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Yabroff KR, Doran JF, Zhao J, Chino F, Shih YCT, Han X, Zheng Z, Bradley CJ, Bryant MF. Cancer diagnosis and treatment in working-age adults: Implications for employment, health insurance coverage, and financial hardship in the United States. CA Cancer J Clin 2024; 74:341-358. [PMID: 38652221 DOI: 10.3322/caac.21837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/19/2024] [Accepted: 03/05/2024] [Indexed: 04/25/2024] Open
Abstract
The rising costs of cancer care and subsequent medical financial hardship for cancer survivors and families are well documented in the United States. Less attention has been paid to employment disruptions and loss of household income after a cancer diagnosis and during treatment, potentially resulting in lasting financial hardship, particularly for working-age adults not yet age-eligible for Medicare coverage and their families. In this article, the authors use a composite patient case to illustrate the adverse consequences of cancer diagnosis and treatment for employment, health insurance coverage, household income, and other aspects of financial hardship. They summarize existing research and provide nationally representative estimates of multiple aspects of financial hardship and health insurance coverage, benefit design, and employee benefits, such as paid sick leave, among working-age adults with a history of cancer and compare them with estimates among working-age adults without a history of cancer from the most recently available years of the National Health Interview Survey (2019-2021). Then, the authors identify opportunities for addressing employment and health insurance coverage challenges at multiple levels, including federal, state, and local policies; employers; cancer care delivery organizations; and nonprofit organizations. These efforts, when informed by research to identify best practices, can potentially help mitigate the financial hardship associated with cancer.
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Affiliation(s)
- K Robin Yabroff
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, Georgia, USA
| | | | - Jingxuan Zhao
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, Georgia, USA
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ya-Chen Tina Shih
- Department of Radiation Oncology, University of California-Los Angeles Jonsson Comprehensive Cancer Center, School of Medicine, Los Angeles, California, USA
| | - Xuesong Han
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, Georgia, USA
| | - Zhiyuan Zheng
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, Georgia, USA
| | - Cathy J Bradley
- University of Colorado Comprehensive Cancer Center and Colorado School of Public Health, Aurora, Colorado, USA
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Li L, Yang C, Huang Y, Zhan S, Hu L, Zou J, Yu M, Mazumdar M, Liu B. Medicaid expansion in California and breast cancer incidence across neighborhoods with varying social vulnerabilities. Cancer Causes Control 2024:10.1007/s10552-024-01893-1. [PMID: 38874815 DOI: 10.1007/s10552-024-01893-1] [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: 02/21/2024] [Accepted: 05/31/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE To investigate changes in breast cancer incidence rates associated with Medicaid expansion in California. METHODS We extracted yearly census tract-level population counts and cases of breast cancer diagnosed among women aged between 20 and 64 years in California during years 2010-2017. Census tracts were classified into low, medium and high groups according to their social vulnerability index (SVI). Using a difference-in-difference (DID) approach with Poisson regression models, we estimated the incidence rate, incidence rate ratio (IRR) during the pre- (2010-2013) and post-expansion periods (2014-2017), and the relative IRR (DID estimates) across three groups of neighborhoods. RESULTS Prior to the Medicaid expansion, the overall incidence rate was 93.61, 122.03, and 151.12 cases per 100,000 persons among tracts with high, medium, and low-SVI, respectively; and was 96.49, 122.07, and 151.66 cases per 100,000 persons during the post-expansion period, respectively. The IRR between high and low vulnerability neighborhoods was 0.62 and 0.64 in the pre- and post-expansion period, respectively, and the relative IRR was 1.03 (95% CI 1.00 to 1.06, p = 0.026). In addition, significant DID estimate was only found for localized breast cancer (relative IRR = 1.05; 95% CI, 1.01 to 1.09, p = 0.049) between high and low-SVI neighborhoods, not for regional and distant cancer stage. CONCLUSIONS The Medicaid expansion had differential impact on breast cancer incidence across neighborhoods in California, with the most pronounced increase found for localized cancer stage in high-SVI neighborhoods. Significant pre-post change was only found for localized breast cancer between high and low-SVI neighborhoods.
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Affiliation(s)
- Lihua Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, USA
- Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, USA
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chen Yang
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, USA
- Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, USA
| | - Yuanhui Huang
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Serena Zhan
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, USA
- Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Liangyuan Hu
- Department of Biostatistics & Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Joe Zou
- Information Management Services, Inc, Rockville, MD, USA
| | - Mandi Yu
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Madhu Mazumdar
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, USA
- Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, USA
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, USA.
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, USA.
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Sabik LM, Kwon Y, Drake C, Yabes J, Bhattacharya M, Sun Z, Bradley CJ, Jacobs BL. Impact of the Affordable Care Act on access to accredited facilities for cancer treatment. Health Serv Res 2024. [PMID: 38698670 DOI: 10.1111/1475-6773.14315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVE To examine differential changes in receipt of surgery at National Cancer Institute (NCI)-designated comprehensive cancer centers (NCI-CCC) and Commission on Cancer (CoC) accredited hospitals for patients with cancer more likely to be newly eligible for coverage under Affordable Care Act (ACA) insurance expansions, relative to those less likely to have been impacted by the ACA. DATA SOURCES AND STUDY SETTING Pennsylvania Cancer Registry (PCR) for 2010-2019 linked with discharge records from the Pennsylvania Health Care Cost Containment Council (PHC4). STUDY DESIGN Outcomes include whether cancer surgery was performed at an NCI-CCC or a CoC-accredited hospital. We conducted a difference-in-differences analysis, estimating linear probability models for each outcome that control for residence in a county with above median county-level pre-ACA uninsurance and the interaction between county-level baseline uninsurance and cancer treatment post-ACA to capture differential changes in access between those more and less likely to become newly eligible for insurance coverage (based on area-level proxy). All models control for age, sex, race and ethnicity, cancer site and stage, census-tract level urban/rural residence, Area Deprivation Index, and year- and county-fixed effects. DATA COLLECTION/EXTRACTION METHODS We identified adults aged 26-64 in PCR with prostate, lung, or colorectal cancer who received cancer-directed surgery and had a corresponding surgery discharge record in PHC4. PRINCIPAL FINDINGS We observe a differential increase in receiving care at an NCI-CCC of 6.2 percentage points (95% CI: 2.6-9.8; baseline mean = 9.8%) among patients in high baseline uninsurance areas (p = 0.001). Our estimate of the differential change in care at the larger set of CoC hospitals is positive (3.9 percentage points [95% CI: -0.5-8.2; baseline mean = 73.7%]) but not statistically significant (p = 0.079). CONCLUSIONS Our findings suggest that insurance expansions under the ACA were associated with increased access to NCI-CCCs.
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Affiliation(s)
- Lindsay M Sabik
- University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Youngmin Kwon
- University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Coleman Drake
- University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Jonathan Yabes
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Zhaojun Sun
- University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Cathy J Bradley
- Colorado School of Public Health and University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Bruce L Jacobs
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Lawrence WR, Freedman ND, McGee-Avila JK, Mason L, Chen Y, Ewing AP, Shiels MS. Severe housing cost burden and premature mortality from cancer. JNCI Cancer Spectr 2024; 8:pkae011. [PMID: 38372706 PMCID: PMC11071114 DOI: 10.1093/jncics/pkae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/25/2023] [Accepted: 02/05/2024] [Indexed: 02/20/2024] Open
Abstract
Unaffordable housing has been associated with poor health. We investigated the relationship between severe housing cost burden and premature cancer mortality (death before 65 years of age) overall and by Medicaid expansion status. County-level severe housing cost burden was measured by the percentage of households that spend 50% or more of their income on housing. States were classified on the basis of Medicaid expansion status (expanded, late-expanded, nonexpanded). Mortality-adjusted rate ratios were estimated by cancer type across severe housing cost burden quintiles. Compared with the lowest quintile of severe housing cost burden, counties in the highest quintile had a 5% greater cancer mortality rate (mortality-adjusted rate ratio = 1.05, 95% confidence interval = 1.01 to 1.08). Within each severe housing cost burden quintile, cancer mortality rates were greater in states that did not expand Medicaid, though this association was significant only in the fourth quintile (mortality-adjusted rate ratio = 1.08, 95% confidence interval = 1.03 to 1.13). Our findings demonstrate that counties with greater severe housing cost burden had higher premature cancer death rates, and rates are potentially greater in non-Medicaid-expanded states than Medicaid-expanded states.
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Affiliation(s)
- Wayne R Lawrence
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Jennifer K McGee-Avila
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Lee Mason
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Yingxi Chen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Aldenise P Ewing
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
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Moss JL, Geyer NR, Lengerich EJ. Patterns of Cancer-Related Healthcare Access across Pennsylvania: Analysis of Novel Census Tract-Level Indicators of Persistent Poverty. Cancer Epidemiol Biomarkers Prev 2024; 33:616-623. [PMID: 38329390 DOI: 10.1158/1055-9965.epi-23-1255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/14/2023] [Accepted: 02/06/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Persistent poverty census tracts have had ≥20% of the population living below the federal poverty line for 30+ years. We assessed the relationship between persistent poverty and cancer-related healthcare access across census tracts in Pennsylvania. METHODS We gathered publicly available census tract-level data on persistent poverty, rurality, and sociodemographic variables, as well as potential access to healthcare (i.e., prevalence of health insurance, last-year check-up), realized access to healthcare (i.e., prevalence of screening for cervical, breast, and colorectal cancers), and self-reported cancer diagnosis. We used multivariable spatial regression models to assess the relationships between persistent poverty and each healthcare access indicator. RESULTS Among Pennsylvania's census tracts, 2,789 (89.8%) were classified as non-persistent poverty, and 316 (10.2%) were classified as persistent poverty (113 did not have valid data on persistent poverty). Persistent poverty tracts had lower prevalence of health insurance [estimate = -1.70, standard error (SE) = 0.10], screening for cervical cancer (estimate = -4.00, SE = 0.17) and colorectal cancer (estimate = -3.13, SE = 0.20), and cancer diagnosis (estimate = -0.34, SE = 0.05), compared with non-persistent poverty tracts (all P < 0.001). However, persistent poverty tracts had higher prevalence of last-year check-up (estimate = 0.22, SE = 0.08) and screening for breast cancer (estimate = 0.56, SE = 0.15; both P < 0.01). CONCLUSIONS Relationships between persistent poverty and cancer-related healthcare access outcomes differed in direction and magnitude. Health promotion interventions should leverage data at fine-grained geographic units (e.g., census tracts) to motivate focus on communities or outcomes. IMPACT Future studies should extend these analyses to other states and outcomes to inform public health research and interventions to reduce geographic disparities.
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Affiliation(s)
- Jennifer L Moss
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania
- Penn State Cancer Institute, Hershey, Pennsylvania
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | | | - Eugene J Lengerich
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania
- Penn State Cancer Institute, Hershey, Pennsylvania
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
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Islami F, Baeker Bispo J, Lee H, Wiese D, Yabroff KR, Bandi P, Sloan K, Patel AV, Daniels EC, Kamal AH, Guerra CE, Dahut WL, Jemal A. American Cancer Society's report on the status of cancer disparities in the United States, 2023. CA Cancer J Clin 2024; 74:136-166. [PMID: 37962495 DOI: 10.3322/caac.21812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 11/15/2023] Open
Abstract
In 2021, the American Cancer Society published its first biennial report on the status of cancer disparities in the United States. In this second report, the authors provide updated data on racial, ethnic, socioeconomic (educational attainment as a marker), and geographic (metropolitan status) disparities in cancer occurrence and outcomes and contributing factors to these disparities in the country. The authors also review programs that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. There are substantial variations in risk factors, stage at diagnosis, receipt of care, survival, and mortality for many cancers by race/ethnicity, educational attainment, and metropolitan status. During 2016 through 2020, Black and American Indian/Alaska Native people continued to bear a disproportionately higher burden of cancer deaths, both overall and from major cancers. By educational attainment, overall cancer mortality rates were about 1.6-2.8 times higher in individuals with ≤12 years of education than in those with ≥16 years of education among Black and White men and women. These disparities by educational attainment within each race were considerably larger than the Black-White disparities in overall cancer mortality within each educational attainment, ranging from 1.03 to 1.5 times higher among Black people, suggesting a major role for socioeconomic status disparities in racial disparities in cancer mortality given the disproportionally larger representation of Black people in lower socioeconomic status groups. Of note, the largest Black-White disparities in overall cancer mortality were among those who had ≥16 years of education. By area of residence, mortality from all cancer and from leading causes of cancer death were substantially higher in nonmetropolitan areas than in large metropolitan areas. For colorectal cancer, for example, mortality rates in nonmetropolitan areas versus large metropolitan areas were 23% higher among males and 21% higher among females. By age group, the racial and geographic disparities in cancer mortality were greater among individuals younger than 65 years than among those aged 65 years and older. Many of the observed racial, socioeconomic, and geographic disparities in cancer mortality align with disparities in exposure to risk factors and access to cancer prevention, early detection, and treatment, which are largely rooted in fundamental inequities in social determinants of health. Equitable policies at all levels of government, broad interdisciplinary engagement to address these inequities, and equitable implementation of evidence-based interventions, such as increasing health insurance coverage, are needed to reduce cancer disparities.
