Cancer-related Healthcare Research Articles

Palliative care and catastrophic costs in Malawi after a diagnosis of advanced cancer: a prospective cohort study

SummaryBackgroundInclusive universal health coverage requires access to quality health care without financial barriers. Receipt of palliative care after advanced cancer diagnosis might reduce household poverty, but evidence from low-income and middle-income settings is sparse.MethodsIn this prospective study, the primary objective was to investigate total household costs of cancer-related health care after a diagnosis of advanced cancer, with and without the receipt of palliative care. Households comprising patients and their unpaid family caregiver were recruited into a cohort study at Queen Elizabeth Central Hospital in Malawi, between Jan 16 and July 31, 2019. Costs of cancer-related health-care use (including palliative care) and health-related quality-of-life were recorded over 6 months. Regression analysis explored associations between receipt of palliative care and total household costs on health care as a proportion of household income. Catastrophic costs, defined as 20% or more of total household income, sale of assets and loans taken out (dissaving), and their association with palliative care were computed.FindingsWe recruited 150 households. At 6 months, data from 89 (59%) of 150 households were available, comprising 89 patients (median age 50 years, 79% female) and 64 caregivers (median age 40 years, 73% female). Patients in 55 (37%) of the 150 households died and six (4%) were lost to follow-up. 19 (21%) of 89 households received palliative care. Catastrophic costs were experienced by nine (47%) of 19 households who received palliative care versus 48 (69%) of 70 households who did not (relative risk 0·69, 95% CI 0·42 to 1·14, p=0·109). Palliative care was associated with substantially reduced dissaving (median US$11, IQR 0 to 30 vs $34, 14 to 75; p=0·005). The mean difference in total household costs on cancer-related health care with receipt of palliative care was −36% (95% CI −94 to 594; p=0·707).InterpretationVulnerable households in low-income countries are subject to catastrophic health-related costs following a diagnosis of advanced cancer. Palliative care might result in reduced dissaving in these households. Further consideration of the economic benefits of palliative care is justified.FundingWellcome Trust; National Institute for Health Research; and EMMS International.

Real-world treatment patterns and outcomes in platinum-sensitive recurrent high-grade serous ovarian cancer patients.

Aim: To describe the overall cancer-related healthcare utilization patterns, treatment patterns and outcomes in women diagnosed with platinum-sensitive recurrent high-grade serous ovarian cancer. Patients & methods: Subanalysis of the Spanish sample of a retrospective, noninterventional, multinational, observational study. Results:BRCA-mutated patients had better outcomes in terms of progression-free survival and overall survival than patients who were BRCA wild-type. It was observed that patients' treatment outcomes after the first recurrence progressively worsened as the patient underwent subsequent chemotherapy lines. Healthcare resource utilization when accounting for the follow-up time did not substantially differ between BRCA1/2-mutated and BRCA wild-type patients. Conclusion:BRCA1/2 mutation carriers have better treatment outcomes, including longer survival, without a negative impact on the use of healthcare resources.

Healthcare utilization and cost of cancer-related care prior to allogeneic hematopoietic cell transplantation for hematologic malignancies in the US: a retrospective real-world analysis

