National and State Estimates of Lost Earnings From Cancer Deaths in the United States

Diagnostic performance and inter-reader reliability of bone reporting and data system (Bone-RADS) on computed tomography

OBJECTIVE

To evaluate the diagnostic performance and inter-reader reliability of the Bone Reporting and Data System (Bone-RADS) for solitary bone lesions on CT.

MATERIALS AND METHODS

This retrospective analysis included 179 patients (mean age, 56 ± 18 years; 94 men) who underwent bone biopsies between March 2005 and September 2021. Patients with solitary bone lesions on CT and sufficient histopathology results were included. Two radiologists categorized the bone lesions using the Bone-RADS (1, benign; 4, malignant). The diagnostic performance of the Bone-RADS was calculated using histopathology results as a standard reference. Inter-reader reliability was calculated.

RESULTS

Bone lesions were categorized into two groups: 103 lucent (pathology: 34 benign, 12 intermediate, 54 malignant, and 3 osteomyelitis) and 76 sclerotic/mixed (pathology: 46 benign, 2 intermediate, 26 malignant, and 2 osteomyelitis) lesions. The Bone-RADS for lucent lesions had sensitivities of 95% and 82%, specificities of 11% and 11%, and accuracies of 57% and 50% for readers 1 and 2, respectively. The Bone-RADS for sclerotic/mixed lesions had sensitivities of 75% and 68%, specificities of 27% and 27%, and accuracies of 45% and 42% for readers 1 and 2, respectively. Inter-reader reliability was moderate to very good (κ = 0.744, overall; 0.565, lucent lesions; and 0.851, sclerotic/mixed lesions).

CONCLUSION

Bone-RADS has a high sensitivity for evaluating malignancy in lucent bone lesions and good inter-reader reliability. However, it has poor specificity and accuracy for both lucent and sclerotic/mixed lesions. A possible explanation is that proposed algorithms heavily depend on clinical features such as pain and history of malignancy.

A comprehensive review of phytoconstituents in liver cancer prevention and treatment: targeting insights into molecular signaling pathways

Primary liver cancer is a type of cancer that develops in the liver. Hepatocellular carcinoma is a primary liver cancer that usually affects adults. Liver cancer is a fatal global condition that affects millions of people worldwide. Despite advances in technology, the mortality rate remains alarming. There is growing interest in researching alternative medicines to prevent or reduce the effects of liver cancer. Recent studies have shown growing interest in herbal products, nutraceuticals, and Chinese medicines as potential treatments for liver cancer. These substances contain unique bioactive compounds with anticancer properties. The causes of liver cancer and potential treatments are discussed in this review. This study reviews natural compounds, such as curcumin, resveratrol, green tea catechins, grape seed extracts, vitamin D, and selenium. Preclinical and clinical studies have shown that these medications reduce the risk of liver cancer through their antiviral, anti-inflammatory, antioxidant, anti-angiogenic, and antimetastatic properties. This article discusses the therapeutic properties of natural products, nutraceuticals, and Chinese compounds for the prevention and treatment of liver cancer.

Quantifying the Value of Reduced Health Disparities: Low-Dose Computed Tomography Lung Cancer Screening of High-Risk Individuals Within the United States

OBJECTIVE

This study aimed to measure the value of increasing lung cancer screening rates for high-risk individuals and its impact on health disparities.

METHODS

The model estimated changes in health economic outcomes if low-dose computed tomography screening increased from current to 100% compliance, following clinical guidelines. Current low-dose computed tomography screening rates were estimated by income, education, and race, using 2017-2019 Behavioral Risk Factor Surveillance System data. The model contained a decision tree module to segment the population by screening outcomes and a Markov chain module to estimate cancer progression over time. Model parameters included information on survival, quality of life, and costs related to cancer diagnosis, treatment, and adverse events. Distributional cost-effectiveness analysis estimated the net monetary value from reduced health disparities-measured using quality-adjusted life expectancy-across income, education, and race groups. Outcomes were assessed over 30 years.

RESULTS

Lung cancer screening eligibility using US Preventive Services Task Force guidelines was higher for individuals with income <$15 000 (47.2%) and without a high-school education (46.1%) than individuals with income >$50 000 (16.6%) and with a college degree (13.5%), respectively. Increasing lung cancer screening to 100% compliance was cost-effective ($64 654 per quality-adjusted life-year) and produced economic value by up to $560 per person ($182.1 billion for United States overall). Up to 32.2% of the value was due to reductions in health disparities.

CONCLUSIONS

Significant value in increasing lung cancer screening rates derived from reducing health disparities. Policy makers and clinicians may not be appropriately prioritizing cancer screening if value from reducing health disparities is unconsidered.

Candidiasis in breast cancer: Tumor progression or not?

Candida albicans is an "opportunistic fungal agent" in cancer patients that can become colonized in both mucosal and deep tissues and cause severe infections. Most evidence has shown that C. albicans can enhance the progress of different cancers by several mechanisms such as generating virulence factors, participation in endogenous production of pro-inflammatory mediators, and stimulating a wide range of immune cells in the host. The main idea of this review is to describe a range of Candida-used mechanisms that are important in candidiasis-associated malignant processes and cancer development, particularly breast cancer. This review intends to provide a detailed discussion on different regulatory mechanisms of C. albicans that undoubtedly help to open new therapeutic horizons of cancer therapy in patients with fungal infection. The current therapeutic approach is not fully effective in immunocompromised and cancer patients, and further studies are required to find new products with effective antifungal properties and minimal side effects to increase the susceptibility of opportunistic fungal infections to conventional antifungal agents. So, in this situation, a special therapy should be considered to control the infection and simultaneously have the most therapeutic index on tumor patients.

Estimated impact of ECHELON-1 overall survival on productivity costs in stage III/IV classical Hodgkin lymphoma in the United States

BACKGROUND

A 2010 study on the impact of cancer mortality on productivity costs found Hodgkin lymphoma to have the second largest productivity cost lost per death in the United States. The ECHELON-1 trial demonstrated that frontline brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine (A+AVD) improves overall survival (OS) vs doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) in stage III/IV classical Hodgkin lymphoma (cHL), reducing the risk of death to 41% (hazard ratio = 0.59; 95% CI = 0.40-0.88; P = 0.009).

OBJECTIVES

To assess the estimated impact of frontline treatment choice on mortality and productivity using an oncology simulation model informed by ECHELON-1 data.

METHODS

Individual productivity was estimated using the human capital approach and reported via present value lifetime earnings (PVLE) estimates. Deaths avoided and lifeyears saved without and with A+AVD were calculated using a model informed by realworld treatment use, treatment-specific OS, and expert clinicians' opinions. A+AVD use in the base case was 27% (range: 0%-80%). Stage III/IV cHL prevalence over a 10-year period was estimated; downstream lifetime productivity costs were projected without and with A+AVD.

RESULTS

In 2031, 3,645 patients were estimated to be newly diagnosed with stage III/IV cHL. Over 10 years with 27% A+AVD vs no A+AVD use, estimates predicted 14% fewer deaths (2,290 vs 2,650) and 14% less total PVLE losses ($1.438 vs $1.664 billion). Results from scenario analyses (40%-80% vs no A+AVD use) showed 20% to 32% decreases in PVLE losses ($1.331-$1.137 billion vs $1.664 billion), saving up to $527 million over 10 years.

CONCLUSIONS

Productivity cost losses due to mortality in stage III/IV cHL are high. Increasing A+AVD use for patients with stage III/IV cHL would reduce productivity cost losses as deaths are avoided, based on ECHELON-1 OS results.

