201
|
Henley SJ, Jemal A. Rural Cancer Control: Bridging the Chasm in Geographic Health Inequity. Cancer Epidemiol Biomarkers Prev 2019; 27:1248-1251. [PMID: 30385497 DOI: 10.1158/1055-9965.epi-18-0807] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/09/2018] [Accepted: 08/29/2018] [Indexed: 01/25/2023] Open
Affiliation(s)
- S Jane Henley
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| |
Collapse
|
202
|
Gebremariam A, Addissie A, Worku A, Assefa M, Pace LE, Kantelhardt EJ, Jemal A. Time intervals experienced between first symptom recognition and pathologic diagnosis of breast cancer in Addis Ababa, Ethiopia: a cross-sectional study. BMJ Open 2019; 9:e032228. [PMID: 31719089 PMCID: PMC6858206 DOI: 10.1136/bmjopen-2019-032228] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES This study aimed to estimate the magnitude of patient and diagnostic delays and associated factors among women with breast cancer in Addis Ababa. DESIGN This is a cross-sectional study. SETTINGS AND PARTICIPANTS All women newly diagnosed with breast cancer in seven major healthcare facilities in Addis Ababa (n=441) were included in the study. MAIN OUTCOMES AND MEASURES Patient interval (time from recognition of first symptom to medical consultation) and diagnostic interval (time from first consultation to diagnosis). Patient intervals >90 days and diagnostic intervals >30 days were considered delays, and associated factors were determined using multivariable Poisson regressions with robust variance. RESULTS Thirty-six percent (95% CI [31.1%, 40.3%]) of the patients had patient intervals of >90 days, and 69% (95% CI [64.6%, 73.3%]) of the patients had diagnostic intervals of >30 days. Diagnostic interval exceeded 1 year for 18% of patients. Ninety-five percent of the patients detected the first symptoms of breast cancer by themselves, with breast lump (78.0%) as the most common first symptom. Only 8.0% were concerned about cancer initially, with most attributing their symptoms to other factors. In the multivariable analysis, using traditional medicine before consultation was significantly associated with increased prevalence of patient delay (adjusted prevalence ratio (PR) = 2.13, 95% CI [1.68, 2.71]). First consultation at health centres (adjusted PR = 1.19, 95% CI [1.02, 1.39]) and visiting ≥4 facilities (adjusted PR = 1.24, 95% CI [1.10, 1.40]) were associated with higher prevalence of diagnostic delay. However, progression of symptoms before consultation (adjusted PR = 0.73, 95% CI [0.60, 0.90]) was associated with decreased prevalence of diagnostic delay. CONCLUSIONS Patients with breast cancer in Addis Ababa have prolonged patient and diagnostic intervals. These underscore the need for public health programme to increase knowledge about breast cancer symptoms and the importance of early presentation and early diagnosis among the general public and healthcare providers.
Collapse
Affiliation(s)
- Alem Gebremariam
- Public Health, Adigrat University College of Medicine and Health Sciences, Adigrat, Ethiopia
- Preventive Medicine, Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
| | - Adamu Addissie
- Preventive Medicine, Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- Preventive Medicine, Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
| | - Mathewos Assefa
- Radiotherapy Center, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
| | - Lydia E Pace
- Medicine, Brigham and Women's Hospital, Boston, Massachuset, USA
| | - Eva Johanna Kantelhardt
- Institute for Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia, USA
| |
Collapse
|
203
|
Begoihn M, Mathewos A, Aynalem A, Wondemagegnehu T, Moelle U, Gizaw M, Wienke A, Thomssen C, Worku D, Addissie A, Jemal A, Kantelhardt EJ. Cervical cancer in Ethiopia - predictors of advanced stage and prolonged time to diagnosis. Infect Agent Cancer 2019; 14:36. [PMID: 31737087 PMCID: PMC6849163 DOI: 10.1186/s13027-019-0255-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/05/2019] [Indexed: 01/20/2023] Open
Abstract
Introduction In Ethiopia, most cervical cancer patients present at advanced cancer stages, long time after they experience first symptoms. We investigated possible predictors of long time spans between symptom onset and pathologic diagnosis (patient intervals). We also aimed to seek out predictors for advanced cancer stage diagnosis. Methods We conducted a retrospective cohort study among 1575 cervical cancer patients who were registered at Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia between September 2008 and September 2012. Cox proportional hazards regression was used to find predictors of long patient intervals. Cumulative odds ordinal logistic regression was used to identify predictors of cancer stage at diagnosis. Results Median patient interval was 30 weeks, with the interval substantially longer in patients residing in rural than urban areas. Longer patient intervals were associated with more advanced cancer stages at pathologic diagnosis. HIV-positive women had an almost 1.5 times increased risk of diagnosis at a more advanced stage. Conclusion Cervical cancer patients are diagnosed after long time periods leading to advanced stages at diagnosis. Measures to raise awareness about cervical cancer, to increase screening and to shorten the time interval from recognition of symptoms to diagnosis are urgently needed.
Collapse
Affiliation(s)
- Matthias Begoihn
- 1Department of Gynecology, Martin-Luther-University, Halle (Saale), Germany
| | - Assefa Mathewos
- 2Radiotherapy Center, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abreha Aynalem
- 2Radiotherapy Center, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Ulrike Moelle
- 1Department of Gynecology, Martin-Luther-University, Halle (Saale), Germany
| | - Muluken Gizaw
- 3Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle (Saale), Germany.,4Department of Preventive Medicine School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Andreas Wienke
- 3Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle (Saale), Germany
| | - Christoph Thomssen
- 1Department of Gynecology, Martin-Luther-University, Halle (Saale), Germany
| | - Dawit Worku
- 5Department of Gynecology, School of Medicine Addis Ababa University, Addis Ababa, Ethiopia
| | - Adamu Addissie
- 3Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle (Saale), Germany.,4Department of Preventive Medicine School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ahmedin Jemal
- Department of Intramural Research, American Cancer Society, Atlanta, Georgia
| | - Eva Johanna Kantelhardt
- 1Department of Gynecology, Martin-Luther-University, Halle (Saale), Germany.,3Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle (Saale), Germany
| |
Collapse
|
204
|
Abstract
Abstract
Data on recent trends in mortality from major cancers by individual-level socioeconomic status (SES) are lacking in the US. We examined mortality trends and disparities by educational attainment (rate ratio ≤12 vs. ≥16 years of education) from 2001-2016 for lung, colorectal, female breast, and prostate cancers among persons aged 25-74 years. During 2001-2016, death rates continued to decrease in each stratum of sex/education categories for all four cancers, with the steepest decline among those with ≥16 years of education. Consequently, relative educational disparities widened over time. Among men for example, lung cancer death rates from 2001-2016 decreased 2.70% per year in persons with ≤12 years of education compared to 5.44% per year among those with ≥16 years of education, and the rate ratio increased from 2.96 (95%CI, 2.84-3.09) to 4.58 (95%CI, 4.41-4.76). Enhanced interventions targeting low SES populations are needed to reduce the inequality and accelerate progress against cancer.
Collapse
Affiliation(s)
- Jiemin Ma
- Surveillance & Health Services Research Program, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Surveillance & Health Services Research Program, American Cancer Society, Atlanta, GA
| |
Collapse
|
205
|
DeSantis CE, Ma J, Gaudet MM, Newman LA, Miller KD, Goding Sauer A, Jemal A, Siegel RL. Breast cancer statistics, 2019. CA Cancer J Clin 2019; 69:438-451. [PMID: 31577379 DOI: 10.3322/caac.21583] [Citation(s) in RCA: 1726] [Impact Index Per Article: 345.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 12/16/2022] Open
Abstract
This article is the American Cancer Society's biennial update on female breast cancer statistics in the United States, including data on incidence, mortality, survival, and screening. Over the most recent 5-year period (2012-2016), the breast cancer incidence rate increased slightly by 0.3% per year, largely because of rising rates of local stage and hormone receptor-positive disease. In contrast, the breast cancer death rate continues to decline, dropping 40% from 1989 to 2017 and translating to 375,900 breast cancer deaths averted. Notably, the pace of the decline has slowed from an annual decrease of 1.9% during 1998 through 2011 to 1.3% during 2011 through 2017, largely driven by the trend in white women. Consequently, the black-white disparity in breast cancer mortality has remained stable since 2011 after widening over the past 3 decades. Nevertheless, the death rate remains 40% higher in blacks (28.4 vs 20.3 deaths per 100,000) despite a lower incidence rate (126.7 vs 130.8); this disparity is magnified among black women aged <50 years, who have a death rate double that of whites. In the most recent 5-year period (2013-2017), the death rate declined in Hispanics (2.1% per year), blacks (1.5%), whites (1.0%), and Asians/Pacific Islanders (0.8%) but was stable in American Indians/Alaska Natives. However, by state, breast cancer mortality rates are no longer declining in Nebraska overall; in Colorado and Wisconsin in black women; and in Nebraska, Texas, and Virginia in white women. Breast cancer was the leading cause of cancer death in women (surpassing lung cancer) in four Southern and two Midwestern states among blacks and in Utah among whites during 2016-2017. Declines in breast cancer mortality could be accelerated by expanding access to high-quality prevention, early detection, and treatment services to all women.
Collapse
Affiliation(s)
- Carol E DeSantis
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Jiemin Ma
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Mia M Gaudet
- Behavioral and Epidemiology Research, American Cancer Society, Atlanta, Georgia
| | - Lisa A Newman
- Department of Surgery, Weill Cornell Medical Center, New York, New York
| | - Kimberly D Miller
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ann Goding Sauer
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| |
Collapse
|
206
|
Zheng Z, Jemal A, Banegas MP, Han X, Yabroff KR. High-Deductible Health Plans and Cancer Survivorship: What Is the Association With Access to Care and Hospital Emergency Department Use? J Oncol Pract 2019; 15:e957-e968. [DOI: 10.1200/jop.18.00699] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: To examine the associations among high-deductible health plan (HDHP) enrollment, cancer survivorship, and access to care and utilization. MATERIALS AND METHODS: The 2010 to 2017 National Health Interview Survey was used to identify privately insured adults ages 18 to 64 years (cancer survivors, n = 4,321; individuals without a cancer history, n = 95,316). We used multivariable logistic regressions to evaluate the associations among HDHP/health savings account (HSA) status, delayed/forgone care for financial reasons, and hospital emergency department (ED) visits among cancer survivors compared with individuals without a cancer history. RESULTS: Among cancer survivors, HDHPs with or without HSA (8.9% and 13.9%, respectively; both P < .05) were associated with more delayed/forgone care compared with low-deductible health plans (LDHPs) (7.9%). HSA enrollment was associated with less delayed/forgone care among HDHP cancer survivors ( P < .05). ED visits were similar by insurance type. Among individuals without a cancer history, HDHP with or without HSA (9.5% and 10.8%, respectively; both P < .05) were both associated with more delayed/forgone care compared with LDHPs (5.9%). HSA enrollment also was associated with less delayed/forgone care among HDHP enrollees without a cancer history. A small difference in ED visits was observed between HDHPs without HSA (15.3%) and LDHPs (14.1%; P < .05) or HDHPs with HSA (13.4%; P < .05) among individuals without a cancer history. CONCLUSION: HDHP enrollment and HSA status affect access to care and hospital ED visits similarly by cancer history. HDHP enrollment may serve as a barrier to access to care among cancer survivors, although HSA enrollment coupled with an HDHP may mitigate the impact on access. HDHPs and HSA status were not associated with ED visits among cancer survivors. Improvement to care coordination efforts may be needed to reduce ED visits among privately insured cancer survivors.
Collapse
Affiliation(s)
- Zhiyuan Zheng
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA
| | | | - Xuesong Han
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA
| | - K. Robin Yabroff
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA
| |
Collapse
|
207
|
Fedewa SA, Anderson JC, Robinson CM, Weiss JE, Smith RA, Siegel RL, Jemal A, Butterly LF. Prevalence of 'one and done' in adenoma detection rates: results from the New Hampshire Colonoscopy Registry. Endosc Int Open 2019; 7:E1344-E1354. [PMID: 31673604 PMCID: PMC6805237 DOI: 10.1055/a-0895-5410] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 02/25/2019] [Indexed: 02/06/2023] Open
Abstract
Background and study aims Adenoma detection rate (ADR), the proportion of an endoscopist's screening colonoscopies in which at least one adenoma is found, is an established quality metric. Several publications have suggested that a technique referred to as "one and done," where less attention is paid to additional polyp detection following discovery of one likely adenoma, may be occurring 1 2 3 . To investigate whether this practice occurs and provide additional context to the significance of ADR, we examined ADR by single and multiple adenomas in the statewide New Hampshire Colonoscopy Registry (NHCR). Patients and methods A total of 25,324 NHCR patients receiving screening colonoscopies between 2009 and 2014 by 69 endoscopists were analyzed. ADR was dichotomized into high (≥ 20 %) and low (< 20 %) based on 2006 recommended targets in place during the time of the study. ADR-plus (the average number of adenomas in colonoscopies with > 1 adenoma) was dichotomized at mean values into high (≥ 1.5) and low (< 1.5). As suggested by others, a high ADR but low ADR-plus was used to indicate the "one and done" approach. Results Among endoscopists with an ADR ≥ 20 %, only 5 (7.2 %) had low ADR-plus values and were classified as "one and done." Results for serrated polyp detection were similar. ADR and ADR-plus decreased monotonically with increasing years since residency ( P values for trend ADR = 0.02; ADR-plus = 0.003) after adjusting for patient risk factors. Conclusion "One and done" infrequently occurred among endoscopists with high ADR in a large statewide registry. The need to replace ADR with other polyp detection metrics (such as ADR-plus) to accurately ascertain performance quality is not supported by these findings.
