首页 > 最新文献

JCO oncology practice最新文献

英文 中文
Reducing Cancer Drug Cost: 3-Year Analysis of Automated Dose Rounding in Electronic Health Records. 降低癌症药物成本:电子健康记录中自动剂量调整的 3 年分析。
IF 4.7 3区 医学 Q1 ONCOLOGY Pub Date : 2025-03-01 Epub Date: 2024-08-05 DOI: 10.1200/OP.23.00688
Vishal S Shah, Clayton Irvine, Robert R McWilliams, Parminder Singh, Scott A Soefje

Purpose: Globally, cancer drug expenditure exceeds $185 in US dollars (USD) billion, with the United States contributing $75 (USD) billion. Many cancer drug doses are calculated on the basis of body weight or body surface area, which often results in leftover drug in partially used single-dose vials (SDVs). The cost of wasted drug is a huge financial burden on the US health care system. We evaluated the cost savings resulting from the reduction of SDV wastage, achieved through the implementation of automated dose rounding rules in electronic health records (EHRs).

Methods: Mayo Clinic implemented automated dose rounding rules within the EHR. These rules were designed to round calculated doses to the nearest SDV if the vial size closely matched the original calculated dose, within a 10% threshold. We assessed doses administered between January 2019 and December 2021, and computed cost-savings, waste reduction, and cost of waste for chemotherapy drugs.

Results: In 3 years, 36.1% of doses were rounded down, 35.8% were rounded up, and 28.1% were exact doses. By rounding doses down to a vial size, we achieved cost-savings of $39.75 (USD) million and prevented 62,065 SDV of cancer drugs from going to waste. By rounding doses up, we avoided wasting $9.95 (USD) million worth of drugs. However, there were still instances where the rounding fell outside of the 10%, resulting in wasted drugs worth $25 (USD) million.

Conclusion: The substantial burden imposed on patients and the US health care system because of cancer drug wastage is of significant concern. Although the automated dose rounding system represents a partial solution for this issue, a comprehensive approach involves the imperative development of policy and legislative solutions to effectively mitigate the challenges associated with cancer drug waste.

目的:全球抗癌药物支出超过 1,850 亿美元,其中美国为 750 亿美元。许多抗癌药物的剂量都是根据体重或体表面积计算的,这往往会导致部分使用过的单剂量药瓶(SDV)中有剩余药物。浪费药物的成本给美国医疗系统造成了巨大的经济负担。我们评估了通过在电子病历(EHR)中实施自动剂量调整规则而减少 SDV 浪费所节省的成本:梅奥诊所在电子病历中实施了自动剂量舍入规则。这些规则旨在将计算出的剂量四舍五入到最接近的 SDV,前提是药瓶大小与原始计算剂量密切匹配,且不超过 10% 的阈值。我们评估了 2019 年 1 月至 2021 年 12 月期间的用药剂量,并计算了化疗药物的成本节约、浪费减少和浪费成本:3年中,36.1%的剂量被四舍五入,35.8%的剂量被四舍五入,28.1%的剂量为精确剂量。通过将剂量四舍五入到药瓶大小,我们节省了 3,975 万美元的成本,避免了 62,065 SDV 的抗癌药物浪费。通过四舍五入,我们避免了价值 995 万美元的药物浪费。然而,仍有四舍五入未达到 10%的情况,造成了价值 2,500 万美元的药物浪费:癌症药物浪费给患者和美国医疗系统造成的巨大负担令人深感忧虑。尽管自动剂量舍入系统是解决这一问题的部分方法,但全面的方法还包括必须制定政策和立法解决方案,以有效缓解与抗癌药物浪费相关的挑战。
{"title":"Reducing Cancer Drug Cost: 3-Year Analysis of Automated Dose Rounding in Electronic Health Records.","authors":"Vishal S Shah, Clayton Irvine, Robert R McWilliams, Parminder Singh, Scott A Soefje","doi":"10.1200/OP.23.00688","DOIUrl":"10.1200/OP.23.00688","url":null,"abstract":"<p><strong>Purpose: </strong>Globally, cancer drug expenditure exceeds $185 in US dollars (USD) billion, with the United States contributing $75 (USD) billion. Many cancer drug doses are calculated on the basis of body weight or body surface area, which often results in leftover drug in partially used single-dose vials (SDVs). The cost of wasted drug is a huge financial burden on the US health care system. We evaluated the cost savings resulting from the reduction of SDV wastage, achieved through the implementation of automated dose rounding rules in electronic health records (EHRs).</p><p><strong>Methods: </strong>Mayo Clinic implemented automated dose rounding rules within the EHR. These rules were designed to round calculated doses to the nearest SDV if the vial size closely matched the original calculated dose, within a 10% threshold. We assessed doses administered between January 2019 and December 2021, and computed cost-savings, waste reduction, and cost of waste for chemotherapy drugs.</p><p><strong>Results: </strong>In 3 years, 36.1% of doses were rounded down, 35.8% were rounded up, and 28.1% were exact doses. By rounding doses down to a vial size, we achieved cost-savings of $39.75 (USD) million and prevented 62,065 SDV of cancer drugs from going to waste. By rounding doses up, we avoided wasting $9.95 (USD) million worth of drugs. However, there were still instances where the rounding fell outside of the 10%, resulting in wasted drugs worth $25 (USD) million.</p><p><strong>Conclusion: </strong>The substantial burden imposed on patients and the US health care system because of cancer drug wastage is of significant concern. Although the automated dose rounding system represents a partial solution for this issue, a comprehensive approach involves the imperative development of policy and legislative solutions to effectively mitigate the challenges associated with cancer drug waste.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"400-407"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Racial/Ethnic Disparities in Hospitalization Outcomes by Palliative Care Utilization and Trends Among Women With Metastatic Breast Cancer in the United States. 美国患有转移性乳腺癌的妇女在住院治疗结果中使用姑息治疗的种族/族裔差异及趋势。
IF 4.7 3区 医学 Q1 ONCOLOGY Pub Date : 2025-03-01 Epub Date: 2024-10-15 DOI: 10.1200/OP.24.00434
Inimfon Jackson, Qian Lu, Debasish Tripathy

