Journal of Cancer Policy最新文献

{"title":"Post-surgical acute care utilization and cost of care among cancer survivors with an ostomy: Findings from three large hospital systems in the United States","authors":"Daniel Maeng ,&nbsp;Rebecca L. Hoffman ,&nbsp;Virginia Sun ,&nbsp;Robert P. Sticca ,&nbsp;Robert S. Krouse","doi":"10.1016/j.jcpo.2024.100534","DOIUrl":"10.1016/j.jcpo.2024.100534","url":null,"abstract":"<div><h3>Purpose</h3><div>To describe patterns of 6-month total cost of care and acute care utilization among cancer survivors who received ostomy surgeries in 3 large hospital systems in the United States between 2018 and 2022 and to identify reasons for acute care utilization.</div></div><div><h3>Methods</h3><div>A retrospective cohort study using electronic medical records and the corresponding hospital revenue data obtained from 3 geographically diverse hospital systems in the United States was performed. 6-month all-cause post-surgical encounters subsequent to respective ostomy surgery dates were included. Clinical reasons for acute care utilization were captured and examined via available diagnosis codes.</div></div><div><h3>Results</h3><div>Mean six-month total cost of care per patient varied greatly by hospital and by payer type, ranging between $18,000 and $80,000. Inpatient care was the largest driver of these cost, accounting for 70 % of the total cost of care. In the sample, 56 % of the patients experienced one or more post-surgical inpatient admissions over a six-month period. Moreover, 26 % of the acute care events were associated with primary or secondary diagnosis codes potentially attributable to post-surgical ostomy-related complications, accounting for approximately 18 % of the total cost. Patients who received urostomy and/or had metastatic cancer had higher rates of acute care utilization, although statistical significances were not achieved.</div></div><div><h3>Conclusion</h3><div>The results are indicative of significant financial burdens as well as morbidities associated with post-surgical ostomy care that are common across hospital systems. Some of these cost burdens are potentially avoidable with improved ostomy follow-up care.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"43 ","pages":"Article 100534"},"PeriodicalIF":2.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trend of sales revenue by year for top selling cancer drugs in the US and the effect of loss of market exclusivity","authors":"Myung Sun Kim ,&nbsp;Alyson Haslam ,&nbsp;Vinay Prasad","doi":"10.1016/j.jcpo.2024.100533","DOIUrl":"10.1016/j.jcpo.2024.100533","url":null,"abstract":"<div><div>Biosimilars and generics have led to reduced cancer drug prices. The effect of biosimilar or generic drug competition on drug manufacturer revenue has not been previously described. In this study, the majority of top selling cancer drugs had a greater than 50 % decline in sales revenue within 2 years of generic or biosimilar market entry, reflecting both the decline in market share and reduction in unit drug price. This results in important drug manufacturer incentives, which may shape clinical trial agendas. The market structure incentives are unique for pharmaceutical companies due to the relatively short and limited duration of profitability. Policy changes such as patent reform leading to shorter duration of exclusivity may lead to greater incentive to expand low value indications in oncology.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"43 ","pages":"Article 100533"},"PeriodicalIF":2.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking public health in wartime: Smoking and long-term health outcomes amidst the war in Ukraine","authors":"Paweł Koczkodaj,&nbsp;Irmina Maria Michalek","doi":"10.1016/j.jcpo.2024.100532","DOIUrl":"10.1016/j.jcpo.2024.100532","url":null,"abstract":"","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"43 ","pages":"Article 100532"},"PeriodicalIF":2.0,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of conflict on cancer care in Libya","authors":"Abeir El-Mogassabi ,&nbsp;Ibtisam Gheith Kaziri","doi":"10.1016/j.jcpo.2024.100528","DOIUrl":"10.1016/j.jcpo.2024.100528","url":null,"abstract":"<div><h3>Background</h3><div>The ongoing Libyan Civil Conflict, initiated in 2011, has had a devastating impact on the country's healthcare system, particularly cancer care. This review delves into the challenges faced by cancer patients and healthcare providers in Libya.</div></div><div><h3>Methods</h3><div>A comprehensive literature review was conducted to identify relevant studies, reports, and news articles relating to cancer care in Libya. The review focused on the impact of the conflict on cancer prevention, diagnosis, treatment, and palliative care.