Current Research

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Understanding Cancer Care

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)

Principal Investigator: Cary Gross

COPPER’s 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

Principal Investigator: Cary Gross

Breast ultrasound and MRI for cancer screening is not fully covered by most insurance plans, so some state legislatures have enacted laws requiring insurance companies to cover the procedures. Our study will assess the impact of enacted states laws on breast cancer screening, patient out-of-pocket costs and women’s knowledge about breast density. We will use health insurance claims to evaluate whether the use of the new screening modalities among women in their 40s and 50s has increased over time. We will also conduct a survey on a national sample of women in their 40s to evaluate women’s knowledge about breast density, breast cancer risk, and the impact of out of pocket cost on screening decisions.

Funding source: American Cancer Society

Principal Investigator: Cary Gross

In this grant, we will evaluate the contributions of patient demographics, disease characteristics, market structure, and practice patterns to overall expenditures and geographic variation of expenditures for end-of-life cancer care. In addition, we will determine the impact of continuity of care on quality of end-of-life care.

Funding source: Yale Cancer Center

Principal Investigator: Shiyi Wang

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 (Career Development Award)

Principal Investigator: Simon Kim

Improving Decision-Making

The lack of routine, complete collection and use of PROs relevant to patients and caregivers for patients with metastatic breast cancer is a major deficit in the current cancer care delivery system.  We aim to bring together a diverse team of providers and patients to create an innovative approach to optimizing the care of metastatic breast cancer patients through improving patients’ knowledge of and engagement in their care, and communication between providers and patients. Our project focuses on building stakeholder partnerships to facilitate the integration of PRO information into clinical care, in order to assess, manage, and mitigate adverse effects of metastatic breast cancer treatment. 

Funding source: National Comprehensive Cancer Network & Pfizer

Principal Investigator: Cary Gross

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 (Career Development Award)

Principal Investigator: Shiyi Wang

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. Clinical Trial information.

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

Principal Investigator: Cary Gross (site PI)

Outcomes & Effectiveness

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

Principal Investigator: Sarah Mougalian

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

Principal Investigator: James Yu

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

Principal Investigator: Shiyi Wang

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

Principal Investigator: Jersey Chen

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)

Principal Investigator: Rong Wang 

Developing New Methods

This project aims to develop novel statistical methods to handle spatial uncertainty in the event locations when conducting cancer research, allowing researchers to take advantage of the full spectrum of available data at both an individual level and a group/regional level. 

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

Principal Investigator: Xiaomei Ma (Co-PI)