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Olafimihan A, Obomanu E, Cuartas-Mesa MC, Turk E, Fawehinmi P, Olatunji G, Kokori E, Aderinto N, Shaka H, Mba B, Mullane M. Trends and disparities in colorectal cancer hospitalizations and outcomes: a 10-year joinpoint trend study. Proc AMIA Symp 2024; 37:535-542. [PMID: 38910805 PMCID: PMC11188818 DOI: 10.1080/08998280.2024.2346404] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/11/2024] [Indexed: 06/25/2024] Open
Abstract
Background Colorectal cancer (CRC) poses a significant burden on healthcare systems globally. Sociodemographic factors intricately influence CRC epidemiology, yet their impact on inpatient care remains underexplored. This study aimed to assess trends in CRC hospitalization and the effect of sociodemographic factors on outcomes of CRC patients. Methods A retrospective longitudinal analysis was conducted using data from the Healthcare Cost and Utilization Project National Inpatient Sample. Trends in CRC admissions were assessed, stratified by sociodemographic variables. Disparities in hospital-associated outcomes were examined. Statistical methods included multivariable regression and joinpoint regression analysis. Results The prevalence of CRC hospitalizations uptrended from 760 per 100,000 hospitalizations in 2010 to 841 per 100,000 hospitalizations in 2019 (P trend < 0.001). The mean age decreased from 67 to 66 years (P < 0.001). Male gender and White race were predominant across the study period. Inpatient mortality decreased from 4.5% in 2010 to 4.16% in 2019 (P trend = 0.033). On sex subgroup analysis, men had a significantly higher mortality rate (P = 0.034). Racially, Blacks had the highest mortality rate (P = 0.550) and only Whites showed a significant decline in mortality over the study period (P = 0.003). Hospitalization length decreased while total hospital charges increased. Conclusion Our study highlights sociodemographic disparities in CRC outcomes, emphasizing the need for targeted interventions to address inequity in screening, diagnosis, and treatment. Continued research is needed to inform effective healthcare practices in mitigating these disparities and improving survival outcomes.
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Affiliation(s)
- Ayobami Olafimihan
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Elvis Obomanu
- Department of Internal Medicine, Jefferson-Einstein Hospital, Philadelphia, Pennsylvania, USA
| | | | - Ekrem Turk
- Department of Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Praise Fawehinmi
- Department of Pharmaceutical Sciences, Southern Illinois University Edwardsville, Edwardsville, Illinois, USA
| | - Gbolahan Olatunji
- Department of Medicine and Surgery, University of Ilorin, Ilorin, Nigeria
| | - Emmanuel Kokori
- Department of Medicine and Surgery, University of Ilorin, Ilorin, Nigeria
| | - Nicholas Aderinto
- Department of Medicine and Surgery, Ladoke Akintola University of Technology, Ogbomosho, Nigeria
| | - Hafeez Shaka
- Department of General Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Benjamin Mba
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael Mullane
- Department of Hematology and Oncology, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA
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Peerenboom R, Ackroyd S, Lee N. The burden of cervical cancer survivorship: Understanding morbidity and survivorship needs through hospital admissions. Gynecol Oncol Rep 2024; 51:101328. [PMID: 38318201 PMCID: PMC10839575 DOI: 10.1016/j.gore.2024.101328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 02/07/2024] Open
Abstract
Objective To describe disease- and treatment-related survivorship burden amongst survivors of cervical cancer and identify risk factors for hospital admissions after initial treatment. Methods Retrospective chart review including patients treated for cervical cancer from 2014 to 2020 at a single urban academic institution. Clinical, demographic, and hospital admission characteristics were summarized. Associations between patient characteristics and likelihood of admission were examined using univariate and multivariate regression. Results Of 366 patients undergoing surveillance following completion of primary treatment, 156 (43 %) were hospitalized for cancer or treatment-related sequela in the median follow-up of 3.6 years (IQR 1.4-6.4), with a median of 2 admissions (IQR 1-4.5) per patient and 570 unique admissions. While 65 (35 %) of admitted patients had multiple reasons for admission, the most common reasons for admission were: gastrointestinal complications (43 %), infection (38 %), genitourinary complications (33 %), and pain control (23 %). A substantial proportion of admitted patients underwent interventions including surgical procedures (57 %), transfusion of blood products (40 %), and interventional radiology procedures (28 %) and utilized supportive care services including case management (53 %), physical therapy (40 %), and occupational therapy (36 %). On multivariate analysis, odds of admission were higher among Black patients (aOR 2.4, p <.01), uninsured patients (aOR 2.7, p <.05), those with lower performance status (aOR 1.4, p <.05), and those with recurrence (aOR 5.5, p <.001). Conclusion Survivors of cervical cancer represent a high-risk population frequently hospitalized after initial treatment. Black patients, uninsured patients, those with recurrence, and those with lower performance status faced higher odds of admission. Comprehensive, team-based care is necessary to address complex survivorship needs.
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Affiliation(s)
- Rayne Peerenboom
- University of Chicago, Pritzker School of Medicine, United States
| | - Sarah Ackroyd
- University of Chicago, Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, United States
| | - Nita Lee
- University of Chicago, Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, United States
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Youk TM, Hong JH, Park BK, Park YM, Park EC. Estimation of the Three Phases by Direct Cost of Care for Non-surviving Patients with Cancer: A National Population-based Patient-level Study. J Cancer 2024; 15:20-29. [PMID: 38164281 PMCID: PMC10751664 DOI: 10.7150/jca.78491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/06/2023] [Indexed: 01/03/2024] Open
Abstract
Background: Determining the cost structure of medical care from diagnosis to the death of patients with cancer is crucial for establishing budgets to support patients with cancer. The breakdown of the cost estimation in distinct phases of survival is essential for optimizing the allocation of limited funds. Therefore, this study aims to examine the patterns of direct medical costs of cancer care associated with seven major cancer types and estimate cost thresholds to distinguish each phase based on the incurred cost. Methods: In this nationwide, population-based study, we used claims data from the National Health Insurance Service, Korea. Patients newly diagnosed with cancer since 2006 and who died in 2016-2017 were enrolled, and their use of medical services during cancer survival from at least 6 months up to 12 years was observed. The monthly cost exhibited a non-linear function with two unknown thresholds resembling a U-shape; therefore, we fitted three linear segment models. Individual costs were assessed by dividing the survival time into the initial, continuing, and terminal phases by estimated thresholds, and the average medical cost for each phase was calculated. Results: Based on survival durations of 12 years or less, the initial phase occurred within 1.1-4.8 months after diagnosis, while the terminal phase was observed in 1.4-4.7 months before death. The length of these two phases increased with the increased survival time of the patients. Medical costs in these phases ranged from $4067-7431 and $3127-6114 (US dollars), respectively, regardless of the variations in survival time. However, the average costs in the continuing phase were higher for patients with a short survival time. Conclusions: This study highlights the cost dynamics in cancer care through a breakdown of the phases of survival. It suggests that through a more refined definition of the initial and terminal phases, the average cost in these stages increases, indicating the significant implications of the findings for resource allocation and tailored financial support strategies for patients with cancer with varying prognoses.
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Affiliation(s)
- Tae Mi Youk
- Research Institute, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
- Department of Statistics, Korea University, Seoul, Republic of Korea
| | - Jung Hwa Hong
- Research Institute, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Byung Kyu Park
- Division of Gastroenterology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Young Min Park
- Department of Family Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Eun-Cheol Park
- Department of Preventive Medicine and Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea
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Rezaei S, Babaei M. A systematic literature review on direct and indirect costs of triple-negative breast cancer. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:92. [PMID: 38037138 PMCID: PMC10688084 DOI: 10.1186/s12962-023-00503-2] [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: 03/17/2023] [Accepted: 11/24/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Triple-negative breast cancer (TNBC) is an aggressive and therapy-resistant form of breast cancer with a significant economic burden on patients and healthcare systems. Therefore, we completed a systematic review to classify and synthesize the literature on the direct and indirect costs of TNBC. METHODS Databases including ISI Web of Science, Scopus, PubMed, and Google Scholar were searched for all related articles assessing the economic burden of TNBC from 2010 until December 2022. The quality and eligibility assessments were done accordingly. We adjusted all costs to January 2023 $US. RESULTS From 881 records, 15 studies were eligible. We found that studies are widely disparate in the timetable, study design, patient populations, and cost components assessed. The annual per-patient direct costs of metastatic TNBC (mTNBC) were about $24,288 to $316,800. For early TNCB patients (eTNBC) this was about $21,120 to $105,600. Cancer management anticancer therapy costs account for the majority of direct costs. Along with an increase in cancer stage and line of therapy, healthcare costs were increased. Moreover, the indirect costs of patients with mTNBC and eTNBC were about $1060.875 and about $186,535 for each patient respectively. CONCLUSION The results showed that the direct and indirect costs of TNBC, mainly those of mTNBC, were substantial, suggesting attention to medical progress in cancer prognosis and therapy approaches.
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Affiliation(s)
- Sadeq Rezaei
- Faculty of Entrepreneurship, University of Tehran, Tehran, Iran
| | - Majid Babaei
- Social Determinants of Health Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran.
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Achour L, Drira C, Sboui MZ, Fazaa I, Soussi MA, Hammami S, Ben Othman T, Razgallah Khrouf M. Economic analysis of allogeneic hematopoietic stem cell transplantation in the Bone Marrow Transplant Center of Tunisia. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2023; 11:2236851. [PMID: 37576087 PMCID: PMC10416733 DOI: 10.1080/20016689.2023.2236851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023]
Abstract
Introduction: New procedures and diagnostic tests in hematopoietic stem cell transplantation (HSCT) are associated with a significant increase in costs. The last cost estimate of allogeneic HSCT done in Tunisia was in 1996 and concerned only direct medical costs. Therefore, an updated cost analysis is needed. Objective: Analysis of direct costs during the first-year post-allogeneic HSCT in two groups of patients: Bone Marrow Transplant (Allo-BMT) and Peripheral Blood Stem Cell Transplant (Allo-PBSCT) and identification of factors leading to interindividual variations in costs in order to compare these costs with the budget allocated by the payer (CNAM). Methods: Pharmacoeconomic retrospective study, concerning patients who underwent allogeneic HSCT in 2013. Clinical and unit cost data were obtained from medical and administration records. Results:This study showed that the average direct cost of allogeneic HSCT in the population during the first year reached 56 638€. The average cost of Allo-BMT was 63 612€, and Allo-PBSCT was 45 966€ (p > 0.05). The initial hospitalization counted for 88% of total direct cost with an average cost of 41 441€ in Allo-BMT and 24 672€ in Allo-PBSCT (p < 0.05). Direct medical costs represented more than 70% of total direct costs, drugs, and laboratory tests occupied the largest share. Antifungals, antitumors, and antiviral drugs were the most expensive pharmaceutical classes with a mean cost, respectively, of 4 526€; 3 737€ and 3 268€. Some clinical criteria were significantly related to total direct costs like length of aplasia (p < 0.01) and GVHD (p < 0.05). However, the type of blood disease, its risk, length of mucositis, and the treatment protocol have no effect on the costs for all allogeneic patients. Conclusion: Our results showed that the costs of Allo HSCT have exceeded by far the budget allocated by the CNAM to the center, since the 90s to this day. That's why the total reimbursement mechanism should be revised.
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Affiliation(s)
- Leila Achour
- Pharmacy department, Bone Marrow Transplant Center of Tunisia, Tunis, Tunisia
| | - Chema Drira
- Pharmacy department, Bone Marrow Transplant Center of Tunisia, Tunis, Tunisia
| | - Mohamed Zied Sboui
- Pharmacy department, Bone Marrow Transplant Center of Tunisia, Tunis, Tunisia
| | - Ikram Fazaa
- Pharmacy department, Bone Marrow Transplant Center of Tunisia, Tunis, Tunisia
| | - Mohamed Ali Soussi
- Pharmacy department, Bone Marrow Transplant Center of Tunisia, Tunis, Tunisia
| | - Senda Hammami
- Pharmacy department, Bone Marrow Transplant Center of Tunisia, Tunis, Tunisia
| | - Tarek Ben Othman
- Hematopoietic Stem Cell Transplantation Unit, Hematology Department, Bone Marrow Transplant Center of Tunisia, Tunis, Tunisia
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Andrade AM, Teixeira VR, Pogue R, Figueiredo ACMG, Carvalho JL. A systematic review on the cost-effectiveness assessment of tisagenlecleucel for refractory or relapsing B-cell acute lymphoblastic leukemia (R/R B-ALL) treatment in children and young adults. Cytotherapy 2023:S1465-3249(23)00957-X. [PMID: 37341664 DOI: 10.1016/j.jcyt.2023.05.011] [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: 09/09/2022] [Revised: 05/02/2023] [Accepted: 05/26/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND AIMS The advanced therapy product tisagenlecleucel is a CD19-directed genetically modified autologous T-cell immunotherapy that has brought hope for children and young adults with relapsed/refractory (R/R) B-cell acute lymphoblastic leukemia (B-ALL). We sought to evaluate the cost-effectiveness of tisagenlecleucel compared with conventional salvage therapies in pediatric and young adult patients with R/R B-ALL. METHODS This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses parameters as registered in International Prospective Register of Systematic Reviews (CRD42021266998). Literature was searched using the MEDLINE databases via PubMed, EMBASE, Lilacs, the Cochrane Central Register of Controlled Trials and Web of Science in January 2022. Titles were screened independently by two reviewers. Articles deemed to meet the inclusion criteria were screened independently on abstract, and full texts were reviewed. RESULTS In total, 5627 publications were identified, from which six eligible studies were selected. The conventional therapies identified were blinatumomab (Blina), clofarabine monotherapy (Clo-M), clofarabine combined with cyclophosphamide and etoposide (Clo-C) and the combination of fludarabine, cytarabine and idarubicin (FLA-IDA). The discounted incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained for tisagenlecleucel compared with Clo-C and Blina averages was $38 837 and $25 569, respectively. In relation to the cost of the drug, the average of tisagenlecleucel was approximately 4.3 times, 10.8 times or 4.7 times greater than the Clo-M, Clo-C and Blina, respectively. CONCLUSIONS This systematic review highlighted that tisagenlecleucel is a much more expensive therapy than conventional alternatives. However, tisagenlecleucel performed well on the ICER, not exceeding $100 000/QALY. It was also found that the advanced therapy product was more effective than the conventional small molecule and biological drugs, in terms of life years and QALY gained.