BackgroundHematopoietic cell transplantation (HCT) is a potentially curative therapy as well as a costly procedure. Published studies have examined the cost of HCT in the US and the complications that follow but little is known about the cancer-related healthcare costs and resource utilization prior to the procedure and none of the studies have examined the variability in cost based on the type of hematologic malignancy involved. The aim of this study was to estimate mean cancer-related costs and resources incurred before the HCT is performed from the time the hematologic malignancy first develops.MethodsThe IBM® MarketScan® Research Databases were used to identify adult patients ≥18 years of age with commercial or Medicare supplemental insurance who had undergone allogeneic HCT for hematologic malignancies from January 1, 2008 to December 31, 2017. Healthcare utilization and costs were assessed during the 6 months prior to diagnosis (pre-diagnostic period) and the follow-up period from diagnosis just prior to the HCT (pre-HCT period). Multivariable regression models were constructed to estimate total all-cause costs and cancer-related costs as well as healthcare utilization by type in each time period.ResultsA total of 2663 commercially insured patients and 266 with Medicare supplemental insurance were included in the study population. The mean-adjusted incremental cancer-related costs for commercially insured patients was $399,011 in the overall observation period including the pre-diagnostic and pre-HCT periods combined, 9% of which was incurred in the pre-diagnostic period. The corresponding mean-adjusted incremental cancer-related costs for Medicare supplemental patients was $195,575 for the same time period but the patterns of healthcare utilization were similar to the commercially insured population. Inpatient care accounted for approximately one-half the cost in both patient populations. By type of hematologic malignancy, costs were lowest for myeloproliferative disorders ($211,561) and highest for acute lymphocytic leukemia ($462,072) in the commercially insured population.ConclusionThis study demonstrates that overall patients with hematologic malignancies requiring HCT have considerable cancer-related healthcare resource utilization and costs leading up to HCT compared to the period of time prior to developing cancer.

Unbalanced Treatment Costs of Breast Cancer in China: Implications From the Direct Costs of Inpatient and Outpatient Care in Liaoning Province.

The increasing incidence of breast cancer and its financial burden highlights the need for controlling treatment costs. This study aimed to assess the direct costs of inpatient and outpatient care for breast cancer patients in Liaoning Province to provide a policy reference for cost containment. Based on the System of Health Accounts 2011 (SHA 2011), systematic data collection was conducted via multistage stratified cluster random sampling. A total of 1160 health institutions, including 83 hospitals, 16 public health institutions, 120 primary health institutions, and 941 outpatient institutions were enrolled in 2017. A database was established containing 20 035 patient-level medical records from the information system of these institutions. Curative care expenditure (CCE)was calculated, and generalized linear modeling was performed to determine cost-related factors. In 2017, the CCE for breast cancer was approximately CNY 830.19 million (US$122.96 million) in Liaoning province (0.7% of the total health expenditure and 9.9% of cancer-related healthcare costs). Inpatient care costs were estimated to be CNY 617.27 million (US$91.42 million), accounting for 74.4% of the CCE for breast cancer, almost three times as large as outpatient costs (25.6%). The average inpatient and outpatient costs for breast cancer were estimated to be CNY 12 108 (US$1793) and CNY 829 (US$123) per visit. Medication cost was the main cost driver, which comprised 84.0% of the average outpatient cost and 37.2% of the mean inpatient cost. Breast cancer imposes a large economic burden on patients and the social health insurance system. Results show an irrational cost pattern of inpatient and outpatient services, with patients relying excessively on inpatient services for treatment. Promoting outpatient care whenever relevant is conducive to cost containment and rational utilization of resources.

Patient concerns and disruptions in cancer care during the COVID-19 pandemic.

