Patterns of Care Study. The ACS is analyzing the National Hospital Discharge Surveys from 1988 to 1995 to describe patterns of use of inpatient surgical procedures for treating cancers of the lung, colorectum, prostate, and female breast, by age, race, gender, and geographic region. This is an intramural research activity of the Department of Epidemiology and Surveillance Research (P. Wingo, Department of Epidemiology and Surveillance Research, American Cancer Society, personal communication to Maria Hewitt, October 1998).

Behavioral Research Center. Although not designed as health services research initiatives per se, several activities within ACS's Behavioral Research Center could have applications to health services research (ACS, 1998).

Population-Based Surveys of Cancer Survivors. The Behavioral Research Center is conducting two large population-based surveys of cancer survivors at a cost of $2 million for the pilot phases (Baker, VP Behavioral Research, ACS, personal communication to Maria Hewitt, October 1997). The first is the "Study of Cancer Survivors—Incidence." This survey of up to 100,000 cancer survivors is underway in a pilot phase and is designed as a 10-year prospective study of survivors enrolled within the first year after diagnosis of any one of the ten most common cancers (i.e., prostate, female breast, lung, colorectal, urinary bladder, non-Hodgkin's lymphoma, skin melanoma, uterine, kidney, ovarian). A population-based sample is being selected from area cancer registries in sufficient numbers to provide state-level estimates. The major aim of the survey is to examine the behavioral, psychosocial, treatment, and support factors that influence quality of life and survival of cancer patients. The survey is being fielded on a pilot basis in four states (Iowa, Minnesota, Wisconsin, Georgia), and plans are to extend the study to other states that have adequate cancer registration and an interest in participating. The survey includes a number of scales that have been validated (e.g., problems in daily living, physical and mental health functioning, problems with work) along with basic information about the cancer (type of cancer), treatment, health insurance, and site of health care. It should be possible, therefore, to examine quality-of-life issues by insurance or site of care, controlling for type of cancer (although it is unclear what information on comorbidity will be available).

The second survey is the "Study of Long-Term Cancer Survivors—Prevalence." This survey is a cross-sectional study of 6,000 long-term survivors (i.e., those who are 5, 10, and 15 years beyond diagnosis) of six cancers (prostate, breast, colorectal, bladder, melanoma, uterine). There will be 1,000 respondents for each type of cancer. Twenty-seven states have registries that were established in 1983 or earlier, and four SEER metro area registries also meet this requirement, which is necessary to identify 15-year survivors. Only 12 state registries and all four SEER registries have complete data (85 percent complete) for 1983, 1988, and 1993.

Complementary Therapies. Surveys of complementary therapies (e.g., acupuncture, visualization, yoga) have been conducted to determine the extent to which people with cancer are using these unconventional treatments and what their impact is on quality of life. In addition, surveys of oncology physicians, nurses, and social workers have been completed regarding the extent to which providers are aware of commonly used complementary therapies and whether they are supportive of cancer patients' use of these therapies.

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