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Affiliation(s)
- Aurélio Matos Andrade
- Medical Sciences Program, University of Brasilia, Brasilia, Distrito Federal, Brazil; Program of Evidence for Health Policy and Technologies, Oswaldo Cruz Brasilia Foundation, Brasilia, Distrito Federal, Brazil; Interdisciplinary Biosciences Laboratory, Faculty of Medicine, University of Brasília, Brasília, Distrito Federal, Brazil
| | | | - Robert Pogue
- Genomic Sciences and Biotechnology Program, Catholic University of Brasília, Brasília, Brazil
| | | | - Juliana Lott Carvalho
- Medical Sciences Program, University of Brasilia, Brasilia, Distrito Federal, Brazil; Interdisciplinary Biosciences Laboratory, Faculty of Medicine, University of Brasília, Brasília, Distrito Federal, Brazil; Faculty of Medicine, University of Brasilia, Brasilia, Distrito Federal, Brazil.
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Propolis: A Detailed Insight of Its Anticancer Molecular Mechanisms. Pharmaceuticals (Basel) 2023; 16:ph16030450. [PMID: 36986549 PMCID: PMC10059947 DOI: 10.3390/ph16030450] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/10/2023] [Accepted: 03/12/2023] [Indexed: 03/19/2023] Open
Abstract
Cancer is the second most life-threatening disease and has become a global health and economic problem worldwide. Due to the multifactorial nature of cancer, its pathophysiology is not completely understood so far, which makes it hard to treat. The current therapeutic strategies for cancer lack the efficacy due to the emergence of drug resistance and the toxic side effects associated with the treatment. Therefore, the search for more efficient and less toxic cancer treatment strategies is still at the forefront of current research. Propolis is a mixture of resinous compounds containing beeswax and partially digested exudates from plants leaves and buds. Its chemical composition varies widely depending on the bee species, geographic location, plant species, and weather conditions. Since ancient times, propolis has been used in many conditions and aliments for its healing properties. Propolis has well-known therapeutic actions including antioxidative, antimicrobial, anti-inflammatory, and anticancer properties. In recent years, extensive in vitro and in vivo studies have suggested that propolis possesses properties against several types of cancers. The present review highlights the recent progress made on the molecular targets and signaling pathways involved in the anticancer activities of propolis. Propolis exerts anticancer effects primarily by inhibiting cancer cell proliferation, inducing apoptosis through regulating various signaling pathways and arresting the tumor cell cycle, inducing autophagy, epigenetic modulations, and further inhibiting the invasion and metastasis of tumors. Propolis targets numerous signaling pathways associated with cancer therapy, including pathways mediated by p53, β-catenin, ERK1/2, MAPK, and NF-κB. Possible synergistic actions of a combination therapy of propolis with existing chemotherapies are also discussed in this review. Overall, propolis, by acting on diverse mechanisms simultaneously, can be considered to be a promising, multi-targeting, multi-pathways anticancer agent for the treatment of various types of cancers.
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Tapia JL, Taberner-Bonastre MT, Collado-Martínez D, Pouptsis A, Núñez-Abad M, Duñabeitia JA. Effectiveness of a Computerized Home-Based Cognitive Stimulation Program for Treating Cancer-Related Cognitive Impairment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4953. [PMID: 36981862 PMCID: PMC10049401 DOI: 10.3390/ijerph20064953] [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: 01/16/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
Cancer patients assert that after chemotherapy their cognitive abilities have deteriorated. Cognitive stimulation is the clinical treatment of choice for reversing cognitive decline. The current study describes a computerized home-based cognitive stimulation program in patients who survived breast cancer. It aims to assess safety and effectiveness of cognitive stimulation in the oncology population. A series of 45-min training sessions was completed by the participants. A thorough assessment was performed both before and after the intervention. The mini-Mental Adjustment to Cancer Scale, the Cognitive Assessment for Chemo Fog Research, and the Functionality Assessment Instrument in Cancer Treatment-Cognitive Function served as the main assessment tools. The State-Trait Anxiety Inventory, Beck Depression Inventory, Brief Fatigue Inventory, and Measuring Quality of Life-The World Health Organization data were gathered as secondary outcomes. Home-based cognitive stimulation demonstrated beneficial effects in the oncology population, with no side effects being reported. Cognitive, physical, and emotional improvements were observed, along with decreased interference in daily life activities and a better overall quality of life.
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Affiliation(s)
- Jose L. Tapia
- Centro de Investigación Nebrija en Cognición (CINC), Universidad Nebrija, 28015 Madrid, Spain
| | | | - David Collado-Martínez
- Servicio de Oncología Médica, Hospital Universitario de la Ribera, 46600 Valencia, Spain
| | - Athanasios Pouptsis
- Servicio de Oncología Médica, Hospital Universitario de la Ribera, 46600 Valencia, Spain
| | - Martín Núñez-Abad
- Servicio de Oncología Médica, Hospital Universitario de la Ribera, 46600 Valencia, Spain
| | - Jon Andoni Duñabeitia
- Centro de Investigación Nebrija en Cognición (CINC), Universidad Nebrija, 28015 Madrid, Spain
- AcqVA Aurora Center, The Arctic University of Norway, 9019 Tromsø, Norway
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Santini S, Fabbietti P, Galassi F, Merizzi A, Kropf J, Hungerländer N, Stara V. The Impact of Digital Coaching Intervention for Improving Healthy Ageing Dimensions among Older Adults during Their Transition from Work to Retirement. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4034. [PMID: 36901045 PMCID: PMC10001821 DOI: 10.3390/ijerph20054034] [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: 01/10/2023] [Revised: 02/13/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
Retirement is a critical step in older adults' lives, so it is important to motivate them to stay physically active, mentally healthy, and socially connected in the transition from work to retirement, including through digital health coaching programs. This study aims to: evaluate the impact of a digital coaching intervention to enhance three healthy ageing dimensions, i.e., physical activity, mental well-being, and socialization of a group of adults near retirement; understand the users' experience; and identify the system strengths and weaknesses. This longitudinal mixed-methods study, carried out in 2021 in Italy and the Netherlands, enrolled 62 individuals. In the first 5 weeks of the trial, participants used a digital coach with the support of human coaches, and then they continued autonomously for another 5 weeks. The use of the digital coach improved the participants' physical activity, mental well-being and self-efficacy during the first period and only the physical activity in the second. An effective coaching system should be flexible and attractive. High levels of personalization remain the golden key to aligning the health program to the physical, cognitive and social status of the intended target, thus increasing the user-system interaction, usability, and acceptability, as well as enhancing adherence to the intervention.
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Affiliation(s)
- Sara Santini
- Centre for Socio-Economic Research on Aging, IRCCS INRCA-National Institute of Health and Science on Aging, 60124 Ancona, Italy
| | - Paolo Fabbietti
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA-National Institute of Health and Science on Aging, 60124 Ancona, Italy
| | - Flavia Galassi
- Centre for Socio-Economic Research on Aging, IRCCS INRCA-National Institute of Health and Science on Aging, 60124 Ancona, Italy
| | - Alessandra Merizzi
- Centre for Socio-Economic Research on Aging, IRCCS INRCA-National Institute of Health and Science on Aging, 60124 Ancona, Italy
| | | | | | - Vera Stara
- Model of Care and New Technologies, IRCCS INRCA-National Institute of Health and Science on Aging, 60124 Ancona, Italy
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Melamed A, Lin YL, Hassan AM, Rauh-Hain JA, Herring B, Keating NL, Offodile AC. Trends in Episode-of-Care Spending for Cancer-Directed Surgery Among US Medicare Beneficiaries From 2011 to 2019. JAMA Surg 2023; 158:216-218. [PMID: 36477545 PMCID: PMC9856890 DOI: 10.1001/jamasurg.2022.4493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This cross-sectional study examines trends in the number of cancer-directed surgeries from 2011 to 2019 among US patients aged 65 years or older and in Medicare spending for those surgeries overall and by inpatient vs outpatient sites of care.
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Affiliation(s)
- Alexander Melamed
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston
| | - Yu-Li Lin
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Abbas M. Hassan
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - J. Alejandro Rauh-Hain
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas,Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bradley Herring
- Peter T. Paul College of Business and Economics, University of New Hampshire, Durham
| | - Nancy L. Keating
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts,Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Anaeze C. Offodile
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas,Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas,Baker Institute for Public Policy, Rice University, Houston, Texas
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Li J, Chan NB, Xue J, Tsoi KKF. Time series models show comparable projection performance with joinpoint regression: A comparison using historical cancer data from World Health Organization. Front Public Health 2022; 10:1003162. [PMID: 36311591 PMCID: PMC9614249 DOI: 10.3389/fpubh.2022.1003162] [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: 07/25/2022] [Accepted: 09/21/2022] [Indexed: 01/27/2023] Open
Abstract
Background Cancer is one of the major causes of death and the projection of cancer incidences is essential for future healthcare resources planning. Joinpoint regression and average annual percentage change (AAPC) are common approaches for cancer projection, while time series models, traditional ways of trend analysis in statistics, were considered less popular. This study aims to compare these projection methods on seven types of cancers in 31 geographical jurisdictions. Methods Using data from 66 cancer registries in the World Health Organization, projection models by joinpoint regression, AAPC, and autoregressive integrated moving average with exogenous variables (ARIMAX) were constructed based on 20 years of cancer incidences. The rest of the data upon 20-years of record were used to validate the primary outcomes, namely, 3, 5, and 10-year projections. Weighted averages of mean-square-errors and of percentage errors on predictions were used to quantify the accuracy of the projection results. Results Among 66 jurisdictions and seven selected cancers, ARIMAX gave the best 5 and 10-year projections for most of the scenarios. When the ten-year projection was concerned, ARIMAX resulted in a mean-square-error (or percentage error) of 2.7% (or 7.2%), compared with 3.3% (or 15.2%) by joinpoint regression and 7.8% (or 15.0%) by AAPC. All the three methods were unable to give reasonable projections for prostate cancer incidence in the US. Conclusion ARIMAX outperformed the joinpoint regression and AAPC approaches by showing promising accuracy and robustness in projecting cancer incidence rates. In the future, developments in projection models and better applications could promise to improve our ability to understand the trend of disease development, design the intervention strategies, and build proactive public health system.
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Affiliation(s)
- Jinhui Li
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Nicholas B. Chan
- SH Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jiashu Xue
- SH Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Kelvin K. F. Tsoi
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China,SH Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China,*Correspondence: Kelvin K. F. Tsoi
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Shih YCT, Xu Y, Bradley C, Giordano SH, Yao J, Yabroff KR. Costs Around the First Year of Diagnosis for 4 Common Cancers Among the Privately Insured. J Natl Cancer Inst 2022; 114:1392-1399. [PMID: 36099068 PMCID: PMC9552304 DOI: 10.1093/jnci/djac141] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/03/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We estimated trends in total and out-of-pocket (OOP) costs around the first year of diagnosis for privately insured nonelderly adult cancer patients. METHODS We constructed incident cohorts of breast, colorectal, lung, and prostate cancer patients diagnosed between 2009 and 2016 using claims data from the Health Care Cost Institute. We identified cancer-related surgery, intravenous (IV) systemic therapy, and radiation and calculated associated total and OOP costs (in 2020 US dollars). We assessed trends in health-care utilization and cost by cancer site with logistic regressions and generalized linear models, respectively. RESULTS The cohorts included 105 255 breast, 23 571 colorectal, 11 321 lung, and 59 197 prostate cancer patients. For patients diagnosed between 2009 and 2016, total mean costs per patient increased from $109 544 to $140 732 for breast (29%), $151 751 to $168 730 for lung (11%) or $53 300 to $55 497 for prostate (4%) cancer were statistically significant. Increase for colorectal cancer (1%, $136 652 to $137 663) was not statistically significant (P = .09). OOP costs increased to more than 15% for all cancers, including colorectal, to more than $6000 by 2016. Use of IV systemic therapy and radiation statistically significantly increased, except for lung cancer. Cancer surgeries statistically significantly increased for breast and colorectal cancer but decreased for prostate cancer (P < .001). Total costs increased statistically significantly for nearly all treatment modalities, except for IV systemic therapy in colorectal and radiation in prostate cancer. CONCLUSIONS Rising costs of cancer treatments, compounded with greater cost sharing, increased OOP costs for privately insured, nonelderly cancer patients. Policy initiatives to mitigate financial hardship should consider cost containment as well as insurance reform.
