Welcome Comparative Effectiveness Research on Cancer in Texas (CERCIT)

The goal of CERCIT is to find evidence that will help patients and their physicians make individualized decisions about the best cancer care options, including screening, treatment and end of life care in cancer.

CERCIT is a multidisciplinary consortium of investigators at the University of Texas Medical Branch (UTMB), MD Anderson Cancer Center (MDACC), UT Health Science Center at Houston (UTHealth), UT Southwestern Medical Center in Dallas (UTSW), and the Texas Department of State Health Services Texas Cancer Registry. CERCIT is funded by the Cancer Prevention Research Institute of Texas (CPRIT).


Demographic Variations in Texas

by UTMB CERCIT, November 2016

Cancer themed typographical graphicThe size and diversity of Texas present substantial challenges to the delivery of cancer care throughout the state. The CERCIT Knowledge Translation Core produced the following report and online resources that map population, economic and health care characteristics of diverse geographic areas in Texas that are relevant to the delivery of cancer care.

Read More: Demographic Variations in Texas


UTMB-led group wins additional 5-year funding from Cancer Prevention Research Institute of Texas

by UTMB CERCIT, September 2016

A multi-institutional group, led by James S. Goodwin, MD, has been awarded a second five years of funding for "Comparative Effectiveness Research on Cancer in Texas" (CERCIT). The $6 million grant is from the Cancer Prevention Research Institute of Texas. The CERCIT renewal will build on our analyses of administrative data but expand our methods to better measure individual patient characteristics and include information on patient preferences and patient reported outcomes. Our goal is to generate evidence that will help patients and their physicians make individualized decisions about the best cancer care options for each patient. These choices include screening, treatment and end of life care in cancer.

Read More: CERCIT Renewal

Rice U. study: Texans are no better off in one city versus another for cancer treatment

by Rice University Press Release

photo of medical professional reading a tablet

HOUSTON – (July 25, 2016) – Regions in Texas differ widely in adherence to recommended cancer treatment for elderly patients, according to a study by researchers at Rice University and the University of Texas MD Anderson Cancer Center.

These differences are not due to the availability of treatment specialists or the presence of teaching hospitals, the study found. The absence of consistent explanations for these treatment differences suggests that variations like these are likely to occur elsewhere nationwide.

"Texans are no better off in one city versus another in terms of treatment across a broad range of cancers," said Vivian Ho, the chair in health economics at Rice's Baker Institute for Public Policy and director of the institute's Center for Health and Biosciences, who co-authored the study. "One might have expected Houston residents to receive better treatment because of MD Anderson's presence, but any beneficial effects could be offset by a large number of elderly in Houston not being treated there." The research findings were published in the journal BMC Health Services Research.