Collapse
Affiliation(s)
- Stacey A. Fedewa
- Department of Intramural Research, American Cancer Society, Atlanta, Georgia, United States,Corresponding author Stacey Fedewa 250 Williams StreetAtlanta, GA 30303(404) 321-4669
| | - Joseph C. Anderson
- Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States,Department of Veterans Affairs Medical Center, White River Junction, Vermont, United States
| | - Christina M. Robinson
- Section of Gastroenterology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, United States
| | - Julie E. Weiss
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States
| | - Robert A. Smith
- Department of Cancer Control, American Cancer Society, Atlanta, Georgia, United States
| | - Rebecca L. Siegel
- Department of Intramural Research, American Cancer Society, Atlanta, Georgia, United States
| | - Ahmedin Jemal
- Department of Intramural Research, American Cancer Society, Atlanta, Georgia, United States
| | - Lynn F. Butterly
- Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States,Section of Gastroenterology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, United States
| |
Collapse
|
208
|
DeSantis CE, Miller KD, Dale W, Mohile SG, Cohen HJ, Leach CR, Goding Sauer A, Jemal A, Siegel RL. Cancer statistics for adults aged 85 years and older, 2019. CA Cancer J Clin 2019; 69:452-467. [PMID: 31390062 DOI: 10.3322/caac.21577] [Citation(s) in RCA: 182] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Adults aged 85 years and older, the "oldest old," are the fastest-growing age group in the United States, yet relatively little is known about their cancer burden. Combining data from the National Cancer Institute, the North American Association of Central Cancer Registries, and the National Center for Health Statistics, the authors provide comprehensive information on cancer occurrence in adults aged 85 years and older. In 2019, there will be approximately 140,690 cancer cases diagnosed and 103,250 cancer deaths among the oldest old in the United States. The most common cancers in these individuals (lung, breast, prostate, and colorectum) are the same as those in the general population. Overall cancer incidence rates peaked in the oldest men and women around 1990 and have subsequently declined, with the pace accelerating during the past decade. These trends largely reflect declines in cancers of the prostate and colorectum and, more recently, cancers of the lung among men and the breast among women. We note differences in trends for some cancers in the oldest age group (eg, lung cancer and melanoma) compared with adults aged 65 to 84 years, which reflect elevated risks in the oldest generations. In addition, cancers in the oldest old are often more advanced at diagnosis. For example, breast and colorectal cancers diagnosed in patients aged 85 years and older are about 10% less likely to be diagnosed at a local stage compared with those diagnosed in patients aged 65 to 84 years. Patients with cancer who are aged 85 years and older have the lowest relative survival of any age group, with the largest disparities noted when cancer is diagnosed at advanced stages. They are also less likely to receive surgical treatment for their cancers; only 65% of breast cancer patients aged 85 years and older received surgery compared with 89% of those aged 65 to 84 years. This difference may reflect the complexities of treating older patients, including the presence of multiple comorbidities, functional declines, and cognitive impairment, as well as competing mortality risks and undertreatment. More research on cancer in the oldest Americans is needed to improve outcomes and anticipate the complex health care needs of this rapidly growing population.
Collapse
Affiliation(s)
- Carol E DeSantis
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Kimberly D Miller
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - William Dale
- Department of Supportive Care Medicine, Center for Cancer and Aging, City of Hope National Medical Center, Duarte, California
| | - Supriya G Mohile
- Wilmot Cancer Center, Geriatric Oncology Research Program, University of Rochester Medical Center, Rochester, New York
| | - Harvey J Cohen
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina
| | - Corinne R Leach
- Behavioral and Epidemiology Research, American Cancer Society, Atlanta, Georgia
| | - Ann Goding Sauer
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| |
Collapse
|
209
|
Rai A, Han X, Zheng Z, Yabroff KR, Jemal A. Determinants and Outcomes of Satisfaction With Healthcare Provider Communication Among Cancer Survivors. J Natl Compr Canc Netw 2019; 16:975-984. [PMID: 30099374 DOI: 10.6004/jnccn.2018.7034] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 04/11/2018] [Indexed: 11/17/2022]
Abstract
Background: Despite the surge of interest in improving provider communication, empirical research is sparse on the determinants and outcomes of cancer survivors' satisfaction with healthcare provider communication. Methods: Longitudinal Medical Expenditure Panel Survey data spanning 2008 through 2014 was used to identify 4,588 respondents who were ever diagnosed with cancer. A composite score was generated by combining 5 measures of satisfaction. We used multivariate logistic regressions and 2-part models to examine the associations between satisfaction ratings and outcomes, including general, mental, and physical health; office visits; and total healthcare, drug, and out-of-pocket expenditures. Results: The study sample comprised 2,257 nonelderly (age 18-64 years) and 2,331 elderly (age ≥65 years) respondents. Among both age groups, higher satisfaction was associated with fewer comorbidities, fewer year 1 office visits, and absence of year 1 emergency department visits. Membership of higher satisfaction tertile in year 1 was associated with better year 2 mental health (tertile 1 [T1]: predictive margin [PM], 27.1%; tertile 2 [T2]: PM, 35.5%; P=.013; tertile 3 [T3]: PM, 37.0%; P=.005) and general health (T1 [ref]: PM, 30.3%; T3: PM, 38.9%; P=.007) among the elderly. Greater satisfaction was associated with fewer year 2 office visits (T1 [ref]: PM, 7.42 visits; T3: PM, 6.26 visits; P=.038) among the nonelderly; and lower year 2 healthcare expenditures (T1 [ref]: PM, $34,071; T3: PM, $26,995; P=.049) among the elderly. Conclusions: We identified potential differences in cancer survivors' needs and expectations of provider communication based on comorbidities and baseline service use. These results emphasize the need for individualized communication strategies for patients with cancer and survivors shaped by their distinct requirements. Our findings of better health, lower service use, and lower expenditures among more satisfied cancer survivors suggest that interventions to improve provider communication could lead to a more efficient use of healthcare resources.
Collapse
|
210
|
Fedewa SA, Jemal A, Flanders WD. Self-reported receipt of colonoscopy in national surveys: is it over- or under-reported? Ann Epidemiol 2019; 40:35-36.e1. [PMID: 31732229 DOI: 10.1016/j.annepidem.2019.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/10/2019] [Accepted: 10/14/2019] [Indexed: 01/16/2023]
Affiliation(s)
- Stacey A Fedewa
- Department of Intramural Research, American Cancer Society, Atlanta, GA.
| | - Ahmedin Jemal
- Department of Intramural Research, American Cancer Society, Atlanta, GA
| | - W Dana Flanders
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| |
Collapse
|
211
|
Han X, Yabroff KR, Ward E, Brawley OW, Jemal A. Comparison of Insurance Status and Diagnosis Stage Among Patients With Newly Diagnosed Cancer Before vs After Implementation of the Patient Protection and Affordable Care Act. JAMA Oncol 2019; 4:1713-1720. [PMID: 30422152 DOI: 10.1001/jamaoncol.2018.3467] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Having health insurance is a strong determinant of cancer outcomes in the United States, and Medicaid expansion under the Patient Protection and Affordable Care Act (ACA) may have reduced the prevalence of uninsured patients. Prior research has only assessed the aggregate effects of expansions, and little is known about changes in uninsured patients by state and key sociodemographic groups, including sex, race/ethnicity, census tract-level poverty, and rurality. Objective To examine changes in the percentage of uninsured patients and stage at diagnosis among nonelderly patients with cancer by state and key sociodemographic groups after implementation of the ACA. Design, Setting, and Participants This study used difference-in-differences analysis to determine the percentage of uninsured patients and early-stage cancer diagnoses among patients aged 18 to 64 years from the population-based cancer registries of 40 states before (January 1, 2010, to December 31, 2013) and after (January 1, 2014, to December 31, 2014) the ACA Medicaid expansion. Data analysis was performed from November 2017 to April 2018. Main Outcomes and Measures Changes in the percentage of uninsured patients and early-stage diagnoses. Results A total of 2 471 154 patients (mean age, 52.7 years; age range, 18-64 years; 51.4% female; 70.9% non-Hispanic white) were included from Medicaid expansion (n = 1 234 156) and nonexpansion (n = 1 236 998) states. In 2014, the percentage of uninsured patients decreased in almost all states. However, decreases were greater in expansion than nonexpansion states and were greatest in expansion states with high baseline uninsured rates. For example, the percentage of uninsured patients decreased from 8.3% before implementation of the ACA to 2.1% (-6.2 difference) after implementation of the ACA in the expansion state of Kentucky compared with 9.1% to 7.5% (-1.5 difference) in the nonexpansion state of Tennessee. In expansion states, the decreases in the percentage of uninsured patients were higher among minorities and patients in high-poverty or rural areas, diminishing or eliminating disparities. In contrast, sociodemographic disparities in the percentage of uninsured patients remained high in nonexpansion states. Stage at diagnosis shifted slightly to earlier stage for most cancer types in Medicaid expansion states. Conclusions and Relevance This study found state variation in reductions in the percentage of uninsured patients among nonelderly patients with cancer after implementation of the ACA, with larger decreases in expansion than nonexpansion states. Disparities in the percentage of uninsured patients by race/ethnicity, census tract-level poverty, and rurality were diminished or eliminated in Medicaid expansion states but remained high in nonexpansion states, highlighting the promising role of Medicaid expansion in reducing disparities among sociodemographic subpopulations. Future studies should monitor changes in cancer presentation, treatment, and outcomes after implementation of the ACA.
Collapse
Affiliation(s)
- Xuesong Han
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - K Robin Yabroff
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Elizabeth Ward
- Intramural Research Department, American Cancer Society, Atlanta, Georgia
| | - Otis W Brawley
- Office of the Chief Medical Officer, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| |
Collapse
|
212
|
Memirie ST, Habtemariam MK, Asefa M, Deressa BT, Abayneh G, Tsegaye B, Abraha MW, Ababi G, Jemal A, Rebbeck TR, Verguet S. Estimates of Cancer Incidence in Ethiopia in 2015 Using Population-Based Registry Data. J Glob Oncol 2019; 4:1-11. [PMID: 30241262 PMCID: PMC6223441 DOI: 10.1200/jgo.17.00175] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose Noncommunicable diseases, prominently cancer, have become the second leading cause of death in the adult population of Ethiopia. A population-based cancer registry has been used in Addis Ababa (the capital city) since 2011. Availability of up-to-date estimates on cancer incidence is important in guiding the national cancer control program in Ethiopia. Methods We obtained primary data on 8,539 patients from the Addis Ababa population-based cancer registry and supplemented by data on 1,648 cancer cases collected from six Ethiopian regions. We estimated the number of the commonest forms of cancer diagnosed among males and females in Ethiopia and computed crude and age-standardized incidence rates. Results For 2015 in Ethiopia, we estimated that 21,563 (95% CI, 17,416 to 25,660) and 42,722 (95% CI, 37,412 to 48,040) incident cancer cases were diagnosed in males and females, respectively. The most common adult cancers were: cancers of the breast and cervix, colorectal cancer, non-Hodgkin lymphoma, leukemia, and cancers of the prostate, thyroid, lung, stomach, and liver. Leukemia was the leading cancer diagnosis in the pediatric age group (age 0 to 14 years). Breast cancer was by far the commonest cancer, constituting 33% of the cancers in women and 23% of all cancers identified from the Addis Ababa cancer registry. It was also the commonest cancer in four of the six Ethiopian regions included in the analysis. Colorectal cancer and non-Hodgkin lymphoma were the commonest malignancies in men. Conclusion Cancer, and more prominently breast cancer, poses a substantial public health threat in Ethiopia. The fight against cancer calls for expansion of population-based registry sites to improve quantifying the cancer burden in Ethiopia and requires both increased investment and application of existing cancer control knowledge across all segments of the Ethiopian population.
Collapse
Affiliation(s)
- Solomon Tessema Memirie
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Mahlet Kifle Habtemariam
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Mathewos Asefa
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Biniyam Tefera Deressa
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Getamesay Abayneh
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Biniam Tsegaye
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Mihiret Woldetinsae Abraha
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Girma Ababi
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Timothy R Rebbeck
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Stéphane Verguet
- Solomon Tessema Memirie, Timothy R. Rebbeck, and Stéphane Verguet, Harvard T.H. Chan School of Public Health; Timothy R. Rebbeck, Dana-Farber Cancer Institute, Boston, MA; Mahlet Kifle Habtemariam, Federal Ministry of Health; Mathewos Asefa, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa; Biniyam Tefera Deressa, Gondar University, Gondar; Getamesay Abayneh, Haromaya University, Dire Dawa; Biniam Tsegaye, Ayder Comprehensive Specialized Hospital, Mekele University, Mekele; Mihiret Woldetinsae Abraha, Harar General Hospital, Harar; Girma Ababi, Hawassa University, Hawassa, Ethiopia; and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| |
Collapse
|
213
|
Zheng Z, Han X, Banegas MP, Zhao J, Rai A, Tucker-Seeley R, Jemal A, Yabroff KR. Employer provided health benefits among cancer survivors in the United States. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.27_suppl.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
155 Background: Nearly 40% of cancer survivors are of working age in the U.S. Access to high quality diagnosis, treatment, and survivorship care requires both health insurance coverage and sick leave, key components of employer health benefits. This study examines work limitations, paid sick leave, and employer offered health insurance among cancer survivors. Methods: We used the National Health Interview Survey (2001-2017) to identify cancer survivors aged 18-64 years. Work limitations were asked among all cancer survivors regardless of work status (n = 15,247), and categorized into unable to work, limited in type/amount of work, and not limited at all. Paid sick leave and employer offered health insurance offered were asked of cancer survivors who were working in the last week (n = 8741). We used generalized ordinal logistic regressions to examine work limitation and employer health benefits among cancer survivors, controlling for demographic characteristics, time since cancer diagnosis, number of cancer diagnoses, income, and comorbidities. Stratified analyses by type of workplace (private sector, federal/state/local government, and self-employed), and hours worked per week (full time with 35+ hours per week vs part time < 35 hours per week) was conducted. Results: Among cancer survivors aged 18-64 years, 10.7% and 5.3% reported unable to work at all and limited in types/amounts of work, respectively; 57.7% and 67.6% of those working in the last week received paid sick leave and employer offered health insurance, respectively. In stratified analyses, government jobs were associated with the highest paid sick leave and employer insurance (85.7% and 85.6%, respectively), followed by private sector (58.3% and 70.7%, respectively), and self-employed (8.3% and 15.7%), respectively. Moreover, full time jobs had higher paid sick leave (65.2% and 21.9%, respectively) and employer insurance (75.7% and 29.1%, respectively) then part time jobs. Conclusions: Cancer survivors experience work limitations and many working cancer survivors do not receive paid sick leave or health insurance from their employers. Evaluation of the effects of employer-based health benefits on survivorship care and outcomes will be important for future research.
