Health Services Research

The Health Services Research (HSR) program analyzes cancer treatment and outcomes using data collected by the National Cancer Database (NCDB, a joint project of the American College of Surgeons and the American Cancer Society), SEER-Medicare, and other administrative and registry databases. Research has focused on defining the role of health insurance in cancer disparities, and has included studies examining the relationships between insurance status, race/ethnicity, stage at cancer diagnosis, quality of care, and cancer outcomes.

Managing Director: Katherine S. Virgo, PhD, MBA, katherine.virgo@cancer.org 

Highlights and Collaboration

2010

Dr. Robbins published “Insurance status and survival disparities among non-elderly rectal cancer patients in the National Cancer Data Base” in Cancer, a study which adds significantly to understanding the relationship between insurance status and survival among cancer patients. Using data on rectal cancer patients in the National Cancer Data Base (NCDB), Dr. Robbins and colleagues found the 5-year survival was significantly lower for patients without private insurance. These findings were covered both by print (Wall Street Journal) and broadcast media (CBS Radio).

Stacey Fedewa was the lead author on the “Delays in Adjuvant Chemotherapy Treatment among Patients with Breast Cancer Are More Likely in African American and Hispanic Populations: A National Cohort Study 2004-2006” study, which was published in the Journal of Clinical Oncology. She also recently published a study in Cancer Epidemiology Biomarkers and Prevention examining prostate cancer disease severity by insurance status among NCDB patients.

The Health Services Research group hosted two visiting research fellows, Dr. Derrick Cox, a surgical resident from Roswell Park Cancer Institute and Dr. Ugo Fedeli, an epidemiologist from the Veneto Region’s Epidemiology Department in Italy. Dr. Cox was awarded a Poster of Exceptional Merit recognition and is nominated for the Best Scientific Exhibit award for his upcoming presentation on factors related to receipt of liver transplantation at the American College of Surgeon’s Clinical Congress meeting in Washington DC. Dr. Fedeli’s study on treatment patterns among muscle invasive bladder cancer patients has been accepted to the Journal of Urology.

Dr. Katherine Virgo is leading the collaboration with the National Cancer Institute and the Centers for Disease Control to expand the research capabilities of the Medical Expenditures Panel Survey (MEPS) as pertains to cancer. The MEPS survey is one of the main sources of information on healthcare costs among people under age 65 in the U.S. The project goals are to: 1) oversample cancer survivor households from the National Health Interview Survey, 2) develop a supplemental survey instrument to permit gathering additional information on health care utilization, insurance, out-of-pocket costs, productivity, and quality of life, and 3) create a unique longitudinal resource for measuring and understanding the economic burden of cancer and the quality of life of cancer survivors and their families in the United States.

2009 

HSR staff continue to collaborate with the American College of Surgeons to develop and use the NCDB to evaluate quality of cancer care in the U.S. A cooperative agreement to continue this collaboration in 2009-2011 was completed. Staff also provided feedback to the NCDB on data quality. 

Dr. Katherine Virgo was appointed chair of the Health Services Committee of the Medical Care Section of the American Public Health Association and organized the Update on Health Services Research session for the annual conference and coordinated presentation sessions for all contributed health services research presentations. Dr. Virgo also was invited to be a member of the Health Services Research Section of Scientific Program Committee for the American Society of Clinical Oncology. 

A study by Dr. Amy Chen investigated trends in differentiated (papillary and follicular) thyroid cancer by size, age, race, and sex and found increases in thyroid cancers of all sizes increased between 1988 and 2005 in both men and women. The study concluded that increased diagnostic scrutiny is not the sole explanation for increasing incidence, and that other factors, including environmental influences and molecular pathways, should be explored. Dr. Chen also presented a paper on Patterns of care for differentiated thyroid cancer at the World Congress on Thyroid Cancer, Toronto, Ontario, Canada, August 8, 2009. 

Dr. Chen represented the American Cancer Society at a United States Senate Roundtable Discussion on access to medical care in Washington, DC, May 19, 2009.

Publications

Allam E, Patel A, Lewis G, Mushi E, Audisio RA, Virgo KS, Johnson FE. Cholecystectomy in patients with prior ventriculoperitoneal shunts. American Journal of Surgery. Apr;201(4):503-7. 2011.

Cokkinides VE, Bandi P, Shah M, Virgo KS, Ward EM. The association between state mandates of colorectal cancer screening coverage and colorectal cancer screening utilization among US adults aged 50 to 64 years with health insurance. BMC Cancer.11:19. 2011.

Fedeli U, Fedewa SA, Ward EM. Treatment of muscle invasive bladder cancer: Evidence from the National Cancer Database, 2003 to 2007. Journal of Urology. 185(1):72-78. 2011. Epub Nov 10, 2010.

Fedewa SA, Lerro C, Chase D, Ward EM. Insurance status and racial differences in uterine cancer survival: A study of patients in the National Cancer Database. Gynecologic Oncology. Jul;122(1):63-8. 2011. Epub 2011 April 3, 2011.

Fedewa SA, Edge SB, Stewart AK, Halpern MT, Marlow NM, Ward EM. Race and ethnicity are associated with delays in breast cancer treatment (2003-2006). Journal of Health Care for the Poor and Underserved. 22(1):128-41. 2011.

