The quality of treatment for cancer-associated complications, those complications directly attributable to the cancer itself or that result from chemotherapy and/or radiation, have received little attention. This is particularly problematic as cancer-associated complications are associated with significant morbidity, are often accompanied by pain and discomfort, and require the expenditure of substantial healthcare resources for treatment. The management of cancer-associated complications is compounded by the availability of a myriad of treatment options, many of which are unproven and associated with significant cost. Little is known about the factors that influence allocation of care for thes complications and what factors influence outcome. The health care a patient receives and its associated outcomes are influenced by the interplay of a number of patient, physician, and hospital factors. For acute inpatient medical conditions the characteristics of the hospital in which a patient is treated play a crucial role. There is growing recognition that there is widespread between-hospital variation in how care is allocated and that these differences in practice patterns explain a large portion of treatment variability. Uninsured and minority patients are particularly vulnerable to these hospital level disparities as these patients are disproportionately more likely to receive care at facilities with limited clinical and financial resources that may adversely affect quality. In this proposal we will determine the quality of treatment for hospitalized patients admitted with a primary diagnosis of: febrile neutropenia, hypercalcemia of malignancy, esophagitis, and acute cancer-associated pain. For each cancer-associated complication we will determine patterns of treatment, the factors that underlie treatment decisions, and the effect of prompt initiation of guideline-based therapy on outcomes. For each condition we will first examine the utilization of guideline-based and non-indicated treatments. We will then comprehensively examine the influence of patient, physician, and hospital characteristics as well as between- hospital variations on the allocation of guideline-based care. We hypothesize that there is substantial variation in treatment between hospitals that is unexplained by traditional measures. Finally, we will perform novel causal inference and mediation analyses to determine the direct and indirect effects operating through a mediator of prompt guideline-based treatment on outcomes (length of stay, readmission, cost, non-routine discharge and mortality) for each complication. In addition to including a number of novel statistical methodologies, this proposal will utilize a unique database ideally suited to the study of these complications. The data from these studies will lead to immediately actionable results that can be used to guide the implementation pragmatic hospital-based interventions to improve the quality of care for patients with cancer-associated complications.

Public Health Relevance

To date, the complications that result either directly from cancer or from its treatment have received almost no attention. Our findings will provide important data on the management of these complications to patients, providers, and payers that are immediately actionable and can guide the development of targeted hospital-based interventions to improve the quality of care for patients with cancer-associated complications.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA169121-02
Application #
8601054
Study Section
Health Services Organization and Delivery Study Section (HSOD)
Program Officer
Castro, Kathleen M
Project Start
2013-01-01
Project End
2017-12-31
Budget Start
2014-02-11
Budget End
2014-12-31
Support Year
2
Fiscal Year
2014
Total Cost
$298,800
Indirect Cost
$112,050
Name
Columbia University
Department
Obstetrics & Gynecology
Type
Schools of Medicine
DUNS #
621889815
City
New York
State
NY
Country
United States
Zip Code
10032
Wright, Jason D; Desai, Vrunda B; Chen, Ling et al. (2017) Utilization of gynecologic services in women with breast cancer receiving hormonal therapy. Am J Obstet Gynecol 217:59.e1-59.e12
Ruiz, Maria P; Huang, Yongmei; Hou, June Y et al. (2017) All-cause mortality in young women with endometrial cancer receiving progesterone therapy. Am J Obstet Gynecol 217:669.e1-669.e13
Cham, Stephanie; Huang, Yongmei; Tergas, Ana I et al. (2017) Utility of radiation therapy for early-stage uterine papillary serous carcinoma. Gynecol Oncol 145:269-276
Wright, Jason D; Chen, Ling; Gabor, Lisa et al. (2017) Patterns of Specialty-Based Referral and Perioperative Outcomes for Women With Endometrial Cancer Undergoing Hysterectomy. Obstet Gynecol 130:81-90
Hsu, Jennifer Y; Chen, Ling; Gumer, Arielle R et al. (2017) Disparities in the management of ectopic pregnancy. Am J Obstet Gynecol 217:49.e1-49.e10
Bercow, Alexandra S; Chen, Ling; Chatterjee, Sudeshna et al. (2017) Cost of Care for the Initial Management of Ovarian Cancer. Obstet Gynecol 130:1269-1275
Accordino, Melissa K; Wright, Jason D; Vasan, Sowmya et al. (2017) Factors and Costs Associated With Delay in Treatment Initiation and Prolonged Length of Stay With Inpatient EPOCH Chemotherapy in Patients With Hematologic Malignancies. Cancer Invest 35:202-214
Accordino, Melissa K; Wright, Jason D; Vasan, Sowmya et al. (2017) Association between survival time with metastatic breast cancer and aggressive end-of-life care. Breast Cancer Res Treat 166:549-558
Wright, Jason D; Cham, Stephanie; Chen, Ling et al. (2017) Utilization of sentinel lymph node biopsy for uterine cancer. Am J Obstet Gynecol 216:594.e1-594.e13
Wright, Jason D; Chen, Ling; Hou, June Y et al. (2017) Association of Hospital Volume and Quality of Care With Survival for Ovarian Cancer. Obstet Gynecol 130:545-553

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