Collapse
|
214
|
Zhao J, Han X, Nogueira LM, Jemal A, Yabroff KR. The association between health insurance coverage disruptions and access to care and affordability among cancer survivors in the United States. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.27_suppl.121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
121 Background: Having health insurance is a strong predictor of access to care and affordability. To date, most studies evaluating the effects of insurance coverage measured it only at a single time point. Little is known about the effects of coverage disruptions. This study aims to assess associations of a health insurance coverage disruption with access and affordability among cancer survivors in the United States. Methods: We identified 6476 cancer survivors aged 18-64 years with current health insurance coverage from the 2011-2017 National Health Interview Survey. Coverage disruption was measured by the question “In the past 12 months, was there any time when you did not have any health insurance or coverage?”. Access to care and affordability was measured by: 1) preventive services use (e.g. blood pressure check); and 2) forgoing care because of cost, respectively, in the past 12 months. We used separate multivariable logistic models to evaluate the associations between a coverage disruption and healthcare access and affordability, by current health insurance coverage. Results: Among survivors with current health insurance coverage, 3.7% of those with private and 8.1% with public insurance reported a coverage disruption in the past 12 months. Among survivors with current private coverage, those with a recent coverage disruption reported lower likelihood of any preventive services use (OR = 0.1, 95% CI: 0.1-0.3) and higher likelihood of forgoing any care because of cost (OR = 6.0, 95% CI: 3.9-9.5) compared to those with continuous private coverage. Among survivors with current public coverage, those with a recent coverage disruption reported lower likelihood of any preventive services use (OR = 0.4, 95% CI: 0.2-0.9) and higher likelihood of forgoing any care because of cost (OR = 4.3, 95% CI: 2.5-7.3) compared to those with continuous public coverage. Conclusions: Currently insured cancer survivors with a recent health insurance coverage disruption were more likely to report problems in access to care and affordability compared to the continuously insured. Improving private and public insurance coverage continuity may be effective in addressing these problems.
Collapse
|
215
|
Han X, Zhao J, Ma J, Yabroff KR, Jemal A. Cancer-related suicide in the United States, 1999-2015. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.27_suppl.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
148 Background: Cancer patients have an elevated risk of suicide given the prevalent psychological distress, treatment side effects, and uncontrolled pain. This study aims to examine temporal trends in cancer-related suicide in the US during the past two decades in view of progress in psycho-oncology care and symptom control for cancer patients in the country. Methods: Cancer-related suicide was defined as deaths with suicide as the underlying cause and cancer as a contributing cause in the US Multiple Cause of Death Data. We first calculated annual age-standardized cancer-related suicide rates and overall suicide rates from 1999 to 2015. Then, we fitted the log-transformed age-standardized rates to Joinpoint regression models to calculate the annual percentage change (APC) by demographic factors and overall. Results: Among 599,786 suicides in the US from 1999 to 2015, 5,559 were cancer-related. Seventy-three percent of the cancer-related suicides were committed by firearm and 14% were by poisoning. The age-standardized cancer-related suicide rate per 100,000 persons decreased from 0.17 in 1999 to 0.12 in 2015, with an APC of -2.5% (95% CI: -3.3%, -1.7%). In contrast, the age-standardized overall suicide rate per 10,000 persons increased from 13.22 in 1999 to 16.73 in 2015, with APC of 0.9% (95% CI: 0.4%, 1.3%) from 1999 to 2006 and 2.0% (95% CI: 1.7%, 2.2%) from 2006 to 2015. The decline in cancer-related suicide rate was largest among male (APC = -3.1%, 95% CI: -3.9%, -2.3%), 65-74-year-olds (APC = -3.1%, 95% CI: -4.2%, -2.0%), in the South (APC = -4.0%, 95% CI: -5.8%, -2.3%), and in urban area (APC = -3.0%, 95% CI: -4.2%, -1.7%). Conclusions: Despite the continuous increasing overall suicide rates in the US during the past two decades, cancer-related suicide has been decreasing, suggesting an evolving role of psycho-oncology care and symptom control during this period. Well-designed prospective studies are warranted to identify cancer patients at high-risk of suicide and to develop effective care intervention.
Collapse
Affiliation(s)
| | | | - Jiemin Ma
- American Cancer Society, Atlanta, GA
| | | | | |
Collapse
|
216
|
Zheng Z, Tucker-Seeley R, Han X, Zhao J, Banegas MP, Rai A, Jemal A, Yabroff KR. Financial hardship associated health care utilization among cancer survivors in the United States. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.27_suppl.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
133 Background: A cancer diagnosis is associated with medical financial hardship in the U.S. However, little is known about health consequences associated with financial hardship. This study examines associations between medical and non-medical financial hardship on healthcare utilization among cancer survivors. Methods: We used the National Health Interview Survey (2013-2017) to identify cancer survivors (18-64 years: n = 5200; 65+ years: n = 7326). Medical financial hardship included material (e.g., problems paying medical bills), psychological (e.g., worry about medical bills), and behavioral (e.g., forgoing care due to cost) domains, and non-medical financial hardship included food hardship and worry for other financial needs (e.g. retirement, monthly bills, standard of living, and housing costs). We compared cancer survivors by intensities of medical and non-medical financial hardships in: 1) emergency department (ED) visits; 2) preventive services use (receipt of influenza vaccine, and blood pressure/cholesterol screenings); and 3) cervical/breast/colorectal cancer screenings among eligible cancer survivors. We used generalized ordinal logistic regressions, controlling for demographic characteristics, time since diagnosis, number of cancer diagnoses, insurance, income, and comorbidities. Results: Across age groups, both higher medical and non-medical hardship intensities were associated with higher ED visits and lower use of preventive services. Compared to cancer survivors with lowest intensity, higher percentages of ED visits were observed among those with highest medical hardship intensity (ages 18-64: 42% vs 26.2%; ages 65+: 37.2% vs 27.9%, all p < .01) and highest non-medical hardship intensity (ages 18-64: 37.6% vs 24.3%, p = .01). Moreover, compared to lowest intensity, highest medical hardship intensity was associated with lower influenza vaccination (ages 18-64: 45.6% vs 52.5%; ages 65+: 64.6% vs 75.6%, p < .05) and breast cancer screening (54.4% vs 65.9%, p < .05). Conclusions: Cancer survivors with higher medical and non-medical financial hardships have more ED visits and medical financial hardship was also associated with less use of preventive services and some cancer screening.
Collapse
|
217
|
Islami F, Miller KD, Siegel RL, Zheng Z, Zhao J, Han X, Ma J, Jemal A, Yabroff KR. National and State Estimates of Lost Earnings From Cancer Deaths in the United States. JAMA Oncol 2019; 5:e191460. [PMID: 31268465 DOI: 10.1001/jamaoncol.2019.1460] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Information on the economic burden of cancer mortality can serve as a tool in setting policies and prioritizing resources for cancer prevention and control. However, contemporary data are lacking for the United States nationally and by state. Objective To estimate lost earnings due to death from cancer overall and for the major cancers in the United States nationally and by state. Design, Setting, and Participants Person-years of life lost (PYLL) were calculated using numbers of cancer deaths and life expectancy data in individuals aged 16 to 84 years who died from cancer in the United States in 2015. The annual median earnings in the United States were used to assign a monetary value for each PYLL by age and sex. Cancer mortality and life expectancy data were obtained from the National Center for Health Statistics and annual median earnings from the US Census Bureau's 2016 Current Population Survey's March Annual Social and Economic Supplement. Data analysis was performed from October 22, 2018, to February 25, 2019. Main Outcomes and Measures Lost earnings due to cancer death, represented as estimated future wages in the absence of premature death. Results A total of 8 739 939 person-years of life were lost to cancer death in persons aged 16 to 84 years in the United States in 2015, translating to lost earnings of $94.4 billion (95% CI, $91.7 billion-$97.3 billion). For individual cancer sites, lost earnings were highest for lung cancer ($21.3 billion), followed by colorectal ($9.4 billion), female breast ($6.2 billion), and pancreatic ($6.1 billion) cancer. Age-standardized lost earning rates per 100 000 were lowest in the West and highest in the South, ranging from $19.6 million (95% CI, $19.1 million-$20.2 million) in Utah to $35.3 million ($34.4 million-$36.3 million) in Kentucky. Approximately 2.4 million PYLL and $27.7 billion (95% CI, $26.9 billion-$28.5 billion) in lost earnings (29.3% of total that occurred in 2015) would have been avoided in 2015 if all states had the same age-specific PYLL or lost earning rates as Utah. Conclusions and Relevance Our findings indicate large state variation in the economic burden of cancer and suggest the potential for substantial financial benefit through delivery of effective cancer prevention, screening, and treatment to minimize premature cancer mortality in all states.
Collapse
Affiliation(s)
- Farhad Islami
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Kimberly D Miller
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Zhiyuan Zheng
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Jingxuan Zhao
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Xuesong Han
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Jiemin Ma
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - K Robin Yabroff
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| |
Collapse
|
218
|
Ma J, Jemal A, Fedewa SA, Islami F, Lichtenfeld JL, Wender RC, Cullen KJ, Brawley OW. The American Cancer Society 2035 challenge goal on cancer mortality reduction. CA Cancer J Clin 2019; 69:351-362. [PMID: 31066919 DOI: 10.3322/caac.21564] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
A summary evaluation of the 2015 American Cancer Society (ACS) challenge goal showed that overall US mortality from all cancers combined declined 26% over the period from 1990 to 2015. Recent research suggests that US cancer mortality can still be lowered considerably by applying known interventions broadly and equitably. The ACS Board of Directors, therefore, commissioned ACS researchers to determine challenge goals for reductions in cancer mortality by 2035. A statistical model was used to estimate the average annual percent decline in overall cancer death rates among the US general population and among college-educated Americans during the most recent period. Then, the average annual percent decline in the overall cancer death rates of college graduates was applied to the death rates in the general population to project future rates in the United States beginning in 2020. If overall cancer death rates from 2020 through 2035 nationally decline at the pace of those of college graduates, then death rates in 2035 in the United States will drop by 38.3% from the 2015 level and by 54.4% from the 1990 level. On the basis of these results, the ACS 2035 challenge goal was set as a 40% reduction from the 2015 level. Achieving this goal could lead to approximately 1.3 million fewer cancer deaths than would have occurred from 2020 through 2035 and 122,500 fewer cancer deaths in 2035 alone. The results also show that reducing the prevalence of risk factors and achieving optimal adherence to evidence-based screening guidelines by 2025 could lead to a 33.5% reduction in the overall cancer death rate by 2035, attaining 85% of the challenge goal.
Collapse
Affiliation(s)
- Jiemin Ma
- Senior Principal Scientist, Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Scientific Vice President, Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA
| | - Stacey A Fedewa
- Senior Principal Scientist, Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA
| | - Farhad Islami
- Scientific Director, Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA
| | | | - Richard C Wender
- Chief Cancer Control Officer, American Cancer Society, Atlanta, GA
| | - Kevin J Cullen
- Director, University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD
| | - Otis W Brawley
- Chief Medical Officer (Former), American Cancer Society, Atlanta, GA
| |
Collapse
|
219
|
Abstract
The number of cancer survivors continues to increase in the United States because of the growth and aging of the population as well as advances in early detection and treatment. To assist the public health community in better serving these individuals, the American Cancer Society and the National Cancer Institute collaborate every 3 years to estimate cancer prevalence in the United States using incidence and survival data from the Surveillance, Epidemiology, and End Results cancer registries; vital statistics from the Centers for Disease Control and Prevention's National Center for Health Statistics; and population projections from the US Census Bureau. Current treatment patterns based on information in the National Cancer Data Base are presented for the most prevalent cancer types. Cancer-related and treatment-related short-term, long-term, and late health effects are also briefly described. More than 16.9 million Americans (8.1 million males and 8.8 million females) with a history of cancer were alive on January 1, 2019; this number is projected to reach more than 22.1 million by January 1, 2030 based on the growth and aging of the population alone. The 3 most prevalent cancers in 2019 are prostate (3,650,030), colon and rectum (776,120), and melanoma of the skin (684,470) among males, and breast (3,861,520), uterine corpus (807,860), and colon and rectum (768,650) among females. More than one-half (56%) of survivors were diagnosed within the past 10 years, and almost two-thirds (64%) are aged 65 years or older. People with a history of cancer have unique medical and psychosocial needs that require proactive assessment and management by follow-up care providers. Although there are growing numbers of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based resources are needed to optimize care.
