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Brenner DR, Gillis J, Demers AA, Ellison LF, Billette JM, Zhang SX, Liu JL, Woods RR, Finley C, Fitzgerald N, Saint-Jacques N, Shack L, Turner D. Projection du fardeau du cancer au Canada en 2024. CMAJ 2024; 196:E836-E845. [PMID: 38955403 DOI: 10.1503/cmaj.240095-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 07/04/2024] Open
Affiliation(s)
- Darren R Brenner
- Départements d'oncologie et de sciences de la santé communautaire (Brenner), Cumming School of Medicine, Université de Calgary, Calgary, Alb.; Surveillance, Société canadienne du cancer (Gillis), Vancouver, C.-B.; Centre de surveillance et de recherche appliquée (Demers), Agence de la santé publique du Canada; Centre des données sur la santé de la population (Ellison, Billette, Zhang, Liu), Statistique Canada, Ottawa, Ont.; Population Oncology, BC Cancer (Woods), Vancouver, C.-B.; Département de chirurgie (Finley), Université McMaster, St. Joseph's Health Care Centre, Hamilton, Ont.; Performance du système et analyses (Fitzgerald), Partenariat canadien contre le cancer, Toronto, Ont.; Programme de soins contre le cancer de Santé Nouvelle-Écosse (Saint-Jacques), Halifax, N.-É.; Analyses avancées du cancer (Shack), Cancer Care Alberta, Calgary, Alb.; Département des sciences de la santé communautaire (Turner), Collège de médecine Max Rady, Université du Manitoba; Paul Albrechtsen Research Institute (Turner), CancerCare Manitoba, Winnipeg, Man.
| | - Jennifer Gillis
- Départements d'oncologie et de sciences de la santé communautaire (Brenner), Cumming School of Medicine, Université de Calgary, Calgary, Alb.; Surveillance, Société canadienne du cancer (Gillis), Vancouver, C.-B.; Centre de surveillance et de recherche appliquée (Demers), Agence de la santé publique du Canada; Centre des données sur la santé de la population (Ellison, Billette, Zhang, Liu), Statistique Canada, Ottawa, Ont.; Population Oncology, BC Cancer (Woods), Vancouver, C.-B.; Département de chirurgie (Finley), Université McMaster, St. Joseph's Health Care Centre, Hamilton, Ont.; Performance du système et analyses (Fitzgerald), Partenariat canadien contre le cancer, Toronto, Ont.; Programme de soins contre le cancer de Santé Nouvelle-Écosse (Saint-Jacques), Halifax, N.-É.; Analyses avancées du cancer (Shack), Cancer Care Alberta, Calgary, Alb.; Département des sciences de la santé communautaire (Turner), Collège de médecine Max Rady, Université du Manitoba; Paul Albrechtsen Research Institute (Turner), CancerCare Manitoba, Winnipeg, Man
| | - Alain A Demers
- Départements d'oncologie et de sciences de la santé communautaire (Brenner), Cumming School of Medicine, Université de Calgary, Calgary, Alb.; Surveillance, Société canadienne du cancer (Gillis), Vancouver, C.-B.; Centre de surveillance et de recherche appliquée (Demers), Agence de la santé publique du Canada; Centre des données sur la santé de la population (Ellison, Billette, Zhang, Liu), Statistique Canada, Ottawa, Ont.; Population Oncology, BC Cancer (Woods), Vancouver, C.-B.; Département de chirurgie (Finley), Université McMaster, St. Joseph's Health Care Centre, Hamilton, Ont.; Performance du système et analyses (Fitzgerald), Partenariat canadien contre le cancer, Toronto, Ont.; Programme de soins contre le cancer de Santé Nouvelle-Écosse (Saint-Jacques), Halifax, N.-É.; Analyses avancées du cancer (Shack), Cancer Care Alberta, Calgary, Alb.; Département des sciences de la santé communautaire (Turner), Collège de médecine Max Rady, Université du Manitoba; Paul Albrechtsen Research Institute (Turner), CancerCare Manitoba, Winnipeg, Man
| | - Larry F Ellison
- Départements d'oncologie et de sciences de la santé communautaire (Brenner), Cumming School of Medicine, Université de Calgary, Calgary, Alb.; Surveillance, Société canadienne du cancer (Gillis), Vancouver, C.-B.; Centre de surveillance et de recherche appliquée (Demers), Agence de la santé publique du Canada; Centre des données sur la santé de la population (Ellison, Billette, Zhang, Liu), Statistique Canada, Ottawa, Ont.; Population Oncology, BC Cancer (Woods), Vancouver, C.-B.; Département de chirurgie (Finley), Université McMaster, St. Joseph's Health Care Centre, Hamilton, Ont.; Performance du système et analyses (Fitzgerald), Partenariat canadien contre le cancer, Toronto, Ont.; Programme de soins contre le cancer de Santé Nouvelle-Écosse (Saint-Jacques), Halifax, N.-É.; Analyses avancées du cancer (Shack), Cancer Care Alberta, Calgary, Alb.; Département des sciences de la santé communautaire (Turner), Collège de médecine Max Rady, Université du Manitoba; Paul Albrechtsen Research Institute (Turner), CancerCare Manitoba, Winnipeg, Man
| | - Jean-Michel Billette
- Départements d'oncologie et de sciences de la santé communautaire (Brenner), Cumming School of Medicine, Université de Calgary, Calgary, Alb.; Surveillance, Société canadienne du cancer (Gillis), Vancouver, C.-B.; Centre de surveillance et de recherche appliquée (Demers), Agence de la santé publique du Canada; Centre des données sur la santé de la population (Ellison, Billette, Zhang, Liu), Statistique Canada, Ottawa, Ont.; Population Oncology, BC Cancer (Woods), Vancouver, C.-B.; Département de chirurgie (Finley), Université McMaster, St. Joseph's Health Care Centre, Hamilton, Ont.; Performance du système et analyses (Fitzgerald), Partenariat canadien contre le cancer, Toronto, Ont.; Programme de soins contre le cancer de Santé Nouvelle-Écosse (Saint-Jacques), Halifax, N.-É.; Analyses avancées du cancer (Shack), Cancer Care Alberta, Calgary, Alb.; Département des sciences de la santé communautaire (Turner), Collège de médecine Max Rady, Université du Manitoba; Paul Albrechtsen Research Institute (Turner), CancerCare Manitoba, Winnipeg, Man
| | - Shary Xinyu Zhang
- Départements d'oncologie et de sciences de la santé communautaire (Brenner), Cumming School of Medicine, Université de Calgary, Calgary, Alb.; Surveillance, Société canadienne du cancer (Gillis), Vancouver, C.-B.; Centre de surveillance et de recherche appliquée (Demers), Agence de la santé publique du Canada; Centre des données sur la santé de la population (Ellison, Billette, Zhang, Liu), Statistique Canada, Ottawa, Ont.; Population Oncology, BC Cancer (Woods), Vancouver, C.-B.; Département de chirurgie (Finley), Université McMaster, St. Joseph's Health Care Centre, Hamilton, Ont.; Performance du système et analyses (Fitzgerald), Partenariat canadien contre le cancer, Toronto, Ont.; Programme de soins contre le cancer de Santé Nouvelle-Écosse (Saint-Jacques), Halifax, N.-É.; Analyses avancées du cancer (Shack), Cancer Care Alberta, Calgary, Alb.; Département des sciences de la santé communautaire (Turner), Collège de médecine Max Rady, Université du Manitoba; Paul Albrechtsen Research Institute (Turner), CancerCare Manitoba, Winnipeg, Man
| | - JiaQi Leon Liu
- Départements d'oncologie et de sciences de la santé communautaire (Brenner), Cumming School of Medicine, Université de Calgary, Calgary, Alb.; Surveillance, Société canadienne du cancer (Gillis), Vancouver, C.-B.; Centre de surveillance et de recherche appliquée (Demers), Agence de la santé publique du Canada; Centre des données sur la santé de la population (Ellison, Billette, Zhang, Liu), Statistique Canada, Ottawa, Ont.; Population Oncology, BC Cancer (Woods), Vancouver, C.-B.; Département de chirurgie (Finley), Université McMaster, St. Joseph's Health Care Centre, Hamilton, Ont.; Performance du système et analyses (Fitzgerald), Partenariat canadien contre le cancer, Toronto, Ont.; Programme de soins contre le cancer de Santé Nouvelle-Écosse (Saint-Jacques), Halifax, N.-É.; Analyses avancées du cancer (Shack), Cancer Care Alberta, Calgary, Alb.; Département des sciences de la santé communautaire (Turner), Collège de médecine Max Rady, Université du Manitoba; Paul Albrechtsen Research Institute (Turner), CancerCare Manitoba, Winnipeg, Man
| | - Ryan R Woods
