Donna B Jeffe

Washington University in St. Louis, San Luis, Missouri, United States

Are you Donna B Jeffe?

Claim your profile

Publications (175)645.42 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: We examined the effects of surgery type and adjuvant chemotherapy on change in early-stage breast cancer patients' quality of life (QOL) over time. Methods: A cohort of 549 patients (33.5 % ductal carcinoma in situ, 66.5 % stages I/IIA) were interviewed a mean 6.1 weeks (Time1), and 6.2 (Time2), 12.3 (Time3), and 24.4 (Time4) months following definitive breast-conserving surgery (BCS) or mastectomy. QOL was measured using the total Functional Assessment of Cancer Therapy-Breast (FACT-B). Adjusting for demographic, psychosocial, and clinical variables, multiple linear regression models estimated the associations between QOL and each of surgery type, chemotherapy, and their 2-way interaction at each interview. Adjusted generalized estimating equation (GEE) models tested Time1-Time4 change in QOL. Results: At Time2, chemotherapy (P < .001) and BCS (P < .001) were independently associated with worse QOL in adjusted linear regression, and the adverse effect of chemotherapy was prominent among patients who received BCS compared with those who received mastectomy (P interaction = .031). In the GEE model, QOL significantly improved over time among patients who received BCS (P trend = .047), mastectomy (P trend = .024), and chemotherapy (P trend < .001), but not among patients who did not receive chemotherapy (P trend = .720). All patients completed adjuvant chemotherapy and radiation by Time3. Regardless of surgery type, patients receiving chemotherapy reported lower QOL following surgery, and QOL improved after completion of adjuvant treatment. Conclusions: Chemotherapy had a short-term negative impact on QOL after definitive surgical treatment regardless of surgery type. QOL rebounded after completion of adjuvant treatment.
    No preview · Article · Oct 2015 · Annals of Surgical Oncology

  • No preview · Article · Oct 2015 · Journal of the American College of Surgeons

  • No preview · Article · Sep 2015

  • No preview · Article · Aug 2015 · Neurosurgery
  • Dorothy A Andriole · Donna B Jeffe · Robert H Tai
    [Show abstract] [Hide abstract]
    ABSTRACT: We sought to determine the prevalence of college laboratory research apprenticeship (CLRA) participation among students considering medical careers and to examine the relationship between CLRA participation and medical-school acceptance among students who applied to medical school. We used multivariate logistic regression to identify predictors of: 1) CLRA participation in a national cohort of 2001-2006 Pre-Medical College Admission Test (MCAT) Questionnaire (PMQ) respondents and 2) among those PMQ respondents who subsequently applied to medical school, medical-school acceptance by June 2013, reporting adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). Of 213,497 PMQ respondents in the study sample (81.2% of all 262,813 PMQ respondents in 2001-2006), 72,797 (34.1%) reported CLRA participation. Each of under-represented minorities in medicine (URM) race/ethnicity (vs. white, aOR: 1.04; 95% CI: 1.01-1.06), Asian/Pacific Islander race/ethnicity (vs. white, aOR: 1.20; 95% CI: 1.17-1.22), and high school summer laboratory research apprenticeship (HSLRA) participation (aOR: 3.95; 95% CI: 3.84-4.07) predicted a greater likelihood of CLRA participation. Of the 213,497 PMQ respondents in the study sample, 144,473 (67.7%) had applied to medical school and 87,368 (60.5% of 144,473 medical-school applicants) had been accepted to medical school. Each of female gender (vs. male, aOR: 1.19; 95% CI: 1.16-1.22), URM race/ethnicity (vs. white, aOR: 3.91; 95% CI: 3.75-4.08), HSLRA participation (aOR: 1.11; 95% CI: 1.03-1.19), CLRA participation (aOR: 1.12; 95% CI: 1.09-1.15), college summer academic enrichment program participation (aOR: 1.26; 95% CI: 1.21-1.31), and higher MCAT score (per point increase, aOR: 1.31; 95% CI: 1.30-1.31) predicted a greater likelihood of medical-school acceptance. About one-third of all PMQ respondents had participated in CLRAs prior to taking the MCAT, and such participation was one of the several variables identified that were independently associated with medical-school acceptance.