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Affiliation(s)
| | | | | | | | | | - Priti Bandi
- American Cancer Society, Atlanta, Georgia, USA
| | | | | | | | | | - Carmen E Guerra
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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7
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Berlin NL, Albright BB, Moss HA, Offodile AC. Catastrophic health expenditures, insurance churn, and non-employment among women with breast cancer. JNCI Cancer Spectr 2024; 8:pkae006. [PMID: 38331405 PMCID: PMC11003299 DOI: 10.1093/jncics/pkae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/19/2024] [Accepted: 01/25/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Breast cancer treatment and survivorship entails a complex and expensive continuum of subspecialty care. Our objectives were to assess catastrophic health expenditures, insurance churn, and non-employment among women younger than 65 years who reported a diagnosis of breast cancer. We also evaluated changes in these outcomes related to implementation of the Affordable Care Act. METHODS The data source for this study was the Medical Expenditure Panel Survey (2005-2019), which is a national annual cross-sectional survey of families, providers, and insurers in the United States. To assess the impact of breast cancer, comparisons were made with a matched cohort of women without cancer. We estimated predicted marginal probabilities to quantify the effects of covariates in models for catastrophic health expenditures, insurance churn, and non-employment. RESULTS We identified 1490 respondents younger than 65 years who received care related to breast cancer during the study period, representing a weight-adjusted annual mean of 1 062 129 patients. Approximately 31.8% of women with breast cancer reported health expenditures in excess of 10% of their annual income. In models, the proportion of women with breast cancer who experienced catastrophic health expenditures and non-employment was inversely related to increasing income. During Affordable Care Act implementation, mean number of months of uninsurance decreased and expenditures increased among breast cancer patients. CONCLUSIONS Our study underscores the impact of breast cancer on financial security and opportunities for patients and their families. A multilevel understanding of these issues is needed to design effective and equitable strategies to improve quality of life and survivorship.
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Affiliation(s)
- Nicholas L Berlin
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Benjamin B Albright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - Haley A Moss
- Division of Gynecologic Oncology, Duke University School of Medicine, Durham, NC, USA
| | - Anaeze C Offodile
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Elmohr MM, Javed Z, Dubey P, Jordan JE, Shah L, Nasir K, Rohren EM, Lincoln CM. Social Determinants of Health Framework to Identify and Reduce Barriers to Imaging in Marginalized Communities. Radiology 2024; 310:e223097. [PMID: 38376404 PMCID: PMC10902599 DOI: 10.1148/radiol.223097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 02/21/2024]
Abstract
Social determinants of health (SDOH) are conditions influencing individuals' health based on their environment of birth, living, working, and aging. Addressing SDOH is crucial for promoting health equity and reducing health outcome disparities. For conditions such as stroke and cancer screening where imaging is central to diagnosis and management, access to high-quality medical imaging is necessary. This article applies a previously described structural framework characterizing the impact of SDOH on patients who require imaging for their clinical indications. SDOH factors can be broadly categorized into five sectors: economic stability, education access and quality, neighborhood and built environment, social and community context, and health care access and quality. As patients navigate the health care system, they experience barriers at each step, which are significantly influenced by SDOH factors. Marginalized communities are prone to disparities due to the inability to complete the required diagnostic or screening imaging work-up. This article highlights SDOH that disproportionately affect marginalized communities, using stroke and cancer as examples of disease processes where imaging is needed for care. Potential strategies to mitigate these disparities include dedicating resources for clinical care coordinators, transportation, language assistance, and financial hardship subsidies. Last, various national and international health initiatives are tackling SDOH and fostering health equity.
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Affiliation(s)
- Mohab M. Elmohr
- From the Department of Radiology, Baylor College of Medicine, Houston, 1 Baylor Plaza, BCM 360, Houston, TX 77030 (M.M.E., E.M.R.); Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist Hospital, Houston, Tex (Z.J., K.N.); Houston Radiology Associates, Houston Methodist Hospital, Houston, Tex (P.D.); ACR Commission on Neuroradiology, American College of Radiology, Reston, Va (J.E.J.); Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University School of Medicine, Stanford, Calif (J.E.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (L.S.); Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex (K.N.); Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist Hospital, Houston, Tex (K.N.); and Department of Neuroradiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, Tex (C.M.L.)
| | - Zulqarnain Javed
- From the Department of Radiology, Baylor College of Medicine, Houston, 1 Baylor Plaza, BCM 360, Houston, TX 77030 (M.M.E., E.M.R.); Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist Hospital, Houston, Tex (Z.J., K.N.); Houston Radiology Associates, Houston Methodist Hospital, Houston, Tex (P.D.); ACR Commission on Neuroradiology, American College of Radiology, Reston, Va (J.E.J.); Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University School of Medicine, Stanford, Calif (J.E.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (L.S.); Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex (K.N.); Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist Hospital, Houston, Tex (K.N.); and Department of Neuroradiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, Tex (C.M.L.)
| | - Prachi Dubey
- From the Department of Radiology, Baylor College of Medicine, Houston, 1 Baylor Plaza, BCM 360, Houston, TX 77030 (M.M.E., E.M.R.); Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist Hospital, Houston, Tex (Z.J., K.N.); Houston Radiology Associates, Houston Methodist Hospital, Houston, Tex (P.D.); ACR Commission on Neuroradiology, American College of Radiology, Reston, Va (J.E.J.); Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University School of Medicine, Stanford, Calif (J.E.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (L.S.); Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex (K.N.); Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist Hospital, Houston, Tex (K.N.); and Department of Neuroradiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, Tex (C.M.L.)
| | - John E. Jordan
- From the Department of Radiology, Baylor College of Medicine, Houston, 1 Baylor Plaza, BCM 360, Houston, TX 77030 (M.M.E., E.M.R.); Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist Hospital, Houston, Tex (Z.J., K.N.); Houston Radiology Associates, Houston Methodist Hospital, Houston, Tex (P.D.); ACR Commission on Neuroradiology, American College of Radiology, Reston, Va (J.E.J.); Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University School of Medicine, Stanford, Calif (J.E.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (L.S.); Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex (K.N.); Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist Hospital, Houston, Tex (K.N.); and Department of Neuroradiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, Tex (C.M.L.)
| | - Lubdha Shah
- From the Department of Radiology, Baylor College of Medicine, Houston, 1 Baylor Plaza, BCM 360, Houston, TX 77030 (M.M.E., E.M.R.); Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist Hospital, Houston, Tex (Z.J., K.N.); Houston Radiology Associates, Houston Methodist Hospital, Houston, Tex (P.D.); ACR Commission on Neuroradiology, American College of Radiology, Reston, Va (J.E.J.); Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University School of Medicine, Stanford, Calif (J.E.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (L.S.); Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex (K.N.); Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist Hospital, Houston, Tex (K.N.); and Department of Neuroradiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, Tex (C.M.L.)
| | - Khurram Nasir
- From the Department of Radiology, Baylor College of Medicine, Houston, 1 Baylor Plaza, BCM 360, Houston, TX 77030 (M.M.E., E.M.R.); Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist Hospital, Houston, Tex (Z.J., K.N.); Houston Radiology Associates, Houston Methodist Hospital, Houston, Tex (P.D.); ACR Commission on Neuroradiology, American College of Radiology, Reston, Va (J.E.J.); Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University School of Medicine, Stanford, Calif (J.E.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (L.S.); Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex (K.N.); Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist Hospital, Houston, Tex (K.N.); and Department of Neuroradiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, Tex (C.M.L.)
| | - Eric M. Rohren
- From the Department of Radiology, Baylor College of Medicine, Houston, 1 Baylor Plaza, BCM 360, Houston, TX 77030 (M.M.E., E.M.R.); Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist Hospital, Houston, Tex (Z.J., K.N.); Houston Radiology Associates, Houston Methodist Hospital, Houston, Tex (P.D.); ACR Commission on Neuroradiology, American College of Radiology, Reston, Va (J.E.J.); Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University School of Medicine, Stanford, Calif (J.E.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (L.S.); Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex (K.N.); Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist Hospital, Houston, Tex (K.N.); and Department of Neuroradiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, Tex (C.M.L.)
| | - Christie M. Lincoln
- From the Department of Radiology, Baylor College of Medicine, Houston, 1 Baylor Plaza, BCM 360, Houston, TX 77030 (M.M.E., E.M.R.); Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist Hospital, Houston, Tex (Z.J., K.N.); Houston Radiology Associates, Houston Methodist Hospital, Houston, Tex (P.D.); ACR Commission on Neuroradiology, American College of Radiology, Reston, Va (J.E.J.); Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University School of Medicine, Stanford, Calif (J.E.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (L.S.); Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex (K.N.); Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist Hospital, Houston, Tex (K.N.); and Department of Neuroradiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, Tex (C.M.L.)
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9
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Howard DH, Tangka FK, Miller J, Sabatino SA. Variation in State-Level Mammography Use, 2012 and 2020. Public Health Rep 2024; 139:59-65. [PMID: 36927203 PMCID: PMC10905756 DOI: 10.1177/00333549231155876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES Mammography is a screening tool for early detection of breast cancer. Uptake in screening use in states can be influenced by Medicaid coverage and eligibility policies, public health outreach efforts, and the Centers for Disease Control and Prevention-funded National Breast and Cervical Cancer Early Detection Program. We described state-specific mammography use in 2020 and changes as compared with 2012. METHODS We estimated the proportion of women aged ≥40 years who reported receiving a mammogram in the past 2 years, by age group, state, and demographic and socioeconomic characteristics, using 2020 Behavioral Risk Factor Surveillance System data. We also compared 2020 state estimates with 2012 estimates. RESULTS The proportion of women aged 50-74 years who received a mammogram in the past 2 years was 78.1% (95% CI, 77.4%-78.8%) in 2020. Across measures of socioeconomic status, mammography use was generally lower among women who did not have health insurance (52.0%; 95% CI, 48.3%-55.6%) than among those who did (79.9%; 95% CI, 79.3%-80.6%) and among those who had a usual source of care (49.4%; 95% CI, 46.1%-52.7%) than among those who did not (81.0%; 95% CI, 80.4%-81.7%). Among women aged 50-74 years, mammography use varied across states, from a low of 65.2% (95% CI, 61.4%-69.0%) in Wyoming to a high of 86.1% (95% CI, 83.8%-88.3%) in Massachusetts. Four states had significant increases in mammography use from 2012 to 2020, and 8 states had significant declines. CONCLUSION Mammography use varied widely among states. Use of evidence-based interventions tailored to the needs of local populations and communities may help close gaps in the use of mammography.
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Affiliation(s)
- David H. Howard
- Department of Health Policy and Management, Winship Cancer Center, Emory University, Atlanta, GA, USA
| | - Florence K.L. Tangka
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jacqueline Miller
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan A. Sabatino
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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10
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Hu X, Yang NN, Fan Q, Yabroff KR, Han X. Health insurance coverage among incident cancer cases from population-based cancer registries in 49 US states, 2010-2019. HEALTH AFFAIRS SCHOLAR 2024; 2:qxad083. [PMID: 38756397 PMCID: PMC10986217 DOI: 10.1093/haschl/qxad083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/16/2023] [Accepted: 12/20/2023] [Indexed: 05/18/2024]
Abstract
Having health insurance coverage is a strong determinant of cancer care access and survival in the United States. The expansion of Medicaid income eligibility under the Affordable Care Act has increased insurance coverage for working-age adults. Using data from the Cancer Incidence in North America (CiNA) in 2010-2019, we identified 6 432 117 incident cancer cases with known insurance status diagnosed at age 18-64 years from population-based registries of 49 states. Considerable variation in Medicaid coverage and uninsured rate exists across states, especially by Medicaid expansion status. Among expansion states, Medicaid coverage increased from 14.1% in 2010 to 19.9% in 2019, while the Medicaid coverage rate remained lower (range = 11.7% - 12.7%) in non-expansion states. The uninsured rate decreased from 4.9% to 2.1% in expansion states, while in non-expansion states, the uninsured rate decreased slightly from 9.5% to 8.1%. In 2019, 111 393 cancer cases (16.9%) had Medicaid coverage at diagnosis (range = 7.6%-37.9% across states), and 48 357 (4.4%) were uninsured (range = 0.5%-13.2%). These estimates suggest that many patients with cancer may face challenges with care access and continuity, especially following the unwinding of COVID-19 pandemic protections for Medicaid coverage. State cancer prevention and control efforts are needed to mitigate cancer care disparities among vulnerable populations.
