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Breast Cancer Setting Priorities for Effectiveness Research (1990) / Chapter Skim
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Factors Important for the Selection of Key Patient Management Issues and Related Research Activities
Pages 19-23

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From page 19...
... 9A recent General Accounting Office report on breast cancer survival among women treated with adjuvant chemotherapy contends that the question of whether chemotherapy extends patient survival has been answered affirmatively. What remains unanswered is whether the use of chemotherapy in everyday practice has realized this potential.
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From page 20...
... Finally, the committee believed that separate studies to determine the content and outcomes of care provided to the Medicare population will be of particular value, especially if those analyses can help to advance the understanding of the role and results of prevention strategies, to clarify whether treatments offered to older women differ systematically from those offered to younger women, and to identify preferred patient management regimens. SELECTING PATIENT MANAGEMENT ISSUES Several factors figure in selecting key patient management issues in breast cancer for effectiveness research, especially for elderly women.
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From page 21...
... First, at the 1988 Clinical Workshop, the committee had identified four generic areas of concern: (1) clarification of the implications of the difference between efficacy and effectiveness for the overall purposes of this research program; (2)
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From page 22...
... patients with early disease with those with locally advanced disease.~° For instance, very ill patients may not have been hospitalized but rather were irradiated as outpatients. Patients in an "other than mastectomy" category can include two very different types of bone committee member argued that in addition to pathologic stage and estrogen receptor status, cell kinetic and DNA analysis should be considered for staging and case-mix adjustment because they are more useful in predicting aggressiveness of the tumor than is estrogen receptor status.
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From page 23...
... They can also be used to look at in-hospital survival, time-based survival, readmissions, some complications, and other simple outcome measures when one is unable to measure functional status, mental health, or other health status outcomes directly. Thus, although the discussion emphasized the necessity of obtaining richer clinical and patient outcome data through Medicare PROs, linkages with local SEER registries, and (most important)
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Key Terms

  • patient management
  • effectiveness research
  • management issues
  • functional status
  • elderly women

  • cancer committee
  • variation beyond
  • outcome measures
  • key patient
  • medicare population

  • initially treated
  • epidemiologic aspects
  • equivalent results
  • occasioned considerable
  • office report

  • advanced stage
  • substantial variation
  • critical issues
  • women treated
  • patient outcome

  • remain critical
  • severely restricted
  • outcomes directly
  • treatments offered
  • valid outcome

  • medicare expenditures
  • administrative files
  • produce equivalent
  • status outcomes
  • richer clinical


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