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Showing papers by "Joan R. Bloom published in 2011"


Journal ArticleDOI
TL;DR: What women regret about their breast cancer treatment 5 years later, and what characteristics of disease and treatment predict post‐treatment regret, are addressed.
Abstract: Objective The study addresses: (1) what women regret about their breast cancer treatment five years later, and (2) what characteristics of disease and treatment predict post-treatment regret.

66 citations


Journal ArticleDOI
TL;DR: English-speaking Latinas were more likely to receive radiation than their Spanish-speaking or white counterparts, controlling for demographic and other factors, and physician recommendation was the strongest predictor of receipt of radiation.
Abstract: Background: The growing rates of ductal carcinoma in situ (DCIS) and evidence that Latinas may underuse breast-conserving surgery (BCS) compared with white women highlight the need to better understand how treatment decisions are made in this understudied group. To help address this gap, this study compared surgery and radiation treatment decision making among white and Spanish-speaking and English-speaking Latina women with DCIS recruited from eight population-based cancer registries from 35 California counties. Methods: Women aged ≥18 who self-identified as Latina or non-Latina white diagnosed with DCIS between 2002 and 2005 were selected from eight California Cancer Registry (CCR) regions and surveyed about their DCIS treatment decision making by telephone approximately 24 months after diagnosis. Survey data were merged with CCR hospital-based records to obtain tumor and treatment data. Results: Mean age was 57 years. Multivariate analysis indicated no differences by ethnicity or language in t...

27 citations


Journal ArticleDOI
TL;DR: The evidence suggests that different strategies were used by the not-for-profit and for-profit programs to control expenditures and utilization and that the for-profits were more successful in reducing cost per user.
Abstract: Objective:Capitated Medicaid mental health programs have reduced costs over the short term by lowering the utilization of high-cost inpatient services. This study examined the five-year effects of capitated financing in community mental health centers (CMHCs) by comparing not-for-profit with for-profit programs. Methods:Data were from the Medicaid billing system in Colorado for the precapitation year (1994) and a shadow billing system for the postcapitation years (1995–1999). In a panel design, a random-effect approach estimated the impact of two financing systems on service utilization and cost while adjusting for all the covariates. Results:Consistent with predictions, in both the for-profit and the not-for-profit CMHCs, relative to the precapitation year, there were significant reductions in each postcapitation year in high-cost treatments (inpatient treatment) for all but one comparison (not-for-profit CMHCs in 1999). Also consistent with predictions, the for-profit programs realized significant reduc...

14 citations


Journal ArticleDOI
TL;DR: Multivariable analysis showed that women who were aged 65 and older, unemployed, and had a lower ratio of plastic surgeons in their county were less likely to have reconstructive surgery after mastectomy and the most frequent reasons mentioned not to receive reconstruction.
Abstract: Treatment decisions associated with ductal carcinoma in situ (DCIS), including the decision to undergo breast reconstruction, may be more problematic for Latinas due to access and language issues. To help understand the factors that influence patients’ receipt of reconstruction following mastectomy for DCIS, we conducted a population-based study of English- and Spanish-speaking Latina and non-Latina white women from 35 California counties. The objectives of this study were to identify the role of ethnicity and language in the receipt of reconstruction, the relationship between system-level factors and the receipt of reconstruction, and women’s reasons for not undergoing reconstruction. Women aged 18 and older, who self-identified as Latina or non-Latino white and were diagnosed with DCIS between 2002 and 2005 were selected from eight California Cancer Registry (CCR) regions encompassing 35 counties. Approximately 24 months after diagnosis, they were surveyed about their DCIS treatment decisions. Survey data were merged with CCR records to obtain tumor and treatment data. The survey was successfully completed by 745 women, 239 of whom had a mastectomy and represent the sample included in this study. Whites had a higher completion rate than Latinas (67 and 55%, respectively). Analysis included descriptive statistics and logistic regression modeling. Mean age was 54 years. A greater proportion of whites had reconstruction (72%) compared to English-speaking Latinas (69%) and Spanish-speaking Latinas (40%). Multivariate analysis showed that women who were aged 65 and older, unemployed, and had a lower ratio of plastic surgeons in their county were less likely to have reconstructive surgery after mastectomy. The most frequent reasons mentioned not to receive reconstruction included lack of importance and desire to avoid additional surgery. Although ethnic/language differences in treatment selection were observed, multivariable analysis suggests that these differences could be explained by differential employment levels and geographic availability of plastic surgeons.

8 citations