Historical Perspective on Lung Cancer Screening

Lung cancer represents a large burden on society with a staggering incidence and mortality rate that has steadily increased until recently. The impetus to design an effective screening program for the deadliest cancer in the United States and worldwide began in 1950. It has taken more than 50 years of numerous clinical trials and continued persistence to arrive at the development of modern-day screening program. As the program continues to grow, it is important for clinicians to understand its evolution, track outcomes, and continually assess the impact and bias of screening on the medical, social, and economic systems.

Biomarkers and biosensors for early cancer diagnosis, monitoring and prognosis

Cancers continue to be of major concern due to their serious global socioeconomic impact, apart from the continued increase in the incidence of various cancer types. A major challenge that this disease poses is due to the low "early detection" rates which limit the therapeutic outcomes for the affected individuals. Current research has highlighted the discovering biomarkers that help in early cancer detection and the development of technologies for the detection and quantification of such biomarkers. Biomarkers range from proteins to nucleic acids, and can be specific to a particular cancer type. Detection and quantification of such biomarkers at low levels from biological samples is being made possible by the advent of developing biosensors and by using biomedical engineering technologies such as tumor-on-a-chip models. Here, we present biomarkers that can be helpful for the early detection of breast, colorectal, esophageal, lung, liver, ovarian, and prostate cancer. In addition, we discuss the potential of circulating tumor cell DNA (ctDNA) as an early diagnostic marker. Finally, biosensors available for the detection of cancer biomarkers, which is a recent advancement in this area of research, are discussed.

The Disease Burden and Economic Burden of Cancer in 9 Countries in the Middle East and Africa

OBJECTIVES

The objective of this study was to characterize the epidemiological development of cancer in the Middle East and Africa since 2000 and to quantify its current economic impact.

METHODS

Nine countries were studied: Algeria, Egypt, Jordan, Kuwait, Lebanon, Morocco, Saudi Arabia, South Africa, and the United Arab Emirates. Information on causes of death and disability-adjusted life-years (DALYs) was obtained from the World Health Organization. Information on cancer incidence was collected from local cancer registries and estimations by the World Health Organization. The economic burden of cancer was estimated from local health expenditure data and from age-specific mortality data.

RESULTS

Between 2000 and 2019, cancer went from third-leading to second-leading cause of death (10% to 13% of all deaths) across these 9 countries. It also climbed from the sixth-leading to third-leading cause of DALYs (6% to 8% of all DALYs). New cancer cases per 100 000 inhabitants increased by 10% to 100% between 2000 and 2019, whereas future increases until 2040 range from 27% in Egypt to 208% in the United Arab Emirates, solely because of expected demographic changes. The economic burden of cancer ranged from around USD 15 per capita in the 4 African countries to USD 79 in Kuwait in 2019.

CONCLUSIONS

Cancer is becoming one of the leading causes of disease burden in the Middle East and Africa. Patient numbers are expected to rise strongly in the coming decades. Increasing healthcare expenditure on appropriate cancer care is important to improve patient outcomes and can attenuate the economic impact of cancer on society.

Current and Emerging Treatments for Urothelial Carcinoma: A Focus on Enfortumab Vedotin

Urothelial carcinoma is a common malignancy that affects the urinary system, with bladder cancer being the most prevalent form. Although the management of early-stage disease has seen significant improvements, the treatment of locally advanced and metastatic urothelial carcinoma remains challenging. Over the past decade, there has been an explosion in the number of therapies available for the treatment of advanced disease, with immune checkpoint inhibitors and antibody-drug conjugates leading the way. Enfortumab vedotin is an antibody-drug conjugate that targets Nectin-4, a protein that is overexpressed in urothelial carcinoma cells. In clinical trials, it has shown promising outcomes for the treatment of advanced urothelial carcinoma that has progressed after chemotherapy or immunotherapy. The US Food and Drug Administration has granted expedited approval for enfortumab vedotin in the treatment of advanced urothelial carcinoma. This review provides an overview of the current and emerging treatments for urothelial carcinoma, with a particular focus on enfortumab vedotin. We discuss the mechanisms of action, clinical efficacy, safety, and ongoing research of enfortumab vedotin, along with the current landscape of other approved therapies and promising agents in development. The aim of this review is to provide a comprehensive and up-to-date summary of the available treatment options for urothelial carcinoma, including their limitations and future prospects.

Evaluation of the association between health insurance status and healthcare utilization and expenditures among adult cancer survivors in the United States

BACKGROUND

Health care expenditures for cancer care has increased significantly over the past decade and is further projected to rise. This study examined the associations between health insurance status and total direct health care expenditures and health care utilization among cancer survivors living in the United States.

METHODS

A cross-sectional study of cancer survivors aged ≥18 years, identified from the Medical Expenditures Panel Survey (MEPS) during 2017 using International Classification of Diseases, Tenth Revision codes specific for cancer. Health insurance was categorized into Private, Medicare, Medicaid, and uninsured. Multivariable ordinary least squares regression was used to examine the association between log expenditures and health insurance. Negative binomial regression with log link was used to obtain adjusted incident rate ratios (AIRR) for health care utilization. Survey weights were used to produce nationally representative estimates of the US population.

RESULTS

A total of 1140 (weighted = 13.9 million) cancer survivors were identified. Compared to the adjusted mean annual health care expenditures for the private group ($14,265; 95% confidence interval (CI): $12,645 to $16,092), the adjusted mean annual health care expenditures for the Medicare group were higher ($15,112; 95%CI: $13,361 to $17,092). As compared to the private group, the average annual expenditures for uninsured cancer survivors ($2315; 95%CI:1038 to $3501) was significantly lower and so was their health care utilization. Adjusted rates of ER visits for Medicaid were twice (AIRR:2.04; SE:0.28; p = 0.001) as compared to privately insured.

CONCLUSIONS

A difference in the average total direct expenditures between uninsured and privately insured patients was found. Uninsured had the lowest health care utilization while Medicaid reported significantly higher number of ER visits. Despite differences in program structures, health care expenditures across insurance types were similar. Lower utilization of health care services among uninsured suggests cost maybe a barrier to accessing care.

Population, Clinical, and Scientific Impact of National Cancer Institute's National Clinical Trials Network Treatment Studies

PURPOSE

In the United States, the National Cancer Institute National Cancer Clinical Trials Network (NCTN) groups have conducted publicly funded oncology research for 50 years. The combined impact of all adult network group trials has never been systematically examined.

METHODS

We identified randomized, phase III trials from the adult NCTN groups, reported from 1980 onward, with statistically significant findings for ≥ 1 clinical, time-dependent outcomes. In the subset of trials in which the experimental arm improved overall survival, gains in population life-years were estimated by deriving trial-specific hazard functions and hazard ratios to estimate the experimental treatment benefit and then mapping this trial-level benefit onto the US cancer population using registry and life-table data. Scientific impact was based on citation data from Google Scholar. Federal investment costs per life-year gained were estimated. The results were derived through December 31, 2020.

RESULTS

One hundred sixty-two trials comprised of 108,334 patients were analyzed, representing 29.8% (162/544) of trials conducted. The most common cancers included breast (34), gynecologic (28), and lung (14). The trials were cited 165,336 times (mean, 62.2 citations/trial/year); 87.7% of trials were cited in cancer care guidelines in favor of the recommended treatment. These studies were estimated to have generated 14.2 million (95% CI, 11.5 to 16.5 million) additional life-years to patients with cancer, with projected gains of 24.1 million (95% CI, 19.7 to 28.2 million) life-years by 2030. The federal investment cost per life-year gained through 2020 was $326 in US dollars.