    No preview · Article · Jun 2015 · Medical Education Online
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In this study, we sought to determine the predictors of pathological complete response (pCR) and compare the chemotherapeutic regimens administered to breast cancer patients with and those without pCR. We retrospectively reviewed the data of 879 patients treated at the Alvin J. Siteman Cancer Center between 2006 and 2010, to identify patients who were diagnosed with primary stage II or III breast cancer and received neoadjuvant chemotherapy. Patients who received only neoadjuvant endocrine therapy were considered to be ineligible. Patient, tumor, and treatment characteristics, including type of chemotherapy, were compared between patients who did and those who did not achieve pCR using Chi-square or Fishers exact tests and multivariate logistic regression analysis. Two-sided P-values of <0.05 were considered significant. Of the 333 patients who met the inclusion criteria, 61 (18.3%) had documented pCR. Compared with patients not achieving pCR, a greater proportion of patients with pCR had stage II disease (80.3 vs. 68%, P=0.057), had poorly differentiated (grade 3) tumors (82 vs. 59.2%, P<0.001), had negative lymph node involvement (41 vs. 34%, P=0.0004) and had tumors that were HER2-amplified (41 vs. 23.5%, P=0.0054). A greater proportion of patients with pCR received taxane-based chemotherapy (23 vs. 12.5%, P=0.016) or trastuzumab in conjunction with chemotherapy (41.0 vs. 16.9%, P<0.001). No patients receiving solely anthracycline-based therapy achieved pCR in our study. Our study demonstrated that, for stage II and III breast cancer, lower stage, negative lymph node involvement and HER2 receptor amplification were each associated with pCR. Taxane therapy and the concurrent use of trastuzumab were also associated with a higher likelihood of pCR.
    Preview · Article · Jun 2015 · Molecular and Clinical Oncology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We examined the utility of January 2004 to April 2014 Google Trends data from information searches for cancer screenings and preparations as a complement to population screening data, which are traditionally estimated through costly population-level surveys. State-level data across the USA. Persons who searched for terms related to cancer screening using Google, and persons who participated in the Behavioral Risk Factor Surveillance System (BRFSS). (1) State-level Google Trends data, providing relative search volume (RSV) data scaled to the highest search proportion per week (RSV100) for search terms over time since 2004 and across different geographical locations. (2) RSV of new screening tests, free/low-cost screening for breast and colorectal cancer, and new preparations for colonoscopy (Prepopik). (3) State-level breast, cervical, colorectal and prostate cancer screening rates. Correlations between Google Trends and BRFSS data ranged from 0.55 for ever having had a colonoscopy to 0.14 for having a Pap smear within the past 3 years. Free/low-cost mammography and colonoscopy showed higher RSV during their respective cancer awareness months. RSV for Miralax remained stable, while interest in Prepopik increased over time. RSV for lung cancer screening, virtual colonoscopy and three-dimensional mammography was low. Google Trends data provides enormous scientific possibilities, but are not a suitable substitute for, but may complement, traditional data collection and analysis about cancer screening and related interests. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    Full-text · Article · Jun 2015 · BMJ Open
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Given the prognostic significance of pathological complete response (pCR) to neoadjuvant chemotherapy, we sought to chronicle the clinical course of breast cancer patients whose tumors exhibited pCR at our institution. We retrospectively reviewed 5,533 cancer center patients treated for a first primary breast cancer between March, 1999 and September, 2010 to identify those who received neoadjuvant chemotherapy that resulted in pCR (i.e., no residual invasive malignancy in the breast or axilla). The descriptive statistics of treatments received, recurrence, morbidity and mortality as of October, 2013 were reported. Of the 5,533 patients reviewed, 86 met the inclusion criteria. The mean age at diagnosis was 48 years [standard deviation (SD), 9.4 years] and the mean length of follow-up was 68 months (SD, 27 months). The majority of the patients underwent axillary lymph node dissection (ALND; n=60, 69.8%), received adjuvant radiation therapy (XRT; n=72, 83.7%), had poorly differentiated (grade 3) tumors (n=74, 86.1%) and had pure ductal histology (n=74, 86.1%). A total of 5 patients (5.8%) developed disease recurrence. All the patients who recurred had grade 3 tumors with ductal histology and underwent ALND for known pre-neoadjuvant-treatment lymph node metastases; none received adjuvant chemotherapy. A total of 4 patients (4.7%) succumbed to the disease, 3 due to breast cancer recurrence <18 months following the initial diagnosis. Recurrence following pCR was rare, but when it did occur, time- to-recurrence was short at <18 months. All the patients who recurred and eventually succumbed to breast cancer had axillary metastases at diagnosis, indicating that axillary disease is a major negative prognostic factor in patients who achieve pCR following neoadjuvant chemotherapy.