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Affiliation(s)
- Xin Hu
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA 22911, United States
| | - Nuo Nova Yang
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA 30144, United States
| | - Qinjin Fan
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA 30144, United States
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA 30144, United States
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA 30144, United States
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11
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Lafata KJ, Read C, Tong BC, Akinyemiju T, Wang C, Cerullo M, Tailor TD. Lung Cancer Screening in Clinical Practice: A 5-Year Review of Frequency and Predictors of Lung Cancer in the Screened Population. J Am Coll Radiol 2023:S1546-1440(23)00861-X. [PMID: 37952807 DOI: 10.1016/j.jacr.2023.05.027] [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: 10/26/2022] [Revised: 05/05/2023] [Accepted: 05/16/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE The aims of this study were to evaluate (1) frequency, type, and lung cancer stage in a clinical lung cancer screening (LCS) population and (2) the association between patient characteristics and Lung CT Screening Reporting & Data System (Lung-RADS®) with lung cancer diagnosis. METHODS This retrospective study enrolled individuals undergoing LCS between January 1, 2015, and June 30, 2020. Individuals' sociodemographic characteristics, Lung-RADS scores, pathology-proven lung cancers, and tumor characteristics were determined via electronic health record and the health system's tumor registry. Associations between the outcome of lung cancer diagnosis within 1 year after LCS and covariates of sociodemographic characteristics and Lung-RADS score were determined using logistic regression. RESULTS Of 3,326 individuals undergoing 5,150 LCS examinations, 102 (3.1%) were diagnosed with lung cancer within 1 year of LCS; most of these cancers were screen detected (97 of 102 [95.1%]). Over the study period, there were 118 total LCS-detected cancers in 113 individuals (3.4%). Most LCS-detected cancers were adenocarcinomas (62 of 118 [52%]), 55.9% (65 of 118) were stage I, and 16.1% (19 of 118) were stage IV. The sensitivity, specificity, positive predictive value, and negative predictive value of Lung-RADS in diagnosing lung cancer within 1 year of LCS were 93.1%, 83.8%, 10.6%, and 99.8%, respectively. On multivariable analysis controlling for sociodemographic characteristics, only Lung-RADS score was associated with lung cancer (odds ratio for a one-unit increase in Lung-RADS score, 4.68; 95% confidence interval, 3.87-5.78). CONCLUSIONS The frequency of LCS-detected lung cancer and stage IV cancers was higher than reported in the National Lung Screening Trial. Although Lung-RADS was a significant predictor of lung cancer, the positive predictive value of Lung-RADS is relatively low, implying opportunity for improved nodule classification.
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Affiliation(s)
- Kyle J Lafata
- Department of Radiology, Duke University Medical Center, Durham, North Carolina; Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina; Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina; Department of Medical Physics Graduate Program, Duke University, Durham, North Carolina
| | - Charlotte Read
- Department of Medical Physics Graduate Program, Duke University, Durham, North Carolina
| | - Betty C Tong
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Cancer Institute, Durham, North Carolina; Clinical Director, Duke Lung Cancer Screening Program
| | - Tomi Akinyemiju
- Vice Chair, Diversity and Inclusion, Department of Population Health Sciences, Duke University Medical Center, Durham, North Carolina; Associate Director, Community Outreach, Engagement, and Equity, Duke Cancer Institute, Durham, North Carolina
| | - Chunhao Wang
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Marcelo Cerullo
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Tina D Tailor
- Department of Radiology, Duke University Medical Center, Durham, North Carolina; Research Director, Duke Lung Cancer Screening Program, and Cardiothoracic Radiology Fellowship Director.
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12
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Lansey DG, Ramalingam R, Brawley OW. Health Care Policy and Disparities in Health. Cancer J 2023; 29:287-292. [PMID: 37963360 DOI: 10.1097/ppo.0000000000000680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
ABSTRACT The United States has seen a 33% decline in age-adjusted cancer mortality since 1991. Despite this achievement, the United States has some of the greatest health disparities of any developed nation. US government policies are increasingly directed toward reducing health disparities and promoting health equity. These policies govern the conduct of research, cancer prevention, access, and payment for care. Although implementation of policies has played a significant role in the successes of cancer control, inconsistent implementation of policy has resulted in divergent outcomes; poorly designed or inadequately implemented policies have hindered progress in reducing cancer death rates and, in certain cases, exacerbated existing disparities. Examining policies affecting cancer control in the United States and realizing their unintended consequences are crucial in addressing cancer inequities.
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Affiliation(s)
| | - Rohan Ramalingam
- From the Department of Oncology, Johns Hopkins School of Medicine
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13
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Abstract
Lung cancer represents a large burden on society with a staggering incidence and mortality rate that has steadily increased until recently. The impetus to design an effective screening program for the deadliest cancer in the United States and worldwide began in 1950. It has taken more than 50 years of numerous clinical trials and continued persistence to arrive at the development of modern-day screening program. As the program continues to grow, it is important for clinicians to understand its evolution, track outcomes, and continually assess the impact and bias of screening on the medical, social, and economic systems.
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Affiliation(s)
- Hai V N Salfity
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati School of Medicine, 231 Albert Sabin Way Suite 2472, Cincinnati, OH 45267, USA.
| | - Betty C Tong
- Division of Thoracic Surgery, Department of Surgery, Duke University School of Medicine, Box 3531 DUMC, Durham, NC 27710, USA
| | - Madison R Kocher
- Division of Cardiothoracic Imaging, Department of Radiology, Duke University School of Medicine, Box 3808 DUMC, Durham, NC 27710, USA
| | - Tina D Tailor
- Division of Cardiothoracic Imaging, Department of Radiology, Duke University School of Medicine, Box 3808 DUMC, Durham, NC 27710, USA
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14
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Lee R, Xu W, Dozier M, McQuillan R, Theodoratou E, Figueroa J. A rapid review of COVID-19's global impact on breast cancer screening participation rates and volumes from January to December 2020. eLife 2023; 12:e85680. [PMID: 37698273 PMCID: PMC10569787 DOI: 10.7554/elife.85680] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 08/20/2023] [Indexed: 09/13/2023] Open
Abstract
COVID-19 has strained population breast mammography screening programs that aim to diagnose and treat breast cancers earlier. As the pandemic has affected countries differently, we aimed to quantify changes in breast screening volume and uptake during the first year of COVID-19 . We systematically searched Medline, the World Health Organization (WHO) COVID-19 database, and governmental databases. Studies covering January 2020 to March 2022 were included. We extracted and analyzed data regarding study methodology, screening volume, and uptake. To assess for risk of bias, we used the Joanna Briggs Institute (JBI) Critical Appraisal Tool. Twenty-six cross-sectional descriptive studies (focusing on 13 countries/nations) were included out of 935 independent records. Reductions in screening volume and uptake rates were observed among eight countries. Changes in screening participation volume in five nations with national population-based screening ranged from -13 to -31%. Among two countries with limited population-based programs, the decline ranged from -61 to -41%. Within the USA, population participation volumes varied ranging from +18 to -39%, with suggestion of differences by insurance status (HMO, Medicare, and low-income programs). Almost all studies had high risk of bias due to insufficient statistical analysis and confounding factors. The extent of COVID-19-induced reduction in breast screening participation volume differed by region and data suggested potential differences by healthcare setting (e.g., national health insurance vs. private healthcare). Recovery efforts should monitor access to screening and early diagnosis to determine whether prevention services need strengthening to increase the coverage of disadvantaged groups and reduce disparities.
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Affiliation(s)
- Reagan Lee
- Usher Institute, University of EdinburghEdinburghUnited Kingdom
| | - Wei Xu
- Usher Institute, University of EdinburghEdinburghUnited Kingdom
- Centre for Global Health, University of EdinburghEdinburghUnited Kingdom
| | - Marshall Dozier
- Information Services, University of EdinburghEdinburghUnited Kingdom
| | - Ruth McQuillan
- Usher Institute, University of EdinburghEdinburghUnited Kingdom
| | - Evropi Theodoratou
- Centre for Global Health, University of EdinburghEdinburghUnited Kingdom
| | - Jonine Figueroa
- Centre for Global Health, University of EdinburghEdinburghUnited Kingdom
- Division of Cancer Epidemiology and Genetics, National Cancer InstituteBethesdaUnited States
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15
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Janopaul‐Naylor JR, Corriher TJ, Switchenko J, Hanasoge S, Esdaille A, Mahal BA, Filson CP, Patel SA. Disparities in time to prostate cancer treatment initiation before and after the Affordable Care Act. Cancer Med 2023; 12:18258-18268. [PMID: 37537835 PMCID: PMC10523962 DOI: 10.1002/cam4.6419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 06/19/2023] [Accepted: 07/26/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Delayed access to care may contribute to disparities in prostate cancer (PCa). The Affordable Care Act (ACA) aimed at increasing access and reducing healthcare disparities, but its impact on timely treatment initiation for PCa men is unknown. METHODS Men with intermediate- and high-risk PCa diagnosed 2010-2016 and treated with curative surgery or radiotherapy were identified in the National Cancer Database. Multivariable logistic regression modeled the effect of race and insurance type on treatment delay >180 days after diagnosis. Cochran-Armitage test measured annual trends in delays, and joinpoint regression assessed if 2014, the year the ACA became fully operationalized, was significant for inflection in crude rates of major delays. RESULTS Of 422,506 eligible men, 18,720 (4.4%) experienced >180-day delay in treatment initiation. Compared to White patients, Black (OR 1.79, 95% CI 1.72-1.87, p < 0.001) and Hispanic (OR 1.37, 95% CI 1.28-1.48, p < 0.001) patients had higher odds of delay. Compared to uninsured, those with Medicaid had no difference in odds of delay (OR 0.94, 95% CI 0.84-1.06, p = 0.31), while those with private insurance (OR 0.57, 95% CI 0.52-0.63, p < 0.001) or Medicare (OR 0.64, 95% CI 0.58-0.70, p < 0.001) had lower odds of delay. Mean time to treatment significantly increased from 2010 to 2016 across all racial/ethnic groups (trend p < 0.001); 2014 was associated with a significant inflection for increase in rates of major delays. CONCLUSIONS Non-White and Medicaid-insured men with localized PCa are at risk of treatment delays in the United States. Treatment delays have been consistently rising, particularly after implementation of the ACA.
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Affiliation(s)
- James R. Janopaul‐Naylor
- Department of Radiation OncologyWinship Cancer Institute at Emory UniversityAtlantaGeorgiaUSA
- Department of Radiation OncologyMemorial Sloan Kettering CancerNew YorkNew YorkUSA
| | - Taylor J. Corriher
- Department of Radiation OncologyWinship Cancer Institute at Emory UniversityAtlantaGeorgiaUSA
| | - Jeffrey Switchenko
- Department of Biostatistics and BioinformaticsRollins School of Public HealthAtlantaGeorgiaUSA
| | - Sheela Hanasoge
- Department of Radiation OncologyWinship Cancer Institute at Emory UniversityAtlantaGeorgiaUSA
| | - Ashanda Esdaille
- Department of UrologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Brandon A. Mahal
- Department of Radiation OncologyUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | | | - Sagar A. Patel
- Department of Radiation OncologyWinship Cancer Institute at Emory UniversityAtlantaGeorgiaUSA
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16
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Beckett M, Goethals L, Kraus RD, Denysenko K, Barone Mussalem Gentiles MF, Pynda Y, Abdel-Wahab M. Proximity to Radiotherapy Center, Population, Average Income, and Health Insurance Status as Predictors of Cancer Mortality at the County Level in the United States. JCO Glob Oncol 2023; 9:e2300130. [PMID: 37769217 PMCID: PMC10581634 DOI: 10.1200/go.23.00130] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/20/2023] [Accepted: 08/22/2023] [Indexed: 09/30/2023] Open
Abstract
PURPOSE Sufficient radiotherapy (RT) capacity is essential to delivery of high-quality cancer care. However, despite sufficient capacity, universal access is not always possible in high-income countries because of factors beyond the commonly used parameter of machines per million people. This study assesses the barriers to RT in a high-income country and how these affect cancer mortality. METHODS This cross-sectional study used US county-level data obtained from Center for Disease Control and Prevention and the International Atomic Energy Agency Directory of Radiotherapy Centres. RT facilities in the United States were mapped using Geographic Information Systems software. Univariate analysis was used to identify whether distance to a RT center or various socioeconomic factors were predictive of all-cancer mortality-to-incidence ratio (MIR). Significant variables (P ≤ .05) on univariate analysis were included in a step-wise backward elimination method of multiple regression analysis. RESULTS Thirty-one percent of US counties have at least one RT facility and 8.3% have five or more. The median linear distance from a county's centroid to the nearest RT center was 36 km, and the median county all-cancer MIR was 0.37. The amount of RT centers, linear accelerators, and brachytherapy units per 1 million people were associated with all-cancer MIR (P < .05). Greater distance to RT facilities, lower county population, lower average income per county, and higher proportion of patients without health insurance were associated with increased all-cancer MIR (R-squared, 0.2113; F, 94.22; P < .001). CONCLUSION This analysis used unique high-quality data sets to identify significant barriers to RT access that correspond to higher cancer mortality at the county level. Geographic access, personal income, and insurance status all contribute to these concerning disparities. Efforts to address these barriers are needed.
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Affiliation(s)
| | - Luc Goethals
- International Atomic Energy Agency, Vienna, Austria
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17
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Han X, Shi KS, Zhao J, Nogueira L, Parikh RB, Kamal AH, Jemal A, Yabroff KR. Medicaid Expansion Associated With Increase In Palliative Care For People With Advanced-Stage Cancers. Health Aff (Millwood) 2023; 42:956-965. [PMID: 37406229 DOI: 10.1377/hlthaff.2023.00035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Clinical guidelines have endorsed early palliative care for patients with advanced malignancies, but receipt remains low in the US. This study examined the association between Medicaid expansion under the Affordable Care Act and receipt of palliative care among patients newly diagnosed with advanced-stage cancers. Using the National Cancer Database, we found that the percentage of eligible patients who received palliative care as part of first-course treatment increased from 17.0 percent preexpansion to 18.9 percent postexpansion in Medicaid expansion states and from 15.7 percent to 16.7 percent, respectively, in nonexpansion states, resulting in a net increase of 1.3 percentage points in expansion states in adjusted analyses. Increases in receipt of palliative care associated with Medicaid expansion were largest for patients with advanced pancreatic, colorectal, lung, and oral cavity and pharynx cancers and non-Hodgkin lymphoma. Our findings suggest that increasing Medicaid coverage facilitates access to guideline-based palliative care for advanced cancer, and they provide additional evidence of benefit in cancer care from states' expansion of income eligibility for Medicaid.