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Affiliation(s)
- Ya-Chen Tina Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ying Xu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cathy Bradley
- Department of Health Systems, Management & Policy, University of Colorado Comprehensive Cancer Center and Colorado School of Public Health, Aurora, CO, USA
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - James Yao
- Department of GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K Robin Yabroff
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA, USA
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13
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Torkki P, Leskelä RL, Bugge C, Torfadottir JE, Karjalainen S. Cancer-related costs should be allocated in a comparable way-benchmarking costs of cancer in Nordic countries 2012-2017. Acta Oncol 2022; 61:1216-1222. [PMID: 36151990 DOI: 10.1080/0284186x.2022.2124883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND High costs of cancer, and especially the increase in treatment costs, have raised concerns about the financial sustainability of publicly funded health care systems around the world. As cancers get more prevalent with age, treatment costs are expected to keep rising with aging populations. The objective of the study is to analyze the changes in cost of cancer care broken down into separate cost components and outcomes of cancer treatment in the Nordic countries 2012-2017. MATERIALS AND METHODS We estimated direct costs of cancer based on retrospective data from national registers: outpatient care and inpatient care in primary care and specialized care as well as medicine costs. The number of cancer cases and survival data was obtained from NORDCAN. Cancer was defined as ICD-10 codes C00-C97. RESULTS Healthcare costs of cancer in real terms increased in all countries: CAGR was between 1 and 6% depending on the country. Medicine costs have increased rapidly (37-125%) in all countries during the observation period. In Finland and Denmark, inpatient care costs have decreased, whereas in Iceland, Norway, and Sweden, they have increased, although the number of inpatient days has decreased everywhere. The age-standardized cancer mortality has decreased constantly over time. CONCLUSION Cancer care in Nordic countries has significant differences in both cost structures and in the development of cost drivers, indicating differences in the organization of care and different focus in health policy. It is important to compare the cancer care costs internationally on a detailed level to understand the reasons for cost development. The registration of cost data, especially medicine costs, should be more standardized to enable better cost and outcomes comparisons between countries in the future.
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Affiliation(s)
- Paulus Torkki
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Riikka-Leena Leskelä
- Department of Public Health, University of Helsinki, Helsinki, Finland.,NHG Finland Ltd., Helsinki, Finland
| | - Christoffer Bugge
- Oslo Economics AS, Oslo, Norway.,Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
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14
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Preoperative inflammatory markers as prognostic predictors after hepatocellular carcinoma resection: data from a western referral center. BMC Surg 2022; 22:329. [PMID: 36056350 PMCID: PMC9440527 DOI: 10.1186/s12893-022-01779-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 08/26/2022] [Indexed: 12/23/2022] Open
Abstract
Background Recent studies from eastern centers have demonstrate an association between inflammatory response and long-term outcomes after hepatocellular carcinoma (HCC) resection. However, the prognostic impact of inflammatory markers in western patients, with distinct tumor and epidemiologic features, is still unknown. Aim To evaluate the prognostic impact of preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), as well as their impact according to tumor size (< 5 cm, 5–10 cm, > 10 cm) in patients undergoing HCC resection with curative intent.
Methods Optimal cut-off values for NLR, PLR, and MLR were determined by plotting the receiver operator curves. Overall survival (OS) and disease-free survival (DFS) curves were calculated using the Kaplan–Meier method and compared using the log-rank test. The Cox method was used to identify independent predictors of OS and DFS. Results In total, 161 consecutive adult patients were included. A high NLR (> 1.715) was associated with worse OS (P = 0.018). High NLR (> 2.475; P = 0.047) and PLR (> 100.25; P = 0.028) were predictors of short DFS. In HCC < 5 cm, MLR (> 1.715) was associated with worse OS (P = 0.047). In the multivariate analysis, high PLR was an independent predictor of worse DFS [hazard ratio (HR) 3.029; 95%CI 1.499–6.121; P = 0.002]. Conclusion Inflammatory markers are useful tools to predict long-term outcomes after liver resection in western patients, high NLR was able to stratify subgroups of patients with short OS and DFS, an increased PLR was an independent predictor of short DFS, while high MLR was associated with short OS in patients with early HCC. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-022-01779-6.
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15
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Yu B, Wang Y, Geng Z, Qu Y, Pan J, Zhai Q. Establishment and validation of analytical methods for 15 hazardous drugs by UPLC-Q/Orbitrap-HRMS. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:686. [PMID: 35845485 PMCID: PMC9279804 DOI: 10.21037/atm-22-2330] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/16/2022] [Indexed: 11/06/2022]
Abstract
Background Cytotoxic drug residues in pharmacy intravenous admixture services (PIVAS) have always been a major problem for pharmaceutical workers and the PIVAS environment,which is not only pollutes the PIVAS environment, but also causes serious harm to the life and health of the staff. This study aimed to establish an ultra-high performance liquid chromatography quadrupole orbitrap high resolution mass spectrometry (UPLC-Q/Orbitrap-HRMS) method for the rapid detection and monitor of 15 cytotoxic drugs. Methods UPLC-Q/Orbitrap-HRMS method was used to establish a rapid detection method for 15 cytotoxic drugs such as cytarabine, gemcitabine and so on. The daily precision and accuracy of this method were verified by injecting four concentrations of standard solution on the same day, and the same four concentrations of standard solution were injected within three days respectively to verify the daily precision of this method. The signal-to-noise ratio (SNR) of 10:1 was calculated as the limit of quantity. The mixed standard solution of 15 cytotoxic drugs with concentrations of 0.5, 1, 3, 10, 30, 100, 300, and 1,000 ng/mL was configured and detected by this method for linearity and range.The stability of this method was investigated using a mixture of 15 drugs (15MIX) standard solutions at high concentration (300 ng/mL) and low concentration (10 ng/mL) at room temperature for 12 and 24 hours, respectively. A standard solution of each drug, 15MIX and blank solution were taken to verify the exclusivity of the method. Results The results showed that the method had good specificity, and the intraday precision of all drugs was less than 10% and the intraday precision was less than 15%. At the same time, the standard curve had good linearity, R2 was greater than 0.99, and the limit of quantification of most drugs was about 1 ng/mL. Conclusions In this study, an UPLC-Q/Orbitrap-HRMS method was established for the rapid detection of 15 cytotoxic drugs, providing technical support for the monitoring of cytotoxic drug residues in PIVAS, which is of great significance for environmental contamination mornitoring as well as occupational exposure alert.
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Affiliation(s)
- Bo Yu
- Department of Pharmacy, Shanghai Cancer Center, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Pharmacy, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Wang
- Department of Pharmacy, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhou Geng
- Department of Pharmacy, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuchen Qu
- Department of Pharmacy, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jie Pan
- Department of Pharmacy, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Qing Zhai
- Department of Pharmacy, Shanghai Cancer Center, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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16
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Bhimani N, Wong GYM, Molloy C, Dieng M, Hugh TJ. Cost of colorectal cancer by treatment type from different health economic perspectives: A systematic review. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:2082-2093. [DOI: 10.1016/j.ejso.2022.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/03/2022] [Accepted: 06/19/2022] [Indexed: 12/23/2022]
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17
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Huang M, Haiderali A, Fox GE, Frederickson A, Cortes J, Fasching PA, O'Shaughnessy J. Economic and Humanistic Burden of Triple-Negative Breast Cancer: A Systematic Literature Review. PHARMACOECONOMICS 2022; 40:519-558. [PMID: 35112331 PMCID: PMC9095534 DOI: 10.1007/s40273-021-01121-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/28/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Triple-negative breast cancer (TNBC) accounts for 10-20% of all breast cancers (BCs). It is more commonly diagnosed in younger women and often has a less favorable prognosis compared with other BC subtypes. OBJECTIVE The objective of this study was to provide a literature-based extensive overview of the economic and humanistic burden of TNBC to assist medical decisions for healthcare payers, providers, and patients. METHODS A systematic literature review was performed using multiple databases, including EMBASE, MEDLINE, Econlit, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews, from database inception to 16 May 2021. In addition, a targeted search was performed in the Northern Light Life Sciences Conference Abstracts database from 2016 through June 2021. The bibliographies of included articles were reviewed to identify other potentially relevant publications. Quality assessment of the included studies was conducted. RESULTS The review identified 19 studies assessing the economic burden and 10 studies assessing the humanistic burden of TNBC. Studies varied widely in study design, settings, patient populations, and time horizons. The estimates of mean per-patient annual direct medical costs ranged from around $20,000 to over $100,000 in stage I-III TNBC and from $100,000 to $300,000 in stage IV TNBC. Healthcare costs and resource utilization increased significantly with disease recurrence, progression, and increased cancer stage or line of therapy. Compared with the costs of systemic anticancer therapy, cancer management costs comprised a larger portion of total direct costs. The estimates of indirect costs due to productivity loss ranged from $207 to $1573 per patient per month (all costs presented above were adjusted to 2021 US dollars). Cancer recurrence led to significantly reduced productivity and greater rates of leaving the workforce. A rapid deterioration of health utility associated with disease progression was observed in TNBC patients. Treatment with pembrolizumab or talazoparib showed significantly greater improvements in health-related quality of life (HRQoL) compared with chemotherapy, as measured by EORTC QLQ-C30, QLQ-BR23, and FACT-B. CONCLUSION TNBC is associated with a substantial economic burden on healthcare systems and societies and considerably reduced productivity and HRQoL for patients. This study synthesized the published literature on the economic and humanistic burden of TNBC and highlighted the need for continued research due to the rapidly changing landscape of TNBC care.
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Affiliation(s)
- Min Huang
- Merck & Co., Inc., Kenilworth, NJ, USA.
| | | | | | | | - Javier Cortes
- International Breast Cancer Center (IBCC), Barcelona, Spain
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen, EMN, University Hospital Erlangen, Friedrich-Alexander University Erlangen, Nuremberg, Erlangen, Germany
| | - Joyce O'Shaughnessy
- Baylor University Medical Center, Texas Oncology and US Oncology, Dallas, TX, USA
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18
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Erfani P, Phelan J, Orav EJ, Figueroa JF, Jha AK, Lam MB. Spending outcomes among patients with cancer in accountable care organizations 4 years after implementation. Cancer 2022; 128:1093-1100. [PMID: 34767638 PMCID: PMC8837672 DOI: 10.1002/cncr.34022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/16/2021] [Accepted: 09/07/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The long-term impact of affordable care organizations (ACOs) on cancer spending remains unknown. The authors examined whether practices that became ACOs altered their spending for patients with cancer in the first 4 years after ACO implementation. METHODS By using national Medicare data from 2011 to 2017, a random sample of 20% of fee-for-service Medicare beneficiaries aged 65 years and older with cancer was obtained (n = 866,532), and each patient was assigned to a practice. Practices that became ACOs in the Medicare Shared Savings Program were matched to non-ACO practices. Total, cancer-specific, and service category-specific yearly spending per patient was calculated. A difference-in-differences model was used to determine spending changes associated with ACO status for patients with cancer in the 4 years after ACO implementation. RESULTS The introduction of ACOs did not have a significant impact on overall spending for patients with cancer in the 2 years after ACO implementation (difference, -$38; 95% CI, -$268, $191; P = .74). Changes in spending also did not differ between ACO and non-ACO patients within service categories or among the 11 cancer types examined. The lack of difference in spending for patients with cancer in ACO and non-ACO practices persisted in the third and fourth years after ACO implementation (difference, -$120; 95% CI, -$284, $525; P = .56). CONCLUSIONS ACOs did not significantly change spending for patients with cancer in the first 4 years after their implementation compared with non-ACOs. This prompts a reevaluation of the current efficacy of ACOs in reducing spending for cancer care and may encourage policymakers to reconsider the incentive structures of ACOs. LAY SUMMARY Accountable care organizations (ACOs) were developed to curtail health care spending and improve quality, but their effects on cancer spending in their first 2 years have been minimal. The long-term impact of ACOs on cancer spending remains unknown. By using data from 866,532 Medicare beneficiaries with cancer, the authors observed that the association of a practice with an ACO did not significantly change total yearly spending per patient in the first 4 years after ACO implementation. This finding prompts a reevaluation of the current efficacy of ACOs in reducing spending for cancer care.
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Affiliation(s)
- Parsa Erfani
- Harvard Medical School, School of Medicine in Boston, MA
| | - Jessica Phelan
- Harvard T.H. Chan School of Public Health, Department of Health Policy and Management in Boston, MA
| | - E. John Orav
- Harvard Medical School, School of Medicine in Boston, MA,Harvard Medical School, Department of Medicine in Boston, MA,Harvard T.H. Chan School of Public Health, Department of Biostatistics in Boston, MA
| | - Jose F Figueroa
- Harvard Medical School, School of Medicine in Boston, MA,Harvard T.H. Chan School of Public Health, Department of Health Policy and Management in Boston, MA,Harvard Medical School, Department of Medicine in Boston, MA
| | - Ashish K. Jha
- Brown University School of Public Health in Providence, RI
| | - Miranda B. Lam
- Harvard Medical School, School of Medicine in Boston, MA,Harvard T.H. Chan School of Public Health, Department of Health Policy and Management in Boston, MA,Brigham and Women’s Hospital / Dana Farber Cancer Institute, Department of Radiation Oncology in Boston, MA
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19
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Mukherjee K, Davisson N, Malik S, Duszak R, Kokabi N. National Utilization, Survival, and Costs Analysis of Treatment Options for Stage I Non-Small Cell Lung Cancer: A SEER-Medicare Database Analysis. Acad Radiol 2022; 29 Suppl 2:S173-S180. [PMID: 34404607 DOI: 10.1016/j.acra.2021.07.009] [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: 05/05/2021] [Revised: 07/07/2021] [Accepted: 07/16/2021] [Indexed: 11/01/2022]
Abstract
RATIONALE AND OBJECTIVES To compare utilization, outcomes, and costs of surgery, radiation therapy, and percutaneous ablation for the treatment of stage I non-small cell lung cancer (NSCLC). MATERIALS AND METHODS Using 2006-2016 Medicare-linked Surveillance, Epidemiology, and End Results (SEER) databases, stage I NSCLC patients who underwent surgery, radiotherapy, or percutaneous ablation were identified using relevant billing codes. National utilization rates were determined. Overall survival for treatment arms were compared using log-rank test and Cox-proportional hazard modeling. Mean direct costs for each treatment strategy during the first year after diagnosis were compared using Analysis of Variance. RESULTS A total of 15,847 Stage I NSCLC patients were identified; mean age at diagnosis was 75.5 years (minimum age = 66 years) and 59.2% were female. A total of 10,732 patients (67.7%) underwent only surgery, 5013 (31.6%) only radiotherapy, and 102 (0.6%) only ablation. Utilization of surgery and ablation decreased while radiotherapy utilization increased from 2007 to 2015 (p < 0.0001). Compared to the ablation group, overall survival was greater for the surgery group (HR: 0.7, 95% CI of HR: 0.6-0.9, p = 0.0047) and lower for the radiotherapy group (HR: 1.4, 95% CI of HR: 1.1-1.8, p = 0.002). The mean first year cost of therapy for ablation = $11,976) was significantly less (p < 0.05) than for radiotherapy ($15,447) and surgery ($22,669). CONCLUSION In Medicare patients with stage I NSCLC, the utilization of radiation therapy has increased and surgery has declined, while utilization of percutaneous ablation has remained uniformly low. Although overall survival is best for surgery, then ablation, and then radiation therapy, first year treatment costs are lowest for ablation.