    Preview · Article · Mar 2015 · Molecular and Clinical Oncology
  • [Show abstract] [Hide abstract]
    ABSTRACT: To develop evidence-based treatment guidelines for Chiari malformation type 1 (CM-1), preoperative prognostic indices capable of stratifying patients for comparative trials are needed. To develop a preoperative Chiari Severity Index (CSI) integrating the clinical and neuroimaging features most predictive of long-term patient-defined improvement in quality of life (QOL) after CM-1 surgery. We recorded preoperative clinical (eg, headaches, myelopathic symptoms) and neuroimaging (eg, syrinx size, tonsillar descent) characteristics. Brief follow-up surveys were administered to assess overall patient-defined improvement in QOL. We used sequential sequestration to develop clinical and neuroimaging grading systems and conjunctive consolidation to integrate these indices to form the CSI. We evaluated statistical significance using the Cochran-Armitage test and discrimination using the C statistic. Our sample included 158 patients. Sequential sequestration identified headache characteristics and myelopathic symptoms as the most impactful clinical parameters, producing a clinical grading system with improvement rates ranging from 81% (grade 1) to 58% (grade 3) (P = .01). Based on sequential sequestration, the neuroimaging grading system included only the presence (55% improvement) or absence (74% improvement) of a syrinx ≥6 mm (P = .049). Integrating the clinical and neuroimaging indices, improvement rates for the CSI ranged from 83% (grade 1) to 45% (grade 3) (P = .002). The combined CSI had moderately better discrimination (c = 0.66) than the clinical (c = 0.62) or neuroimaging (c = 0.58) systems alone. Integrating clinical and neuroimaging characteristics, the CSI is a novel tool that predicts patient-defined improvement after CM-1 surgery. The CSI may aid preoperative counseling and stratify patients in comparative effectiveness trials. CM-1, Chiari malformation type 1CSI, Chiari Severity IndexQOL, quality of life.
    No preview · Article · Jan 2015 · Neurosurgery
  • Joan L Rosenbaum · Joan R Smith · Yan Yan · Nancy Abram · Donna B Jeffe
    [Show abstract] [Hide abstract]
    ABSTRACT: ABSTRACT This study tested the effect of a neonatal-bereavement-support DVD on parental grief after their baby's death in our Neonatal Intensive Care Unit compared with standard bereavement care (controls). Following a neonatal death, we measured grief change from 3- to 12-month follow-up using a mixed-effects model. Intent-to-treat analysis was not significant, but only 18 parents selectively watched the DVD. Thus, we subsequently compared DVD-viewers with DVD-non-viewers and controls. DVD-viewers reported higher grief at 3-month interviews compared with DVD-non-viewers and controls. Higher grief at 3 months was negatively correlated with social support and spiritual/religious beliefs. These findings have implications for neonatal-bereavement care.
