Lisa Tolnitch

Positions:

Assistant Professor of Surgery

Surgical Oncology
School of Medicine

Member / of the / Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1983

University of Louisville, School of Medicine

Publications:

Characterizing participants in the North Carolina Breast and Cervical Cancer Control Program: A retrospective review of 90,000 women.

BACKGROUND: The North Carolina Breast and Cervical Cancer Control Program (NC BCCCP) provides breast cancer screening services to underserved women to mitigate disparities in access to care. The authors sought to characterize this understudied population. METHODS: Women 21 years old or older who underwent their first breast cancer screen through NC BCCCP from 2008 to 2018 were included. Demographic factors associated with the timeline of care and odds of a breast cancer diagnosis were identified with negative binomial and logistic regression, respectively. RESULTS: Of the 88,893 women identified, 45.5% were non-Hispanic (NH) White, 30.9% were NH Black, 19.6% were Hispanic, 1.7% were American Indian, and 1.1% were Asian. Breast cancer was diagnosed in 2.5% of the women (n = 2255). Hispanic women were the least likely to be diagnosed with breast cancer (odds ratio vs NH White women, 0.40; 95% confidence interval [CI], 0.34-0.47). Among patients with breast pathology, the median time to diagnosis was 19 days (interquartile range [IQR], 10-33 days), and the time to treatment was 33 days (IQR, 19-54 days). After adjustments, a longer time to diagnosis was significantly associated with age (incidence rate ratio [IRR], 1.01; 95% CI, 1.01-1.02) and being NH Black (vs NH White; IRR, 1.17; 95% CI, 1.06-1.29). A longer time to treatment was significantly associated with age (IRR, 1.01; 95% CI, 1.01-1.01), being NH Black (vs NH White; IRR, 1.20; 95% CI, 1.10-1.31), and being Hispanic (vs NH White; IRR, 1.22; 95% CI, 1.05-1.41). CONCLUSIONS: NC BCCCP participants with breast cancer received treatment within approximately 1 month of presentation, and this finding aligns with quality care benchmarks. Nevertheless, racial/ethnic disparities in timeliness of care persist, and this suggests opportunities for improvement. LAY SUMMARY: This review of approximately 90,000 participants in a breast cancer screening program for uninsured and underinsured women highlights the importance of safety net programs in providing timely care to underserved patients. The authors found that the North Carolina Breast and Cervical Cancer Control Program met timeliness benchmarks from the Centers for Disease Control and Prevention across all racial/ethnic groups. However, non-Hispanic Black women experienced relative delays in the time to diagnosis, and both non-Hispanic Black women and Hispanic women experienced relative delays in the time to treatment. These findings demonstrate how racial/ethnic disparities in the timeliness of care can persist even within a program intended to reduce barriers to access.
Authors
Tait, SD; Ren, Y; Horton, CC; Oshima, SM; Thomas, SM; Wright, S; Caesar, A; Plichta, JK; Hwang, ES; Greenup, RA; Rosenberger, LH; DiLalla, GD; Menendez, CS; Tolnitch, L; Hyslop, T; Nelson, D; Fayanju, OM
MLA Citation
Tait, Sarah D., et al. “Characterizing participants in the North Carolina Breast and Cervical Cancer Control Program: A retrospective review of 90,000 women.Cancer, vol. 127, no. 14, 2021, pp. 2515–24. Pubmed, doi:10.1002/cncr.33473.
URI
https://scholars.duke.edu/individual/pub1473539
PMID
33826758
Source
pubmed
Published In
Cancer
Volume
127
Published Date
Start Page
2515
End Page
2524
DOI
10.1002/cncr.33473

Rare breast metastasis from adenoid cystic carcinoma of the submandibular gland.

