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Publications
Publications (66)
PurposeHealthcare systems contribute to disparities in breast cancer outcomes. Patient navigation is a widely cited system-based approach to improve outcomes among populations at risk for delays in care. Patient navigation programs exist in all major Boston hospitals, yet disparities in outcomes persist. The objective of this study was to conduct a...
Objectives: The purpose of this study was to investigate disparities in breast cancer outcomes at an urban safety net hospital. This study examined the relationship of sociodemographic factors, hypertension, and diabetes with recurrence rates in a cohort of patients with breast cancer.
Methods: A retrospective review was performed on patients who w...
215
Background: Hospital administrative data has large ramifications for quality of care and quality improvement projects. Unexpected inpatient mortality among patients with a hematology/oncology (H/O) diagnostic related group (DRG) is not widely studied and reported. We sought to investigate the unexpected inpatient mortality rate among cancer pat...
Significance:
Diffuse optical imaging (DOI) provides in vivo quantification of tissue chromophores such as oxy- and deoxyhemoglobin (HbO2 and HHb, respectively). These parameters have been shown to be useful for predicting neoadjuvant treatment response in breast cancer patients. However, most DOI devices designed for the breast are nonportable, m...
591
Background: Multi-gene testing of primary breast tumors in early-stage breast cancer is used to classify the risk of developing distant metastases and predict the benefit of adjuvant chemotherapy. The association between the tumor genomic prognostic score (GPS) and response to neoadjuvant chemotherapy (NACT) and survival is not well characteriz...
Introduction Oral chemotherapy agents have become increasingly common for the treatment of various malignancies, specifically in the metastatic setting. In metastatic breast cancer, oral chemotherapy is now considered the standard of care for first-line treatment due to progression-free survival and overall survival benefits. Oral agents are also c...
PURPOSE
Hospital readmissions occur commonly in those receiving cancer care and result in impaired quality of life and increased costs. Causes of readmission in safety net hospitals that serve vulnerable populations are not well understood. The primary goal of this project was to identify potentially avoidable and intervenable causes of readmission...
Purpose
To examine the impact of pre-diagnosis depressive symptoms and mental health-related quality of life (HRQOL) on survival among older patients with multiple myeloma (MM).
Methods
We performed a retrospective cohort study using the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey data resource. Patients aged 65 yea...
Background:
The differential occurrence of second primary cancers by race following ovarian cancer is poorly understood. Our objective was to determine the incidence of second primary gynecologic cancers (SPGC) following definitive therapy for ovarian cancer. Specifically, we aimed to determine differences in SPGC incidence by Asian ethnic subgrou...
PurposePatient-reported outcomes such as self-reported health (SRH) are important in understanding quality cancer care, yet little is known about links between SRH and outcomes in older patients with multiple myeloma (MM). We evaluated associations between SRH and mortality among older patients with MM.Methods
We analyzed a retrospective cohort of...
Abstract Background Breast cancer patients with early-stage disease are increasingly administered neoadjuvant chemotherapy (NAC) to downstage their tumors prior to surgery. In this setting, approximately 31% of patients fail to respond to therapy. This demonstrates the need for techniques capable of providing personalized feedback about treatment r...
Importance
Compared with non-Hispanic white women, racial/ethnic minority women receive a diagnosis of breast cancer at a more advanced stage and have higher morbidity and mortality with breast cancer diagnosis. Access to care with adequate insurance may be associated with earlier diagnosis, expedited treatment, and improved prognosis.
Objective
T...
We present here our recent clinical data and technological developments in diffuse optical technologies for monitoring breast cancer at early timepoints.
We present a high-optode density continuous-wave (CW) wearable diffuse optical device for the investigation of hemodynamic responses of locally advanced breast tumors. Initial results from tissue-simulating phantoms and a normal volunteer study are described.
Despite near universal health coverage under Medicare, racial disparities persist in the treatment of diffuse large B-cell lymphoma (DLBCL) among older patients in the United States. Studies evaluating DLBCL outcomes often treat socioeconomic status (SES) measures as confounders, potentially introducing biases when SES factors are mediators of disp...
Background
There is a need for guidelines on patient navigation activities to promote both the quality of patient navigation and the standards of reimbursement for these services because a lack of reimbursement is a major barrier to the implementation, maintenance, and sustainability of these programs.
Methods
A broad community‐based participatory...
Introduction
The purpose of this research was to assess the feasibility, acceptability and potential effectiveness of a program to support the occupational performance of urban breast cancer survivors living with cancer-related cognitive impairment.
Method
Participants ( n = 15) reporting cognitive changes following breast cancer treatment were en...
Diffuse Optical Spectroscopic Imaging (DOSI) is a non-invasive near-infrared imaging modality than can provide label-free functional and metabolic information about breast tumors, probing depths up to several centimeters. Previous work has shown that DOSI has prognostic value for pathological response at key timepoints during neoadjuvant (presurgic...