</div></div><div><h3>Results</h3><div>The conflict has significantly disrupted cancer care in Libya. Key challenges include limited access to care due to infrastructure damage and security concerns. Shortages of essential medications and medical equipment have hindered cancer treatment. Inadequate healthcare infrastructure, resulting from damage and destruction, limits the availability of diagnostic and treatment services. The shortage of skilled healthcare professionals exacerbates the situation. Additionally, the absence of reliable data on cancer incidence and mortality hinders effective planning and resource allocation.</div></div><div><h3>Policy summary</h3><div>To improve cancer care in Libya, urgent action is needed to address the challenges posed by the conflict. This includes increasing investment in healthcare infrastructure, providing adequate funding for cancer control programmes, and strengthening the capacity of healthcare workers. Additionally, international cooperation and support are essential to help Libya rebuild its healthcare system and provide quality cancer care to its citizens.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"43 ","pages":"Article 100528"},"PeriodicalIF":2.0,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Financial conflicts among physician speakers at the April 12, 2024 Oncology Drug Advisory Meeting: Who decided that MRD can be a novel regulatory endpoint in myeloma?","authors":"Noah J. Carr ,&nbsp;Alyson Haslam ,&nbsp;Vinay Prasad","doi":"10.1016/j.jcpo.2024.100529","DOIUrl":"10.1016/j.jcpo.2024.100529","url":null,"abstract":"<div><h3>Background</h3><div>In April 2024, the Oncology Drug Advisory Committee (ODAC) voted to approve minimal residual disease (MRD) as a new regulatory endpoint for multiple myeloma (MM) despite its poor trial-level surrogacy. This is expected to result in faster MM drug approvals, a potential boon for the pharmaceutical companies that make them. This study investigates the prevalence of financial conflicts of interest (FCOIs) with these companies among United States (US)-based physician speakers at the meeting.</div></div><div><h3>Methods</h3><div>Public data regarding the past 3 years of pharmaceutical company payments to US-based physician speakers at the ODAC meeting discussing MRD (available at <span><span>https://openpaymentsdata.cms.gov/</span><svg><path></path></svg></span>) were collected. For each general payment (GP), we recorded the amount, company payor, reason for payment, and associated products. Descriptive analyses were performed on payments from companies who manufacture MM therapeutics (MM payments).</div></div><div><h3>Results</h3><div>12 of the 20 physician speakers (60 %) eligible to have FCOIs recorded on the OpenPayments database received MM payments from 2021 to 2023, totaling more than $792,200. A majority of both voting and non-voting members had MM payments (median $11,800 and $764), most of which were consulting fees. Speakers earned more than 3.7 times as much from GPs associated with MM-related products compared to those associated with non-MM-related products.</div></div><div><h3>Conclusion</h3><div>Most US-based physician speakers at the April 2024 ODAC meeting had FCOIs from MM companies, including those with voting power.</div></div><div><h3>Policy summary</h3><div>Our findings highlight the need for greater policing of FCOIs among US-based physicians involved in cancer drug regulatory policy.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"43 ","pages":"Article 100529"},"PeriodicalIF":2.0,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards promoting a legal framework for ending discrimination against cancer survivors. A human rights-centered approach","authors":"Françoise Meunier ,&nbsp;Grazia Scocca ,&nbsp;Françoise Tulkens","doi":"10.1016/j.jcpo.2024.100527","DOIUrl":"10.1016/j.jcpo.2024.100527","url":null,"abstract":"<div><div>The article explores the development of the right to be forgotten (RTBF) for cancer survivors, with a focus on preventing discrimination based on their medical history. It discusses legal progress in European Union (EU) countries, including national laws and EU initiatives such as Europe’s Beating Cancer Plan and the Consumer Credits Directive, which aim to protect survivors from financial and social obstacles. These measures are designed to standardize protection across member states and ensure that cancer survivors are not unfairly treated due to their past illness. The article advocates for continued progress in fully reintegrating cancer survivors into society, which involves eliminating the stigma associated with their medical history, and promoting justice, equality, and respect for their human dignity.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"43 ","pages":"Article 100527"},"PeriodicalIF":2.0,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic inequalities in kidney and renal pelvis cancer mortality in Canada: Trends over three decades","authors":"Mohammad Hajizadeh ,&nbsp;Nazanin Nasiri ,&nbsp;Grace Johnston","doi":"10.1016/j.jcpo.2024.100524","DOIUrl":"10.1016/j.jcpo.2024.100524","url":null,"abstract":"<div><h3>Background</h3><div>Kidney and renal pelvis cancer (KCa) presents significant health challenges that require investigation. This study measured and examined trends in socioeconomic inequalities in the mortality of KCa in Canada over the period 1990–2019.