Collapse
Affiliation(s)
| | - Leticia Nogueira
- Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Angela B Mariotto
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | | | - K Robin Yabroff
- Health Services Research, American Cancer Society, Atlanta, Georgia
| | | | - Ahmedin Jemal
- Surveillance Research, American Cancer Society, Atlanta, Georgia
- Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Joan L Kramer
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance Research, American Cancer Society, Atlanta, Georgia
| |
Collapse
|
220
|
Coghill AE, Han X, Suneja G, Lin CC, Jemal A, Shiels MS. Advanced stage at diagnosis and elevated mortality among US patients with cancer infected with HIV in the National Cancer Data Base. Cancer 2019; 125:2868-2876. [PMID: 31050361 PMCID: PMC6663596 DOI: 10.1002/cncr.32158] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/14/2019] [Accepted: 03/18/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND People living with HIV (PLWH) are at an increased risk of developing several cancers, but to the authors' knowledge less is known regarding how HIV impacts the rate of progression to advanced cancer or death. METHODS The authors compared stage of disease at the time of presentation and mortality after diagnosis between 14,453 PLWH and 6,368,126 HIV-uninfected patients diagnosed with cancers of the oral cavity, stomach, colorectum, anus, liver, pancreas, lung, female breast, cervix, prostate, bladder, kidney, and thyroid and melanoma using data from the National Cancer Data Base (2004-2014). Polytomous logistic regression and Cox proportional hazards regression were used to evaluate the association between HIV, cancer stage, and stage-adjusted mortality after diagnosis, respectively. Regression models accounted for the type of health facility at which cancer treatment was administered and the type of individual health insurance. RESULTS HIV-infected patients with cancer were found to be more likely to be uninsured (HIV-infected: 5.0% vs HIV-uninfected: 3.3%; P < .0001) and were less likely to have private health insurance (25.4% vs 44.7%; P < .0001). Compared with those not infected with HIV, the odds of being diagnosed at an advanced stage of disease were significantly elevated in PLWH for melanoma and cancers of the oral cavity, liver, female breast, prostate, and thyroid (odds ratio for stage IV vs stage I range, 1.24-2.06). PLWH who were diagnosed with stage I to stage III disease experienced elevated mortality after diagnosis across 13 of the 14 cancer sites evaluated, with hazard ratios ranging from 1.20 (95% CI, 1.14-1.26) for lung cancer to 1.85 (95% CI, 1.68-2.04), 1.85 (95% CI, 1.51-2.27), and 2.93 (95% CI, 2.08-4.13), respectively, for cancers of the female breast, cervix, and thyroid. CONCLUSIONS PLWH were more likely to be diagnosed with advanced-stage cancers and to experience elevated mortality after a cancer diagnosis, even after accounting for health care-related factors.
Collapse
Affiliation(s)
- Anna E. Coghill
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda MD
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa FL
| | - Xuesong Han
- Surveillance and Health Services Research, American Cancer Society, Atlanta GA
| | - Gita Suneja
- Radiation Oncology, Duke University, Durham NC
| | - Chun Chieh Lin
- Surveillance and Health Services Research, American Cancer Society, Atlanta GA
- Health Services Research Program, University of Michigan, Ann Arbor MI
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta GA
| | - Meredith S. Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda MD
| |
Collapse
|
221
|
Leon ME, Kassa E, Bane A, Gemechu T, Tilahun Y, Endalafer N, McKay-Chopin S, Brancaccio RN, Ferro G, Assefa M, Ward E, Tommasino M, Aseffa A, Schüz J, Jemal A, Gheit T. Prevalence of human papillomavirus and Helicobacter pylori in esophageal and gastroesophageal junction cancer biopsies from a case-control study in Ethiopia. Infect Agent Cancer 2019; 14:19. [PMID: 31406502 PMCID: PMC6686489 DOI: 10.1186/s13027-019-0233-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/10/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Ethiopia lies in the high-risk corridor of esophageal squamous cell carcinoma in East Africa, where individuals with this malignancy often do not report established risk factors, suggesting unidentified etiologies. Here, we report the prevalence of mucosal human papillomavirus (HPV) and of Helicobacter pylori (H. pylori) detection in endoscopy-obtained esophageal and gastroesophageal junction biopsies and in oral cell specimens taken at the time of esophageal cancer diagnosis in a case-control study in Addis Ababa, Ethiopia. METHODS DNA extraction was performed from fresh frozen tissue and oral cell pellets obtained with saline solution gargling subsequently fixed with ethanol. Mucosal HPV and H. pylori DNA was detected using highly sensitive assays that combine multiplex polymerase chain reaction and bead-based Luminex technology. The proportions of specimens testing positive were expressed as percentages, with binomial 95% confidence intervals. Agreement of results between tissue biopsy and oral cell specimens was estimated using the kappa statistic. Comparison of study participants' characteristics by test results was done using the Pearson chi-square test. RESULTS HPV DNA was detected in 1 of 62 tumor specimens (2, 95% confidence interval (CI): 0-9%), corresponding to HPV16 type. HPV DNA was detected in the oral cavity of 7 cases (11, 95% CI: 5-22%) and 4 of 56 matched healthy controls (7, 95% CI: 2-17%), with multiple HPV types detected. Detection of H. pylori DNA was 55% (95% CI: 42-68%), and 20 of 34 H. pylori-positive specimens (59, 95% CI: 41-75%) were positive for the cagA gene. Agreement of detection rates between tissue and oral cells in cases was poor for HPV and for H. pylori. CONCLUSIONS The prevalence of mucosal-type HPV was very low, whereas H. pylori was more commonly detected, with a high proportion testing positive for the pro-inflammatory gene cagA. These novel findings remain to be replicated in larger studies and with the addition of serological determinations to better understand their biological significance in the context of esophageal and gastroesophageal junction cancers.
Collapse
Affiliation(s)
- Maria E. Leon
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69008 Lyon, France
| | - Endale Kassa
- Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abate Bane
- Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tufa Gemechu
- Pathology, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yared Tilahun
- Department of Internal Medicine, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Sandrine McKay-Chopin
- Section of Infections, International Agency for Research on Cancer (IARC), Lyon, France
| | - Rosario N. Brancaccio
- Section of Infections, International Agency for Research on Cancer (IARC), Lyon, France
| | - Gilles Ferro
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69008 Lyon, France
| | - Mathewos Assefa
- Department of Internal Medicine, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Elizabeth Ward
- Surveillance and Health Services Research, American Cancer Society (ACS), Atlanta, USA
| | - Massimo Tommasino
- Section of Infections, International Agency for Research on Cancer (IARC), Lyon, France
| | - Abraham Aseffa
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Joachim Schüz
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69008 Lyon, France
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society (ACS), Atlanta, USA
| | - Tarik Gheit
- Section of Infections, International Agency for Research on Cancer (IARC), Lyon, France
| |
Collapse
|
222
|
Nogueira LM, Yabroff KR, Siegel RL, Jemal A. Data challenges for evaluating new treatments. Cancer 2019; 125:2528-2531. [PMID: 31095739 DOI: 10.1002/cncr.32157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/20/2019] [Accepted: 03/23/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Leticia M Nogueira
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - K Robin Yabroff
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| |
Collapse
|
223
|
Abstract
Cancer awareness in the general population is an absolute essential and the basis on which a cancer-control programme can be constructed. Elements that go into cancer awareness and prevention efforts include knowledge of the problem and its solutions, a group of people who respect and care for the populations they want to serve, and resources. This paper discusses the importance of cancer awareness to cancer control and outlines some successful cancer awareness and control programmes in Africa. There is an audience in North America, Europe and Asia with resources that can be used. Awareness campaigns can also be used to recruit assistance and resources from governments, non-governmental organisations and pharmaceutical companies. Potential funders will provide support if they see a well-defined problem, a solution that is likely to be implemented and likely to work and organisations that can implement that solution.
Collapse
Affiliation(s)
- Ahmedin Jemal
- American Cancer Society, 250 Williams Street, Atlanta, GA 30303, USA
| | - Otis W Brawley
- Johns Hopkins University, 1550 Orleans Street, Suite 1M16, Baltimore, MD 21231, USA
| |
Collapse
|
224
|
Gizaw M, Teka B, Ruddies F, Abebe T, Kaufmann AM, Worku A, Wienke A, Jemal A, Addissie A, Kantelhardt EJ. Uptake of Cervical Cancer Screening in Ethiopia by Self-Sampling HPV DNA Compared to Visual Inspection with Acetic Acid: A Cluster Randomized Trial. Cancer Prev Res (Phila) 2019; 12:609-616. [PMID: 31337647 DOI: 10.1158/1940-6207.capr-19-0156] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 05/23/2019] [Accepted: 07/16/2019] [Indexed: 12/24/2022]
Abstract
In Ethiopia, the standard method of cervical cancer screening is using Visual Inspection with Acetic Acid (VIA). Self-collection-based human papillomavirus (HPV) testing is assumed to improve the uptake of screening, especially for hard to reach populations. We investigated whether HPV DNA testing with the self-collection of cervical samples would be associated with increased uptake and adherence to procedures at the population level compared with VIA within defined rural population in Ethiopia. A total of 22 clusters (comprising 2,356 women ages 30-49 years) were randomized in two arms. Following the community mobilization, women of the clusters were invited to go either to the local health post for a self-collection-based HPV DNA testing (arm A) or Butajira Hospital for VIA screening (arm B). In the HPV arm, of the 1,213 sensitized women, 1,020 (84.1%) accessed the health post for self-sampling compared with the VIA arm, where 575 of 1,143 (50.5%) visited the hospital for VIA (P < 0.0001). Of those women who attended the VIA and HPV arms, 40% and 65.4% adhered to all procedures expected after screening, respectively. Out of women positive for high risk HPV, 122 (85%) attended VIA as a follow-up test. The trial demonstrated significantly higher levels of population-based uptake and adherence for self-collection HPV testing. Women were more receptive for VIA after their HPV testing result was positive. Self-collection HPV testing can be done at the local health facility and may significantly improve the uptake of cervical cancer screening in Ethiopia.
Collapse
Affiliation(s)
- Muluken Gizaw
- Addis Ababa University, School of Public Health, Department of Preventive Medicine, Ethiopia.,Institute of Medical Epidemiology, Biometrics and Informatics Martin-Luther-University, Halle-Wittenberg, Germany
| | - Brhanu Teka
- Addis Ababa University, School of Medicine, Department of Microbiology, Immunology and Parasitology, Ethiopia
| | - Friederike Ruddies
- Institute of Medical Epidemiology, Biometrics and Informatics Martin-Luther-University, Halle-Wittenberg, Germany
| | - Tamrat Abebe
- Addis Ababa University, School of Medicine, Department of Microbiology, Immunology and Parasitology, Ethiopia
| | - Andreas M Kaufmann
- Department of Gynecology, Charité-Universitätmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Berlin and Berlin Institute of Health, Berlin, Germany
| | - Alemayehu Worku
- Addis Ababa University, School of Public Health, Department of Preventive Medicine, Ethiopia
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biometrics and Informatics Martin-Luther-University, Halle-Wittenberg, Germany
| | - Ahmedin Jemal
- Department of Intramural Research, American Cancer Society, Atlanta, Georgia
| | - Adamu Addissie
- Addis Ababa University, School of Public Health, Department of Preventive Medicine, Ethiopia
| | - Eva Johanna Kantelhardt
- Institute of Medical Epidemiology, Biometrics and Informatics Martin-Luther-University, Halle-Wittenberg, Germany. .,Department of Gynecology Martin-Luther-University, Halle-Wittenberg, Germany
| |
Collapse
|
225
|
Nogueira LM, Sahar L, Efstathiou JA, Jemal A, Yabroff KR. Association Between Declared Hurricane Disasters and Survival of Patients With Lung Cancer Undergoing Radiation Treatment. JAMA 2019; 322:269-271. [PMID: 31310288 PMCID: PMC6635902 DOI: 10.1001/jama.2019.7657] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This study uses National Cancer Database data to estimate associations between hurricane disaster declarations, which could disrupt electrical power, and survival of patients undergoing radiotherapy for nonoperative locally advanced non–small cell lung cancer between 2004 and 2014.
Collapse
Affiliation(s)
- Leticia M. Nogueira
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Liora Sahar
- Statistics and Evaluation Center, American Cancer Society, Atlanta, Georgia
| | | | - Ahmedin Jemal
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - K. Robin Yabroff
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| |
Collapse
|
226
|
Abstract
Objective In the United States, colorectal cancer incidence has increased in adults under age 55. Although debate remains about whether this rise is a result of increased detection because of more colonoscopy utilization, population-based trends in colonoscopy among this age group are unknown. We examined changes in colonoscopy rates, as well as colorectal cancer incidence, among adults aged 40–54, using nationally representative data. Methods Recent (past year) colonoscopy rates were computed among 53,175 respondents aged 40–54 in National Health Interview Survey data from 2000 through 2015 by five-year age group. Colorectal cancer incidence rates and incidence rate ratios were estimated from 18 population-based Surveillance Epidemiology and End Result registries during the same period. Results Among respondents aged 40–44, past-year colonoscopy rates were stable during 2000–2015, and ranged from 2.3% to 3.5% ( p-value for trend = 0.771). In contrast, colonoscopy rates increased from 2.5% in 2000 to 5.2% in 2015 among ages 45–49, and from 5.0% to 14.1% in ages 50–54 (test for trend p-values < 0.001). During 2000–2015, colorectal cancer incidence rates increased by 28% in people aged 40–44 (incidence rate ratio = 1.28, 95% CI 1.20, 2.37), 15% in those aged 45–49 (incidence rate ratio = 1.15, 95%CI 1.10, 1.21), and 17% in those aged 50–54 (incidence rate ratio = 1.17, 95%CI 1.13, 1.21), respectively. Conclusion Increases in colonoscopy rates were confined to ages 45–54, whereas colorectal cancer incidence rates rose in those aged 40–44, 45–49, and 50–54. Colonoscopy trends do not fully align with colorectal cancer incidence patterns.