Adenoid cystic carcinomas (ACCs) are rare malignant neoplasms of exocrine glands, most commonly found in salivary glands. This report describes a 67-year-old woman with metastatic ACC to the breast, only the third reported case of its kind. The salivary gland ACC was first diagnosed 5 years prior. Routine mammogram identified a Breast Imaging and Reporting Systems (BIRADS) 4 lesion. Core breast biopsy demonstrated findings consistent with metastatic ACC to the breast. The patient ultimately underwent local excision but suffered a recurrence of disease less than 2 months later despite chemotherapy. She passed away 15 months after excision due to complications associated with a small bowel obstruction and decompensated respiratory status from pulmonary metastases. While metastatic salivary ACC to the breast is rare, it is important to be able to distinguish metastatic salivary ACC to the breast from primary ACC of the breast as the treatment considerations for the two disease processes differ significantly.
Authors
Krucoff, KB; Shammas, RL; Stoecker, M; Tolnitch, LA
MLA Citation
Krucoff, Kate Buretta, et al. “Rare breast metastasis from adenoid cystic carcinoma of the submandibular gland.Bmj Case Rep, vol. 2018, Aug. 2018. Pubmed, doi:10.1136/bcr-2017-223345.
URI
https://scholars.duke.edu/individual/pub1338612
PMID
30068574
Source
pubmed
Published In
Bmj Case Reports
Volume
2018
Published Date
DOI
10.1136/bcr-2017-223345

Financial Costs and Burden Related to Decisions for Breast Cancer Surgery.

PURPOSE: Financial toxicity is a well-recognized adverse effect of cancer care, yet little is known about how women consider treatment costs when facing preference-sensitive decisions for breast cancer surgery or how surgical treatment choice affects financial harm. We sought to determine how financial costs and burden relate to decisions for breast cancer surgery. METHODS: Women (≥ 18 years old) with a history of breast cancer were recruited from the Army of Women and Sisters Network to complete an 88-item electronic survey. Descriptive statistics and regression analysis were used to evaluate the impact of costs on surgical decisions and financial harm after breast cancer surgery. RESULTS: A total of 607 women with stage 0 to III breast cancer were included. Most were white (90%), were insured privately (70%) or by Medicare (25%), were college educated (78%), and reported household incomes of more than $74,000 (56%). Forty-three percent underwent breast-conserving surgery, 25% underwent mastectomy, 32% underwent bilateral mastectomy, and 36% underwent breast reconstruction. Twenty-eight percent reported that costs of treatment influenced their surgical decisions, and at incomes of $45,000 per year, costs were prioritized over breast preservation or appearance. Overall, 35% reported financial burden as a result of their cancer treatment, and 78% never discussed costs with their cancer team. When compared with breast-conserving surgery, bilateral mastectomy with or without reconstruction was significantly associated with higher incurred debt, significant to catastrophic financial burden, treatment-related financial hardship, and altered employment. Among the highest incomes, 65% of women were fiscally unprepared, reporting higher-than-expected (26%) treatment costs. CONCLUSION: Cancer treatment costs influenced decisions for breast cancer surgery, and comparably effective surgical treatments differed significantly in their risk of patient-reported financial burden, debt, and impact on employment. Cost transparency may inform preference-sensitive surgical decisions and improve patient-centered care.
Authors
Greenup, RA; Rushing, C; Fish, L; Campbell, BM; Tolnitch, L; Hyslop, T; Peppercorn, J; Wheeler, SB; Zafar, SY; Myers, ER; Hwang, ES
MLA Citation
Greenup, Rachel A., et al. “Financial Costs and Burden Related to Decisions for Breast Cancer Surgery.J Oncol Pract, vol. 15, no. 8, Aug. 2019, pp. e666–76. Pubmed, doi:10.1200/JOP.18.00796.
URI
https://scholars.duke.edu/individual/pub1402269
PMID
31356147
Source
pubmed
Published In
J Oncol Pract
Volume
15
Published Date
Start Page
e666
End Page
e676
DOI
10.1200/JOP.18.00796

Perspectives on the Costs of Cancer Care: A Survey of the American Society of Breast Surgeons.