CONCLUSION

NCTN randomized trials have been widely cited and are routinely included in clinical guidelines. Moreover, their conduct has predicted substantial improvements in overall survival in the United States for patients with oncologic disease, suggesting they have contributed meaningfully to this nation's health. These findings demonstrate the critical role of government-sponsored research in extending the lives of patients with cancer.

Baits-trap chip for accurate and ultrasensitive capture of living circulating tumor cells

Accurate analysis of living circulating tumor cells (CTCs) plays a crucial role in cancer diagnosis and prognosis evaluation. However, it is still challenging to develop a facile method for accurate, sensitive, and broad-spectrum isolation of living CTCs. Herein, inspired by the filopodia-extending behavior and clustered surface-biomarker of living CTCs, we present a unique baits-trap chip to achieve accurate and ultrasensitive capture of living CTCs from peripheral blood. The baits-trap chip is designed with the integration of nanocage (NCage) structure and branched aptamers. The NCage structure could "trap" the extended filopodia of living CTCs and resist the adhesion of filopodia-inhibited apoptotic cells, thus realizing the accurate capture (∼95% accuracy) of living CTCs independent of complex instruments. Using an in-situ rolling circle amplification (RCA) method, branched aptamers were easily modified onto the NCage structure, and served as "baits" to enhance the multi-interactions between CTC biomarker and chips, leading to ultrasensitive (99%) and reversible cell capture performance. The baits-trap chip successfully detects living CTCs in broad-spectrum cancer patients and achieves high diagnostic sensitivity (100%) and specificity (86%) of early prostate cancer. Therefore, our baits-trap chip provides a facile, accurate, and ultrasensitive strategy for living CTC isolation in clinical. STATEMENT OF SIGNIFICANCE: A unique baits-trap chip integrated with precise nanocage structure and branched aptamers was developed for the accurate and ultrasensitive capture of living CTCs. Compared with the current CTC isolation methods that are unable to distinguish CTC viability, the nanocage structure could not only "trap" the extended-filopodia of living CTCs, but also resist the adhesion of filopodia-inhibited apoptotic cells, thus realizing the accurate capture of living CTCs. Additionally, benefiting from the "baits-trap" synergistic effects generated by aptamer modification and nanocage structure, our chip achieved ultrasensitive, reversible capture of living CTCs. Moreover, this work provided a facile strategy for living CTC isolation from the blood of patients with early-stage and advanced cancer, exhibiting high consistency with the pathological diagnosis.

Feasibility of a Palliative Care Intervention within Routine Care of Hepatocellular Carcinoma: A Pilot Randomized Controlled Trial

Background: Patients with hepatocellular cancer (HCC) are at risk for poor quality of life (QoL) and high symptom burden, coupled with limited treatment options. Palliative care (PC) can play an important role in reducing the suffering of this population, but remains underutilized. Aim: To demonstrate feasibility of an outpatient PC intervention within HCC care. Methods: This is a pilot randomized controlled trial conducted at an academic center. All stages of HCC patients (except Barcelona Clinic Liver Cancer stage D) with a scheduled hepatology appointment were eligible. Patients were randomized to receive PC intervention or usual care (control arm). In the PC arm, patients received PC from a PC provider at enrollment and at three months from the baseline visit, in addition to continued standard of care. Control arm received only standard care. All patients completed FACT-Hep (Functional Assessment of Cancer Therapy-Hepatobiliary Cancer) and modified Edmonton Symptom Assessment Scale at baseline and at three-month visit. Descriptive statistics were utilized to summarize questionnaires, and change in QoL and symptoms from baseline to three months were compared between the two study groups. Results: Of the 109 approached, 57 patients (52.3%) consented to enroll, and 52 (91%) completed the study. QoL and symptom burden assessments demonstrated impaired QoL and high symptom burden in both arms of the study. At least 50% of enrolled patients in each arm had some degree of fatigue, pain, sleep disturbance, and appetite loss, at baseline. Post-intervention, symptom burden and QoL improved in the intervention arm and remained same or worsened in the control group. All FACT-Hep scores decreased numerically among controls and increased numerically among patients in the PC intervention group. Conclusion: Outpatient PC intervention within routine HCC care is feasible, and can potentially improve QoL and symptoms.

Prevalence, incidence, and mortality rates of breast cancer in Kazakhstan: data from the Unified National Electronic Health System, 2014-2019

Background

Although there are numerous sources of epidemiologic information on breast cancer in Kazakhstan, none of them have specifically examined the burden of this disease. Therefore, this article aims to provide an overview of the breast cancer prevalence, incidence, mortality, and distribution and changes over time in Kazakhstan based on nationwide large-scale healthcare data from the National Registry in order to encourage more research on the impact of various diseases at the regional and national levels.

Methods

The study cohort included all adult women older than 25 years who were diagnosed with breast cancer in any clinical setting of the Republic of Kazakhstan during the period of 2014-2019. The data were extracted from the Unified Nationwide Electronic Health System (UNEHS) to get an overview of descriptive statistics, incidence, prevalence, and mortality rate calculations and the Cox proportional hazards regression model. All survival functions and factors associated with mortality were tested for significance.

Results

The cohort population (n = 55,465) comprised subjects with the age at the diagnosis of breast cancer from 25 to 97 years, with a mean of 55.7 ± 12.0 years. The majority of the study population belonged to the age group 45-59 years, which is 44.8% of the cohort. The all-cause mortality rate of the cohort is 16%. The prevalence rate increased from 30.4 per 10,000 population in 2014 to 50.6 in 2019. The incidence rate varied from 4.5 per 10,000 population in 2015 to 7.3 in 2016. Mortality rates were stable and high in the senile age patients (75-89 years old). Breast cancer mortality was positively associated with women who had been diagnosed with diabetes, HR 1.2 (95% CI, 1.1-2.3), whereas it was negatively associated with arterial hypertension, HR 0.4 (95% CI, 0.4-0.5).

Conclusion

Overall, Kazakhstan is experiencing an increase in the incidence of breast cancer cases, but the mortality rate has started to decline. The switch to population mammography screening could reduce the breast cancer mortality rate. These findings should be utilized to help Kazakhstan determine what cancer control priorities should be utilized, including the need to implement efficient and affordable screening and prevention programs.

Productivity Loss and Indirect Costs for Patients Newly Diagnosed with Early- versus Late-Stage Cancer in the USA: A Large-Scale Observational Research Study

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.

Índice para predecir el riesgo de cáncer de pulmón

El cáncer de pulmón es la consecuencia de un crecimiento incontrolado y anormal de las células del pulmón, su incidencia y mortalidad es elevada en todo el mundo. El objetivo de este trabajo fue diseñar un índice para predecir el riesgo de desarrollar el cáncer de pulmón. Se realizó un estudio de casos y testigos desde el 1ro de enero de 2018 hasta 30 de junio de 2020, en pacientes diagnosticados con cáncer de pulmón en el hospital general universitario “Carlos Manuel de Céspedes” de Bayamo provincia de Granma. Los factores de mayor valor patogénico fueron índice tabáquico (OR = 5,21; IC = 2,57 a 10,55; p = 0,000) la fibrosis pulmonar (OR = 4,06; IC = 1,61 a 10,23; p = 0,000) y el antecedente familiar de cáncer (OR = 3,30; IC = 1,50 a 7,06; p = 0,000) todos de forma independiente. El índice clasificó correctamente al 78 % de los pacientes, con una sensibilidad (70,0 %) y la especificidad (86,0 %). Un área bajo la curva ROC de 0,802 (IC 95 % = 0,706 a 0,818; p = 0,000) indica que el índice discrimina mejor que el azar el riesgo de desarrollar el cáncer de pulmón de forma significativa. También la prueba de Hosmer y Lemeshow indica buena calibración del índice (p 0,489). El índice diseñado, a partir de los factores de riesgo independientes, permite predecir, el riesgo de desarrollar el cáncer de pulmón con adecuada validez. Palabras claves: cáncer de pulmón, factores de riesgo, índice

Persistent Disparities in Colorectal Cancer Screening: A Tell-Tale Sign for Implementing New Guidelines in Younger Adults

BACKGROUND

In May 2021, the U.S. Preventive Services Task Force began recommending initiating colorectal cancer screening at age 45 (vs. 50) years.

