Breast Cancer Setting Priorities for Effectiveness Research (1990) / Chapter Skim
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Appendix A: Background and Conduct of the Workshop
Appendix A: Background and Conduct of the Workshop
Pages 45-64
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From page 45... ...
data sets and analyses done for the workshop, and a committee homework exercise that yielded a "first round" set of patient management topics. The workshop was conducted in three public sessions and an executive session, in addition to the previous evenings reception and background session.
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Record, contains considerable information on hospitals, skilled nursing facilities, home health agencies, independent laboratories, ambulatory surgical centers, and similar providers for Medicare. The third and fourth files are the Utilization Records for Medicare Parts A and B billing information, including hospital days of care, diagnoses, surgical procedures, physician visits, charges, and payments.
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as part of the proposed Uniform Clinical Data Set. In 1987, HCFA's Health Standards and Quality Bureau (HSQB)
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The availability of extensive clinical information collected in UCDS formats would support much more thorough and detailed analysis of patterns of interventions and of outcomes than is possible simply with billing data. Thus, for patients with particular medical conditions, such as breast cancer, a large body of information could be made available to the medical community and for intramural and extramural research.
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SOURCE: "Resource Manual for Uniform Clinical Data Set (UCDS) " prepared by Case Mix Research, Queens University Department of Community Health and Epidemiology, Kingston, Ontario, Canada in association with Wisconsin Peer Review Organization (WIPRO)
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was mentioned in connection with the Part B files. Breast Cancer Analyses Illustrating the Use of Medicare Data HCFA staff compiled an array of data tables from their analyses of Medicare files on breast cancer as well as a set of tables on acute myocardial infarction, coronary artery bypass graft, and angiography illustrative of types of analyses that might in the future be done with breast cancer data.
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A final set of analyses centered on risk factors, specifically on the time to death following admission for breast cancer or for resection of breast cancer as those measures related to demographic characteristics, other diagnoses suggesting coexisting chronic conditions, and type of treatment. More detailed severity-adjusted data on patients admitted for acute myocardial infarction were used as examples of how the risk-factor issue might be pursued for breast cancer.
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Primary treatment and follow-up Local/regional therapies for breast cancer Systemic therapy for breast cancer Role of biologic markers in selecting therapy and monitoring for reoccurrence Use of biologic variables in selecting systemic therapy Use of adjuvant chemotherapy Use of adjuvant chemotherapy even when axillary nodes are negative Management of metastatic disease Breast cancer as a chronic illness-treatment and care Rehabilitation Rehabilitative issues, use and type of prosthesis reconstruction Emotional aspects Improved educational materials for physicians and patients Breast carcinoma education: would a standard curriculum in school be costeffective
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Tables A.3 to A.8 give detailed information on issues raised by the first round of committee homework for six patient management topics: prevention and screening; diagnosis and staging; alternative treatment regimens; rehabilitation; psychological aspects of breast cancer, treatment, and recovery; and patient and physician education. The information in these tables represented the views of skilled clinicians, some of whom specialize in the care of patients with breast cancer, and experts in research and other disciplines needed for successful effectiveness research.
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From page 54... ...
overall screening practices for other diseases: Determine incidence of mammogram screening as a function of incidence of colorectal cancer screening by physician supply and characteristics, to answer the question: Are physicians who are educated to appropriate screening guidelines for mammography also screening appropriately for colorectal cancer (or vice versa)
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and how they would guide a screening strategy, through either cohort studies or case-control studies Determine appropriate screening intervals for various age groups and an appropriate maximal age, ideally through RCTs but possibly with computer modeling and only secondarily with case-control stud~es Develop screening protocols that include establishing ages at which mammograms are no longer life-prolonging Table A.3 continues
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Study ways to increase compliance with screening mammography guidelines (this relates to several other points reducing uncertainties about guidelines for screening, improving physician education, etc.) Develop ways to provide information on the proven effectiveness of screening (disseminate information as a result of mass screening)
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4. scan of chest and abdomen, bone scans, and other nuclear scans Surgical data: type of biopsy, type of excision of primary tumor and/or mastectomy and details of axillary node sampling Other clinical and health status measures not directly related to breast cancer physiologic measures B
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Other Suggested Studies relating to Auxiliary Node Involvement A Evaluate axillary node dissection 1.
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Adjuvant chemotherapy therapy with hormonal therapy 6. Systemic therapy used as substitution or as adjunctive therapy c.
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Of modified radical mastectomy versus local excision plus tamoxifen for Stage I and Stage II breast carcinoma in women over 70 with com parison of 1. Disease-free survival 2.
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Of adjuvant chemotherapy in women with no ancillary node metastases E Of response rates to adjuvant and relapsed therapy according to numer ous pathologic/physiologic/biologic variables, to identify appropriate therapies for different biologic subgroups of breast cancers IV.
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Links to pretreatment evaluation before definitive local-regional therapy-chest X-ray, bilateral mammogram, bone scan, lab, ER and PR, flow cytometry Questions raised about surgical interventions 1. Indications for axillary node dissection (therapeutic or staging?
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2. Is recovery altered after primary therapy in older age groups?
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Develop Psychosocial Adjustment Indicators of Patients at High Risk for Adjustment Problems III. Determine the Ambulatory Resources for Those Patients Requiring Support TABLE A.8 Summary of Recommended Research Activities Related to Patient and Physician Education in Breast Cancer I
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