- Départements d'oncologie et de sciences de la santé communautaire (Brenner), Cumming School of Medicine, Université de Calgary, Calgary, Alb.; Surveillance, Société canadienne du cancer (Gillis), Vancouver, C.-B.; Centre de surveillance et de recherche appliquée (Demers), Agence de la santé publique du Canada; Centre des données sur la santé de la population (Ellison, Billette, Zhang, Liu), Statistique Canada, Ottawa, Ont.; Population Oncology, BC Cancer (Woods), Vancouver, C.-B.; Département de chirurgie (Finley), Université McMaster, St. Joseph's Health Care Centre, Hamilton, Ont.; Performance du système et analyses (Fitzgerald), Partenariat canadien contre le cancer, Toronto, Ont.; Programme de soins contre le cancer de Santé Nouvelle-Écosse (Saint-Jacques), Halifax, N.-É.; Analyses avancées du cancer (Shack), Cancer Care Alberta, Calgary, Alb.; Département des sciences de la santé communautaire (Turner), Collège de médecine Max Rady, Université du Manitoba; Paul Albrechtsen Research Institute (Turner), CancerCare Manitoba, Winnipeg, Man
| | - Christian Finley
- Départements d'oncologie et de sciences de la santé communautaire (Brenner), Cumming School of Medicine, Université de Calgary, Calgary, Alb.; Surveillance, Société canadienne du cancer (Gillis), Vancouver, C.-B.; Centre de surveillance et de recherche appliquée (Demers), Agence de la santé publique du Canada; Centre des données sur la santé de la population (Ellison, Billette, Zhang, Liu), Statistique Canada, Ottawa, Ont.; Population Oncology, BC Cancer (Woods), Vancouver, C.-B.; Département de chirurgie (Finley), Université McMaster, St. Joseph's Health Care Centre, Hamilton, Ont.; Performance du système et analyses (Fitzgerald), Partenariat canadien contre le cancer, Toronto, Ont.; Programme de soins contre le cancer de Santé Nouvelle-Écosse (Saint-Jacques), Halifax, N.-É.; Analyses avancées du cancer (Shack), Cancer Care Alberta, Calgary, Alb.; Département des sciences de la santé communautaire (Turner), Collège de médecine Max Rady, Université du Manitoba; Paul Albrechtsen Research Institute (Turner), CancerCare Manitoba, Winnipeg, Man
| | - Natalie Fitzgerald
- Départements d'oncologie et de sciences de la santé communautaire (Brenner), Cumming School of Medicine, Université de Calgary, Calgary, Alb.; Surveillance, Société canadienne du cancer (Gillis), Vancouver, C.-B.; Centre de surveillance et de recherche appliquée (Demers), Agence de la santé publique du Canada; Centre des données sur la santé de la population (Ellison, Billette, Zhang, Liu), Statistique Canada, Ottawa, Ont.; Population Oncology, BC Cancer (Woods), Vancouver, C.-B.; Département de chirurgie (Finley), Université McMaster, St. Joseph's Health Care Centre, Hamilton, Ont.; Performance du système et analyses (Fitzgerald), Partenariat canadien contre le cancer, Toronto, Ont.; Programme de soins contre le cancer de Santé Nouvelle-Écosse (Saint-Jacques), Halifax, N.-É.; Analyses avancées du cancer (Shack), Cancer Care Alberta, Calgary, Alb.; Département des sciences de la santé communautaire (Turner), Collège de médecine Max Rady, Université du Manitoba; Paul Albrechtsen Research Institute (Turner), CancerCare Manitoba, Winnipeg, Man
| | - Nathalie Saint-Jacques
- Départements d'oncologie et de sciences de la santé communautaire (Brenner), Cumming School of Medicine, Université de Calgary, Calgary, Alb.; Surveillance, Société canadienne du cancer (Gillis), Vancouver, C.-B.; Centre de surveillance et de recherche appliquée (Demers), Agence de la santé publique du Canada; Centre des données sur la santé de la population (Ellison, Billette, Zhang, Liu), Statistique Canada, Ottawa, Ont.; Population Oncology, BC Cancer (Woods), Vancouver, C.-B.; Département de chirurgie (Finley), Université McMaster, St. Joseph's Health Care Centre, Hamilton, Ont.; Performance du système et analyses (Fitzgerald), Partenariat canadien contre le cancer, Toronto, Ont.; Programme de soins contre le cancer de Santé Nouvelle-Écosse (Saint-Jacques), Halifax, N.-É.; Analyses avancées du cancer (Shack), Cancer Care Alberta, Calgary, Alb.; Département des sciences de la santé communautaire (Turner), Collège de médecine Max Rady, Université du Manitoba; Paul Albrechtsen Research Institute (Turner), CancerCare Manitoba, Winnipeg, Man
| | - Lorraine Shack
- Départements d'oncologie et de sciences de la santé communautaire (Brenner), Cumming School of Medicine, Université de Calgary, Calgary, Alb.; Surveillance, Société canadienne du cancer (Gillis), Vancouver, C.-B.; Centre de surveillance et de recherche appliquée (Demers), Agence de la santé publique du Canada; Centre des données sur la santé de la population (Ellison, Billette, Zhang, Liu), Statistique Canada, Ottawa, Ont.; Population Oncology, BC Cancer (Woods), Vancouver, C.-B.; Département de chirurgie (Finley), Université McMaster, St. Joseph's Health Care Centre, Hamilton, Ont.; Performance du système et analyses (Fitzgerald), Partenariat canadien contre le cancer, Toronto, Ont.; Programme de soins contre le cancer de Santé Nouvelle-Écosse (Saint-Jacques), Halifax, N.-É.; Analyses avancées du cancer (Shack), Cancer Care Alberta, Calgary, Alb.; Département des sciences de la santé communautaire (Turner), Collège de médecine Max Rady, Université du Manitoba; Paul Albrechtsen Research Institute (Turner), CancerCare Manitoba, Winnipeg, Man
| | - Donna Turner
- Départements d'oncologie et de sciences de la santé communautaire (Brenner), Cumming School of Medicine, Université de Calgary, Calgary, Alb.; Surveillance, Société canadienne du cancer (Gillis), Vancouver, C.-B.; Centre de surveillance et de recherche appliquée (Demers), Agence de la santé publique du Canada; Centre des données sur la santé de la population (Ellison, Billette, Zhang, Liu), Statistique Canada, Ottawa, Ont.; Population Oncology, BC Cancer (Woods), Vancouver, C.-B.; Département de chirurgie (Finley), Université McMaster, St. Joseph's Health Care Centre, Hamilton, Ont.; Performance du système et analyses (Fitzgerald), Partenariat canadien contre le cancer, Toronto, Ont.; Programme de soins contre le cancer de Santé Nouvelle-Écosse (Saint-Jacques), Halifax, N.-É.; Analyses avancées du cancer (Shack), Cancer Care Alberta, Calgary, Alb.; Département des sciences de la santé communautaire (Turner), Collège de médecine Max Rady, Université du Manitoba; Paul Albrechtsen Research Institute (Turner), CancerCare Manitoba, Winnipeg, Man
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Haouatti F, Belhadj IK, Goumidi A, Yafour N, Toumi H. The cost of multiple myeloma and its complications: A single-center study from Oran, Algeria. ANNALES PHARMACEUTIQUES FRANÇAISES 2024; 82:654-662. [PMID: 38340806 DOI: 10.1016/j.pharma.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 02/04/2024] [Accepted: 02/05/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND The expenses of multiple myeloma (MM) represent a real economic and societal burden for patients and health authorities. However, very little is known about the situation in Algeria. Therefore, the aim of this study is to evaluate the costs generated by the management of MM and its complications in Algerian patients. MATERIALS AND METHODS An observational retrospective study conducted on patients diagnosed with MM, from January 1st, 2019 to April 31st, 2023, at the Establishment Hospitalier Universitaire November 1st, Oran. A bottom-up costing methodology was used to assess the phase-specific cost and the complication burden. RESULTS In total, 249 qualified for the study. For autologous stem cell transplantation (ASCT) eligible patients, the mean per patient cost of treating myeloma was estimated at: induction regimen ($4072); ASCT ($2899); consolidation ($1538); and maintenance ($355.76). The mean drug cost for ASCT-ineligible patients was $1421. The use of generic bortezomib and generic melphalan has led to a reduction in expenses of $1,075,181 ($5,024 per patient; 55.35%) and $10,864 ($487 per patient; 15.07%), respectively. Another cost-saving adaptation was ASCT using non-cryopreserved (NC) stem cells. The cost of managing MM complications was $177,782 per year. CONCLUSION A number of adjustments have been implemented to the management of MM over time to improve clinical efficacy and reduce costs in Algeria. However, this may have come with a startlingly high cost of complications.