e18716 Background: The COVID-19 pandemic has uniquely impacted the lives of people with cancer, but the specifics of these impacts are not fully understood. We examined: 1) the impact of COVID-19 on cancer-related health care, and 2) patients’ most prominent COVID-related concerns. Methods: From Sept-Dec 2020, 502 cancer patients completed an online survey about disruptions in cancer-related health care (types and causes of disruptions and length of health care delays). COVID-related concerns (e.g., accessing basic and medical needs, financial concerns, psychosocial impact) were assessed via 25 items rated not at all to extremely concerning, or not applicable. Group differences were examined with Pearson Chi-Square. Sample: 75% women, 82% White, age range 20-88 years (M = 60, SD = 12.1); 61% in remission, 16% experiencing cancer relapse, 13% experiencing cancer for the first time; current stage: 40% metastatic, 25% localized, 35% no stage/don’t know; time since diagnosis range 0-36 years (M = 8.8, SD = 7.0); primary cancer diagnoses: 29% breast, 27% blood cancers, 6% prostate, 5% lung, 5% colorectal, and 28% other; 47% currently in treatment. 49% were tested for COVID-19, 3% tested positive. Results: 40% (n = 200) reported a disruption in cancer-related health care: of these, 34% reported disruption in imaging services, 30% lab service, 26% routine screening, 25% supportive services, 12% treatment session (including 46% chemotherapy, 13% radiation, 13% hormone therapy, 4% surgery), and 14% other disruption, with 10% reporting delay in cancer diagnosis. Nearly half with care delays reported a delay of 2-3 months (18%) or 3+ months (30%), with 3+ months delays occurring most often for routine screenings (40%) and supportive services (37%). Primary causes for disruptions included clinicians recommending the delay (46%) and patient fear of contracting COVID-19 via in person care (31%). The top 3 areas of COVID-19-related concerns ( somewhat to extremely concerned) were: 1) others not following safety recommendations e.g., wearing masks (85%), 2) getting COVID-19 due to a weakened immune system (76%), and 3) worrying about loved ones’ health (73%). Those in remission less frequently experienced delay in care (35%) than those with first time cancer (50%) or relapse (51%, χ2= 10.5, p < .05), and those in current treatment more frequently experienced delay in care (44%) than those not in treatment (36%, χ2= 3.5, p < .10). Conclusions: Findings highlight the substantial impact of COVID-19 on cancer care, across various forms of care needs and health services. Patients experiencing cancer for the first time, a cancer relapse, or those undergoing treatment reported high levels of delays, with many delays in excess of 3 months. Given the unique impact of COVID-19 to cancer patients, these results highlight opportunities for care service delivery improvements as the health care community navigates competing priorities of patient safety and care quality.

Decreased public pursuit of cancer-related information during the COVID-19 pandemic in the United States.

BackgroundIn response to the prioritization of healthcare resources towards the COVID-19 pandemic, routine cancer screening and diagnostic have been disrupted, potentially explaining the apparent COVID-era decline in cancer cases and mortality. In this study, we identified temporal trends in public interest in cancer-related health information using the nowcasting tool Google Trends.MethodsWe used Google Trends to query search terms related to cancer types for short-term (September 2019–September 2020) and long-term (September 2016–September 2020) trends in the US. We compared average relative search volumes (RSV) for specified time ranges to detect recent and seasonal variation.ResultsGeneral search interest declined for all cancer types beginning in March 2020, with changes in search interest for “Breast cancer,” “Colorectal cancer,” and “Melanoma” of − 30.6%, − 28.2%, and − 26.7%, respectively, and compared with the mean RSV of the two previous months. In the same time range, search interest for “Telemedicine” has increased by + 907.1% and has reached a 4-year peak with a sustained increased level of search interest. Absolute cancer mortality has declined and is presently at a 4-year low; however, search interest in cancer has been recuperating since July 2020.ConclusionWe observed a marked decline in searches for cancer-related health information that mirrors the reduction in new cancer diagnoses and cancer mortality during the COVID-19 pandemic. Health professions need to be prepared for the coming demand for cancer-related healthcare, foreshadowed by recovering interest in cancer-related information on Google Trends.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10552-021-01409-1.

Factors associated with waiting time to breast cancer diagnosis among symptomatic breast cancer patients: a population-based study from Ontario, Canada.

