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Background Cancer costs should be discussed by patients and providers, but information is not readily available. Results from recently published studies (in the last 5 years) on direct and indirect cancer costs may help guide thes...
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Background Cancer costs should be discussed by patients and providers, but information is not readily available. Results from recently published studies (in the last 5 years) on direct and indirect cancer costs may help guide these discussions. Methods The authors reviewed studies published between 2013 and 2017 that reported direct health care costs and indirect (productivity losses) costs. The annual mean total and net costs of cancer were summarized for all payers and for survivors only by age (ages 18‐64 and ≥65 years), by phase of care (initial [ie, 12 months from diagnosis], continuing, and end‐of‐life [ie, 12 months before death]), or for recently diagnosed (within 1‐2 years of diagnosis) and longer term survivors. Results For all payers combined, costs for cancers like breast, prostate, colorectal, and lung cancers were $20,000 to $100,000 in the initial phase, $1000 to $30,000 annually in the continuing phase, and ≥$60,000 in the end‐of‐life phase. Annual out‐of‐pocket costs to recently diagnosed survivors were >$1000 for medical care and time costs, approximately $2000 for productivity losses, and from $2500 to >$4000 for employment disability, depending on age. For longer term survivors, the cost of medical care was approximately $1500 for older survivors and $747 for younger survivors, time costs were $831 to $955 for older survivors and $459 to $630 for younger survivors, and productivity losses were approximately $800. Disability among long‐term survivors was similar to that among short‐term survivors. Limitations of the reviewed studies included older data and under‐representation of higher cost cancers. Conclusions Frequently updated cost information for all cancer types is needed to guide discussions of anticipated short‐term and long‐term cancer‐related costs with survivors. Cancer 2018;000:000‐000 . ? 2018 American Cancer Society .
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ABSTRACT Osteoporosis screening rates by DXA are low (9.5% women, 1.7% men) in the US Medicare population aged 65 years and older. Addressing this care gap, we estimated the benefits of a validated osteoporosis diagnostic test sui...
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ABSTRACT Osteoporosis screening rates by DXA are low (9.5% women, 1.7% men) in the US Medicare population aged 65 years and older. Addressing this care gap, we estimated the benefits of a validated osteoporosis diagnostic test suitable for patients age 65 years and older with an abdominal computed tomography (CT) scan taken for any indication but without a recent DXA. Our analysis assessed a hypothetical cohort of 1000 such patients in a given year, and followed them for 5 years. Separately for each sex, we used Markov modeling to compare two mutually exclusive scenarios: (i) utilizing the CT scans, perform one‐time “biomechanical computed tomography” (BCT) analysis to identify high‐risk patients on the basis of both femoral strength and hip BMD T ‐scores; (ii) ignore the CT scan, and rely instead on usual care, consisting of future annual DXA screening at typical Medicare rates. For patients with findings indicative of osteoporosis, 50% underwent 2 years of treatment with alendronate. We found that BCT provided greater clinical benefit at lower cost for both sexes than usual care. In our base case, compared to usual care, BCT prevented hip fractures over a 5‐year window (3.1 per 1000 women; 1.9 per 1000 men) and increased quality‐adjusted life years (2.95 per 1000 women; 1.48 per 1000 men). Efficacy and savings increased further for higher‐risk patient pools, greater treatment adherence, and longer treatment duration. When the sensitivity and specificity of BCT were set to those for DXA, the prevented hip fractures versus usual care remained high (2.7 per 1000 women; 1.5 per 1000 men), indicating the importance of high screening rates on clinical efficacy. Therefore, for patients with a previously taken abdominal CT and without a recent DXA, osteoporosis screening using biomechanical computed tomography may be a cost‐effective alternative to current usual care. ? 2019 American Society for Bone and Mineral Research.
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BACKGROUND As the population of older adults with cancer continues to grow, the most important factors contributing to their health‐related quality of life (HRQOL) remain unclear. METHODS A total of 1457 older adults (aged ≥65 y...