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Affiliation(s)
- Xuesong Han
- Xuesong Han , American Cancer Society, Kennesaw, Georgia
| | | | | | | | - Ravi B Parikh
- Ravi B. Parikh, University of Pennsylvania, Philadelphia, Pennsylvania
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18
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Wang S, Yin M, Wang P, Folefac E, Monk JP, Tabung FK, Clinton SK. Chemotherapy for the initial treatment of metastatic prostate adenocarcinoma and neuroendocrine carcinoma at diagnosis: real world application and impact in the SEER database (2004 -2018). Front Oncol 2023; 13:1165188. [PMID: 37361592 PMCID: PMC10288985 DOI: 10.3389/fonc.2023.1165188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/18/2023] [Indexed: 06/28/2023] Open
Abstract
Background Randomized controlled phase III trials have reported significant improvements in disease response and survival with the addition of chemotherapy to androgen deprivation therapy for men presenting with metastatic prostate cancer. We examined the implementation of such knowledge and its impact within the Surveillance, Epidemiology, and End Results (SEER) database. Method The administration of chemotherapy for men with an initial presentation of metastatic prostate cancer from 2004 to 2018 in the SEER database and its association with survival outcomes was examined. Kaplan-Meier estimates were applied to compare survival curves. Cox proportion hazard survival models were used to analyze the association of chemotherapy and other variables with both cancer- specific and overall survival. Result A total of 727,804 patients were identified with 99.9% presenting with adenocarcinoma and 0.1% with neuroendocrine histopathology. Chemotherapy as initial treatment for men with de novo distant metastatic adenocarcinoma increased from 5.8% during 2004-2013 to 21.4% during 2014-2018. Chemotherapy was associated with a poorer prognosis during 2004-2013 but was associated with improved cancer-specific (hazard ratio (HR) = 0.85, 95% confidence interval (CI): 0.78-0.93, p=0.0004) and overall survival (HR= 0.78, 95% CI: 0.71-0.85, p < 0.0001) during 2014-2018. The improved prognosis during 2014-2018 was observed in patients with visceral or bone metastasis and most impactful for patients aged 71-80 years. These findings were confirmed by subsequent propensity score matching analyses. Furthermore, chemotherapy was consistently provided to 54% of patients with neuroendocrine carcinoma at diagnosis from 2004 to 2018. Treatment was associated with improved cancer-specific survival (HR= 0.62, 95% CI: 0.45-0.87, p=0.0055) and overall survival (HR= 0.69, 95% CI: 0.51-0. 94, p=0.0176) during 2014-2018 but not significant in earlier years. Conclusion Chemotherapy at initial diagnosis was increasingly employed in men with metastatic adenocarcinoma after 2014 and consistent with the evolution of National Comprehensive Cancer Network (NCCN) guidelines. Benefits for chemotherapy are suggested after 2014 in the treatment of men with metastatic adenocarcinoma. The use of chemotherapy for neuroendocrine carcinoma at diagnosis has remained stable, and outcomes have improved in more recent years. Further development and optimization of chemotherapy continues to evolve for men with de novo diagnosis of metastatic prostate cancer.
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Affiliation(s)
- Shihua Wang
- The Ohio State University Comprehensive Cancer Center and Arthur G. James Cancer Hospital, Columbus, OH, United States
| | - Ming Yin
- The Ohio State University Comprehensive Cancer Center and Arthur G. James Cancer Hospital, Columbus, OH, United States
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Peng Wang
- The Ohio State University Comprehensive Cancer Center and Arthur G. James Cancer Hospital, Columbus, OH, United States
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Edmund Folefac
- The Ohio State University Comprehensive Cancer Center and Arthur G. James Cancer Hospital, Columbus, OH, United States
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH, United States
| | - J. Paul Monk
- The Ohio State University Comprehensive Cancer Center and Arthur G. James Cancer Hospital, Columbus, OH, United States
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Fred K. Tabung
- The Ohio State University Comprehensive Cancer Center and Arthur G. James Cancer Hospital, Columbus, OH, United States
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Steven K. Clinton
- The Ohio State University Comprehensive Cancer Center and Arthur G. James Cancer Hospital, Columbus, OH, United States
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH, United States
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Evaluation of the association between health insurance status and healthcare utilization and expenditures among adult cancer survivors in the United States. Res Social Adm Pharm 2023; 19:821-829. [PMID: 36842898 DOI: 10.1016/j.sapharm.2023.02.005] [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: 06/06/2022] [Revised: 11/03/2022] [Accepted: 02/15/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Health care expenditures for cancer care has increased significantly over the past decade and is further projected to rise. This study examined the associations between health insurance status and total direct health care expenditures and health care utilization among cancer survivors living in the United States. METHODS A cross-sectional study of cancer survivors aged ≥18 years, identified from the Medical Expenditures Panel Survey (MEPS) during 2017 using International Classification of Diseases, Tenth Revision codes specific for cancer. Health insurance was categorized into Private, Medicare, Medicaid, and uninsured. Multivariable ordinary least squares regression was used to examine the association between log expenditures and health insurance. Negative binomial regression with log link was used to obtain adjusted incident rate ratios (AIRR) for health care utilization. Survey weights were used to produce nationally representative estimates of the US population. RESULTS A total of 1140 (weighted = 13.9 million) cancer survivors were identified. Compared to the adjusted mean annual health care expenditures for the private group ($14,265; 95% confidence interval (CI): $12,645 to $16,092), the adjusted mean annual health care expenditures for the Medicare group were higher ($15,112; 95%CI: $13,361 to $17,092). As compared to the private group, the average annual expenditures for uninsured cancer survivors ($2315; 95%CI:1038 to $3501) was significantly lower and so was their health care utilization. Adjusted rates of ER visits for Medicaid were twice (AIRR:2.04; SE:0.28; p = 0.001) as compared to privately insured. CONCLUSIONS A difference in the average total direct expenditures between uninsured and privately insured patients was found. Uninsured had the lowest health care utilization while Medicaid reported significantly higher number of ER visits. Despite differences in program structures, health care expenditures across insurance types were similar. Lower utilization of health care services among uninsured suggests cost maybe a barrier to accessing care.
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Olarewaju E, Obeng-Gyasi E. Cadmium, Lead, Chronic Physiological Stress and Endometrial Cancer: How Environmental Policy Can Alter the Exposure of At-Risk Women in the United States. Healthcare (Basel) 2023; 11:healthcare11091278. [PMID: 37174820 PMCID: PMC10178079 DOI: 10.3390/healthcare11091278] [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: 03/09/2023] [Revised: 04/04/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
The health and life outcomes of individuals are intertwined with the context in which they grow and live. The totality of exposures one experiences affects health in the short term and throughout the life course. Environmental exposure to multiple contaminants can increase stress levels in individuals and neighborhoods with psychosocial stressors such as crime, drug and alcohol misuse, and violence also taking a toll on individual and neighborhood wellbeing. In addition, the availability, organization, and quality of local institutions and infrastructure all affect health in the short and long term. The role of these factors in endometrial cancer will be explored in this paper. In addition, policy implications regarding lead, chronic physiological stress, and endometrial cancer will be explored to ascertain the impact of these factors on at-risk women.
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Affiliation(s)
- Elizabeth Olarewaju
- Department of Built Environment, North Carolina A&T State University, Greensboro, NC 27411, USA
- Environmental Health and Disease Laboratory, North Carolina A&T State University, Greensboro, NC 27411, USA
| | - Emmanuel Obeng-Gyasi
- Department of Built Environment, North Carolina A&T State University, Greensboro, NC 27411, USA
- Environmental Health and Disease Laboratory, North Carolina A&T State University, Greensboro, NC 27411, USA
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21
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Ji X, Shi KS, Mertens AC, Zhao J, Yabroff KR, Castellino SM, Han X. Survival in Young Adults With Cancer Is Associated With Medicaid Expansion Through the Affordable Care Act. J Clin Oncol 2023; 41:1909-1920. [PMID: 36525612 PMCID: PMC10082236 DOI: 10.1200/jco.22.01742] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/26/2022] [Accepted: 11/08/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Medicaid expansion through the Affordable Care Act (ACA) has been shown to improve insurance coverage and early diagnosis of cancer in young adults (YAs); whether these improvements translate to survival benefits remains unknown. We examined the association between Medicaid expansion under the ACA and 2-year overall survival among YAs with cancer. METHODS Using the National Cancer Database, we identified 345,413 YAs (age 18-39 years) diagnosed with cancer in 2010-2017. We applied the difference-in-differences (DD) method to estimate changes in 2-year overall survival after versus before Medicaid expansion in expansion versus nonexpansion states. RESULTS Among all YAs, 2-year overall survival increased more in expansion states (90.39% pre-expansion to 91.85% postexpansion) than in nonexpansion states (88.98% pre-expansion to 90.07% postexpansion), resulting in a net increase of 0.55 percentage points (ppt; 95% CI, 0.13 to 0.96). The expansion-associated survival benefit was concentrated in patients with female breast cancer (DD, 1.20 ppt; 95%CI, 0.27 to 2.12) when stratifying by cancer type and in patients with stage IV disease (DD, 2.56; 95%CI, 0.36 to 4.77) when stratifying by stage. In addition, greater survival benefit associated with Medicaid expansion was observed among racial and ethnic minoritized groups (DD, 1.01 ppt; 95% CI, 0.14 to 1.87) as compared with non-Hispanic White peers (DD, 0.41 ppt; 95% CI, -0.06 to 0.87) and among patients with a Charlson comorbidity score of ≥ 2 (DD, 6.48 ppt; 95% CI, 0.81 to 12.16) than those with a comorbidity score of 0 (DD, 0.44 ppt; 95% CI, 0.005 to 0.87). CONCLUSION Medicaid expansion under the ACA was associated with an improvement in overall survival among YAs with cancer, with survival benefits most pronounced among patients of under-represented race and ethnicity and patients with high-risk diseases.
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Affiliation(s)
- Xu Ji
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
| | - Kewei Sylvia Shi
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Ann C. Mertens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
| | - Jingxuan Zhao
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - K. Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Sharon M. Castellino
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
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Parsons SK, Keegan THM, Kirchhoff AC, Parsons HM, Yabroff KR, Davies SJ. Cost of Cancer in Adolescents and Young Adults in the United States: Results of the 2021 Report by Deloitte Access Economics, Commissioned by Teen Cancer America. J Clin Oncol 2023:JCO2201985. [PMID: 36827624 DOI: 10.1200/jco.22.01985] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
PURPOSE The purpose of this report, commissioned by Teen Cancer America and performed by Deloitte Access Economics in 2021, was to estimate the total costs incurred by adolescent and young adults (AYAs) after cancer diagnosis in the United States (US) over their life course. METHODS The incidence of cancer in 2019 among AYAs age 15-39 years was estimated from the US Cancer Statistics Public Use Database, and relative survival was projected from the Surveillance, Epidemiology, and End Results Program. Cost domains included health system, productivity, and well-being costs. Components were estimated with published literature and pooled data from the Medical Expenditure Panel Survey from 2008 to 2012 and inflated to 2019 dollars. RESULTS The economic and human costs of cancer in AYAs are substantial-$23.5 billion overall, corresponding to $259,324 per person over the lifetime. The majority of costs are borne by AYA cancer survivors themselves in the form of lost productivity, loss of well-being, and loss of life. CONCLUSION These findings underscore the need to address the burden of cancer in AYAs through targeted programs for AYAs, such as financial navigation and health insurance literacy interventions, as well as local and national policy initiatives to address access to and enhanced coverage for clinical trials participation, fertility services, and survivorship care.
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Affiliation(s)
- Susan K Parsons
- Divisions of Hematology/Oncology and Clinical Care Research, Tufts Medical Center, Tufts University School of Medicine, Boston, MA.,Departments of Medicine and Pediatrics, Tufts University School of Medicine, Boston, MA
| | - Theresa H M Keegan
- Center for Oncology Hematology Outcomes Research and Training and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Anne C Kirchhoff
- Huntsman Cancer Institute and University of Utah, School of Medicine, Salt Lake City, UT
| | - Helen M Parsons
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN
| | - K Robin Yabroff
- Scientific Vice President, Health Services Research, American Cancer Society, Inc
| | - Simon J Davies
- Executive Director, Teen Cancer America, Los Angeles, CA
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23
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Association Between Insurance Status and Chondrosarcoma Stage at Diagnosis in the United States: Implications for Detection and Outcomes. J Am Acad Orthop Surg 2023; 31:e189-e197. [PMID: 36730695 DOI: 10.5435/jaaos-d-22-00379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/20/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Chondrosarcoma is a common primary bone tumor, and survival is highly influenced by stage at diagnosis. Early detection is paramount to improve outcomes. The aim of this study is to analyze the association between insurance status and stage of chondrosarcoma at the time of diagnosis. METHODS A comparative cross-sectional study was conducted using the Surveillance, Epidemiology and End Results database. Patients with a diagnosis of chondrosarcoma between 2007 and 2016 were included. Exposure variable was insurance status and the outcome chondrosarcoma staging at the time of diagnosis. Control variables included tumor grade, age, sex, race, ethnicity, marital status, place of residence, and primary site. Both unadjusted and adjusted (multiple logistic regression) odds ratios (ORs) and 95% confidence intervals (CIs) were computed to estimate the association between insurance status and stage. RESULTS An effective sample of 2,187 patients was included for analysis. In total, 1824 (83%) patients had health insurance (nonspecified), 277 (13%) had Medicaid, and the remaining 86 (4%) had no insurance. Regarding stage at diagnosis, 1,213 (55%) had localized disease, whereas 974 (45%) had a later stage at presentation. Before adjustment, the odds of being diagnosed at an advanced (regional/distant) stage were 55% higher in patients without insurance (unadjusted OR 1.55; 95% CI 1.003 to 2.39). After adjusting for potential confounders, the odds increased (adjusted OR 1.94; 95% CI 1.12 to 3.32). Variables with a significant association with a later stage at diagnosis included older age ( P < 0.001), male sex ( P < 0.001), pelvic location ( P < 0.001), and high grade ( P < 0.001). CONCLUSION Being uninsured in the United States increased the odds of a late-stage diagnosis of chondrosarcoma by 94% when compared with insured patients. Lack of medical insurance presumably leads to diminished access to necessary diagnostic testing, which results in a more advanced stage at diagnosis and ultimately a worse prognosis. Efforts are required to remediate healthcare access disparities. LEVEL OF EVIDENCE Level III.
