Nationwide Sample Of Women Research Articles

Hormonal contraception use and insomnia: A nested case-control study

Evidence is limited concerning possible associations between the use of hormonal contraception and insomnia. We applied the nested case-control design on a nationwide sample of women, aged 15–49 years, derived from national health care registries to characterize the association between the use of hormonal contraception and the occurrence of insomnia. There were altogether 294,356 users and 294,356 non-users of hormonal contraception. 11,105 new cases of insomnia emerged among the 1,148,969 person-years of the follow-up period of two years. All the significant associations of hormonal contraception with insomnia emerged among the participants aged 34 years or younger, and if only the tertiary care data was concerned, among the those aged 15–19 years. The users of the fixed combination of drospirenone and ethinylestradiol as well as that of cyproterone and ethinylestradiol had significantly decreased odds for insomnia, whereas the users levonorgestrel-releasing intrauterine devise as well as those of vaginal ring with etonogestrel and ethinylestradiol had significantly increased odds for insomnia as compared with non-users. Our findings suggest that different products prescribed for hormonal contraception may be differentially associated with the occurrence of insomnia.

Abstract PD3-10: Patient perspectives on chemotherapy de-escalation: “Don’t de-escalate! I don’t want to die!”

Abstract Introduction: Given excellent survival outcomes in breast cancer and new methods to predict treatment response, oncologists are interested in de-escalating the amount of chemotherapy delivered to patients. This is particularly important in the setting of COVID-19, where patient perspectives of de-escalation may be altered by perception of COVID-19 risk.Methods: This concurrent mixed methods study included (1) semi-structured interview data from patients with breast cancer treated at the University of Alabama at Birmingham and patient advocates from nationally representative advocacy organizations (10/2019-5/2020) and (2) cross-sectional survey data from a nationwide sample of women with breast cancer (11/19-12/2019). Questions evaluated interest in de-escalation study participation, perceived barriers/facilitators to participation, and language describing de-escalation. Participant perspectives surrounding COVID-19 impact on de-escalation were elicited in interviews post 3/2020.Results: Quantitative and qualitative findings were synergistic. Interviews were conducted with 40 female participants (24 patients, 16 patient advocates). Participant ages ranged from 33-79 years old; 30% were minorities; 35% didn’t have a college degree. Common barriers to acceptance of de-escalation included fear of recurrence, worry about decision regret, lack of clinical trial interest, and dislike for the focus on less treatment. Fear of recurrence was the most commonly expressed barrier, with one participant stating, “I’m just afraid it wouldn’t get it all”. Common facilitators included trust in the physician, toxicity avoidance, monitoring with the option of increasing treatment intensity, perception of good prognosis, and impact on daily life. Participants interviewed during the COVID-19 pandemic (n=16) expressed substantial virus-related fear, including fear of exposure, fear of infecting their personal contacts or health care team, fear of cancer-related complications, and fear about their immunocompromised state. These fears contributed to participants perspective on de-escalation, as highlighted by participants stating, “I wouldn't worry about getting the chemo as much as I would worry about getting the virus” and “Less is more for me right now”.Of 91 survey respondents (69% response rate), median age was 58 years (interquartile range [IQR] 48-69), 86% had early stage breast cancer. Many (43%) patients were not interested in participation in a study testing lower doses of chemotherapy than standard of care. Patients not interested in participating were more often unmarried (55% vs. 32%, V=.23), disabled (56% vs. 40%, V=.17), or diagnosed with early stage cancer (45% vs. 22%, V=.14). Barriers to participation included fear of cancer recurrence (85%) and regret about the decision to receive less chemotherapy if the cancer were to recur (79%). Few patients (19%) considered clinical trials themselves as a barrier. Patients were interested in participation due to lessened physical side effects of treatment (82%), lessened long-term problems related to treatment (76%), and lessened impact on daily life (72%). The most popular terminology describing chemotherapy de-escalation was “lowest effective chemotherapy dose” (53%); no patients preferred the term “de-escalation.” Conclusion: Fear of recurrence is a common barrier to de-escalation clinical trial participation in patients with breast cancer. Fears may be altered for patients considering treatment during the COVID-19 pandemic. Trust in the physician and use of patient-generated language, such as “customized” instead of “de-escalation”, are potential areas for future interventions engaging patients in trials. Citation Format: Gabrielle Rocque, Courtney P. Williams, Courtney J. Andrews, Kathleen Gallagher, Timothy C. Childers, Kimberly D. Wiseman, Alan Balch, Stacey A. Ingram, Thelma Brown, Tara Kaufman, Nadine Tung, Mary Lou Smith, Antonio C. Wolff, Angela DeMichele, Lynn Wagner. Patient perspectives on chemotherapy de-escalation: “Don’t de-escalate! I don’t want to die!” [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD3-10.