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20
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Varon E, Blumrosen G, Shefi O. A predictive model for personalization of nanotechnology-based phototherapy in cancer treatment. Front Oncol 2022; 12:1037419. [PMID: 36911792 PMCID: PMC9999042 DOI: 10.3389/fonc.2022.1037419] [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: 09/11/2022] [Accepted: 11/21/2022] [Indexed: 01/06/2023] Open
Abstract
A major challenge in radiation oncology is the prediction and optimization of clinical responses in a personalized manner. Recently, nanotechnology-based cancer treatments are being combined with photodynamic therapy (PDT) and photothermal therapy (PTT). Predictive models based on machine learning techniques can be used to optimize the clinical setup configuration, including such parameters as laser radiation intensity, treatment duration, and nanoparticle features. In this article we demonstrate a methodology that can be used to identify the optimal treatment parameters for PDT and PTT by collecting data from in vitro cytotoxicity assay of PDT/PTT-induced cell death using a single nanocomplex. We construct three machine learning prediction models, employing regression, interpolation, and low- degree analytical function fitting, to predict the laser radiation intensity and duration settings that maximize the treatment efficiency. To examine the accuracy of these prediction models, we construct a dedicated dataset for PDT, PTT, and a combined treatment; this dataset is based on cell death measurements after light radiation treatment and is divided into training and test sets. The preliminary results show that the performance of all three models is sufficient, with death rate errors of 0.09, 0.15, and 0.12 for the regression, interpolation, and analytical function fitting approaches, respectively. Nevertheless, due to its simple form, the analytical function method has an advantage in clinical application and can be used for further analysis of the sensitivity of performance to the treatment parameters. Overall, the results of this study form a baseline for a future personalized prediction model based on machine learning in the domain of combined nanotechnology- and phototherapy-based cancer treatment.
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Affiliation(s)
- Eli Varon
- Faculty of Engineering, Bar-Ilan University, Ramat Gan, Israel.,Bar-Ilan Institute of Nanotechnology and Advanced Materials, Bar-Ilan University, Ramat Gan, Israel
| | - Gaddi Blumrosen
- Department of Digital Medical Technologies, Holon Institute of Technology, Holon, Israel.,Department of Computer Science, Holon Institute of Technology, Holon, Israel
| | - Orit Shefi
- Faculty of Engineering, Bar-Ilan University, Ramat Gan, Israel.,Bar-Ilan Institute of Nanotechnology and Advanced Materials, Bar-Ilan University, Ramat Gan, Israel.,Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
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21
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Anderson PM, Thomas SM, Sartoski S, Scott JG, Sobilo K, Bewley S, Salvador LK, Salazar-Abshire M. Strategies to Mitigate Chemotherapy and Radiation Toxicities That Affect Eating. Nutrients 2021; 13:nu13124397. [PMID: 34959948 PMCID: PMC8706251 DOI: 10.3390/nu13124397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/06/2021] [Indexed: 01/02/2023] Open
Abstract
Background: Cancer and its therapy is commonly associated with a variety of side effects that impact eating behaviors that reduce nutritional intake. This review will outline potential causes of chemotherapy and radiation damage as well as approaches for the amelioration of the side effects of cancer during therapy. Methods: Information for clinicians, patients, and their caregivers about toxicity mitigation including nausea reduction, damage to epithelial structures such as skin and mucosa, organ toxicity, and education is reviewed. Results: How to anticipate, reduce, and prevent some toxicities encountered during chemotherapy and radiation is detailed with the goal to improve eating behaviors. Strategies for health care professionals, caregivers, and patients to consider include (a) the reduction in nausea and vomiting, (b) decreasing damage to the mucosa, (c) avoiding a catabolic state and muscle wasting (sarcopenia), and (d) developing therapeutic alliances with patients, caregivers, and oncologists. Conclusions: Although the reduction of side effects involves anticipatory guidance and proactive team effort (e.g., forward observation, electronic interactions, patient reported outcomes), toxicity reduction can be satisfying for not only the patient, but everyone involved in cancer care.
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Affiliation(s)
- Peter M. Anderson
- Pediatric Hematology/Oncology and Bone Marrow Transplant, Cleveland Clinic Children’s, Cleveland, OH 44195, USA; (S.M.T.); (S.S.); (K.S.); (S.B.)
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA;
- Correspondence: or ; Tel.: +216-445-7140 or +216-308-2706
| | - Stefanie M. Thomas
- Pediatric Hematology/Oncology and Bone Marrow Transplant, Cleveland Clinic Children’s, Cleveland, OH 44195, USA; (S.M.T.); (S.S.); (K.S.); (S.B.)
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Shauna Sartoski
- Pediatric Hematology/Oncology and Bone Marrow Transplant, Cleveland Clinic Children’s, Cleveland, OH 44195, USA; (S.M.T.); (S.S.); (K.S.); (S.B.)
- Department of Nursing, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Jacob G. Scott
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA;
- Department of Radiation Oncology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Kaitlin Sobilo
- Pediatric Hematology/Oncology and Bone Marrow Transplant, Cleveland Clinic Children’s, Cleveland, OH 44195, USA; (S.M.T.); (S.S.); (K.S.); (S.B.)
- Department of Nursing, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Sara Bewley
- Pediatric Hematology/Oncology and Bone Marrow Transplant, Cleveland Clinic Children’s, Cleveland, OH 44195, USA; (S.M.T.); (S.S.); (K.S.); (S.B.)
- Peds Nutritional Services, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Laura K. Salvador
- Department of Pediatrics, MD Anderson Cancer Center, Houston, TX 77030, USA; (L.K.S.); (M.S.-A.)
| | - Maritza Salazar-Abshire
- Department of Pediatrics, MD Anderson Cancer Center, Houston, TX 77030, USA; (L.K.S.); (M.S.-A.)
- Department of Nursing Education, MD Anderson Cancer Center, Houston, TX 77030, USA
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22
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Faramarzi A, Javan-Noughabi J, Tabatabaee SS, Najafpoor AA, Rezapour A. The lost productivity cost of absenteeism due to COVID-19 in health care workers in Iran: a case study in the hospitals of Mashhad University of Medical Sciences. BMC Health Serv Res 2021; 21:1169. [PMID: 34711242 PMCID: PMC8552614 DOI: 10.1186/s12913-021-07200-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/20/2021] [Indexed: 12/15/2022] Open
Abstract
Background Human resources management plays an important role in social development and economic growth. Absence from work due to health problems can make obstacles to the growth of economy. This study conducted aimed to estimate the absenteeism costs of COVID-19 among the personnel of hospitals affiliated to Mashhad University of Medical Sciences in Mashhad, Iran. Methods This cross-sectional study was conducted between February 19, 2020, and September 21, 2020. The absenteeism costs were calculated using the human capital approach. Finally, we applied the linear regression to assess the impact of variables on the lost productivity of absenteeism due to COVID-19 among the personnel of hospitals affiliated to Mashhad University of Medical Sciences. Results The results of this study showed that 1958 personnel had COVID-19. The total of absenteeism days in our study were 32,209 days, with an average of 16.44 absenteeism days. Total costs due to absenteeism were estimated to be nearly $1.3 million, with an average of $671.4 per patient. The results of regression model showed that gender (male), age (> 50 years), employment Type (non-permanent) and monthly income had a positive relationship with the absenteeism cost. Also, there are a negative significant relationship between absenteeism cost with job (physicians) and work experience. Conclusions Absenteeism costs of COVID-19 in the hospitals of Mashhad University of Medical Sciences represent a significant economic burden. The findings of our study emphasize the emergency strategies to prevent and control COVID-19 among the healthcare workers. It can decrease the economic impacts of COVID-19 and improve human resources management during the COVID-19 pandemic.
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Affiliation(s)
- Ahmad Faramarzi
- Department of Health Management and Economics, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Javad Javan-Noughabi
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Seyed Saeed Tabatabaee
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Asghar Najafpoor
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Aziz Rezapour
- Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
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Desai A, Jella TK, Cwalina TB, Wright CH, Wright J. Demographic Analysis of Financial Hardships Faced by Brain Tumor Survivors. World Neurosurg 2021; 158:e111-e121. [PMID: 34687933 DOI: 10.1016/j.wneu.2021.10.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Quantitative analysis of the financial hardship faced by patients with brain tumors is lacking. The present study sought to conduct a longitudinal analysis of responses to the National Health Interview Survey by patients diagnosed with brain tumors and characterize the impact of demographic factors on financial hardship indices. METHODS National Health Interview Survey respondents between 1997 and 2018 who reported previous diagnosis with cancer of the brain and who responded to 4 survey questions that assessed financial stress were included. Sociodemographic exposures included age, ethnicity/race, marriage status, insurance status, and degree of highest educational attainment. RESULTS Educational attainment, marital status, and insurance status were the most significant risk factors for temporary or indefinite delays to necessary medical care. Those with only a high-school diploma had 9.6 times higher odds (adjusted odds ratio, 9.68; 95% confidence interval, 2.96-31.70; P < 0.001) of reporting that, in the past 12 months, one of their family members had to limit their medical care in an effort to save money. Similarly, patients with brain tumors who were not married had 3.94 times greater odds (adjusted odds ratio, 3.94; 95% confidence interval, 1.49-10.44; P = 0.009) of avoiding necessary medical care because of an inability to afford it. CONCLUSIONS Given this variation in self-reported financial burden, demographics clearly have an impact on a patient's holistic experience after a brain cancer diagnosis. Therefore, by using the comparisons in this study, we hope that medical institutions and neurosurgical societies can more accurately predict which patients are most susceptible to significant financial stress and distribute resources accordingly.
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Affiliation(s)
- Ansh Desai
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Tarun K Jella
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Thomas B Cwalina
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Christina Huang Wright
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - James Wright
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
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Khushalani JS, Cudhea FP, Ekwueme DU, Ruan M, Shan Z, Harris DM, Mozaffarian D, Zhang FF. Estimated economic burden of cancer associated with suboptimal diet in the United States. Cancer Causes Control 2021; 33:73-80. [PMID: 34652592 DOI: 10.1007/s10552-021-01503-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/01/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Suboptimal diet is a preventable cause of cancer. We aimed to estimate the economic burden of diet-associated cancer among US adults. METHODS We used a Comparative Risk Assessment model to quantify the number of new cancer cases attributable to seven dietary factors among US adults ages 20 + years. A Markov cohort model estimated the 5-year medical costs for 15 diet-associated cancers diagnosed in 2015. We obtained dietary intake from 2013 to 2016 National Health and Nutrition Examination Survey, cancer incidence, and survival from 2008 to 2014 Surveillance, Epidemiology, and End Results (SEER) program, and medical costs from 2007 to 2013 linked SEER-Medicare data. RESULTS The estimated 5-year medical costs of new diet-associated cancer cases diagnosed in 2015 were $7.44 (2018 US$). Colorectal cancer had the largest diet-related 5-year medical costs of $5.32B. Suboptimal consumption of whole grains ($2.76B), dairy ($1.82B), and high consumption of processed meats ($1.5B) accounted for the highest medical costs. Per-person medical costs attributable to suboptimal diet vary by gender, race, and age group. CONCLUSIONS Suboptimal diet contributes substantially to the economic burden of diet-associated cancers among US adults. This study highlights the need to implement population-based strategies to improve diet and reduce cancer burden in the US.
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Affiliation(s)
- Jaya S Khushalani
- Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30328, USA.
| | - Frederick P Cudhea
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Donatus U Ekwueme
- Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30328, USA
| | - Mengyuan Ruan
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Zhilei Shan
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Diane M Harris
- Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30328, USA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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Kusoski C, Booth J, Salch S, Jozefczyk H, Kennerly-Shah J. Costs associated with United States pharmacopeia compliant infusion clinics. J Oncol Pharm Pract 2021; 28:141-148. [PMID: 34648391 DOI: 10.1177/10781552211048871] [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: 11/16/2022]
Abstract
PURPOSE As costs continue to rise in oncology, a strategy that has been implemented to limit these costs is use of alternative sites of care. However, there are differences in regulatory standards between common sites of care such as freestanding infusion clinics and hospital outpatient departments. The costs associated with United States Pharmacopeia compliance were evaluated in order to better understand the cost of universally compliant hospital outpatient departments. METHODS Annual operational costs associated with United States Pharmacopeia compliance were estimated for a 30-chair infusion clinic with United States Pharmacopeia <797> and <800> pharmacy cleanrooms for non-hazardous and hazardous drugs, respectively. Annual United States Pharmacopeia compliance costs included: competency assessments, personal protective equipment, closed system transfer devices, labels, cleaning supplies, and environmental monitoring. One-time costs included initial cleanroom construction and renovations. Published information and benchmarks provided baseline assumptions for patient volume, staffing, and unit costs. If no published data was available, prices were estimated based on a similarly sized clinic. RESULTS Recurring annual costs for a 30-chair fully compliant infusion clinic were calculated to be $785,207. One-time costs associated with initial construction and renovations were estimated to be $1,365,207-$1,535,207 and $965,207-$1,005,207, respectively. CONCLUSIONS Costs associated with increased operational oversight and regulatory standards are a major contributing factor to the facility fee of hospital outpatient departments. Ultimately, all sites of care share in the goal to provide optimal patient care while considering all aspects of patient care, including cost. Therefore, a move towards consistent regulatory standards across all settings would aid in preventing discrepancies in care.
