Background:The overdose crisis is increasingly characterized by opioid and stimulant co-use. Despite effective pharmacologic treatment for both opioid use disorder (OUD) and contingency management ...

Purpose: To assess whether the poor prognosis of triple-negative breast cancer (TNBC) necessitates a more aggressive surgical approach. Methods: We examined the association of: breast-conserving su...

BACKGROUND AND OBJECTIVES: Despite research documenting gender differences in numerous outcomes in later life, we know little about gender differences in quality of life (QoL) for nursing home (NH) residents. This study examines the relationship between gender and residents' QoL, including possible reasons for differences observed. RESEARCH DESIGN AND METHODS: We used a mixed methods design including surveys with a random sample of Minnesota NH residents using a multidimensional measure of QoL (n=9,852), resident clinical data, facility-level characteristics (n=364), interviews with residents (n=64), and participant observations. We used linear mixed models and thematic analysis of resident interviews and observations to examine possible gender-related differences in residents' QoL. RESULTS: After controlling for individual and facility characteristics, men reported lower overall QoL than women, including significantly lower ratings in several QoL domains. In interviews, men noted being less satisfied with activities than women, having fewer friends, and being less able to rely on family for support. Some women described the NH as a place of respite, but men more often described being dissatisfied with life in the NH and undesirable for long-term living. Our observations were consistent with interview findings but provide additional nuances, such as that some men organized their own social groups. DISCUSSION AND IMPLICATIONS: Our findings suggest men and women experience QoL differently in NHs, with men reporting lower QoL in several domains. Tailoring more activities for men and finding ways to strengthen relationships for men in NHs could help reduce the gender differences in QoL we observed.

Background

Background: Travel distance to care facilities may shape urban-rural cancer survival disparities by creating barriers to specific treatments. Guideline-supported treatment options for women with early stage breast cancer involves considerations of breast conservation and travel burden: Mastectomy requires travel for surgery, whereas breast-conserving surgery (BCS) with adjuvant radiation therapy (RT) requires travel for both surgery and RT. This provides a unique opportunity to evaluate the impact of travel distance on surgical decisions and receipt of guideline-concordant treatment. Materials and Methods: We included 61,169 women diagnosed with early stage breast cancer between 2004 and 2013 from the Surveillance Epidemiology and End Results (SEER)-Medicare database. Driving distances to the nearest radiation facility were calculated by using Google Maps. We used multivariable regression to model treatment choice as a function of distance to radiation and Cox regression to model survival. Results: Women living farthest from radiation facilities (>50 miles vs. <10 miles) were more likely to undergo mastectomy versus BCS (odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.22-1.79). Among only those who underwent BCS, women living farther from radiation facilities were less likely to receive guideline-concordant RT (OR: 1.72, 95% CI: 1.32-2.23). These guideline-discordant women had worse overall (hazards ratio [HR]: 1.50, 95% CI: 1.42-1.57) and breast-cancer specific survival (HR: 1.44, 95% CI: 1.29-1.60). Conclusions: We report two breast cancer treatments with different clinical and travel implications to show the association between travel distance, treatment decisions, and receipt of guideline-concordant treatment. Differential access to guideline-concordant treatment resulting from excess travel burden among rural patients may contribute to rural-urban survival disparities among cancer patients.

<p>Objectives: To investigate trends in racial/ethnic differences in nursing home (NH) residents’ quality of life (QoL) and assess these patterns within and between facilities. Method: Data include resident-reported QoL surveys ( n = 60,093), the Minimum Data Set, and facility-level characteristics ( n = 376 facilities) for Minnesota. Hierarchical linear models were estimated to identify differences in QoL by resident race/ethnicity and facility racial/ethnic minority composition for 2011–2015. Results: White residents in low-proportion racial/ethnic minority facilities reported higher QoL than both minority and white residents in high-proportion minority facilities. While the year-to-year differences were not statistically significant, the point estimates for white–minority disparity widened over time. Discussion: Racial/ethnic differences in QoL are persistent and may be widening over time. The QoL disparity reported by minority residents and all residents in high-proportion minority facilities underscores the importance of examining NH structural characteristics and practices to ultimately achieve the goal of optimal, person-centered care in NHs.</p>

OBJECTIVE: Recent large-scale studies have observed differences in survival following treatment for early laryngeal carcinoma depending on treatment type but were not able to take sociodemographic, comorbidity, and facility data into account. The objective of this study was to determine whether survival differences across treatment types persist when these factors are included in the analysis. STUDY DESIGN: Retrospective cohort analysis. SETTING: Linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data files. SUBJECTS AND METHODS: Medicare beneficiaries who were identified through the SEER registries (1991-2009) as having T1 glottic squamous cell carcinoma (scca) and a known treatment type were included. RESULTS: A total of 2338 patients with incident T1 glottic scca were identified. Most were white and male. Treatment type was radiation only in 47%, local surgery and radiation in 39%, and local surgery only in 14%. Black race and increased comorbidities were associated with worse survival. When sociodemographics, comorbidities, and facility characteristics were taken into account, survival differences were observed across treatment types, with those receiving local surgery demonstrating better overall and cancer-specific survival. CONCLUSION: These results suggest that following treatment of T1 glottic scca, there may be survival differences across treatment types beyond those explained by sociodemographic, comorbidity, and facility characteristics.