Collapse
Affiliation(s)
- Stacey A Fedewa
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Rebecca L Siegel
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| |
Collapse
|
227
|
Freeman M, Jemal A. Abstract LB-171: Global variation in prostate cancer incidence and mortality rates, 1980-2013. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-lb-171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Context: Previous studies documented significant international variation in prostate cancer rates due to differences in detection practices, availability of treatment, and genetic factors.
Objective: To provide updated contemporary prostate cancer incidence and mortality patterns across five continents using the most recent cancer incidence data from the International Agency for Research on Cancer and mortality data from the World Health Organization (WHO).
Evidence acquisition: We present estimated age-standardized prostate cancer incidence and mortality rates by country and WHO regions for 2012 based on GLOBOCAN. We examined long-term (1980 onwards) trends in prostate cancer incidence and mortality rates for 38 countries with high quality population-based incidence and mortality data. Trends were expressed as annual percent change using Joinpoint model. We also examined short-term (most recent 5 years) trends in prostate cancer among 44 countries with available incidence data and 71 countries with available mortality data.
Evidence synthesis: The highest incidence rates during the most recent 5 years are found in Brazil, Lithuania, and Australia, whereas the lowest incidence rates are found in Asia (India, Thailand, and Bahrain). The highest mortality rates are found in the Caribbean (Barbados, Trinidad and Tobago, and Cuba), sub-Saharan Africa (South Africa), parts of former Soviet Union (Lithuania, Estonia, and Latvia), whereas the lowest rates are found in Asia (Thailand and Turkmenistan). Of the 44 countries with high quality incidence data, prostate cancer incidence rates during the most recent five data years increased in 4 countries (with Bulgaria showing the largest increase), decreased in 7 countries (with the biggest decrease in the United States), and stabilized in the remaining 31 countries. During the same time period, in contrast, among the 71 countries considered for the mortality trend, rates decreased in 14 countries, increased in 3 countries, and remained stable in 54 countries.
Conclusions: In 2012, prostate cancer was the most commonly diagnosed cancer among men in 96 countries and the leading cause of death in 51 countries. In the most recent 5 years of data examined, prostate cancer incidence and mortality rates are decreasing or stabilizing in most parts of the world. Future studies should monitor trends in mortality rates and late-stage disease to assess the impact of reduction in PSA testing in several countries.
Citation Format: MaryBeth Freeman, Ahmedin Jemal. Global variation in prostate cancer incidence and mortality rates, 1980-2013 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr LB-171.
Collapse
|
228
|
Zhao J, Zheng Z, Han X, Davidoff AJ, Banegas MP, Rai A, Jemal A, Yabroff KR. Cancer History, Health Insurance Coverage, and Cost-Related Medication Nonadherence and Medication Cost-Coping Strategies in the United States. Value Health 2019; 22:762-767. [PMID: 31277821 DOI: 10.1016/j.jval.2019.01.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 01/15/2019] [Accepted: 01/28/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To evaluate the relationship between cancer history and cost-related medication nonadherence (CRN) as well as cost-coping strategies, by health insurance coverage. METHODS We used the 2013 to 2016 National Health Interview Survey to identify adults aged 18 to 64 years with (n = 3599) and without (n = 56 909) a cancer history. Cost-related changes in medication use included (1) CRN, measured as skipping, taking less, or delaying medication because of cost, and (2) cost-coping strategies, measured as requesting lower cost medication or using alternative therapies to save money. Separate multivariable logistic regressions were used to calculate the adjusted odds ratios (AORs) of CRN and cost-coping strategies associated with cancer history, stratified by insurance. RESULTS Cancer survivors were more likely than adults without a cancer history to report CRN (AOR 1.26; 95% confidence interval [CI] 1.10-1.43) and cost-coping strategies (AOR 1.10; 95% CI 0.99-1.19). Among the privately insured, the difference in CRN by cancer history was the greatest among those enrolled in high-deductible health plans (HDHPs) without health savings accounts (HSAs) (AOR 1.78; 95% CI 1.30-2.44). Among adults with HDHP and HSA, cancer survivors were less likely to report cost-coping strategies (AOR 0.62; 95% CI 0.42-0.90). Regardless of cancer history, CRN and cost-coping strategies were the highest for those uninsured, enrolled in HDHP without HSA, and without prescription drug coverage under their health plan (all P<.001). CONCLUSIONS Cancer survivors are prone to CRN and more likely to use cost-coping strategies. Expanding options for health insurance coverage, use of HSAs for those with HDHP, and enhanced prescription drug coverage may effectively address CRN.
Collapse
Affiliation(s)
- Jingxuan Zhao
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, USA.
| | - Zhiyuan Zheng
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, USA
| | - Xuesong Han
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, USA
| | - Amy J Davidoff
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Matthew P Banegas
- The Center for Health Research, Kaiser Permanente, Portland, OR, USA
| | - Ashish Rai
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, USA
| | - Ahmedin Jemal
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, USA
| | - K Robin Yabroff
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, USA
| |
Collapse
|
229
|
Fedewa SA, Yabroff KR, Smith RA, Goding Sauer A, Han X, Jemal A. Changes in Breast and Colorectal Cancer Screening After Medicaid Expansion Under the Affordable Care Act. Am J Prev Med 2019; 57:3-12. [PMID: 31128952 DOI: 10.1016/j.amepre.2019.02.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Medicaid expansions following the Affordable Care Act have improved insurance coverage in low-income adults, but little is known about its impact on cancer screening. This study examined associations between Medicaid expansion timing and colorectal cancer (CRC) and breast cancer (BC) screening. METHODS Up-to-date and past 2-year CRC (n=95,400) and BC (women, n=43,279) screening prevalence were computed among low-income respondents aged 50-64 years in 2012, 2014, and 2016 Behavioral Risk Factor Surveillance System data. Respondents were grouped according to Medicaid expansion timing as: very early ([VE] six states expanding March 1, 2010-April 14, 2011), early (21 states expanding January 1, 2014-August 15, 2014), late (five states expanding January 1, 2015-July 1, 2016), and non-expansion states (19 states). Absolute adjusted difference-in-differences (aDDs) were computed in 2018-2019 (ref, non-expansion states). RESULTS Between 2012 and 2016, absolute up-to-date CRC screening increased by 8.8%, 2.9%, 2.4%, and 3.8% among low-income adults in VE, early, late, and non-expansion states, respectively. Past 2-year CRC screening increased by 8.0% in VE and 2.8% in non-expansion states, with an aDD of 4.9% (p=0.041). In 2012-2016, up-to-date BC screening increased by 5.1%, 4.9%, and 3.7% among low-income women in VE, early, and non-expansion states, respectively, but aDDs were not statistically significant. CONCLUSIONS Prevalence of CRC and BC screening among low-income adults rose in Medicaid expansion states, though increases were significantly higher than those in non-expansion states only for recent CRC screening in VE expansion states. Large-scale improvements in cancer screening may take several years following expansion in access to care.
Collapse
Affiliation(s)
- Stacey A Fedewa
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia.
| | - K Robin Yabroff
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Robert A Smith
- Cancer Control Sciences, American Cancer Society, Atlanta, Georgia
| | - Ann Goding Sauer
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Xuesong Han
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| |
Collapse
|
230
|
Sung H, DeSantis CE, Fedewa SA, Kantelhardt EJ, Jemal A. Breast cancer subtypes among Eastern‐African–born black women and other black women in the United States. Cancer 2019; 125:3401-3411. [DOI: 10.1002/cncr.32293] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Hyuna Sung
- Surveillance and Health Services Research American Cancer Society Atlanta Georgia
| | - Carol E. DeSantis
- Surveillance and Health Services Research American Cancer Society Atlanta Georgia
| | - Stacey A. Fedewa
- Surveillance and Health Services Research American Cancer Society Atlanta Georgia
| | - Eva J. Kantelhardt
- Department of Gynecology, Institute of Medical Epidemiology, Biometrics and Informatics Martin‐Luther University Halle Germany
| | - Ahmedin Jemal
- Surveillance and Health Services Research American Cancer Society Atlanta Georgia
| |
Collapse
|
231
|
Islami F, Fedewa SA, Jemal A. Trends in cervical cancer incidence rates by age, race/ethnicity, histological subtype, and stage at diagnosis in the United States. Prev Med 2019; 123:316-323. [PMID: 31002830 DOI: 10.1016/j.ypmed.2019.04.010] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/01/2019] [Accepted: 04/14/2019] [Indexed: 11/28/2022]
Abstract
Recent trends of cervical cancer incidence by histology and age in the United States (U.S.) have not been reported. We examined contemporary trends in cervical squamous cell carcinoma (SCC) and adenocarcinoma (AC) incidence rates in the U.S. by age group, race/ethnicity, and stage at diagnosis after accounting for hysterectomy. Incidence data (1999-2015) were obtained from the U.S. Cancer Statistics Incidence Analytic Database. Hysterectomy prevalence was estimated using National Health Interview Survey data (2000-2015). Overall SCC incidence rates continued to decrease in all racial/ethnic groups except among non-Hispanic whites in whom rates stabilized in the 2010s, largely driven by stable trends in ages <50 years and a slower pace of decrease in ages 50-59 years. After a stable trend between 1999 and 2002, AC incidence rates among non-Hispanic whites rose during 2002-2015 (1.3% per year), mostly due to increases in ages 40-49 (4.4% annually since 2004) and 50-59 years (5.5% annually since 2011). Overall AC incidence rates during 1999-2015 decreased in blacks and Hispanics but were stable in Asian/Pacific Islanders; in all these race/ethnicities, rates were generally stable in ages <50 years but decreasing in older ages. Rates of distant stage cervical SCC and AC among non-Hispanic whites increased in several age groups but were generally stable in non-whites. Increasing or stabilized incidence trends for AC and attenuation of earlier declines for SCC in several subpopulations underscore the importance of intensifying efforts to reverse the increasing trends and further reduce the burden of cervical cancer in the U.S.
Collapse
Affiliation(s)
- Farhad Islami
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, United States of America.
| | - Stacey A Fedewa
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, United States of America
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, United States of America
| |
Collapse
|
232
|
Sineshaw HM, Jemal A, Ng K, Osarogiagbon RU, Robin Yabroff K, Ruddy KJ, Freedman RA. Treatment Patterns Among De Novo Metastatic Cancer Patients Who Died Within 1 Month of Diagnosis. JNCI Cancer Spectr 2019; 3:pkz021. [PMID: 31119208 PMCID: PMC6521896 DOI: 10.1093/jncics/pkz021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/18/2018] [Accepted: 01/22/2019] [Indexed: 01/15/2023] Open
Abstract
Background Little is known about patterns of and factors associated with treatment for de novo metastatic cancer patients who die soon after diagnosis. In this study, we examine treatment patterns for patients newly diagnosed with metastatic lung, colorectal, breast, or pancreatic cancer who died within 1 month of diagnosis. Methods We identified 100 848 adult patients in the National Cancer Database with de novo metastatic lung, colorectal, breast, and pancreatic cancer, diagnosed between 2004 and 2014 and who died within 1 month. We performed descriptive and multivariable logistic regression analyses to examine receipt of surgery, chemotherapy, radiation, and hormonal therapy by cancer type, adjusting for sociodemographic and clinical variables. Results Treatment substantially varied by cancer type, over time, age, insurance, and facility type. Surgery ranged from 0.4% in pancreatic to 28.3% in colorectal cancer (CRC) patients, chemotherapy from 5.8% among CRC to 11% in lung and breast cancer patients, and radiotherapy from 1.3% in pancreatic to 18.7% in lung cancer patients. Use of some treatments (eg, surgery for CRC and breast cancer) progressively declined between 2004 and 2014. Compared with lung cancer patients treated at National Cancer Institute-designated cancer centers, those treated at community cancer centers had 48% lower odds of radiation. Conclusions Treatment of patients diagnosed with imminently fatal de novo metastatic cancer varied markedly by cancer type and patient/facility characteristics. These variations warrant more research to better identify patients with imminently fatal de novo metastatic cancer who may not benefit from aggressive and expensive therapies.