A prolonged time from first presentation to cancer diagnosis has been associated with worse disease-related outcomes. This study evaluated potential determinants of a long diagnostic interval among symptomatic breast cancer patients. This was a population-based, cross-sectional study of symptomatic breast cancer patients diagnosed in Ontario, Canada from 2007 to 2015 using administrative health data. The diagnostic interval was defined as the time from the earliest breast cancer-related healthcare encounter before diagnosis to the diagnosis date. Potential determinants of the diagnostic interval included patient, disease and usual healthcare utilization characteristics. We used multivariable quantile regression to evaluate their relationship with the diagnostic interval. We also examined differences in diagnostic interval by the frequency of encounters within the interval. Among 45,967 symptomatic breast cancer patients, the median diagnostic interval was 41days (interquartile range 20-92). Longer diagnostic intervals were observed in younger patients, patients with higher burden of comorbid disease, recent immigrants to Canada, and patients with higher healthcare utilization prior to their diagnostic interval. Shorter intervals were observed in patients residing in long-term care facilities, patients with late stage disease, and patients who initially presented in an emergency department. Longer diagnostic intervals were characterized by an increased number of physician visits and breast procedures. The identification of groups at risk of longer diagnostic intervals provides direction for future research aimed at better understanding and improving breast cancer diagnostic pathways. Ensuring that all women receive a timely breast cancer diagnosis could improve breast cancer outcomes.

'Under Pressure': Access to Cancer Care in Chile During the COVID-19 Pandemic

Background: A decreased health services utilization due to the COVID pandemic is a global concern, potentially deepening health inequalities, particularly for time-sensitive conditions such as cancer, a leading cause of death. Disruptions in its diagnosis and treatment impose severe long-term consequences. We examine the impact of the SARS-COV-2 pandemic on access to cancer care in the context of a highly unequal latin-american health system like Chile. We analyze differential effects by insurance-type, proxy of socioeconomic status, gender and age.Methods: Quasi-experimental study using interrupted time series analysis (ITSA). We obtained information from multiple sources for a wide evaluation of cancer-related healthcare utilization in Chile two to three years prior to the pandemic until December-2020. We fitted negative binomial ITSA models adjusted by population groups for a range of health services and cancer diagnoses.Results: We observed a sharp reduction in oncological healthcare utilization in March. This is followed by a slow, yet incomplete, recovery over 2020. There was a one-third accumulated reduction of cancer-related services, diagnostic confirmations and sick-leaves in 2020. The reduction was more pronounced on women and the publicly-insured population. We estimate 5,132 persons with four common cancers missed an early diagnosis.Interpretation: The pandemic stressed the Chilean healthcare system, reducing access to essential cancer services with a sizable and wide impact on cancer care. Service utilization reduction preceded the implementation of large-scale lockdowns and supply-side disruptions. Importantly, not all population groups were equally affected, with patterns suggesting increasing gender and socio-economic inequalities.Funding: This work was funded by the National Research & Development Agency of Chile - ANID (Project ANID-COVID 0960). JP’s and SFA’s PhD studies are supported by ANID (CONICYT-PFCHA/Doctorado Nacional/2020-21200241 and CONICYT-PFCHA/Doctorado Nacional/2020-21200398).Conflict of Interest: The authors have no conflicts of interest to declare.

PORTEC-4a: international randomized trial of molecular profile-based adjuvant treatment for women with high-intermediate risk endometrial cancer

BackgroundVaginal brachytherapy is currently recommended as adjuvant treatment in patients with high-intermediate risk endometrial cancer to maximize local control and has only mild side effects and no or limited impact...

Cost-Effectiveness of a National Sugar-Sweetened Beverage Tax to Reduce CancerBurdens and Disparities in the United States.