</div></div><div><h3>Methods</h3><div>We constructed a census division level dataset pooled from the Canadian Vital Death Statistics Database (CVSD), the Canadian Census of the Population (CCP), and the National Household Survey (NHS) to measure income and education inequalities in the mortality rate of KCa in Canada over the study period. The age-standardized Concentration index (C), which measures inequality across all socioeconomic groups, was used to quantify income and education inequalities in the mortality of KCa in Canada. Trend analyses evaluated changes in these inequalities over time.</div></div><div><h3>Results</h3><div>The average crude KCa mortality rates were found to be 5.97 and 3.40 per 100,000 for the male and female populations, respectively. The crude KCa mortality consistently increased over time in eastern but not western Canada. Statistically negative values of the age-standardized C index showed higher KCa mortality in the lower-income and less-educated population, particularly among females, with no changes observed over the 30-year study period.</div></div><div><h3>Conclusion</h3><div>The higher KCa mortality in socioeconomically disadvantaged groups in Canada indicates the continuing need for primary prevention through lowering smoking rates, reducing obesity, and controlling hypertension. Additionally, promoting greater use of abdominal imaging for the incidental early KCa detection can enable more effective treatment and improved survival rates, especially for females of lower socioeconomic status.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"43 ","pages":"Article 100524"},"PeriodicalIF":2.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The burden of metastatic breast cancer on caregiver productivity and quality of life: A survey study in the United States, United Kingdom, and Germany","authors":"Erin Comerford ,&nbsp;Sukyung Chung ,&nbsp;Marlon Graf ,&nbsp;Natalie Land ,&nbsp;Anh-Thy Nguyen ,&nbsp;Medha Sasane ,&nbsp;Ying Zheng ,&nbsp;Suepattra G. May","doi":"10.1016/j.jcpo.2024.100526","DOIUrl":"10.1016/j.jcpo.2024.100526","url":null,"abstract":"<div><h3>Background</h3><div>Caring for a patient with metastatic breast cancer (mBC) can impose a substantial burden and can lead to significant productivity losses. However, the extent to which productivity loss impacts caregiver well-being has not been well-elucidated. This study examined the relationship between productivity and other characteristics with quality of life (QoL) to illuminate the multifaceted challenges faced by caregivers in the context of mBC.</div></div><div><h3>Methods</h3><div>We conducted a one-time, cross-sectional survey of 345 informal caregivers of people living with mBC in the United States, United Kingdom, and Germany in December 2021. Caregivers were asked about their QoL using the Caregiver Quality of Life Index-Cancer (CQOLC) and pre-/post-caregiving productivity impacts. Heterogeneity in reported burden was assessed across a variety of caregiver characteristics.</div></div><div><h3>Results</h3><div>One in three caregivers changed work status after onset of caregiving, either reducing working hours (12 %), stopping work altogether (13 %), or increasing working hours (8 %). Caregivers who reduced hours or stopped working reported better QoL overall with total CQOLC scores of 71.8 and 65.3, compared to those who maintained or increased work hours (CQOLC scores of 61.3 and 54.4, respectively, [p &lt; 0.001]). While there were no differences in caregiver QoL by patients’ disease status (p = 0.48), longer time spent caregiving was associated with lower burden (p = 0.002).</div></div><div><h3>Conclusions</h3><div>Caregiver productivity and QoL scores indicate leaving the workforce may ease the challenges associated with caregiving, suggesting a need for workplace flexibility to better support caregivers. Our study emphasizes the importance of supporting caregivers alongside patients, acknowledging caregiver well-being can significantly influence patient outcomes.</div></div><div><h3>Policy Summary</h3><div>Although the burden associated with cancer caregiving has been well-documented, policies supporting caregivers, such as flexible employment leave and mental health support resources, are urgently needed to improve QoL and health outcomes for both patients and their informal caregivers.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"43 ","pages":"Article 100526"},"PeriodicalIF":2.