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Nathan PC, Huang IC, Chen Y, Henderson TO, Park ER, Kirchhoff AC, Robison LL, Krull K, Leisenring W, Armstrong GT, Conti RM, Yasui Y, Yabroff KR. Financial Hardship in Adult Survivors of Childhood Cancer in the Era After Implementation of the Affordable Care Act: A Report From the Childhood Cancer Survivor Study. J Clin Oncol 2023; 41:1000-1010. [PMID: 36179267 PMCID: PMC9928627 DOI: 10.1200/jco.22.00572] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/09/2022] [Accepted: 08/05/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To estimate the prevalence of financial hardship among adult survivors of childhood cancer compared with siblings and identify sociodemographic, cancer diagnosis, and treatment correlates of hardship among survivors in the era after implementation of the Affordable Care Act. METHODS A total of 3,555 long-term (≥ 5 years) survivors of childhood cancer and 956 siblings who completed a survey administered in 2017-2019 were identified from the Childhood Cancer Survivor Study. Financial hardship was measured by 21 survey items derived from US national surveys that had been previously cognitively tested and fielded. Principal component analysis (PCA) identified domains of hardship. Multiple linear regression examined the association of standardized domain scores (ie, scores divided by standard deviation) with cancer and treatment history and sociodemographic characteristics among survivors. RESULTS Survivors were more likely than siblings to report hardship in ≥ 1 item (63.4% v 53.7%, P < .001). They were more likely to report being sent to debt collection (29.9% v 22.3%), problems paying medical bills (20.7% v 12.8%), foregoing needed medical care (14.1% v 7.8%), and worry/stress about paying their rent/mortgage (33.6% v 23.2%) or having enough money to buy nutritious meals (26.8% v 15.5%); all P < .001. Survivors reported greater hardship than siblings in all three domains identified by principal component analysis: behavioral hardship (mean standardized domain score 0.51 v 0.35), material hardship/financial sacrifices (0.64 v 0.46), and psychological hardship (0.69 v 0.44), all P < .001. Sociodemographic (eg, CONCLUSION Survivors of childhood cancer were more likely to experience financial hardship than siblings. Correlates of hardship can inform survivorship care guidelines and intervention strategies.
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Affiliation(s)
- Paul C. Nathan
- The Hospital for Sick Children, Division of Hematology/Oncology, The University of Toronto, Toronto, Ontario, Canada
| | - I-Chan Huang
- St Jude Children's Research Hospital, Department of Epidemiology & Cancer Control, Memphis, TN
| | - Yan Chen
- University of Alberta, Edmonton, School of Public Health Alberta, Edmonton, Alberta, Canada
| | - Tara O. Henderson
- University of Chicago Comer Children's Hospital, Section of Pediatric Hematology, Oncology and Stem Cell Transplantation, Chicago, IL
| | - Elyse R. Park
- Massachusetts General Hospital Cancer Center, Boston, MA
| | - Anne C. Kirchhoff
- Huntsman Cancer Institute, Cancer Control and Population Sciences, University of Utah, Salt Lake City, UT
| | - Leslie L. Robison
- St Jude Children's Research Hospital, Department of Epidemiology & Cancer Control, Memphis, TN
| | - Kevin Krull
- St Jude Children's Research Hospital, Department of Epidemiology & Cancer Control, Memphis, TN
| | - Wendy Leisenring
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA
| | - Gregory T. Armstrong
- St Jude Children's Research Hospital, Department of Epidemiology & Cancer Control, Memphis, TN
| | - Rena M. Conti
- Department of Markets, Public Policy and Law, Questrom School of Business, Boston University, Boston, MA
| | - Yutaka Yasui
- St Jude Children's Research Hospital, Department of Epidemiology & Cancer Control, Memphis, TN
| | - K. Robin Yabroff
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA
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Siapno AED, Gaither TW, Tandel MD, Kwan L, Meng YY, Connor SE, Maliski SL, Fink A, George S, Litwin MS. Impact of Comprehensive Health Insurance on Quality of Life in Low-Income Hispanic Men with Prostate Cancer. Urology 2023; 172:89-96. [PMID: 36400270 DOI: 10.1016/j.urology.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/24/2022] [Accepted: 11/02/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the effect of the transition from IMPACT, a disease-focused treatment program, to comprehensive health insurance under Medicaid through the Affordable Care Act (ACA) on general and prostate cancer-specific quality of life (QoL) on a cohort of previously uninsured low-income men. We hypothesize that general QoL would improve and prostate cancer-specific QoL would remain the same after the transition to comprehensive health insurance. METHODS We assessed and compared general QoL using the RAND SF-12v2™ (12-Item Short Form Survey, version 2) and prostate cancer-specific QoL using the UCLA PCI (Prostate Cancer Index) one year before, at, and one year after the transition between 30 men who transitioned to comprehensive insurance (newly insured/Medicaid group) and 54 men who remained in the prostate cancer program (uninsured/IMPACT group). We assessed the independent effects of Medicaid coverage on QoL outcomes using repeated-measures regression. RESULTS Our cohort was composed primarily of Hispanic men (82%). At transition, patient demographics and clinical characteristics were similar between the groups. General and prostate cancer-specific QoL did not differ between the groups and remained stable over time, Radical prostatectomy as primary treatment and shorter time since treatment were associated with worse urinary and sexual function across both groups and over all three time points. CONCLUSION Those who transitioned to full-scope insurance and those who remained in the free prostate cancer-focused treatment program had stable general and prostate cancer-specific QoL. High-touch navigation aspects of a disease-focused program may have contributed to stability in outcomes.
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Affiliation(s)
- Allen Enrique D Siapno
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA.
| | - Thomas W Gaither
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Megha D Tandel
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, CA
| | - Lorna Kwan
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Ying-Ying Meng
- Center for Health Policy Research, University of California, Los Angeles, CA
| | - Sarah E Connor
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | | | - Arlene Fink
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA; Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA
| | - Sheba George
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA; Department of Preventive and Social Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA
| | - Mark S Litwin
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA; Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA
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Brawley OW, Lansey DG. Disparities in Breast Cancer Outcomes and How to Resolve Them. Hematol Oncol Clin North Am 2023; 37:1-15. [PMID: 36435603 DOI: 10.1016/j.hoc.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
There has been a 40% decline in breast cancer age-adjusted death rate since 1990. Black American women have not experienced as great a decline; indeed, the Black-White disparity in mortality in the United States is greater today than it has ever been. Certain states (areas of residence), however, do not see such dramatic differences in outcome by race. This latter finding suggests much more can be done to reduce disparities and prevent deaths. Interventions to get high-quality care (screening, diagnostics, and treatment) involve understanding the needs and concerns of the patient and addressing those needs and concerns. Patient navigators are 1 way to improve outcomes.
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Affiliation(s)
- Otis W Brawley
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Dina George Lansey
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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27
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Tailor TD, Bell S, Doo FX, Carlos RC. Repeat Annual Lung Cancer Screening After Baseline Screening Among Screen-Negative Individuals: No-Cost Coverage Is Not Enough. J Am Coll Radiol 2023; 20:29-36. [PMID: 36436778 DOI: 10.1016/j.jacr.2022.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/24/2022] [Accepted: 11/03/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Adherence to lung cancer screening (LCS) is central to effective screening. The authors evaluated the likelihood of repeat annual LCS in a national commercially insured population and associations with individual characteristics, insurance characteristics, and annual out-of-pocket cost (OOPC) burden. METHODS Using claims data from an employer-insured population (Clinformatics), individuals 55 to 80 years of age undergoing LCS between January 1, 2015, to September 30, 2019, with "negative" LCS were included. Repeat LCS was defined as low-dose chest CT occurring 10 to 15 months after the preceding LCS. Analysis was conducted over a 6-year period. Multivariable logistic regression was used to evaluate associations between repeat LCS and individual characteristics, insurance characteristics, and total OOPC incurred by the individual in the year of the index LCS, even if unrelated to LCS. RESULTS Of 14,943 individuals with negative LCS, 4,561 (30.5%) underwent repeat LCS. Likelihood of repeat LCS was decreased for men (adjusted odds ratio [aOR], 0.91; 95% confidence interval [CI], 0.86-0.97), Hispanic ethnicity (aOR, 0.82; 95% CI, 0.69-0.97), and indemnity insurance plans (aOR, 0.36; 95% CI, 0.25-0.53). Relative to New England, individuals in nearly all US geographic regions were less likely to undergo repeat LCS. Finally, individuals with total OOPC in the highest two quartiles were less likely to undergo repeat LCS (aOR, 0.85 [95% CI, 0.77-0.92] for OOPC >$1,069.02-$2,475.09 vs $0-$351.82; aOR, 0.75 [95% CI, 0.68-0.82] for OOPC >$2,475.09 vs $0-$351.82). CONCLUSIONS Although federal policies facilitate LCS without cost sharing, individuals incurring high OOPC, even when unrelated to LCS, are less likely to undergo repeat LCS. Future policy design should consider the permeative burden of OOPC across the health continuum on preventive services use.
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Affiliation(s)
- Tina D Tailor
- Department of Radiology, Duke University Medical Center; Research Director, Duke Lung Cancer Screening Program; and Fellowship Director, Cardiothoracic Radiology, Duke Radiology, Durham, North Carolina.
| | - Sarah Bell
- Department of Obstetrics and Gynecology, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Florence X Doo
- Department of Radiology, Stanford Health Care, Palo Alto, California; and ACR Informatics Fellow Member, Committee on Economics in Academic Radiology, ACR Commission on Economics
| | - Ruth C Carlos
- Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan; Chair, GE AUR Research Radiology Academic Fellowship; and Editor-in-Chief, JACR
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Wu J, Moss H. Financial Toxicity in the Post-Health Reform Era. J Am Coll Radiol 2023; 20:10-17. [PMID: 36509218 DOI: 10.1016/j.jacr.2022.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 12/13/2022]
Abstract
The Patient Protection and Affordable Care Act (ACA), enacted in March 2010, was comprehensive health care reform legislation aimed to improve health care access and quality of care and curb health care-related costs. This review focuses on key provisions of the ACA and their impact on financial toxicity. We will focus our review on cancer care, because this is the most commonly studied disease process in respect to financial toxicity. Patients with cancer face rising expenditures and financial burden, which in turn impact quality of life, compliance to treatment, and survival outcomes. Health insurance expansion include dependent-coverage expansion, Medicaid expansion, and establishment of the Marketplace. Coverage reform focused on reducing financial barriers by limiting cost sharing. Payment reforms included new innovative payment and delivery systems to focus on improving outcomes and reducing costs. Challenges remain as efforts to reduce costs have led to the expansion of insurance plans, such as high-deductible health plans, that may ultimately worsen financial toxicity in cancer and high out-of-pocket costs for further diagnostic testing and procedures. Further research is necessary to evaluate the long-term impacts of the ACA provisions-and threats to the ACA-on outcomes and the costs accrued by patients.
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Affiliation(s)
- Jenny Wu
- Resident, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina.
| | - Haley Moss
- Assistant Professor, Division of Gynecologic Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
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Abstract
Lung cancer is a leading cause of cancer death in the United States and globally with the majority of lung cancer cases attributable to cigarette smoking. Given the high societal and personal cost of a diagnosis of lung cancer including that most cases of lung cancer when diagnosed are found at a late stage, work over the past 40 years has aimed to detect lung cancer earlier when curative treatment is possible. Screening trials using chest radiography and sputum failed to show a reduction in lung cancer mortality however multiple studies using low dose CT have shown the ability to detect lung cancer early and a survival benefit to those screened. This review will discuss the history of lung cancer screening, current recommendations and screening guidelines, and implementation and components of a lung cancer screening program.
