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Maraud J, Bedhomme S, Pereira B, Trévis S, Jary M, Balayssac D. Self-Medication during and after Cancer: A French Nation-Wide Cross-Sectional Study. Cancers (Basel) 2023; 15:3190. [PMID: 37370800 DOI: 10.3390/cancers15123190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: Little data are available in Western countries regarding self-medication practices in the context of cancer. The aim of this study was to describe the prevalence of self-medication practices during (cancer patients) and after cancer (cancer survivors). (2) Methods: This multicenter, cross-sectional, and online study was designed to assess self-medication prevalence. Other objectives were explored, notably the medication types, the perceived risks, and the relation with symptoms and quality of life. (3) Results: Among the 518 patients analyzed, 56.4% declared they practiced self-medication. Dietary supplements and pain medications were used by more than half of the patients. Self-medication was practiced in order to manage the adverse effects of anticancer therapies (63.8%), for which pain was the leading indication (39%), and to improve the efficacy of anticancer therapies (43.8%, cancer patients). Patients believed that self-medication could not lead to drug interactions with anticancer therapies (84.9%, cancer patients), or to adverse effects (84.6%, cancer patients and survivors). Self-medication practices were associated with altered social functioning, pain, insomnia, and financial difficulties. (4) Conclusions: Self-medication was performed by more than half of the responders (ongoing or past cancer) and could be a marker of the undermanagement of cancer and treatment-related adverse effects.
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Affiliation(s)
- Julie Maraud
- UFR de Pharmacie, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Sabrina Bedhomme
- UR ACCePPT, Université Clermont Auvergne, F-63000 Clermont-Ferrand, France
| | - Bruno Pereira
- Direction de la Recherche Clinique et de l'Innovation, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Sophie Trévis
- Pharmacie, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - Marine Jary
- Chirurgie et Oncologie Digestive, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
| | - David Balayssac
- UMR1107, NEURO-DOL, INSERM, Direction de la Recherche Clinique et de l'Innovation, Université Clermont Auvergne, CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France
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Zheng Z, Han X, Zhao J, Fan Q, Yabroff KR. Parental Cancer History and Its Association With Minor Children's Unmet Food, Housing, and Transportation Economic Needs. JAMA Netw Open 2023; 6:e2319359. [PMID: 37347484 PMCID: PMC10288335 DOI: 10.1001/jamanetworkopen.2023.19359] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/28/2023] [Indexed: 06/23/2023] Open
Abstract
Importance A cancer diagnosis is associated with substantial economic burden for patients and their families. Young adult cancer survivors with dependent children may be particularly vulnerable to financial hardship. Objective To examine associations of parental cancer with their children's unmet economic needs. Design, Setting, and Participants This cross-sectional study used data from the nationally representative 2013 to 2018 US National Health Interview Survey. Children aged 5 to 17 years living in families with and without parental cancer history were queried about recent 1-year experiences. Statistical analyses were conducted from January 2022 to April 2023. Exposure Parental cancer history. Main Outcomes and Measures The main outcomes were children's unmet economic needs, including family-level food insecurity, parent's financial worry about paying for monthly bills and housing costs, and delayed child medical care owing to lack of transportation. Multivariable logistic regressions adjusted for (1) child's characteristics (ie, age group, sex, and race and ethnicity), (2) parent's characteristics (ie, age group, sex, health insurance coverage, comorbid conditions, and obesity status), and (3) family's characteristics (ie, family structure [married or cohabiting parents vs single parent families], highest educational attainment in the family, and family income). Additional analyses focused on children with a parental cancer history to identify potentially modifiable characteristics associated with unmet economic needs. Results In this cross-sectional study of 22 941 children with (812 children; weighted number, 860 488 children) and without (22 129 children; weighted number, 24 545 463 children) a parental cancer history, the majority of children were aged 5 to 11 years (12 022 children [52.4%]), male (11 920 children [52.0%]), and non-Hispanic White (11 863 children [51.7%]). In adjusted analyses, parental cancer history was associated with more severe family-level food insecurity, including worrying about food running out (odds ratio [OR], 1.97; 95% CI, 1.56-2.49; P < .001), food not lasting (OR, 2.01; 95% CI, 1.56-2.58; P < .001), and inability to afford balanced meals (OR, 1.38; 95% CI, 1.06-1.79; P = .02). Moreover, parental cancer history was associated with parent's worry about paying monthly bills (OR, 1.41; 95% CI, 1.15-1.74; P = .001) and housing-related costs (OR, 1.31; 95% CI, 1.07-1.60; P = .009) and delays in child medical care because of lack of transportation (OR, 2.31; 95% CI, 1.49-3.59; P < .001). Among children with parental cancer history, female children, non-Hispanic Black children, children whose parents had multiple comorbidities, and children living in low-income families were especially vulnerable to unmet economic needs. Conclusions and Relevance Parental cancer is associated with greater likelihood of food insecurity, unaffordability of housing and other necessities, and transportation barriers to medical care for minor children. Strategies to identify such children and address their needs are warranted.
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Affiliation(s)
- Zhiyuan Zheng
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Jingxuan Zhao
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Qinjin Fan
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - K. Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
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Olivier T, Haslam A, Prasad V. Is Financial Toxicity Captured in Assessments of Quality of Life In Oncology Randomized Clinical Trials? J Cancer Policy 2023; 36:100423. [PMID: 37075841 DOI: 10.1016/j.jcpo.2023.100423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/24/2023] [Accepted: 04/14/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Financial difficulties in relation with diagnosis and treatment of patients with cancer affects their quality-of-life (QoL). We aim to characterize how financial toxicity was captured in oncology randomized clinical trials (RCTs), and to estimate how often the study-drug or other expenses were covered by sponsors. METHODS This was a cross-sectional analysis of articles published in six high impact journals (The New England Journal of Medicine, The Lancet, JAMA, The Lancet Oncology, Journal of Clinical Oncology, and JAMA Oncology). Selected articles needed to report on a RCT published between January 2018 and December 2019, study an anti-cancer drug, and have reported QoL results. We abstracted the QoL questionnaires used; whether the survey was directly assessing financial difficulties; whether a difference in financial toxicity was reported between arms; and whether the sponsor supplied the study-drug or covered other expenses. RESULTS For all 73 studies that met inclusion criteria, 34 studies (47%) utilized QoL questionnaires without direct assessment of financial difficulties. The study drug was provided by the sponsor in at least 51 trials (70%), provided according to local rules in 3 trials (4%), and undeterminated in the remaining 19 trials (26%). We found 2 trials (3%) with payments or compensation to enrolled patients. CONCLUSION This cross-sectional study found 47% of articles reporting on QoL in oncology RCTs did not use QoL questionnaires directly assessing financial toxicity. Additionnaly, the study drug was supplied by the sponsor in most trials. Financial toxicity occurs in real-life settings when patients have to pay for the drugs and other medical expenses. QoL assessments from oncology RCTs lack generalizability to real-world settings, due to limited querying of financial toxicity. POLICY SUMMARY Real-world evidence could be demanded by regulators as post-requirement studies to ensure QoL results observed in trials will replicate in patients treated outside investigational trials.
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Affiliation(s)
- Timothée Olivier
- Department of Oncology, Geneva University Hospital, 4 Gabrielle-Perret-Gentil Street, 1205, Geneva, Switzerland; Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St, 2nd Fl, San Francisco, CA 94158, USA.
| | - Alyson Haslam
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St, 2nd Fl, San Francisco, CA 94158, USA
| | - Vinay Prasad
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St, 2nd Fl, San Francisco, CA 94158, USA
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Homayoonfal M, Gilasi H, Asemi Z, Mahabady MK, Asemi R, Yousefi B. Quercetin modulates signal transductions and targets non-coding RNAs against cancer development. Cell Signal 2023; 107:110667. [PMID: 37023996 DOI: 10.1016/j.cellsig.2023.110667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/22/2023] [Accepted: 03/29/2023] [Indexed: 04/08/2023]
Abstract
In recent decades, various investigations have indicated that natural compounds have great potential in the prevention and treatment of different chronic disorders including different types of cancer. As a bioactive flavonoid, Quercetin (Qu) is a dietary ingredient enjoying high pharmacological values and health-promoting effects due to its antioxidant and anti-inflammatory characterization. Conclusive in vitro and in vivo evidence has revealed that Qu has great potential in cancer prevention and development. Qu exerts its anticancer influences by altering various cellular processes such as apoptosis, autophagy, angiogenesis, metastasis, cell cycle, and proliferation. In this way, Qu by targeting numerous signaling pathways as well as non-coding RNAs regulates several cellular mechanisms to suppress cancer occurrence and promotion. This review aimed to summarize the impact of Qu on the molecular pathways and non-coding RNAs in modulating various cancer-associated cellular mechanisms.
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Affiliation(s)
- Mina Homayoonfal
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Hamidreza Gilasi
- Department of Biostatistics and Epidemiology, Kashan University of Medical Sciences, Kashan, Iran.
| | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran.
| | - Mahmood Khaksary Mahabady
- Anatomical Sciences Research Center, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Reza Asemi
- Department of Internal Medicine, School of Medicine, Cancer Prevention Research Center, Seyyed Al-Shohada Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bahman Yousefi
- Molecular Medicine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Biochemistry, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
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55
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Piccinelli S, Romee R, Shapiro RM. The natural killer cell immunotherapy platform: an overview of the landscape of clinical trials in liquid and solid tumors. Semin Hematol 2023; 60:42-51. [PMID: 37080710 DOI: 10.1053/j.seminhematol.2023.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/23/2023] [Indexed: 03/07/2023]
Abstract
The translation of natural killer (NK) cells to the treatment of malignant disease has made significant progress in the last few decades. With a variety of available sources and improvements in both in vitro and in vivo NK cell expansion, the NK cell immunotherapy platform has come into its own. The enormous effort continues to further optimize this platform, including ways to enhance NK cell persistence, trafficking to the tumor microenvironment, and cytotoxicity. As this effort bears fruit, it is translated into a plethora of clinical trials in patients with advanced malignancies. The adoptive transfer of NK cells, either as a standalone therapy or in combination with other immunotherapies, has been applied for the treatment of both liquid and solid tumors, with numerous early-phase trials showing promising results. This review aims to summarize the key advantages of NK cell immunotherapy, highlight several of the current approaches being taken for its optimization, and give an overview of the landscape of clinical trials translating this platform into clinic.