Collapse
Affiliation(s)
| | | | - Kimmie Ng
- Dana-Farber Cancer Institute, Boston, MA
| | | | | | | | | |
Collapse
|
233
|
Nogueira LM, Efstathiou JA, Sineshaw HM, Yabroff KR, Jemal A. Trends in the use of proton beam therapy among newly diagnosed cancer patients in the United States. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.6551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6551 Background: Proton Beam Therapy (PBT) is a potentially superior radiotherapy technology for tumors with complex anatomy surrounded by sensitive tissues and for childhood cancers where sparing surrounding normal tissue is better achieved than with photon radiotherapy. The first conditions for payment of PBT claims went into effect in 2009. In 2014, the American Society of Radiation Oncology categorized PBT clinical indications into Group 1, for which health insurance coverage is recommended, and Group 2, for which coverage is recommended only if additional requirements are met. Methods: We evaluated 21,920 newly diagnosed patients in the National Cancer Database (NCDB) who received PBT between 2004 and 2016. Joinpoint analyses were used to evaluate the Annual Percent Change (APC) in the number and characteristics of patients treated with PBT. Results: The number of patients treated with PBT in NCDB facilities increased from 1,114 in 2004 to 3,173 in 2016 (APC = 8.78, p < .001), due mainly to increases in Group 1 cancers after 2010 (from 271 patients in 2010 to 1,124 in 2016, APC = 26.4, p < .001). The number of Group 2 patients treated with PBT increased slower (from 937 in 2004 to 2,049 in 2016, APC = 6.1, p < .05). Breast and prostate cancers were most common, although trends varied substantially by cancer site. Between 2010 and 2016, receipt of PBT increased for breast cancer patients from 40 in 2010 to 405 in 2016 (APC = 48.5, p < .001), but decreased for prostate cancer patients from 1,205 in 2011 to 680 in 2016 (APC = -14.06, p < .001). While most of Group 1 patients had private insurance coverage (59.3% of patients treated in 2016), Medicare was the most common primary insurance type among Group 2 patients (50% of patients treated in 2016). Conclusions: The number of newly diagnosed cancer patients treated with PBT has increased between 2004 to 2016 in the US, with a sharp increase for cancers with clinical indications for health insurance coverage since 2010. While most of these patients have private insurance coverage, the steady increase in the number of patients being treated with PBT for cancers with additional requirements for health insurance coverage is primarily in those with Medicare coverage.
Collapse
|
234
|
Sineshaw HM, Yabroff KR, Tsikitis VL, Jemal A, Mitin T. Early mortality after resection of locally advanced rectal cancer in elderly United States patients. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11529 Background: Early mortality after resection of locally advanced rectal cancer in patients age 75 and older has not been studied in the United States. This information could inform clinical decision-making for patients who achieve complete clinical response after neoadjuvant therapy and consider watchful waiting versus surgical resection. Methods: Using the National Cancer Data Base, we identified patients age 75 years and older who underwent surgery for clinical stage II or III rectal cancer between 2004-2015. We performed multivariable logistic regression analyses to assess associations between patient and facility characteristics and 30-day, 90-day, and 6-month mortality. Results: Among 11,326 patients, 94% underwent resection and the remaining 6% underwent local excision. Overall early mortality rates after surgery were 4%, 7.6% and 11% for 30-day, 90-day and six-month, respectably. Six-month mortality varied by age subgroup (8% in 75-79 years old to 17.7% in 85 years and older), and comorbidity score (9.5% for comorbidity score = 0 to 18.5% for comorbidity score ≥ 2). Between 2004 and 2015, six-month mortality declined significantly from 11.9% in 2004-2007 to 9.8% in 2012-2015 ( P trend = 0.0029), with the decline larger among patients age 85 years and older (from 19.4% in 2004-2007 to 15.3% in 2012-2015, P trend = 0.0377). In the multivariable analysis, older age, higher comorbidity score, and lower facility case volume were significantly associated with higher odds of six-month mortality. Patients treated at National Cancer Institute (NCI) designated centers had 32% lower odds of six-month mortality compared with those treated at non-NCI designated teaching/research centers. Conclusions: Post-operative six-month mortality among patients age 75 years and older with locally advanced rectal cancer in the US declined steadily over the past decade. Older age, high comorbidity score, and low facility case volume were associated with higher six-month mortality after surgery. Additional efforts are needed to guide elderly patients and their physicians in discussing treatment options for locally advanced rectal cancer.
Collapse
Affiliation(s)
| | | | | | | | - Timur Mitin
- Oregon Health and Science University, Portland, OR
| |
Collapse
|
235
|
Affiliation(s)
- Ahmedin Jemal
- Surveillance & Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Stacey A Fedewa
- Surveillance & Health Services Research, American Cancer Society, Atlanta, Georgia
| |
Collapse
|
236
|
Abstract
In the United States, African American/black individuals bear a disproportionate share of the cancer burden, having the highest death rate and the lowest survival rate of any racial or ethnic group for most cancers. To monitor progress in reducing these inequalities, every 3 years the American Cancer Society provides the estimated number of new cancer cases and deaths for blacks in the United States and the most recent data on cancer incidence, mortality, survival, screening, and risk factors using data from the National Cancer Institute, the North American Association of Central Cancer Registries, and the National Center for Health Statistics. In 2019, approximately 202,260 new cases of cancer and 73,030 cancer deaths are expected to occur among blacks in the United States. During 2006 through 2015, the overall cancer incidence rate decreased faster in black men than in white men (2.4% vs 1.7% per year), largely due to the more rapid decline in lung cancer. In contrast, the overall cancer incidence rate was stable in black women (compared with a slight increase in white women), reflecting increasing rates for cancers of the breast, uterine corpus, and pancreas juxtaposed with declining trends for cancers of the lung and colorectum. Overall cancer death rates declined faster in blacks than whites among both males (2.6% vs 1.6% per year) and females (1.5% vs 1.3% per year), largely driven by greater declines for cancers of the lung, colorectum, and prostate. Consequently, the excess risk of overall cancer death in blacks compared with whites dropped from 47% in 1990 to 19% in 2016 in men and from 19% in 1990 to 13% in 2016 in women. Moreover, the black-white cancer disparity has been nearly eliminated in men <50 years and women ≥70 years. Twenty-five years of continuous declines in the cancer death rate among black individuals translates to more than 462,000 fewer cancer deaths. Continued progress in reducing disparities will require expanding access to high-quality prevention, early detection, and treatment for all Americans.
Collapse
Affiliation(s)
- Carol E DeSantis
- Principal Scientist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Kimberly D Miller
- Senior Associate Scientist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Ann Goding Sauer
- Senior Associate Scientist, Surveillance and Health Services Research, Intramural Research, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Vice President, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Rebecca L Siegel
- Scientific Director, Surveillance Research, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| |
Collapse
|
237
|
Piszczan S, Desalegn D, Petros H, Gurmu M, Kroeber ES, Addissie A, Mikolajczyk R, Ghebre RG, Mathewos A, Thomssen C, Jemal A, Kantelhardt EJ. Clinical Characteristics and Survival of Patients with Malignant Ovarian Tumors in Addis Ababa, Ethiopia. Oncologist 2019; 24:e303-e311. [PMID: 31023861 DOI: 10.1634/theoncologist.2018-0869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/18/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Ovarian cancer is the third leading cause of cancer death among women in Ethiopia, with about 2,550 diagnosed cases and 2,000 deaths each year. The incidence and mortality rates of this disease have been increasing in Ethiopia and other parts of sub-Saharan Africa over the past decades because of changing lifestyle and reproductive factors. In this study, we describe the clinical characteristics, treatment patterns, and survival of patients with ovarian cancer in Ethiopia. MATERIALS AND METHODS This retrospective cohort study included 485 patients diagnosed between January 2009 and October 2015 at Addis Ababa University Hospital, Zewditu Memorial Hospital, or registered in the Addis Ababa population-based cancer registry. Follow-up data were obtained via telephone. Primary endpoint was all-cause mortality. RESULTS The median age was 46 years (range, 11-95). The estimated 1- and 2-year overall survival rates were 78% (95% confidence interval [CI] 0.741-0.82.5) and 59% (95% CI, 0.538-0.646), respectively. Of those patients with result available (n = 423), 73.0% had epithelial cancers. Almost half were classified as Federation of Gynecology and Oncology stage III or IV (48.2%; stage available n = 201) resulting in worse outcomes (hazard ratio [HR], 2.91 [CI 0.67-12.64] and 3.03 [0.69-15.79], respectively). Four out of five patients received some form of surgery (82%), three out of five received platinum-containing chemotherapy. Patients with residual tumor after surgery (n = 83) showed worse survival outcome (HR, 2.23; 95% CI 1.08-4.49). CONCLUSION Our study revealed substantial treatment gaps with respect to surgery and adequate chemotherapy. Higher stage, residual tumor and lack of chemotherapy impaired the outcome. Access to higher standards of ovarian cancer treatment is urgently needed in Ethiopia. IMPLICATIONS FOR PRACTICE Ovarian cancer is often a fatal disease in high resource settings; now it is also becoming important in Ethiopia. This study included 485 women with malignant ovarian tumors treated in Addis Ababa who had a mean age of only 46 years because of the young population structure. Three quarters had the typical epithelial cancer, with half presenting with advanced stage III and IV. Improved oncologic surgery and sufficient chemotherapy could possibly improve their outcome. The relatively high proportion of women with nonepithelial cancer need adequate treatment options to have good prognosis.
Collapse
Affiliation(s)
- Swantje Piszczan
- Department of Gynecology, Martin-Luther-University, Halle an der Saale, Germany
| | - Dawit Desalegn
- Department of Gynecology and Obstetrics, Addis Ababa University, Ethiopia
| | - Hezkiel Petros
- Department of Gynecology and Obstetrics, Addis Ababa University, Ethiopia
| | - Mengistu Gurmu
- Department of Gynecology and Obstetrics, Addis Ababa University, Ethiopia
| | - Eric Sven Kroeber
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle an der Saale, Germany
| | - Adamu Addissie
- Radiotherapy Center, School of Medicine, Addis Ababa University, Ethiopia
| | - Rafael Mikolajczyk
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle an der Saale, Germany
| | - Rahel G Ghebre
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Assefa Mathewos
- Radiotherapy Center, School of Medicine, Addis Ababa University, Ethiopia
| | - Christoph Thomssen
- Department of Gynecology, Martin-Luther-University, Halle an der Saale, Germany
| | | | | |
Collapse
|
238
|
Chernyavskiy P, Kennerley VM, Jemal A, Little MP, Rosenberg PS. Heterogeneity of colon and rectum cancer incidence across 612 SEER counties, 2000-2014. Int J Cancer 2019; 144:1786-1795. [PMID: 30152110 PMCID: PMC10667616 DOI: 10.1002/ijc.31776] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 06/13/2018] [Accepted: 07/18/2018] [Indexed: 01/04/2023]
Abstract
Recent analyses have suggested decreases over time in colorectal cancer incidence at older ages (≥55 years) but increases at younger ages (20-54 years). Understanding the geographic heterogeneity of incidence facilitates resource allocation for potential interventions and advances our knowledge of differential etiologies for these cancers. We performed age-period-cohort analysis using 2000-2014 county-level incidence from the Surveillance, Epidemiology, and End Results (SEER) database, estimating relative risk (RR) and age-adjusted annual percent change (Net Drifts) simultaneously for 612 counties via a hierarchical model, separately for colon and rectum cancer, stratified by age group (20-54 vs. 55-84). We also studied correlates of RR and Net Drift with various county-level characteristics. In all SEER counties, colon and rectum cancer incidence rates increased at ages 20-54, whereas rates decreased at ages 55-84. There was marked heterogeneity in both RR and Net Drift among states and counties for both cancer types. Maps of county RR and Net Drift revealed localized clusters in several states. For both cancer types, counties with high RR and unfavorable Net Drift tended to have higher prevalence of obesity and diabetes and to be of a lower socioeconomic status. Counties with higher overall screening rates tended to have lower Net Drifts for both cancer types. Increasing colorectal cancer incidence in the younger age group is geographically widespread, although there is significant heterogeneity in temporal trends and risk both within and between states. These geographic patterns correlate with different county-level characteristics depending on cancer type and age group.
Collapse
Affiliation(s)
- Pavel Chernyavskiy
- Biostatistics Branch, National Cancer Institute, DHHS, NIH, Division of Cancer Epidemiology and Genetics, Bethesda, Maryland 20892-9778, USA
- Radiation Epidemiology Branch, National Cancer Institute, DHHS, NIH, Division of Cancer Epidemiology and Genetics, Bethesda, Maryland 20892-9778, USA
- University of Wyoming, Department of Mathematics and Statistics, Laramie, Wyoming, USA
| | - Victoria M. Kennerley
- Biostatistics Branch, National Cancer Institute, DHHS, NIH, Division of Cancer Epidemiology and Genetics, Bethesda, Maryland 20892-9778, USA
| | - Ahmedin Jemal
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA
| | - Mark P. Little
- Radiation Epidemiology Branch, National Cancer Institute, DHHS, NIH, Division of Cancer Epidemiology and Genetics, Bethesda, Maryland 20892-9778, USA
| | - Philip S. Rosenberg
- Biostatistics Branch, National Cancer Institute, DHHS, NIH, Division of Cancer Epidemiology and Genetics, Bethesda, Maryland 20892-9778, USA
| |
Collapse
|
239
|
Pilleron S, Soerjomataram I, Charvat H, Chokunonga E, Somdyala NIM, Wabinga H, Korir A, Bray F, Jemal A, Maxwell Parkin D. Cancer incidence in older adults in selected regions of sub-Saharan Africa, 2008-2012. Int J Cancer 2019; 144:1824-1833. [PMID: 30238972 DOI: 10.1002/ijc.31880] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/03/2018] [Accepted: 08/06/2018] [Indexed: 12/15/2022]
Abstract
Although the countries of Sub-Sharan Africa represent among the most rapidly growing and aging populations worldwide, no previous studies have examined the cancer patterns in older adults in the region as a means to inform cancer policies. Using data from Cancer Incidence in Five Continents, we describe recent patterns and trends in incidence rates for the major cancer sites in adults aged ≥60 years and in people aged 0-59 for comparison in four selected population-based cancer registries in Kenya (Nairobi), the Republic of South Africa (Eastern Cape Province), Uganda (Kyadondo country), and Zimbabwe (Harare blacks). Over the period 2008-2012, almost 9,000 new cancer cases were registered in older adults in the four populations, representing one-third of all cancer cases. Prostate and esophageal cancers were the leading cancer sites in older males, while breast, cervical and esophageal cancers were the most common among older females. Among younger people, Kaposi sarcoma and non-Hodgkin lymphoma were common. Over the past 20 years, incidence rates among older adults have increased in both sexes in Uganda and Zimbabwe while rates have stabilized among the younger age group. Among older adults, the largest rate increase was observed for breast cancer (estimated annual percentage change: 5% in each country) in females and for prostate cancer (6-7%) in males. Due to the specific needs of older adults, tailored considerations should be given to geriatric oncology when developing, funding and implementing national and regional cancer programmes.