Quantifying treatment preferences and their association with financial toxicity in women with breast cancer.

The objective of the current study was to understand treatment preferences and their association with financial toxicity in Patient Advocate Foundation clients with breast cancer. This choice-based conjoint analysis used data from a nationwide sample of women with breast cancer who received assistance from the Patient Advocate Foundation. Choice sets created from 13 attributes of 3 levels each elicited patient preferences and trade-offs. Latent class analysis segmented respondents into distinct preference archetypes. The Comprehensive Score for Financial Toxicity (COST) tool captured financial toxicity. Adjusted generalized linear models estimated COST score differences by preference archetype. Of 220 respondents (for a response rate of 10%), the median age was 58 years (interquartile range, 49-66 years); 28% of respondents were Black, indigenous, or people of color; and approximately 60% had household incomes <$40,000. The majority of respondents were diagnosed with early-stage cancer (91%), 38% had recurrent disease, and 61% were receiving treatment. Treatment choice was most affected by preferences related to affordability and impact on activities of daily living. Two distinct treatment preference archetypes emerged. The "cost-prioritizing group" (75% of respondents) was most concerned about affordability, impact on activities of daily living, and burdening care partners. The "functional independence-prioritizing group" (25% of respondents) was most concerned about their ability to work, physical side effects, and interference with life events. COST scores were found to be similar between the archetypes in adjusted models (cost-prioritizing group COST score, 12 [95% confidence interval, 9-14]; and functional independence-prioritizing COST score, 11 [95% confidence interval, 9-13]). Patients with breast cancer prioritized affordability or maintaining functional independence when making treatment decisions. Because of this variability, preference evaluation during treatment decision making could optimize patients' treatment experiences.

Quantifying treatment preferences and their association with financial toxicity in women with breast cancer.

141 Background: This study sought to understand treatment preferences and their association with financial toxicity in breast cancer patients served by Patient Advocate Foundation (PAF). Methods: This cross-sectional study used survey data from a nationwide sample of women with breast cancer who received assistance from PAF. Choice-based conjoint analysis elicited patient preferences and trade-offs. Latent class analysis segmented respondents into distinct preference groups. The Comprehensive Score for Financial Toxicity (COST) tool captured financial toxicity (range 0-44, lower scores indicate worse financial toxicity). Cramer’s V determined magnitude of relationships in bivariate associations. COST score differences by preference archetype was estimated by least square means and naïve 95% confidence intervals (CI) from adjusted generalized linear models. Results: Of 220 respondents (65% response rate), median age was 58 years (interquartile range [IQR] 49-66) and 60% had household incomes &lt; $40,000. Most respondents were diagnosed with early stage cancer (91%), with 41% diagnosed within the past 2 years; 38% had recurred. Almost two-thirds (61%) were on active treatment. Treatment choice was most affected by preferences related to affordability and impact on activities of daily living (ADLs). Two distinct treatment preference archetypes emerged. The “Cost-Prioritizing Group” (75% of respondents) was most concerned about affordability, impact on ADLs, and burdening care partners. The “Functional Independence-Prioritizing Group” (25% of respondents) was most concerned about ability to work, physical side effects, and interference with important life events. Cost- vs. functional independence-prioritizing respondents were more often diagnosed with an early stage cancer (88% vs. 78%; V = .22), white (78% vs. 56%; V = .21), or privately insured (45% vs. 36%; V = .12). Functional independence- vs. cost-prioritizing respondents more often had household incomes &lt; $40,000 (76% vs. 54%; V = .20), identified as Hispanic/Latino (20% vs. 9%; V = .15), or had Medicaid (15% vs. 7%; V = .12). COST scores were similar between archetypes in adjusted models (Cost-Prioritizing COST = 12, 95% CI 9-14; Functional Independence-Prioritizing COST = 11, 95% CI 9-13). Conclusions: Patients with breast cancer prioritized affordability or maintaining functional independence when making treatment decisions. Because of this variability, preference evaluation during treatment decision-making could optimize patients’ treatment experiences.

