Abstract P6-16-03: The impact of ductal carcinoma in situ of the breast on health services utilization and general health and well-being of women
Notice bibliographique
Résumé
Abstract Background: The impact of DCIS diagnosis on the development of significant anxiety and depression and on the utilization of breast imaging and breast biopsy procedures, which may reflect fears of breast cancer recurrence, is unknown. We established a population cohort of women with DCIS and examined the impact of the DCIS diagnosis on health services utilization (physician, emergency room visits) before and after DCIS, including those related to anxiety or depression, and all breast-related interventions, compared to similar women without DCIS. Methods: From hospital claims we identified a population-based cohort of women with a first diagnosis of DCIS between 2010-2015. Cases with prior history of cancer were excluded. We identified treatment (mastectomy, breast-conserving surgery (BCS) +/- radiation therapy (RT) by linkage of administrative databases. Using DCIS diagnosis date for each case, we matched 5 unaffected controls (with no history of DCIS) by age, mammography history, socioeconomic status, and comorbidity at same date. For all cases and controls we extracted the following from physician billing claims: breast imaging (mammography, ultrasound, MRI), breast biopsies, breast surgery, all physician visits, and all hospital claims (including those with a diagnosis of anxiety or depression), for five years prior to and following the index date. We excluded claims from the year prior to and subsequent to the index date to remove the effect of services utilization surrounding the diagnosis and management of the index DCIS lesion. We then computed the rate of each service per 100 person-years for 5 years before and after the index date. Cases who developed local recurrence (LR) (and their matched controls) were censored 3 months prior to LR date. We used negative binomial regression to test differences in rates of service utilization before and after DCIS diagnosis and between cases and unaffected controls. Results: The cohort includes 4,977 women treated for DCIS were identified, each matched to 5 controls. 911/4,977 (18.3%) of cases were < 50 years old at diagnosis; 1,006/4,977 (20.2%) were treated by BCS alone, 2,995/4,977 (60.2%) by BCS+RT, and 976 (19.6%) by mastectomy. For cases diagnosed with visits with a breast diagnosis code, utilization of breast imaging procedures and the use of breast surgery was significantly greater relative to unaffected controls irrespective of age at diagnosis and treatment (all p values <0.0001). Primary care visits were higher among cases (RR=1.10 (95% CI 1.06, 1.14), p<0.0001), including those with a breast diagnosis code (RR=3.69 (95%CI 3.29, 4.14)). However, there was no increase in relative rates of physician or hospital visits for anxiety or depression (RR 1.13 (95% CI 0.97, 1.32 p=0.11), psychiatry visits (RR 1.07 (95% CI 0.82, 1.40) p=0.6), non-breast surgical procedures (RR 1.10 (95% CI 0.88, 1.37) p=0.4), or emergency department visits (unrelated to breast) in cases with DCIS compared to unaffected controls. Conclusion: DCIS is associated with more visits and procedures related to the breast compared to women without a diagnosis of DCIS but overall health services utilization and visits related to anxiety and depression were not increased. Citation Format: Rakovitch E, Sutradhar R, Zhou L, Nofech-Mozes S, Hanna W, Paszat L. The impact of ductal carcinoma in situ of the breast on health services utilization and general health and well-being of women [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-16-03.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».