2016 CERCIT Publications
Chavez-MacGregor, M., Clarke, C. A., Lichtensztajn, D. Y., & Giordano, S. H. (2016). Delayed Initiation of Adjuvant Chemotherapy Among Patients With Breast Cancer. JAMA Oncol, 2(3), 322-329. doi:10.1001/jamaoncol.2015.3856 PMID26659132
Dimou, F., Sineshaw, H., Parmar, A. D., Tamirisa, N. P., Jemal, A., & Riall, T. S. (2016). Trends in Receipt and Timing of Multimodality Therapy in Early-Stage Pancreatic Cancer. J Gastrointest Surg, 20(1), 93-103; discussion 103. doi:10.1007/s11605-015-2952-7 PMID26503262
Elting LS, Xu Y, Chavez-MacGregor M, Giordano SH. Granulocyte growth factor use in elderly patients with non-Hodgkin's lymphoma in the United States: adherence to guidelines and comparative effectiveness. J Supp. Care Cancer, 2016 Jan 3 24(6), 2695-2706. PMID26797253
Esselen, K. M., Cronin, A. M., Bixel, K., Bookman, M. A., Burger, R. A., Cohn, D. E., . . . Wright, A. A. (2016). Use of CA-125 Tests and Computed Tomographic Scans for Surveillance in Ovarian Cancer. JAMA Oncol, 2(11), 1427-1433. doi:10.1001/jamaoncol.2016.1842 PMID27442965
Goodwin, J. S., Sheffield, K., Li, S., & Tan, A. (2016). Receipt of Cancer Screening Is a Predictor of Life Expectancy. J Gen Intern Med, 31(11), 1308-1314. doi:10.1007/s11606-016-3787-y PMID27364834
Ho V, Ku-Goto MH, Zhao H, Hoffman E, Smith B, Giordano S. Regional differences in recommended cancer treatment for the elderly. BMC Health Services Research, 2016 16:262 DOI 10.1186/s12913-016-1534-z Download PDF
Huo, J., Giordano, S. H., Smith, B. D., Shaitelman, S. F., & Smith, G. L. (2016). Contemporary Toxicity Profile of Breast Brachytherapy Versus External Beam Radiation After Lumpectomy for Breast Cancer. Int J Radiat Oncol Biol Phys, 94(4), 709-718. doi:10.1016/j.ijrobp.2015.12.013 PMID26972643
Huo, J., Smith, B. D., Giordano, S. H., Reece, G. P., & Tina Shih, Y. C. (2016). A comparison of patient-centered economic and clinical outcomes of post-mastectomy breast reconstruction between obese and non-obese patients. Breast, 30, 118-124. doi:10.1016/j.breast.2016.09.004 PMID27697676
Kehl, K. L., Shen, C., Litton, J. K., Arun, B., & Giordano, S. H. (2016). Rates of BRCA1/2 mutation testing among young survivors of breast cancer. Breast Cancer Res Treat, 155(1), 165-173. doi:10.1007/s10549-015-3658-y PMID26706041
Lewis, Z. H., Ottenbacher, K. J., Fisher, S. R., Jennings, K., Brown, A. F., Swartz, M. C., & Lyons, E. J. (2016). Testing Activity Monitors' Effect on Health: Study Protocol for a Randomized Controlled Trial Among Older Primary Care Patients. JMIR Res Protoc, 5(2), e59. doi:10.2196/resprot.5454 PMID27129602
Lewis, Z. H., Swartz, M. C., & Lyons, E. J. (2016). What's the Point?: A Review of Reward Systems Implemented in Gamification Interventions. Games Health J, 5(2), 93-99. doi:10.1089/g4h.2015.0078 PMID26812253
Lin, S. H., Zhang, N., Godby, J., Wang, J., Marsh, G. D., Liao, Z., . . . Giordano, S. H. (2016). Radiation modality use and cardiopulmonary mortality risk in elderly patients with esophageal cancer. Cancer, 122(6), 917-928. doi:10.1002/cncr.29857 PMID26716915
Lowenstein, L. M., Richards, V. F., Leal, V. B., Housten, A. J., Bevers, T. B., Cantor, S. B., . . . Volk, R. J. (2016). A brief measure of Smokers' knowledge of lung cancer screening with low-dose computed tomography. Prev Med Rep, 4, 351-356. doi:10.1016/j.pmedr.2016.07.008 PMID27512650
Lyons, E. J., Baranowski, T., Basen-Engquist, K. M., Lewis, Z. H., Swartz, M. C., Jennings, K., & Volpi, E. (2016). Testing the effects of narrative and play on physical activity among breast cancer survivors using mobile apps: study protocol for a randomized controlled trial. BMC Cancer, 16, 202. doi:10.1186/s12885-016-2244-y PMID26960972