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Affiliation(s)
- Carolyn Kusoski
- 24600The Arthur G. James Cancer Hospital and Richard Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jennifer Booth
- 24600The Arthur G. James Cancer Hospital and Richard Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Stephanie Salch
- 24600The Arthur G. James Cancer Hospital and Richard Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Harrison Jozefczyk
- 24600The Arthur G. James Cancer Hospital and Richard Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Julie Kennerly-Shah
- 24600The Arthur G. James Cancer Hospital and Richard Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Zaorsky NG, Khunsriraksakul C, Acri SL, Liu DJ, Ba DM, Lin JL, Liu G, Segel JE, Drabick JJ, Mackley HB, Leslie DL. Medical Service Use and Charges for Cancer Care in 2018 for Privately Insured Patients Younger Than 65 Years in the US. JAMA Netw Open 2021; 4:e2127784. [PMID: 34613403 PMCID: PMC8495533 DOI: 10.1001/jamanetworkopen.2021.27784] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Currently, there are limited published data regarding resource use and spending on cancer care in the US. OBJECTIVE To characterize the most frequent medical services provided and the associated spending for privately insured patients with cancer in the US. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the MarketScan database for the calendar year 2018 from a sample of 27.1 million privately insured individuals, including patients with a diagnosis of the 15 most prevalent cancers, predominantly from large insurers and self-insured employers. Overall societal health care spending was estimated for each cancer type by multiplying the mean total spending per patient (estimated from MarketScan) by the number of privately insured patients living with that cancer in 2018, as reported by the National Cancer Institute's Surveillance, Epidemiology, and End Results program. Analyses were performed from February 1, 2018, to July 8, 2021. EXPOSURES Evaluation and management as prescribed by treating care team. MAIN OUTCOMES AND MEASURES Current Procedural Terminology and Healthcare Common Procedure Coding System codes based on cancer diagnosis code. RESULTS The estimated cost of cancer care in 2018 for 402 115 patients with the 15 most prevalent cancer types was approximately $156.2 billion for privately insured adults younger than 65 years in the US. There were a total of 38.4 million documented procedure codes for 15 cancers in the MarketScan database, totaling $10.8 billion. Patients with breast cancer contributed the greatest total number of services (10.9 million [28.4%]), followed by those with colorectal cancer (3.9 million [10.2%]) and prostate cancer (3.6 million [9.4%]). Pathology and laboratory tests contributed the highest number of services performed (11.7 million [30.5%]), followed by medical services (6.3 million [16.4%]) and medical supplies and nonphysician services (6.1 million [15.9%]). The costliest cancers were those of the breast ($3.4 billion [31.5%]), followed by lung ($1.1 billion [10.2%]) and colorectum ($1.1 billion [10.2%]). Medical supplies and nonphysician services contributed the highest total spent ($4.0 billion [37.0%]), followed by radiology ($2.1 billion [19.4%]) and surgery ($1.8 billion [16.7%]). CONCLUSIONS AND RELEVANCE This analysis suggests that patients with breast, colorectal, and prostate cancers had the greatest number of services performed, particularly for pathology and laboratory tests, whereas patients with breast, lung, lymphoma, and colorectal cancer incurred the greatest costs, particularly for medical supplies and nonphysician services. The cost of cancer care in 2018 for the 15 most prevalent cancer types was estimated to be approximately $156.2 billion for privately insured adults younger than 65 years in the US.
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Affiliation(s)
- Nicholas G. Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | | | - Samantha L. Acri
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Dajiang J. Liu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Djibril M. Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - John L. Lin
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Guodong Liu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Joel E. Segel
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Health Policy and Administration, Pennsylvania State University, University Park
- Penn State Cancer Institute, Hershey, Pennsylvania
| | - Joseph J. Drabick
- Department of Medical Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Heath B. Mackley
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
- Department of Radiation Oncology, Geisinger Health System, Danville, Pennsylvania
| | - Douglas L. Leslie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
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Risk of Cancer and Cost of Surgery Outweigh Urgency and Messaging in Hypothetical Decisions to Remove Tumors. PSYCHOLOGICAL RECORD 2021. [DOI: 10.1007/s40732-021-00489-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mukherjee K, Small W, Duszak R. Trends and variations in utilization and costs of radiotherapy for prostate cancer: A SEER medicare analysis from 2007 through 2016. Brachytherapy 2021; 21:12-21. [PMID: 34380592 DOI: 10.1016/j.brachy.2021.06.148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/15/2021] [Accepted: 06/24/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To assess recent changes and disparities in utilization and costs of radiotherapy in Medicare beneficiaries with prostate cancer. METHODS Surveillance, Epidemiology and End Results (SEER) -Medicare linked data from 2006-2016 were used to identify continuously enrolled Medicare beneficiaries with a first-time diagnosis of prostate cancer who, within 12 months of diagnosis, underwent at least one radiotherapy related service. Trends in the utilization of different radiotherapy techniques over time, yearly changes in per-patient costs of radiotherapy, and effect of socio-demographic and clinical characteristics on total cost were measured. Per patient annual costs, annual incidence of prostate cancer, and utilization of radiotherapy were used to estimate total costs of radiotherapy to the Medicare program. RESULTS For Medicare beneficiaries with a first-time diagnosis of prostate cancer, the utilization of intensity modulated radiation therapy (IMRT), proton therapy, and stereotactic body radiation therapy (SBRT) increased 23.62%, 0.74% and 1.61% respectively (p <0.0001) while brachytherapy decreased 17.04% (p <0.0001). Cost per beneficiary decreased $340.24 (95% CI: $136.05 - $544.43) annually (p = 0.0065). Age, registry region, and Gleason score were all associated with expenditures. The total cost to the Medicare program was estimated at US $1.16 billion in the year 2016. DISCUSSION In Medicare beneficiaries with prostate cancer treated with radiotherapy, IMRT is the primary mode of treatment. Utilization of brachytherapy decreased significantly despite the efficacy and cost-effectiveness. Although per patient costs have decreased, the share of patient responsibility remained unaltered across years. The current costs to Medicare of radiotherapy for newly diagnosed prostate cancer patients is substantial.
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Affiliation(s)
- Kumar Mukherjee
- Philadelphia College of Osteopathic Medicine, Suwanee, GA 30024.
| | - William Small
- Loyola University Chicago, Stritch School of Medicine, Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Maywood, IL, 60153 USA
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322
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29
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Caba Y, Dharmarajan K, Gillezeau C, Ornstein KA, Mazumdar M, Alpert N, Schwartz RM, Taioli E, Liu B. The Impact of Dementia on Cancer Treatment Decision-Making, Cancer Treatment, and Mortality: A Mixed Studies Review. JNCI Cancer Spectr 2021; 5:pkab002. [PMID: 34056540 PMCID: PMC8152697 DOI: 10.1093/jncics/pkab002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/21/2020] [Accepted: 11/16/2020] [Indexed: 11/12/2022] Open
Abstract
Dementia and cancer occur commonly in older adults. Yet, little is known about the effect of dementia on cancer treatment and outcomes in patients diagnosed with cancer, and no guidelines exist. We performed a mixed studies review to assess the current knowledge and gaps on the impact of dementia on cancer treatment decision-making, cancer treatment, and mortality. A search in PubMed, Medline, and PsycINFO identified 55 studies on older adults with a dementia diagnosis before a cancer diagnosis and/or comorbid cancer and dementia published in English from January 2004 to February 2020. We described variability using range in quantitative estimates, ie, odds ratios (ORs), hazard ratios (HRs), and risk ratios (RR) when appropriate and performed narrative review of qualitative data. Patients with dementia were more likely to receive no curative treatment (including hospice or palliative care) (OR, HR, and RR range = 0.40-4.4, n = 8), while less likely to receive chemotherapy (OR and HR range = 0.11-0.68, n = 8), radiation (OR range = 0.24-0.56, n = 2), and surgery (OR range = 0.30-1.3, n = 4). Older adults with cancer and dementia had higher mortality than those with cancer alone (HR and OR range = 0.92-5.8, n = 33). Summarized findings from qualitative studies consistently revealed that clinicians, caregivers, and patients tended to prefer less aggressive care and gave higher priority to quality of life over life expectancy for those with dementia. Current practices in treatment-decision making for patients with both cancer and dementia are inconsistent. There is an urgent need for treatment guidelines for this growing patient population that considers patient and caregiver perspectives.
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Affiliation(s)
- Yaelin Caba
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Kavita Dharmarajan
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christina Gillezeau
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Katherine A Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Madhu Mazumdar
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Healthcare Delivery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Naomi Alpert
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Rebecca M Schwartz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Occupational Medicine, Epidemiology and Prevention, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Emanuela Taioli
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Awano N, Izumo T, Inomata M, Kuse N, Tone M, Takada K, Muto Y, Fujimoto K, Kimura H, Miyamoto S, Igarashi A, Kunitoh H. Medical costs of lung cancer care in Japan during the first one or two years after initial diagnosis. Jpn J Clin Oncol 2021; 51:778-785. [PMID: 33506249 DOI: 10.1093/jjco/hyaa258] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/19/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Japan's healthcare expenditures, especially on oncology, are rapidly growing; however, there are scant data on actual costs and cost-effectiveness in the real world. The aim was to assess the medical costs and outcomes of patients with advanced lung cancer. METHODS We retrospectively investigated all patients who were diagnosed with advanced lung cancer at the Japanese Red Cross Medical Center between 1 January 2008 and 31 December 2018. Patients were classified into three cohorts according to the year of diagnosis-Cohort 1: 2008-2010, Cohort 2: 2011-2014 and Cohort 3: 2015-2018-and assessed for medical costs and outcome. Medical costs were divided into outpatient and inpatient costs and were calculated on a monthly basis. RESULTS Ninety-five patients with small cell lung cancer (SCLC) and 330 with nonsmall cell lung cancer (NSCLC) were included. There was a trend toward increased costs during the first two years after diagnosis in NSCLC patients, without changes in monthly costs, reflecting improved survival. Compared to Cohort 1, Cohort 3 patients with NSCLC had longer survival (median: 24 versus 12 months, P < 0.001), with a median incremental cost of Japanese Yen 6 million during the initial two years. The proportion of outpatient costs increased over time, especially for NSCLC patients (P < 0.001). No changes in costs or survival were observed in SCLC patients. CONCLUSIONS In NSCLC patients, medical costs increased with prolonged survival during the last decade. The costs on a monthly basis did not change. The proportion of outpatient costs increased.
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Affiliation(s)
- Nobuyasu Awano
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Takehiro Izumo
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Minoru Inomata
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Naoyuki Kuse
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Mari Tone
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Kohei Takada
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yutaka Muto
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Kazushi Fujimoto
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Hitomi Kimura
- Department of Pharmacy, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Shingo Miyamoto
- Department of Medical Oncology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Ataru Igarashi
- Unit of Public Health and Preventive Medicine, Yokohama City University School of Medicine, Japan.,Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Hideo Kunitoh
- Department of Medical Oncology, Japanese Red Cross Medical Center, Tokyo, Japan
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de Moor JS, Mollica M, Sampson A, Adjei B, Weaver SJ, Geiger AM, Kramer BS, Grenen E, Miscally M, Ciolino HP. Delivery of Financial Navigation Services Within National Cancer Institute-Designated Cancer Centers. JNCI Cancer Spectr 2021; 5:pkab033. [PMID: 34222790 DOI: 10.1093/jncics/pkab033] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/05/2021] [Accepted: 04/07/2021] [Indexed: 01/08/2023] Open
Abstract
Background Cancer centers have a responsibility to help patients manage the costs of their cancer treatment. This article describes the availability of financial navigation services within the National Cancer Institute (NCI)-designated cancer centers. Methods Data were obtained from the NCI Survey of Financial Navigation Services and Research, an online survey administered to NCI-designated cancer centers from July to September 2019. Of the 62 eligible centers, 57 completed all or most of the survey, for a response rate of 90.5%. Results Nearly all cancer centers reported providing help with applications for pharmaceutical assistance programs and medical discounts (96.5%), health insurance coverage (91.2%), assistance with nonmedical costs (96.5%), and help understanding medical bills and out-of-pocket costs (85.9%). Although other services were common, in some cases they were only available to certain patients. These services included direct financial assistance with medical and nonmedical costs and referrals to outside organizations for financial assistance. The least common services included medical debt management (63.2%), detailed discussions about the cost of treatment (54.4%), and guidance about legal protections (50.1%). Providing treatment cost transparency to patients was reported as a common challenge: 71.9% of centers agreed or strongly agreed that it is difficult to determine how much a cancer patient's treatment will cost, and 70.2% of oncologists are reluctant to discuss financial issues with patients. Conclusions Cancer centers provide many financial services and resources. However, there remains a need to build additional capacity to deliver comprehensive financial navigation services and to understand the extent to which patients are referred and helped by these services.