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Affiliation(s)
- Fairouz Haouatti
- Department of Pharmacovigilance, Establishment Hospitalier Universitaire 1st November, Oran, Algeria; Faculty of Medicine, Ahmed Benbella Oran 1 University, Oran, Algeria.
| | - Ikram K Belhadj
- Department of Hematology and Cell Therapy, Establishment Hospitalier Universitaire 1st November, Oran, Algeria; Faculty of Medicine, Ahmed Benbella Oran 1 University, Oran, Algeria
| | - Ahlem Goumidi
- Department of Hematology and Cell Therapy, Establishment Hospitalier Universitaire 1st November, Oran, Algeria; Faculty of Medicine, Ahmed Benbella Oran 1 University, Oran, Algeria
| | - Nabil Yafour
- Department of Hematology and Cell Therapy, Establishment Hospitalier Universitaire 1st November, Oran, Algeria; Faculty of Medicine, Ahmed Benbella Oran 1 University, Oran, Algeria
| | - Houari Toumi
- Department of Pharmacovigilance, Establishment Hospitalier Universitaire 1st November, Oran, Algeria; Faculty of Medicine, Ahmed Benbella Oran 1 University, Oran, Algeria
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Rawson NSB, Stewart DJ. Timeliness of Health Technology Assessments and Price Negotiations for Oncology Drugs in Canada. CLINICOECONOMICS AND OUTCOMES RESEARCH 2024; 16:437-445. [PMID: 38812711 PMCID: PMC11135564 DOI: 10.2147/ceor.s462872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 05/14/2024] [Indexed: 05/31/2024] Open
Abstract
Purpose To evaluate whether time targets for Canadian Agency for Drugs and Technologies in Health (CADTH) reimbursement reviews and pan-Canadian Pharmaceutical Alliance (pCPA) price negotiations are being achieved for oncology drugs. Materials and Methods Recommendations, dates of submission and publication, and indications for oncology medicines issued between January 2014 and December 2023 were recorded from CADTH's reimbursement reports webpage. The date any negotiation began and the date it was completed (successfully or not), or when a decision was made not to pursue negotiation was extracted from the pCPA's webpage. The duration of each CADTH review and pCPA negotiation was calculated, together with time between CADTH's recommendation and start of the pCPA negotiation or a decision not to negotiate. Percentages of reviews completed within CADTH's target and of times taken by the pCPA to decide whether to negotiate and by its price negotiations completed within the relevant targets were calculated. Results CADTH achieved its 270-days target in 88.2% to 100% of reviews issued between 2015 and 2019 but only in 65.9% to 73.1% of reviews issued in the last three years of the decade. CADTH's "typical timeline" of 180 days was achieved in under 40% of reviews issued in 2015 and not attained in any review in 2021, 2022 or 2023. The pCPA's target of 60 days for deciding whether to negotiate was achieved for all recommendations issued in 2014 but dropped below 40% for the last seven years of the decade; its target of 130 days for negotiations was achieved for over 85% of the recommendations in 2014 but decreased to only 14.3% in 2016 and then gradually increased to 61.5% in 2023. Conclusion CADTH's "typical timeline" and the pCPA's targets were not met sufficiently to be meaningful. Their processes take too long for cancer drugs.
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Affiliation(s)
- Nigel S B Rawson
- Macdonald-Laurier Institute, Ottawa, Ontario, Canada
- Canadian Health Policy Institute, Toronto, Ontario, Canada
- Centre for Health Policy Studies, Fraser Institute, Vancouver, British Columbia, Canada
| | - David J Stewart
- Department of Medicine, The University of Ottawa, Ottawa, Ontario, Canada
- Division of Medical Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada
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Wang C, Qiu X, Yang X, Mao J, Li Q. Factors Influencing Social Isolation among Cancer Patients: A Systematic Review. Healthcare (Basel) 2024; 12:1042. [PMID: 38786452 PMCID: PMC11120751 DOI: 10.3390/healthcare12101042] [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] [Received: 03/28/2024] [Revised: 04/29/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
(1) Background: Social isolation, which has numerous adverse effects on health status, is prevalent among cancer patients. This review proposes to identify the influencing factors of social isolation among cancer patients. (2) Methods: Articles published in English or Chinese from six electronic databases before December 2023 were identified via a systematic search. A manual search was also performed. (3) Results: Twenty-eight studies were identified in this systematic review. The factors associated with social isolation can be summarized into the following categories: demographic characteristics, having cancer, health status, coping, social support and social interaction. Despite the heterogeneity, 20 factors were significantly associated with social isolation, including age, gender, comorbidity burden, education level, residence, medical insurance, occupation status, personality, race, smoking status, having children, not living alone, household income level, marital status, the role of primary caregiver, physical health status, mental health status, social health status, coping styles, and the level of social support and social interaction. (4) Conclusions: The systematic review showed that cancer patients' social isolation was influenced by their demographic characteristics, cancer-related factors, physical condition, psychological status, social health status, coping styles, and level of social support and social interaction. In addition, future group intervention could be considered to improve social isolation.
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Affiliation(s)
| | | | | | | | - Qiuping Li
- Wuxi School of Medicine, Jiangnan University, Wuxi 214122, China; (C.W.); (X.Q.); (X.Y.); (J.M.)
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Brenner DR, Gillis J, Demers AA, Ellison LF, Billette JM, Zhang SX, Liu JL, Woods RR, Finley C, Fitzgerald N, Saint-Jacques N, Shack L, Turner D. Projected estimates of cancer in Canada in 2024. CMAJ 2024; 196:E615-E623. [PMID: 38740416 PMCID: PMC11090635 DOI: 10.1503/cmaj.240095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Cancer surveillance data are essential to help understand where gaps exist and progress is being made in cancer control. We sought to summarize the expected impact of cancer in Canada in 2024, with projections of new cancer cases and deaths from cancer by sex and province or territory for all ages combined. METHODS We obtained data on new cancer cases (i.e., incidence, 1984-2019) and deaths from cancer (i.e., mortality, 1984-2020) from the Canadian Cancer Registry and Canadian Vital Statistics Death Database, respectively. We projected cancer incidence and mortality counts and rates to 2024 for 23 types of cancer, overall, by sex, and by province or territory. We calculated age-standardized rates using data from the 2011 Canadian standard population. RESULTS In 2024, the number of new cancer cases and deaths from cancer are expected to reach 247 100 and 88 100, respectively. The age-standardized incidence rate (ASIR) and mortality rate (ASMR) are projected to decrease slightly from previous years for both males and females, with higher rates among males (ASIR 562.2 per 100 000 and ASMR 209.6 per 100 000 among males; ASIR 495.9 per 100 000 and ASMR 152.8 per 100 000 among females). The ASIRs and ASMRs of several common cancers are projected to continue to decrease (i.e., lung, colorectal, and prostate cancer), while those of several others are projected to increase (i.e., liver and intrahepatic bile duct cancer, kidney cancer, melanoma, and non-Hodgkin lymphoma). INTERPRETATION Although the overall incidence of cancer and associated mortality are declining, new cases and deaths in Canada are expected to increase in 2024, largely because of the growing and aging population. Efforts in prevention, screening, and treatment have reduced the impact of some cancers, but these short-term projections highlight the potential effect of cancer on people and health care systems in Canada.
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Affiliation(s)
- Darren R Brenner
- Departments of Oncology and Community Health Sciences (Brenner), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surveillance, Canadian Cancer Society (Gillis), Vancouver, BC; Centre for Surveillance and Applied Research (Demers), Public Health Agency of Canada; Centre for Population Health Data (Ellison, Billette, Zhang, Liu), Statistics Canada, Ottawa, Ont.; Population Oncology, BC Cancer (Woods), Vancouver, BC; Department of Surgery (Finley), McMaster University and St. Joseph's Health Care Centre, Hamilton, Ont.; System Performance & Analytics (Fitzgerald), Canadian Partnership Against Cancer, Toronto, Ont.; Nova Scotia Health Cancer Care Program (Saint-Jacques), Halifax, NS; Cancer Advanced Analytics (Shack), Cancer Care Alberta, Calgary, Alta; Department of Community Health Sciences (Turner), Max Rady College of Medicine, University of Manitoba; Paul Albrechtsen Research Institute (Turner), CancerCare Manitoba, Winnipeg, Man.