METHODS

We estimated prevalence of colorectal cancer screening (by colonoscopy, sigmoidoscopy, CT colonography, or stool-based tests) in adults ages 50 to 75 years using data from the National Health Interview Survey in 2000, 2003, 2005, 2008, 2010, 2013, 2015, and 2018. For each survey year, we estimated prevalence by age, race/ethnicity, educational attainment, family income, and health insurance. We also compared increases in prevalence of screening from 2000 to 2018 in 5-year age groups (50-54, 55-59, 60-64, 65-69, and 70-75 years).

RESULTS

Overall, prevalence of colorectal cancer screening increased from 36.7% in 2000 to 66.1% in 2018. Screening prevalence in 2018 was lowest for age 50 to 54 years (47.6%), Hispanics (56.5%), Asians (57.1%), and participants with less than a high school degree (53.6%), from low-income families (56.6%), or without insurance (39.7%). Increases in prevalence over time differed by five-year age group. For example, prevalence increased from 28.2% in 2000 to 47.6% in 2018 (+19.4%; 95% CI, 13.1-25.6) for age 50 to 54 years but from 46.4% to 78.0% (+31.6%; 95% CI, 25.4%-37.7%) for age 70 to 75 years. This pattern was consistent across race/ethnicity, educational attainment, family income, and health insurance.

CONCLUSIONS

Prevalence of colorectal cancer screening remains low in adults ages 50 to 54 years.

IMPACT

As new guidelines are implemented, care must be taken to ensure screening benefits are realized equally by all population groups, particularly newly eligible adults ages 45 to 49 years. See related commentary by Brawley, p. 1671.

Colorectal cancer in the 45-to-50 age group in the United States: a National Cancer Database (NCDB) analysis

BACKGROUND

Amid increasing awareness of early-onset colorectal cancer (CRC), guidelines in the United States (US) recently lowered the recommended routine CRC screening age from 50 to 45 in average-risk individuals. There are little data on the number of patients in this age group diagnosed with CRC prior to these changes. Our objective was to audit the historic CRC case trends and impact of CRC in the 45-to-50-year-old category prior to new screening recommendations.

METHODS

Colorectal adenocarcinoma cases in 45-to-50-year-old patients were queried from the NCDB (2004-2017). Cases were stratified by sex, race, and site. The disability-adjusted lost years (DALY) and lost earnings were estimated. The average annual percentage changes (AAPC) of CRC incidence were estimated using jointpoint analysis. The main outcome measures were DALY and lost earnings. Secondary outcome measures were the 2004-2017 AAPC and the cumulative incidence of potential CRC cases in the 45-to-50 cohort through 2030 without guideline changes.

RESULTS

67,442 CRC patients in the 45-to-50 demographic were identified. The CRC burden resulted 899,905 DALY and $17 billion in lost earnings. The 2004-2017 AAPC was 1.6%, with an estimated 13-year increase of 25%. There were sex-, race-, and anatomic site-specific discrepancies with estimated 13-year increases of 30% for males, 110% for American Indian/ Alaska Natives/ Asian American/ Pacific Islander races, and 31% for rectal cancer by 2030.

CONCLUSION

CRC has been steadily increasing in the 45-to-50 age group, with tremendous disability and cost ensuing. There is great potential benefit from lowering the recommended routine CRC screening age to 45. Targeted intervention could ensure the most vulnerable segments benefit from the new guidelines, in both reducing the incidence and improving survivorship in CRC patients.

Person-years of life lost and lost earnings from cigarette smoking-attributable cancer deaths, United States, 2019

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.

Controversies and challenges in lung cancer screening

Two large randomized controlled trials have shown mortality benefit from lung cancer screening (LCS) in high-risk groups. Updated guidelines by the United State Preventative Service Task Force in 2020 will allow for inclusion of more patients who are at high risk of developing lung cancer and benefit from screening. As medical clinics and lung cancer screening programs around the country continue to work on perfecting the LCS workflow, it is important to understand some controversial issues surrounding LCS that should be addressed. In this article, we identify some of these issues, including false positive rates of low-dose CT, over-diagnosis, cost expenditure, LCS disparities in minorities, and utility of biomarkers. We hope to provide clarity, potential solutions, and future directions on how to address these controversies.

Sustainable Green Synthesis of Yttrium Oxide (Y2O3) Nanoparticles Using Lantana camara Leaf Extracts: Physicochemical Characterization, Photocatalytic Degradation, Antibacterial, and Anticancer Potency

Due to their appropriate physicochemical properties, nanoparticles are used in nanomedicine to develop drug delivery systems for anticancer therapy. In biomedical applications, metal oxide nanoparticles are used as powerful and flexible multipurpose agents. This work described a green synthesis of Y₂O₃ nanoparticles (NPs) using the sol-gel technique with the use of aqueous leaf extracts of Lantana camara L (LC). These nanoparticles were characterized with the aid of different methods, including UV, X-ray diffraction (XRD), Fourier transformed infrared spectroscopy (FTIR), transmitted electron microscopy (TEM), and photocatalytic degradation. Y₂O₃ nanoparticles showed excellent antibacterial activity against Gram-positive Bacillus subtilis and Gram-negative Escherichia coli with a 10 to 15 mm inhibitory zone. Green Y₂O₃ NPs were released with a 4 h lag time and 80% sustained release rate, indicating that they could be used in drug delivery. In addition, the bioavailability of green Y₂O₃ NPs was investigated using cell viability in cervical cancer cell lines. These green-synthesized Y₂O₃ NPs demonstrated photocatalytic degradation, antibacterial, and anticancer properties.

Hypofractionated Radiation Therapy for Breast Cancer: Financial Risk and Expenditures in the United States, 2008 to 2017

PURPOSE

Rising cancer care expenditures and technological advancement of shorter radiation therapy regimens have drawn significant attention to the use of hypofractionated radiation therapy in clinical care. We examine the costs of hypofractionated whole breast irradiation (HF-WBI) compared with conventional whole breast irradiation (CF-WBI) in the United States and investigate the influences of patient characteristics and commercial insurance on HF-WBI use.

METHODS AND MATERIALS

In a retrospective study using private employer-sponsored insurance claims, a pooled cross-sectional evaluation of radiation therapy in patients with commercial insurance was performed from 2008 to 2017. The study population included female patients with early-stage breast cancer treated with lumpectomy and whole breast irradiation.

RESULTS

A total of 15,869 women received HF-WBI, and 59,328 received CF-WBI. HF-WBI use increased from 2008 to 2017. Community-level factors such as a higher proportion of college graduates and greater mixed racial composition were associated with increased HF-WBI use. Mean insurer-paid radiation therapy expenditures were significantly lower for HF-WBI versus CF-WBI (adjusted difference, $6375; 95% confidence interval, $6147-$6603). Mean patient out-of-pocket expenditure for HF-WBI was $139 less than that for CF-WBI. Geographic variation existed across the United States in HF-WBI use (range, 9.6%-36.2%), with no consistent relationship between HF-WBI use and corresponding average cost differences between HF-WBI and CF-WBI.