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56
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Hensley A, Campbell T, Gonzales C. Using Patient-Reported Outcomes Measurement Information System® (PROMIS) to Identify Physical and Psychosocial Quality of Life Issues in Lung Cancer Survivors. J Dr Nurs Pract 2023; 16:22-35. [PMID: 36918282 DOI: 10.1891/jdnp-2022-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Background: Lung cancer survivors (LCS) are living longer due to improved screening and treatment but often experience long-term treatment effects. Due to a traditionally poor prognosis, research related to LCS symptomology and associated quality of life (QOL) is lacking. Objective: The objective of this study was to develop a process for identifying symptomology and unmet needs affecting QOL in LCS. Methods: A literature review identified recommended methods of implementing a QOL screening program in LCS. Training guidelines using the best evidence were presented to the survivorship clinic (SC) staff. The Patient-Reported Outcomes Measurement Information System® (PROMIS-29) profile was used to collect data from LCS. The experience of the SC staff (N = 2) and providers (N = 2) in implementing the QOL screening program in LCS was assessed. Results: A 100% compliance rate in completing the PROMIS-29 profile was achieved. Physical function and pain interference were the most impacted QOL domains identified by LCS, while depression was the least. No challenges were identified in assisting LCS with profile completion. Providers agreed that the PROMIS-29 was instrumental in identifying QOL issues. Conclusion: A QOL screening program tailored to LCS-improved compliance and reliability in identifying QOL issues. Implications for Nursing: A QOL screening program using the PROMIS-29 may improve patient-provider interactions and value-based oncology care.
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Affiliation(s)
- Amy Hensley
- Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Tracy Campbell
- Forsyth Technical Community College, Clemmons, North Carolina, USA
| | - Clifford Gonzales
- Department of Academic Nursing, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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57
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Hager A, Gracia G, Rodin D, Conti RM. Out-of-Pocket Costs of Treatment Among Employer-Insured Women With Invasive Breast Cancer. JAMA Netw Open 2023; 6:e231507. [PMID: 36867412 PMCID: PMC9984972 DOI: 10.1001/jamanetworkopen.2023.1507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
This cross-sectional study examines out-of-pocket costs for the treatment of invasive breast cancer in employer-insured women younger than 65 years.
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Affiliation(s)
- Audrey Hager
- Department of Markets, Public Policy, and Law, Boston University, Boston, Massachusetts
| | - Gabriela Gracia
- Department of Markets, Public Policy, and Law, Boston University, Boston, Massachusetts
| | - Danielle Rodin
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Rena M. Conti
- Department of Markets, Public Policy, and Law, Boston University, Boston, Massachusetts
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Waters AR, van Thiel Berghuijs KM, Kaddas HK, Vaca Lopez PL, Chevrier A, Ray N, Tsukamoto T, Allen K, Fair DB, Lewis MA, Perez GK, Park ER, Kirchhoff AC, Warner EL. Sources of informal financial support among adolescent and young adult cancer survivors: a mixed methods analysis from the HIAYA CHAT study. Support Care Cancer 2023; 31:159. [PMID: 36773110 PMCID: PMC10601020 DOI: 10.1007/s00520-023-07626-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/01/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE The purpose of this exploratory sequential mixed methods study was to describe the sources of informal financial support used by adolescent and young adult (AYA) cancer survivors and how financial toxicity and demographic factors were associated with different types and magnitudes of informal financial support. METHODS This analysis is part of a larger health insurance literacy study that included pre-trial interviews and a randomized controlled trial (RCT) for AYA cancer survivors. Eligible study participants were 18 years of age, diagnosed with cancer as an AYA (15-39 years), insured, and for the RCT sample less than 1 year from diagnosis. Interview audio was transcribed, quality checked, and thematically analyzed. RCT baseline and follow-up surveys captured informal financial support use. Chi-squared and Fisher's exact tests were used to assess differences in informal financial support type use and frequency by financial toxicity and AYA demographics. RESULTS A total of N = 24 and N = 86 AYAs participated in pre-trial interviews and the RCT respectively. Interview participants reported a variety of informal financial support sources including savings, community, family/friends, and fundraisers. However, only half of participants reported their informal financial support to be sufficient. High financial toxicity was associated with the most types of informal financial support and a higher magnitude of use. The lowest income group accessed informal financial supports less frequently than higher income groups. CONCLUSION Our study demonstrates that AYA survivors experiencing financial toxicity frequently turn to informal sources of financial support and the magnitude is associated with financial toxicity. However, low-income survivors, and other at-risk survivors, may not have access to informal sources of financial support potentially widening inequities.
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Affiliation(s)
- Austin R Waters
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA.
| | - Karely M van Thiel Berghuijs
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
| | - Heydon K Kaddas
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
| | - Perla L Vaca Lopez
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
| | - Amy Chevrier
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
| | - Nicole Ray
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
| | - Tomoko Tsukamoto
- Intermountain Medical Oncology, Intermountain Healthcare, Murray, UT, USA
| | - Karlie Allen
- Patient and Public Education, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
| | - Douglas B Fair
- Deparment of Pediatrics, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Mark A Lewis
- Intermountain Medical Oncology, Intermountain Healthcare, Murray, UT, USA
| | - Giselle K Perez
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Elyse R Park
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Echo L Warner
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
- College of Nursing, University of Utah, Salt Lake City, UT, USA
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Shih YCT, Yabroff KR, Bradley CJ. Prescription Drug Provisions in the Inflation Reduction Act: Any Relief of Financial Hardship for Patients With Cancer? JAMA Oncol 2023; 9:165-167. [PMID: 36480188 PMCID: PMC10550564 DOI: 10.1001/jamaoncol.2022.5805] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This Viewpoint discusses the potential of provisions of the Inflation Reduction Act of 2022 to mitigate cancer-related financial hardship.
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Affiliation(s)
- Ya-Chen Tina Shih
- Section of Cancer Economics and Policy, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
| | - K Robin Yabroff
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, Georgia
| | - Cathy J Bradley
- University of Colorado Comprehensive Cancer Center and Colorado School of Public Health, Aurora
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Rubio C, Alfaro M, Mejia-Giraldo A, Fuertes G, Mosquera R, Vargas M. Multivariate analysis in data science for the geospatial distribution of the breast cancer mortality rate in Colombia. Front Oncol 2023; 12:1055655. [PMID: 36686819 PMCID: PMC9853892 DOI: 10.3389/fonc.2022.1055655] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023] Open
Abstract
This research is framed in the area of biomathematics and contributes to the epidemiological surveillance entities in Colombia to clarify how breast cancer mortality rate (BCM) is spatially distributed in relation to the forest area index (FA) and circulating vehicle index (CV). In this regard, the World Health Organization has highlighted the scarce generation of knowledge that relates mortality from tumor diseases to environmental factors. Quantitative methods based on geospatial data science are used with cross-sectional information from the 2018 census; it's found that the BCM in Colombia is not spatially randomly distributed, but follows cluster aggregation patterns. Under multivariate modeling methods, the research provides sufficient statistical evidence in terms of not rejecting the hypothesis that if a spatial unit has high FA and low CV, then it has significant advantages in terms of lower BCM.
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Affiliation(s)
- Carlos Rubio
- Facultad de Ingeniería, Universidad de San Buenaventura, Cali, Colombia
| | - Miguel Alfaro
- Industrial Engineering Department, University of Santiago de Chile, Santiago, Chile
| | | | - Guillermo Fuertes
- Industrial Engineering Department, University of Santiago de Chile, Santiago, Chile,Faculty of Engineering, Science and Technology, Universidad Bernardo O’Higgins, Santiago, Chile,*Correspondence: Guillermo Fuertes,
| | - Rodolfo Mosquera
- Escuela de Estudios Industriales y Empresariales, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Manuel Vargas
- Industrial Engineering Department, University of Santiago de Chile, Santiago, Chile
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Patel KB, Turner K, Alishahi Tabriz A, Gonzalez BD, Oswald LB, Nguyen OT, Hong YR, Jim HSL, Nichols AC, Wang X, Robinson E, Naso C, Spiess PE. Estimated Indirect Cost Savings of Using Telehealth Among Nonelderly Patients With Cancer. JAMA Netw Open 2023; 6:e2250211. [PMID: 36626174 PMCID: PMC9856804 DOI: 10.1001/jamanetworkopen.2022.50211] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
IMPORTANCE Patients with cancer typically have greater financial hardships and time costs than individuals without cancer. The COVID-19 pandemic has exacerbated this, while posing substantial challenges to delivering cancer care and resulting in important changes in care-delivery models, including the rapid adoption of telehealth. OBJECTIVE To estimate patient travel, time, and cost savings associated with telehealth for cancer care delivery. DESIGN, SETTING, AND PARTICIPANTS An economic evaluation of cost savings from completed telehealth visits from April 1, 2020, to June 30, 2021, in a single-institution National Cancer Institute-Designated Comprehensive Cancer Center. All patients aged 18 to 65 years who completed telehealth visits within the designated time frame and had a Florida mailing address documented in their electronic medical record were included in the study cohort. Data were analyzed from April 2020 to June 2021. MAIN OUTCOMES AND MEASURES The main outcome was estimated patient cost savings from telehealth, which included 2 components: costs of travel (defined as roundtrip distance saved from car travel) and potential loss of productivity due to the medical visit (defined as loss of income from roundtrip travel plus loss of income from in-person clinic visits). Two different models with a combination of 2 different mileage rates ($0.56 and $0.82 per mile) and census tract-level median hourly wages were used. RESULTS The study included 25 496 telehealth visits with 11 688 patients. There were 4525 (3795 patients) new or established visits and 20 971 (10 049 patients) follow-up visits. Median (IQR) age was 55.0 (46.0-61.0) years among the telehealth visits, with 15 663 visits (61.4%) by women and 18 360 visits (72.0%) by Hispanic non-White patients. According to cost models, the estimated mean (SD) total cost savings ranged from $147.4 ($120.1) at $0.56/mile to $186.1 ($156.9) at $0.82/mile. For new or established visits, the mean (SD) total cost savings per visit ranged from $176.6 ($136.3) at $0.56/mile to $222.8 ($177.4) at $0.82/mile, and for follow-up visits, the mean (SD) total cost savings per visit was $141.1 ($115.3) at $0.56/mile to $178.1 ($150.9) at $0.82/mile. CONCLUSIONS AND RELEVANCE In this economic evaluation, telehealth was associated with savings in patients time and travel costs, which may reduce the financial toxicity of cancer care. Expansion of telehealth oncology services may be an effective strategy to reduce the financial burden among patients with cancer.
