The goal of this study is to understand how clinical and non-clinical factors impact disparities in chemotherapy use among colorectal cancer patients. The specific aims of the study are: 1) to examine the association between clinical, socioeconomic, and psychosocial patient factors and racial differences in use of chemotherapy; and 2) to examine the association between patient-provider relationship factors and use of chemotherapy.

National Institutes of Health: Understanding Variation In Radioactive Iodine Use In Treatment Of Thyroid Cancer. (1K07CA154595, P.I. Megan Haymart, MD) Treatment for well-differentiated thyroid cancer (WDTC) includes thyroid surgery often followed by radioactive iodine (RAI) and suppressive doses of thyroid hormone replacement. The value of routine use of RAI is, however, passionately debated. Reflecting this controversy, our preliminary studies show tremendous variation in RAI use between 1,423 hospitals which encompasses over 200,000 patients. This variation in RAI use has health and financial implications, but the correlates of use remain unknown. Through both multilevel hierarchical modeling of retrospective cohort data including over 280,000 WDTC patients over a 21 year period and a two-sample comparison of data acquired from 1575 physician surveys, we will address the relationship between characteristics of the patient, provider, and hospital relative to RAI use as treatment for WDTC.

Vulnerable Populations

National Cancer Institute: Breast Cancer Treatment Decisions and Outcomes in Latinas. (1R01 CA109696, P.I. Steven Katz, MD, MPH) The major goals of this study and supplemental activity are to: 1) evaluate patterns of treatment and decision making among racial/ethnic minority women, especially Latinas, with breast cancer in Los Angeles, and 2) survey all surgeons and oncologists treating women with breast cancer in the Los Angeles area, and to link the provider and patient data.

National Cancer Institute: Racial/Ethnic Disparities in Work and QOL Outcomes in Survivors of Breast Cancer. (2R01CA109696, Dual P.I. Steven Katz, MD, MPH; Sarah Hawley PhD, MPH) The goal of this study is to evaluate survivorship outcomes at 3 years after diagnosis in a large population-based inception cohort of racially/ethnically diverse patients diagnosed with breast cancer in the metropolitan areas of Los Angeles and Detroit. We will perform a follow-up survey at 3 years after diagnosis of a cohort of 2498 patients diagnosed with breast cancer during a period from May 2005 to February 2007 and reported to the Los Angeles and Detroit SEER registries. We will examine racial/ethnic differences in disruption in paid work for patients with breast cancer into the survivorship period. We will also examine racial/ethnic differences in quality of life domains for these patients.

National Cancer Institute: Disparity in Quality of Breast Cancer Treatment and Effects on Outcomes. (R01 CA119202, P.I. Jennifer Griggs, MD, MPH) The goal of this study is to assess the effect of quality of care on outcomes; quantify differences in treatment according to race, ethnicity, socioeconomic status and obesity status; and identify the dimensions of quality that generate disparities in outcomes.

National Cancer Institute: Racial/Ethnic and SES Disparities in Quality of Breast Cancer Systemic Therapy (R01 CA139014, Dual P.I. Jennifer Griggs, MD, MPH and Steven Katz, MD, MPH) The major goals of this application are to examine the demographic and social support variables that may affect the quality of systemic adjuvant therapy for first time breast cancer in women aged 21-79. The research will also examine both chemotherapy and hormonal therapy practices, as well as examine the rate of discordance between original laboratory results and central laboratory results for testing of estrogen receptors (ER) and human epidermal growth factor-2 (HER2) over-expression or overamplification.

Clinician and Health care system factors

National Cancer Institute: Health System Factors and Patient Outcomes in Breast Cancer. (R01 CA088370, P.I. Steven Katz, MD, MPH) The goals of this study and funded supplemental activity were to: 1) evaluate clinician and delivery system factors that shape the treatment experiences of patients with breast cancer in the Detroit Metropolitan Area. All attending surgeons, medical oncologists, and radiation oncologists who treated the sample patient population were surveyed and data were merged to SEER clinical data, 2) evaluate the quality of chemotherapy treatment delivery for this cohort of patients, and 3) develop a website for surgeons and oncologists treating breast cancer patients in the Detroit SEER catchment area.

National Comprehensive Cancer Network. A Nationwide Physician Survey to Evaluate the Role of the NCCN Guidelines in Cancer Management Recommendations (P.I. Reshma Jagsi, MD, DPhil) The goal of this study is to conduct a nationwide survey of both medical oncologist and surgeons to characterize their familiarity with and use of NCCN guidelines in cancer management generally and breast cancer management in particular, with a focus on their responses to specific locoregional treatment screnarios in which the strength of the guideline recommendation for radiation treatment varies.