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Affiliation(s)
- Janet S de Moor
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Michelle Mollica
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Annie Sampson
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Brenda Adjei
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Sallie J Weaver
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Ann M Geiger
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Barnett S Kramer
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | | | | | - Henry P Ciolino
- Office of Cancer Centers, National Cancer Institute, Rockville, MD, USA
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The Financial Burden of Cancer on Families in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073790. [PMID: 33916454 PMCID: PMC8038578 DOI: 10.3390/ijerph18073790] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 11/22/2022]
Abstract
This study examined the relationship between a diagnosis of cancer and the likelihood of having any out-of-pocket costs (OOPC) and medical debt, and the amounts of OOPC and medical debt, at the household level. We used the 2013 Panel Study of Income Dynamics, a continuous, representative panel survey that collects demographic, economic, and social data in the United States. The analytic sample included head of households and their spouse (if married), 18–64 years old. Two-part models were used. The first part consisted of logistic regression models and the second part consisted of generalized linear models with logarithmic link and a gamma distribution. Logistic regression results showed odds of 2.13 (CI: 1.27, 3.57, p < 0.01) for any OOPC and odds of 1.55 (CI: 0.93, 2.58, p < 0.1) for any medical debt for households in which either the head or spouse (if married) reported a diagnosis of cancer compared to those that did not report a diagnosis of cancer. Likewise, results from the second part of the model for households with a positive amount of OOPC showed an exponentiated coefficient of 1.73 (CI: 1.33, 2.25, p < 0.01) for households in which either the head or spouse (if married) reported a diagnosis of cancer compared to households without a diagnosis of cancer. This study shows that a diagnosis of cancer places a financial burden on families, particularly with all types of debt, in the United States even after controlling for differences between households with a diagnosis of cancer and those without a diagnosis of cancer.
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Choi SY, Lim B, Chi BH, Kim JH, Lee W, Kyung YS, You D, Song HY, Kim CS. Efficacy and tolerability of metallic stent in patients with malignant prostatic obstruction secondary to prostatic cancer. Low Urin Tract Symptoms 2021; 13:329-334. [PMID: 33768708 DOI: 10.1111/luts.12367] [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: 07/15/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the efficacy and tolerability of a self-expandable covered metallic stent in patients with malignant prostatic obstruction secondary to prostate cancer (PC). METHODS We reviewed 22 cases of insertion of self-expandable covered metallic stents with barbs. Data were collected about PC status. Uroflowmetry variables, residual urine volume, International Prostate Symptom Score (IPSS), quality of life (QOL), and duration from stent insertion to removal were surveyed. These clinical parameters were compared before and after stent insertion. RESULTS The patients with PC showed a mean age of 75.5 ± 6.5 years and mean 5.1 ± 1.9 Charlson comorbidity index. The average flow rate (2.4 ± 1.9 vs 5.9 ± 2.4 mL/s, P = .005), peak flow rate (6.9 ± 6.2 vs 14.1 ± 5.5 mL/s, P = .003), flow time (54.6 ± 29.1 vs 23.6 ± 13.7 s, P = .002), residual urine volume (178.7 ± 195.5 vs 7.0 ± 7.1 mL, P = .004), IPSS (26.2 ± 8.1 vs 8.0 ± 6.5 points, P = .001), and QOL (4.7 ± 1.3 vs 2.4 ± 2.1 points, P = .030) improved between before and after stent insertion, respectively. Pain was the most common complication, but 60% of the patients were managed without any intervention. There were hematuria, urinary retention, urinary frequency, obstruction, and urinary incontinence. However, there was no urinary tract infection due to the stent. The median time to stent removal was 5.7 months. CONCLUSIONS The stent was maintained for about 6 months with improved objective and subjective outcomes. The patients with PC, who had a poor comorbidity index and advanced PC status showed a tolerable maintenance period. Self-expandable covered metallic stents can be used for PC patients with a short life expectancy and unsuitability for general anesthesia.
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Affiliation(s)
- Se Young Choi
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Bumjin Lim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Hoon Chi
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jung Hoon Kim
- Department of Urology, Hanil General Hospital, Seoul, Korea
| | - Wonchul Lee
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoon Soo Kyung
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho-Young Song
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Postoperative Surveillance in Older Adults With T1N0M0 Low-risk Papillary Thyroid Cancer. J Surg Res 2021; 264:37-44. [PMID: 33765509 DOI: 10.1016/j.jss.2021.01.049] [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: 10/06/2020] [Revised: 11/27/2020] [Accepted: 01/29/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The frequency and cost of postoperative surveillance for older adults (>65 y) with T1N0M0 low-risk papillary thyroid cancer (PTC) have not been well studied. METHODS Using the SEER-Medicare (2006-2013) database, frequency and cost of surveillance concordant with American Thyroid Association (ATA) guidelines (defined as an office visit, ≥1 thyroglobulin measurement, and ultrasound 6- to 24-month postoperatively) were analyzed for the overall cohort of single-surgery T1N0M0 low-risk PTC, stratified by lobectomy versus total thyroidectomy. RESULTS Majority of 2097 patients in the study were white (86.7%) and female (77.5%). Median age and tumor size were 72 y (interquartile range 68-76) and 0.6 cm (interquartile range 0.3-1.1 cm), respectively; 72.9% of patients underwent total thyroidectomy. Approximately 77.5% of patients had a postoperative surveillance visit; however, only 15.9% of patients received ATA-concordant surveillance. Patients who underwent total thyroidectomy as compared with lobectomy were more likely to undergo surveillance testing, thyroglobulin (61.7% versus 24.8%) and ultrasound (37.5% versus 29.2%) (all P < 0.01), and receive ATA-concordant surveillance (18.5% versus 9.0%, P < 0.001). Total surveillance cost during the study period was $621,099. Diagnostic radioactive iodine, ablation, and advanced imaging (such as positron emission tomography scans) accounted for 55.5% of costs ($344,692), whereas ATA-concordant care accounted for 44.5% of costs. After multivariate adjustment, patients who underwent total thyroidectomy as compared with lobectomy were twice as likely to receive ATA-concordant surveillance (adjusted odds ratio 2.0, 95% confidence interval: 1.5-2.8, P < 0.001). CONCLUSIONS Majority of older adults with T1N0M0 low-risk PTC do not receive ATA-concordant surveillance; discordant care was costly. Total thyroidectomy was the strongest predictor of receiving ATA-concordant care.
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Jo YY, Han J, Park HW, Jung H, Lee JD, Jung J, Cha HS, Sohn DK, Hwangbo Y. Prediction of Prolonged Length of Hospital Stay After Cancer Surgery Using Machine Learning on Electronic Health Records: Retrospective Cross-sectional Study. JMIR Med Inform 2021; 9:e23147. [PMID: 33616544 PMCID: PMC7939945 DOI: 10.2196/23147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 01/06/2021] [Accepted: 01/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Postoperative length of stay is a key indicator in the management of medical resources and an indirect predictor of the incidence of surgical complications and the degree of recovery of the patient after cancer surgery. Recently, machine learning has been used to predict complex medical outcomes, such as prolonged length of hospital stay, using extensive medical information. OBJECTIVE The objective of this study was to develop a prediction model for prolonged length of stay after cancer surgery using a machine learning approach. METHODS In our retrospective study, electronic health records (EHRs) from 42,751 patients who underwent primary surgery for 17 types of cancer between January 1, 2000, and December 31, 2017, were sourced from a single cancer center. The EHRs included numerous variables such as surgical factors, cancer factors, underlying diseases, functional laboratory assessments, general assessments, medications, and social factors. To predict prolonged length of stay after cancer surgery, we employed extreme gradient boosting classifier, multilayer perceptron, and logistic regression models. Prolonged postoperative length of stay for cancer was defined as bed-days of the group of patients who accounted for the top 50% of the distribution of bed-days by cancer type. RESULTS In the prediction of prolonged length of stay after cancer surgery, extreme gradient boosting classifier models demonstrated excellent performance for kidney and bladder cancer surgeries (area under the receiver operating characteristic curve [AUC] >0.85). A moderate performance (AUC 0.70-0.85) was observed for stomach, breast, colon, thyroid, prostate, cervix uteri, corpus uteri, and oral cancers. For stomach, breast, colon, thyroid, and lung cancers, with more than 4000 cases each, the extreme gradient boosting classifier model showed slightly better performance than the logistic regression model, although the logistic regression model also performed adequately. We identified risk variables for the prediction of prolonged postoperative length of stay for each type of cancer, and the importance of the variables differed depending on the cancer type. After we added operative time to the models trained on preoperative factors, the models generally outperformed the corresponding models using only preoperative variables. CONCLUSIONS A machine learning approach using EHRs may improve the prediction of prolonged length of hospital stay after primary cancer surgery. This algorithm may help to provide a more effective allocation of medical resources in cancer surgery.
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Affiliation(s)
- Yong-Yeon Jo
- Healthcare AI Team, National Cancer Center, Goyang, Republic of Korea
| | - JaiHong Han
- Department of Surgery, National Cancer Center, Goyang, Republic of Korea
| | - Hyun Woo Park
- Healthcare AI Team, National Cancer Center, Goyang, Republic of Korea
| | - Hyojung Jung
- Healthcare AI Team, National Cancer Center, Goyang, Republic of Korea
| | - Jae Dong Lee
- Healthcare AI Team, National Cancer Center, Goyang, Republic of Korea
| | - Jipmin Jung
- Cancer Data Center, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Hyo Soung Cha
- Cancer Data Center, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Dae Kyung Sohn
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Yul Hwangbo
- Healthcare AI Team, National Cancer Center, Goyang, Republic of Korea
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Ibarrondo O, Lizeaga G, Martínez-Llorente JM, Larrañaga I, Soto-Gordoa M, Álvarez-López I. Health care costs of breast, prostate, colorectal and lung cancer care by clinical stage and cost component. GACETA SANITARIA 2021; 36:246-252. [PMID: 33612313 DOI: 10.1016/j.gaceta.2020.12.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/21/2020] [Accepted: 12/24/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To measure 3-year care costs of breast, prostate, colorectal and lung cancers disaggregated by site and clinical stage. METHOD A retrospective observational design was employed to investigate care costs of cases recorded in the Registry of the Basque Country between 2010 and 2015. Data gathered included TNM stage and demographic, clinical and resource use variables. Total costs per patient with stage IV disease were calculated by combining generalized linear models with parametric survival analysis. Unit costs were obtained from the analytical accounting system of the Basque Health Service. RESULTS The sample comprised 23,782 cancer cases (7801 colorectal, 5530 breast, 4802 prostate and 5649 lung cancer). The mean 3-year costs per patient with stage I to III disease were €11,323, €13,727, €8,651 and €12,023 for colorectal, breast, prostate and lung cancer, respectively. The most important cost components were surgery and chemotherapy. Total survival-adjusted costs until death for patients with stage IV disease (€27,568, €26,296, €16,151 and €15,931 for breast, colorectal, lung and prostate cancer, respectively) were higher than the 3-year costs for those with earlier-stage disease. CONCLUSIONS This study quantitatively shows the pattern of changes in the economic burden of cancer throughout its natural history and the great magnitude of this burden for the health system. The use of indicators based on real-world data from each regional health service would allow cancer care in each region to be tailored to local population needs.
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Affiliation(s)
- Oliver Ibarrondo
- Basque Health Service (Osakidetza), Debagoiena Integrated Healthcare Organisation, Research Unit, Arrasate-Mondragón, Gipuzkoa, Spain; Biodonostia Health Research Institute, Donostia-San Sebastián, Spain; RS-Statistics, Arrasate-Mondragón, Gipuzkoa, Spain.
| | - Garbiñe Lizeaga
- Basque Health Service (Osakidetza), Donostia University Hospital, Pharmacy Services, Donostia-San Sebastián, Spain
| | - José Miguel Martínez-Llorente
- Basque Health Service (Osakidetza), Debagoiena Integrated Healthcare Organisation, Accounting Department, Arrasate-Mondragón, Gipuzkoa, Spain
| | - Igor Larrañaga
- Kronikgune Institute for Health Service Research, Barakaldo, Bizkaia, Spain
| | - Myriam Soto-Gordoa
- Mondragon Unibertsitatea, Faculty of Engineering, Arrasate-Mondragón, Gipuzkoa, Spain
| | - Isabel Álvarez-López
- Biodonostia Health Research Institute, Donostia-San Sebastián, Spain; RS-Statistics, Arrasate-Mondragón, Gipuzkoa, Spain; Basque Health Service (Osakidetza), Donostia University Hospital, Medical Oncology Service, Donostia-San Sebastián, Spain
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Sun M, Marchese M, Friedlander DF, Nguyen DD, Cole AP, Fletcher SA, Mahal BA, Nguyen PL, Choueiri TK, Kibel AS, Trinh QD. Health care spending in prostate cancer: An assessment of characteristics and health care utilization of high resource-patients. Urol Oncol 2020; 39:130.e17-130.e24. [PMID: 33309298 DOI: 10.1016/j.urolonc.2020.09.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 08/25/2020] [Accepted: 09/29/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Prostate cancer ranks among the top 5 cancers in contribution to national expenditures. Previous reports have identified that 5% of the population accounts for 50% of the nation's annual health care spending. To date, the assessment of the top 5% resource-patients among men diagnosed with prostate cancer (PCa) has never been performed. We investigate the determinants and health care utilization of high resource-patients diagnosed with PCa using a population-based cohort using the Surveillance, Epidemiology, and End Results Medicare-linked database. METHODS Men aged ≥66-year-old with a primary diagnosis of PCa in 2009 were identified. High resource spenders were defined as the top 5% of the sum of the total cost incurred for all services rendered per beneficiary. The spending in each group and predictors of being a high resource-patient were assessed. RESULTS The top 5% resource-patients consisted of 646 men who spent a total of $62,474,504, comprising 26% of the total cost incurred for all 12,875 men who were diagnosed with PCa in 2009. Of the top 5% resource-patients, the average amount spent per patient was $96,710 vs. $14,664 among the bottom 95% resource-patients. In adjusted analyses, older (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.00-1.03), Charlson Comorbidity Index ≥2 (OR: 3.78, 95% CI: 3.10-4.60) men, and advanced disease (metastasis OR: 2.29, 95% CI: 1.68-3.11) were predictors of being a top 5% resource-patient. Of these patients, 210 men died within 1 year of PCa diagnosis (32.5%) vs. 606 men of the bottom 95% resource-patients (5.0%, P < 0.001). CONCLUSION Five percent of men diagnosed with PCa bore 26% of the total cost incurred for all men diagnosed with the disease in 2009. Multimorbidity and advanced disease stage represent the primary drivers of being a high-resource PCa patient. Multidisciplinary care and shared decision-making is encouraged for such patients to better manage cost and quality of care.