Abstract 2314: Prevalence and risk factors for occult tubal and ovarian cancer at the time of benign gynecologic surgery in the general population: A nationwide analysis of privately insured women

Abstract Background: Compelling molecular and pathological evidence demonstrating early invasive cancers in the fallopian tubes of BRCA1/2 carriers at the time of prophylactic surgery support the hypothesis that fallopian tube cancers are precursors of high-grade serous ovarian cancer. These findings have led to a rapid increase in opportunistic salpingectomy (OS) for ovarian cancer prevention among women in the general population. However, little data exists on the prevalence and risk factors for occult cancer in the general population. Methods: We identified all benign gynecologic surgeries (hysterectomy, bilateral salpingo-oophorectomy [BSO], OS, tubal ligation [TL]) among 45 million women aged 18-64 years from the Truven Health Analytics MarketScan Commercial Claims and Encounters Database between 2010 and 2017. Among the 557,693 women identified, we evaluated the prevalence and risk factors for tubal, ovarian, and peritoneal cancers at the time of surgery using log-binomial regression. Additionally, we examined the incidence of subsequent peritoneal cancer after BSO using Poisson regression. All models were adjusted for age, type of surgery, geographic region, rural/urban location, type of insurance, family history of breast and/or ovarian cancer, BRCA1/2 testing, and Charlson comorbidity index. Results: The most common indications for surgery were sterilization (34%), menstrual disorders (17%), and uterine fibroids (15%). A total of 192 occult cancers (149 ovarian, 22 fallopian tube, 21 peritoneal) were diagnosed at surgery. The median age at occult cancer diagnosis was 51 years (IQR: 44-57 years), and the age-adjusted prevalence was 0.035% (95% CI: 0.031-0.039) overall and 0.027% (95% CI: 0.023-0.032) excluding women with a family history of breast and/or ovarian cancer. Age-adjusted prevalence of occult cancer was highest in women with hysterectomy and BSO (0.113%; 95% CI: 0.084-0.144) followed by OS (0.047%, 95% CI: 0.005-0.089). Prevalence was similar for women with hysterectomy (0.027%, 95% CI: 0.020-0.033) and hysterectomy and OS (0.027%, 95% CI: 0.005-0.048) while women with TL had the lowest prevalence of occult cancer (0.007%, 95% CI: 0.003-0.011). In adjusted analyses, older age (prevalence ratio (PR) 40-54 years: 2.94, 95% CI: 1.81-4.79 vs &amp;lt;40 years; PR ≥55 years: 14.66, 95% CI: 8.35-25.74 vs &amp;lt;40 years), family history of breast and/or ovarian cancer (PR breast or ovarian cancer: 2.82, 95% CI: 2.01-3.97 vs none; PR breast and ovarian cancer: 10.62, 95% CI: 4.53-24.90 vs none), and number of comorbidities (PR 1+ comorbidities: 1.86, 95% CI: 1.19-2.88 vs 0 comorbidities) were significantly associated with occult cancer diagnosis. No women developed subsequent peritoneal cancer after an average follow-up of 2.2 years. Conclusions: In this large nationwide sample of women undergoing benign gynecologic surgery, occult cancers developed &amp;gt;10 years before the median age at which women are diagnosed with ovarian cancer. The prevalence of occult cancer was significantly lower than the prevalence reported by prior studies in selected BRCA1/2 carriers (2.5%-5.0%) and non-carriers (0.5%) undergoing prophylactic surgery. We also identified pre-surgical comorbidities as a novel risk factor for occult cancer. Citation Format: Pritesh S. Karia, Corinne E. Joshu, Kala Visvanathan. Prevalence and risk factors for occult tubal and ovarian cancer at the time of benign gynecologic surgery in the general population: A nationwide analysis of privately insured women [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2314.