| | - Jennifer Gillis
- Departments of Oncology and Community Health Sciences (Brenner), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surveillance, Canadian Cancer Society (Gillis), Vancouver, BC; Centre for Surveillance and Applied Research (Demers), Public Health Agency of Canada; Centre for Population Health Data (Ellison, Billette, Zhang, Liu), Statistics Canada, Ottawa, Ont.; Population Oncology, BC Cancer (Woods), Vancouver, BC; Department of Surgery (Finley), McMaster University and St. Joseph's Health Care Centre, Hamilton, Ont.; System Performance & Analytics (Fitzgerald), Canadian Partnership Against Cancer, Toronto, Ont.; Nova Scotia Health Cancer Care Program (Saint-Jacques), Halifax, NS; Cancer Advanced Analytics (Shack), Cancer Care Alberta, Calgary, Alta; Department of Community Health Sciences (Turner), Max Rady College of Medicine, University of Manitoba; Paul Albrechtsen Research Institute (Turner), CancerCare Manitoba, Winnipeg, Man
| | - Alain A Demers
- Departments of Oncology and Community Health Sciences (Brenner), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surveillance, Canadian Cancer Society (Gillis), Vancouver, BC; Centre for Surveillance and Applied Research (Demers), Public Health Agency of Canada; Centre for Population Health Data (Ellison, Billette, Zhang, Liu), Statistics Canada, Ottawa, Ont.; Population Oncology, BC Cancer (Woods), Vancouver, BC; Department of Surgery (Finley), McMaster University and St. Joseph's Health Care Centre, Hamilton, Ont.; System Performance & Analytics (Fitzgerald), Canadian Partnership Against Cancer, Toronto, Ont.; Nova Scotia Health Cancer Care Program (Saint-Jacques), Halifax, NS; Cancer Advanced Analytics (Shack), Cancer Care Alberta, Calgary, Alta; Department of Community Health Sciences (Turner), Max Rady College of Medicine, University of Manitoba; Paul Albrechtsen Research Institute (Turner), CancerCare Manitoba, Winnipeg, Man
| | - Larry F Ellison
- Departments of Oncology and Community Health Sciences (Brenner), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surveillance, Canadian Cancer Society (Gillis), Vancouver, BC; Centre for Surveillance and Applied Research (Demers), Public Health Agency of Canada; Centre for Population Health Data (Ellison, Billette, Zhang, Liu), Statistics Canada, Ottawa, Ont.; Population Oncology, BC Cancer (Woods), Vancouver, BC; Department of Surgery (Finley), McMaster University and St. Joseph's Health Care Centre, Hamilton, Ont.; System Performance & Analytics (Fitzgerald), Canadian Partnership Against Cancer, Toronto, Ont.; Nova Scotia Health Cancer Care Program (Saint-Jacques), Halifax, NS; Cancer Advanced Analytics (Shack), Cancer Care Alberta, Calgary, Alta; Department of Community Health Sciences (Turner), Max Rady College of Medicine, University of Manitoba; Paul Albrechtsen Research Institute (Turner), CancerCare Manitoba, Winnipeg, Man
| | - Jean-Michel Billette
- Departments of Oncology and Community Health Sciences (Brenner), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surveillance, Canadian Cancer Society (Gillis), Vancouver, BC; Centre for Surveillance and Applied Research (Demers), Public Health Agency of Canada; Centre for Population Health Data (Ellison, Billette, Zhang, Liu), Statistics Canada, Ottawa, Ont.; Population Oncology, BC Cancer (Woods), Vancouver, BC; Department of Surgery (Finley), McMaster University and St. Joseph's Health Care Centre, Hamilton, Ont.; System Performance & Analytics (Fitzgerald), Canadian Partnership Against Cancer, Toronto, Ont.; Nova Scotia Health Cancer Care Program (Saint-Jacques), Halifax, NS; Cancer Advanced Analytics (Shack), Cancer Care Alberta, Calgary, Alta; Department of Community Health Sciences (Turner), Max Rady College of Medicine, University of Manitoba; Paul Albrechtsen Research Institute (Turner), CancerCare Manitoba, Winnipeg, Man
| | - Shary Xinyu Zhang
- Departments of Oncology and Community Health Sciences (Brenner), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surveillance, Canadian Cancer Society (Gillis), Vancouver, BC; Centre for Surveillance and Applied Research (Demers), Public Health Agency of Canada; Centre for Population Health Data (Ellison, Billette, Zhang, Liu), Statistics Canada, Ottawa, Ont.; Population Oncology, BC Cancer (Woods), Vancouver, BC; Department of Surgery (Finley), McMaster University and St. Joseph's Health Care Centre, Hamilton, Ont.; System Performance & Analytics (Fitzgerald), Canadian Partnership Against Cancer, Toronto, Ont.; Nova Scotia Health Cancer Care Program (Saint-Jacques), Halifax, NS; Cancer Advanced Analytics (Shack), Cancer Care Alberta, Calgary, Alta; Department of Community Health Sciences (Turner), Max Rady College of Medicine, University of Manitoba; Paul Albrechtsen Research Institute (Turner), CancerCare Manitoba, Winnipeg, Man
| | - JiaQi Leon Liu
- Departments of Oncology and Community Health Sciences (Brenner), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surveillance, Canadian Cancer Society (Gillis), Vancouver, BC; Centre for Surveillance and Applied Research (Demers), Public Health Agency of Canada; Centre for Population Health Data (Ellison, Billette, Zhang, Liu), Statistics Canada, Ottawa, Ont.; Population Oncology, BC Cancer (Woods), Vancouver, BC; Department of Surgery (Finley), McMaster University and St. Joseph's Health Care Centre, Hamilton, Ont.; System Performance & Analytics (Fitzgerald), Canadian Partnership Against Cancer, Toronto, Ont.; Nova Scotia Health Cancer Care Program (Saint-Jacques), Halifax, NS; Cancer Advanced Analytics (Shack), Cancer Care Alberta, Calgary, Alta; Department of Community Health Sciences (Turner), Max Rady College of Medicine, University of Manitoba; Paul Albrechtsen Research Institute (Turner), CancerCare Manitoba, Winnipeg, Man
| | - Ryan R Woods
- Departments of Oncology and Community Health Sciences (Brenner), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surveillance, Canadian Cancer Society (Gillis), Vancouver, BC; Centre for Surveillance and Applied Research (Demers), Public Health Agency of Canada; Centre for Population Health Data (Ellison, Billette, Zhang, Liu), Statistics Canada, Ottawa, Ont.; Population Oncology, BC Cancer (Woods), Vancouver, BC; Department of Surgery (Finley), McMaster University and St. Joseph's Health Care Centre, Hamilton, Ont.; System Performance & Analytics (Fitzgerald), Canadian Partnership Against Cancer, Toronto, Ont.; Nova Scotia Health Cancer Care Program (Saint-Jacques), Halifax, NS; Cancer Advanced Analytics (Shack), Cancer Care Alberta, Calgary, Alta; Department of Community Health Sciences (Turner), Max Rady College of Medicine, University of Manitoba; Paul Albrechtsen Research Institute (Turner), CancerCare Manitoba, Winnipeg, Man
| | - Christian Finley
- Departments of Oncology and Community Health Sciences (Brenner), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surveillance, Canadian Cancer Society (Gillis), Vancouver, BC; Centre for Surveillance and Applied Research (Demers), Public Health Agency of Canada; Centre for Population Health Data (Ellison, Billette, Zhang, Liu), Statistics Canada, Ottawa, Ont.; Population Oncology, BC Cancer (Woods), Vancouver, BC; Department of Surgery (Finley), McMaster University and St. Joseph's Health Care Centre, Hamilton, Ont.; System Performance & Analytics (Fitzgerald), Canadian Partnership Against Cancer, Toronto, Ont.; Nova Scotia Health Cancer Care Program (Saint-Jacques), Halifax, NS; Cancer Advanced Analytics (Shack), Cancer Care Alberta, Calgary, Alta; Department of Community Health Sciences (Turner), Max Rady College of Medicine, University of Manitoba; Paul Albrechtsen Research Institute (Turner), CancerCare Manitoba, Winnipeg, Man
| | - Natalie Fitzgerald
- Departments of Oncology and Community Health Sciences (Brenner), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surveillance, Canadian Cancer Society (Gillis), Vancouver, BC; Centre for Surveillance and Applied Research (Demers), Public Health Agency of Canada; Centre for Population Health Data (Ellison, Billette, Zhang, Liu), Statistics Canada, Ottawa, Ont.; Population Oncology, BC Cancer (Woods), Vancouver, BC; Department of Surgery (Finley), McMaster University and St. Joseph's Health Care Centre, Hamilton, Ont.; System Performance & Analytics (Fitzgerald), Canadian Partnership Against Cancer, Toronto, Ont.; Nova Scotia Health Cancer Care Program (Saint-Jacques), Halifax, NS; Cancer Advanced Analytics (Shack), Cancer Care Alberta, Calgary, Alta; Department of Community Health Sciences (Turner), Max Rady College of Medicine, University of Manitoba; Paul Albrechtsen Research Institute (Turner), CancerCare Manitoba, Winnipeg, Man
| | - Nathalie Saint-Jacques
- Departments of Oncology and Community Health Sciences (Brenner), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surveillance, Canadian Cancer Society (Gillis), Vancouver, BC; Centre for Surveillance and Applied Research (Demers), Public Health Agency of Canada; Centre for Population Health Data (Ellison, Billette, Zhang, Liu), Statistics Canada, Ottawa, Ont.; Population Oncology, BC Cancer (Woods), Vancouver, BC; Department of Surgery (Finley), McMaster University and St. Joseph's Health Care Centre, Hamilton, Ont.; System Performance & Analytics (Fitzgerald), Canadian Partnership Against Cancer, Toronto, Ont.; Nova Scotia Health Cancer Care Program (Saint-Jacques), Halifax, NS; Cancer Advanced Analytics (Shack), Cancer Care Alberta, Calgary, Alta; Department of Community Health Sciences (Turner), Max Rady College of Medicine, University of Manitoba; Paul Albrechtsen Research Institute (Turner), CancerCare Manitoba, Winnipeg, Man
| | - Lorraine Shack
- Departments of Oncology and Community Health Sciences (Brenner), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surveillance, Canadian Cancer Society (Gillis), Vancouver, BC; Centre for Surveillance and Applied Research (Demers), Public Health Agency of Canada; Centre for Population Health Data (Ellison, Billette, Zhang, Liu), Statistics Canada, Ottawa, Ont.; Population Oncology, BC Cancer (Woods), Vancouver, BC; Department of Surgery (Finley), McMaster University and St. Joseph's Health Care Centre, Hamilton, Ont.; System Performance & Analytics (Fitzgerald), Canadian Partnership Against Cancer, Toronto, Ont.; Nova Scotia Health Cancer Care Program (Saint-Jacques), Halifax, NS; Cancer Advanced Analytics (Shack), Cancer Care Alberta, Calgary, Alta; Department of Community Health Sciences (Turner), Max Rady College of Medicine, University of Manitoba; Paul Albrechtsen Research Institute (Turner), CancerCare Manitoba, Winnipeg, Man
| | - Donna Turner
- Departments of Oncology and Community Health Sciences (Brenner), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Surveillance, Canadian Cancer Society (Gillis), Vancouver, BC; Centre for Surveillance and Applied Research (Demers), Public Health Agency of Canada; Centre for Population Health Data (Ellison, Billette, Zhang, Liu), Statistics Canada, Ottawa, Ont.; Population Oncology, BC Cancer (Woods), Vancouver, BC; Department of Surgery (Finley), McMaster University and St. Joseph's Health Care Centre, Hamilton, Ont.; System Performance & Analytics (Fitzgerald), Canadian Partnership Against Cancer, Toronto, Ont.; Nova Scotia Health Cancer Care Program (Saint-Jacques), Halifax, NS; Cancer Advanced Analytics (Shack), Cancer Care Alberta, Calgary, Alta; Department of Community Health Sciences (Turner), Max Rady College of Medicine, University of Manitoba; Paul Albrechtsen Research Institute (Turner), CancerCare Manitoba, Winnipeg, Man
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6
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Longo CJ, Maity T, Fitch MI, Young JT. Patient and Family Financial Burden in Cancer: A Focus on Differences across Four Provinces, and Reduced Spending Including Decisions to Forego Care in Canada. Curr Oncol 2024; 31:2713-2726. [PMID: 38785487 PMCID: PMC11119025 DOI: 10.3390/curroncol31050206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 04/30/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
GOAL This study aimed to examine provincial differences in patient spending for cancer care and reductions in household spending including decisions to forego care in Canada. METHODS Nine-hundred and one patients with cancer, from twenty cancer centers across Canada, completed a self-administered questionnaire (P-SAFE version 7.2.4) (344 breast, 183 colorectal, 158 lung, and 216 prostate) measuring direct and indirect costs and spending changes. RESULTS Provincial variations showed a high mean out-of-pocket cost (OOPC) of CAD 938 (Alberta) and a low of CAD 280 (Manitoba). Differences were influenced by age and income. Income loss was highest for Alberta (CAD 2399) and lowest for Manitoba (CAD 1126). Travel costs were highest for Alberta (CAD 294) and lowest for British Columbia (CAD 67). Parking costs were highest for Ontario (CAD 103) and lowest for Manitoba (CAD 53). A total of 41% of patients reported reducing spending, but this increased to 52% for families earning CONCLUSIONS Levels of financial burden for patients with cancer in Canada vary provincially, including for OOPC, travel and parking costs, and lost income. Decisions to forego cancer care are highest in relation to vitamins/supplements, CAM, and drugs. Provincial differences suggest that regional health policies and demographics may impact patients' overall financial burden.