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of medicaid expansion on screenable versus non-screenable gastrointestinal cancers","authors":"Omid Salehi ,&nbsp;Kanishka Uttam Chandani ,&nbsp;Cara J. Sammartino ,&nbsp;Ponnandai Somasundar ,&nbsp;N.Joseph Espat ,&nbsp;Abdul Saied Calvino ,&nbsp;Steve Kwon","doi":"10.1016/j.jcpo.2024.100525","DOIUrl":"10.1016/j.jcpo.2024.100525","url":null,"abstract":"<div><h3>Background</h3><div>Medicaid expansion afforded increased healthcare access to low-income Americans contributing to a positive impact on cancer outcomes. However, it is unclear if these benefits were mainly due to enhanced access to cancer screening and earlier diagnosis versus access to cancer treatment</div></div><div><h3>Methods</h3><div>The National Cancer Database (NCDB) was queried between 2010 and 2021 for Medicaid and uninsured patients with GI malignancies. Patients were stratified by screenable (SGI) and non-screenable (NGI) cancers and expansion state (ES) categories: early (EES) and late (LES) adopters, and non-expansion state (NES) cohorts. Statistical analyses, including difference-in-difference (DiD) and adjusted models, assessed the impact of Medicaid expansion on stage at diagnosis.</div></div><div><h3>Results</h3><div>There were 230,159 pre-expansion and 539,028 post-expansion patients. There was an increase in Medicaid coverage (14.8 % vs. 11.1 %) and a concomitant decline in the uninsured population (5.3 % vs. 8.2 %) in the post-expansion era. For SGI cancers, Medicaid expansion was associated with significantly lower mean stage at diagnosis (DiD Coef. −0.12; p &lt; 0.01). For NGI cancers, Medicaid expansion was associated with a lower mean stage at diagnosis but with much smaller coefficient (DiD Coef. −0.015; p &lt; 0.01). Comparing EES and LES to NES, EES had more impact on lower mean stage at diagnosis (vs NES DiD Coef. −0.16; p &lt; 0.01) compared to LES (vs NES DiD Coef. −0.02; p = 0.04) for SGI cancers. For NGI cancers, there was a modest reduction in mean stage at diagnosis only for EES (vs NES DiD Coef. −0.04; p &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>Medicaid expansion, particularly for SGI cancers and early adopters, had a profound impact in lowering the mean stage at diagnosis. This emphasizes that long-term advantages of providing access to preventive care and screening, and thus earlier treatment, may be one of the main mechanisms of Medicaid expansion on improving cancer outcomes for GI malignancies.</div></div><div><h3>Policy summary</h3><div>To establish the benefits of Medicaid expansion under the Affordable Care Act 2010 for gastrointestinal cancer patients particularly in screening.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"43 ","pages":"Article 100525"},"PeriodicalIF":2.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilisation patterns of radiotherapy among older patients: Insights from Portuguese National Cancer Registry data","authors":"Edna Darlene Rodrigues ,&nbsp;Maria José Bento ,&nbsp;Rita Calisto ,&nbsp;Jéssica Rodrigues ,&nbsp;Paulo Almeida ,&nbsp;Escarlata López ,&nbsp;Laetitia Teixeira","doi":"10.1016/j.jcpo.2024.100522","DOIUrl":"10.1016/j.jcpo.2024.100522","url":null,"abstract":"<div><h3>Introduction</h3><div>Radiation therapy (RT) will be required by millions of those aged 70 or older by 2040 based on European growth in cancer incidence among this age group.</div></div><div><h3>Purpose</h3><div>This study evaluates the use of external radiotherapy (EBRT) using data from the Portuguese National Cancer Registry (RON), analysing various cancer locations and age groups. A comparative analysis was conducted between actual EBRT utilization and comorbidity-adjusted optimal rates.</div></div><div><h3>Methods</h3><div>Based on RON’s data, cancer diagnoses from January to June 2018 were analysed. Optimal Utilization Proportions (OUP) of EBRT were obtained from European SocieTy for Radiotherapy and Oncology (ESTRO), Health Economics in Radiation Oncology (HERO) project. Actual utilization percentages (AUP) were calculated using national cancer registry data, and a comparative analysis adjusting for comorbidities was conducted.</div></div><div><h3>Results</h3><div>For most cancer locations and age groups, the actual EBRT utilisation fell below the ESTRO-HERO recommendations, with potential untreated patients estimated at 22 % of all new cancer cases across all age groups. Disparities were observed for older patients, such as breast cancer EBRT actual utilisation declining from 68 % to 25 % for patients aged under 70 and 85 or older, respectively. Also, cervix cancer patients aged 75 or older exhibited nearly 100 % optimal EBRT utilisation. Conversely, older patients with bladder and colon cancer had significantly lower RT actual utilisation rates. Comorbidity-adjusted EBRT utilisation rates for lung, rectal, cervix, and breast cancers in patients aged 70–79 did not reached ESTRO-HERO task force recommended rates. The actual EBRT usage in Portugal failed to meet the comorbidity-adjusted optimal utilisation rate for all cancer locations and age groups. Nevertheless, Portuguese actual EBRT for rectal and prostate cancer, exceeded the actual rates in Australian cohort.</div></div><div><h3>Conclusion</h3><div>While EBRT is essential for older adults with cancer, disparities and suboptimal utilization highlight opportunities for improving cancer care provision.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"43 ","pages":"Article 100522"},"PeriodicalIF":2.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}