BACKGROUND: Cancer treatment costs are not routinely addressed in shared decisions for breast cancer surgery. Thus, we sought to characterize cost awareness and communication among surgeons treating breast cancer. METHODS: We conducted a self-administered, confidential electronic survey among members of the American Society of Breast Surgeons from 1 July to 15 September 2018. Questions were based on previously published or validated survey items, and assessed surgeon demographics, cost sensitivity, and communication. Descriptive summaries and cross-tabulations with Chi-square statistics were used, with exact tests where warranted, to assess findings. RESULTS: Of those surveyed (N = 2293), 598 (25%) responded. Surgeons reported that 'risk of recurrence' (70%), 'appearance of the breast' (50%), and 'risks of surgery' (47%) were the most influential on patients' decisions for breast cancer surgery; 6% cited out-of-pocket costs as significant. Over half (53%) of the surgeons agreed that doctors should consider patient costs when choosing cancer treatment, yet the majority of surgeons (58%) reported 'infrequently' (43%) or 'never' (15%) considering patient costs in medical recommendations. The overwhelming majority (87%) of surgeons believed that patients should have access to the costs of their treatment before making medical decisions. Surgeons treating a higher percentage of Medicaid or uninsured patients were more likely to consistently consider costs (p < 0.001). Participants reported that insufficient knowledge or resources (61%), a perceived inability to help with costs (24%), and inadequate time (22%) impeded cost discussions. Notably, 20% of participants believed that discussing costs might impact the quality of care patients receive. CONCLUSIONS: Cost transparency remains rare, however in shared decisions for breast cancer surgery, improved cost awareness by surgeons has the potential to reduce financial hardship.
Authors
Greenup, RA; Rushing, CN; Fish, LJ; Lane, WO; Peppercorn, JM; Bellavance, E; Tolnitch, L; Hyslop, T; Myers, ER; Zafar, SY; Hwang, ES
MLA Citation
Greenup, Rachel A., et al. “Perspectives on the Costs of Cancer Care: A Survey of the American Society of Breast Surgeons.Ann Surg Oncol, vol. 26, no. 10, 2019, pp. 3141–51. Pubmed, doi:10.1245/s10434-019-07594-3.
URI
https://scholars.duke.edu/individual/pub1385788
PMID
31342390
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
26
Published Date
Start Page
3141
End Page
3151
DOI
10.1245/s10434-019-07594-3

The Impact of the Affordable Care Act on North Carolinian Breast Cancer Patients Seeking Financial Support for Treatment.

BACKGROUND: The Affordable Care Act (ACA) was instated on 23 March 2010 to improve healthcare quality, reduce costs, and increase access. The Pretty in Pink Foundation (PIPF), a non-profit 501(C)(3) organization in North Carolina, provides financial assistance and in-kind support to individuals seeking help with breast cancer care. The objective of this study was to determine whether sociodemographic variables and treatment services varied among PIPF recipients since enactment of the ACA. METHODS: North Carolinians who received financial assistance from the PIPF between 1 January 2013 and 31 December 2014 were included in the study, and the cohort was divided into two groups based on receipt of assistance before or after the enactment of the ACA. Descriptive statistics were tabulated as frequencies. Comparative univariate analysis between both groups was conducted using the χ (2) and Mann-Whitney U tests. All tests were two-sided and a p value <0.05 was considered statistically significant. All analyses were conducted using Stata. RESULTS: Overall, 1016 individuals fulfilled the inclusion criteria, and the median age of the cohort was 49 years (interquartile range 45-55). The ACA groups did not differ significantly by age, race, and sex; however, the groups varied with respect to income, employment, and clinical stage. In addition, the groups differed on the types of services for which they received financial assistance, but no difference was observed between groups with respect to insurance status. CONCLUSION: Since the enactment of the health insurance market component of the ACA, there has been a reduction in subjects receiving assistance from the PIPF; however, no change in their insurance status has been observed.
Authors
Obeng-Gyasi, S; Tolnitch, L; Greenup, RA; Shelley Hwang, E
MLA Citation
Obeng-Gyasi, Samilia, et al. “The Impact of the Affordable Care Act on North Carolinian Breast Cancer Patients Seeking Financial Support for Treatment.Ann Surg Oncol, vol. 23, no. 10, Oct. 2016, pp. 3412–17. Pubmed, doi:10.1245/s10434-016-5311-3.
URI
https://scholars.duke.edu/individual/pub1137704
PMID
27411550
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
23
Published Date
Start Page
3412
End Page
3417
DOI
10.1245/s10434-016-5311-3