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Affiliation(s)
- Christopher J. Longo
- DeGroote School of Business—Health Policy & Management, McMaster University, Hamilton, ON L8S 4L8, Canada;
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada;
| | - Tuhin Maity
- DeGroote School of Business—Health Policy & Management, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Margaret I. Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5S 1A1, Canada;
| | - Jesse T. Young
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada;
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON M5T 1R8, Canada
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3052, Australia
- Centre for Adolescent Health, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- School of Population and Global Health, The University of Western Australia, Crawley, WA 6009, Australia
- Curtin School of Population Health, Curtin University, Bentley, WA 6102, Australia
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7
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Golemiec B, Robertson M, Poon V, Foley M, Parker CM, McGann C, O'Callaghan N, Digby GC. Improving Access to Care, Patient Costs, and Environmental Impact Through a Community Outreach Lung Cancer Rapid Assessment Clinic. JCO Oncol Pract 2024:OP2300657. [PMID: 38696740 DOI: 10.1200/op.23.00657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/26/2024] [Accepted: 03/26/2024] [Indexed: 05/04/2024] Open
Abstract
PURPOSE In Southeastern Ontario, increased patient distance from the regional lung cancer diagnostic assessment program (LDAP) is associated with a lower likelihood of patient care via LDAP while receiving care via LDAP is associated with improved survival. We implemented an LDAP outreach clinic to provide specialist assessment for patients with suspected lung cancer at a regional community hospital and assessed the impact on timeliness and accessibility of care. MATERIALS AND METHODS The Kingston Health Sciences Centre LDAP team engaged with community hospital partners to develop and launch the LDAP outreach clinic. We performed a retrospective chart review of LDAP patients (N = 1,070) before (August-November 2021; n = 234) and after implementation of the outreach clinic (November 2021-October 2022; n = 836). Descriptive data are reported as No. (%). Unpaired t tests and statistical process control charts assess for significance. A cost analysis of out-of-pocket patient costs related to travel and parking is presented in 2022 Canadian dollars (CAD). RESULTS Compared with a 3-month matched time period before (August-October 2021) and after outreach clinic (August-October 2022), the mean time from referral to assessment and time from referral to diagnosis decreased from 20.3 to 14.4 days (P = .0019) and 40.0 to 28.9 days (P = .0007), respectively. Over 12 months, the total patient travel was reduced by 8,856 km, which combined with parking cost-savings, resulted in patient out-of-pocket savings of CAD $5,755.60 (CAD $47.60/patient). Accounting for physician travel, the total travel saved was 5,688 km, corresponding to reduced CO2 emissions by 1.9 tCO2. CONCLUSION Implementation of a lung cancer outreach clinic led to improved timeliness of care, patient cost-savings, and reduced carbon footprint while serving patients in their community.
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Affiliation(s)
- Breanne Golemiec
- Department of Medicine, Queen's University, Kingston, ON, Canada
- Division of Respirology, Queen's University, Kingston, ON, Canada
| | - Madison Robertson
- Kingston Health Sciences Center, Queen's University, Kingston, ON, Canada
| | - Vincent Poon
- Department of Medicine, Division of Medical Oncology, University of British Columbia, Vancouver, BC, Canada
| | - Mary Foley
- Kingston Health Sciences Center, Queen's University, Kingston, ON, Canada
| | - Christopher M Parker
- Department of Medicine, Queen's University, Kingston, ON, Canada
- Division of Respirology, Queen's University, Kingston, ON, Canada
| | - Craig McGann
- Division of Respirology, Queen's University, Kingston, ON, Canada
| | - Nicole O'Callaghan
- Cancer Center of Southeastern Ontario, Queen's University, Kingston, ON, Canada
| | - Geneviève C Digby
- Department of Medicine, Queen's University, Kingston, ON, Canada
- Division of Respirology, Queen's University, Kingston, ON, Canada
- Department of Oncology, Queen's University, Kingston, ON, Canada
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8
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Balijepalli C, Gullapalli L, Joshy J, Rawson NSB. The impact of willingness-to-pay threshold on price reduction recommendations for oncology drugs: a review of assessments conducted by the Canadian Agency for Drugs and Technologies in Health. J Comp Eff Res 2024; 13:e230178. [PMID: 38567953 PMCID: PMC11037021 DOI: 10.57264/cer-2023-0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/15/2024] [Indexed: 04/23/2024] Open
Abstract
Since late 2020, the Canadian Agency of Drugs and Technologies in Health (CADTH) has been using a threshold of $50,000 (CAD) per quality-adjusted life-year (QALY) for both oncology and non-oncology drugs. When used for oncology products, this threshold is hypothesized to have a higher impact on the time to access these drugs in Canada. We studied the impact of price reductions on time to engagement and negotiation with the pan-Canadian Pharmaceutical Alliance for oncology drugs reviewed by CADTH between January 2020 and December 2022. Overall, 103 assessments reported data on price reductions recommended by CADTH to meet the cost-effectiveness threshold for reimbursement. Of these assessments, 57% (59/103) recommendations included a price reduction of greater than 70% off the list price. Eight percent (8/103) were not cost-effective even at a 100% price reduction. Of the 47 assessments that had a clear benefit, in 21 (45%) CADTH recommended a price reduction of at least 70%. The median time to price negotiation (not including time to engagement) for assessments that received at least 70% vs >70% price reduction was 2.6 vs 4.8 months. This study showed that there is a divergence between drug sponsor's incremental cost-effectiveness ratio (ICER) and CADTH revised ICER leading to a price reduction to meet the $50,000/QALY threshold. For the submissions with clear clinical benefit the median length of engagement (2.5 vs 3.3 months) and median length of negotiation (3.1 vs 3.6 months) were slightly shorter compared with the submissions where uncertainties were noted in the clinical benefit according to CADTH. This study shows that using a $50,000 per QALY threshold for oncology products potentially impacts timely access to life saving medications.