Freedman RA, Virgo KS, He Y, Pavluck AL, Winer EP, Ward EM, Keating NL. The association of race/ethnicity, insurance status, and socioeconomic factors with breast cancer care. Cancer. 117:180-9. 2011. Epub October 11, 2010.

Harmandayan GZ, Gao F, Mutch DG, Virgo KS, Gibb RK, Johnson FE. Ovarian cancer patient surveillance after curative-intent initial treatment.  Gynecologic Oncology. 120(2):205-208. 2011.

Robbins AS, Cox DD, Johnson LB, Ward EM.  Persistent disparities in liver transplantation for hepatocellular carcinoma in the United States, 1998-2007. Cancer. 2011. Epub March 29, 2011.

Brawley OW, Virgo KS.  The impact of healthcare reform on cancer patients.  The Cancer Journal:  The Journal of Principles & Practice of Oncology. Nov/Dec;16(6):551-3. 2010.  

Chen AY, Fedewa SA, Pavluck A, Ward EM. Improved survival is associated with treatment at high volume teaching facilities for patients with advanced stage laryngeal cancer. Cancer. Oct 15;116(20):4744-52. 2010. Epub June 29, 2010.

Chen AY. A shifting paradigm for patients with head and neck cancer: transoral robotic surgery (TORS). Oncology. 24 October;11:1010-5. 2010.

Fedewa SA, Etzioni R, Jemal A, Flanders WD, Ward EM. Association of insurance and race/ethnicity with disease severity among men diagnosed with prostate cancer, National Cancer Database 2004-2006. Cancer Epidemiological Biomarkers and Prevention. Oct;19(10):2437-44. 2010. Epub 2010 Aug 12.

Fedewa SA, Ward EM, Edge SB. Delays in adjuvant chemotherapy treatment among black cancer patients are more likely in black and Hispanic populations: A National Cohort Study 2004-2006. Journal of Clinical Oncology. Sep 20;28(27):4135-41. 2010. Epub 2010 Aug 9.

Marlow NM, Halpern MT, Pavluck AL, Ward EM, Chen AY. Disparities associated with advanced prostate cancer stage at diagnosis. Journal of Health Care for the Poor and Underserved. 21:112-131. 2010.

Robbins AS, Chen, AY, Stewart A, Staley CA, Virgo, KS, Ward EM. Insurance status and survival disparities among non-elderly rectal cancer patients in the National Cancer Data Base. Cancer. 116:4178-86. 2010. Epub June 14, 2010.

Sangoi A, Patel U, Ode K, Audisio R, Virgo KS, Johnson FE. Evaluation of patients with clinically detected recurrence of rectal carcinoma: Current practice patterns of colorectal surgeons. Oncology Letters. 1:355-359. 2010.

Virgo KS, Burkhardt LA, Cokkinides VE, Ward EM. The impact of health care reform legislation on uninsured and Medicaid-insured cancer patients. The Cancer Journal: The Journal of Principles & Practice of Oncology. Nov/Dec; 16(6):577-583. 2010.

Ward EM, Fedewa SA, Cokkinides VE, Virgo KS. The association of insurance and stage at diagnosis among patients aged 55-74 in the National Cancer Database. The Cancer Journal: The Journal of Principles & Practice of Oncology. Nov/Dec; 16(6):614-621. 2010.

Chen AY, Jemal A, Ward EM. Increasing incidence of differentiated thyroid cancer in the United States, 1988-2005. Cancer. 2009;115(16):3801-07.

Chen AY, Pavluck A, Halpern M, Ward EM. Impact of treating facilities' volume on survival for early-stage laryngeal cancer. Head Neck. 2009;31(9):1137-43.

Halpern MT, Chen AY, Marlow NS, Ward EM. Disparities in receipt of lymph node biopsy among early-stage female breast cancer patients. Ann Surg Oncol. 2009;16(3):562-70.

Halpern MT, Pavluck AL, Ko CY, Ward EM. Factors associated with colon cancer stage at diagnosis. Dig Dis Sci. 2009; 54:1573-2568.

Marlow NM, Pavluck A, Bian J, Ward EM, Halpern MT. The relationship between insurance coverage and cancer care: A literature synthesis. RTI Press Publication No. RR-0005-0905. May 2009.

Ode K, Patel U, Virgo KS, Audisio RA, Johnson FE. How initial tumor stage affects rectal cancer patient follow-up. Oncol Rep. 2009;21(6):1511-17.

Robbins AS, Pavluck AL, Fedewa SA, Chen AY, Ward EM. Insurance status, comorbidity level, and survival among colorectal cancer patients age 18 to 64 years in the National Cancer Data Base from 2003 to 2005. J Clin Oncol. 2009;27(22):3627-33.

Scherrer JF, Virgo KS, Zeringue A, et al. Depression increases risk of incident myocardial infarction among Veterans Administration patients with rheumatoid arthritis. Gen Hosp Psychiatry. 2009;31(4):353-59.

Schrag NM, McKeown RE, Jackson KL, Cuffe SP, Neuberg RW. Stress-related mental disorders in childhood cancer survivors. Pediatr Blood Cancer. 2008;50(1):98-103.

Skolarus TA, Lee EW, Virgo KS, et al. Intravesical bacille Calmette-Guerin therapy for non-muscle-invasive bladder cancer: effects of concurrent statin therapy. J Am Coll Surg. 2009;209(2):248-53.