Purpose: We examined the trends in palliative care utilization, racial/ethnic disparities in hospitalization outcomes among adult women with a diagnosis of metastatic breast cancer (MBC), and effect modification by palliative care utilization.

Methods: Retrospective cohort analyses were conducted using the Agency for Healthcare Research and Quality sponsored Healthcare Cost and Utilization Project-National Inpatient Sample database from 2016 to 2020. Regression analyses were used to evaluate palliative care trends, and the association between race/ethnicity and in-hospital mortality, length of stay, total hospital charges, and discharge disposition. Stratified analyses were conducted by palliative care use.

Results: Palliative care consultations in the study population increased from 16.4% in 2016 to 20.3% in 2020. Black (adjusted odds ratio [AOR], 1.25 [95% CI, 1.16 to 1.34]) and Hispanic (AOR, 1.12 [95% CI, 1.01 to 1.23]) female patients with MBC had higher in-hospital mortality compared with the White patients. Among those who received palliative care, Blacks had similar odds (AOR, 1.08 [95% CI, 0.97 to 1.20]) of in-hospital mortality when compared with Whites. Black women were more likely to have longer hospital stays relative to White women. Although Black women had similar odds (AOR, 0.98 [95% CI, 0.92 to 1.04]) of discharge to a short-term/skilled nursing facility versus routine discharge compared with White women, Blacks who received palliative care had 19% (95% CI, 0.70 to 0.95) lower odds of discharge to a facility.

Conclusion: Our findings emphasize the importance of palliative care use among patients with MBC and highlight the need to raise awareness of its benefits, especially in minority populations. Further studies are needed to explore ways to narrow the gap in existing disparities and to test these interventions on care metrics and patient outcomes.