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Affiliation(s)
| | | | - Juhi Joshy
- Pharmalytics Group, Vancouver, BC V6B 2Z4, Canada
| | - Nigel SB Rawson
- Canadian Health Policy Institute, Toronto, ON, Canada
- Macdonald-Laurier Institute, Ottawa, ON, Canada
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9
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MiriMoghaddam M, Bohlouli B, Lai H, Viegas S, Amin M. Trends and predictors of unplanned hospitalization among oral and oropharyngeal cancer patients; an 8-year population-based study. Oral Oncol 2024; 151:106742. [PMID: 38460285 DOI: 10.1016/j.oraloncology.2024.106742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 03/02/2024] [Accepted: 03/04/2024] [Indexed: 03/11/2024]
Abstract
PURPOSE The incidence of oral cancers, particularly HPV-related oropharyngeal cancer, is steadily increasing worldwide, presenting a significant healthcare challenge. This study investigates trends and predictors of unplanned hospitalizations for oral cavity cancer (OCC) and oropharyngeal cancer (OPC) patients in the province of Alberta, Canada. METHODS This retrospective, population-based, cohort study used administrative data collected from all hospitals in the province. Using the Alberta Cancer Registry (ACR), a cohort of adult patients diagnosed with a single primary OCC or OPC between January 2010 and December 2017 was identified. Linking this cohort with the Discharge Abstract Database (DAD), trends in hospitalizations, primary diagnoses, and predictors of unplanned hospitalization (UH) and 30-day unplanned readmission were analyzed. RESULTS Of 1,721 patients included, 1,244 experienced 2,228 hospitalizations, with 48 % being categorized as UH. The UHs were significantly associated with a higher mortality rate, 18.5 % as compared to 4.6 % for planned, and influenced by sex, age groups, comorbidities, cancer types, stages, and treatment modalities. The rate of UH per patient decreased from 0.69 to 0.54 visits during the study period (P = 0.02). Common diagnoses for UH were palliative care and post-surgical convalescence, while surgery-related complications such as infection and hemorrhage were frequent in 30-day unplanned readmissions. Predictors of UH included cancer stage, material deprivation, and treatment, while cancer type and comorbidity predicted readmissions. CONCLUSION The rate of UHs showed a noteworthy decline in this study, which could be a result of enhanced care coordination. Furthermore, identified primary diagnosis and predictors associated with UHs and readmissions, provide valuable insights for enhancing the quality of care for cancer patients.
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Affiliation(s)
- Masoud MiriMoghaddam
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Canada
| | - Babak Bohlouli
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Canada
| | - Hollis Lai
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Canada
| | - Shefali Viegas
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Canada
| | - Maryam Amin
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Canada.
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10
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Snow S, Brezden-Masley C, Carter MD, Dhani N, Macaulay C, Ramjeesingh R, Raphael MJ, Slovinec D’Angelo M, Servidio-Italiano F. Barriers and Unequal Access to Timely Molecular Testing Results: Addressing the Inequities in Cancer Care Delays across Canada. Curr Oncol 2024; 31:1359-1375. [PMID: 38534936 PMCID: PMC10969404 DOI: 10.3390/curroncol31030103] [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: 01/30/2024] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 05/26/2024] Open
Abstract
Genomic medicine is a powerful tool to improve diagnosis and outcomes for cancer patients by facilitating the delivery of the right drug at the right dose at the right time for the right patient. In 2023, a Canadian conference brought together leaders with expertise in different tumor types. The objective was to identify challenges and opportunities for change in terms of equitable and timely access to biomarker testing and reporting at the education, delivery, laboratory, patient, and health-system levels in Canada. Challenges identified included: limited patient and clinician awareness of genomic medicine options with need for formal education strategies; failure by clinicians to discuss genomic medicine with patients; delays in or no access to hereditary testing; lack of timely reporting of results; intra- and inter-provincial disparities in access; lack of funding for patients to access testing and for laboratories to provide testing; lack of standardized testing; and impact of social determinants of health. Canada must standardize its approach to biomarker testing across the country, with a view to addressing current inequities, and prioritize access to advanced molecular testing to ensure systems are in place to quickly bring innovation and evidence-based treatments to Canadian cancer patients, regardless of their place of residence or socioeconomic status.
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Affiliation(s)
- Stephanie Snow
- Division of Medical Oncology, QEII Health Sciences Centre, Halifax, NS B3H 2Y9, Canada
| | | | - Michael D. Carter
- Division of Anatomical Pathology, QEII Health Sciences Centre, Halifax, NS B3H 2Y9, Canada
| | - Neesha Dhani
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Cassandra Macaulay
- Colorectal Cancer Resource & Action Network (CCRAN), Toronto, ON M4W 3E2, Canada
| | - Ravi Ramjeesingh
- Division of Medical Oncology, QEII Health Sciences Centre, Halifax, NS B3H 2Y9, Canada
| | - Michael J. Raphael
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
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11
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Azzani M, Atroosh WM, Anbazhagan D, Kumarasamy V, Abdalla MMI. Describing financial toxicity among cancer patients in different income countries: a systematic review and meta-analysis. Front Public Health 2024; 11:1266533. [PMID: 38229668 PMCID: PMC10789858 DOI: 10.3389/fpubh.2023.1266533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/17/2023] [Indexed: 01/18/2024] Open
Abstract
Background There is limited evidence of financial toxicity (FT) among cancer patients from countries of various income levels. Hence, this study aimed to determine the prevalence of objective and subjective FT and their measurements in relation to cancer treatment. Methods PubMed, Science Direct, Scopus, and CINAHL databases were searched to find studies that examined FT. There was no limit on the design or setting of the study. Random-effects meta-analysis was utilized to obtain the pooled prevalence of objective FT. Results Out of 244 identified studies during the initial screening, only 64 studies were included in this review. The catastrophic health expenditure (CHE) method was often used in the included studies to determine the objective FT. The pooled prevalence of CHE was 47% (95% CI: 24.0-70.0) in middle- and high-income countries, and the highest percentage was noted in low-income countries (74.4%). A total of 30 studies focused on subjective FT, of which 9 used the Comprehensive Score for FT (COST) tool and reported median scores ranging between 17.0 and 31.9. Conclusion This study shows that cancer patients from various income-group countries experienced a significant financial burden during their treatment. It is imperative to conduct further studies on interventions and policies that can lower FT caused by cancer treatment.
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Affiliation(s)
- Meram Azzani
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
- Centre of Occupational Safety, Health and Wellbeing, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia
| | - Wahib Mohammed Atroosh
- Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Department of Microbiology and Parasitology, Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen
| | - Deepa Anbazhagan
- Department of Microbiology, International Medical School (IMS), Management & Science University (MSU), Shah Alam, Selangor, Malaysia
| | - Vinoth Kumarasamy
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur, Malaysia
| | - Mona Mohamed Ibrahim Abdalla
- Physiology Department, Human Biology Division, School of Medicine, International Medical University (IMU), Kuala Lumpur, Malaysia
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12
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Nicoll I, Lockwood G, Fitch MI. Perspectives of Cancer Survivors with Low Income: A Content Analysis Exploring Concerns, Positive Experiences, and Suggestions for Improvement in Survivorship Care. Curr Oncol 2023; 30:8134-8148. [PMID: 37754505 PMCID: PMC10528685 DOI: 10.3390/curroncol30090590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/29/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023] Open
Abstract
The number of cancer survivors in Canada has reached 1.5 million and is expected to grow. It is important to understand cancer survivors' perspectives about the challenges they face after treatment is completed. Many factors create barriers to accessing assistance, and limited income may be a significant one. This study is a secondary analysis of data from a publicly available databank (Cancer Survivor Transitions Study) regarding the experiences of Canadian cancer survivors. The goal was to explore major challenges, positive experiences, and suggestions for improvement in survivorship care for low-income Canadian cancer survivors one to three years following treatment. A total of 1708 survey respondents indicated a low annual household income (<$25,000 CD). A content analysis was performed utilizing written comments to open-ended questions. The major challenges respondents described focused on physical capacity limits and treatment side effects; positive experiences emphasized support and attentive care; and suggestions for improvements highlighted the need for better support, information about self-care and side effect management, and timely follow-up care. The relationships between household income and the management of survivors' physical, emotional, and practical concerns require consideration. The design of follow-up care plans, programs, services, and financial assessments of patients may prepare survivors for predictable issues and costs in their transition to survivorship.
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Affiliation(s)
- Irene Nicoll
- Health Care Consultant, Toronto, ON M4C 4V9, Canada;
| | - Gina Lockwood
- Biostatistician Consultant, Toronto, ON M4C 4V9, Canada;
| | - Margaret I. Fitch
- Faculty of Nursing, University of Toronto, 207 Chisholm Ave., Toronto, ON M4C 4V9, Canada
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13
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Kuenzig ME, Im JHB, Coward S, Windsor JW, Kaplan GG, Murthy SK, Benchimol EI, Bernstein CN, Bitton A, Jones JL, Lee K, Peña-Sánchez JN, Rohatinsky N, Ghandeharian S, Jones May T, Tabatabavakili S, Jogendran R, Weinstein J, Khan R, Hazan E, Browne M, Davis T, Goddard Q, Gorospe J, Latos K, Mason K, Kerr J, Balche N, Sklar A, Targownik LE. The 2023 Impact of Inflammatory Bowel Disease in Canada: Indirect (Individual and Societal) and Direct Out-of-Pocket Costs. J Can Assoc Gastroenterol 2023; 6:S16-S22. [PMID: 37674495 PMCID: PMC10478804 DOI: 10.1093/jcag/gwad009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
People living with inflammatory bowel disease (IBD) and their caregivers are faced with indirect and out-of-pocket costs that they would not otherwise experience. These costs impact one's ability to contribute to the economy to their fullest potential. The indirect costs of IBD in Canada are estimated to be at least $1.51 billion in 2023 and include costs associated with lost productivity resulting from a combination of missed work (absenteeism), decreased workplace productivity (presenteeism), unemployment, premature mortality, and caregiving costs. Unemployment is the largest contributor to indirect costs ($1.14 billion), followed by costs of absenteeism and presenteeism ($285 million). Caregiving costs for children with IBD are estimated to be nearly $58 million. Canadians with IBD also pay $536 million every year for care that is not covered by universal or supplemental private health insurance; this includes allied healthcare (e.g., care provided by psychologists), medication, and other supportive therapy. Combined, the indirect and out-of-pocket costs of IBD in Canada are estimated at more than $2 billion CAD in 2023. This is substantially higher than the estimate of $1.29 billion in Crohn's and Colitis Canada's 2018 Impact of IBD report with differences attributable to a combination of rising prevalence, inflation, and the addition of presenteeism and caregiving costs to the total indirect costs.
