Purpose: We examined the association between patient experience of care and utilization of hormone therapy (HT) in the treatment of non-metastatic hormone-receptor positive (HR+) breast cancer. Methods: Patients newly diagnosed with non-metastatic breast cancer were recruited from 2006 to 2010 for a longitudinal multisite cohort study in New York, NY, Detroit, MI, and Northern California. Of 1,145 patients surveyed, 797 had HR+ tumors eligible for HT and all necessary data. We assessed patient experience 4 to 8 weeks after recruitment using 6 subscales of the Interpersonal Processes of Care (IPC) survey: compassion, discrimination, and hurriedness in communication, as well as concern elicitation, result explanation, and patient-centered decision-making. Subscales ranged from 1 to 5 where higher values indicated better experiences. HT for 5 years is standard care for HR+ breast cancer so utilization was defined as time from diagnosis to HT initiation and time from HT initiation to early discontinuation before 5 years as calculated from follow-up survey responses. We evaluated the relationship between patient experience and utilization using Cox proportional hazard models, controlling for education, income, insurance, marital status, social support, site of care, age at diagnosis, stage, grade, tumor size, Charlson comorbidity index, and chemotherapy. Results: Median age at diagnosis was 59 years (interquartile range 51–66) with the majority diagnosed at clinical stage 1 (54%) and with low or moderate grade disease (78%). Less hurried communication was associated with increased probability of HT initiation (Hazards Ratio (HR) 1.15; 95% Confidence Interval (CI) 1.03, 1.30; p = 0.018). Conversely, more patient-centered decision-making was associated with increased probability of early discontinuation (HR 1.29; CI, 1.03, 1.63; p = 0.028). All other associations were null. Conclusion: While unhurried communication was associated with initiation of hormone therapy, patient-centered decision-making was associated with early discontinuation. Different aspects of patient experience may have vastly different relationships with patient utilization of health services. Actionable assessments of patient experience may require measurement along multiple dimensions.
Basal-like intrinsic subtype and poor prognosis are characteristic of breast cancers in BRCA1 families, but other genes also confer inherited predisposition to breast cancer, and subtype associations may differ. The objective of this study was to examine whether family history of breast cancer is associated with basal-like subtype and/or poor prognosis in a population-based sample of women with breast cancer. METHODS: The study population was the Life After Cancer Epidemiology (LACE) cohort, diagnosed with breast cancer in 1996-2000, and the Pathways cohort, diagnosed with breast cancer in 2006-2008. History of breast cancer among first-degree relatives was obtained by self-report at study enrollment, and women were followed for breast cancer recurrence and mortality. Primary breast cancer tissue was obtained for a case-cohort sample. Intrinsic subtypes were classified based on RT-PCR assay of 50 genes (PAM50). Sample-weighted subtype distributions were compared by family history. Hazard ratios (HR) for recurrence and mortality were estimated from Cox proportional hazards models. RESULTS: From 4,256 women in the parent cohorts who responded to the family history question, 20.5% reported a first-degree family history of breast cancer. Among women with family history, 80.6% were diagnosed at ages 50 and older, compared with 76.3% of women without family history, p = 0.007. Among cases with family history, 79.2% were non-Hispanic whites, compared with 72.3% of cases without family history, p < 0.001. Within the subcohort with PAM50 results (n = 1,319), cases with and without family history had 8.5% and 10.2% prevalence of basal-like tumors, respectively, p = 0.27. For cases diagnosed before age 50, the prevalences of basal-like subtype for women with and without family history were 18.6% and 15.9%, respectively, p = 0.62. Women with family history had similar recurrence risk to those without, HR 0.82 (95% CI 0.61, 1.11; age- and race-adjusted). Women with family history had a suggestive reduced risk of death from all causes, HR 0.75 (95% 0.55, 1.02). Family history was not significantly associated with recurrence or survival within any intrinsic subtype group. DISCUSSION: Although BRCA1 is known to predispose to basal-like subtype, we found no association between family history of breast cancer and basal-like subtype or worse prognosis in this population-based cohort. Mutation status for BRCA1 and other cancer susceptibility genes are unknown for cohort members. First-degree family history of breast cancer may represent the presence of one of the several inherited breast cancer susceptibility genes, or chance aggregation of sporadic cases. Particularly for a woman diagnosed at an older age, her mother and sisters would also have reached ages when sporadic breast cancer incidence is high. Among women diagnosed before age 50, family history was associated with a small and non-significant excess of basal-like tumors. Implications of this study are that for women from the general population diagnosed with breast cancer, a first-degree family history of breast cancer indicates neither a higher probability of a basal-like tumor nor worse prognosis. Support: NIH CA129059 and CA105274. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-07-01.
Ninety percent of head and neck cancer (HNC) survivors experience disease and treatment related symptoms. Diet has the Cancer Epidemiology, Biomarkers & Prevention
operational definitions for each dimension (aggregating sexual minority women into one group and disaggregating sexual minority women into subgroups). Weighted logistic regression models determined how HPV infection outcomes (any HPV type, high-risk HPV type, and vaccine-preventable HPV type) varied by dimension. Results: Similar patterns emerged for sexual identity and sexual behavior. In bivariate analyses, HPV infection outcomes were more common among non-heterosexual women compared to heterosexual women (any type: 49.7% vs. 41.1%; high-risk type: 37.0% vs. 27.9%), as well as among women who reported any same-sex partners compared to women who reported only opposite-sex partners (any type: 55.9% vs. 41.0%; high-risk type: 37.7% vs. 28.2%; vaccinepreventable type: 19.1% vs. 14.0%) (P < 0.05). When we disaggregated dimensions of sexual orientation into subgroups, bisexual women and women who reported partners of both sexes had greater odds of HPV infection outcomes (P < 0.05 in bivariate analyses). Multivariate models attenuated several of these differences, though lesbian women and women who reported only same-sex partners had lower odds of most HPV infection outcomes in multivariate analyses (P < 0.05). Conclusions: HPV infection is common among sexual minority women. However, prevalence estimates vary slightly between sexual orientation dimensions and greatly depending on how a dimension is operationally defined. These findings highlight the importance of measuring sexual orientation in various ways and can help inform targeted HPV and cervical cancer prevention efforts for sexual minority women. Purpose: Cervical cancer (CC) incidence and mortality rates are increased and CC screening rates are low among women living in Ohio Appalachia. Mailing human papillomavirus (HPV) self-tests to women to complete at home is a potential new strategy in the United States to engage women in the CC screening process. Our study sought to understand both providers' and women's perspectives on an HPV self-test that could be mailed to women and how those viewpoints may differ and/or concur. Methods: Focus groups were conducted (2014-2015) among: 1) healthcare providers practicing in four Federally Qualified Health Centers (FQHCs) located in three Ohio Appalachia counties; and 2) women living in Ohio Appalachia. Results: Providers (n ¼ 28) and women (n ¼ 15) were accepting of HPV self-testing, however, the reason for acceptance differed between groups. Providers thought HPV self-testing would increase the possibility that under-screened women would return to the healthcare system, while women thought completing HPV self-tests at home would eliminate logistical/psychological CC screening barriers. Facilitators of completing an HPV self-test at home reported by women included decreased embarrassment, and the time and money saved by avoiding a doctor's appointment. Barriers to completing an HPV self-test at home reported by providers and women included women not being aware of the test, concerns about incorrectly completing the t...
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