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Affiliation(s)
- Krupal B. Patel
- Department of Head and Neck and Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida
- Department of Otolaryngology, Head and Neck Surgery, University of South Florida, Tampa
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Brian D. Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Laura B. Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Oliver T. Nguyen
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Young-Rock Hong
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville
| | - Heather S. L. Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Anthony C. Nichols
- Department of Otolaryngology, Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Xuefeng Wang
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Edmondo Robinson
- Department of Internal and Hospital Medicine, Moffitt Cancer Center, Tampa, Florida
- Center for Digital Health, Moffitt Cancer Center, Tampa, Florida
| | - Cristina Naso
- Virtual Health Program, Moffitt Cancer Center, Tampa, Florida
| | - Philippe E. Spiess
- Virtual Health Program, Moffitt Cancer Center, Tampa, Florida
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida
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Fradelos EC, Prapa PM, Tsaras K, Papagiannis D, Chatzi M, Papathanasiou IV, Guillen B, Saridi M, Souliotis K. The Validation of the COmprehensive Score for Financial Toxicity (COST) Scale in Greek Language. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1425:191-197. [PMID: 37581793 DOI: 10.1007/978-3-031-31986-0_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
The aim of this study was to investigate the psychometric properties of the Greek version of FACIT-COST, as well as to assess the levels of financial distress of patients suffering from lung cancer in relation to their quality of life and lung cancer symptom burden. This was a cross-sectional quantitative study. A self-assessment instrument was used to gather the data. The study involved 120 lung cancer patients who were treated using chemotherapy in a day clinic of a General Hospital in Athens. Data were collected with the COST-FACIT-v2 (used to assess the patients' financial toxicity), The 12-item Health Survey (SF-12), and functional Assessment of Cancer Therapy-Lung Symptom Index Questionnaire-7 items-version 4 (FACIT-FACT-LCS). Descriptive statistics as well as exploratory factor analysis performed all the statistical analyses, which were conducted using IBM SPSS Statistics 25 and had p-values with a significance level of 0.05. The majority of the participants were male (68.3%), married or cohabitated (81.3%), and had been diagnosed with microcell cancer (90%). The factor analysis resulted in one factor that interpreted 35% of the total variance. FACT-L (r = 0.365, p < 0.001), physical component SF-12 (r = 0.184, p = 0.045), and mental health component SF-12 (r = 0.268, p = 0.003) were positively correlated to FACIT-OST, as expected. The Greek validated COST-FACIT-v2 is a reliable tool in providing rapid assessment of cancer patients' level of financial distress.
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Affiliation(s)
| | | | | | | | - Maria Chatzi
- Department of Infections, University Hospital of Larissa, Larissa, Greece
| | | | | | - Maria Saridi
- Department of Nursing, University of Thessaly, Larissa, Greece
| | - Kyriakos Souliotis
- Department of Social and Education Policy, University of Peloponnese, Corinth, Greece
- Health Policy Institute, Athens, Greece
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63
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Prediction of chemotherapy-related complications in pediatric oncology patients: artificial intelligence and machine learning implementations. Pediatr Res 2023; 93:390-395. [PMID: 36302858 DOI: 10.1038/s41390-022-02356-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 10/08/2022] [Accepted: 10/12/2022] [Indexed: 11/08/2022]
Abstract
Although the overall incidence of pediatric oncological diseases tends to increase over the years, it is among the rare diseases of the pediatric population. The diagnosis, treatment, and healthcare management of this group of diseases are important. Prevention of treatment-related complications is vital for patients, particularly in the pediatric population. Nowadays, the use of artificial intelligence and machine learning technologies in the management of oncological diseases is becoming increasingly important. With the advancement of software technologies, improvements have been made in the early diagnosis of risk groups in oncological diseases, in radiology, pathology, and imaging technologies, in cancer staging and management. In addition, these technologies can be used to predict the outcome in chemotherapy treatment of oncological diseases. In this context, this study identifies artificial intelligence and machine learning methods used in the prediction of complications due to chemotherapeutic agents used in childhood cancer treatment. For this purpose, the concepts of artificial intelligence and machine learning are explained in this review. A general framework for the use of machine learning in healthcare and pediatric oncology has been drawn and examples of studies conducted on this topic in pediatric oncology have been given. IMPACT: Artificial intelligence and machine learning are advanced tools that can be used to predict chemotherapy-related complications. Algorithms can assist clinicians' decision-making processes in the management of complications. Although studies are using these methods, there is a need to increase the number of studies on artificial intelligence applications in pediatric clinics.
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64
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Muacevic A, Adler JR, Nittala MR, Duggar WN. The Emerging Boon of Information and Communication Technology in Multidisciplinary Cancer Care: A Force Multiplier With a Human Touch. Cureus 2023; 15:e33665. [PMID: 36788838 PMCID: PMC9917828 DOI: 10.7759/cureus.33665] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 01/13/2023] Open
Abstract
Cancer care (CC) is incredibly complex and requires the coordination of multiple disciplines for optimal outcomes. Historically, this has been accomplished with multidisciplinary tumor boards (MDTBs), but the benefits, while perhaps intuitive, have not always been demonstrated with sufficient research robustness and validity. We hypothesize that this difficulty in demonstrating the benefit of MDTBs may be related to a delay in decision-making and operationalizing those decisions. The history and value of MDTBs are presented as well as their weaknesses and limited demonstration of improved outcomes. A major weakness highlighted by the challenges of MDTBs is the concept of total package time (TPT) (rather, the inability to keep it as short as possible); any significant delays in CC for any discipline may have a deleterious impact on any given patient's care outcome. Drawing on our own experience with utilizing information and communication technology (ICT) during an effort to apply accountability theory to improve specifically radiation therapy package time (RTPT), we argue that similar principles will be applicable in the improvement of not only the TPT which relies on multiple disciplines, but other factors of CC as well, such as coordination. Experience with improvement in RTPT is discussed and the underlying theory is demonstrated as a sound methodology to apply beyond RTPT to TPT involving coordination of multiple disciplines and stands to lead to the full realization of the benefits of the multidisciplinary approach. The complexity of cancer means that real solutions to optimal outcomes are also, by nature, complex, but here simple accountability theory is demonstrated that may unlock the next phase of multidisciplinary coordination. In this work, we argue that the benefits of the MDTB format can be fully realized with the addition of ICT, a technological breakthrough in the past two decades, while not forgetting about continued human factors.
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65
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McGarvey N, Gitlin M, Fadli E, Chung KC. Out-of-pocket cost by cancer stage at diagnosis in commercially insured patients in the United States. J Med Econ 2023; 26:1318-1329. [PMID: 37907436 DOI: 10.1080/13696998.2023.2254649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 08/30/2023] [Indexed: 11/02/2023]
Abstract
AIMS Out-of-pocket (OOP) costs may constitute a substantial financial burden to patients diagnosed with cancer. Earlier stage diagnosis and treatment of cancers may promote decreased morbidity and mortality, subsequently also lowering costs. To better understand costs experienced by patients with cancer, OOP costs by stage post-diagnosis were estimated. MATERIALS AND METHODS A retrospective analysis was conducted using Optum's de-identified Integrated Claims-Clinical dataset with Enriched Oncology, which includes data from commercially insured members (June 1, 2015-July 31, 2020). Mean annual and cumulative OOP costs (co-pay + co-insurance + deductible) (2020 USD) were reported through a 3-year period post-cancer diagnosis among adult commercially insured members (not including Medicare Advantage members) diagnosed with staged breast, cervical, colorectal, lung, ovarian, or prostate cancer between January 1, 2016 and June 30, 2020 with continuous enrollment for ≥1-month post-diagnosis. RESULTS A total of 7,494 eligible members were identified who were diagnosed with breast, cervical, colorectal, lung, ovarian, or prostate cancer. A greater proportion of OOP costs were incurred in year 1 post-diagnosis but remained relatively high through year 3 post-diagnosis. Cumulative mean OOP costs were as high as $35,243 (lung stage IV) per commercially insured patient by year 3 post-diagnosis and were generally higher among those diagnosed at later stages (III/IV) than those diagnosed at earlier stages (I/II) across all cancers. LIMITATIONS Generalizability of these results is limited to those with commercial health insurance coverage. Additionally, cancer staging was dependent on accuracy of staging as recorded in the electronic medical record and as determined by Optum's proprietary algorithm using natural language processing. CONCLUSION Cumulative mean OOP costs among commercially insured patients during the 3-year period post-cancer diagnosis were substantial and generally higher among those with later stage cancer diagnoses. Diagnosis of cancer at earlier stages may allow for more timely treatment and lessen patient OOP costs.
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Affiliation(s)
| | | | - Ela Fadli
- BluePath Solutions, Los Angeles, CA, USA
| | - Karen C Chung
- GRAIL LLC, a subsidiary of Illumina Inc. currently held separate from Illumina Inc. under the terms of the Interim Measures Order of the European Commission dated 29 October 2021, Menlo Park, CA, USA
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66
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Ursolic Acid Analogs as Potential Therapeutics for Cancer. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27248981. [PMID: 36558113 PMCID: PMC9785537 DOI: 10.3390/molecules27248981] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
Ursolic acid (UA) is a pentacyclic triterpene isolated from a large variety of vegetables, fruits and many traditional medicinal plants. It is a structural isomer of Oleanolic Acid. The medicinal application of UA has been explored extensively over the last two decades. The diverse pharmacological properties of UA include anti-inflammatory, antimicrobial, antiviral, antioxidant, anti-proliferative, etc. Especially, UA holds a promising position, potentially, as a cancer preventive and therapeutic agent due to its relatively non-toxic properties against normal cells but its antioxidant and antiproliferative activities against cancer cells. Cell culture studies have shown interference of UA with multiple pharmacological and molecular targets that play a critical role in many cells signaling pathways. Although UA is considered a privileged natural product, its clinical applications are limited due to its low absorption through the gastro-intestinal track and rapid elimination. The low bioavailability of UA limits its use as a therapeutic drug. To overcome these drawbacks and utilize the importance of the scaffold, many researchers have been engaged in designing and developing synthetic analogs of UA via structural modifications. This present review summarizes the synthetic UA analogs and their cytotoxic antiproliferative properties reported in the last two decades.