Mehta, H. B., Parmar, A. D., Adhikari, D., Tamirisa, N. P., Dimou, F., Jupiter, D., & Riall, T. S. (2016). Relative impact of surgeon and hospital volume on operative mortality and complications following pancreatic resection in Medicare patients. J Surg Res, 204(2), 326-334. doi:10.1016/j.jss.2016.05.008 PMID27565068
Meyer, L. A., Cronin, A. M., Sun, C. C., Bixel, K., Bookman, M. A., Cristea, M. C., . . . Wright, A. A. (2016). Use and Effectiveness of Neoadjuvant Chemotherapy for Treatment of Ovarian Cancer. J Clin Oncol. doi:10.1200/JCO.2016.68.1239 PMID27601552
Nayak, P., Luo, R., Elting, L., Zhao, H., & Suarez-Almazor, M. E. (2016). Impact of Rheumatoid Arthritis on the Mortality of Elderly Patients who Develop Cancer: A Population-Based Study. Arthritis Care Res (Hoboken). doi:10.1002/acr.22997 PMID27483088
Nayak, P., Vernon, S. W., Savas, L. S., Basen-Engquist, K., Morgan, R. O., & Elting, L. S. (2016). Functional Impairment and Physical Activity Adherence Among Gynecologic Cancer Survivors: A Population-Based Study. Int J Gynecol Cancer, 26(2), 381-388. doi:10.1097/IGC.0000000000000620 PMID26807568
Raber, M., Swartz, M. C., Santa Maria, D., O'Connor, T., Baranowski, T., Li, R., & Chandra, J. (2016). Parental involvement in exercise and diet interventions for childhood cancer survivors: a systematic review. Pediatr Res, 80(3), 338-346. doi:10.1038/pr.2016.84 PMID27064243
Sharma, G., Nishi, S. P., Lin, Y. L., Kuo, Y. F., Goodwin, J. S., & Riall, T. S. (2016). Pattern of Imaging after Lung Cancer Resection. 1992-2005. Ann Am Thorac Soc, 13(9), 1559-1567. doi:10.1513/AnnalsATS.201511-768OC PMID27243464
Shirvani, S. M., Jiang, J., Likhacheva, A., Hoffman, K. E., Shaitelman, S. F., Caudle, A., . . . Smith, B. D. (2016). Trends in Local Therapy Utilization and Cost for Early-Stage Breast Cancer in Older Women: Implications for Payment and Policy Reform. Int J Radiat Oncol Biol Phys, 95(2), 605-616. doi:10.1016/j.ijrobp.2016.01.059 PMID27034179
Smith, B. D., Jiang, J., Shih, Y. C., Giordano, S. H., Huo, J., Jagsi, R., . . . Shirvani, S. M. (2017). Cost and Complications of Local Therapies for Early-Stage Breast Cancer. J Natl Cancer Inst, 109(1). doi:10.1093/jnci/djw178 PMID27678203
Smith, G. L. (2016). Toward Minimizing Overtreatment and Undertreatment of Ductal Carcinoma In Situ in the United States. J Clin Oncol, 34(11), 1172-1174. doi:10.1200/JCO.2015.66.2064 PMID26884563
Swartz, M. C., Basen-Engquist, K. M., Markham, C., Lyons, E. J., Cox, M., Chandra, J., . . . Swank, P. R. (2016). Psychometric Analysis of the Three-Factor Eating Questionnaire-R18V2 in Adolescent and Young Adult-Aged Central Nervous System Tumor Survivors. J Adolesc Young Adult Oncol, 5(3), 278-285. doi:10.1089/jayao.2015.0058 PMID27042872
Volk, R. J., Linder, S. K., Lopez-Olivo, M. A., Kamath, G. R., Reuland, D. S., Saraykar, S. S., . . . Pignone, M. P. (2016). Patient Decision Aids for Colorectal Cancer Screening: A Systematic Review and Meta-analysis. Am J Prev Med. doi:10.1016/j.amepre.2016.06.022 PMID27593418
Williams, S. B., Duan, Z., Chamie, K., Hoffman, K. E., Smith, B. D., Hu, J. C., . . . Giordano, S. H. (2016). Risk of hospitalisation after primary treatment for prostate cancer. BJU Int. doi:10.1111/bju.13647 PMID27561186
Zanwar, P., Lin, Y. L., Kuo, Y. F., & Goodwin, J. S. (2016). Downstream tests, treatments, and annual direct payments in older men cared for by primary care providers with high or low prostate-specific antigen screening rates using 100 percent Texas U.S. Medicare public insurance claims data: a retrospective cohort study. BMC Health Serv Res, 16, 17. doi:10.1186/s12913-016-1265-1 PMID26772175