CONCLUSIONS

If trends continue, HF-WBI will soon become the dominant form of radiation treatment in the United States. Although HF-WBI represents significant savings to the health care system and individual patients, no evidence indicated that a financial disincentive had slowed adoption of HF-WBI. Therefore, multilevel approaches, including individuals, the community, and health policy, should be used to promote cost-effective cancer care. Innovations to policies on cost-effective radiation therapy treatment might consider non-financial incentives to promote HF-WBI use.

Cancer death and potential years of life lost in Feicheng City, China: Trends from 2013 to 2018

ABSTRACT

This study aimed to evaluate the impact of cancer-related mortality on life expectancy in Feicheng City.We extracted the death records and population data of Feicheng City from 2013 to 2018 through the Feicheng Center for Disease Control and Prevention. The mortality, premature mortality, cause-eliminated life expectancy, potential years of life lost (PYLL), average potential years of life lost (APYLL), annual change percentage (APC), and other indicators of cancer were calculated. The age-standardized rates were calculated using the sixth national census (2010).From 2013 to 2018, the mortality rate of cancer in Feicheng City was 221.55/100,000, and the standardized mortality rate was 166.37/100,000. The standardized mortality rate increased from 2013 to 2014 and then decreased annually. The premature mortality of cancer was 8.98% and showed a downward trend (APC = -2.47%, t = -3.10, P = .04). From 2013 to 2018, the average life expectancy of residents in Feicheng City was 78.63 years. Eliminating the impact of cancer, life expectancy could increase by 3.72 years. The rate of life loss caused by cancer in men was higher than that in women. The total life loss caused by cancer deaths was 126,870.50 person-years, the potential life loss rate was 22.51‰, and the average potential life loss was 13.30 years. The standardized potential years of life lost rate showed a downward trend (APC = -2.96%, t = -3.72, P = .02), and APYLL decreased by 1.98% annually (t = -5.44, P = .01). The top 5 malignant tumors in APYLL were leukemia, breast cancer, brain tumor, liver cancer, and ovarian cancer.Lung cancer, esophageal cancer, female breast cancer, and childhood leukemia have a great impact on the life expectancy of residents in Feicheng City. Effective measures need to be taken to reduce the disease burden of malignant tumors.

The impact of increasing multitarget stool DNA use among colorectal cancer screeners in a self-insured US employer population

Background: In the United States (US), colorectal cancer (CRC) is the second leading cause of cancer-related deaths. With the majority of the US population covered by employer-based health plans, employers can play a critical role in increasing CRC screening adherence, which may help avert CRC-related deaths. Therefore, it is important for self-insured employers to consider the impact of appropriate utilization of CRC screening options. Objective: To evaluate the impact of increasing multitarget stool DNA [mt-sDNA (Cologuard®)] use among CRC screeners from the perspective of a US self-insured employer. Methods:A 5-year Markov model was developed to quantify the budget impact of increasing mt-sDNA from 6% to 15% among average-risk screeners using colonoscopy, fecal immunological test, and mt-sDNA. Data on direct medical costs were obtained from published literature, Medicare CPT codes, and the Healthcare cost and Utilization project. Indirect costs included productivity loss due to workplace absenteeism for CRC screening and treatment. Results: With a hypothetical population of 100,000 employees with screeners aged 50-64 years, compared to status quo, increased mt-sDNA utilization resulted in no differences in the numbers of cancers detected and the overall direct and indirect cost savings were ~$214,000 ($0.04 per-employee-per-month) over 5 years. Most of the savings were due to a reduction in the direct medical expenditure related to CRC screening, adverse events, and productivity loss due to colonoscopy screening. Similar results were observed in the model simulation among screeners aged 45-64 years. Conclusion: Increased utilization of mt-sDNA for CRC screening averts direct and indirect medical costs from a self-insured US employer perspective.

Association Between Social Media Use and Cancer Screening Awareness and Behavior for People Without a Cancer Diagnosis: Matched Cohort Study

BACKGROUND

The use of social media in communications regarding cancer prevention is rapidly growing. However, less is known about the general population's social media use related to cancer screening awareness and behavior for different cancers.

OBJECTIVE

We aimed to examine the relationship between social media use and cancer screening awareness and behavior among people without a cancer diagnosis.

METHODS

Data were collected from the Health Information National Trends Survey 5 Cycle 1 to 3 in the United States (n=12,227). Our study included 10,124 participants without a cancer diagnosis and 3 measures of screening awareness (those who had heard of hepatitis C virus [HCV], human papillomavirus [HPV], and the HPV vaccine) and 4 measures of behavior (those who had prostate-specific antigen tests, Papanicolaou tests for cervical cancer, as well as breast cancer and colon cancer tests). Propensity-score matching was conducted to adjust for the sociodemographic variables between the social media user and nonuser participants. Multivariable logistic regression was used to assess the association of social media use by gender. Jackknife replicate weights were incorporated into the analyses.

RESULTS

Of the 3794 matched participants, 1861 (57.6% weighted) were male, and the mean age was 55.5 (SD 0.42) years. Compared to social media nonusers, users were more likely to have heard of HCV (adjusted odds ratio [aOR]=2.27, 95% CI, 1.29-3.98 and aOR=2.86, 95% CI, 1.51-5.40, for male and female users, respectively) and HPV (aOR=1.82, 95% CI, 1.29-2.58 and aOR=2.35, 95% CI, 1.65-3.33, for male and female users, respectively). In addition, female users were more likely to have heard of the HPV vaccine (aOR=2.06, 95% CI, 1.41-3.00). No significant associations were found between social media use and prostate-specific antigen tests in males, Papanicolaou tests and breast cancer tests in females, or colon cancer tests in both male and female users.

CONCLUSIONS

While social media services can potentially promote cancer screening awareness in the general population, but they did not improve screening behavior after adjusting for socioeconomic status. These findings strengthened our understanding of social media use in targeting health communications for different cancers.

Socioeconomic Status and Adult Gliomas Mortality Risk: An Observational Study Based on SEER Data

BACKGROUND

Socioeconomic status (SES) is presented as a complex structure and has not been studied adequately among adult patients with glioma. This study aims to identify the intrinsic linkages of community-level SES multivariables and discover the effects of the various patterns of these indicators on prognosis of adult gliomas.

METHODS

Based on data from the SEER (Surveillance Epidemiology and End Results) database, 44,816 adults diagnosed with gliomas from 2007 to 2016 were enrolled for the research. We first used factor analysis and cluster analysis to process SES data. Then, univariable and multivariable Cox proportional hazards models were used to analyze the risk indicators.

RESULTS

Four integrated SES factors were identified: factor 1, economic and social disadvantage (economic and education disadvantage); factor 2, immigration-associated characteristics (foreign-born, language isolation, less household room, recent interstate residential stability); factor 3, housing instability; and factor 4, absence of intrastate mobility. Factor 1 was a risk indicator for survival, whereas factor 2 and factor 4 were protective indicators. All patients fell into 7 cluster groups. Compared with cluster 1, clusters 2, 3, 4, and 7 had a better prognosis, whereas cluster 6 had a shorter survival.