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Affiliation(s)
- Maxine Sun
- Department of Urology, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA; Genitourinary Lank Center, Dana-Farber Cancer Institute, Boston, MA.
| | - Maya Marchese
- Department of Urology, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | - David F Friedlander
- Department of Urology, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | - David-Dan Nguyen
- Department of Urology, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | - Alexander P Cole
- Department of Urology, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | - Sean A Fletcher
- Department of Urology, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | - Brandon A Mahal
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Toni K Choueiri
- Department of Urology, Brigham and Women's Hospital, Boston, MA; Genitourinary Lank Center, Dana-Farber Cancer Institute, Boston, MA
| | - Adam S Kibel
- Department of Urology, Brigham and Women's Hospital, Boston, MA
| | - Quoc-Dien Trinh
- Department of Urology, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA; Genitourinary Lank Center, Dana-Farber Cancer Institute, Boston, MA.
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Cost Analysis of Cancer in Brazil: A Population-Based Study of Patients Treated by Public Health System From 2001-2015. Value Health Reg Issues 2020; 23:137-147. [PMID: 33227545 DOI: 10.1016/j.vhri.2020.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 03/13/2020] [Accepted: 05/11/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the federal government expenditures with oncological care, for the most incident cancer types among the Brazilian population, using registries of all patients treated by the Brazilian National Health Service (SUS) between 2001 and 2015. We adopted the formal healthcare sector perspective in this study, with the costs per patient estimated by the reimbursement price paid by the Ministry of Health to service providers. METHODS The costs were adjusted by the follow-up time for each patient. We performed multivariate regression analysis using ordinary least squares. We analyzed 952 960 patients aged ≥19 years who underwent cancer treatment, between 2001 and 2015, for breast, prostate, colorectal, cervix, lung, and stomach cancers. RESULTS The annual mean costs per patient (in USD purchasing power parity) was $9572.30, varying from $5782.10 for breast cancer to $16 656 for cervical cancer. Several variables predicted higher costs of cancer treatment, namely: to be male (+14%), with younger age ranges at treatment initiation, resident in the Northeast region (+26%), treated for colorectal cancer (+482%), with treatment initiation from 2010 to 2014, tumor stages III and IV (III: +182%; IV: +165%), hospitalization for other reasons besides the cancer treatment, and suffering from some a comorbidity. CONCLUSIONS Given the forthcoming Brazilian demographic changes, which strongly suggest that the economic burden of cancer is about to increase in the near future, our estimates provide relevant information to produce useful projections about future cancer-related costs.
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Bharat A, Duncan F, Williams M. Novel Presentation of Pulmonary Atypical Carcinoid Tumor as Acute Pancreatitis. Cureus 2020; 12:e11063. [PMID: 33224658 PMCID: PMC7676822 DOI: 10.7759/cureus.11063] [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] [Indexed: 11/05/2022] Open
Abstract
Pulmonary neuroendocrine tumors (NETs) are a group of rare tumors that pose a high financial burden on patients and the United States healthcare system. The usual presenting symptoms include cough or wheezing, hemoptysis, or chest pain. Due to bronchial obstruction, patients may also present with recurrent pneumonia. Acute pancreatitis has yet to be documented as the initial manifestation of this disease. Atypical carcinoids - a subtype of NETs - are heterogeneous regarding their site of origin, biological behavior, and malignant potential. Studies show that the most common primary tumor site varies by race, with the lung being the most common in white patients and the rectum being the most common in Asian/Pacific Islander, American Indian/Alaskan Native, and African American patients. Certain carcinoid tumors, such as those of the rectum, are over-represented among the Black and Asian populations within the United States, suggesting the role of genetics in the development of this intriguing disease. Furthermore, the pancreas is not a usual site of metastasis for primary lung NET. Our case study describes the rare occurrence of a primary pulmonary NET (atypical carcinoid) metastasizing to the pancreas and presenting as acute pancreatitis.
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Affiliation(s)
- Anchit Bharat
- Internal Medicine, Indiana University Health Ball Memorial Hospital, Muncie, USA
| | - Francesca Duncan
- Pulmonary and Critical Care Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Mark Williams
- Pulmonary and Critical Care Medicine, Indiana University School of Medicine, Indianapolis, USA
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Francisci S, Guzzinati S, Capodaglio G, Pierannunzio D, Mallone S, Tavilla A, Lopez T, Busco S, Mazzucco W, Angiolini C, Zorzi M, Serraino D, Barchielli A, Fusco M, Stracci F, Bianconi F, Rugge M, Iacovacci S, Russo AG, Cusimano R, Gigli A. Patterns of care and cost profiles of women with breast cancer in Italy: EPICOST study based on real world data. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:1003-1013. [PMID: 32399781 DOI: 10.1007/s10198-020-01190-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 04/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To estimate total direct health care costs associated to diagnosis and treatment of women with breast cancer in Italy, and to investigate their distribution by service type according to the disease pathway and patient characteristics. METHODS Data on patients provided by population-based Cancer Registries are linked at individual level with data on health-care services and corresponding claims from administrative databases. A combination of cross-sectional approach and a threephase of care decomposition model with initial, continuing and final phases-of-care defined according to time occurred since diagnosis and disease outcome is adopted. Direct estimation of cancer-related costs is obtained. RESULTS Study cohort included 49,272 patients, 15.2% were in the initial phase absorbing 42% of resources, 79.7% in the continuing phase absorbing 44% of resources and 5.1% in the final phase absorbing 14% of resources. Hospitalization was the most important cost driver, accounting for over 55% of the total costs. CONCLUSIONS This paper represents the first attempt in Italy to estimate the economic burden of cancer at population level taking into account the entire disease pathway and using multiple current health care databases. The evidence produced by the study can be used to better plan resources allocation. The model proposed is replicable to countries with individual health care information on services and claims.
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Affiliation(s)
- Silvia Francisci
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | | | | | - Daniela Pierannunzio
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Sandra Mallone
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Andrea Tavilla
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Tania Lopez
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Susanna Busco
- UOC Programmazione e Controllo di Gestione, ASL Latina, Latina, Italy
| | - Walter Mazzucco
- Sciences for Health Promotion and Mother and Child (PROSAMI) Department, University of Palermo, Palermo, Italy
- Clinical Epidemiology and Cancer Registry Unit, Palermo University Hospital "P. Giaccone", Palermo, Italy
| | - Catia Angiolini
- Breast Oncology, Careggi University Hospital, Florence, Italy
| | - Manuel Zorzi
- Veneto Tumour Registry, Azienda Zero, Padua, Italy
| | - Diego Serraino
- SOC Epidemiologia Oncologica, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | | | - Mario Fusco
- Registro Tumori ASL Napoli 3 sud, Naples, Italy
| | - Fabrizio Stracci
- Umbria Cancer Registry, Public Health Section, Department Experimental Medicine, University of Perugia, Perugia, Italy
| | - Fortunato Bianconi
- Umbria Cancer Registry, Public Health Section, Department Experimental Medicine, University of Perugia, Perugia, Italy
| | - Massimo Rugge
- Department of Medicine, Surgical Pathology Unit, University of Padua, Padua, Italy
| | | | | | | | - Anna Gigli
- Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
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Jo W. Funding sources and breast cancer research frame. PLoS One 2020; 15:e0238026. [PMID: 32834005 PMCID: PMC7446886 DOI: 10.1371/journal.pone.0238026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 07/18/2020] [Indexed: 11/19/2022] Open
Abstract
This study aims to analyze the formation of the frame of breast cancer research. To test our hypothesis that the research frame depends on the funding sources, we collected the abstracts of 48,448 breast cancer research papers from PubMed and applied structural topic modeling, word network analysis, and LASSO logistic regression to the data. In particular, we analyzed the relationship between funding sources and the molecularization of breast cancer knowledge. The results show that government-funded research is likely to have molecular objects or population as the unit of interest, whereas the research not funded by the government is likely to have individual patients as the unit of interest in relation to specific treatments. This phenomenon is attributed to the different interests of government institutions and the private sector. This study improves our understanding of molecularization and medical knowledge production.
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Affiliation(s)
- Wonkwang Jo
- Department of Sociology, College of Social Science, Seoul National University, Seoul, Republic of Korea
- The Institute for Social Development and Policy Research, Seoul National University, Seoul, Republic of Korea
- * E-mail:
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Eaglehouse YL, Georg MW, Richard P, Shriver CD, Zhu K. Cost-Efficiency of Breast Cancer Care in the US Military Health System: An Economic Evaluation in Direct and Purchased Care. Mil Med 2020; 184:e494-e501. [PMID: 30839064 DOI: 10.1093/milmed/usz025] [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: 08/03/2018] [Revised: 11/07/2018] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION With the rising costs of cancer care, it is critical to evaluate the overall cost-efficiency of care in real-world settings. In the United States, breast cancer accounts for the largest portion of cancer care spending due to high incidence and prevalence. The purpose of this study is to assess the relationship between breast cancer costs in the first 6 months after diagnosis and clinical outcomes by care source (direct or purchased) in the universal-access US Military Health System (MHS). MATERIALS AND METHODS We conducted a retrospective analysis of data from the Department of Defense Central Cancer Registry and MHS Data Repository administrative records. The institutional review boards of the Walter Reed National Military Medical Center and the Defense Health Agency reviewed and approved the data linkage. We used the linked data to identify women aged 40-64 who were diagnosed with pathologically-confirmed breast cancer between 2003 and 2007 with at least 1 year of follow-up through December 31, 2008. We identified cancer treatment from administrative data using relevant medical procedure and billing codes and extracted costs paid by the MHS for each claim. Multivariable Cox proportional hazards models estimated hazards ratios (HR) and 95% confidence intervals (CI) for recurrence or all-cause death as a function of breast cancer cost in tertiles. RESULTS The median cost per patient (n = 2,490) for cancer care was $16,741 (interquartile range $9,268, $28,742) in the first 6 months after diagnosis. In direct care, women in the highest cost tertile had a lower risk for clinical outcomes compared to women in the lowest cost tertile (HR 0.58, 95% CI 0.35, 0.96). When outcomes were evaluated separately, there was a statistically significant inverse association between higher cost and risk of death (p-trend = 0.025) for women receiving direct care. These associations were not observed among women using purchased care or both care sources. CONCLUSIONS In the MHS, higher breast cancer costs in the first 6 months after diagnosis were associated with lower risk for clinical outcomes in direct care, but not in purchased care. Organizational, institutional, and provider-level factors may contribute to the observed differences by care source. Replication of our findings in breast and other tumor sites may have implications for informing cancer care financing and value-based reimbursement policy.
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Affiliation(s)
- Yvonne L Eaglehouse
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Suite 1120, Rockville, MD.,Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
| | - Matthew W Georg
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Suite 1120, Rockville, MD
| | - Patrick Richard
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Suite 1120, Rockville, MD.,Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
| | - Kangmin Zhu
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Suite 1120, Rockville, MD.,Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
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Rice DR, Farooq A, Hyer JM, Paredes AZ, Bae J, Tsilimigras DI, Pawlik TM. Health expenditures and financial burden among patients with major gastrointestinal cancers relative to other common cancers in the United States. Surgery 2020; 167:985-990. [DOI: 10.1016/j.surg.2020.02.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/11/2020] [Accepted: 02/26/2020] [Indexed: 12/20/2022]
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Pang J, Crawford K, Faraji F, Ramsey C, Kemp A, Califano JA. An Analysis of 1-Year Charges for Head and Neck Cancer: Targets for Value-Based Interventions. Otolaryngol Head Neck Surg 2020; 163:546-553. [PMID: 32450778 DOI: 10.1177/0194599820921401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To identify the dominant clinical factors associated with increased 1-year charges in treating head and neck cancer. STUDY DESIGN Retrospective review. SETTING Single academic institution. SUBJECTS AND METHODS We retrospectively reviewed 1-year charges for 196 consecutive patients with head and neck cancer (HNC) who were treated exclusively at our institution. We analyzed charges by department as well as factors associated with increased charges per multivariable regression. RESULTS The mean age was 59.6 years (SD, 14.9). Most of the population was male (64%), white (70%), and commercially insured (46%). The most common primary sites were the oropharynx (25%; 76%, HPV positive), skin (19%), and thyroid (17%). Eighty-three percent of total charges were due to standard-of-care treatment for HNC: surgery ($16 million), radiation therapy ($22 million), or chemotherapy ($11 million). The median total charge per patient was $212,484 (interquartile range, $78,630-$475,823). Multivariable regression demonstrated that the following were associated with increased charges: nasopharynx subsite ($250,929 [95% CI, $93,290-$408,569]; effect size in US dollars, P = .002), advanced stage (American Joint Committee on Cancer, seventh edition; $80,331 [$22,726-$137,936], P = .007), therapeutic surgery ($281,893 [$117,371-$446,415], P = .001), chemotherapy ($183,331 [$125,497-$241,165], P < .001), radiation ($203,397 [$143,454-$263,341], P < .001), surgical complication requiring return to the operating room ($147,247 [$37,240-$257,254], P = .009), emergency department visits ($89,050 [$23,811-$154,289], P = .008), and admissions ($140,894 [$82,895-$198,893], P < .001; constant, -$233,927 [-$410,790 to -$57,064]). The top quartile accrued 55% of the total charges. CONCLUSION Radiation, followed by surgery and chemotherapy, were the most expensive components of HNC care. In this analysis, we identified the dominant clinical factors associated with increased charges.