Multi-PI Grants
A Workshop Presented by James S. Goodwin, MD and others at UTMB

Fun with Medicare Part D Data
A CERCIT Workshop presented by James S. Goodwin, MD, August 2014

Shared Decision Making in Cancer Care
A CERCIT Workshop presented by Nina Tamirisa, MD, August 2014

The Use of Surgery in the Elderly for Management of Metastatic Epidural Spinal Cord Compression
A CERCIT Workshop presented by Justin E. Bird, MD, June 2014

Population-Based Assessment of Breast Reconstruction
A CERCIT Workshop presented by Ben Smith, MD, June 2014

Data & Reports

Fact Sheets

Prostate Cancer [PDF]: Prostate Specific Antigen (PSA) Testing in Men Aged 65 & Older

Mammography [PDF]: Mammography in Women Aged 65 & Older

Colonoscopy [PDF]: Colonoscopy in Adults Aged 65 & Older

Reports and Special Publications

Surveillance Patterns Following Lung Cancer Resection [PDF]: This report describes the current population-based trends in surveillance practices and the use of these modalities in patients with non-small cell lung cancer (NSCLC) following curative resection.

Comparative Effectiveness of MRI vs. Mammography Alone in Patients Undergoing Breast-Conserving Therapy for Breast Cancer [PDF]: This report compares the effectiveness of MRI vs. mammography alone in patients undergoing breast-conserving therapy for breast cancer

Hispanic Cancer Report [PDF]: From A quarterly publication of the Texas Public Health Association (TPHA) Supplement, Fall 2013, A Comprehensive Report on Cancer among Hispanics in Texas.

