This project will identify the determinants of and calculate cost- effectiveness ratios for 3 alternative treatments for local breast cancer in the elderly: modified radical mastectomy (MRM), breast conserving surgery (BCS) with radiotherapy (RT), and BCS without RT. Treatment choice and short- and intermediate-term outcomes will be analyzed using data from a prospective convenience cohort of approximately 800 newly-diagnosed elderly (65+) breast cancer patients who will be interviewed post- treatment and followed for up to 2 years. Their surgeons will be surveyed by mail with telephone follow-up. We will also conduct surveys of nationally representative, retrospective, random samples of breast cancer surgeons (n = 1,000) and their Medicare patients (1,575 decedents and 3,000 survivors) who were treated in 1992 in order to (a) validate and extend the treatment choice model to a national sample and (b) measure 5- year outcomes. Cost-effectiveness ratios for each treatment will be calculated for all older women and for substrata defined by age, race, geography, and initial health status, based on 5-year outcomes and short- and intermediate-term outcomes imputed from the convenience sample. Medical care costs will be measured using Medicare claims data. The proposed analyses are multidisciplinary, drawing on theoretical models and prior research in economics, behavioral science, and cost- effectiveness analysis, as well as the relevant clinical literature. Recognizing the observational nature of the data, estimation of the treatment choice and treatment-outcome models uses the instrumental variable approach, a common econometric method, to adjust for the joint selection of providers and treatment choices by patients and for the effects of unobservable differences in patients' initial health and preferences. The project will develop clear recommendations regarding the appropriateness of observed patterns of treating local breast cancer in the elderly, taking account of circumstances that may differ with age, initial health, and access to different types of providers.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project (R01)
Project #
5R01HS008395-04
Application #
2591645
Study Section
Special Emphasis Panel (ZHS1-HCPR-C (01))
Program Officer
Cummings, Mary
Project Start
1994-09-30
Project End
1999-12-31
Budget Start
1997-11-01
Budget End
1998-12-31
Support Year
4
Fiscal Year
1998
Total Cost
Indirect Cost
Name
Georgetown University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
049515844
City
Washington
State
DC
Country
United States
Zip Code
20057
Mandelblatt, Jeanne; Kreling, Barbara; Figeuriedo, Melissa et al. (2006) What is the impact of shared decision making on treatment and outcomes for older women with breast cancer? J Clin Oncol 24:4908-13
Yabroff, K Robin; Mandelblatt, Jeanne S; Ingham, Jane (2004) The quality of medical care at the end-of-life in the USA: existing barriers and examples of process and outcome measures. Palliat Med 18:202-16
Figueiredo, Melissa I; Cullen, Jennifer; Hwang, Yi-Ting et al. (2004) Breast cancer treatment in older women: does getting what you want improve your long-term body image and mental health? J Clin Oncol 22:4002-9
Mandelblatt, Jeanne; Armetta, Catherine; Yabroff, K Robin et al. (2004) Descriptive review of the literature on breast cancer outcomes: 1990 through 2000. J Natl Cancer Inst Monogr :8-44
Kerner, Jon F; Yedidia, Michael; Padgett, Deborah et al. (2003) Realizing the promise of breast cancer screening: clinical follow-up after abnormal screening among Black women. Prev Med 37:92-101
Polsky, Daniel; Mandelblatt, Jeanne S; Weeks, Jane C et al. (2003) Economic evaluation of breast cancer treatment: considering the value of patient choice. J Clin Oncol 21:1139-46
O'Malley, Ann S; Lawrence, William; Liang, Wenchi et al. (2002) Feasibility of mobile cancer screening and prevention. J Health Care Poor Underserved 13:298-319
Mandelblatt, Jeanne S; Kerner, Jon F; Hadley, Jack et al. (2002) Variations in breast carcinoma treatment in older medicare beneficiaries: is it black or white. Cancer 95:1401-14
Mandelblatt, J S; Yabroff, K R (2000) Breast and cervical cancer screening for older women: recommendations and challenges for the 21st century. J Am Med Womens Assoc 55:210-5
Yabroff, K R; Kerner, J F; Mandelblatt, J S (2000) Effectiveness of interventions to improve follow-up after abnormal cervical cancer screening. Prev Med 31:429-39

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