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Affiliation(s)
- M Ellen Kuenzig
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - James H B Im
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stephanie Coward
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Joseph W Windsor
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Gilaad G Kaplan
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sanjay K Murthy
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada
| | - Eric I Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada
| | - Alain Bitton
- Division of Gastroenterology and Hepatology, McGill University Health Centre IBD Centre, McGill University, Montréal, Quebec, Canada
| | - Jennifer L Jones
- Departments of Medicine, Clinical Health, and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kate Lee
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | - Juan-Nicolás Peña-Sánchez
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Noelle Rohatinsky
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Tyrel Jones May
- Division of Gastroenterology and Hepatology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Rohit Jogendran
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jake Weinstein
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rabia Khan
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Elias Hazan
- Department of Internal Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mira Browne
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tal Davis
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Quinn Goddard
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Julia Gorospe
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kate Latos
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | - Kate Mason
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | - Jack Kerr
- Department of Medicine, Memorial University of Newfoundland, St John’s Newfoundland, Canada
| | - Naji Balche
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | - Anna Sklar
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | - Laura E Targownik
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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14
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Jones JM, Howell D, Longo C, Olson K, Bedard P, Amir E, Zheng S, Chow B, Avery L. The association of cancer-related fatigue on the social, vocational and healthcare-related dimensions of cancer survivorship. J Cancer Surviv 2023:10.1007/s11764-023-01451-9. [PMID: 37644355 DOI: 10.1007/s11764-023-01451-9] [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: 06/15/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Cancer-related fatigue (CRF) is well documented in cancer survivors, but little is known about the personal and societal impact of CRF. This study aimed to examine the impact of CRF in relation to social and vocational functioning and health care utilization in a large sample of post-treatment cancer survivors. METHODS We conducted a cross-sectional descriptive study of early stage breast and colorectal cancer survivors (n = 454) who were within 5 years from treatment completion. Social difficulties (SDI-21), work status, absenteeism and presenteeism (WHO-HPQ) and healthcare utilization (HSUQ) were compared in those with (CFR +) and without (CRF -) clinically significant fatigue (FACT-F ≤ 34). RESULTS A total of 32% met the cut-off criteria for CRF (≤ 34). Participants with CRF + had significantly higher scores on the SDI-21 across all domains and 55% of CRF + vs. 11% in CRF - was above the SDI cut-off (> 10) for significant social difficulties. Participants with CRF + were 2.74 times more likely to be unemployed or on leave (95% CI 1.62, 4.61, p < 0.001). In the subgroup of participants who were currently working (n = 249), those with CRF + reported working on average 27.4 fewer hours in the previous 4 weeks compared to CRF - (p = 0.05), and absolute presenteeism was on average 13% lower in the CRF + group (95% CI 8.0, 18.2, p < 0.001). Finally, individuals with CRF + reported significantly more physician (p < 0.001), other health care professional (p = 0.03) and psychosocial visits (p = 0.002) in the past month. CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS CRF is associated with substantial disruption in social and work role functioning in the early transitional phase of cancer survivorship. Better management of persistent CRF and funding for the implementation of existing guidelines and recommended evidence-based interventions are urgently needed.
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Affiliation(s)
- Jennifer M Jones
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre and Department of Psychiatry, University of Toronto, 200 Elizabeth Street, B-PMB-045, Toronto, ON, M5G 2C4, Canada.
| | - Doris Howell
- Department of Supportive Care, Princess Margaret Cancer Centre and Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Christopher Longo
- Health Policy and Management, DeGroote School of Business, McMaster University, Hamilton, Canada
| | - Karin Olson
- Faculty of Nursing, University of Alberta, and Edmonton Clinic Health Academy, Edmonton, Canada
| | - Philippe Bedard
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre and Department of Medicine, University of Toronto, Toronto, Canada
| | - Eitan Amir
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre and Department of Medicine, University of Toronto, Toronto, Canada
| | - Shiyu Zheng
- MD Program, University of Toronto, Toronto, Canada
| | - Brittany Chow
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Lisa Avery
- Department of Biostatistics, Princess Margaret Cancer Centre, and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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15
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Wilkinson AN, Seely JM, Rushton M, Williams P, Cordeiro E, Allard-Coutu A, Look Hong NJ, Moideen N, Robinson J, Renaud J, Mainprize JG, Yaffe MJ. Capturing the True Cost of Breast Cancer Treatment: Molecular Subtype and Stage-Specific per-Case Activity-Based Costing. Curr Oncol 2023; 30:7860-7873. [PMID: 37754486 PMCID: PMC10527628 DOI: 10.3390/curroncol30090571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Breast cancer (BC) treatment is rapidly evolving with new and costly therapeutics. Existing costing models have a limited ability to capture current treatment costs. We used an Activity-Based Costing (ABC) method to determine a per-case cost for BC treatment by stage and molecular subtype. METHODS ABC was used to proportionally integrate multidisciplinary evidence-based patient and provider treatment options for BC, yielding a per-case cost for the total duration of treatment by stage and molecular subtype. Diagnostic imaging, pathology, surgery, radiation therapy, systemic therapy, inpatient, emergency, home care and palliative care costs were included. RESULTS BC treatment costs were higher than noted in previous studies and varied widely by molecular subtype. Cost increased exponentially with the stage of disease. The per-case cost for treatment (2023C$) for DCIS was C$ 14,505, and the mean costs for all subtypes were C$ 39,263, C$ 76,446, C$ 97,668 and C$ 370,398 for stage I, II, III and IV BC, respectively. Stage IV costs were as high as C$ 516,415 per case. When weighted by the proportion of molecular subtype in the population, case costs were C$ 31,749, C$ 66,758, C$ 111,368 and C$ 289,598 for stage I, II, III and IV BC, respectively. The magnitude of cost differential was up to 10.9 times for stage IV compared to stage I, 4.4 times for stage III compared to stage I and 35.6 times for stage IV compared to DCIS. CONCLUSION The cost of BC treatment is rapidly escalating with novel therapies and increasing survival, resulting in an exponential increase in treatment costs for later-stage disease. We provide real-time, case-based costing for BC treatment which will allow for the assessment of health system economic impacts and an accurate understanding of the cost-effectiveness of screening.
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Affiliation(s)
- Anna N. Wilkinson
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Jean M. Seely
- Department of Radiology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON K1H 8L6, Canada;
| | - Moira Rushton
- The Ottawa Hospital Cancer Centre, 501 Smyth Rd., Ottawa, ON K1H 8L6, Canada; (M.R.); (N.M.); (J.R.); (J.R.)
| | - Phillip Williams
- Division of Anatomic Pathology, The Ottawa Hospital, 501 Smyth Rd., Ottawa, ON K1H 8L6, Canada;
| | - Erin Cordeiro
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (E.C.); (A.A.-C.)
| | - Alexandra Allard-Coutu
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (E.C.); (A.A.-C.)
| | | | - Nikitha Moideen
- The Ottawa Hospital Cancer Centre, 501 Smyth Rd., Ottawa, ON K1H 8L6, Canada; (M.R.); (N.M.); (J.R.); (J.R.)
| | - Jessica Robinson
- The Ottawa Hospital Cancer Centre, 501 Smyth Rd., Ottawa, ON K1H 8L6, Canada; (M.R.); (N.M.); (J.R.); (J.R.)
| | - Julie Renaud
- The Ottawa Hospital Cancer Centre, 501 Smyth Rd., Ottawa, ON K1H 8L6, Canada; (M.R.); (N.M.); (J.R.); (J.R.)
| | - James G. Mainprize
- Department of Medical Biophysics, University of Toronto, Toronto, ON M4N 3M5, Canada; (J.G.M.); (M.J.Y.)
| | - Martin J. Yaffe
- Department of Medical Biophysics, University of Toronto, Toronto, ON M4N 3M5, Canada; (J.G.M.); (M.J.Y.)