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67
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Kansara M, Bhardwaj N, Thavaneswaran S, Xu C, Lee JK, Chang L, Madison RW, Lin F, Hsu E, Patel VK, Aleshin A, Oxnard GR, Simes J, Nimeiri H, Thomas DM. Early circulating tumor DNA dynamics as a pan-tumor biomarker for long-term clinical outcome in patients treated with durvalumab and tremelimumab. Mol Oncol 2022; 17:298-311. [PMID: 36426653 PMCID: PMC9892824 DOI: 10.1002/1878-0261.13349] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/13/2022] [Accepted: 11/09/2022] [Indexed: 11/27/2022] Open
Abstract
There is an urgent need to identify biomarkers of early response that can accurately predict the benefit of immune checkpoint inhibitors (ICI). Patients receiving durvalumab/tremelimumab had tumor samples sequenced before treatment (baseline) to identify variants for the design of a personalized circulating tumor (ctDNA) assay. ctDNA was assessed at baseline and at 4 and/or 8 weeks into treatment. Correlations between ctDNA changes to radiographic response and overall survival (OS) were made to assess potential clinical benefit. 35/40 patients (87.5%) had personalized ctDNA assays designed, and 29/35 (82.9%) had plasma available for baseline analysis, representing 16 unique solid tumor histologies. As early as 4 weeks after treatment, decline in ctDNA from baseline predicted improved OS (P = 0.0144; HR = 9.98) and ctDNA changes on treatment-supported and refined radiographic response calls. ctDNA clearance at any time through week 8 identified complete responders by a median lead time of 11.5 months ahead of radiographic imaging. ctDNA response monitoring is emerging as a dynamic, personalized biomarker method that may predict survival outcomes in patients with diverse solid tumor histologies, complementing and sometimes preceding standard-of-care imaging assessments.
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Affiliation(s)
- Maya Kansara
- The Kinghorn Cancer CentreGarvan Institute of Medical ResearchDarlinghurstNSWAustralia,Faculty of Medicine, St. Vincent's Clinical SchoolUNSW SydneyKensingtonNSWAustralia
| | | | - Subotheni Thavaneswaran
- The Kinghorn Cancer CentreGarvan Institute of Medical ResearchDarlinghurstNSWAustralia,Faculty of Medicine, St. Vincent's Clinical SchoolUNSW SydneyKensingtonNSWAustralia,National Health and Medical Research Council Clinical Trials CentreUniversity of SydneyNSWAustralia
| | - Chang Xu
- Foundation Medicine, Inc.CambridgeMAUSA
| | | | | | | | - Frank Lin
- The Kinghorn Cancer CentreGarvan Institute of Medical ResearchDarlinghurstNSWAustralia,Faculty of Medicine, St. Vincent's Clinical SchoolUNSW SydneyKensingtonNSWAustralia,National Health and Medical Research Council Clinical Trials CentreUniversity of SydneyNSWAustralia
| | - Eugene Hsu
- Radiology DepartmentSt Vincent's HospitalSydneyNSWAustralia
| | | | | | | | - John Simes
- National Health and Medical Research Council Clinical Trials CentreUniversity of SydneyNSWAustralia
| | | | - David M. Thomas
- The Kinghorn Cancer CentreGarvan Institute of Medical ResearchDarlinghurstNSWAustralia,Faculty of Medicine, St. Vincent's Clinical SchoolUNSW SydneyKensingtonNSWAustralia
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68
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Graboyes EM, Chaiyachati KH, Sisto Gall J, Johnson W, Krishnan JA, McManus SS, Thompson L, Shulman LN, Yabroff KR. Addressing Transportation Insecurity Among Patients With Cancer. J Natl Cancer Inst 2022; 114:1593-1600. [PMID: 36130286 PMCID: PMC9745432 DOI: 10.1093/jnci/djac134] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/18/2022] [Accepted: 05/04/2022] [Indexed: 01/11/2023] Open
Abstract
Health-care-related transportation insecurity is common in the United States. Patients with cancer are especially vulnerable because cancer care is episodic in nature, occurs over a prolonged period, is marked by frequent clinical encounters, requires intense treatments, and results in substantial financial hardship. As a result of transportation insecurity, patients with cancer may forego, miss, delay, alter, and/or prematurely terminate necessary care. Limited data suggest that these alterations in care have the potential to increase the rates of cancer recurrence and mortality and exacerbate disparities in cancer incidence, severity, and outcomes. Transportation insecurity also negatively impacts at the informal caregiver, provider, health system, and societal levels. Recognizing that transportation is a critical determinant of outcomes for patients with cancer, there are ongoing efforts to develop evidence-based protocols to identify at-risk patients and address transportation insecurity at federal policy, health system, not-for-profit, and industry levels. In 2021, the National Cancer Policy Forum of the National Academies of Science, Engineering, and Medicine sponsored a series of webinars addressing key social determinants of health including food, housing, and transportation among patients with cancer. This commentary summarizes the formal presentations and discussions related to transportation insecurity and will 1) discuss the heterogeneous nature of transportation insecurity among patients with cancer; 2) characterize its prevalence along the cancer continuum; 3) examine its multilevel consequences; 4) discuss measurement and screening tools; 5) highlight ongoing efforts to address transportation insecurity; 6) suggest policy levers; and 7) outline a research agenda to address critical knowledge gaps.
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Affiliation(s)
- Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Krisda H Chaiyachati
- Department of Medicine, Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Jerry A Krishnan
- Population Health Sciences Program, University of Illinois Chicago, Chicago, IL, USA
| | - Sapna S McManus
- Chief Diversity Office, Genentech Inc, San Francisco, CA, USA
| | | | - Lawrence N Shulman
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
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69
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Fan Q, Keene DE, Banegas MP, Gehlert S, Gottlieb LM, Yabroff KR, Pollack CE. Housing Insecurity Among Patients With Cancer. J Natl Cancer Inst 2022; 114:1584-1592. [PMID: 36130291 PMCID: PMC9949594 DOI: 10.1093/jnci/djac136] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/03/2022] [Accepted: 06/13/2022] [Indexed: 01/11/2023] Open
Abstract
Social determinants of health are the economic and environmental conditions under which people are born, live, work, and age that affect health. These structural factors underlie many of the long-standing inequities in cancer care and outcomes that vary by geography, socioeconomic status, and race and ethnicity in the United States. Housing insecurity, including lack of safe, affordable, and stable housing, is a key social determinant of health that can influence-and be influenced by-cancer care across the continuum, from prevention to screening, diagnosis, treatment, and survivorship. During 2021, the National Cancer Policy Forum of the National Academies of Science, Engineering, and Medicine sponsored a series of webinars addressing social determinants of health, including food, housing, and transportation insecurity, and their associations with cancer care and patient outcomes. This dissemination commentary summarizes the formal presentations and panel discussions from the webinar devoted to housing insecurity. It provides an overview of housing insecurity and health care across the cancer control continuum, describes health system interventions to minimize the impact of housing insecurity on patients with cancer, and identifies challenges and opportunities for addressing housing insecurity and improving health equity. Systematically identifying and addressing housing insecurity to ensure equitable access to cancer care and reduce health disparities will require ongoing investment at the practice, systems, and broader policy levels.
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Affiliation(s)
- Qinjin Fan
- Correspondence to: Qinjin Fan, PhD, Surveillance & Health Equity Science Department, American Cancer Society, 3380 Chastain Meadows Pkwy, NW Suite 200, Kennesaw, GA 30144, USA (e-mail: )
| | - Danya E Keene
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Matthew P Banegas
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, CA, USA
| | - Sarah Gehlert
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Laura M Gottlieb
- Social Interventions Research and Evaluation Network, University of California, San Francisco, CA, USA
| | - K Robin Yabroff
- Surveillance & Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - Craig E Pollack
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Johns Hopkins School of Nursing, Baltimore, MD, USA
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70
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Cancer in 2022. Cancer Discov 2022; 12:2733-2738. [PMID: 36458429 DOI: 10.1158/2159-8290.cd-22-1134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Excerpts from the 12th edition of the annual AACR Cancer Progress Report (https://cancerprogressreport.aacr.org/progress/) to U.S. Congress and the public highlight how medical research continues to extend and improve lives by accelerating advances in cancer prevention, detection, diagnosis, and treatment. Current challenges are described, and a call to action is issued.
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71
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Awareness of Prostate Cancer among the Sportsmen in the Republic of Serbia. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2022; 2022:8400768. [PMID: 36438931 PMCID: PMC9683981 DOI: 10.1155/2022/8400768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/01/2022] [Accepted: 10/05/2022] [Indexed: 11/18/2022]
Abstract
Prostate cancer is the second most commonly occurring cancer in men. Regardless of statistics, screening for prostate cancer is an individual decision and most male patients come for their first examination with an already developed disease, as they are not adequately informed. The study aimed to emphasize the importance of preventive tests for urological diseases in the Republic of Serbia, raise awareness about urinary problems, and present social marketing strategies for prevention. The results confirm the generally lower awareness of respondents under the age of 30, followed by those who finished university, go to the doctor two or three times a year, and receive information other than by watching TV. Implemented research indicates the influence of the marketing principles and social marketing strategies on possible target groups of the male population over 50, which is aimed at raising awareness of the importance of prevention of urological diseases and the expected changes in the health behavior of the target population.
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72
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Disease and debt: Findings from the 2019 Panel Study of Income Dynamics in the United States. Prev Med 2022; 164:107248. [PMID: 36087623 PMCID: PMC10068838 DOI: 10.1016/j.ypmed.2022.107248] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/18/2022] [Accepted: 09/02/2022] [Indexed: 11/20/2022]
Abstract
Medical debt has grown dramatically over the past few decades. While cancer and diabetes are known to be associated with medical debt, little is known about the impact of other medical conditions and health behaviors on medical debt. We analyzed cross-sectional data on 9174 households - spanning lower-income, middle-income, and higher-income based on the Census poverty threshold - participating in the 2019 wave of the nationally representative United States Panel Study of Income Dynamics (PSID). The outcomes were presence of any medical debt and presence of medical debt≥ $2000. Respondents reported on medical conditions (diabetes, cancer, heart disease, chronic lung disease, asthma, arthritis, anxiety disorders, mood disorders) and on health behaviors (smoking, heavy drinking). Medical debt was observed in lower-income households with heart disease (OR = 2.64, p-value = 0.006) and anxiety disorders (OR = 2.16, p-value = 0.02); middle-income households with chronic lung disease (OR = 1.73, p-value = 0.03) and mood disorders (OR = 1.53, p-value = 0.04); and higher-income households with a current smoker (OR = 2.99, p-value<0.001). Additionally, medical debt ≥$2000 was observed in lower-income households with asthma (OR = 2.16, p-value = 0.009) and a current smoker (OR = 1.62, p-value = 0.04); middle income households with hypertension (OR = 1.65, p-value = 0.05). These novel findings suggest that the harms of medical debt extend beyond cancer, diabetes and beyond lower-income households. There is an urgent need for policy and health services interventions to address medical debt in a wider range of disease contexts than heretofore envisioned. Intervention development would benefit from novel conceptual frameworks on the causal relationships between health behaviors, health conditions, and medical debt that center social-ecological influences on all three of these domains.