    No preview · Article · Dec 2014 · Death Studies

  • No preview · Conference Paper · Oct 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study is to examine the associations of neighborhood socioeconomic deprivation and triple-negative breast cancer (TNBC) subtype with causes of death [breast cancer (BC)-specific and non-BC-specific] among non-metastatic invasive BC patients. We identified 3,312 patients younger than 75 years (mean age 53.5 years; 621 [18.8 %] TNBC) with first primary BC treated at an academic medical center from 1999 to 2010. We constructed a census-tract-level socioeconomic deprivation index using the 2000 U.S. Census data and performed a multilevel competing-risk analysis to estimate the hazard ratios (HR) and 95 % confidence intervals (CI) of BC-specific and non-BC-specific mortality associated with neighborhood socioeconomic deprivation and TNBC subtype. The adjusted models controlled for patient sociodemographics, health behaviors, tumor characteristics, comorbidity, and cancer treatment. With a median 62-month follow-up, 349 (10.5 %) patients died; 233 died from BC. In the multivariate models, neighborhood socioeconomic deprivation was independently associated with non-BC-specific mortality (the most- vs. the least-deprived quartile: HR = 2.98, 95 % CI = 1.33-6.66); in contrast, its association with BC-specific mortality was explained by the aforementioned patient-level covariates, particularly sociodemographic factors (HR = 1.15, 95 % CI = 0.71-1.87). TNBC subtype was independently associated with non-BC-specific mortality (HR = 2.15; 95 % CI = 1.20-3.84), while the association between TNBC and BC-specific mortality approached significance (HR = 1.42; 95 % CI = 0.99-2.03, P = 0.057). Non-metastatic invasive BC patients who lived in more socioeconomically deprived neighborhoods were more likely to die as a result of causes other than BC compared with those living in the least socioeconomically deprived neighborhoods. TNBC was associated with non-BC-specific mortality but not BC-specific mortality.
    Preview · Article · Sep 2014 · Breast Cancer Research and Treatment
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: To develop a prognostic model to predict 30-day mortality following colorectal cancer (CRC) surgery using the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked data and to assess whether race/ethnicity, neighborhood, and hospital characteristics influence model performance. Methods: We included patients aged 66 years and older from the linked 2000-2005 SEER-Medicare database. Outcome included 30-day mortality, both in-hospital and following discharge. Potential prognostic factors included tumor, treatment, sociodemographic, hospital, and neighborhood characteristics (census-tract-poverty rate). We performed a multilevel logistic regression analysis to account for nesting of CRC patients within hospitals. Model performance was assessed using the area under the receiver operating characteristic curve (AUC) for discrimination and the Hosmer-Lemeshow goodness-of-fit test for calibration. Results: In a model that included all prognostic factors, important predictors of 30-day mortality included age at diagnosis, cancer stage, and mode of presentation. Race/ethnicity, census-tract-poverty rate, and hospital characteristics were independently associated with 30-day mortality, but they did not influence model performance. Our SEER-Medicare model achieved moderate discrimination (AUC = 0.76), despite suboptimal calibration. Conclusions: We developed a prognostic model that included tumor, treatment, sociodemographic, hospital, and neighborhood predictors. Race/ethnicity, neighborhood, and hospital characteristics did not improve model performance compared with previously developed models.
    Full-text · Article · Aug 2014 · Cancer Causes and Control
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: Up to 14% of children with epilepsy continue to experience seizures despite having appropriate medical therapy and develop medically refractory epilepsy (MRE). Assessing clinical outcomes and therapeutic efficacy in children with MRE undergoing palliative epilepsy surgery has been challenging because of the lack of a quantitative instrument capable of estimating the clinical status of these patients. The ideal instrument would at once consider seizure control, neurodevelopment, caregiver burden, and quality of life. The purpose of this study was to develop and pilot the Pediatric Refractory Epilepsy Questionnaire (PREQ), a quantitative instrument to assess the severity and individual burden of epilepsy in children with MRE undergoing palliative epilepsy treatments. Methods: The caregivers of 25 patients with MRE completed the PREQ and the Quality of Life in Childhood Epilepsy (QOLCE) measure and participated in a semistructured interview. Medical records of the patients were reviewed, an Early Childhood Epilepsy Severity Scale (E-CHESS) score was calculated, and a Global Assessment of Severity of Epilepsy (GASE) score was obtained for each patient. Key findings: The initial PREQ was modified based on the analysis of responses, association with previously validated scales, comments from caregivers, and expertise of the PREQ panelists. Pediatric Refractory Epilepsy Questionnaire subscale scores were calculated based on clinical paradigm and compared with independent measures of seizure severity and quality of life. Significant correlations were observed between the seizure severity subscale and the GASE score (r=0.55) and between the mood subscale and the well-being score (r=0.61) on the QOLCE. Significant correlations were also observed between the caregiver rating of seizure severity and the GASE score (r=0.53), the social activity score (r=0.57), and the behavior score (r=0.43) on the QOLCE. Correlations between the caregiver rating of quality of life and the quality of life score (r=0.58) and the number of AEDs used (r=0.45) were also significant. Significance: This pilot study is an initial, critical step in the development of the PREQ. The significant correlations between the PREQ subscales and the external epilepsy severity and quality of life measures lend preliminary support to our hypothesis that the PREQ is assessing the severity of epilepsy along with other important domains, such as mood, neurodevelopment, and quality of life. A larger prospective study of this modified PREQ is currently underway to further develop the PREQ.