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Zhao J, Han X, Nogueira L, Fedewa SA, Jemal A, Halpern MT, Yabroff KR. Health insurance status and cancer stage at diagnosis and survival in the United States. CA Cancer J Clin 2022; 72:542-560. [PMID: 35829644 DOI: 10.3322/caac.21732] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 12/30/2022] Open
Abstract
Previous studies using data from the early 2000s demonstrated that patients who were uninsured were more likely to present with late-stage disease and had worse short-term survival after cancer diagnosis in the United States. In this report, the authors provide comprehensive data on the associations of health insurance coverage type with stage at diagnosis and long-term survival in individuals aged 18-64 years who were diagnosed between 2010 and 2013 with 19 common cancers from the National Cancer Database, with survival follow-up through December 31, 2019. Compared with privately insured patients, Medicaid-insured and uninsured patients were significantly more likely to be diagnosed with late-stage (III/IV) cancer for all stageable cancers combined and separately. For all stageable cancers combined and for six cancer sites-prostate, colorectal, non-Hodgkin lymphoma, oral cavity, liver, and esophagus-uninsured patients with Stage I disease had worse survival than privately insured patients with Stage II disease. Patients without private insurance coverage had worse short-term and long-term survival at each stage for all cancers combined; patients who were uninsured had worse stage-specific survival for 12 of 17 stageable cancers and had worse survival for leukemia and brain tumors. Expanding access to comprehensive health insurance coverage is crucial for improving access to cancer care and outcomes, including stage at diagnosis and survival.
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Affiliation(s)
- Jingxuan Zhao
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Leticia Nogueira
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Stacey A Fedewa
- Department of Hematology and Oncology, Emory University, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Michael T Halpern
- National Cancer Institute at the National Institutes of Health, Bethesda, Maryland
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
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Xiang K, Yanshan H, Chunmei Z, Minmin G, Yan W, Xiaojia Y. GP5 regulates epithelial-mesenchymal transition in breast cancer via the PI3K/AKT signaling pathway. Exp Biol Med (Maywood) 2022; 247:1501-1517. [PMID: 35880886 PMCID: PMC9554163 DOI: 10.1177/15353702221110642] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Recent evidences have shown that glycoprotein V (GP5) protein, which is initially considered as an important adhesion molecule unique to the megakaryocyte line, was also specifically expressed in malignant human breast epithelial cells. However, its expression level and function are not clear. This study aimed to reveal the abnormal expression of GP5 in breast cancer (BC), research the associations between the GP5 abnormal expression and BC progression, and explore the molecular mechanism of GP5 in BC. Immunohistochemistry, Western blot (WB), and quantitative reverse transcription-polymerase chain reaction (RT-PCR) assays were used to determine the expression patterns of GP5 in BC tissues and cells. The expression profiles of GP5 in the Cancer Genome Atlas databases were analyzed by UALCAN. The GP5 knockdown and over-expression BC cell lines were constructed and confirmed by RT-PCR and WB. Transcriptome sequencing and KEGG database were performed to screen cellular processes and signal pathways. Phosphatidylinositol 3-kinase (PI3K)/AKT pathway was verified by RT-qPCR, and epithelial-mesenchymal transition (EMT) was confirmed by WB. The results indicated GP5 was highly expressed in BC tissues and might play an important role as a cancer-promoting gene in BC. The high expression of GP5 was significantly associated with higher nuclear grade, higher TNM stage, and human epidermal growth factor receptor 2 (HER2) negativity. GP5 may promote the proliferation, invasion, and metastasis of BC cells by activating PI3K/AKT signaling pathway to up-regulate the EMT. This study provides a new idea that GP5 was expected to become a potential molecular target for early BC clinic diagnosis and treatment.
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Affiliation(s)
- Kui Xiang
- Department of Pathology, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China
| | - Hua Yanshan
- Department of Pathology, The Third Affiliated Hospital of Kunming Medical University and Yunnan Cancer Center, Yunnan Cancer Hospital, Kunming 650118, China
| | - Zhao Chunmei
- Department of Pathology, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China
| | - Guo Minmin
- Department of Pathology, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China
| | - Wang Yan
- Department of Pathology, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China,Wang Yan.
| | - Yi Xiaojia
- Department of Pathology, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China
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Carrasco-Aguilar A, Galán JJ, Carrasco RA. Obamacare: A bibliometric perspective. Front Public Health 2022; 10:979064. [PMID: 36033824 PMCID: PMC9416003 DOI: 10.3389/fpubh.2022.979064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/22/2022] [Indexed: 01/25/2023] Open
Abstract
Obamacare is the colloquial name given to the Affordable Care Act (ACA) signed into law by President Obama in the USA, which ultimately aims to provide universal access to health care services for US citizens. The aim of this paper is to provide an overview of the political-legal, economic, social, management (or administrative), and medical (or health) repercussions of this law, using a bibliometric methodology as a basis. In addition, the main contributors to research on ACA issues have been identified in terms of authors, organizations, journals, and countries. The downward trend in scientific production on this law has been noted, and it has been concluded that a balance has not yet been reached between the coexistence of private and public health care that guarantees broad social coverage without economic or other types of barriers. The law requires political consensus to be implemented in a definitive and global manner for the whole of the United States.
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Martinez ME, Gomez SL, Canchola AJ, Oh DL, Murphy JD, Mehtsun W, Yabroff KR, Banegas MP. Changes in Cancer Mortality by Race and Ethnicity Following the Implementation of the Affordable Care Act in California. Front Oncol 2022; 12:916167. [PMID: 35912225 PMCID: PMC9327742 DOI: 10.3389/fonc.2022.916167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
Although Affordable Care Act (ACA) implementation has improved cancer outcomes, less is known about how much the improvement applies to different racial and ethnic populations. We examined changes in health insurance coverage and cancer-specific mortality rates by race/ethnicity pre- and post-ACA. We identified newly diagnosed breast (n = 117,738), colorectal (n = 38,334), and cervical cancer (n = 11,109) patients < 65 years in California 2007-2017. Hazard rate ratios (HRR) and 95% confidence intervals (CI) were calculated using multivariable Cox regression to estimate risk of cancer-specific death pre- (2007-2010) and post-ACA (2014-2017) and by race/ethnicity [American Indian/Alaska Natives (AIAN); Asian American; Hispanic; Native Hawaiian or Pacific Islander (NHPI); non-Hispanic Black (NHB); non-Hispanic white (NHW)]. Cancer-specific mortality from colorectal cancer was lower post-ACA among Hispanic (HRR = 0.82, 95% CI = 0.74 to 0.92), NHB (HRR = 0.69, 95% CI = 0.58 to 0.82), and NHW (HRR = 0.90; 95% CI = 0.84 to 0.97) but not Asian American (HRR = 0.95, 95% CI = 0.82 to 1.10) patients. We observed a lower risk of death from cervical cancer post-ACA among NHB women (HRR = 0.68, 95% CI = 0.47 to 0.99). No statistically significant differences in breast cancer-specific mortality were observed for any racial or ethnic group. Cancer-specific mortality decreased following ACA implementation for colorectal and cervical cancers for some racial and ethnic groups in California, suggesting Medicaid expansion is associated with reductions in health inequity.
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Affiliation(s)
- Maria Elena Martinez
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, United States,Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States,*Correspondence: Maria Elena Martinez,
| | - Scarlett L. Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, United States
| | - Alison J. Canchola
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Debora L. Oh
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - James D. Murphy
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States,Department of Radiation Medicine and Applied Sciences, University of California, San Diego School of Medicine, La Jolla, CA, United States
| | - Winta Mehtsun
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States,Department of Surgery, University of California, San Diego School of Medicine, La Jolla, CA, United States
| | - K. Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, United States
| | - Matthew P. Banegas
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States,Department of Radiation Medicine and Applied Sciences, University of California, San Diego School of Medicine, La Jolla, CA, United States
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Davidoff AJ, Akif K, Halpern MT. Research on the Economics of Cancer-Related Health Care: An Overview of the Review Literature. J Natl Cancer Inst Monogr 2022; 2022:12-20. [PMID: 35788372 DOI: 10.1093/jncimonographs/lgac011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/21/2022] [Indexed: 01/16/2023] Open
Abstract
We reviewed current literature reviews regarding economics of cancer-related health care to identify focus areas and gaps. We searched PubMed for systematic and other reviews with the Medical Subject Headings "neoplasms" and "economics" published between January 1, 2010, and April 1, 2020, identifying 164 reviews. Review characteristics were abstracted and described. The majority (70.7%) of reviews focused on cost-effectiveness or cost-utility analyses. Few reviews addressed other types of cancer health economic studies. More than two-thirds of the reviews examined cancer treatments, followed by screening (15.9%) and survivorship or end-of-life (13.4%). The plurality of reviews (28.7%) cut across cancer site, followed by breast (20.7%), colorectal (11.6%), and gynecologic (8.5%) cancers. Specific topics addressed cancer screening modalities, novel therapies, pain management, or exercise interventions during survivorship. The results indicate that reviews do not regularly cover other phases of care or topics including financial hardship, policy, and measurement and methods.
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Affiliation(s)
- Amy J Davidoff
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Kaitlin Akif
- Office of the Associate Director, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Michael T Halpern
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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Yang D, Yang L, Cai J, Li H, Xing Z, Hou Y. Phosphoinositide 3-kinase/Akt and its related signaling pathways in the regulation of tumor-associated macrophages polarization. Mol Cell Biochem 2022; 477:2469-2480. [PMID: 35590082 DOI: 10.1007/s11010-022-04461-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 04/28/2022] [Indexed: 12/24/2022]
Abstract
Tumor-associated macrophages (TAMs) are a type of functionally plastic immune cell population in tumor microenvironment (TME) and mainly polarized into two phenotypes: M2 and M1-like TAMs. The M2-like TAMs could stimulate tumor growth and metastasis, tissue remodeling and immune-suppression, whereas M1-like TAMs could initiate immune response to dampen tumor progression. TAMs with different polarization phenotypes can produce various kinds of cytokines, chemokines and growth factors to regulate immunity and inflammatory responses. It is an effective method to treat cancer through ameliorating TME and modulating TAMs by converting M2 into M1-like phenotype. However, intracellular signaling mechanisms underlying TAMs polarization are largely undefined. Phosphoinositide 3-kinase (PI3K)/Akt is an important signaling pathway participating in M2-like TAMs polarization, survival, growth, proliferation, differentiation, apoptosis and cytoskeleton rearrangement. In the present review, we analyzed the mechanism of TAMs polarization focusing on PI3K/Akt and its downstream mitogen‑activated protein kinase (MAPK) as well as nuclear factor kappa B (NF-κB) signaling pathways, thus provides the first evidence of intracellular targets for cancer immunotherapy.
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Affiliation(s)
- Depeng Yang
- School of Life Sciences and Technology, Harbin Institute of Technology, Harbin, 150001, Heilongjiang, China
| | - Lijun Yang
- School of Life Sciences and Technology, Harbin Institute of Technology, Harbin, 150001, Heilongjiang, China
| | - Jialing Cai
- School of Life Sciences and Technology, Harbin Institute of Technology, Harbin, 150001, Heilongjiang, China
| | - Huaxin Li
- School of Life Sciences and Technology, Harbin Institute of Technology, Harbin, 150001, Heilongjiang, China
| | - Zheng Xing
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, 100191, China
| | - Ying Hou
- Institute of Basic and Translational Medicine, Shaanxi Key Laboratory of Ischemic Cardiovascular Disease, Shaanxi Key Laboratory of Brain Disorders, Xi'an Medical University, Xi'an, 710021, Shaanxi, China.
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Han X, Zhao J, Yabroff KR, Johnson CJ, Jemal A. Association Between Medicaid Expansion Under the Affordable Care Act and Survival Among Newly Diagnosed Cancer Patients. J Natl Cancer Inst 2022; 114:1176-1185. [PMID: 35583373 DOI: 10.1093/jnci/djac077] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/09/2022] [Accepted: 04/04/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Medicaid expansion under the Affordable Care Act (ACA) is associated with increased insurance coverage among patients with cancer. Whether these gains translate to improved survival is largely unknown. This study examines changes in 2-year survival among patients newly diagnosed with cancer following the ACA Medicaid expansion. METHODS Patients aged 18-62 years from 42 states' population-based cancer registries diagnosed pre (2010-2012) and post (2014-2016) ACA Medicaid expansion were followed through September 30, 2013, and December 31, 2017, respectively. Difference-in-differences (DD) analysis of 2-year overall survival was stratified by sex, race and ethnicity, census tract-level poverty, and rurality. RESULTS A total of 2 555 302 patients diagnosed with cancer were included from Medicaid expansion (n = 1 523 585) and nonexpansion (n = 1 031 717) states. The 2-year overall survival increased from 80.58% pre-ACA to 82.23% post-ACA in expansion states and from 78.71% to 80.04% in nonexpansion states, resulting in a net increase of 0.44 percentage points (ppt) (95% confidence interval [CI] = 0.24ppt to 0.64ppt) in expansion states after adjusting for sociodemographic factors. By cancer site, the net increase was greater for colorectal cancer (DD = 0.90ppt, 95% CI = 0.19ppt to 1.60ppt), lung cancer (DD = 1.29ppt, 95% CI = 0.50ppt to 2.08ppt), non-Hodgkin lymphoma (DD = 1.07ppt, 95% CI = 0.14ppt to 1.99ppt), pancreatic cancer (DD = 1.80ppt, 95% CI = 0.40ppt to 3.21ppt), and liver cancer (DD = 2.57ppt, 95% CI = 1.00ppt to 4.15ppt). The improvement in 2-year overall survival was larger among non-Hispanic Black patients (DD = 0.72ppt, 95% CI = 0.12ppt to 1.31ppt) and patients residing in rural areas (DD = 1.48ppt, 95% CI= -0.26ppt to 3.23ppt), leading to narrowing survival disparities by race and rurality. CONCLUSIONS Medicaid expansion was associated with greater increase in 2-year overall survival, and the increase was prominent among non-Hispanic Blacks and in rural areas, highlighting the role of Medicaid expansion in reducing health disparities. Future studies should monitor changes in longer-term health outcomes following the ACA.