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73
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Wang C, Onega T, Wang F. Multiscale analysis of cancer service areas in the United States. Spat Spatiotemporal Epidemiol 2022; 43:100545. [PMID: 36460451 DOI: 10.1016/j.sste.2022.100545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 10/20/2022] [Accepted: 10/26/2022] [Indexed: 11/30/2022]
Abstract
The purpose of delineating Cancer Service Areas (CSAs) is to define a reliable unit of analysis, more meaningful than geopolitical units such as states and counties, for examining geographic variations of the cancer care markets using geographic information systems (GIS). This study aims to provide a multiscale analysis of the U.S. cancer care markets based on the 2014-2015 Medicare claims of cancer-directed surgery, chemotherapy, and radiation. The CSAs are delineated by a scale-flexible network community detection algorithm automated in GIS so that the patient flows are maximized within CSAs and minimized between them. The multiscale CSAs include those comparable in size to those 4 census regions, 9 divisions, 50 states, and also 39 global optimal CSAs that generates the highest modularity value. The CSAs are more effective in capturing the U.S. cancer care markets because of its higher localization index, lower cross-border utilizations, and shorter travel time. The first two comparisons reveal that only a few regions or divisions are representative of the underlying cancer care markets. The last two comparisons find that among the 39 CSAs, 54% CSAs comprise multiple states anchored by cities near inner state borders, 28% are single-state CSAs, and 18% are sub-state CSAs. Their (in)consistencies across state borders or within each state shed new light on where the intervention of cancer care delivery or the adjustment of cancer care costs are needed to meet the challenges in the U.S. cancer care system. The findings could guide stakeholders to target public health policies for more effective coordination of cancer care in improving outcomes and reducing unnecessary costs.
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Affiliation(s)
- Changzhen Wang
- Department of Geography, University of Alabama, Tuscaloosa, AL 35401, United States
| | - Tracy Onega
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, United States
| | - Fahui Wang
- The Graduate School and Department of Geography and Anthropology, Louisiana State University, Baton Rouge, LA 70803, United States.
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74
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Semprini J. Oral cancer screening prevalence in low-income adults before and after the ACA. Oral Oncol 2022; 134:106055. [PMID: 36029746 PMCID: PMC11129732 DOI: 10.1016/j.oraloncology.2022.106055] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/15/2022] [Accepted: 07/29/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Detecting oral cancer early is associated with higher probability of survival, reduced treatment costs, and improved quality of life. Unfortunately, <30% of oral cancers are detected early. Recent health insurance expansions from the Affordable Care Act (ACA) could improve outcomes by increasing access to screening. However, due to the differences in screening practices by physicians and dentists, the impact of expanded access to insurance on oral cancer screenings remains unknown. METHODS Self-reported oral cancer screening data were obtained from The National Health and Nutrition Examination Survey (NHANES) for years 2011-2017. NHANES questionnaires ask respondents if they have received an oral cancer screen from a physician or dentist in the past year. Along with adjusting for demographic characteristics, this study accounts for unobserved heterogeneity by comparing "Differences-in-Differences" estimates of low-income adults (<200 % FPL) with high-income adults, before and after the ACA (2014), for adults most exposed (<age 65) to insurance expansion. RESULTS Before and after the ACA, low-income adults had the lowest prevalence of oral cancer screenings. However, relative to high-income adults, the ACA was associated with a 5-6%-point increase in oral cancer screenings for low-income adults under age 65, but only for screenings performed by dentists. CONCLUSIONS Overall, oral cancer screening rates have been declining across the population, but the ACA may have slowed the decline in low-income adults. Understanding why oral cancer screenings are declining could inform cancer control policies. Research evaluating the impact of access to oral cancer screenings remains warranted.
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Affiliation(s)
- Jason Semprini
- University of Iowa, College of Public Health, Department of Health Management and Policy; University of Iowa College of Dentistry, 45 N. Riverside Dr. N265, Iowa City, IA 52242, United States.
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Cong Z, Tran O, Nelson J, Silver M, Chung K. Productivity Loss and Indirect Costs for Patients Newly Diagnosed with Early- versus Late-Stage Cancer in the USA: A Large-Scale Observational Research Study. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:845-856. [PMID: 36040661 PMCID: PMC9596506 DOI: 10.1007/s40258-022-00753-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The total economic burden of cancer reflects direct and indirect costs, including productivity loss due to employment change, absenteeism, and presenteeism of patients and caregivers. OBJECTIVE This study estimated the magnitude of employment decrease, work absence (WA), short-term disability (STD), long-term disability (LTD), and associated indirect costs among employees newly diagnosed with metastatic versus non-metastatic cancer in the USA. METHODS IBM® MarketScan® Commercial Claims and Encounters and Health and Productivity Management databases were used to identify employees aged 18-64 years and newly diagnosed with any cancer from 2009 to 2019. Proportions of patients with employment decrease, WA, STD, and LTD claims, and number of days missing from work were summarized by metastatic status during the first 12 months after diagnosis and the entire follow-up period. Subgroup analyses were conducted by age (< 50 years, ≥ 50 years) and cancer type (breast, lung, colon, pancreatic, and liver cancer). RESULTS During the first year after diagnosis, compared to patients without metastases, significantly higher proportions of patients with metastases had employment decrease and STD or LTD claims (p < 0.001). The mean total number of days missing from work for patients with versus without metastases was 33.39 versus 14.91 (ratio = 2.40), 64.05 versus 27.15 (ratio = 2.36), and 105.93 versus 46.29 (ratio = 2.29) days within 3, 6, and 12 months after diagnosis, respectively. Estimates of indirect cost differences between the two groups ranged from $6,877 to $22,283 in the first year. CONCLUSION Earlier detection of cancer may reduce productivity loss of patients and indirect costs by initiating treatment before cancer progresses to late stage.
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Affiliation(s)
- Ze Cong
- GRAIL, LLC, a subsidiary of Illumina, Inc., Menlo Park, CA, USA.
| | - Oth Tran
- Previously IBM Watson Health, San Francisco, USA
| | | | | | - Karen Chung
- GRAIL, LLC, a subsidiary of Illumina, Inc., Menlo Park, CA, USA
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76
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Weng X, Shen C, Van Scoy LJ, Boltz M, Joshi M, Wang L. End-of-Life Costs of Cancer Patients With Alzheimer's Disease and Related Dementias in the U.S. J Pain Symptom Manage 2022; 64:449-460. [PMID: 35931403 DOI: 10.1016/j.jpainsymman.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT End-of-Life (EOL) care consumes a substantial amount of healthcare resources, especially among older persons with cancer. Having Alzheimer's Disease and Related Dementias (ADRD) brings additional complexities to these patients' EOL care. OBJECTIVES To examine the Medicare expenditures at the EOL (last 12 months of life) among beneficiaries having cancer and ADRD vs. those without ADRD. METHODS A retrospective cohort study used 2004-2016 Surveillance, Epidemiology, and End Results-Medicare data. Patient populations were deceased Medicare beneficiaries with cancer (breast, lung, colorectal, and prostate) and continuously enrolled for 12 months before death. Beneficiaries with ADRD were propensity score matched with non-ADRD counterparts. Generalized Estimating Equation Model was deployed to estimate monthly Medicare expenditures. Generalized Linear Models were constructed to assess total EOL expenditures. RESULTS Eighty six thousand three hundred ninety-six beneficiaries were included (43,198 beneficiaries with ADRD and 43,198 beneficiaries without ADRD). Beneficiaries with ADRD utilized $64,901 at the EOL, which was roughly $407 more than those without ADRD ($64,901 vs. $64,494, P = 0.31). Compared to beneficiaries without ADRD, those with ADRD had 11% higher monthly expenditure and 7% higher in total expenditures. Greater expenditure was incurred on inpatient (5%), skilled nursing facility (SNF) (119%), home health (42%), and hospice (44%) care. CONCLUSION Medicare spending at the EOL per beneficiary was not statistically different between cohorts. However, specific types of service (i.e., inpatient, SNF, home health, and hospice) were significantly higher in the ADRD group compared to their non-ADRD counterparts. This study underscored the potential financial burden and informed Medicare about allocation of resources at the EOL.
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Affiliation(s)
- Xingran Weng
- Department of Public Health Sciences, Penn State College of Medicine (X.W., C.S., L.J.V.S., L.W.), Hershey, Pennsylvania, USA.