    No preview · Article · Aug 2014 · Epilepsy & Behavior
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: MD-PhD scientists are a successful, but small and fairly homogenous group of biomedical researchers. The authors conducted a retrospective cohort study to identify predictors of MD-PhD program enrollment to inform evidence-based strategies to increase the size and diversity of the biomedical research workforce. Method: Using deidentified data from all 2001-2006 Pre-Medical College Admission Test Questionnaire (PMQ) respondents, they developed multivariate logistic regression models to identify demographic, experiential, and attitudinal variables associated with MD-PhD program enrollment at matriculation compared with all other MD program enrollment at matriculation and with not enrolling in medical school by August 2012. Results: Of 207,436 PMQ respondents with complete data for all variables of interest, 2,575 (1.2%) were MD-PhD program enrollees, 80,856 (39.0%) were other MD program enrollees, and 124,005 (59.8%) were non-medical-school matriculants. Respondents who were black (versus white), were high school and college laboratory research apprenticeship participants, and highly endorsed the importance of research/finding cures as reasons to study medicine were more likely to be MD-PhD program enrollees, whereas respondents who highly endorsed the status of medicine as a reason to study medicine were less likely to be MD-PhD program enrollees than either other MD program enrollees or non-medical-school matriculants. Conclusions: MD-PhD program directors succeed in enrolling students whose attitudes and interests align with MD-PhD program goals. Continued efforts are needed to promote MD-PhD workforce diversity and the value of high school and college research apprenticeships for students considering careers as physician-scientists.
    No preview · Article · Jul 2014 · Academic medicine: journal of the Association of American Medical Colleges
  • Richard T Griffey · Donna B Jeffe · Thomas Bailey
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: Although computerized decision support for imaging is often recommended for optimizing computed tomography (CT) use, no studies have evaluated emergency physicians' (EPs') preferences regarding computerized decision support in the emergency department (ED). In this needs assessment, the authors sought to determine if EPs view overutilization as a problem, if they want decision support, and if so, the kinds of support they prefer. Methods: A 42-item, Web-based survey of EPs was developed and used to measure EPs' attitudes, preferences, and knowledge. Key contacts at local EDs sent letters describing the study to their physicians. Exploratory principal components analysis (PCA) was used to determine the underlying factor structure of multi-item scales, Cronbach's alpha was used to measure internal consistency of items on a scale, Spearman correlations were used to describe bivariate associations, and multivariable linear regression analysis was used to identify variables independently associated with physician interest in decision support. Results: Of 235 surveys sent, 155 (66%) EPs responded. Five factors emerged from the PCA. EPs felt that: 1) CT overutilization is a problem in the ED (α = 0.75); 2) a patient's cumulative CT study count affects decisions of whether and what type of imaging study to order only some of the time (α = 0.75); 3) knowledge that a patient has had prior CT imaging for the same indication makes EPs less likely to order a CT (α = 0.42); 4) concerns about malpractice, patient satisfaction, or insistence on CTs affect CT ordering decisions (α = 0.62); and 5) EPs want decision support before ordering CTs (α = 0.85). Performance on knowledge questions was poor, with only 18% to 39% correctly responding to each of the three multiple-choice items about effective radiation doses of chest radiograph and single-pass abdominopelvic CT, as well as estimated increased risk of cancer from a 10-mSv exposure. Although EPs wanted information on patients' cumulative exposures, they feel inadequately familiar with this information to make use of it clinically. If provided with patients' cumulative radiation exposures from CT, 87% of EPs said that they would use this information to discuss imaging options with their patients. In the multiple regression model, which included all variables associated with interest in decision support at p < 0.10 in bivariate tests, items independently associated with EPs' greater interest in all types of decision support proposed included lower total knowledge scores, greater frequency that cumulative CT study count affects EP's decision to order CTs, and greater agreement that overutilization of CT is a problem and that awareness of multiple prior CTs for a given indication affects CT ordering decisions. Conclusions: Emergency physicians view overutilization of CT scans as a problem with potential for improvement in the ED and would like to have more information to discuss risks with their patients. EPs are interested in all types of imaging decision support proposed to help optimize imaging ordering in the ED and to reduce radiation to their patients. Findings reveal several opportunities that could potentially affect CT utilization.