Collapse
Affiliation(s)
- Sophie Pilleron
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Hadrien Charvat
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | | | - Nontuthuzelo I M Somdyala
- South African Medical Research Council, Burden of Disease Research Unit; Eastern Cape Cancer Registry, Tygerberg, South Africa
| | - Henry Wabinga
- Department of Pathology Kampala Cancer Registry, Makerere University, Kampala, Uganda
| | - Anne Korir
- Nairobi Cancer Registry, Kenya Medical Research Institute, Nairobi, Kenya
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - D Maxwell Parkin
- Nuffield Department of Public Health, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
240
|
Gebremariam A, Addissie A, Worku A, Hirpa S, Assefa M, Pace LE, Kantelhardt EJ, Jemal A. Breast and cervical cancer patients' experience in Addis Ababa city, Ethiopia: a follow-up study protocol. BMJ Open 2019; 9:e027034. [PMID: 30967409 PMCID: PMC6500298 DOI: 10.1136/bmjopen-2018-027034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Cancer is an emerging public health problem in Ethiopia, with breast and cervical cancers accounting for over half of all newly diagnosed cancers in women. The majority of women with breast and cervical cancer are diagnosed at late stage of the disease and most patients do not receive care consistent with global standards. However, little is known about the health-seeking behaviours, barriers to early detection and treatment, patient-reported outcomes, financial burden and survival of women with breast and cervical cancer in the country. Therefore, this study aims to document the experience of women with breast and cervical cancer from recognition of symptoms to diagnosis, treatment and survivorship/mortality in Addis Ababa city, Ethiopia. METHODS AND ANALYSIS A prospective follow-up study using mixed methods (both quantitative and qualitative) will be employed. All women newly diagnosed with breast and cervical cancer from 1 January, 2017 to 30 June 2018 in Addis Ababa will be included in the study. Interviewer-administered questionnaires will be used to collect information about medical consultations after recognition of symptoms, health-seeking behaviours, treatment received, barriers to early detection and treatment, and survivorship care. In-depth interview will be conducted on purposefully selected women with breast and cervical cancer. The primary outcomes of the study are time intervals (patient and diagnostic waiting times), stage at diagnosis and survival. Multivariable analysis will be employed to determine the contributions of independent variables on the outcomes of interest. HRs with 95% CIs will be calculated for time-to-event outcomes. Qualitative data will be analysed using thematic analysis. ETHICS AND DISSEMINATION This protocol is ethically approved by Institutional Review Board of Addis Ababa University. Verbal informed consent will be obtained from study participants. Results will be disseminated in international peer-reviewed journals and presented in relevant conferences.
Collapse
Affiliation(s)
- Alem Gebremariam
- Public Health, College of Medicine and Health Sciences, Adigrat University, Adigrat, Tigray, Ethiopia
- Preventive Medicine, Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
| | - Adamu Addissie
- Preventive Medicine, Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- Preventive Medicine, Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
| | - Selamawit Hirpa
- Preventive Medicine, Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
| | - Mathewos Assefa
- Oncology, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
| | - Lydia E Pace
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Eva Johanna Kantelhardt
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle, Germany
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia, USA
| |
Collapse
|
241
|
Ma J, Siegel RL, Islami F, Jemal A. Temporal trends in liver cancer mortality by educational attainment in the United States, 2000-2015. Cancer 2019; 125:2089-2098. [PMID: 30957228 DOI: 10.1002/cncr.32023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Liver cancer is the most rapidly rising cause of cancer death in the United States. However, it is unclear whether the mortality trend differs by socioeconomic and/or hepatitis C virus (HCV) infection status. METHODS Joinpoint analyses and Poisson regression modeling were performed to examine trends in death rates from liver cancer by education and HCV infection status among persons aged 25 to 74 years from 2000 to 2015. Disparities in liver cancer mortality were measured as a relative index of inequality by education. RESULTS From 2000 to 2015, the overall liver cancer death rate (per 100,000 persons) increased from 7.5 to 11.2 in men and from 2.8 to 3.8 in women. The increase was generally steeper in less educated groups for women and was confined to persons with ≤15 years of education for men. Consequently, the relative disparity increased until 2006 and then levelled off in women, whereas it continued to increase from 3.49 (95% CI, 3.08-3.97) to 7.74 (95% CI, 7.13-8.40) in men, with the increase more pronounced for HCV-related liver cancer than HCV-unrelated liver cancer. CONCLUSIONS The increases in liver cancer death rates in the United States have largely been confined to less educated persons, especially among men. Enhanced and targeted efforts are needed to halt and reverse the undue growing burden of liver cancer in lower socioeconomic groups.
Collapse
Affiliation(s)
- Jiemin Ma
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Farhad Islami
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| |
Collapse
|
242
|
Sung H, Siegel RL, Torre LA, Pearson-Stuttard J, Islami F, Fedewa SA, Goding Sauer A, Shuval K, Gapstur SM, Jacobs EJ, Giovannucci EL, Jemal A. Global patterns in excess body weight and the associated cancer burden. CA Cancer J Clin 2019; 69:88-112. [PMID: 30548482 DOI: 10.3322/caac.21499] [Citation(s) in RCA: 191] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The prevalence of excess body weight and the associated cancer burden have been rising over the past several decades globally. Between 1975 and 2016, the prevalence of excess body weight in adults-defined as a body mass index (BMI) ≥ 25 kg/m2 -increased from nearly 21% in men and 24% in women to approximately 40% in both sexes. Notably, the prevalence of obesity (BMI ≥ 30 kg/m2 ) quadrupled in men, from 3% to 12%, and more than doubled in women, from 7% to 16%. This change, combined with population growth, resulted in a more than 6-fold increase in the number of obese adults, from 100 to 671 million. The largest absolute increase in obesity occurred among men and boys in high-income Western countries and among women and girls in Central Asia, the Middle East, and North Africa. The simultaneous rise in excess body weight in almost all countries is thought to be driven largely by changes in the global food system, which promotes energy-dense, nutrient-poor foods, alongside reduced opportunities for physical activity. In 2012, excess body weight accounted for approximately 3.9% of all cancers (544,300 cases) with proportion varying from less than 1% in low-income countries to 7% or 8% in some high-income Western countries and in Middle Eastern and Northern African countries. The attributable burden by sex was higher for women (368,500 cases) than for men (175,800 cases). Given the pandemic proportion of excess body weight in high-income countries and the increasing prevalence in low- and middle-income countries, the global cancer burden attributable to this condition is likely to increase in the future. There is emerging consensus on opportunities for obesity control through the multisectoral coordinated implementation of core policy actions to promote an environment conducive to a healthy diet and active living. The rapid increase in both the prevalence of excess body weight and the associated cancer burden highlights the need for a rejuvenated focus on identifying, implementing, and evaluating interventions to prevent and control excess body weight.
Collapse
Affiliation(s)
- Hyuna Sung
- Principal Scientist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Rebecca L Siegel
- Scientific Director, Scientist Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Lindsey A Torre
- Scientist, Surveillance and Health Services Research, American Cancer Society, Scientist, Atlanta, GA
| | | | - Farhad Islami
- Scientific Director, Scientist Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Stacey A Fedewa
- Senior Principal Scientist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Ann Goding Sauer
- Senior Associate Scientist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Kerem Shuval
- Senior Principal Scientist, Physical Activity and Nutrition Research, Economic and Health Policy Research Program, Atlanta, GA
| | - Susan M Gapstur
- Senior Vice President, Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA
| | - Eric J Jacobs
- Senior Scientific Director, Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA
| | - Edward L Giovannucci
- Professor, Departments of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Ahmedin Jemal
- Scientific Vice President, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| |
Collapse
|
243
|
Ruddy KJ, Sangaralingham LR, Freedman RA, Jemal A, Mougalian SS, Keegan T, Loprinzi CL, Gross CP, Henk HJ, Shah N. Abstract PD6-07: Trends in the cost of care for breast cancer among women with commercial insurance. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd6-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Breast cancer care imposes a significant financial burden to U.S. healthcare systems and has become a key focus in the health care debate. Therapies for breast cancer are expensive, and the economic burden of these therapies may be rising due to the rapid introduction of pricey new drugs and techniques. There are limited data on the health care costs of individuals with breast cancer after initial diagnosis and how these costs have changed over time.
Methods: We conducted a retrospective analysis of commercially insured adult women with newly diagnosed non-metastatic breast cancer (identified via previously published claims-based algorithms) using 2007-2016 data from a large US health plan available in OptumLabs® Data Warehouse. We included patients with continuous health plan coverage for at least 2 years after initial diagnosis 2007-2014 and assessed how total health care spending and out-of-pocket costs (paid amounts) changed over this time. Costs were adjusted to 2016 US dollars using the general Consumer Price Index. Inpatient, outpatient, and outpatient pharmacy costs were evaluated. A multivariable logistic regression model was used to examine predictors of above average cost (cost > mean for that year of diagnosis).
Results: A total of 12,446 newly diagnosed breast cancer patients were identified (mean age, 51.6 years). Forty percent had undergone mastectomy, 38% chemotherapy, and 63% radiation. After adjustment for inflation, total healthcare costs increased 29.7% from 2007 to 2014 (Table 1), with increases primarily observed during the first year after diagnosis. Out-of-pocket costs remained relatively stable, and accounted for 5.3% of the total spending. Approximately 80% of the total costs were related to care received in the outpatient setting. Factors independently associated with above average spending included treatment with mastectomy [OR 1.78 (95% CI 1.5-2.1)], reconstruction [OR 3.0 (95% CI 2.6-3.5)], radiation [OR 4.0 (95% CI 3.4-4.7)] and chemotherapy [OR 18.4 (95% CI 16.6-20.3].
Table 1.Average healthcare spending over time Mean cost during first year after diagnosisMean cost during second year after diagnosisYear of diagnosistotalout-of-pockettotalout-of-pocket2007$80,296.17$4,271.25$16,559.21$1,907.012008$84,126.70$4,445.78$16,785.43$2,205.982009$88,331.45$4,728.42$17,005.68$2,214.932010$91,502.58$5,067.78$17,243.91$2,126.192011$93,826.40$5,089.45$16,862.45$2,027.962012$96,690.06$5,449.91$17,814.09$2,179.262013$104,064.93$5,678.19$17,087.47$2,115.972014$104,169.74$5,620.51$16,714.12$1,590.67
Conclusions: Breast cancer care is increasingly expensive during the first year after diagnosis, and costs are greatest for the recipients of more aggressive treatments. Costs during the second year after diagnosis have remained relatively stable.
Citation Format: Ruddy KJ, Sangaralingham LR, Freedman RA, Jemal A, Mougalian SS, Keegan T, Loprinzi CL, Gross CP, Henk HJ, Shah N. Trends in the cost of care for breast cancer among women with commercial insurance [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD6-07.