BackgroundSugar-sweetened beverage (SSB) consumption contributes to obesity, a risk factor for 13 cancers. Although SSB taxes can reduce intake, the health and economic impact on reducing cancer burdens in the United States are unknown, especially among low-income Americans with higher SSB intake and obesity-related cancer burdens.MethodsWe used the Diet and Cancer Outcome Model, a probabilistic cohort state-transition model, to project health gains and economic benefits of a penny-per-ounce national SSB tax on reducing obesity-associated cancers among US adults aged 20 years and older by income.ResultsA national SSB tax was estimated to prevent 22 075 (95% uncertainty interval [UI] = 16 040-28 577) new cancer cases and 13 524 (95% UI = 9841-17 681) cancer deaths among US adults over a lifetime. The policy was estimated to cost $1.70 (95% UI = $1.50-$1.95) billion for government implementation and $1.70 (95% UI = $1.48-$1.96) billion for industry compliance, while saving $2.28 (95% UI = $1.67-$2.98) billion cancer-related healthcare costs. The SSB tax was highly cost-effective from both a government affordability perspective (incremental cost-effectiveness ratio [ICER] = $1486, 95% UI = -$3516-$9265 per quality-adjusted life year [QALY]) and a societal perspective (ICER = $13 220, 95% UI = $3453-$28 120 per QALY). Approximately 4800 more cancer cases and 3100 more cancer deaths would be prevented, and $0.34 billion more healthcare cost savings would be generated among low-income (federal poverty-to-income ratio [FPIR] ≤ 1.85) than higher-income individuals (FPIR > 1.85).ConclusionsA penny-per-ounce national SSB tax is cost-effective for cancer prevention in the United States, with the largest health gains and economic benefits among low-income Americans.

Breast cancer diagnosis and treatment wait times in specialized diagnostic units compared with usual care: a population-based study.

Breast assessment sites (bass) were developed to provide expedited and coordinated care for patients being evaluated for breast cancer (bca) in Ontario. We compared the diagnostic and treatment intervals for patients diagnosed at a bas and for those diagnosed through a usual care (uc) route. This population-based, cross-sectional study of patients diagnosed with bca in Ontario during 2007-2015 used linked administrative data. "Diagnostic interval" was the time from the earliest cancer-related health care encounter before diagnosis to diagnosis; "treatment interval" was the time from diagnosis to treatment. Diagnosis at a bas was determined from the patient's biopsy and mammography institutions. Interval lengths for the bas and uc groups were compared using multivariable quantile regression, stratified by detection method. The diagnostic interval was shorter for patients who were bas-diagnosed than for those who were uc-diagnosed, with adjusted median differences of -4.0 days [95% confidence interval (ci): -3.2 days to -4.9 days] for symptomatic patients and -5.4 days (95% ci: -4.7 days to -6.1 days) for screen-detected patients. That association was modified by stage at diagnosis, with larger differences in patients with early-stage cancers. In contrast, the treatment interval was longer in patients who were bas-diagnosed than in those who were uc-diagnosed, with adjusted median differences of 4.2 days (95% ci: 3.8 days to 4.7 days) for symptomatic patients and 4.2 days (95% ci: 3.7 days to 4.8 days) for screen-detected patients. Diagnosis of bca through a bas was associated with a shorter diagnostic interval, but a longer treatment interval. Although efficiencies in the diagnostic interval might help to reduce distress experienced by patients, the longer treatment intervals for patients who are bas-diagnosed remain a cause for concern.

Colorectal cancer survivors' quality of life: a qualitative study of unmet need.

Cancer survivors' perceptions of healthcare have been identified as a predictor of quality of life (QoL) outcomes. This study aims to explore colorectal cancer (CRC) survivors' perceptions of how cancer-related healthcare affects their QoL. Semistructured interviews were conducted with 22 CRC survivors receiving follow-up care between 1 and 5 years post diagnosis. Interviews were recorded, transcribed and analysed thematically. Five themes described the impact of healthcare experiences on CRC survivors' QoL. While cancer survivors spoke positively of their relationships with healthcare professionals, many experienced a range of unmet information and supportive care needs. Participants described a range of positive and negative experiences, as power dynamics and navigation of healthcare systems had implications for their QoL. Where negative healthcare events aligned, survivors' autonomy, dignity and confidence were undermined, and survivorship issues could be inadequately addressed. To address persistent unmet needs, survivors developed a safety net(work) of supports to bridge the gap of unmet needs in healthcare with varying outcomes. Cancer survivors' experience of follow-up and healthcare can positively or negatively affect their QoL. Preparation for cancer survivorship must be incorporated into the acute phase of diagnosis and treatment and interlinked with clear pathways of survivorship care and accessible supportive care, which support survivors to be equal partners in their healthcare. Understanding cancer survivors' knowledge, expertise and mastery of their condition is essential to ensure delivery of person-centred supportive care that adequately addresses the survivor's unmet needs.

