Current Research

Current areas of inquiry include the dissemination of new cancer technology, patterns and cost of cancer screening and treatment, and the impact of age and multimorbidity on patient outcomes. Project funding currently comes from the National Institutes of Health, Yale Cancer Center, American Cancer Society, and the American Heart Association.

Current Research Projects

Radiation Therapy for Medicare Patients

COPPER’s NIH-funded R01 grant, The Use and Outcomes of Radiation Therapy for Medicare Patients with Common Cancers, assesses the use of new radiation modalities for patients with lung, prostate, and breast cancer. This proposal will generate comparative effectiveness data, determining the rates of adverse events associated with use of new modalities in actual clinical practice. Additionally, the work will identify how healthcare system and local market conditions affect the diffusion of new technology, and how new technology affects the costs of care.

Funding source: National Institutes of Health (National Cancer Institute)

Understanding Cost and Value in Cancer Screening and Treatment

Using SEER-Medicare data, we are assessing trends and geographic variation in Medicare expenditures for screening and treatment of breast and prostate cancers and treatment of myelodysplastic syndromes. Most studies of cancer focus exclusively on the cost of treatment, but we incorporate expenditures related to cancer screening and surveillance as well as treatment.

Studies of the cost of screening are particularly relevant in situations where guidelines and evidence do not support the use of the test or procedure. We assess concurrent trends between Medicare beneficiaries residing within defined geographic regions to assess the impact of screening and treatment approach on cost.

Funding source: Yale Cancer Center

Cardiovascular Outcomes of Cancer

COPPER investigators are examining cardiovascular outcomes among breast and bladder cancer patients receiving potentially cardiotoxic chemotherapy including trastuzumab and anthracyclines for breast cancer and platinum-based agents for bladder cancer. Analysis shows that trastuzumab is increasingly used among older women undergoing adjuvant breast cancer therapy, and heart failure/cardiomyopathy is a common complication persisting up to 3 years after diagnosis. Additionally, thromboembolic events are more likely to occur in bladder cancer patients receiving platinum-based chemotherapy, especially in the first year after diagnosis. 

Funding source: American Heart Association

Predictors of Chemotherapy Toxicity in Older Adults

The goal of this study is to help doctors predict which patients 65 years and above are more likely to tolerate chemotherapy for stages I to III breast cancer with minimal side effects. Dr. Gross is PI at Yale, which is one of ten sites participating in this research project coordinated by City of Hope National Medical Center in California.

We plan to enroll a total of 40 women at Yale as part of 500 women who will participate in the study. ID= NCT01472094.

Funding source: National Institutes of Health (National Institute on Aging)

Comparative Effectiveness of Treatments for Acute Myeloid Leukemia in the Elderly

We plan to assess the clinical effectiveness and cost-effectiveness of intensive and low-intensity chemotherapy in a large, population-based cohort of elderly patients with acute myeloid leukemia (AML). Findings from the study will enable physicians and patients to make more informed treatment decisions and will probably have significant policy implications.

Funding source: National Institutes of Health (National Cancer Institute)

Understanding Disparities in the New Era of Personalized Breast Cancer Care

COPPER’s recent grant through the American Cancer Society will examine patterns of Gene Expression Profile (GEP) use among women diagnosed with breast cancer at the population level. We will specifically look at the adoption of the Oncotype Dx test, and other tests coming into the market during the study period. Through this grant we will assess independent patient and hospital factors associated with adoption, if these newer technologies are contributing to disparities in breast cancer care, and if GEP testing follows current guideline recommendations.

Funding source: American Cancer Society

National Trends in Active Surveillance for Prostate Cancer and Barriers To Its Use

The objective of this grant is to gain a better understanding of the contemporary use of active surveillance in prostate cancer and barriers to its use.  The study will determine the national trends of active surveillance among men with prostate cancer in Medicare and privately insured patient populations.  We will also perform a national survey of radiation oncologists and urologists to identify the barriers to active surveillance in the management of prostate cancer.  

Funding source: ASCO Conquer Cancer Foundation

The Influence of Preoperative Breast MRI on Outcomes in Medicare Patients with Early-Stage Breast Cancer

Analyzing SEER-Medicare data, we plan to estimate the impact of preoperative breast MRI on 1) synchronous and metachronous contralateral breast cancer occurrence and corresponding stage; and 2) treated ipsilateral recurrence and breast cancer mortality. This research will provide important information for clinicians, patients, and policy decision makers about the effects and appropriate use of preoperative MRI.

Funding source: Yale Cancer Center

Outcomes of Adjuvant Chemotherapy in Breast Cancer

Anthracycline-based chemotherapy has been a mainstay of adjuvant breast cancer treatment for over twenty years, but a feared side effect of anthracyclines is cardiotoxicity. The aims of this study are to examine the use of chemotherapy regimens with and without anthracyclines in Medicare beneficiaries as well as to determine what patient, clinical, and provider factors are associated with the adoption of each type of regimen. In addition, we will compare survival and the incidence of major toxicities among chemotherapy patients treated with and without anthracyclines. The proposed analysis assessing outcomes associated with chemotherapy regimens is the first of its kind to be completed using Medicare claims.  

Funding source: CT Breast Health Initiative

Quantifying the Benefit of Modern Cancer Therapy for Elderly Patients: A population Level Measurement

Using the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) – Medicare Health Outcomes Survey (MHOS) linked database, this project attempts to calculate the difference in quality of life of patients who were treated a decade apart: in 1998-1999, and 2008-2009 for elderly patients with breast, prostate, and lung cancer. In this way, this project attempts to quantify the progress that has been made over the past decade in cancer care in a manner that can directly translate into discussions of the cost-effectiveness of modern cancer care. 

Funding source: PhRMA Foundation

Development and Evaluation of a Decision Analysis Based Decision Aid

We aim to develop an individualized decision analysis-based decision aid to help older women with early stage breast cancer decide whether to receive radiotherapy. 

Funding source: Agency for Healthcare Research and Quality

The Impact of Social Contagion on Physician Use of Unproven Cancer Interventions

Prior work in the social sciences suggests that individuals are profoundly affected by the actions of their peers; we posit that the same principle applies to how physicians care for their patients with cancer. This proposal aims to apply this concept of “social contagion” to cancer practice, shedding new light on the role of physicians and physician patient-sharing networks in the adoption of unproven technologies and the abandonment of proven ineffective treatments in cancer care. This work has the potential to transform the field of cancer care by identifying a novel level of behavior change: the diffusion of practices through networks of physicians. 

Funding source: National Institutes of Health (National Cancer Institute)