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BACKGROUND As the population of older adults with cancer continues to grow, the most important factors contributing to their health‐related quality of life (HRQOL) remain unclear. METHODS A total of 1457 older adults (aged ≥65 years) with cancer participated in a telephone survey. Outcomes were measured using the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the 12‐Item Short Form Survey (SF‐12) from the Medical Outcomes Study (version 2). Statistical techniques used to identify factors in 4 domains (physical, psychological, social, and spiritual) most strongly associated with HRQOL included linear models, recursive partitioning, and random forests. Models were developed in a training data set (920 respondents) and performance was assessed in a validation data set (537 respondents). RESULTS Respondents were a median of 19 months from diagnosis, and 28.1% were receiving active treatment. The most relevant factors found to be associated with PCS were symptom severity, comorbidity scores, leisure‐time physical activity, and having physical support needs. The most relevant factors for MCS were having emotional support needs, symptom severity score, and the number of financial hardship events. Results were consistent across modeling techniques. Symptoms found to be strongly associated with PCS included fatigue (adjusted proportion of summary score's variance [R 2 ] = 0.34), pain (adjusted R 2 = 0.32), disturbed sleep (adjusted R 2 = 0.16), and drowsiness (adjusted R 2 = 0.16). Symptoms found to be strongly associated with MCS included fatigue (adjusted R 2 = 0.23), problems remembering things (adjusted R 2 = 0.17), disturbed sleep (adjusted R 2 = 0.16), and lack of appetite (adjusted R 2 = 0.16). CONCLUSIONS The findings of the current study support the importance of addressing persistent symptoms, managing comorbidities, promoting leisure‐time physical activity, and addressing financial challenges. A long‐term comprehensive approach is needed to ensure the well‐being of older adults with cancer. Cancer 2018;124:596‐605 . ? 2017 American Cancer Society .
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Abstract Objective To examine health care costs in diverse older Medicare beneficiaries with epilepsy. Methods Using 2008‐2010 claims data, we conducted a longitudinal cohort study of a random sample of Medicare beneficiaries aug...
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Abstract Objective To examine health care costs in diverse older Medicare beneficiaries with epilepsy. Methods Using 2008‐2010 claims data, we conducted a longitudinal cohort study of a random sample of Medicare beneficiaries augmented for minority representation. Epilepsy cases (n?=?36?912) had ≥1 International Classification of Diseases, Ninth Edition ( ICD ‐9) 345.x or ≥2 ICD ‐9 780.3x claims, and ≥1 antiepileptic drug ( AED ) in 2009; new cases (n?=?3706) had no seizure/epilepsy claims nor AED s in the previous 365?days. Costs were measured by reimbursements for all care received. High cost was defined as follow‐up 1‐year cost ≥ 75th percentile. Logistic regressions examined association of high cost with race/ethnicity, adjusting for demographic, clinical, economic, and treatment quality factors. In cases with continuous 2‐year data, we obtained costs in two 6‐month periods before and two after the index event. Results Cohort was ~62% African Americans ( AA s), 11% Hispanics, 5% Asians, and 2% American Indian/Alaska Natives. Mean costs in the follow‐up were ~$30?000 (median = $11?547; new cases, mean = $44?642; median = $25?008). About 19% white compared to 27% AA cases had high cost. AA had higher odds of high cost in adjusted analyses (odds ratio [ OR ] = 1.20, 95% confidence interval [ CI ] = 1.11‐1.29), although this was only marginally significant when adjusting for AED adherence ( OR = 1.09, 95% CI = 1.01‐1.18, P? = ? 0.03). Factors associated with high cost included ≥1 comorbidity, neurological care, and low AED adherence. Costs were highest at ~$17?000 in the 6?months immediately before and after the index event (>$29?000 for new cases). Significance The financial sequelae of epilepsy among older Americans disproportionally affect minorities. Studies should examine contributors to high costs.
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Background The impact of National Comprehensive Cancer Network (NCCN) treatment guideline concordance on costs, health care utilization, and mortality for patients with breast cancer and secondary metastases is unknown. Methods Fr...
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Background The impact of National Comprehensive Cancer Network (NCCN) treatment guideline concordance on costs, health care utilization, and mortality for patients with breast cancer and secondary metastases is unknown. Methods From 2007 to 2013, women with early‐stage breast cancer who received treatment for secondary metastases (n = 5651) were evaluated for first recorded systemic therapy concordance with NCCN guidelines within the Surveillance, Epidemiology, and End Results Program–Medicare linked database. Generalized linear and mixed effects models evaluated factors associated with nonconcordance and the relation between concordance status and health care utilization and costs. Mortality risk was estimated with Cox regression. Results Eighteen percent of the patients received nonconcordant therapy, with the most common being single‐agent, human epidermal growth factor receptor 2 (HER2)–targeted therapy (36%), therapy mismatched with the estrogen receptor/HER2 status (11%), unapproved bevacizumab regimens (10%), and adjuvant regimens in a metastatic setting (6%). A younger age, a hormone receptor–negative status, and a HER2‐positive status were associated with nonconcordance ( P < .05). Nonconcordance was associated with 22% and 21% increased rates of emergency department visits and hospitalizations, respectively, and $1765 higher average monthly Medicare costs. Differences in adjusted mortality risk were noted by the category of nonconcordance; single‐agent, HER2‐targeted therapy was associated with decreased mortality risk (hazard ratio [HR], 0.66; 95% confidence limit [CL], 0.57‐0.76), and increased mortality risk was observed with unapproved bevacizumab use (HR, 1.40; 95% CL, 1.13‐1.74). Conclusions Most patients (82%) received treatment consistent with NCCN guidelines. Nonconcordant treatment was associated with higher health care utilization and costs, with mortality differences observed by the type of guideline deviation. Consideration of both patient and financial outcomes will be important as health systems increase the emphasis on guideline‐based care.