CONCLUSIONS

The combinatorial patterns of SES indicators and pattern-based groups do influence the outcomes of adult gliomas. Special attention is given to patients living in areas with specialized economic-educational disadvantages, relocation instability, and immigration-related characteristics.

Dual role of microRNA-1297 in the suppression and progression of human malignancies

MicroRNAs (miRNAs) are endogenous, non-coding, single-stranded and tiny RNAs that modulate several biological functions, more importantly, the pathophysiology of numerous human cancers. They are bound with target mRNAs and thereby regulate gene expression at post-transcriptional levels. MiRNAs can either trigger cancer progression as an oncogene or alleviate it as a tumor suppressor. Abnormal expression of microRNA-1297 (miR-1297) has been noticed in several human cancers suggesting a distinct role for the miRNA in tumorigenesis. More specifically, it is both up-regulated and down-regulated in various cancers suggesting that it can act as both tumor suppressor and oncogene. This review systematically highlights the different roles of miR-1297 in the pathophysiology of human cancers, explains the mechanisms underlying miR-1297-mediated tumorigenesis, and discusses its potential prognostic, diagnostic, and therapeutic importance.

Scoping Review and Meta-Analysis Suggests that Cannabis Use May Reduce Cancer Risk in the United States

Introduction: Cannabis smoke contains carcinogens similar to tobacco, in addition to compounds with antitumor activity. Cannabis use reduces the risk of obesity and cannabinoids inhibit chronic inflammation, known causes of cancer. The net effect of Cannabis use on cancer risk is not known. Objective: To examine the association between Cannabis use and cancer risk in the United States. Methods: Identify and analyze published data on cancer risk in Cannabis users. Results: A total of 55 data points, consisting of risk ratios of cancer in Cannabis users and nonusers, were identified from 34 studies. Of these, 5 did not contain data essential for inclusion in the meta-analysis. The remaining data showed a nonsignificant trend to an association with reduced risk (relative risk [RR]=0.90, p>0.06, N=50) although heterogeneity is high (I²=72.4%). Removal of data with high risk of selection bias (defined as those from North Africa and those that failed to adjust for tobacco) and data with high risk of performance bias (defined as those with fewer than 20 cases or controls among Cannabis users) resulted in an RR <1.0 (RR=0.86, p<0.017, N=24) and large effect size (Hedges g=0.66), but did not decrease heterogeneity (I²=74.9). Of all cancer sites, only testicular cancer showed an RR value >1, although this was not significant and had a negligible effect size (RR=1.12, p=0.3, Hedges g=0.02). Following removal of testicular cancers the remaining data showed a decrease in risk (RR=0.87, p<0.025, N=41). Cancers of the head and neck showed a negative association with cancer risk (RR=0.83, p<0.05), with a large effect size (Hedges g=0.55), but high heterogeneity (I²=79.2%). RR did not reach statistical significance in the remaining cancer site categories (lung, testicular, obesity-associated, other). The data are consistent with a negative association between Cannabis use and nontesticular cancer, but there is low confidence in this result due to high heterogeneity and a paucity of data for many cancer types.

3D Bioprinted cancer models: Revolutionizing personalized cancer therapy

After cardiovascular disease, cancer is the leading cause of death worldwide with devastating health and economic consequences, particularly in developing countries. Inter-patient variations in anti-cancer drug responses further limit the success of therapeutic interventions. Therefore, personalized medicines approach is key for this patient group involving molecular and genetic screening and appropriate stratification of patients to treatment regimen that they will respond to. However, the knowledge related to adequate risk stratification methods identifying patients who will respond to specific anti-cancer agents is still lacking in many cancer types. Recent advancements in three-dimensional (3D) bioprinting technology, have been extensively used to generate representative bioengineered tumor in vitro models, which recapitulate the human tumor tissues and microenvironment for high-throughput drug screening. Bioprinting process involves the precise deposition of multiple layers of different cell types in combination with biomaterials capable of generating 3D bioengineered tissues based on a computer-aided design. Bioprinted cancer models containing patient-derived cancer and stromal cells together with genetic material, extracellular matrix proteins and growth factors, represent a promising approach for personalized cancer therapy screening. Both natural and synthetic biopolymers have been utilized to support the proliferation of cells and biological material within the personalized tumor models/implants. These models can provide a physiologically pertinent cell-cell and cell-matrix interactions by mimicking the 3D heterogeneity of real tumors. Here, we reviewed the potential applications of 3D bioprinted tumor constructs as personalized in vitro models in anticancer drug screening and in the establishment of precision treatment regimens.

Impacts of anticancer drug parity laws on mortality rates

This study investigates the impacts of anticancer drug parity laws on mortality rates in the United States using a difference-in-differences approach. Using data from 2004 to 2017 Compressed Mortality Files, we show that the anticancer drug parity laws reduce the mortality rate for head/neck malignant cancers but have no impact on malignant cancers of other types. We also rule out an insurance expansion channel that may influence the relationship between anticancer drug parity laws and malignant cancer mortality. Our results are robust to various specifications and falsification tests. Our findings imply that providing equal access to oral anticancer drugs is an effective tool for the prevention of premature mortality.

Population-level economic burden of lung cancer in China: Provisional prevalence-based estimations, 20172030

Objective

Population-level economic burden is essential for prioritizing healthcare resources and healthcare budget making in the future. However, little is known about the economic burden of lung cancer in China.

Methods

A prevalence-based approach was adopted to estimate the economic burden of lung cancer, including direct expenditure (medical and non-medical) and indirect cost (disability and premature death). Data on direct expenditure and work-loss days per patient in each year post-diagnosis were obtained from two primary surveys. Other parameters were obtained from literatures and official reports. Projections were conducted based on varying parameters. All expenditure data were reported in United States dollars (USD) using 2017 value (exchange rate: 1 USD= 6.760 CNY), with the discount rate of 3%.

Results

The total economic burden of lung cancer was estimated to be 25,069 million USD in China in 2017 (0.121% of gross domestic productivity, GDP). The estimated direct expenditure was 11,098 million USD, up to 1.43% of total healthcare expenditure for China, covering 10,303 million USD and 795 million USD for medical and non-medical expenditure, respectively. The estimated indirect cost was 13,971 million, including 1,517 million USD due to disability and 12,454 million USD due to premature death. Under current assumptions, the projected total economic burden would increase to 30.1 billion USD, 40.4 billion USD, and 53.4 billion USD in 2020, 2025, and 2030, accounting for 0.121%, 0.131%, and 0.146% of China’s GDP, respectively. However, if China meets the United Nation sustainable development goal of reducing premature death from non-communicable diseases by one-third by 2030, the total economic burden in 2030 would be 31.9 billion USD, 0.087% of China’s GDP.

Conclusions

The economic burden of lung cancer in China in 2017 is substantial and more likely to increase significantly in the future. Policy makers need to take urgent actions in budget making for health systems. The economic burden could be alleviated by reducing the disease burden of lung cancer via effective control and prevention actions.

Changes in mortality associated with cancer drug approvals in the United States from 2000 to 2016

AIMS

To estimate the extent to which the approvals of new pharmacological therapies were associated with cancer mortality in the USA between 2000 and 2016.

MATERIALS AND METHODS

The analysis quantified cancer drug approvals across the 15 tumor types with the highest incidence. Number of approvals in a given time period for each tumor was translated into a treatment stock measure, defined as a weighted sum of new indication approvals since 1976. The primary outcome was the annual tumor-specific cancer mortality, defined as the number of deaths per 100,000 U.S. population. The analysis used a multivariable ordinary least squares and a fixed effects model, controlling for incidence (new cases per 100,000 U.S. population) and the primary exposure, the treatment stock measure by year.