Disparities in Health and Economic Burden of Cancer Attributable to Suboptimal Diet in the United States

Abstract Objectives Suboptimal diet contributes to substantial health disparities among low-income and racial and ethnic minorities, but influences on cancer disparities are not well established. We quantified the health and economic burdens of cancer attributable to suboptimal diet among US adults overall and in key demographic subgroups. Methods Using a probabilistic cohort state transition model, we incorporated national representative demographics and dietary data, national cancer incidence and cancer survival, diet-cancer etiologic associations, and cancer-related healthcare costs to estimate new cancer cases, cancer deaths, and cancer costs attributable to suboptimal intakes of 7 dietary factors (fruits, vegetables, dairy, whole grains, processed meats, red meats, sugar sweetened beverages) among US adults aged 20 + years over their lifetime. Uncertainties in inputs were incorporated using probabilistic sensitivity analyses in 1000 simulations. Results Suboptimal intakes of these 7 dietary factors were estimated to jointly cause 1.76 (95% UI: 1.69–1.81) million new cancer cases, representing 4.6% (4.5–4.8%) of total cases of these cancers, 1.04 (1.00–1.08) million cancer death, and $215B (206–223) cancer-related healthcare costs in US adults over their lifetime. The top 3 diet-attributable cancers were colorectal (n = 824,000 new cases, 17% of the total), oral cavity and pharynx (n = 204,000, 8.4%), and endometrial cancer (n = 175,000, 5.8%). Among subgroups, diet-attributable new cancer cases per 100,000 population were 16% higher for men (805 [777–843]) than women, 20% higher for non-Hispanic blacks (939 [901–954]) than non-Hispanic white, 12% higher for below college educated (771[727–817]) than college graduates, 14% higher for lower income individuals (income-to-poverty ratio < 1.3: 810 [771–839]) and 21% higher for SNAP participants (872 [830–920]) compared to high income individuals. Similar patterns were observed for diet-associated cancer death and cancer costs. Conclusions Our novel findings suggest that suboptimal intakes of 7 dietary factors are contributing to substantial cancer burdens and healthcare costs in the US, with major additional disparities among key population subgroups. These results help inform dietary and policy priorities to reduce diet-related cancer and disparities in the US. Funding Sources NIH/NIMHD.

Socioeconomic Burden of Cancer in Korea from 2011 to 2015.

PurposeThough the socioeconomic burden of cancer on patients is increasing in South Korea, there is little research regarding the type of cancer that incurs the highest costs. This study analyzed the socioeconomic burden on cancer patients from 2011 to 2015 according to sex and age.Materials and MethodsA prevalence-based approach was applied utilizing claim data of the National Health Insurance Service in Korea to estimate the socioeconomic burden of cancer on patients. Patients who received treatment for cancer from 2011 to 2015 were the study subjects. The total socioeconomic burden of their disease and treatment was divided into direct and indirect costs.ResultsThere was an increase of 50.7% for 5 years, from 821,525 to 1,237,739 cancer patients. The cancer costs for men and women increased $8,268.4 million to $9,469.7 million and $3,626.5 million to $4,475.6 million, respectively. Furthermore, the 50-59-year-old age group accounted for a large portion of the total disease cost. Liver, lung, stomach, and colorectal cancers created the heaviest economic burdens on patients.ConclusionOverall, this study indicates new policies for cancer prevention, early detection, and post-cancer treatment management are necessary to help limit the costs associatedwith cancer, especially in the elderly, and provides a foundation for establishing cancer-related health care policies, particularly by defining those cancers with heavier disease burdens.

