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.
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.
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.
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. www.clinicaltrials.gov ID= NCT01472094.
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.
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.
National Trends in Active Surveillance for Prostate Ccancer 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.
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.