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Abstract Background Adequate social support for older adults is necessary to maintain quality of life and reduce mortality and morbidity. However, little is known regarding the social support needs of older adults with cancer. The...
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Abstract Background Adequate social support for older adults is necessary to maintain quality of life and reduce mortality and morbidity. However, little is known regarding the social support needs of older adults with cancer. The objective of the current study was to examine social support needs, specifically the unmet needs, among older adults with cancer. Methods Medicare beneficiaries (those aged ≥65 years) with cancer were identified from the University of Alabama at Birmingham Health System Cancer Community Network. Social support needs were assessed using a modified version of the Medical Outcomes Study Social Support Survey. The authors defined an “unmet need” if participants reported having some/a little/never availability of support and requiring support for that need. Results Of the 1460 participants in the current study, the average age was 74 years (standard deviation, 5.8 years). Approximately two‐thirds of participants (986 participants; 67.5%) reported having at least 1 social support need, with the highest needs noted in the emotional (49.5%) and physical (47.4%) support subdomains. Of those individuals with a support need, approximately 45% had at least 1 unmet need, with the greatest percentages noted in the medical (39%) and informational (36%) subdomains. Multivariable analyses demonstrated that participants who were nonwhite, were divorced or never married, or had a high symptom burden were at greatest risk of having unmet social support needs across subdomains. Conclusions In this population of older adults with cancer, the authors found high levels of unmet social support needs, particularly in the medical and informational support subdomains. Participants who were nonwhite, were divorced or never married, or had a high symptom burden were found to be at greatest risk of having unmet needs.
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Objective This study examined whether metabolic health status is associated with risk of cancer mortality and whether this varies by body mass index (BMI) category. Methods A prospective study of 22,514 participants from the Reaso...
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Objective This study examined whether metabolic health status is associated with risk of cancer mortality and whether this varies by body mass index (BMI) category. Methods A prospective study of 22,514 participants from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort was performed. Metabolically unhealthy status was defined as having three or more of the following: (1) elevated fasting glucose, (2) high triglycerides, (3) dyslipidemia, (4) hypertension, and (5) elevated waist circumference. Participants were categorized into normal weight (BMI 18.5‐24.9 kg/m 2 ), overweight (BMI 25.0‐29.9 kg/m 2 ), and obesity (BMI?≥?30 kg/m 2 ) groups. Cox proportional hazards regression was performed to estimate hazards ratios (HRs) and 95% confidence intervals (CIs) for cancer mortality during follow‐up. Results Among participants with normal weight, participants who were metabolically unhealthy had an increased risk of cancer mortality (HR: 1.65; 95% CI: 1.20‐2.26) compared with metabolically healthy participants. The overall mortality risk for participants who were metabolically unhealthy and had normal weight was stronger for obesity‐related cancers (HR: 2.40; 95% CI: 1.17‐4.91). Compared with participants with normal weight, those who were metabolically healthy and overweight were at a reduced risk of any cancer mortality (adjusted HR: 0.79; 95% CI: 0.63‐0.99). Conclusions There was an increased risk of overall and obesity‐related cancer mortality among metabolically unhealthy participants with normal weight.
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Summary Objective To determine the frequency of older Americans with epilepsy receiving concomitant prescriptions for antiepileptic drugs (AEDs) and non‐epilepsy drugs (NEDs) which could result in significant pharmacokinetic (PK)...