Access to diagnostic facilities in children with cancer in Colombia: Spotting opportunity and distance from a sample

ObjectivesDelivering health care timely and geographically accessible are determining factors for the prognosis of children with cancer. This study analyzed geographic access and timeliness to diagnostic services in Colombia. MethodsIn this Colombian national childhood cancer database-based study, patients and their diagnostic facilities were individually and separately space positioned. Distances between the household to the diagnostic facility, and between the clinical date of suspicion and diagnosis were determined.Using exploratory data analysis, we obtained a probability density function (lambda), which expressed a correlation percentage between the residential location of the patient and either travel time or timeliness of treatment. Results27 % of the sample of 731 patients had access to diagnostic centres in less than 30 min. The travel-distance to diagnostic centres was lowest in the Caribe and Andina Regions (43 % and 32 % distances up to 30 km respectively). However, in Amazonía and Orinoquía Regions, 87 % and 81 % had to travel more than 90 km – representing very long travel times. For more than 23 % of patients, time to diagnosis was more than 90 days, in Orinoquía, this was above 90 days for 1/3 of patients. Despite relatively short travel distances in the Caribe-Region, for 61 % time to diagnosis exceeded 30 days. ConclusionsThis study identified clear shortcomings in the Colombian Health System related to the quality of childhood cancer-related health care in terms of timeliness, cancer networks, and geographic access. These inequities not only depend on sociodemographic-characteristics and should be intervened upon.

Colonoscopy resource availability and its association with the colorectal cancer diagnostic interval: A population-based cross-sectional study.

Colonoscopy is a key resource used to diagnose colorectal cancer (CRC). This study evaluated the relationship between colonoscopy availability and the length of the CRC diagnostic interval. This is a cross-sectional study of CRC patients diagnosed in Ontario, Canada, in 2008-2012. We used administrative health data to characterise colonoscopist density, private colonoscopy clinic access, distance to the closest colonoscopist and the diagnostic interval, defined as the time from patients' first cancer-related healthcare encounter to their cancer diagnosis date. We used multivariable quantile regression to evaluate the association between colonoscopy availability and the diagnostic interval, modelling the median and 90th percentile. The median diagnostic interval was 84days (90th percentile 323days). The diagnostic interval was longer in patients residing in areas with lower colonoscopists density or private clinic access (adjusted median difference=9 and 19days, respectively), with evidence of effect modification by symptom status. Increased distance to a colonoscopist was associated with a longer diagnostic interval in asymptomatic patients, but a shorter diagnostic interval in symptomatic patients (adjusted median difference=29 and -25days, respectively). This study demonstrated that reduced colonoscopy resource availability is associated with longer diagnostic intervals for CRC patients.

Financial burden of thyroid cancer in the United States: An estimate of economic and psychological hardship among thyroid cancer survivors

BackgroundAnnual cancer-related healthcare expenditure in the United States is estimated to exceed $150 billion by 2020. As the prevalence of thyroid cancer increases worldwide, thyroid cancer survivorship is associated with increasing personal and cumulative costs. Few studies have examined the psychological and material economic costs experienced by thyroid cancer survivors. We seek to estimate the comparative prevalence of financial and psychological hardship among thyroid cancer and non-thyroid cancer patients in the United States. MethodsThe 2011 Medical Expenditure Panel Survey Experiences with Cancer databank was queried to identify thyroid and non-thyroid (colon, breast, lung, prostate) cancer survivors. This survey includes assessments of financial stress, material hardship, and psychological financial hardship. Cancer incidence–based weighted estimates of responses were compared between thyroid and non-thyroid cancer survivors. Independent predictors of material and psychological financial burden were identified through separate multivariate regression models. ResultsThyroid cancer survivors more frequently reported psychological financial burden compared to non-thyroid cancer (46.1% vs 24.0%, P = .04). Material financial hardship (28.1% vs 19.9%, P = .37) and concurrent material and psychological hardship (25.1% vs 12.5%, P = .09) were noted at similar frequencies between thyroid and non-thyroid cancer survivors. However, on multivariate analysis, only younger age and lack of health insurance coverage were independently associated with psychological financial hardship. ConclusionThyroid cancer survivors report greater psychological financial hardship than non-thyroid cancer survivors. Because this financial burden may be underrecognized in the medical community, further studies should be conducted to aid physicians in better understanding the impact of a thyroid cancer diagnosis.