| | - Chan Shen
- Department of Public Health Sciences, Penn State College of Medicine (X.W., C.S., L.J.V.S., L.W.), Hershey, Pennsylvania, USA; Division of Outcomes, Research and Quality, Department of Surgery, Penn State College of Medicine (C.S.), Hershey, Pennsylvania, USA
| | - Lauren J Van Scoy
- Department of Public Health Sciences, Penn State College of Medicine (X.W., C.S., L.J.V.S., L.W.), Hershey, Pennsylvania, USA; Department of Medicine, Penn State College of Medicine (L.J.V.S.), Hershey, Pennsylvania, USA; Department of Humanities, Penn State College of Medicine (L.J.V.S.), Hershey, Pennsylvania, USA
| | - Marie Boltz
- Ross and Carole Nese Penn State College of Nursing (M.B.), University Park, Pennsylvania, USA
| | - Monika Joshi
- Division of Hematology-Oncology, Department of Medicine, Penn State Cancer Institute (M.J.), Hershey, Pennsylvania, USA
| | - Li Wang
- Department of Public Health Sciences, Penn State College of Medicine (X.W., C.S., L.J.V.S., L.W.), Hershey, Pennsylvania, USA
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Turcotte LM, Watson D, Tanner L, Hoover A, Gilchrist L, Finch M, Messinger YH. Real-World Cost of Pediatric Acute Lymphoblastic Leukemia Care Among Commercially Insured Individuals in the United States: Effect of Era and Age at Diagnosis. JCO Oncol Pract 2022; 18:e1750-e1761. [PMID: 36166724 PMCID: PMC9653200 DOI: 10.1200/op.22.00344] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/21/2022] [Accepted: 08/15/2022] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy. Five-year survival is approaching 90%. In efforts to further improve outcomes, it is critical to consider the cost of ALL care. MATERIALS AND METHODS Commercial insurance data from OptumLabs Data Warehouse were used to identify patients with ALL, age 1-30 years, diagnosed in 1993-2017 in the United States, with 36 months of continuous insurance coverage. Patients treated with hematopoietic cell transplantation were excluded. Inpatient and outpatient utilization and cumulative reimbursements (inflation-adjusted to December 2020) were computed 8 and 36 months from diagnosis and stratified by age (1-9, 10-12, and ≥ 13 years) as proxies for National Cancer Institute risk groups. Regression models were constructed to assess associations with demographic and clinical characteristics. RESULTS Among 927 patients (median age, 6 years; interquartile range, 3-12 years; 43% female), individuals age ≥ 10 years had 23-25 more inpatient days and 22 more outpatient encounters compared with younger patients. The 36-month median cost was $394,000 (USD) (interquartile range, $256,000-$695,000 [USD]), and 64% of the total cost was incurred during the initial 8 months. The 36-month cost was 1.5-fold higher for those age 10-12 years and 1.7-fold higher for those age ≥ 13 years compared with 1-9 years. The cost for those diagnosed in 2013-2017 was 70% higher compared with 1993-2002, and was not different on the basis of sex, race, or ethnicity. CONCLUSION Older age was associated with higher utilization and cost, and the cost of treatment increased significantly over time. These data provide valuable benchmarks for future studies examining the cost-benefit of ALL therapy modifications.
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Affiliation(s)
| | | | | | - Alex Hoover
- University of Minnesota Medical School, Minneapolis, MN
| | - Laura Gilchrist
- Children's Minnesota, Minneapolis, MN
- St Catherine University, St Paul, MN
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Armbruster C, Knaub M, Farin-Glattacker E, von der Warth R. Predictors of Adherence to Cancer-Related mHealth Apps in Cancer Patients Undergoing Oncological or Follow-Up Treatment-A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13689. [PMID: 36294265 PMCID: PMC9603736 DOI: 10.3390/ijerph192013689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
mHealth interventions in cancer care are being increasingly applied in various settings. Nevertheless, there is a phenomenon wherein individuals show different usage patterns, which could affect the effectiveness of the intervention. In general, it is important to know the predictors of app adherence and usage patterns to improve the design and content (i.e., tailoring). The aim of this scoping review was to provide an overview of predictors of adherence to cancer-related mHealth apps in cancer patients. A systematic literature search was conducted in March 2021 in the electronic databases PubMed, CINAHL, and PsychINFO without limitation in year, focusing on cancer patients undergoing oncological or follow-up treatment using mHealth apps. The initial database search yielded a total of N = 8035 records. After title, abstract, and full-text screening, 10 articles met inclusion criteria. Studies were published between 2013 and 2020. Studies focused on children and adolescents (2/10) as well as adults (8/10). The predictors identified could be categorized into sociodemographic variables, cancer-related factors and others. This study provides an initial insight into relevant predictors of app adherence in cancer patients. However, no clear predictor of increased app adherence was found. Further research of usage patterns is therefore needed so that mHealth interventions can be tailored during development.
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79
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Chan JSK, Satti DI, Lee YHA, Waleed KB, Tang P, Mahalwar G, Minhas AMK, Roever L, Biondi-Zoccai G, Leung FP, Wong WT, Liu T, Zhou J, Tse G. Association between visit-to-visit lipid variability and incident cancer: a population-based cohort study. Curr Probl Cardiol 2022; 48:101421. [PMID: 36167221 DOI: 10.1016/j.cpcardiol.2022.101421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 09/21/2022] [Indexed: 11/24/2022]
Abstract
Dyslipidaemia is associated with increased cancer risk. However, the prognostic value of visit-to-visit lipid variability (VVLV) is unexplored in this regard. To investigate the associations between VVLV and the risk of incident cancer, we conducted a retrospective cohort study on adult patients attending a family medicine clinic in Hong Kong during 2000-2003, excluding those with <3 tests for low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, and total cholesterol (TC) each, those with prior cancer diagnosis, and those with <1 year of follow-up. Visit-to-visit LDL-C, HDL-C, TC, and triglycerides variabilities were measured by the coefficient of variation (CV). Patients were followed up until 31st December 2019 for the primary outcome of incident cancer. Altogether, 69,186 patients were included (26,679 males (38.6%); mean age 60±13 years; mean follow-up 16±3 years); 7958 patients (11.5%) had incident cancer. Higher variability of LDL-C, HDL-C, TC, and TG was associated with higher risk of incident cancer. Patients in the third tercile of the CV of LDL-C (adjusted hazard ratio (aHR) against first tercile 1.06 [1.00, 1.12], p=0.049), HDL-C (aHR 1.37 [1.29, 1.44], p<0.001), TC (aHR 1.10 [1.04, 1.17], p=0.001), and TG (aHR 1.11 [1.06, 1.18], p<0.001) had the highest risks of incident cancer. Among these, only HDL-C variability remained associated with the risk of incident cancer in users of statins/fibrates. To conclude, higher VVLV was associated with significantly higher long-term risks of incident cancer. VVLV may be a clinically useful tool for cancer risk stratification.
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Affiliation(s)
- Jeffrey Shi Kai Chan
- Family Medicine Research Unit, Cardiovascular Analytics Group, United Kingdom - Hong Kong - China collaboration
| | - Danish Iltaf Satti
- Family Medicine Research Unit, Cardiovascular Analytics Group, United Kingdom - Hong Kong - China collaboration
| | - Yan Hiu Athena Lee
- Family Medicine Research Unit, Cardiovascular Analytics Group, United Kingdom - Hong Kong - China collaboration
| | - Khalid Bin Waleed
- Department of Cardiology, St George's University Hospital NHS Foundation Trust, London, United Kingdom
| | - Pias Tang
- Family Medicine Research Unit, Cardiovascular Analytics Group, United Kingdom - Hong Kong - China collaboration
| | - Gauranga Mahalwar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, Ohio, United States of America
| | - Abdul Mannan Khan Minhas
- Department of Medicine, Forrest General Hospital, Hattiesburg, Mississippi, United States of America
| | - Leonardo Roever
- Departamento de Pesquisa Clinica, Universidade Federal de Uberlandia, Uberlandia, MG, Brazil
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | - Fung Ping Leung
- School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Wing Tak Wong
- School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Jiandong Zhou
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China; Kent and Medway Medical School, Canterbury, Kent, CT2 7NT, United Kingdom; pidemiology Research Unit, Cardiovascular Analytics Group, United Kingdom - Hong Kong - China collaboration.
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80
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Miller KD, Nogueira L, Devasia T, Mariotto AB, Yabroff KR, Jemal A, Kramer J, Siegel RL. Cancer treatment and survivorship statistics, 2022. CA Cancer J Clin 2022; 72:409-436. [PMID: 35736631 DOI: 10.3322/caac.21731] [Citation(s) in RCA: 963] [Impact Index Per Article: 481.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 12/12/2022] Open
Abstract
The number of cancer survivors continues to increase in the United States due to 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 triennially 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 Database are presented for the most prevalent cancer types by race, and cancer-related and treatment-related side-effects are also briefly described. More than 18 million Americans (8.3 million males and 9.7 million females) with a history of cancer were alive on January 1, 2022. The 3 most prevalent cancers are prostate (3,523,230), melanoma of the skin (760,640), and colon and rectum (726,450) among males and breast (4,055,770), uterine corpus (891,560), and thyroid (823,800) among females. More than one-half (53%) of survivors were diagnosed within the past 10 years, and two-thirds (67%) were aged 65 years or older. One of the largest racial disparities in treatment is for rectal cancer, for which 41% of Black patients with stage I disease receive proctectomy or proctocolectomy compared to 66% of White patients. Surgical receipt is also substantially lower among Black patients with non-small cell lung cancer, 49% for stages I-II and 16% for stage III versus 55% and 22% for White patients, respectively. These treatment disparities are exacerbated by the fact that Black patients continue to be less likely to be diagnosed with stage I disease than White patients for most cancers, with some of the largest disparities for female breast (53% vs 68%) and endometrial (59% vs 73%). Although there are a growing number of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based strategies and equitable access to available resources are needed to mitigate disparities for communities of color and optimize care for people with a history of cancer. CA Cancer J Clin. 2022;72:409-436.
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Affiliation(s)
| | - Leticia Nogueira
- Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Theresa Devasia
- Data Analytics Branch, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - 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 and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Joan Kramer
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance Research, American Cancer Society, Atlanta, Georgia
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81
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Cancer; Pathophysiology and Stress Modulation (Cancer, Therapeutic Interventions). Semin Oncol Nurs 2022; 38:151328. [PMID: 35989196 DOI: 10.1016/j.soncn.2022.151328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this review is to describe the myriad complications of cancer and its therapies to emphasize the pathophysiological need for prehabilitation. DATA SOURCES The information presented in this review is from applicable, peer-reviewed scientific articles. CONCLUSION Cancer itself renders negative effects on the body, most notably unintentional weight loss and fatigue. Cancer treatments, especially surgical interventions, can cause detrimental short- and long-term impacts on patients, which translate to suboptimal treatment outcomes. Prehabilitation can be used to improve patient health prior to anticancer therapies to improve treatment tolerance and efficacy. IMPLICATIONS FOR NURSING PRACTICE Nurses play an important role in the treatment of patients with cancer throughout the cancer care continuum. Many nurses are already aiding their patients in cancer prehabilitation through education. By describing common impairments amenable to multimodal prehabilitation, nurses may better advocate for their patients and can become even more involved in this aspect of care.