CERCIT Featured in the Texas Public Health Journal Summer 2013
Using research to keep Texans informed about cancer care – that is at the heart of CERCIT (Comparative Effectiveness Research on Cancer in Texas). A description of this project and selected articles from its four research areas are featured in the Spring 2013 issue of the Texas Public Health Journal, a quarterly publication of the Texas Public Health Association (pages 22-55):

Just how much does cancer cost in Texas? [PDF] Texas Public Health Journal, Vol 63, Issue 4, Fall 2011. Findings are reported in the Cost of Cancer in Texas, 2005 [PDF] published by the Texas Cancer Council.


CERCIT Workshop Presentations

In the first five years of CERCIT, we offered clinician-scientist training in Comparative Effectiveness Research on Cancer in Texas.
Trainees attended monthly workshops. A selection of those workshop presentations are now available as resources linked below:

Presenter Presentation
Mary Austin, MD, MPH Identifying Geographic & Socioeconomic Disparities in Access to Care for Pediatric Cancer Patients in Texas
Carlos Barcenas, MD, MSc Breast Imaging Surveillance in Breast Cancer Survivors
  Comparative analysis of chemotherapy-related toxicities in breast cancer regimens using population-based databases
  Toxicities of Chemotherapy Regimens used in Early Breast Cancer
Jaime Bennarch-Gampel, MD Surveillance of Pancreatic Cancer Patients Following Surgical Resection
  Colonoscopist and Primary Care Physician Supply and Disparities in Colorectal Cancer Screening
Justin Bird, MD The use of surgery in the elderly for management of metastatic epidural spinal cord compression
Casey Boyd, MD CERCIT Scholar Presentation- The Survivorship Experience in Pancreatic Cancer
Cheryl Bowcock, MPH (TCR) Overview of Texas Medicaid Data
Mariana Chavez-MacGregor, MD, MSc Cardiac monitoring among trastuzumab- treated patients: A population-based study in older patients with breast cancer
  Trastuzumab-related cardiotoxicity: a population based study in older patients with breast cancer
Catherine Cooksley, DrPH Model of a Proposed Query Tool
  Case Study Using Linked Cancer Registry & Claims Data
Amanda Cooper, MD The Use of PET and PET/CT in the Management of Metastatic Colorectal Cancer
Justin Dimick, MD Advances in the Science of Quality Measurement
Francesca Dimou, MD Trends in Receipt and Timing of Multimodality Therapy in Early Stage Pancreatic Cancer
Xianglin L. Du, PhD Exploring Medicaid Data for Research: Potentials and Pitfalls
Casey B. Duncan et. al. The Effect of Depression on Diagnosis, Treatment, and Survival in Pancreatic Cancer
  Hospital and Medical Care Days in Pancreatic Cancer
Linda Elting, DrPH Comparative Effectiveness of Granulocyte Growth Factors Among Elderly Patients with Non-Hodgkin's Lymphoma
  Screening Mammography Capacity
  Medicaid Coverage Analyses
  Security, Privacy and Ethical Issues in Database Research
Karl Eschbach, PhD Spatial Distribution of Cancer in Texas
  Geography, Geographic Information Systems and Cancer Comparative Effectiveness Research
Jean Freeman, PhD and James S. Goodwin, MD Cancer Effectiveness Research and the Texas Cancer Registry
Sharon Giordano, MD, MPH Clinical trial enrollment among older cancer patients
  CERCIT Project 2: Assessing the Quality of Cancer Treatment in Texas
Daniel Gomez, PhD CERCIT Scholar Presentation - An Estimation of Guideline Adherence to Nausea and Vomiting Prophylaxis in Patients Receiving Concurrent Chemoradiation for Lung Cancer, and the Implications of Chemoradiation for Lung Cancer, and the Implications of Adherence to these Guidelines: A State-wide, Population-based Study
James S. Goodwin, MD Fun with Medicare Part D Data
  Provider Level Analyses of Receipt of Colorectal Cancer Screening (mostly colonoscopy)
  Provider Level Analyses of Screening Mammography Use in Women with Limited Life Expectancy
  Writing a NIH proposal under the new guidelines
  What is Comparative Effectiveness Research?
  Colonoscopist and Primary Care Physician Supply and Disparities in Colorectal Cancer Screening
B. Ashleigh Guadagnolo, MD, MPH Using claims data to investigate RT use at the end of life
Vivian Ho PhD Explaining the Volume-Cost Relationship for Cancer Surgery
  Health Economics and Cancer Effectiveness Research
Karen Hoffman, MD, MHSc, MPH Influence of Diagnosing Urologist on Management of Favorable Prostate Cancer
  Prostate Cancer Treatment of Older Men in Texas: Population-based Practices and Quality of Care
Holly Holmes, MD Using Medicare Part D Data
Elizabeth Jaramillo, MD Variation in PSA Screening among Primary Care Physicians
  Overuse of PSA Screening for Prostate Cancer in Older Men
Yong-Fang Kuo, PhD Data Management of Linkage of Texas Cancer Registry with other Sources
Carol Lewis, MD, MPH Post-Treatment Surveillance for Head and Neck Cancer
Steven Lin, MD, PhD Population-based Analysis of Late Effects and Health Status of Survivors Treated with Radiation for Thoracic Malignancies
  The Impact of Radiation Therapy Technology Use on Cardiopulmonary Mortality in the Elderly with Esophageal Cancer
Elaine Liu, PhD Instrumental Variables Estimation: Why, What and How?
Joann-Grace M. Manzano, MD Unplanned Hospitalizations and Readmissions among Elderly Patients with Gastrointestinal Cancer
Techksell McKnight, MD, MPH The Use of MRI in the Evaluation of Breast Cancer
Sahil Mittal, MD Effectiveness of locoregional therapy before liver transplant for liver cancer
Mary Ninan, MD Hospitalization for toxicity in patients treated with Rituximab
Abhishek Parmar, MD Quality of Post-Treatment Surveillance of Early Stage Breast Cancer in Texas
  Trajectory of Care and Use of Multimodality Therapy in Locoregional Pancreatic Adenocarcinoma
Jeremy Rassen, ScD Instrumental variable methods in comparative effectiveness research
Taylor Riall, MD, PhD Social Network Analysis and Physician Practice Patterns
  Trends and Comparative Effectiveness in Treatment of Stage IV Colorectal Adenocarcinoma
Ana Rodriguez, MD Second primary cancer after radiotherapy in women with invasive cervical carcinoma
  Utilization of BRCA Testing in Older Women with Breast and Ovarian Cancer in Texas
Amanda Scarbrough, PhD, MHSA and Carol Trono, MA Texas AHEC East, CERCIT and Knowledge Translation
Jay Shah, MD The Road Less Traveled: Does Bladder Cancer Care Differ Between Rural and Urban Texas?
Gulshan Sharma MD, MPH Overuse of care, considered aggressive at end of life
Ben Smith, MD Local Therapy for Early Breast Cancer: Trends, Complications, and Patient-Centered Outcomes
  Moving from patient to physician to networks: Old and new approaches to evaluating quality and disparities in breast cancer care
  Population-based assessment of breast reconstruction: Care Patterns, Disparities, and Outcomes
Grace Smith, MD, PhD, MPH Utilization and Outcomes of Breast Brachytherapy in Younger Women
  Patterns of Care in Patients with Cervical Cancer
  Using Claims to Study Cancer Survivors
Maria Suarez-Almazor, MD, PhD Use of DXA in Patients with Prostate Cancer and Breast Cancer Initiating Hormonal Therapy
Nina Tamirisa, MD Shared Decision Making In Cancer Care
  Underuse of Minimally Invasive Breast Biopsy in Texas: The Role of the Surgeon
Gabriela Vargas, MD Physician Follow-Up and Guideline Adherence in Post-Treatment Surveillance of Colorectal Cancer
  Timing of Chemotherapy and Primary Tumor Resection in Older Patients with Stage IV Colorectal Cancer
Melanie Williams, PhD (TCR) The Texas Cancer Registry: Who, What, When, How, etc.
  Linking Texas Cancer Registry Data
Leonard Zwelling, MD, MBA Conflict of Interest in Academia-Straining the Public's Trust
  RED KOOL-AID,BLUE KOOL-AID Health Care Reform-The Key Is the 4 P's
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UTMB MDACC UT Health Science Center Houston UTSW TCR DSHS CPRIT

CERCIT is a multidisciplinary consortium of investigators at the University of Texas Medical Branch (UTMB), MD Anderson Cancer Center (MDACC), UT Health Science Center at Houston (UTHealth), UT Southwestern Medical Center in Dallas (UTSW), and the Texas Department of State Health Services Texas Cancer Registry. CERCIT is funded by the Cancer Prevention Research Institute of Texas (CPRIT). Manuscript Acknowledgement: This work was supported [in part] by the Comparative Effectiveness Research on Cancer in Texas (CERCIT) Grant #RP160674, funded by The Cancer Prevention Research Institute of Texas (CPRIT).