Cost for treatment and follow-up of thyroid cancer increases according to the severity of disease.

The aim of this study was to provide an analysis of thyroid cancer-related health care costs over a 5-year period, according to the extent of thyroid surgery. The study included 33 patients from our institutional database who underwent thyroid cancer surgery in 2010. Patients were divided into four groups based on surgical extent: (1) hemithyroidectomy, (2) total thyroidectomy, (3) total thyroidectomy with ipsilateral radical neck dissection, and (4) total thyroidectomy with bilateral radical neck dissection and mediastinal dissection. Costs for admission and outpatient follow-up for 5 years were analyzed. Costs for outpatient follow-up and admission, and overall cost increased with increasing stage of disease and increasing extent of thyroid surgery. Patients who underwent only hemithyroidectomy had the lowest costs for outpatient follow-up and admission, as well as the lowest overall cost. Over the 5-year follow-up period, surgery performed at an early disease stage was the most cost-effective.

Costs in Different States of Breast Cancer.

This cross-sectional study estimated direct cancer-related health care, productivity and informal care costs for a six-month period for different states of breast cancer (BC). A total of 827 BC patients answered a questionnaire enquiring about informal care, work capacity, and demographic factors. Direct health care resource use and productivity costs were obtained from registries. Mutually exclusive groups were formed based on disease state and time from diagnosis: primary treatment (first six months after diagnosis), rehabilitation (>six months after diagnosis), remission (>1.5 years after diagnosis), and metastatic. Mean total costs were: primary treatment €22,876, rehabilitation €3,456, remission €1,728, and metastatic €24,320. Mean direct health care costs were: primary treatment €11,798, rehabilitation €2,398, remission €1,147, and metastatic €13,923. Mean productivity costs varied between 18-39% and indirect costs (productivity and informal care costs) between 31-48% of the total costs. Direct medical costs were highest, but indirect costs constituted up to half of the total costs and are essential when estimating the total cost burden, as many patients are of working age.

Variations in the breast reconstruction rate in France: A nationwide study of 19,466 patients based on the French medico-administrative database

BackgroundAccess to breast reconstruction (BR) surgery after a mastectomy remains limited, with a large degree of national and international variation despite its known psychological benefits and impact on quality of life. The aim of this study was to investigate the factors influencing breast reconstruction in France where cancer-related healthcare costs are fully reimbursed. MethodsAll primary mastectomies for breast carcinoma performed in 2012 and linked BR surgeries from 2012 to December 2015 were extracted from the French medico-administrative database. A three-level logistic regression analysis was performed to model the probability of breast reconstruction according to patient, hospital and administrative region characteristics. ResultsAmong the 19,466 women who had a mastectomy in 2012, 5328 (27.4%) had breast reconstruction. Multivariate analysis showed that the BR rate was lower in patients living in an area with an unfavourable socioeconomic level (p < .001), in low volume hospitals (p < .001), and in public hospitals (18.6%) compared to private hospitals (25.9%), university hospitals (29.8%), and cancer centres (35.0%) (p < .001). BR rate was significantly lower in patients older than 65 compared to those younger (7.5% versus 42.1%, p < .001). The impact of age was even greater in public hospitals than in other centres (interaction test, p = .001). We also observed significant heterogeneity in the BR rate across regions, which could be partially explained by differences in the plastic surgeon density. ConclusionsBreast reconstruction rate heterogeneity could be attributed to women choice. However, our study suggests that unequal access to high-quality procedures also plays a role, particularly for older breast cancer women.