RESULTS

Between 2000 and 2016, deaths per 100,000 population across the 15 most common tumor types declined by 24%. Additionally, 10.2 new indications were approved per year across the 15 most common tumor types. Cancer drug approvals were associated with statistically significant deaths averted in 2016 for colorectal cancer (4,991, p = 0.004), lung cancer (33,825, p < 0.001), breast cancer (11,502, p < 0.001), non-Hodgkin's lymphoma (6,636, p < 0.001), leukemia (4,011, p < 0.001), melanoma (1,714, p < 0.001), gastric cancer (758, p = 0.019), and renal cancer (739, p < 0.001). Between 2000 and 2016, new cancer treatments were correlated with 1,291,769 (p < 0.001) total deaths prevented across the 15 most common tumor types.

LIMITATIONS AND CONCLUSIONS

Cancer drug approvals between 2000 and 2016 were associated with significant reduction in deaths from the most common cancers in the USA. Mortality changes were largest in prevalent tumor types with relatively more approvals, i.e. lung cancer, breast cancer, melanoma, lymphoma and leukemia. Future research evaluating the relationship between drug approvals and cancer mortality post 2016 is needed.

Theranostic Prospects of Graphene Quantum Dots in Breast Cancer

Breast cancer (BC) is increasing as a significant cause of mortality among women. In this context, early diagnosis and treatment strategies for BC are being developed by researchers at the cellular level using advanced nanomaterials. However, immaculate etiquette is the prerequisite for their implementation in clinical practice. Considering the stolid nature of cancer, combining diagnosis and therapy (theranostics) using graphene quantum dots (GQDs) is a prime focus and challenge for researchers. In a nutshell, GQDs is a new shining star among various fluorescent materials, which has acclaimed fame in a short duration in materials science and the biomedical field as well. From this perspective, we review various strategies in BC treatment using GQDs alone or in combination. In addition, the photophysical properties of GQDs explored in photothermal therapy, hyperthermia therapy, and photodynamic therapy are also discussed. Moreover, we also focus on the strategic use of GQDs both as drug carriers and as combinatorial-guided drug delivery motifs. This Review provides an update for the scientific community to plan and expand advanced theranostic horizons in BC using GQDs.

Productivity costs associated with metastatic breast cancer in younger, midlife, and older women

BACKGROUND

The objective of the current study was to estimate productivity costs due to metastatic breast cancer (mBC) via productive time lost among survivors and potential life-years lost from premature mortality among 3 age groups: younger (aged 18-44 years), midlife (aged 45-64 years), and older (aged ≥65 years) women.

METHODS

The authors estimated the number of work and home productivity days missed due to mBC by age group using data from the 2000 to 2016 National Health Interview Survey. Years of potential life lost (YPLL) due to mBC were calculated for each age group using 2015 National Vital Statistics System data. The authors valued both sources of lost productivity time using the Current Population Survey and prior studies.

RESULTS

The per-woman value of lost productive days (work and home) due to mBC ranged from $680 for older women to $5169 for younger women. In 2015, the value of lost work and home productivity days associated with mBC nationally was $67 million for younger women, $246 million for midlife women, and $66 million for older women. YPLL were highest among midlife women (403,786 life-years), followed by older women (248,522 life-years) and younger women (95,943 life-years). Midlife women were found to have the highest market value of YPLL ($4.1 billion), followed by younger women ($1.6 billion) and older women ($527 million).

CONCLUSIONS

The results of the current study demonstrated that mBC generates a high economic burden through lost productivity, especially among midlife women.

Multidisciplinary standards of care and recent progress in pancreatic ductal adenocarcinoma

Despite tremendous gains in the molecular understanding of exocrine pancreatic cancer, the prognosis for this disease remains very poor, largely because of delayed disease detection and limited effectiveness of systemic therapies. Both incidence rates and mortality rates for pancreatic cancer have increased during the past decade, in contrast to most other solid tumor types. Recent improvements in multimodality care have substantially improved overall survival, local control, and metastasis-free survival for patients who have localized tumors that are amenable to surgical resection. The widening gap in prognosis between patients with resectable and unresectable or metastatic disease reinforces the importance of detecting pancreatic cancer sooner to improve outcomes. Furthermore, the developing use of therapies that target tumor-specific molecular vulnerabilities may offer improved disease control for patients with advanced disease. Finally, the substantial morbidity associated with pancreatic cancer, including wasting, fatigue, and pain, remains an under-addressed component of this disease, which powerfully affects quality of life and limits tolerance to aggressive therapies. In this article, the authors review the current multidisciplinary standards of care in pancreatic cancer with a focus on emerging concepts in pancreatic cancer detection, precision therapy, and survivorship.

Mobile Lung Screening: Should We All Get on the Bus?

BACKGROUND

Despite favorable recommendations, national lung screening adoption remains low (2% to 3%). Patients living in rural areas have additional challenges, including access to lung screening programs. We initiated a mobile lung screening program to serve the rural patients at risk. This is what we learned from this 12-month feasibility project.

METHODS

Utilizing a multidisciplinary approach, we began an 8-month design and build schedule. This was the first build of this type. The operational team included a radiology technician, nurse practitioner, driver with a commercial driver's license, and program developer. Specialized software was used for data mining. Downstream revenue projections were based on previously published Medicare claims data. Generally accepted accounting principles were used.

RESULTS

The prototype bus was delivered January 2018. During the 12-month feasibility period, we performed 548 low-dose lung screenings at 104 sites. Mean patient age was 62 years, mean pack-years of smoking was 41; 258 (47%) were male. Five lung cancers were found in addition to a type B thymoma. Financially, we exceeded the break-even analysis by 28%. The 5-year pro forma using 1 year of actual data and 4 additional years of projected data demonstrated a net present value of 1 million, internal rate of return of 34.6%, and profitability index of 2.2-all highly dependent on downstream revenue.

CONCLUSIONS

Although challenges exist, a commercially viable bus and a financially sound mobile program can be developed. However, without a centralized approach for incidental findings, the downstream revenue may be at risk as well as the financial viability of the project.

Racial/Ethnic Disparities in Lost Earnings From Cancer Deaths in the United States

Background

Little is known about disparities in economic burden due to premature cancer deaths by race or ethnicity in the United States. This study aimed to compare person-years of life lost (PYLLs) and lost earnings due to premature cancer deaths by race/ethnicity.

Methods

PYLLs were calculated using recent national cancer death and life expectancy data. PYLLs were combined with annual median earnings to generate lost earnings. We compared PYLLs and lost earnings among individuals who died at age 16-84 years due to cancer by racial/ethnic groups (non-Hispanic [NH] White, NH Black, NH Asian or Pacific Islander, and Hispanic).

Results

In 2015, PYLLs due to all premature cancer deaths were 6 512 810 for NH Whites, 1 196 709 for NH Blacks, 279 721 for NH Asian or Pacific Islanders, and 665 968 for Hispanics, translating to age-standardized lost earning rates (per 100 000 person-years) of $34.9 million, $43.5 million, $22.2 million, and $24.5 million, respectively. NH Blacks had higher age-standardized PYLL and lost earning rates than NH Whites for 13 of 19 selected cancer sites. If age-specific PYLL and lost earning rates for NH Blacks were the same as those of NH Whites, 241 334 PYLLs and $3.2 billion lost earnings (22.6% of the total lost earnings among NH Blacks) would have been avoided. Disparities were also observed for average PYLLs and lost earnings per cancer death for all cancers combined and 18 of 19 cancer sites.