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Affiliation(s)
- John Pang
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine, University of California-San Diego, La Jolla, CA, USA
| | - Kayva Crawford
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine, University of California-San Diego, La Jolla, CA, USA
| | - Farhoud Faraji
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine, University of California-San Diego, La Jolla, CA, USA
| | - Celia Ramsey
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine, University of California-San Diego, La Jolla, CA, USA
| | - Aaron Kemp
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine, University of California-San Diego, La Jolla, CA, USA
| | - Joseph A Califano
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine, University of California-San Diego, La Jolla, CA, USA
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Lam CJK, Enewold L, McNeel TS, White DP, Warren JL, Mariotto AB. Estimating Chemotherapy Use Among Patients With a Prior Primary Cancer Diagnosis Using SEER-Medicare Data. J Natl Cancer Inst Monogr 2020; 2020:14-21. [PMID: 32412067 DOI: 10.1093/jncimonographs/lgaa005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/09/2020] [Accepted: 02/02/2020] [Indexed: 11/12/2022] Open
Abstract
Cancer treatment studies commonly exclude patients with prior primary cancers due to difficulties in ascertaining for which site treatment is intended. Surveillance, Epidemiology, and End Results-Medicare patients 65 years and older diagnosed with an index colon or rectal cancer (CRC) or female breast cancer (BC) between 2004 and 2013 were included. Chemotherapy, defined as "any chemotherapy" and more restrictively as "chemotherapy with confirmatory diagnoses," was ascertained based on claims data within 6 months of index cancer diagnosis by prior cancer history. Any chemotherapy use was slightly lower among patients with a prior cancer (CRC: no prior = 17.4%, prior = 16.1%; BC: no prior = 12.9%, prior = 12.0%). With confirmatory diagnoses required, estimates were lower, especially among patients with a prior cancer (CRC: no prior = 16.8%, prior = 13.6%; BC: no prior = 12.6%, prior = 11.0%). These findings suggest that patients with prior cancers can be included in studies of chemotherapy use; requiring confirmatory diagnoses can increase treatment assignment confidence.
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Affiliation(s)
- Clara J K Lam
- Data Analytics Branch, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Lindsey Enewold
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | | | - Dolly P White
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Joan L Warren
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Angela B Mariotto
- Data Analytics Branch, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
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Lipitz-Snyderman A, Lavery JA, Bach PB, Li DG, Yang A, Strong VE, Russo A, Panageas KS. Assessment of variation in 30-day mortality following cancer surgeries among older adults across US hospitals. Cancer Med 2020; 9:1648-1660. [PMID: 31918457 PMCID: PMC7050094 DOI: 10.1002/cam4.2800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/05/2019] [Indexed: 11/22/2022] Open
Abstract
Background While public reporting of surgical outcomes for noncancer conditions is common, cancer surgeries have generally been excluded. This is true despite numerous studies showing outcomes to differ between hospitals based on their characteristics. Our objective was to assess whether three prerequisites for quality assessment and reporting are present for 30‐day mortality after cancer surgery: low burden for timely reporting, hospital variation, and potential for public health gains. Study Design We used Fee‐for‐Service (FFS) Medicare claims to examine the extent of variation in 30‐day cancer surgical mortality between 3860 US hospitals. We included 340 489 surgeries for 12 cancer types for FFS Medicare beneficiaries aged ≥66 years, 2011‐2013. Hierarchical mixed‐effects logistic regression models adjusted for patient and hospital characteristics and with a random hospital effect were fit to obtain hospital‐specific risk‐standardized mortality rates (RSMRs) and 99% confidence intervals (CI). We calculated a hospital odds ratio to describe the difference in mortality risk for a hospital above vs below average quality and estimated the potential mortality reduction. Results The median number of cancer surgeries per hospital was 34. The median RSMR overall was 2.41% (99% CI 2.28%, 2.66%). In aggregate and for most cancers, variation between hospitals exceeded that due to differences in patient and hospital characteristics. For individual cancers, relative differences exceeded 20% in mortality risk between patients undergoing surgery at a hospital below vs above average quality, with the potential for an estimated 500 deaths prevented annually given hypothetical improvements. Conclusion Quality measurement and reporting of 30‐day mortality for cancer surgery is worthy of consideration.
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Affiliation(s)
- Allison Lipitz-Snyderman
- Center for Health Policy and Outcomes, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jessica A Lavery
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter B Bach
- Center for Health Policy and Outcomes, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Diane G Li
- Center for Health Policy and Outcomes, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Annie Yang
- Center for Health Policy and Outcomes, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vivian E Strong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ashley Russo
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Katherine S Panageas
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Kaur M, Pusic AL, Cano SJ, Xie F, Bordeleau L, Zhong T, Klassen A. International phase 1 study protocol to develop a health state classification system for a preference-based measure for women with breast cancer: the BREAST-Q Utility module. BMJ Open 2020; 10:e034451. [PMID: 31915176 PMCID: PMC6955575 DOI: 10.1136/bmjopen-2019-034451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/04/2019] [Accepted: 12/12/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Concerns unique to women with breast cancer can include impact of cancer on body image, sexual well-being and changes in breast appearance and sensation. These important issues are not captured by the existing generic preference-based measures (PBMs) and no breast cancer-specific PBM currently exists. This Phase 1 protocol describes a mixed-methods study to develop and validate the descriptive health state classification system for a breast cancer-specific PBM, called the BREAST-Q Utility module. METHODS AND ANALYSIS A heterogeneous sample of women aged 18 years and older diagnosed with breast cancer who are undergoing or have had treatment for breast cancer will be invited to participate in qualitative interviews. Participants will be asked to describe impact of their diagnosis and treatment(s) on their health-related quality of life (HRQOL). Interviews will be audio recorded, transcribed verbatim and coded using a line-by-line approach. At the end of each interview, based on each participant's cancer treatment history, patients will complete the mastectomy, breast-conserving therapy or reconstruction module of BREAST-Q, with modified 5-point Likert scale to measure importance of the BREAST-Q concepts. Both sources of data will be analysed to identify the most important HRQOL concerns.A conceptual framework and item pool will be developed from the qualitative dataset. Preliminary version of the BREAST-Q Utility module will be created and refined at an in-person meeting of multidisciplinary experts. Content validity of the Utility module will be examined (cognitive debriefing, expert feedback). Psychometric properties of Utility module will be evaluated in a large sample of women with breast cancer. ETHICS AND DISSEMINATION The study has been approved by Hamilton Integrated Research Ethics Board, Canada. Results of this study will be presented at international conferences and published in peer-reviewed journals.
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Affiliation(s)
- Manraj Kaur
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Andrea L Pusic
- Plastic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Feng Xie
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Louise Bordeleau
- Medical Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - Toni Zhong
- Plastic Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Anne Klassen
- Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Mustapha M, Ali-Gombe M, Abdullahi A, Adenipekun A, Campbell O. Financial burden of cancer on patients treated at a tertiary health facility in South West Nigeria. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2020; 10:23-29. [PMID: 35814963 PMCID: PMC9267039 DOI: 10.4103/jwas.jwas_4_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/01/2022] [Indexed: 12/04/2022]
Abstract
Background: Cancer is a growing health concern in the world. The financial burden of cancer affects not only cancer patients and their families, but also the society as a whole. In Nigeria there is a dearth of information about the financial burden of cancer on patients. Hence, there is need to estimate the cost of cancer treatment and to show the resources being allocated to the problem. Objectives: The aim of this study was to estimate the financial burden of cancer on patients treated at a tertiary heath facility in South West Nigeria. Materials and Methods: The study was a cross-sectional study and patients were interviewed using a set of questionnaires that addresses sociodemographic and economic questions involving medical and nonmedical costs (direct medical costs). Data Analysis: Data obtained were analyzed using the Statistical Package for Social Sciences (SPSS), version 21.0. Descriptive statistics such as frequencies (%), mean, standard deviation, median, range and P-value were used to highlight important and relevant features of the data. For ease of analysis some of the variables such as sociodemographic, medical, and nonmedical costs were grouped or categorized. Results: Two hundred and twenty cancer patients participated in the study. The mean age of the patients was 54.1 (standard deviation [SD] = 13.4) years and majority were females (81.4%). Approximately one-third of the respondents were those with breast (35.9%) and cervical (35.5%) cancers, respectively. Majority perceived financial burden as a result of cancer to be significant (82.7%). The mean annual income of patients was $5,548.7(SD = $7,245.4). The main sources of income for their treatments were from their children (26.8%). The mean total cost incurred by patients with cancer was $5306.9 (SD = $5045.7), with medical costs accounting for the highest percentage $3889.4 (SD = $4372.9); 73.0% and nonmedical costs of $1417.5 (SD = $1085.6); 27.0%. Patients with colorectal cancer incurred the highest cost, whereas cervical cancer patients incurred the least cost. Conclusion: Financing cancer management is a major challenge for both patients and their caregivers. Cancer care also results in a loss of economic income available to the community/country.
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Solanki S, Chakinala RC, Haq KF, Khan MA, Kifayat A, Linder K, Khan Z, Mansuri U, Haq KS, Nabors C, Aronow WS. Inpatient burden of gastric cancer in the United States. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:772. [PMID: 32042788 DOI: 10.21037/atm.2019.11.54] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Gastric cancer is associated with significant morbidity and mortality. Over one-half of patients have advanced disease at the time of presentation, leading to a significant burden on the healthcare system. Limited epidemiological data exists on national inpatient hospitalization trends. The aim of this study is to determine the inpatient burden of gastric cancer in the United States. Methods We analyzed the Nationwide Inpatient Sample (NIS) database for all subjects with the diagnosis of malignant neoplasm of the stomach (ICD-9 code 151.x) as primary diagnosis during the period from 2001-2011. NIS is the largest all-payer inpatient care database in the U.S. Statistical significance of variation in the number of hospitalizations, patient demographics, and comorbidity measures was determined using Cochran-Armitage trend test. Results From 2001 to 2011, the number of hospitalizations with the diagnosis of malignant neoplasm of the stomach ranged between 22,430 and 25,371, however, the trend was not significant. Men were always more affected than women with no significant change in overall proportion (P<0.0001). Overall, in-hospital mortality decreased from 11.19% in 2001 to 6.47% in 2011 (P<0.0001). However, average cost of care per hospitalization increased from $21,710 in 2001 to $24,706 in 2011 (adjusted for inflation, P<0.0001). Conclusions The total number of hospitalizations remained relatively stable throughout the study period with higher proportion of men affected every year. Although in-hospital mortality in patients with the diagnosis of gastric cancer decreased over the study period, there was a significant rise in the cost of care.
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Affiliation(s)
- Shantanu Solanki
- Hospitalist Department, Guthrie Robert Packer Hospital, Sayre, PA, USA
| | | | - Khwaja Fahad Haq
- Division of Gastroenterology, Henry Ford Hospital, Detroit, MI, USA
| | - Muhammad Ali Khan
- Division of Gastroenterology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Alina Kifayat
- Department of Medicine, New York Medical College at Westchester Medical Center, Valhalla, NY, USA
| | - Katherine Linder
- Division of Hematology-Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Zubair Khan
- Department of Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Uvesh Mansuri
- Department of Medicine, MedStar Health, Baltimore, MD, USA
| | - Khwaja Saad Haq
- Department of Medicine, Kingsbrook Jewish Medical Center, Brooklyn, NY, USA
| | - Christopher Nabors
- Department of Medicine, New York Medical College at Westchester Medical Center, Valhalla, NY, USA
| | - Wilbert S Aronow
- Department of Cardiology, New York Medical College at Westchester Medical Center, Valhalla, NY, USA
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Onyeakusi NE, Mukhtar F, Gbadamosi SO, Oshunbade A, Adejumo AC, Olufajo O, Owoh J. Cancer-Related Pain Is an Independent Predictor of In-Hospital Opioid Overdose: A Propensity-Matched Analysis. PAIN MEDICINE 2019; 20:2552-2561. [PMID: 31197321 DOI: 10.1093/pm/pnz130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND About 50% of patients with cancer who have undergone surgery suffer from cancer-related pain (CP). The use of opioids for postoperative pain management presents the potential for overdose, especially among these patients. OBJECTIVE The primary objective of this study was to determine the association between CP and postoperative opioid overdose among inpatients who had undergone major elective procedures. The secondary objective was to assess the relationship between CP and inpatient mortality, total hospital charge, and length of stay in this population. METHODS Data of adults 18 years and older from the National Inpatient Sample (NIS) were analyzed. Variables were identified using ICD-9 codes. Propensity-matched regression models were employed in evaluating the association between CP and outcomes of interest. RESULTS Among 4,085,355 selected patients, 0.8% (N = 2,665) had CP, whereas 99.92% (N = 4,082,690) had no diagnosis of CP. We matched patients with CP (N = 2,665) and no CP (N = 13,325) in a 1:5 ratio. We found higher odds of opioid overdose (adjusted odds ratio [aOR] = 4.82, 95% confidence interval [CI] = 2.68-8.67, P < 0.0001) and inpatient mortality (aOR = 1.39, 95% CI = 1.11-1.74, P = 0.0043) in patients with CP vs no CP. Also, patients with CP were more likely to stay longer in the hospital (12.76 days vs 7.88 days) with higher total hospital charges ($140,220 vs $88,316). CONCLUSIONS CP is an independent risk factor for opioid overdose, increased length of stay, and increased total hospital charges.
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Affiliation(s)
- Nnaemeka E Onyeakusi
- Department of Anesthesiology, Case Western Reserve University/MetroHealth Med Ctr, Cleveland, Ohio.,Department of Pediatrics, BronxCare Health System, Bronx, New York
| | - Fahad Mukhtar
- Department of Psychiatry, St. Elizabeth's Hospital, Washington, DC.,Department of Epidemiology and Biostatistics, University of South Florida, Tampa, Florida
| | - Semiu O Gbadamosi
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida
| | | | | | - Olubode Olufajo
- Department of Surgery, Howard University College of Medicine, Washington, DC
| | - Jude Owoh
- Quinnipiac University, Hamden, Salem, Connecticut, USA
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