Diffuse Optical Spectroscopic Imaging (DOSI) is a non-invasive near-infrared imaging modality than can provide label-free functional and metabolic information about breast tumors, probing depths up to several centimeters. Previous work has shown that DOSI has prognostic value for pathological response at key timepoints during neoadjuvant (presurgic...
6582
Background: The strength of associations between pre-diagnosis self-reported health (SRH) and mortality differ by medical condition, with a moderately strong association reported among cancer patients. Less is known about the impact of SRH on survival among patients diagnosed with multiple myeloma (MM). We aimed to evaluate pre-diagnosis SRH i...
e18250
Background: Adjuvant intravenous bisphosphonates (IV BP) reduce the risk of skeletal-related events (SRE) in patients with multiple myeloma (MM). We examined the effects of bisphosphonate utilization patterns (adherence, cumulative dose and frequency) on risk of SRE. Methods: Patients aged 65 years or older and diagnosed with first primary M...
e18232
Background: Few studies have evaluated the impacts of depressive symptoms and mental health on patients diagnosed with multiple myeloma (MM). The aim of this study was to examine associations between depressive symptoms and poor mental health-related quality of life in relation to survival in a cohort of older MM patients. Methods: We conduc...
e18165
Background: Intravenous bisphosphonates (IV BP) reduce the risk of skeletal-related events in patients with multiple myeloma (MM). However, data describing racial differences in utilization of IV BP in non-clinical trial settings is limited. In this study, we evaluated population-level IV BP utilization and factors associated with initiation...
e18121
Background: Racial/ethnic minority women are diagnosed with later stage breast cancer. This study identifies the extent insurance can affect stage differences among a large, diverse population of breast cancer patients in the U.S. Methods: Retrospective, population-based study of women aged 40-64 years diagnosed with stages I-III breast canc...
10525
Background: The Massachusetts General Hospital Cancer Care Equity Program conducted a qualitative survey health assessment in the inner-city communities of Boston to study Black Bostonian patients’ perceptions of the barriers to cancer care. Findings revealed a level of mistrust toward large cancer centers and a request for more interactions...
Breast cancer is the most common cancer diagnosed in women worldwide. Over the years, breast cancer treatment has undergone revolutionary changes especially for women with hormone receptor positive metastatic disease. As a result, women are living longer with their disease, particularly in developed countries. The use of cyclin-dependent kinase (CD...
Background
Granulocyte colony‐stimulating factors (G‐CSFs), which are used for the prevention of complications from chemotherapy‐related neutropenia, are linked to the risk of developing second primary myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML). The objective of this study was to examine the correlation between using a specific...
Date Presented 3/31/2017
The implementation of a client-centered self-management program at an urban safety net hospital fills an important gap in the expansion of rehabilitation programs for breast cancer survivors and demonstrates an opportunity for occupational therapy to meet the needs of this underserved population.
Primary Author and Speaker:...
Background
Minority women in the U.S. continue to experience inferior breast cancer outcomes compared with white women, in part due to delays in care delivery. Emerging cancer care delivery models like patient navigation focus on social barriers, but evidence demonstrating how these models increase social capital is lacking. This pilot study descri...
Purpose:
Many patients with breast cancer are treated for other conditions and experience polypharmacy with multiple concurrent medications. Our aim was to evaluate polypharmacy in relation to adherence to adjuvant endocrine therapy (AET) in breast cancer.
Methods:
We conducted a retrospective cohort study of women with incident, invasive breast...
Background:
Disparities in breast cancer care are a worsening problem, requiring effective interventions that seek to address the delivery of high quality cancer care. Evidence from interventions designed to improve timeliness of care routinely identify lack of social support as one of the biggest barriers to care. And, social support is associated...
Background:
Racial and ethnic disparity in breast cancer outcomes is a long-standing problem that continues to worsen. Recent evidence has underscored the importance of timely care, as delays in treatment can lead to decreased survival. We sought to understand predictors of delay to first treatment among a racially diverse cancer population.
Method...
We present a new continuous-wave wearable diffuse optical probe aimed at investigating the hemodynamic response of locally advanced breast cancer patients during neoadjuvant chemotherapy infusions. The system consists of a flexible printed circuit board that supports an array of six dual wavelength surface-mount LED and photodiode pairs. The probe...
A 65-year-old man with metastatic melanoma was started on immunotherapy, switched to alternative targeted therapy and developed disseminated intravascular coagulation. This case underscores the complexity of interpreting and managing side effects of novel therapies in cancer care, identification of progression versus pseudoprogression and challenge...
The authors have drawn to the attention of the editor in chief of the journal errors in the following paper: Katherine J. Strissel, Dequina A. Nicholas, Myriam Castagne-Charlotin, Naomi Ko and Gerald V. Denis. Barriers to Obtaining Sera and Tissue Specimens of African-American Women for the Advancement of Cancer Research. Clinical Medicine Insights...