    No preview · Article · Jul 2014 · Academic Emergency Medicine
  • Donna B. Jeffe · Dorothy A. Andriole

    No preview · Article · Jul 2014 · Academic Medicine
  • Donna B Jeffe · Dorothy A Andriole

    No preview · Article · Jul 2014 · Academic medicine: journal of the Association of American Medical Colleges
  • [Show abstract] [Hide abstract]
    ABSTRACT: The Summer Institute Program to Increase Diversity (SIPID) in Health-Related Research is a career advancement opportunity sponsored by the National Heart, Lung, and Blood Institute. Three mentored programs address difficulties experienced by junior investigators in establishing independent research careers and academic advancement. Aims are to increase the number of faculty from under-represented minority groups who successfully compete for external research funding. Data were collected using a centralized data-entry system from three Summer Institutes. Outcomes include mentees' satisfaction rating about the program, grant and publications productivity and specific comments. Fifty-eight junior faculty mentees (38% male) noticeably improved their rates of preparing/submitting grant applications and publications, with a 18-23% increase in confidence levels in planning and conducting research. According to survey comments, the training received in grantsmanship skills and one-on-one mentoring were the most valuable program components. The SIPID mentoring program was highly valued by the junior faculty mentees. The program will continue in 2011-2014 as PRIDE (PRogram to Increase Diversity among individuals Engaged in health-related research). Long-term follow-up of current mentees will be indexed at five years post training (2013). In summary, these mentoring programs hope to continue increasing the diversity of the next generation of scientists in biomedical research.
    No preview · Article · Jun 2014 · Journal of the National Medical Association
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to describe hospital and geographic variation in 30-day risk of surgical complications and death among colorectal cancer (CRC) patients and the extent to which patient-, hospital-, and census-tract-level characteristics increased risk of these outcomes. We included patients at least 66 years old with first primary stage I-III CRC from the 2000-2005 National Cancer Institute's Surveillance, Epidemiology, and End Results data linked with 1999-2005 Medicare claims. A multilevel, cross-classified logistic model was used to account for nesting of patients within hospitals and within residential census tracts. Outcomes were risk of complications and death after a complication within 30 days of surgery. Data were analyzed for 35,946 patients undergoing surgery at 1,222 hospitals and residing in 12,187 census tracts; 27.2 % of patients developed complications, and of these 13.4 % died. Risk-adjusted variability in complications across hospitals and census tracts was similar. Variability in mortality was larger than variability in complications, across hospitals and across census tracts. Specific characteristics increased risk of complications (e.g., census-tract-poverty rate, emergency surgery, and being African-American). No hospital characteristics increased complication risk. Specific characteristics increased risk of death (e.g. census-tract-poverty rate, being diagnosed with colon (versus rectal) cancer, and emergency surgery), while hospitals with at least 500 beds showed reduced death risk. Large, unexplained variations exist in mortality after surgical complications in CRC across hospitals and geographic areas. The potential exists for quality improvement efforts targeted at the hospital and/or census-tract levels to prevent complications and augment hospitals' ability to reduce mortality risk.
    Full-text · Article · Apr 2014 · Annals of Surgical Oncology