Conclusions

Improving equal access to effective cancer prevention, screening, and treatment will be important in reducing the disproportional economic burden associated with racial/ethnic disparities.

Improving Multi-Tumor Biomarker Health Check-up Tests with Machine Learning Algorithms

BACKGROUND

Tumor markers are used to screen tens of millions of individuals worldwide at annual health check-ups, especially in East Asia. Machine learning (ML)-based algorithms that improve the diagnostic accuracy and clinical utility of these tests can have substantial impact leading to the early diagnosis of cancer.

METHODS

ML-based algorithms, including a cancer screening algorithm and a secondary organ of origin algorithm, were developed and validated using a large real world dataset (RWD) from asymptomatic individuals undergoing routine cancer screening at a Taiwanese medical center between May 2001 and April 2015. External validation was performed using data from the same period from a separate medical center. The data set included tumor marker values, age, and gender from 27,938 individuals, including 342 subsequently confirmed cancer cases.

RESULTS

Separate gender-specific cancer screening algorithms were developed. For men, a logistic regression-based algorithm outperformed single-marker and other ML-based algorithms, with a mean area under the receiver operating characteristic curve (AUROC) of 0.7654 in internal and 0.8736 in external cross validation. For women, a random forest-based algorithm attained a mean AUROC of 0.6665 in internal and 0.6938 in external cross validation. The median time to cancer diagnosis (TTD) in men was 451.5, 204.5, and 28 days for the mild, moderate, and high-risk groups, respectively; for women, the median TTD was 229, 132, and 125 days for the mild, moderate, and high-risk groups. A second algorithm was developed to predict the most likely affected organ systems for at-risk individuals. The algorithm yielded 0.8120 sensitivity and 0.6490 specificity for men, and 0.8170 sensitivity and 0.6750 specificity for women.

CONCLUSIONS

ML-derived algorithms, trained and validated by using a RWD, can significantly improve tumor marker-based screening for multiple types of early stage cancers, suggest the tissue of origin, and provide guidance for patient follow-up.

Association of Sociodemographic and Health-Related Factors With Receipt of Nondefinitive Therapy Among Younger Men With High-Risk Prostate Cancer

IMPORTANCE

Multiple randomized clinical trials have shown that definitive therapy improves overall survival among patients with high-risk prostate cancer. However, many patients do not receive definitive therapy because of sociodemographic and health-related factors.

OBJECTIVE

To identify factors associated with receipt of nondefinitive therapy (NDT) among patients aged 70 years and younger with high-risk prostate cancer.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study identified 72 036 patients aged 70 years and younger with high-risk prostate cancer and Charlson Comorbidity Index scores of 2 or less who were entered in the National Cancer Database between January 2004 and December 2014. Data analysis was conducted from November 2018 to December 2019.

EXPOSURE

Receipt of NDT as an initial treatment approach.

MAIN OUTCOMES AND MEASURES

Survival rates were compared based on receipt of definitive therapy or NDT, and sociodemographic and health-related factors were associated with the type of therapy received. Residual life expectancy was estimated from the National Center for Health Statistics to calculate person-years of life lost.

RESULTS

A total of 72 036 men with a median (range) age of 63 (30-70) years, Charlson Comorbidity Index scores of 2 or less, and high-risk prostate cancer without regional lymph node or distant metastatic disease were analyzed. Among eligible patients, 5252 (7.3%) received NDT as an initial therapeutic strategy. On univariate and multivariate analyses, NDT was associated with worse overall survival (univariate analysis hazard ratio, 2.54; 95% CI, 2.40-2.69; P < .001; multivariate analysis hazard ratio, 2.40; 95% CI, 2.26-2.56; P < .001). Compared with patients with private insurance or managed care, those with no insurance, Medicaid, or Medicare were more likely to receive systemic therapy only (no insurance: odds ratio [OR], 3.34; 95% CI, 2.81-3.98; P < .001; Medicaid: OR, 2.92; 95% CI, 2.48-3.43; P < .001; Medicare: OR, 1.36; 95% CI, 1.20-1.53; P < .001) or no treatment (no insurance: OR, 2.63; 95% CI, 2.24-3.08; P < .001; Medicaid: OR, 1.71; 95% CI, 1.45-2.01; P < .001; Medicare: OR, 1.14; 95% CI, 1.04-1.24; P = .004). Compared with white patients, black patients were more likely to receive systemic therapy only (OR, 1.93; 95% CI, 1.74-2.14; P < .001) or no treatment (OR, 1.46; 95% CI, 1.32-1.61; P < .001), and Hispanic patients were more likely to receive systemic therapy only (OR, 1.36; 95% CI, 1.13-1.64; P = .001) or no treatment (OR, 1.36; 95% CI, 1.14-1.60; P < .001). Between 2004 and 2014, patients without insurance or enrolled in Medicaid had 1.83-fold greater person-years of life lost compared with patients with private insurance (area under the curve, 77 600 vs 42 300 person-years of life lost).

CONCLUSIONS AND RELEVANCE

In this study, receipt of NDT was associated with insurance status and race/ethnicity. While treatment decisions should be individualized for every patient, younger men with high-risk prostate cancer and minimal comorbidities should be encouraged to receive definitive local therapy regardless of other factors. These data suggest that significant barriers to life-extending treatment options for patients with prostate cancer remain.

Exploring Novel Technologies in Lung Cancer Diagnosis: Do We Have Room for Improvement?

Lung cancer remains the leading cause of cancer-related death worldwide. Preventive strategies, mainly smoking cessation have a big impact on the reduction of lung cancer-related mortality. Screening with low dose computed tomography (LDCT) has proven to be beneficial in reducing the mortality related to lung cancer mainly based on early detection of cancer and timely initiation of treatment. Despite its beneficial effects, guideline-directed LDCT screening could lead to high false positive results, subjecting patients to harmful radiation, increase cost of healthcare and induce anxiety amongst the patients. Thus, it is imperative to look beyond the prevailing modalities of lung cancer screening and diagnosis to achieve better yield and mitigate the existent drawbacks.

Assessing the Costs of Screening for Ovarian Cancer in the United States: An Evolving Analysis

The primary objective of this study is to provide an updated analysis of the cost of screening for ovarian cancer in the United States. Here, we use updated information from the University of Kentucky Ovarian Cancer Screening Trial in conjunction with new modifying factors such as U.S. national estimates of the cost of care (Truven Health MarketScan Database), recently published estimates of earnings lost due to ovarian cancer death and estimates of federal income taxes paid on those earnings. In total, 326,998 screens were performed during the Kentucky trial from 1987 to 2019. At a cost of $56 per screen, we estimate that the total base cost to operate the program over the last 32 years is $18,311,888. When accounting for the surgical cost of 381 false-positive cases, the total cost of the screening program increases by $3,030,474. However, these costs are offset by the benefit of treating more early-stage ovarian cancer in the screened population, with a total cost advantage of $4,016,475 at our institution (Kentucky) or $1,525,050 ($725,700–$3,312,650) (U.S.) nationally. Additionally, program costs are offset by approximately $3,549,000 due to the potential earnings gained by the 26 women whose lives have been saved with screening. Furthermore, the cost of the program is offset by the federal tax dollars paid on the recovered earnings and amounts to $383,292. Ultimately, the net adjusted total cost of the Kentucky screening program is an estimated $13,393,595 at our institution or $15,885,020 ($13,978,068–$16,799,083) nationally. Thus, the adjusted cost per screen is an estimated $40.96 in Kentucky or $48.58 ($42.75–$51.37) nationally.