Patient navigation is emerging as a standard in breast cancer care delivery, yet multi-site data on the impact of navigation at reducing delays along the continuum of care are lacking. The purpose of this study was to determine the effect of navigation on reaching diagnostic resolution at specific time points after an abnormal breast cancer screeni...
African-American women, a historically understudied and underserved group, have increased risk for triple-negative breast cancer and obesity-associated disease. Obesity-associated metabolic diseases share a common link of low grade chronic inflammation, but not all obese women have metabolic disturbances or are inflamed. One goal of our ongoing res...
In the era of precision medicine and targeted therapy, diagnostic inaccuracy can have tremendous ramifications. We present the case of a 61-year-old man initially diagnosed with small cell lung cancer by pathology. Prior to initiating chemotherapy, multidisciplinary discussions led to an amendment of the diagnosis to medullary thyroid cancer.
Background
Social and economic conditions that affect one’s ability to satisfy life’s most basic needs such as lack of affordable housing, restricted access to education and employment, or inadequate income are increasingly well-documented barriers to optimal health. The burden of these challenges among vulnerable patients accessing cancer care ser...
Background:
Patient navigation was developed to address barriers to timely care and reduce cancer disparities. The current study explored navigation and racial and ethnic differences in time to the diagnostic resolution of a cancer screening abnormality.
Methods:
The authors conducted an analysis of the multisite Patient Navigation Research Prog...
Health care technology and innovation is a rapidly growing industry with great potential. Hackathons have become an increasingly popular venue for institutions to generate ideas and enthusiasm for innovation. These events can inspire change and eventual improvement in medical systems. However, alongside developers and business-savvy entrepreneurs,...
Background: Disparities in cancer outcomes for low-income, racial/ethnic minority patients are worsening, partly due to delays in care delivery. Patient-centered innovations in care delivery that address these barriers are necessary to improve care for vulnerable populations.
Methods: We used a community-engaged approach to implement a randomized c...
Background: Minority women in the United States continue to experience inferior breast cancer outcomes compared with white women, in part due to delays in care delivery. Emerging cancer care delivery models such as patient navigation focus on the social causes of disparities, but evidence demonstrating how these interventions increase social suppor...
Asian and Pacific Islander (API) women in the United States (U.S.) are a heterogeneous group reported to have better prognosis after breast cancer (BC) compared to their Non-Hispanic White (NHW) counterparts. Few studies have examined differences in BC survival between individual API ethnic groups. We conducted a retrospective cohort study of 462,0...
Disparities exist in breast cancer (BC) outcomes between racial and ethnic groups in the United States. Reasons for these disparities are multifactorial including differences in genetics, stage at presentation, access to care, and socioeconomic factors. Less is documented on racial/ethnic differences in subsequent risk of second primary cancers (SP...
Background: Differences in comorbidity at diagnosis and utilization of appropriate adjuvant breast cancer treatments could potentially contribute to disparities in breast cancer outcomes between racial and ethnic groups. We investigated the influences of race/ethnicity and comorbidity on receipt of adjuvant chemotherapy. Among women treated with ch...
Background: Disparities exist in breast cancer outcomes between specific racial/ethnic groups in the United States. Reasons for these disparities are multifactorial and include genetic differences, later stage at presentation, access to care and socioeconomic factors. While many aspects of disparities in breast cancer are well defined, less has bee...
Purpose:
Poor and underserved women face barriers in receiving timely and appropriate breast cancer care. Patient navigators help individuals overcome these barriers, but little is known about whether patient navigation improves quality of care. The purpose of this study is to examine whether navigated women with breast cancer are more likely to r...
Breast cancer treatment disparities in racial/ethnic minority and low-income populations are well documented; however, underlying reasons remain poorly understood. This study sought to identify barriers to the delivery of quality breast cancer treatment, addressing compliance with the National Quality Forum (NQF) quality metric for adjuvant hormone...
e12509
Background: One in forty women is diagnosed with breast cancer at a very young age (≤35 years). Studies suggest breast cancer molecular subtypes are different in young women, with a higher prevalence of triple negative and HER-2+ disease. Objective: Explore the impact of genetic diversity on molecular subtyping of very young breast cancer pa...
72
Background: The discrepancy in breast cancer outcomes for underserved populations has been linked to lack of receipt of quality treatment. Patient navigation programs are being rapidly adopted as a model to improve cancer outcomes for these vulnerable populations, yet the effect of navigation on their quality of cancer care is unknown. Methods:...
Learning Objectives
After completing this course, the reader will be able to: Describe the role and potential benefits of patient navigation in breast cancer care.Explain disparities in breast cancer care and their impact on patient populations.
CME This article is available for continuing medical education credit at CME.TheOncologist.com
The elimi...
Background: Enrollment rates into cancer clinical trials among the adult population remains at approximately 2–11% with the vast majority being white men and women from high socioeconomic status and educational backgrounds. In order to address the unequal burden of cancer among underserved populations, it is imperative to enroll representative popu...