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16
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Saint-Jacques N, Brown PE, Purcell J, Rainham DG, Terashima M, Dummer TJB. The Nova Scotia Community Cancer Matrix: A geospatial tool to support cancer prevention. Soc Sci Med 2023; 330:116038. [PMID: 37390806 DOI: 10.1016/j.socscimed.2023.116038] [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: 02/06/2023] [Revised: 05/26/2023] [Accepted: 06/16/2023] [Indexed: 07/02/2023]
Abstract
Globally, cancer is a leading cause of death and morbidity and its burden is increasing worldwide. It is established that medical approaches alone will not solve this cancer crisis. Moreover, while cancer treatment can be effective, it is costly and access to treatment and health care is vastly inequitable. However, almost 50% of cancers are caused by potentially avoidable risk factors and are thus preventable. Cancer prevention represents the most cost-effective, feasible and sustainable pathway towards global cancer control. While much is known about cancer risk factors, prevention programs often lack consideration of how place impacts cancer risk over time. Maximizing cancer prevention investment requires an understanding of the geographic context for why some people develop cancer while others do not. Data on how community and individual level risk factors interact is therefore required. The Nova Scotia Community Cancer Matrix (NS-Matrix) study was established in Nova Scotia (NS), a small province in Eastern Canada with a population of 1 million. The study integrates small-area profiles of cancer incidence with cancer risk factors and socioeconomic conditions, to inform locally relevant and equitable cancer prevention strategies. The NS-Matrix Study includes over 99,000 incident cancers diagnosed in NS between 2001 and 2017, georeferenced to small-area communities. In this analysis we used Bayesian inference to identify communities with high and low risk for lung and bladder cancer: two highly preventable cancers with rates in NS exceeding the Canadian average, and for which key risk factors are high. We report significant spatial heterogeneity in lung and bladder cancer risk. The identification of spatial disparities relating to a community's socioeconomic profile and other spatially varying factors, such as environmental exposures, can inform prevention. Adopting Bayesian spatial analysis methods and utilizing high quality cancer registry data provides a model to support geographically-focused cancer prevention efforts, tailored to local community needs.
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Affiliation(s)
- Nathalie Saint-Jacques
- NSH Cancer Care Program, Bethune Building, 1276 South Park St, Halifax, NS, Canada; Healthy Populations Institute, Dalhousie University, 1318 Robie St., Halifax, NS, Canada.
| | - Patrick E Brown
- Department of Statistical Science, University of Toronto, Sidney Smith Hall, 100 St. George Street, Toronto, ON, Canada.
| | - Judy Purcell
- NSH Cancer Care Program, Bethune Building, 1276 South Park St, Halifax, NS, Canada.
| | - Daniel G Rainham
- School of Health and Human Performance, Dalhousie University, 5981 University Avenue, Halifax, NS, Canada; Healthy Populations Institute, Dalhousie University, 1318 Robie St., Halifax, NS, Canada.
| | - Mikiko Terashima
- School of Planning, Dalhousie University, O'Brien Hall, 5217 Morris St., Halifax, NS, Canada.
| | - Trevor J B Dummer
- School of Population and Public Health, University of British Columbia, 226 East Mall, Vancouver, BC, Canada.
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17
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Biddell CB, Waters AR, Angove RSM, Gallagher KD, Rosenstein DL, Spees LP, Kent EE, Planey AM, Wheeler SB. Facing financial barriers to healthcare: patient-informed adaptation of a conceptual framework for adults with a history of cancer. Front Psychol 2023; 14:1178517. [PMID: 37255517 PMCID: PMC10225523 DOI: 10.3389/fpsyg.2023.1178517] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/27/2023] [Indexed: 06/01/2023] Open
Abstract
Background Cancer-related financial hardship is associated with negative clinical outcomes, which may be partially explained by cost-related delayed or forgone care in response to financial barriers. We sought to understand patient experiences facing financial barriers to medical care following a cancer diagnosis. Methods We conducted virtual, semi-structured interviews in Fall 2022 with 20 adults with a history of cancer who had experienced cancer-related financial hardship in the prior year. We used template analysis within a pragmatic paradigm, combining constructivist and critical realist theoretical perspectives, to analyze interview transcripts and adapt an existing conceptual framework of financial barriers to care. Results The majority of interviewees identified as women (70%), non-Hispanic white (60%), and reported an annual household income of <$48,000 (60%). As interviewees sought to overcome financial barriers, they described substantial frustration at the limitations and complexities of United States health and social care systems, resulting in a reliance on a fragmented, uncertain resource landscape. The administrative burden resulting from bureaucratic systems and the advocacy responsibilities required to navigate them ultimately fell on interviewees and their caregivers. Thus, participants described their ability to overcome financial barriers as being influenced by individual and interpersonal factors, such as social support, comfort asking for help, time, prior experience navigating resources, and physical and mental health. However, participants noted health system organizational factors, such as whether all new patients proactively met with a social worker or financial navigator, as having the potential to lessen the administrative and financial burden experienced. Conclusion We present an adapted conceptual framework outlining multi-level factors influencing patient experiences coping with financial barriers to medical care. In addition to influencing whether a patient ultimately delays or forgoes care due to cost, financial barriers also have the potential to independently affect patient mental, physical, and financial health.
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Affiliation(s)
- Caitlin B. Biddell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Austin R. Waters
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Rebekah S. M. Angove
- Patient Insight Institute, Patient Advocate Foundation, Hampton, VA, United States
| | | | - Donald L. Rosenstein
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Departments of Psychiatry and Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Lisa P. Spees
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Erin E. Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Arrianna Marie Planey
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Stephanie B. Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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18
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Larsen K, Rydz E, Peters CE. Inequalities in Environmental Cancer Risk and Carcinogen Exposures: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095718. [PMID: 37174236 PMCID: PMC10178444 DOI: 10.3390/ijerph20095718] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/11/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023]
Abstract
Background: Cancer is the leading cause of death in Canada and a major cause of death worldwide. Environmental exposure to carcinogens and environments that may relate to health behaviors are important to examine as they can be modified to lower cancer risks. Built environments include aspects such as transit infrastructure, greenspace, food and tobacco environments, or land use, which may impact how people move, exercise, eat, and live. While environments may play a role in overall cancer risk, exposure to carcinogens or healthier environments is not equitably spread across space. Exposures to carcinogens commonly concentrate among socially and/or economically disadvantaged populations. While many studies have examined inequalities in exposure or cancer risk, this has commonly been for one exposure. Methods: This scoping review collected and synthesized research that examines inequities in carcinogenic environments and exposures. Results: This scoping review found that neighborhoods with higher proportions of low-income residents, racialized people, or same-sex couples had higher exposures to carcinogens and environments that may influence cancer risk. There are currently four main themes in research studying inequitable exposures: air pollution and hazardous substances, tobacco access, food access, and other aspects of the built environment, with most research still focusing on air pollution. Conclusions: More work is needed to understand how exposures to these four areas intersect with other factors to reduce inequities in exposures to support longer-term goals toward cancer prevention.
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Affiliation(s)
- Kristian Larsen
- Health Canada, Office of Environmental Health, Healthy Environments and Consumer Safety Branch, Environmental and Radiation Health Science Directorate, Ottawa, ON K1A 0K9, Canada
- CAREX Canada, School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Department of Geography and Planning, University of Toronto, Toronto, ON M5S 3G3, Canada
- Department of Geography and Environmental Studies, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada
| | - Ela Rydz
- CAREX Canada, School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Cheryl E Peters
- CAREX Canada, School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Prevention, Screening and Hereditary Cancer, BC Cancer, Vancouver, BC V5Z 4E6, Canada
- Population and Public Health, British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada
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19
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Variations in Emergency Service Utilization among Cancer Survivors: Results from the Pan-Canadian Experiences of Cancer Patients in Transition Study Survey. JOURNAL OF ONCOLOGY 2023; 2023:5056408. [PMID: 36968642 PMCID: PMC10036192 DOI: 10.1155/2023/5056408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/04/2023] [Accepted: 03/07/2023] [Indexed: 03/18/2023]
Abstract
Purpose. The objective of this study was to examine variations in emergency service utilization (ESU) among cancer survivors during the first year after completing primary cancer treatment. Methods. In 2016, the Canadian Partnership Against Cancer collected survey responses from cancer survivors across Canada about self-reported ESU after completing primary cancer treatment. We included survey respondents diagnosed with nonmetastatic breast, hematologic, colorectal, melanoma, or prostate cancer. Multivariable, multinomial logistic regression analysis was used to examine factors associated with cancer survivors’ ESU. Results. Of the 5,774 cancer survivors included in our analysis, 22% reported ESU during the first year after completing their primary cancer treatment, 16% reported ESU one to three times, and 6% reported ESU more than three times. Factors significantly associated with frequent ESU included younger age, colorectal and hematologic cancers, more frequent primary care provider and oncology specialist visits, single or retired status, lower income, and self-reported lower quality of life. Conclusion. Our study identified factors associated with more frequent ESU among cancer survivors in the first year after completing primary cancer treatment. These factors highlight differences in cancer survivors’ demographics, their ability to access and need for healthcare services, and the complexity of using ESU as a metric for quality improvement in survivorship care. These variations must be considered in quality improvement initiatives.
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20
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Longo CJ. Societal Perspectives and Real-World Cost-Effectiveness: Expanding the Scope of Health Economics Inquiry. Curr Oncol 2022; 30:233-235. [PMID: 36661667 PMCID: PMC9857326 DOI: 10.3390/curroncol30010018] [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: 11/25/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
Economic evaluations of health technologies for cancer are frequently seen in the literature, but not all economic perspectives have the same frequency [...].
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Affiliation(s)
- Christopher J. Longo
- Health Policy and Management, DeGroote School of Business, McMaster University, Burlington, ON L7L 5R8, Canada;
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON L8S 4L8, Canada
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