Defining care provided for breast cancer based on medical record review or Medicare claims: information from the Centers for Disease Control and Prevention Patterns of Care Study
ABSTRACT BACKGROUND: Description of care patterns is important as evidence-based guidelines increasingly dictate care. We explore the level of agreement between claims and record abstraction for guideline concordant multidisciplinary breast cancer care. METHODS: From the U.S. Centers for Disease Control and Prevention's National Program of Cancer Registries Patterns of Care study, in which medical record abstraction of breast cancer and treatment was accomplished, cases include breast cancer where Medicare claims were available. Components of care were breast-conserving surgery (BCS), mastectomy, node assessment, radiation (RT), and chemotherapy (CTX), including specific chemotherapeutic agents, and combinations. We compared Medicare claims with record abstraction, and measured concordance using the kappa statistic and sensitivity. RESULTS: The study sample consisted of 1762 women with stage 0 to 4 breast cancer. Level of agreement was excellent for surgery type (kappa = 0.84) and CTX (kappa = 0.89); agreement for RT therapy was slightly lower (kappa = 0.79). For standard multicomponent strategies, sensitivities and specificities were high; for example, 88.8%/93.5% for mastectomy plus nodes and 86.6%/95.4% for BCS plus nodes and RT. For selected, standard, multi-agent, adjuvant CTX regimens, sensitivities ranged from 66.3% to 68.8% (kappa 0.63-0.73). CONCLUSIONS: Medicare claims, compared with chart abstraction, is a reliable method for determining patterns of multicomponent care for breast cancer.
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ABSTRACT: Radiation therapy (RT) and chemotherapy (CTX) following surgery are mainstays of treatment for breast cancer (BC). While multiple studies have recently revealed the significance of immune cells as mediators of CTX response in BC, less is known regarding roles for leukocytes as mediating outcomes following RT. To address this, we utilized a syngeneic orthotopic murine model of mammary carcinogenesis to investigate if response to RT could be improved when select immune cells or immune-based pathways in the mammary microenvironment were inhibited. Treatment of mammary tumor-bearing mice with either a neutralizing monoclonal antibody (mAb) to colony-stimulating factor-1 (CSF-1) or a small molecule inhibitor of the CSF-1 receptor kinase (i.e., PLX3397), resulting in efficient macrophage depletion, significantly delayed tumor regrowth following RT. Delayed tumor growth in this setting was associated with increased presence of CD8+ T cells, and reduced presence of CD4+ T cells, the main source of the TH2 cytokine interleukin (IL)-4 in mammary tumors. Selective depletion of CD4+ T cells or neutralization of IL-4 in combination with RT, phenocopied results following macrophage depletion, whereas depletion of CD8+ T cells abrogated improved response to RT following these therapies. Analogously, therapeutic neutralization of IL-4 or IL-13, or IL-4 receptor alpha deficiency, in combination with the CTX paclitaxel resulted in slowed primary mammary tumor growth by CD8+ T cell-dependent mechanisms. These findings indicate that clinical responses to cytotoxic therapy in general can be improved by neutralizing dominant TH2-based programs driving protumorigenic and immune suppressive pathways in mammary (breast) tumors to improve outcomes. Copyright © 2015, American Association for Cancer Research.02/2015; 3(5). DOI:10.1158/2326-6066.CIR-14-0232