Collapse
Affiliation(s)
- KJ Ruddy
- Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; American Cancer Society, Atlanta, GA; Yale University School of Medicine, New Haven, CT; UC Davis Health, Sacramento, CA; Yale Cancer Center and Yale School of Medicine, New Haven, CT; Optum Labs, Eden Prairie, MN
| | - LR Sangaralingham
- Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; American Cancer Society, Atlanta, GA; Yale University School of Medicine, New Haven, CT; UC Davis Health, Sacramento, CA; Yale Cancer Center and Yale School of Medicine, New Haven, CT; Optum Labs, Eden Prairie, MN
| | - RA Freedman
- Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; American Cancer Society, Atlanta, GA; Yale University School of Medicine, New Haven, CT; UC Davis Health, Sacramento, CA; Yale Cancer Center and Yale School of Medicine, New Haven, CT; Optum Labs, Eden Prairie, MN
| | - A Jemal
- Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; American Cancer Society, Atlanta, GA; Yale University School of Medicine, New Haven, CT; UC Davis Health, Sacramento, CA; Yale Cancer Center and Yale School of Medicine, New Haven, CT; Optum Labs, Eden Prairie, MN
| | - SS Mougalian
- Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; American Cancer Society, Atlanta, GA; Yale University School of Medicine, New Haven, CT; UC Davis Health, Sacramento, CA; Yale Cancer Center and Yale School of Medicine, New Haven, CT; Optum Labs, Eden Prairie, MN
| | - T Keegan
- Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; American Cancer Society, Atlanta, GA; Yale University School of Medicine, New Haven, CT; UC Davis Health, Sacramento, CA; Yale Cancer Center and Yale School of Medicine, New Haven, CT; Optum Labs, Eden Prairie, MN
| | - CL Loprinzi
- Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; American Cancer Society, Atlanta, GA; Yale University School of Medicine, New Haven, CT; UC Davis Health, Sacramento, CA; Yale Cancer Center and Yale School of Medicine, New Haven, CT; Optum Labs, Eden Prairie, MN
| | - CP Gross
- Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; American Cancer Society, Atlanta, GA; Yale University School of Medicine, New Haven, CT; UC Davis Health, Sacramento, CA; Yale Cancer Center and Yale School of Medicine, New Haven, CT; Optum Labs, Eden Prairie, MN
| | - HJ Henk
- Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; American Cancer Society, Atlanta, GA; Yale University School of Medicine, New Haven, CT; UC Davis Health, Sacramento, CA; Yale Cancer Center and Yale School of Medicine, New Haven, CT; Optum Labs, Eden Prairie, MN
| | - N Shah
- Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; American Cancer Society, Atlanta, GA; Yale University School of Medicine, New Haven, CT; UC Davis Health, Sacramento, CA; Yale Cancer Center and Yale School of Medicine, New Haven, CT; Optum Labs, Eden Prairie, MN
| |
Collapse
|
244
|
Sung H, Siegel RL, Rosenberg PS, Jemal A. Emerging cancer trends among young adults in the USA: analysis of a population-based cancer registry. Lancet Public Health 2019; 4:e137-e147. [PMID: 30733056 DOI: 10.1016/s2468-2667(18)30267-6] [Citation(s) in RCA: 293] [Impact Index Per Article: 58.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/11/2018] [Accepted: 12/17/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cancer trends in young adults, often under 50 years, reflect recent changes in carcinogenic exposures, which could foreshadow the future overall disease burden. Previous studies reported an increase in early onset colorectal cancer, which could partly reflect the obesity epidemic. We examined age-specific contemporary incidence trends in the USA for 30 common cancers, including 12 obesity-related cancers. METHODS We obtained incidence data for invasive cancers among people aged 25-84 years diagnosed from Jan 1, 1995, to Dec 31, 2014, for 25 population-based state registries in the USA. All patients in the registry were included in the analyses. We considered the 20 most common cancer types and 12 obesity-related cancers (30 cancer types in total). We used age-period-cohort modelling to estimate average annual percentage change in incidence rates by 5-year age group (25-29 years to 80-84 years in 5-year increments) and incidence rate ratios (IRR) by birth cohort (10-year overlapping birth cohorts from 1910-19 to 1980-89 in 5-year increments). No exclusion criteria were applied after including all invasive cancer cases based on age group and diagnosis year. FINDINGS From 1995 to 2014 there were 14 672 409 incident cases for 30 types of cancer. Incidence significantly increased for six of 12 obesity-related cancers (multiple myeloma, colorectal, uterine corpus, gallbladder, kidney, and pancreatic cancer) in young adults (25-49 years) with steeper rises in successively younger generations. Annual increases ranged from 1·44% (95% CI -0·60 to 3·53) for multiple myeloma to 6·23% (5·32-7·14) for kidney cancer at age 25-29 years, and ranged from 0·37% (0·03-0·72) for uterine corpus cancer to 2·95% (2·74-3·16) for kidney cancer at age 45-49 years. Compared with people born around 1950, IRRs for those born around 1985 ranged from 1·59 (95% CI 1·14-2·21) for multiple myeloma to 4·91 (4·27-5·65) for kidney cancer. Conversely, incidence in young adults increased in successively younger generations for only two cancers (gastric non-cardia cancer and leukaemia), and decreased for eight of the 18 additional cancers, including smoking and HIV infection-associated cancers. INTERPRETATION The risk of developing an obesity-related cancer seems to be increasing in a stepwise manner in successively younger birth cohorts in the USA. Further studies are needed to elucidate exposures responsible for these emerging trends, including excess bodyweight and other risk factors. FUNDING Intramural Research Department of the American Cancer Society and the Intramural Research Program of the National Cancer Institute.
Collapse
Affiliation(s)
- Hyuna Sung
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, USA
| | - Rebecca L Siegel
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, USA
| | - Philip S Rosenberg
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ahmedin Jemal
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, USA.
| |
Collapse
|
245
|
Islami F, DeSantis CE, Jemal A. Incidence Trends of Esophageal and Gastric Cancer Subtypes by Race, Ethnicity, and Age in the United States, 1997-2014. Clin Gastroenterol Hepatol 2019; 17:429-439. [PMID: 29902641 DOI: 10.1016/j.cgh.2018.05.044] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/11/2018] [Accepted: 05/20/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS There is limited information on contemporary incidence rates and trends, by race, ethnicity, and age, for major subtypes of esophageal and gastric cancer in the United States. We examined the most recent nationwide incidence data for esophageal squamous cell carcinoma, esophageal adenocarcinoma (EAC), gastric cardia adenocarcinoma (GCA), and gastric non-cardia adenocarcinoma (GNCA) by race, ethnicity, and age in the United States. METHODS Average contemporary incidence rates (2010-2014) and annual percent changes in rates (from 1997 through 2014) by race, ethnicity, and age were calculated for each cancer subtype using nationwide data compiled by the North American Association of Central Cancer Registries. RESULTS From 1997 through 2014, overall esophageal squamous cell carcinoma incidence rates continuously decreased in both sexes and all racial and ethnic groups, although rates remained stable among younger non-Hispanic white women. Overall, EAC incidence rates decreased or stabilized during the most recent time period (2006-2007 through 2014) in men and women, after increasing from 1997 through 2006 and 2007. However, EAC incidence rates continued to increase from 1997 through 2014 in several subpopulations, including non-Hispanic white men younger than 50 years, non-Hispanic white women younger than 70 years, and Asian/Pacific Islander men (all ages combined). Overall GCA incidence rates increased among non-Hispanic whites, but decreased among Hispanics (men only) and Asian/Pacific Islanders. Although overall GNCA rates decreased in both sexes and all racial and ethnic groups, rates increased in younger age groups among men (all races and ethnicities combined) and non-Hispanic white, non-Hispanic black, and Hispanic women. CONCLUSIONS Using high-quality nationwide population-based data, we found increasing incidence trends for EAC, GCA, and GNCA in several subpopulations in the United States.
Collapse
Affiliation(s)
- Farhad Islami
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia.
| | - Carol E DeSantis
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| |
Collapse
|
246
|
Chen W, Xia C, Zheng R, Zhou M, Lin C, Zeng H, Zhang S, Wang L, Yang Z, Sun K, Li H, Brown MD, Islami F, Bray F, Jemal A, He J. Disparities by province, age, and sex in site-specific cancer burden attributable to 23 potentially modifiable risk factors in China: a comparative risk assessment. Lancet Glob Health 2019; 7:e257-e269. [PMID: 30683243 DOI: 10.1016/s2214-109x(18)30488-1] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/24/2018] [Accepted: 10/18/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Understanding disparities in the burden of cancer attributable to different risk factors is crucial to inform and improve cancer prevention and control. In this report, we estimate the site-specific population-attributable fractions (PAFs) for 23 potentially modifiable risk factors across all provinces in China. METHODS In this comparative risk assessment study, we used 2014 cancer mortality data for adults from 978 county-level surveillance points in 31 provinces of mainland China. Risk-factor prevalence estimates were obtained from representative surveys. We used summary relative risks obtained from several recent large-scale pooled analyses or high-quality meta-analyses of studies in China. We calculated PAFs using multiple formulae incorporating exposure prevalence and relative risk data stratified by age, sex and province and then combined to create summary PAFs by sex, cancer site, and risk factors. FINDINGS About 1 036 004 cancer deaths (45·2% of all cancer deaths [95% CI 44·0-46·4]) in China in 2014 in adults aged 20 years or older were attributable to 23 evaluated risk factors. The PAF was higher in men (51·2% [95% CI 50·0-52·4]) than in women (34·9% [33·6-36·2]), with the leading risk factors being active smoking in men and low fruit intake in women. By province, the PAF in both sexes combined ranged from 35·2% in Shanghai to 52·9% in Heilongjiang, while the PAF varied from 40·9% in Shanghai to 56·4% in Guangdong among men and from 26·9% in Shanghai to 48·0% in Heilongjiang among women. The highest PAF among men was smoking in all 31 provinces, whereas among women it varied among low fruit intake (14 provinces), hepatitis B virus infection (seven provinces), smoking (six provinces), excess bodyweight (three provinces), and human papilloma virus infection (one province). INTERPRETATION The PAFs of cancers attributable to potentially modifiable risk factors vary substantially across provinces in China. Regional adoption of effective primary cancer prevention strategies has a vast potential to reduce the burden of cancer and disparities in China. Smoking, poor diet, and infection warrant particular policy attention as they contributed a large proportion to the total cancer burden. FUNDING National Science and Technology Basic Research Special Foundation of China.
Collapse
Affiliation(s)
- Wanqing Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Changfa Xia
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rongshou Zheng
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chunqing Lin
- International Agency for Research on Cancer, Lyon, France
| | - Hongmei Zeng
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Siwei Zhang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lijun Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhixun Yang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kexin Sun
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - He Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Matthew D Brown
- Center for Global Health, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Farhad Islami
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Freddie Bray
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Jie He
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| |
Collapse
|
247
|
Zheng Z, Jemal A, Han X, Guy GP, Li C, Davidoff AJ, Banegas MP, Ekwueme DU, Yabroff KR. Medical financial hardship among cancer survivors in the United States. Cancer 2019; 125:1737-1747. [DOI: 10.1002/cncr.31913] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Zhiyuan Zheng
- Surveillance and Health Services Research Program, American Cancer Society Atlanta Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research Program, American Cancer Society Atlanta Georgia
| | - Xuesong Han
- Surveillance and Health Services Research Program, American Cancer Society Atlanta Georgia
| | - Gery P. Guy
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention Atlanta Georgia
| | - Chunyu Li
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention Atlanta Georgia
| | - Amy J. Davidoff
- Department of Health Policy and Management Yale School of Public Health New Haven Connecticut
| | | | - Donatus U. Ekwueme
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention Atlanta Georgia
| | - K. Robin Yabroff
- Surveillance and Health Services Research Program, American Cancer Society Atlanta Georgia
| |
Collapse
|
248
|
Nogueira LM, Chawla N, Han X, Jemal A, Yabroff KR. Patterns of Coverage Gains Among Young Adult Cancer Patients Following the Affordable Care Act. JNCI Cancer Spectr 2019; 3:pkz001. [PMID: 31360889 PMCID: PMC6649747 DOI: 10.1093/jncics/pkz001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/13/2018] [Accepted: 01/07/2019] [Indexed: 11/17/2022] Open
Abstract
The dependent coverage expansion (DCE) and Medicaid expansions (ME) under the Affordable Care Act (ACA) may differentially affect eligibility for health insurance coverage in young adult cancer patients. Studies examining temporal patterns of coverage changes in young adults following these policies are lacking. We used data from the National Cancer Database 2003–2015 to conduct a quasi-experimental study of cancer patients ages 19–34 years, grouped as DCE-eligible (19- to 25-year-olds) and DCE-ineligible (27- to 34-year-olds). Although private insurance coverage in DCE-eligible cancer patients increased incrementally following DCE implementation (0.5 per quarter; P < .001), an immediate effect on Medicaid coverage gains was observed after ME in all young adult cancer patients (3.01 for DCE-eligible and 1.62 for DCE-ineligible, both P < .001). Therefore, DCE and ME each had statistically significant and distinct effects on insurance coverage gains. Distinct temporal patterns of ACA policies’ impact on insurance coverage gains likely affect patterns of receipt of cancer care. Temporal patterns should be considered when evaluating the impact of health policies.
Collapse
Affiliation(s)
- Leticia M Nogueira
- Correspondence to: Leticia M. Nogueira, PhD, MPH, Surveillance and Health Service Research, American Cancer Society, 250 Williams St, Suite 600, Atlanta, GA 30303 (e-mail: )
| | | | | | | | | |
Collapse
|
249
|
Negoita S, Mariotto A, Benard V, Kohler BA, Jemal A, Penberthy L. Reply to annual report to the nation on the status of cancer, part II: Recent changes in prostate cancer trends and disease characteristics. Cancer 2019; 125:318-319. [PMID: 30427536 DOI: 10.1002/cncr.31845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Serban Negoita
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Angela Mariotto
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Vicki Benard
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Betsy A Kohler
- North American Association of Central Cancer Registries, Springfield, Illinois
| | | | - Lynne Penberthy
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| |
Collapse
|
250
|
Odutola M, Chokunonga E, Pineros M, Liu B, Jemal A, Parkin DM. Essential TNM: Evaluation of a Training Exercise in Sub-Saharan Africa. J Registry Manag 2019; 46:15-18. [PMID: 31490917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Information on cancer stage at diagnosis is largely missing or poorly documented among population-based cancer registries in sub-Saharan Africa (SSA). In an early field trial of Essential TNM staging, it was observed that some training was needed to enable cancer registrars to abstract the correct TNM from case records. In November 2018, the Addis Ababa City Cancer Registry hosted a training course attended by 17 participants from 16 cancer registries in SSA. The participants were asked to stage 16 cancer cases (from anonymized photocopies of case records obtained from the Global Initiative for Cancer Registry Development) before and after the training. The discrepancy of the stages from before and after were scored and compared. Results showed that there was a substantial improvement in the participants' performance after the training. The application of the Essential TNM staging system, with training in its use, would allow cancer registrars in SSA to abstract cancer stage at diagnosis in a clinically recognized format, which is crucial for cancer control and public health care policy making.
Collapse
|