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Affiliation(s)
- Xuesong Han
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - Jingxuan Zhao
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - K Robin Yabroff
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | | | - Ahmedin Jemal
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, GA, USA
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Mutebi M, Dehar N, Nogueira LM, Shi K, Yabroff KR, Gyawali B. Cancer Groundshot: Building a Robust Cancer Control Platform in Addition To Launching the Cancer Moonshot. Am Soc Clin Oncol Educ Book 2022; 42:1-16. [PMID: 35561297 DOI: 10.1200/edbk_359521] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cancer Groundshot is a philosophy that calls for prioritization of strategies in global cancer control. The underlying principle of Cancer Groundshot is that one must ensure access to interventions that are already proven to work before focusing on the development of new interventions. In this article, we discuss the philosophy of Cancer Groundshot as it pertains to priorities in cancer care and research in low- and middle-income countries and the utility of technology in addressing global cancer disparities; we also address disparities seen in high-income countries. The oncology community needs to realign our priorities and focus on improving access to high-value cancer control strategies, rather than allocating resources primarily to the development of technologies that provide only marginal gains at a high cost. There are several "low-hanging fruit" actions that will improve access to quality cancer care in low- and middle-income countries and in high-income countries. Worldwide, cancer morbidity and mortality can be averted by implementing highly effective, low-cost interventions that are already known to work, rather than investing in the development of resource-intensive interventions to which most patients will not have access (i.e., we can use Cancer Groundshot to first save more lives before we focus on the "moonshots").
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Affiliation(s)
- Miriam Mutebi
- Breast Surgical Oncology, Aga Khan University, Nairobi, Kenya
| | - Navdeep Dehar
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - Leticia M Nogueira
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Kewei Shi
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - K Robin Yabroff
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Bishal Gyawali
- Department of Oncology, Queen's University, Kingston, Ontario, Canada.,Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.,Division of Cancer Care and Epidemiology, Queen's University, Kingston, Ontario, Canada
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Su CT, Veenstra CM, Patel MR. Divergent Patterns in Care Utilization and Financial Distress between Patients with Blood Cancers and Solid Tumors: A National Health Interview Survey Study, 2014-2020. Cancers (Basel) 2022; 14:cancers14071605. [PMID: 35406377 PMCID: PMC8996850 DOI: 10.3390/cancers14071605] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction: Important differences exist between the presentation, treatment, and survivorship of patients and survivors with blood cancers. Furthermore, existing research in financial toxicity has not fully addressed the relationship between medical care utilization and patient-reported outcomes of financial barriers and distress. We answered these questions by using a nationally representative survey. Methods: Respondents with blood cancers and solid tumors from the National Health Interview Survey were identified (2014−2020). We identified 23 survey questions as study outcomes and grouped them into three domains of medical care utilization, financial barriers to care, and financial distress. Associations between the three domains and associations of study outcomes between cancer types were examined using weighted univariate analyses and multivariable linear and logistic regressions. Results: The final study group consisted of 6248 respondents with solid tumors and 398 with blood cancers (diagnosed ≤ 5 years). Across all respondents with cancer, higher medical care utilization is generally associated with increased financial barriers to care. Compared to respondents with solid tumors, respondents with blood cancers had a higher level of medical care utilization (β = 0.36, p = 0.02), a lower level of financial barriers to care (β = −0.19, p < 0.0001), and a higher level of financial distress in affording care (β = 0.64, p = 0.03). Conclusions: Patients and survivors with blood cancers and solid tumors demonstrate divergent patterns in care utilization, financial barriers, and financial distress. Future research and interventions on financial toxicity should be tailored for individual cancer groups, recognizing the differences in medical care utilization, which affect the experienced financial barriers.
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Affiliation(s)
- Christopher T. Su
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109, USA; (C.M.V.); (M.R.P.)
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
- Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI 48109, USA
- Correspondence: ; Tel.: +1-734-615-1623
| | - Christine M. Veenstra
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109, USA; (C.M.V.); (M.R.P.)
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
- Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI 48109, USA
| | - Minal R. Patel
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109, USA; (C.M.V.); (M.R.P.)
- Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI 48109, USA
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
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40
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Islami F, Guerra CE, Minihan A, Yabroff KR, Fedewa SA, Sloan K, Wiedt TL, Thomson B, Siegel RL, Nargis N, Winn RA, Lacasse L, Makaroff L, Daniels EC, Patel AV, Cance WG, Jemal A. American Cancer Society's report on the status of cancer disparities in the United States, 2021. CA Cancer J Clin 2022; 72:112-143. [PMID: 34878180 DOI: 10.3322/caac.21703] [Citation(s) in RCA: 86] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 02/06/2023] Open
Abstract
In this report, the authors provide comprehensive and up-to-date US data on disparities in cancer occurrence, major risk factors, and access to and utilization of preventive measures and screening by sociodemographic characteristics. They also review programs and resources that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. The overall cancer death rate is 19% higher among Black males than among White males. Black females also have a 12% higher overall cancer death rate than their White counterparts despite having an 8% lower incidence rate. There are also substantial variations in death rates for specific cancer types and in stage at diagnosis, survival, exposure to risk factors, and receipt of preventive measures and screening by race/ethnicity, socioeconomic status, and geographic location. For example, kidney cancer death rates by sex among American Indian/Alaska Native people are ≥64% higher than the corresponding rates in each of the other racial/ethnic groups, and the 5-year relative survival for all cancers combined is 14% lower among residents of poorer counties than among residents of more affluent counties. Broad and equitable implementation of evidence-based interventions, such as increasing health insurance coverage through Medicaid expansion or other initiatives, could substantially reduce cancer disparities. However, progress will require not only equitable local, state, and federal policies but also broad interdisciplinary engagement to elevate and address fundamental social inequities and longstanding systemic racism.
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Affiliation(s)
- Farhad Islami
- Cancer Disparity Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Carmen E Guerra
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Adair Minihan
- Screening and Risk Factors Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - K Robin Yabroff
- Health Services Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Stacey A Fedewa
- Screening and Risk Factors Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Kirsten Sloan
- Public Policy, American Cancer Society Cancer Action Network, Washington, District of Columbia
| | - Tracy L Wiedt
- Health Equity, Prevention and Early Detection, American Cancer Society, Atlanta, Georgia
| | - Blake Thomson
- Cancer Disparity Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Nigar Nargis
- Tobacco Control Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Robert A Winn
- Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia
| | - Lisa Lacasse
- American Cancer Society Cancer Action Network, Washington, District of Columbia
| | - Laura Makaroff
- Prevention and Early Detection, American Cancer Society, Atlanta, Georgia
| | - Elvan C Daniels
- Extramural Discovery Science, American Cancer Society, Atlanta, Georgia
| | - Alpa V Patel
- Department of Population Science, American Cancer Society, Atlanta, Georgia
| | - William G Cance
- Office of the Chief Medical and Scientific Officer, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
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Cobb AN, Adesoye T, Teshome M. Progress and Persistent Challenges in Improving Care for Low-Income Women with Breast Cancer. Ann Surg Oncol 2022; 29:2756-2758. [PMID: 35152360 PMCID: PMC8853375 DOI: 10.1245/s10434-022-11343-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/10/2022] [Indexed: 11/22/2022]
Affiliation(s)
- Adrienne N Cobb
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Taiwo Adesoye
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mediget Teshome
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Knotts C, Van Horn A, Orminski K, Thompson S, Minor J, Elmore M, Richmond BK. Clinical and Socioeconomic Factors that Predict Non-completion of Adjuvant Chemotherapy for Colorectal Cancer in a Rural Cancer Center. Am Surg 2022:31348211054708. [PMID: 35850535 DOI: 10.1177/00031348211054708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Previous literature demonstrates correlations between comorbidities and failure to complete adjuvant chemotherapy. Frailty and socioeconomic disparities have also been implicated in affecting cancer treatment outcomes. This study examines the effect of demographics, comorbidities, frailty, and socioeconomic status on chemotherapy completion rates in colorectal cancer patients. Methods This was an observational case-control study using retrospective data from Stage II and III colorectal cancer patients offered chemotherapy between January 01, 2013 and January 01, 2018. Data was obtained using the cancer registry, supplemented with chart review. Patients were divided based on treatment completion and compared with respect to comorbidities, age, Eastern Cooperative Oncology Group (ECOG) score, and insurance status using univariate and multivariate analyses. Results 228 patients were identified: 53 Stage II and 175 Stage III. Of these, 24.5% of Stage II and 30.3% of Stage III patients did not complete chemotherapy. Neither ECOG status nor any comorbidity predicted failure to complete treatment. Those failing to complete chemotherapy were older (64.4 vs 60.8 years, P = .043). Additionally, those with public assistance or self-pay were less likely to complete chemotherapy than those with private insurance ( P = .049). Both factors (older age/insurance status) remained significant on multivariate analysis (increasing age at diagnosis: OR 1.03, P =.034; public insurance: OR 1.84, P = .07; and self-pay status: OR 4.49, P = .03). Conclusions No comorbidity was associated with failure to complete therapy, nor was frailty, as assessed by ECOG score. Though frailty was not significant, increasing age was, possibly reflecting negative attitudes toward chemotherapy in older populations. Insurance status also predicted failure to complete treatment, suggesting disparities in access to treatment, affected by socioeconomic factors.
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Affiliation(s)
| | | | - Krysta Orminski
- West Virginia University/Charleston Division, Charleston, WV, USA
| | - Stephanie Thompson
- Charleston Area Medical Center Health, Institute for Academic Medicine, Charleston, WV, USA
| | - Jacob Minor
- Charleston Area Medical Center, Charleston, WV, USA
| | - Michael Elmore
- Department of Surgery, West Virginia University/Charleston Division, Charleston, WV, USA
| | - Bryan K. Richmond
- Department of Surgery, West Virginia University/Charleston Division, Charleston, WV, USA
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Mobley EM, Tfirn I, Guerrier C, Gutter MS, Vigal K, Pather K, Baskovich B, Awad ZT, Parker AS. Impact of Medicaid Expansion on Pancreatic Cancer: An Examination of Sociodemographic Disparity in 1-Year Survival. J Am Coll Surg 2022; 234:75-84. [PMID: 35213464 PMCID: PMC9132328 DOI: 10.1097/xcs.0000000000000018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND This study examined the effect of Medicaid expansion on 1-year survival of pancreatic cancer for nonelderly adults. We further evaluated whether sociodemographic and county characteristics alter the association of Medicaid expansion and 1-year survival. STUDY DESIGN We obtained data from the Surveillance Epidemiology and End-Results dataset on individuals diagnosed with pancreatic cancer from 2007 to 2015. A Difference-in-Differences model compared those from early-adopting states to non-early-adopting states, before and after adoption (2014), while taking into consideration sociodemographic and county characteristics to estimate the effect of Medicaid expansion on 1-year survival. RESULTS In the univariable Difference-in-Differences model, the probability of 1-year survival for pancreatic cancer increased by 4.8 percentage points (ppt) for those from Medicaid expansion states postexpansion (n = 35,347). After adjustment for covariates, the probability of 1-year survival was reduced to 0.8 ppt. Interestingly, after multivariable adjustment the effect of living in an expansion state on 1-year survival was similar for men and women (0.6 ppt for men vs 1.2 ppt for women), was also similar for Whites (2.6 ppt), and was higher in those of other races (5.9 ppt) but decreased for Blacks (-2.0 ppt). Those who were insured (-0.1 ppt) or uninsured (-2.2 ppt) experienced a decrease in the probability of 1-year survival; however, those who were covered by Medicaid at diagnosis experienced an increase in the probability of 1-year survival (7.4 ppt). CONCLUSIONS Medicaid expansion during or after 2014 is associated with an increase in the probability of 1-year survival for pancreatic cancer; however, this effect is attenuated after adjustment for sociodemographic characteristics. Of note, the positive association was more pronounced in certain categories of key covariates suggesting further inquiry focused on these subgroups.