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82
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Islami F, Marlow EC, Zhao J, Wiese D, Asare S, Bandi P, Thomson B, Zheng Z, Nargis N, Yabroff KR, Jemal A. Person-years of life lost and lost earnings from cigarette smoking-attributable cancer deaths, United States, 2019. Int J Cancer 2022; 151:2095-2106. [PMID: 35946832 DOI: 10.1002/ijc.34217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/07/2022] [Indexed: 11/11/2022]
Abstract
State-specific information on lost earnings due to smoking-attributable cancer deaths to inform and advocate for tobacco control policies is lacking. We estimated person-years of life lost (PYLL) and lost earnings due to cigarette smoking-attributable cancer deaths in the United States nationally and by state. Proportions and numbers of cigarette smoking-attributable cancer deaths and associated PYLL among individuals aged 25 to 79 years in 2019 were calculated and combined with annual median earnings to estimate lost earnings attributable to cigarette smoking. In 2019, estimated total PYLL and lost earnings associated with cigarette smoking-attributable cancer deaths in ages 25 to 79 years in the United States were 2 188 195 (95% CI, 2 148 707-2 231 538) PYLL and $20.9 billion ($20.0 billion-$21.7 billion), respectively. States with the highest overall age-standardized PYLL and lost earning rates generally were in the South and Midwest. The estimated rate per 100 000 population ranged from 352 (339-366) in Utah to 1337 (1310-1367) in West Virginia for PYLL and from $4.3 million ($3.5 million-$5.2 million) in Idaho to $14.8 million ($10.6 million-$20.7 million) in Missouri for lost earnings. If age-specific PYLL and lost earning rates in Utah had been achieved by all states, 58.2% (57.0%-59.5%) of the estimated total PYLL (1 274 178; 1 242 218-1 306 685 PYLL) and 50.5% (34.2%-62.4%) of lost earnings ($10.5 billion; $7.1 billion-$13.1 billion) in 2019 nationally would have been avoided. Lost earnings due to smoking-attributable cancer deaths are substantial in the United States and are highest in states with weaker tobacco control policies.
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Affiliation(s)
- Farhad Islami
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Emily C Marlow
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Jingxuan Zhao
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Daniel Wiese
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Samuel Asare
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Priti Bandi
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Blake Thomson
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Zhiyuan Zheng
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Nigar Nargis
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - K Robin Yabroff
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Ahmedin Jemal
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
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Treatment Costs of Colorectal Cancer by Sex and Age: Population-Based Study on Health Insurance Data from Germany. Cancers (Basel) 2022; 14:cancers14153836. [PMID: 35954499 PMCID: PMC9367511 DOI: 10.3390/cancers14153836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/27/2022] [Accepted: 08/03/2022] [Indexed: 11/17/2022] Open
Abstract
Objective: Evidence on the cost-effectiveness of screening for colorectal cancer (CRC) in the German general population remains scarce as key input parameters, the costs to treat CRC, are largely unknown. Here, we provide detailed estimates on CRC treatment costs over time. Methods: Using insurance claims data from the Vilua healthcare research database, we included subjects with newly diagnosed CRC and subjects who died of CRC between 2012 and 2016. We assessed annualized CRC-related inpatient, outpatient and medication costs for up to five years after first diagnosis and prior to death, stratified by sex and age. Findings: We identified 1748 and 1117 subjects with follow-up data for at least 1 year after diagnosis and prior to death, respectively. In those newly diagnosed, average costs were highest in the first year after diagnosis (men, EUR 16,375−16,450; women, EUR 10,071−13,250) and dropped steeply in the following years, with no consistent pattern of differences with respect to age. Costs prior to death were substantially higher as compared to the initial phase of care and consistently on a high level even several years before death, peaking in the final year of life, with strong differences by sex and age (men vs. women, <70 years, EUR 34,351 vs. EUR 31,417; ≥70 years, EUR 14,463 vs. EUR 9930). Conclusion: Once clinically manifest, CRC causes substantial treatment costs over time, particularly in the palliative care setting. Strong differences in treatment costs by sex and age warrant further investigation.
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84
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Williams CP, Davidoff A, Halpern MT, Mollica M, Castro K, Allaire B, de Moor JS. Cost-Related Medication Nonadherence and Patient Cost Responsibility for Rural and Urban Cancer Survivors. JCO Oncol Pract 2022; 18:e1234-e1246. [PMID: 35947881 PMCID: PMC9377697 DOI: 10.1200/op.21.00875] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 05/13/2022] [Accepted: 06/24/2022] [Indexed: 08/03/2023] Open
Abstract
PURPOSE The relationship between out-of-pocket spending and cost-related medication nonadherence among older rural- and urban-dwelling cancer survivors is not well understood. METHODS This retrospective cohort study used the Surveillance, Epidemiology, and End Results Program, Medicare claims, and the Consumer Assessment of Healthcare Providers and Systems survey linked data resource linked data (2007-2015) to investigate the relationship between cancer survivors' cost responsibility in the year before and after report of delaying or not filling a prescription medication because of cost in the past 6 months (cost-related medication nonadherence). Secondary exposures and outcomes included Medicare spending and utilization. Generalized linear models assessed bidirectional relationships between cost-related medication nonadherence, spending, and utilization. Effects of residence were assessed via interaction terms. RESULTS Of 6,591 older cancer survivors, 13% reported cost-related medication nonadherence. Survivors were a median 8 years (interquartile range, 4.5-12.5 years) from their cancer diagnosis, 15% were dually Medicare/Medicaid-eligible, and prostate (40%) and breast (32%) cancer survivors were most prevalent. With every $500 USD increase in patient cost responsibility, risk of cost-related medication nonadherence increased by 3% (risk ratio, 1.03; 95% CI, 1.02 to 1.04). After report of cost-related medication nonadherence, patient cost responsibility was 22% higher (95% CI, 1.11 to 1.32) compared with those not reporting nonadherence, amounting to $523 USD (95% CI, $430 USD to $630 USD). Medicare spending and utilization were also higher before and after report of cost-related nonadherence versus none. For survivors residing in rural (18%) and urban (82%) areas, residence did not modify adherence or cost outcomes. CONCLUSION A bidirectional relationship exists between patient cost responsibility and cost-related medication nonadherence. Interventions reducing urban- and rural-dwelling survivor health care costs and cost-related adherence barriers are needed.
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Affiliation(s)
- Courtney P. Williams
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Amy Davidoff
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Michael T. Halpern
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Michelle Mollica
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Kathleen Castro
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | | | - Janet S. de Moor
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
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85
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Stoeklé HC, Sekkate S, Ayoubi JM, Beuzeboc P, Hervé C. An ethics of HPV vaccination: beyond principlism. Hum Vaccin Immunother 2022; 18:2082793. [PMID: 35674781 PMCID: PMC9621076 DOI: 10.1080/21645515.2022.2082793] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Henri-Corto Stoeklé
- Department of Ethics and Scientific Integrity, Foch Hospital, Suresnes, France
| | - Sakina Sekkate
- Oncology and Supportive Care Department, Foch Hospital, Suresnes, France
| | - Jean-Marc Ayoubi
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hôpital Foch, Faculté de Médecine Paris Ouest (UVSQ), Suresnes, France
| | - Philippe Beuzeboc
- Oncology and Supportive Care Department, Foch Hospital, Suresnes, France
| | - Christian Hervé
- Department of Ethics and Scientific Integrity, Foch Hospital, Suresnes, France.,Medical School, University of Paris, Paris, France.,Medical School, Versailles-Saint-Quentin-en-Yvelines University, Montigny le Bretonneux, France.,International Academy of Medical Ethics and Public Health, University of Paris, Paris, France.,Veterinary Academy of France, Paris, France
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86
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Chow RD, Bradley EH, Gross CP. Comparison of Cancer-Related Spending and Mortality Rates in the US vs 21 High-Income Countries. JAMA HEALTH FORUM 2022; 3:e221229. [PMID: 35977250 PMCID: PMC9142870 DOI: 10.1001/jamahealthforum.2022.1229] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/06/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Ryan D. Chow
- MD-PhD Program, Yale School of Medicine, New Haven, Connecticut
| | | | - Cary P. Gross
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, Connecticut
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87
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Ascierto PA, Warner AB, Blank C, Caracò C, Demaria S, Gershenwald JE, Khushalani NI, Long GV, Luke JJ, Mehnert JM, Robert C, Rutkowski P, Tawbi HA, Osman I, Puzanov I. The "Great Debate" at Melanoma Bridge 2021, December 2nd-4th, 2021. J Transl Med 2022; 20:200. [PMID: 35538491 PMCID: PMC9087170 DOI: 10.1186/s12967-022-03406-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/24/2022] [Indexed: 11/10/2022] Open
Abstract
The Great Debate session at the 2021 Melanoma Bridge virtual congress (December 2-4) featured counterpoint views from experts on seven important issues in melanoma. The debates considered the use of adoptive cell therapy versus use of bispecific antibodies, mitogen-activated protein kinase (MAPK) inhibitors versus immunotherapy in the adjuvant setting, whether the use of corticosteroids for the management of side effects have an impact on outcomes, the choice of programmed death (PD)-1 combination therapy with cytotoxic T-lymphocyte-associated antigen (CTLA)-4 or lymphocyte-activation gene (LAG)-3, whether radiation is needed for brain metastases, when lymphadenectomy should be integrated into the treatment plan and then the last debate, telemedicine versus face-to-face. As with previous Bridge congresses, the debates were assigned by meeting Chairs and positions taken by experts during the debates may not have necessarily reflected their respective personal view. Audiences voted both before and after each debate.
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Affiliation(s)
- Paolo A Ascierto
- Department of Melanoma, Cancer Immunotherapy and Innovative Therapy, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy.
| | | | | | - Corrado Caracò
- Division of Surgery of Melanoma and Skin Cancer, Istituto Nazionale Tumori "Fondazione Pascale" IRCCS, Naples, Italy
| | - Sandra Demaria
- Department of Radiation Oncology, Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Jeffrey E Gershenwald
- Department of Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine & Health, The University of Sydney, Sydney, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, Australia.,Royal North Shore Hospital, Sydney, Australia
| | - Jason J Luke
- University of Pittsburgh Medical Center, UPMC) Hillman Cancer Center, Pittsburgh, PA, USA
| | - Janice M Mehnert
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Caroline Robert
- Institut de Cancérologie Gustave Roussy Et Université Paris-Saclay, Villejuif, France
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Hussein A Tawbi
- Melanoma Medical Oncology, Investigational Cancer Therapeutics, Division of Cancer Medicine, MD Anderson Brain Metastasis Clinic, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Iman Osman
- New York University Langone Medical Center, New York, NY, USA
| | - Igor Puzanov
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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88
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The Economic Burden of Cancer in Canada from a Societal Perspective. Curr Oncol 2022; 29:2735-2748. [PMID: 35448197 PMCID: PMC9025082 DOI: 10.3390/curroncol29040223] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/05/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022] Open
Abstract
Cancer patients and their families experience considerable financial hardship; however, the current published literature on the economic burden of cancer at the population level has typically focused on the costs from the health system’s perspective. This study aims to estimate the economic burden of cancer in Canada from a societal perspective. The analysis was conducted using the OncoSim-All Cancers model, a Canadian cancer microsimulation model. OncoSim simulates cancer incidence and deaths using incidence and mortality data from the Canadian Cancer Registry and demography projections from Statistics Canada. Using a phase-based costing framework, we estimated the economic burden of cancer in Canada in 2021 by incorporating published direct health system costs and patients’ and families’ costs (out-of-pocket costs, time costs, indirect costs). From a societal perspective, cancer-related costs were CAD 26.2 billion in Canada in 2021; 30% of costs were borne by patients and their families. The economic burden was the highest in the first year after cancer was diagnosed (i.e., initial care). During this time, patients and families’ costs amounted to almost CAD 4.8 billion in 2021. This study provides a comprehensive estimate of the economic burden of cancer, which could inform cost–benefit analyses of proposed cancer prevention interventions.