Evaluating the association between childhood sexual abuse and attempted suicide across the lifespan: Findings from a nationwide study of women in jail.

Previous studies have found childhood sexual abuse to predict suicidal behavior in adulthood. Women in jail suffer disproportionately high rates of childhood sexual abuse and attempted suicide relative to women in the general population. Thus, better understanding the association between childhood sexual abuse and attempted suicide among women in jail may inform prevention, assessment, and treatment initiatives for this at-risk population. This study examined the association between childhood sexual abuse and the onset of attempted suicide across the life span in a nationwide sample of women in jail. Participants included a randomly selected subsample of women (N = 115), drawn from a larger probability sample (N = 491), who completed Life History Calendars, which were coded for the presence/absence of attempted suicide and childhood sexual abuse across life history stages. Survival analysis and Cox regression indicated that women with histories of childhood sexual abuse perpetrated by an adult or a peer were significantly more likely to have attempted suicide across the life span, including increased risk for the onset of attempted suicide in adulthood. This study demonstrates the salience of childhood sexual abuse as a predictor of suicidal behavior among women in jail, and extends previous research by demonstrating the temporal sequence of childhood sexual abuse relative to attempted suicide across the life span. Given these findings, researchers, clinicians, and policymakers should consider further the influence of childhood sexual abuse with regard to the high rates of attempted and completed suicide among women in jail. (PsycINFO Database Record

Physical and functional well-being in women with breast cancer taking gabapentin for hot flashes.

9141 Background: Hot flashes reduce quality of life (QOL) in women with breast cancer. In a randomized, double-blind, placebo-controlled trial of gabapentin for hot flashes, 900 mg of the drug was found to reduce hot flashes in women with breast cancer; however, their QOL of has not been studied. We conducted secondary analyses to study two domains of QOL: physical (PWB) and functional well-being (FWB) in women in this trial. Methods: A nationwide sample of women with breast cancer and hot flashes ≥ 2/day was studied at baseline (T1), 4 weeks (T2), and 8 weeks (T3) of treatment with gabapentin 300mg/day (G300) and 900mg/day (G900) in divided doses, and a matching placebo (PL). PWB and FWB were assessed via subscales of the Functional Assessment of Cancer Therapy-Breast. Linear mixed model analyses of PWB and FWB were conducted, adjusted for demographic and treatment variables. Results: The mean age of women (N=384) was 54.9 years ± 8.07 (range: 31-81, 72% &gt;50 years); 76% were married; 71% had more than high school education; 95% were Caucasian and 3% African-American; 10% were undergoing chemotherapy, and 9% radiotherapy (RT). PWB showed significant time effect (p&lt;.0001) and interaction of time and treatment (p&lt;.0001). There was an improvement in PWB in the G300 by T2 with no change at T3, while the improvement in PL and G900 was more modest at T2 and continued at T3 (PL - T1 20.7, T2 21.2, T3 21.6; G300 - T1 20.9, T2 22.2, T3 22.2; and G900 - T1 21.2, T2 21.5, T3 21.7). FWB also showed a significant time effect (p=.001) and interaction of time and treatment (p&lt;.002). FWB in G300 improved by T2, with no additional improvement at T3; it was unchanged in G900 at T2 with a slight reduction at T3; PL showed a modest improvement at T2 followed by a modest worsening at T3 (PL - T1 17.8, T2 18.1, T3 17.9; G300 - T1 17.9, T2 18.6, T3 18.6; G900 - T1 18.6, T2 18.6, T3 18.5). Conclusions: As reported previously, G900 is effective in reducing hot flashes. In this analysis, however, PWB and FWB showed different patterns of change over time between the two gabapentin and placebo groups with G900 showing minimal effects on PWB and FWB. Future trials to further study the changes in physical and functional well-being of women with breast cancer taking gabapentin for hot flashes are needed.

Detecting Patterns of Magazine Reading

The problem is that of estimating the quantitative and qualitative character of the audience reading any given group of magazines. The tool for attacking this problem is factor analysis. Long used by psychologists and economists, this technique is well suited for a comprehensive approach to many marketing problems. The pairwise audience overlap for fifty-three magazines is analyzed for a nationwide sample of women.