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Affiliation(s)
- Erin M. Mobley
- Department of Surgery, College of Medicine, University of Florida, Jacksonville, FL
| | - Ian Tfirn
- Center for Data Solutions, College of Medicine, University of Florida, Jacksonville, FL
| | - Christina Guerrier
- Center for Data Solutions, College of Medicine, University of Florida, Jacksonville, FL
| | - Michael S. Gutter
- Institute for Food and Agricultural Sciences, College of Medicine, University of Florida, Gainesville, FL
| | - Kim Vigal
- Center for Data Solutions, College of Medicine, University of Florida, Jacksonville, FL
| | - Keouna Pather
- Department of Surgery, College of Medicine, University of Florida, Jacksonville, FL
| | - Brett Baskovich
- Department of Pathology, College of Medicine, University of Florida, Jacksonville, FL
| | - Ziad T. Awad
- Department of Surgery, College of Medicine, University of Florida, Jacksonville, FL
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Wu XP, Xu ZQ, Xie WM, Lai YL, He K, Jiang Y, Xu ZC, Lin YN, Xie YF. Long non-coding RNA GAS6-AS1 enhances breast cancer cell aggressiveness by functioning as a competing endogenous RNA of microRNA-215-5p to enhance SOX9 expression. Exp Ther Med 2022; 23:109. [PMID: 34976151 DOI: 10.3892/etm.2021.11032] [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: 05/31/2020] [Accepted: 12/01/2020] [Indexed: 11/06/2022] Open
Abstract
Long non-coding (lnc) RNAs play crucial functions in human cancer. However, until recently, the involvement of the lncRNA GAS6-AS1 in breast cancer (BCa) malignancy has not been studied exhaustively. The roles and underlying mode of action of GAS6-AS1 action in BCa progression were examined through functional experiments. A decline in GAS6-AS1 level led to a significant decrease in BCa cell proliferation, and the ability for colony formation. Here, GAS6-AS1 competed as endogenous RNA by sequestering microRNA-215-5p (miR-215-5p) causing an enhanced expression of SRY-box transcription factor 9 (SOX9). The effects of silencing GAS6-AS1 on BCa malignant phenotypes could be ameliorated by inhibiting miR-215-5p or restoring SOX9. Thus, GAS6-AS1 acted as a lncRNA that drives tumor in BCa, and enabled progression of BCa through miR-215-5p /SOX9 axis regulation. These outcomes show that the GAS6-AS1/miR-215-5p/SOX9 axis is a potentially effective target for cancer treatment and management.
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Affiliation(s)
- Xiu-Ping Wu
- Department of Breast Surgery, Zhengxing Hospital, Zhangzhou, Fujian 363000, P.R. China
| | - Zhi-Qiang Xu
- Department of Breast Surgery, Zhengxing Hospital, Zhangzhou, Fujian 363000, P.R. China
| | - Wang-Mei Xie
- Department of Breast Surgery, Zhengxing Hospital, Zhangzhou, Fujian 363000, P.R. China
| | - Yao-Long Lai
- Department of Breast Surgery, Zhengxing Hospital, Zhangzhou, Fujian 363000, P.R. China
| | - Kai He
- Department of Breast Surgery, Zhengxing Hospital, Zhangzhou, Fujian 363000, P.R. China
| | - Yan Jiang
- Department of Breast Surgery, Zhengxing Hospital, Zhangzhou, Fujian 363000, P.R. China
| | - Zhen-Chao Xu
- Department of Breast Surgery, Zhengxing Hospital, Zhangzhou, Fujian 363000, P.R. China
| | - Yi-Na Lin
- Department of Radiation Oncology, Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou, Fujian 363000, P.R. China
| | - Yuan-Fu Xie
- Department of Radiation Oncology, Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou, Fujian 363000, P.R. China
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45
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Xie L, Du X, Wang S, Shi P, Qian Y, Zhang W, Tang X, Lin Y, Chen J, Peng L, Yu CC, Qian B. Development and evaluation of cancer differentiation analysis technology: a novel biophysics-based cancer screening method. Expert Rev Mol Diagn 2021; 22:111-117. [PMID: 34846233 DOI: 10.1080/14737159.2021.2013201] [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: 12/21/2022]
Abstract
BACKGROUND Routine health checkup is an essential strategy for monitoring population health and maintaining healthy workforces. However, there was a lack of cancer screening tests among routine health checkups due to high costs and unreliable methods. METHODS We conducted a two-stage study to evaluate the value of a blood test, Cancer Differentiation Analysis (CDATM), which is developed to differentiate the blood samples of healthy individuals from those of cancer patients through measuring and analyzing multiple biophysical properties. RESULTS The first stage of a cross-sectional study included 75,942 healthy individuals in routine health checkup, and the second stage of a prospective population-based cohort included 1,957 healthy community members. Forty-eight and ten cancer cases were identified among cross-sectional study and prospective population-based cohort, respectively. Using a pre-determined cutoff, we found that the CDA™ test could differentiate blood samples between healthy and cancer individuals with >93% specificity and >55% sensitivity in both studies. CONCLUSIONS With high specificity and moderate sensitivity of CDA™ test, our study indicates that we can analyze biophysical properties in the blood to rapidly and reliably screen healthy individuals from cancer patients in a health checkup setting where most individuals are healthy or with average risk of cancer.
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Affiliation(s)
- Li Xie
- Hongqiao International Institute of Medicine, Shanghai Tongren Hospital and School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuedong Du
- AnPac Bio-Medical Science Co., Ltd, Shanghai, China
| | - Suna Wang
- Hongqiao International Institute of Medicine, Shanghai Tongren Hospital and School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peng Shi
- Department of Statistics and Data Management, Children's Hospital of Fudan University, Shanghai, China
| | - Ying Qian
- Hongqiao International Institute of Medicine, Shanghai Tongren Hospital and School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weituo Zhang
- Hongqiao International Institute of Medicine, Shanghai Tongren Hospital and School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xing Tang
- AnPac Bio-Medical Science Co., Ltd, Shanghai, China
| | - Yue Lin
- AnPac Bio-Medical Science Co., Ltd, Shanghai, China
| | - Jie Chen
- AnPac Bio-Medical Science Co., Ltd, Shanghai, China
| | - Lan Peng
- AnPac Bio-Medical Science Co., Ltd, Shanghai, China
| | | | - Biyun Qian
- Hongqiao International Institute of Medicine, Shanghai Tongren Hospital and School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Clinical Research Promotion and Development Center, Shanghai Hospital Development Center, Shanghai, China
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46
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Ji X, Castellino SM, Mertens AC, Zhao J, Nogueira L, Jemal A, Yabroff KR, Han X. Association of Medicaid Expansion With Cancer Stage and Disparities in Newly Diagnosed Young Adults. J Natl Cancer Inst 2021; 113:1723-1732. [PMID: 34021352 PMCID: PMC9989840 DOI: 10.1093/jnci/djab105] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/22/2021] [Accepted: 05/19/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Young adults (YAs) experience higher uninsurance rates and more advanced stage at cancer diagnosis than older counterparts. We examined the association of the Affordable Care Act Medicaid expansion with insurance coverage and stage at diagnosis among YAs newly diagnosed with cancer. METHODS Using the National Cancer Database, we identified 309 413 YAs aged 18-39 years who received a first cancer diagnosis in 2011-2016. Outcomes included percentages of YAs without health insurance at diagnosis, with stage I (early-stage) diagnoses, and with stage IV (advanced-stage) diagnoses. We conducted difference-in-difference (DD) analyses to examine outcomes before and after states implemented Medicaid expansion compared with nonexpansion states. All statistical tests were 2-sided. RESULTS The percentage of uninsured YAs decreased more in expansion than nonexpansion states (adjusted DD = -1.0 percentage points [ppt], 95% confidence interval [CI] = -1.4 to -0.7 ppt, P < .001). The overall percentage of stage I diagnoses increased (adjusted DD = 1.4 ppt, 95% CI = 0.6 to 2.2 ppt, P < .001) in expansion compared with nonexpansion states, with greater improvement among YAs in rural areas (adjusted DD = 7.2 ppt, 95% CI = 0.2 to 14.3 ppt, P = .045) than metropolitan areas (adjusted DD = 1.3 ppt, 95% CI = 0.4 to 2.2 ppt, P = .004) and among non-Hispanic Black patients (adjusted DD = 2.2 ppt, 95% CI = -0.03 to 4.4 ppt, P = .05) than non-Hispanic White patients (adjusted DD = 1.4 ppt, 95% CI = 0.4 to 2.3 ppt, P = .008). Despite the non-statistically significant change in stage IV diagnoses overall, the percentage declined more (adjusted DD = -1.2 ppt, 95% CI = -2.2 to -0.2 ppt, P = .02) among melanoma patients in expansion relative to nonexpansion states. CONCLUSIONS We provide the first evidence, to our knowledge, on the association of Medicaid expansion with shifts to early-stage cancer at diagnosis and a narrowing of rural-urban and Black-White disparities in YA cancer patients.
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Affiliation(s)
- Xu Ji
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Sharon M Castellino
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Ann C Mertens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.,Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Jingxuan Zhao
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - Leticia Nogueira
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
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Fedewa SA, Han X. A First Look at Medicaid Expansion's Impact on Cancer Mortality Rates. J Natl Cancer Inst 2021; 113:1611-1612. [PMID: 34259325 PMCID: PMC8634388 DOI: 10.1093/jnci/djab136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 12/15/2022] Open
Affiliation(s)
- Stacey A Fedewa
- Surveillance and Health Equity Sciences, American Cancer Society, Atlanta, GA, USA
| | - Xuesong Han
- Surveillance and Health Equity Sciences, American Cancer Society, Atlanta, GA, USA
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48
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Fan Q, Yao XA, Han X. Spatial variation and disparity in female breast cancer relative survival in the United States. Cancer 2021; 127:4006-4014. [PMID: 34265081 DOI: 10.1002/cncr.33801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/25/2021] [Accepted: 06/28/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Breast cancer is the most common cancer among women in the United States. However, data on spatial disparities in survival for breast cancer are limited in the country. This study estimated 5-year relative survival (RS) of female breast cancer and examined the spatial variations across the contiguous United States. METHODS Women newly diagnosed with breast cancer in 2003-2010 in the United States were identified from the National Cancer Database and followed up through 2016. The crude 5-year RS at the county level was estimated and adjusted for patients' key sociodemographic and clinical factors. To account for spatial effects, the RS estimates were smoothed using the Bayesian spatial survival model. A local spatial autocorrelation analysis with the Getis-Ord Gi* statistics was applied to identify geographic clusters of low or high RS. RESULTS Clusters of low RS were identified in more than 15 states covering 671 counties, mostly in the southeast and southwest regions, including Georgia, Alabama, Mississippi, Louisiana, Arkansas, Oklahoma, and Texas. Approximately 30% of these clusters can be explained by patients' characteristics: Race, insurance, and stage at diagnosis appeared to be the major attributable factors. CONCLUSIONS Significant spatial disparity in female breast cancer survival was found, with low RS clusters identified in Georgia, Alabama, Mississippi, Louisiana, Arkansas, Oklahoma, and Texas. Policies and interventions that focus on serving Black women, improvements in insurance coverage, and early detection in these areas could potentially mitigate the spatial disparities.
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Affiliation(s)
- Qinjin Fan
- Department of Geography, University of Georgia, Athens, Georgia
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Xiaobai A Yao
- Department of Geography, University of Georgia, Athens, Georgia
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
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49
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Tailor TD, Bell S, Fendrick AM, Carlos RC. Total and Out-of-Pocket Costs of Procedures After Lung Cancer Screening in a National Commercially Insured Population: Estimating an Episode of Care. J Am Coll Radiol 2021; 19:35-46. [PMID: 34600897 DOI: 10.1016/j.jacr.2021.09.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/12/2021] [Accepted: 09/15/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Consequences of lung cancer screening (LCS) with low-dose chest CT in clinical settings, including procedures, costs, and complications, are incompletely understood. We evaluated downstream invasive procedures after LCS, total and out-of-pocket (OOP) costs of these procedures, and correlates of procedural rates and costs. METHODS Using the Clinformatics Data Mart, we retrospectively included patients between ages 55 and 79 years receiving LCS between 2015 and 2017. The types and frequency of downstream invasive procedures (including needle biopsy, bronchoscopy, surgery, and cytology) were described. Treating the LCS examination and downstream procedures as a single LCS episode, we described the per-episode total costs (insurance reimbursement + OOP costs of LCS and downstream procedures) and OOP costs. Correlates of costs were determined using linear and logistic regression. RESULTS A total of 6,268 patients received at least one low-dose chest CT; 462 patients (7.4%) received at least one procedure within 12 months after LCS (needle biopsy 69.0%, cytology 23.6%, bronchoscopy 18.6%, surgery 23.8%). Women and patients ≥65 years were more likely to receive a downstream procedure. Ninety-three patients (20.1%) were diagnosed with lung cancer after LCS. The total cost of managing this population of lung screeners was $5,060,511.04, with an average per-episode total cost of $740.06. The aggregate OOP costs to this population of lung screeners was $427,069.74, with an average per-episode OOP cost of $62.46. CONCLUSIONS Rates of invasive procedures after LCS in a commercially insured population exceeded those of clinical trials. Considering LCS and associated downstream procedures as an episode of care results in modest OOP cost.
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Affiliation(s)
- Tina D Tailor
- Director, Cardiothoracic Radiology Fellowship and Research Director, Duke Lung Cancer Screening Program, Department of Radiology, Duke University Medical Center, Durham, North Carolina.
| | - Sarah Bell
- Department of Obstetrics and Gynecology, University of Michigan Health, Ann Arbor, Michigan
| | - A Mark Fendrick
- Director, University of Michigan Center for Value-Based Insurance Design, Department of Internal Medicine and Department of Health Management and Policy, University of Michigan Health, Ann Arbor Michigan
| | - Ruth C Carlos
- Department of Radiology, University of Michigan Health, Ann Arbor, Michigan
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50
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Diehl TM, Abbott DE. Association of Medicaid Expansion with Diagnosis and Management of Colon Cancer. J Am Coll Surg 2021; 232:156-158. [PMID: 33451446 PMCID: PMC10120391 DOI: 10.1016/j.jamcollsurg.2020.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 11/24/2020] [Indexed: 11/26/2022]
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