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89
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O'Rourke K. Cancer care causes financial hardship for patients: A new annual report examines the out-of-pocket cancer care costs for patients by age group and cancer type: A new annual report examines the out-of-pocket cancer care costs for patients by age group and cancer type. Cancer 2022; 128:1154-1155. [PMID: 35218212 DOI: 10.1002/cncr.34137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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90
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Leung N, Bernacki SE, Kalia N, Bernacki EJ, Almeida JRC. Long-Term Healthcare Utilization and the Cost of Bipolar Disorder Among Participants in a Large Employer's Health Benefit Plan. J Occup Environ Med 2022; 64:e124-e130. [PMID: 34935680 DOI: 10.1097/jom.0000000000002465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Bipolar disorder (BD) is a chronic illness with recurrent exacerbations. The objective was to evaluate longitudinal costs related to BD in an employer-sponsored medical plan. METHODS This analysis utilized 5 years of administrative claims data. Claimants with a diagnosis of BD were matched to plan members (1:5) based on age, sex, and years of follow-up. RESULTS Medical costs for hospitalized BD members were 3.5 times more expensive than the general population (BDhosp = $92.2K vs General population = $26.8K). Average 5-year paid costs among hospitalized members with BD was $107K, $105.4K with cancer, and $103.3K with myocardial infarction (MI). CONCLUSIONS Hospitalized BD plan members consumed more than 3.5 times the medical resources and were similar in longitudinal costs when compared with members with other costly conditions. These findings highlight the need for novel employer-sponsored programs to help manage BD.
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Affiliation(s)
- Nina Leung
- Department of Population Health (Dr Leung); Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland (Dr Leung, Dr Kalia, Dr Bernacki); Texas Mutual Insurance Company (Dr Leung); Campbell University School of Osteopathic Medicine, North Carolina (Dr Bernacki); General Electric, Cinncinati, Ohio (Dr Kalia); Department of Psychiatry and Behavior Sciences (Dr Almeida), Department of Population Health (Dr Leung, Dr Bernacki), Dell Medical School, the University of Texas at Austin, Austin, Texas
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91
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Hermansyah D, Zulhendri F, Perera CO, Firsty NN, Chandrasekaran K, Abdulah R, Herman H, Lesmana R. The Potential Use of Propolis as an Adjunctive Therapy in Breast Cancers. Integr Cancer Ther 2022; 21:15347354221096868. [PMID: 35593403 PMCID: PMC9127854 DOI: 10.1177/15347354221096868] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/01/2022] [Accepted: 04/10/2022] [Indexed: 11/24/2022] Open
Abstract
Propolis is a resinous beehive product that has a wide range of biological activities, namely antimicrobial, antioxidant, and anti-inflammatory properties. Propolis is collected by the bees from plant resin and exudates to protect hives and maintain hive homeostasis. The aim of the present systematic scoping review is to explore the potential and suitability of propolis as an adjunctive treatment in breast cancers, based on the latest available experimental evidence (2012-2021). After applying the exclusion criteria, a total of 83 research publications were identified and retrieved from Scopus, Web of Science, and Pubmed. Several relevant key themes identified from the included studies were cytotoxicity, synergistic/combination treatment, improvement in bioavailability, human clinical trials, and others. A majority of the studies identified were still in the in vitro and in vivo stages. Nonetheless, we managed to identify 4 human clinical trials that demonstrated the successful use of propolis in alleviating side effects of chemotherapy and radiotherapy while increasing the quality of life of breast cancer patients, with minimal adverse effects. In conclusion, propolis, as an adjunctive treatment, may have therapeutic benefits in alleviating symptoms related to breast cancers. However, further clinical trials, preferably with higher number of participants/subjects/patients, are urgently needed.
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Affiliation(s)
| | - Felix Zulhendri
- Universitas Padjadjaran, Bandung, Indonesia
- Kebun Efi, Kabanjahe, Indonesia
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92
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Medical Utilization of Emergency Departments among Patients with Prostate Cancer: A Nationwide Population-Based Study in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413233. [PMID: 34948836 PMCID: PMC8701110 DOI: 10.3390/ijerph182413233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/26/2021] [Accepted: 12/13/2021] [Indexed: 11/17/2022]
Abstract
(1) Background: In Taiwan, prostate cancer is a major malignancy with an increasing incidence among men. This study explores the medical utilization of emergency departments among patients with prostate cancer in Taiwan. (2) Methods: This nationwide, population-based study was conducted via a cross-sectional method based on the Registry for Catastrophic Illness Patient Database from Taiwan’s National Health Insurance Research Database. Patients with newly diagnosed prostate cancer between 1997 and 2013 were enrolled in the study and divided into four treatment-related groups. The rate of emergency department presentation, disease categorization of emergency department visits, emergency department-related medical expenditures, and temporal trends were investigated. (3) Results: A total of 18,728 patients with prostate cancer were identified between 1997 and 2013, for whom 13,098 emergency department visits were recorded. The number of emergency department visits increased during the study period. The incidence rate for the medical utilization of emergency department visits was 822 per 1000 people during the study period. The incidence rates for patients with prostate cancer in the radical prostatectomy, radiotherapy, androgen deprivation therapy, and chemotherapy groups were 549, 1611, 1101, and 372, respectively. The average medical expenditure per emergency department visit was TWD 3779.8 ± 5116.2, and the expenditure was recorded for the chemotherapy group at TWD 4690.8 ± 7043.3. The most common disease diagnoses among patients with prostate cancer who presented to the emergency department were injury/poisoning (16.79%), genitourinary disorders (10.66%), and digestive disorders (10.48%). (4) Conclusions: This nationwide population-based study examined the emergency department visits of patients with prostate cancer in Taiwan, providing useful information for improving the quality of medical care.
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93
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Islami F, Ward EM, Sung H, Cronin KA, Tangka FKL, Sherman RL, Zhao J, Anderson RN, Henley SJ, Yabroff KR, Jemal A, Benard VB. Annual Report to the Nation on the Status of Cancer, Part 1: National Cancer Statistics. J Natl Cancer Inst 2021; 113:1648-1669. [PMID: 34240195 PMCID: PMC8634503 DOI: 10.1093/jnci/djab131] [Citation(s) in RCA: 274] [Impact Index Per Article: 91.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/12/2021] [Accepted: 06/28/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The American Cancer Society, Centers for Disease Control and Prevention, National Cancer Institute, and North American Association of Central Cancer Registries collaborate to provide annual updates on cancer incidence and mortality and trends by cancer type, sex, age group, and racial/ethnic group in the United States. In this report, we also examine trends in stage-specific survival for melanoma of the skin (melanoma). METHODS Incidence data for all cancers from 2001 through 2017 and survival data for melanoma cases diagnosed during 2001-2014 and followed-up through 2016 were obtained from the Centers for Disease Control and Prevention- and National Cancer Institute-funded population-based cancer registry programs compiled by the North American Association of Central Cancer Registries. Data on cancer deaths from 2001 to 2018 were obtained from the National Center for Health Statistics' National Vital Statistics System. Trends in age-standardized incidence and death rates and 2-year relative survival were estimated by joinpoint analysis, and trends in incidence and mortality were expressed as average annual percent change (AAPC) during the most recent 5 years (2013-2017 for incidence and 2014-2018 for mortality). RESULTS Overall cancer incidence rates (per 100 000 population) for all ages during 2013-2017 were 487.4 among males and 422.4 among females. During this period, incidence rates remained stable among males but slightly increased in females (AAPC = 0.2%, 95% confidence interval [CI] = 0.1% to 0.2%). Overall cancer death rates (per 100 000 population) during 2014-2018 were 185.5 among males and 133.5 among females. During this period, overall death rates decreased in both males (AAPC = -2.2%, 95% CI = -2.5% to -1.9%) and females (AAPC = -1.7%, 95% CI = -2.1% to -1.4%); death rates decreased for 11 of the 19 most common cancers among males and for 14 of the 20 most common cancers among females, but increased for 5 cancers in each sex. During 2014-2018, the declines in death rates accelerated for lung cancer and melanoma, slowed down for colorectal and female breast cancers, and leveled off for prostate cancer. Among children younger than age 15 years and adolescents and young adults aged 15-39 years, cancer death rates continued to decrease in contrast to the increasing incidence rates. Two-year relative survival for distant-stage skin melanoma was stable for those diagnosed during 2001-2009 but increased by 3.1% (95% CI = 2.8% to 3.5%) per year for those diagnosed during 2009-2014, with comparable trends among males and females. CONCLUSIONS Cancer death rates in the United States continue to decline overall and for many cancer types, with the decline accelerated for lung cancer and melanoma. For several other major cancers, however, death rates continue to increase or previous declines in rates have slowed or ceased. Moreover, overall incidence rates continue to increase among females, children, and adolescents and young adults. These findings inform efforts related to prevention, early detection, and treatment and for broad and equitable implementation of effective interventions, especially among under resourced populations.
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Affiliation(s)
- Farhad Islami
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - Elizabeth M Ward
- North American Association of Central Cancer Registries, Springfield, IL, USA
| | - Hyuna Sung
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - Kathleen A Cronin
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Florence K L Tangka
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Recinda L Sherman
- North American Association of Central Cancer Registries, Springfield, IL, USA
| | - Jingxuan Zhao
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - Robert N Anderson
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, USA
| | - 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, GA, USA
| | - K Robin Yabroff
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - Ahmedin Jemal
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - Vicki B Benard
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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