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Summary Objective To determine the frequency of older Americans with epilepsy receiving concomitant prescriptions for antiepileptic drugs (AEDs) and non‐epilepsy drugs (NEDs) which could result in significant pharmacokinetic (PK) interaction, and to assess the contributions of racial/ethnic, socioeconomic, and demographic factors. Methods Retrospective analyses of 2008‐2010 Medicare claims for a 5% random sample of beneficiaries ≥67 years old in 2009 augmented for minority representation. Prevalent cases had ≥1 ICD‐9 345.x or ≥2 ICD‐9 780.3x, and ≥1 AED. Among them, incident cases had no seizure/epilepsy claim codes nor AEDs in preceding 365 days. Drug claims for AEDs, and for the 50 most common NEDs within +/? 60 days of the index epilepsy date were tabulated. Interacting pairs of AEDs/NEDs were identified by literature review. Logistic regression models were used to examine factors affecting the likelihood of interaction risk. Results Interacting drug pairs affecting NED efficacy were found in 24.5% of incident, 39% of prevalent cases. Combinations affecting AED efficacy were found in 20.4% of incident, 29.3% of prevalent cases. Factors predicting higher interaction risk included having ≥ 1 comorbidity, being eligible for Part D low Income Subsidy, and not living in the northeastern US. Protective factors were Asian race/ethnicity, and treatment by a neurologist. Significance A substantial portion of older epilepsy patients received NED‐AED combinations that could cause important PK interactions. The lower frequency among incident vs. prevalent cases may reflect changes in prescribing practices. Avoidance of interacting AEDs is feasible for most persons because of the availability of newer drugs.
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Abstract Background American Society of Radiation Oncology Choosing Wisely campaign recommends hypofractionated radiation and against routine use of intensity‐modulated radiation therapy (IMRT) in early‐stage estrogen receptor‐...
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Abstract Background American Society of Radiation Oncology Choosing Wisely campaign recommends hypofractionated radiation and against routine use of intensity‐modulated radiation therapy (IMRT) in early‐stage estrogen receptor‐positive breast cancer. We analyzed guideline recommendation adherence and financial implications in a modern Medicare cohort of women treated across the southeastern United States. Methods Our study population comprised Medicare patients over 65?years of age with breast cancer diagnosis from 12 cancer centers in the Southeast United States with stage 0‐II breast treated with lumpectomy from 2012 to 2015. Hypofractionation was defined as 4 or fewer weeks of radiation treatments. Factors associated with utilization of hypofractionation and IMRT were identified using Poisson regression. Median costs during radiation treatments were compared for hypofractionation and IMRT. Results In older women (median age 71), 75% were treated with conventional fractionation, and 20% received IMRT. Hypofractionated women were more likely to have a positive estrogen(ER) or progestorone(PR) receptor status, lower comorbidity scores, and be treated at a high volume center (all P ?<?0.05). IMRT was utilized in 20% of patients and was more common in women treated with conventional fractionation ( P ?<?0.001). Positive ER/PR status ( P ?<?0.001) and utilization of hormonal blockade ( P ?=?0.02) were associated with increased utilization of IMRT. Conclusion In an older cohort of patients with early‐stage breast cancer, a majority were treated with conventional fractionated radiation, while approximately 20% were treated with IMRT. Both of which were associated with increased cost relative to hypofractionation.
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Abstract Objective The purpose of this study was to describe distressed and underprepared family caregiver's use of and interest in formal support services (eg, professional counseling, education, organizational assistance). Metho...
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Abstract Objective The purpose of this study was to describe distressed and underprepared family caregiver's use of and interest in formal support services (eg, professional counseling, education, organizational assistance). Method Cross‐sectional mail survey conducted in communities of 8 cancer centers in Tennessee, Alabama, and Florida (response rate: 42%). Family caregivers of Medicare beneficiaries with pancreatic, lung, brain, ovarian, head and neck, hematologic, and stage IV cancers reported support service use and completed validated measures of depression, anxiety, burden, preparedness, and health. Results Caregivers (n?=?294) were on average age 65?years and mostly female (73%), White (91%), and care recipients' spouse/partner (60%); patients averaged 75?years were majority male (54%) with lung cancer (39%). Thirty‐two percent of caregivers reported accessing services while 28% were “mostly” or “extremely” interested. Thirty‐five percent of caregivers with high depressive symptoms (n?=?122), 33% with high anxiety symptoms (n?=?100), and 25% of those in the lowest quartile of preparedness (n?=?77) accessed services. Thirty‐eight percent of those with high depressive symptoms, 47% with high anxiety symptoms, and 36% in the lowest quartile of preparedness were “mostly” or “extremely” interested in receiving services. Being interested in support services was significantly associated with being a minority, shorter durations of caregiving, and with higher stress burden. Conclusions A large proportion of family caregivers, including those experiencing depression and anxiety symptoms and who were underprepared, are not using formal support services but have a strong interest in services. Strategies to increase service use may include targeting distressed caregivers early in their caregiving experience.
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