目的:我们研究了姑息治疗利用率的趋势、诊断为转移性乳腺癌(MBC)的成年女性住院治疗结果的种族/民族差异以及姑息治疗利用率的效应修正:利用美国医疗保健研究与质量局赞助的医疗保健成本与利用项目--全国住院患者样本数据库,对2016年至2020年的患者进行了回顾性队列分析。回归分析用于评估姑息治疗趋势,以及种族/民族与院内死亡率、住院时间、住院总费用和出院处置之间的关联。根据姑息关怀的使用情况进行了分层分析:研究人群中的姑息治疗就诊率从2016年的16.4%增至2020年的20.3%。与白人患者相比,黑人(调整后几率比 [AOR],1.25 [95% CI,1.16 至 1.34])和西班牙裔(AOR,1.12 [95% CI,1.01 至 1.23])女性乳腺癌患者的院内死亡率较高。在接受姑息治疗的患者中,黑人的院内死亡率与白人相似(AOR,1.08 [95% CI,0.97-1.20])。与白人妇女相比,黑人妇女的住院时间更长。虽然与白人妇女相比,黑人妇女出院后前往短期/专业护理机构的几率(AOR,0.98 [95% CI,0.92 至 1.04])与常规出院的几率相似,但接受姑息治疗的黑人出院后前往护理机构的几率要低 19% (95% CI,0.70 至 0.95):我们的研究结果强调了在乳腺癌患者中使用姑息治疗的重要性,并强调有必要提高人们对姑息治疗益处的认识,尤其是在少数民族人群中。还需要进一步的研究来探索缩小现有差距的方法,并测试这些干预措施对护理指标和患者预后的影响。
{"title":"Racial/Ethnic Disparities in Hospitalization Outcomes by Palliative Care Utilization and Trends Among Women With Metastatic Breast Cancer in the United States.","authors":"Inimfon Jackson, Qian Lu, Debasish Tripathy","doi":"10.1200/OP.24.00434","DOIUrl":"10.1200/OP.24.00434","url":null,"abstract":"<p><strong>Purpose: </strong>We examined the trends in palliative care utilization, racial/ethnic disparities in hospitalization outcomes among adult women with a diagnosis of metastatic breast cancer (MBC), and effect modification by palliative care utilization.</p><p><strong>Methods: </strong>Retrospective cohort analyses were conducted using the Agency for Healthcare Research and Quality sponsored Healthcare Cost and Utilization Project-National Inpatient Sample database from 2016 to 2020. Regression analyses were used to evaluate palliative care trends, and the association between race/ethnicity and in-hospital mortality, length of stay, total hospital charges, and discharge disposition. Stratified analyses were conducted by palliative care use.</p><p><strong>Results: </strong>Palliative care consultations in the study population increased from 16.4% in 2016 to 20.3% in 2020. Black (adjusted odds ratio [AOR], 1.25 [95% CI, 1.16 to 1.34]) and Hispanic (AOR, 1.12 [95% CI, 1.01 to 1.23]) female patients with MBC had higher in-hospital mortality compared with the White patients. Among those who received palliative care, Blacks had similar odds (AOR, 1.08 [95% CI, 0.97 to 1.20]) of in-hospital mortality when compared with Whites. Black women were more likely to have longer hospital stays relative to White women. Although Black women had similar odds (AOR, 0.98 [95% CI, 0.92 to 1.04]) of discharge to a short-term/skilled nursing facility versus routine discharge compared with White women, Blacks who received palliative care had 19% (95% CI, 0.70 to 0.95) lower odds of discharge to a facility.</p><p><strong>Conclusion: </strong>Our findings emphasize the importance of palliative care use among patients with MBC and highlight the need to raise awareness of its benefits, especially in minority populations. Further studies are needed to explore ways to narrow the gap in existing disparities and to test these interventions on care metrics and patient outcomes.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"418-426"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Real-World Outcomes of Immunotherapy for Melanoma Brain Metastases in New Zealand. 新西兰黑色素瘤脑转移免疫疗法的实际效果。
IF 4.7 3区 医学 Q1 ONCOLOGY Pub Date : 2025-03-01 Epub Date: 2024-07-25 DOI: 10.1200/OP.24.00208
Niamh Walsh, Rosalie Stephens, Alvin Tan, Vanessa Durandt, Jennifer McLachlan, Jody Jordan, Kate Gregory, Sean Sutton, Catherine Barrow, Annie N M Wong

Purpose: Melanoma brain metastases (BMs) are associated with poor survival. Combination immune checkpoint inhibitors (ICIs) with anti-PD1 and anti-CTLA-4 are the international standard-of-care treatment. Most landmark clinical trials excluded real-world patients with symptomatic disease, poor performance status (PS), and steroid use. Despite the high incidence of melanoma in New Zealand (NZ), the only publicly funded systemic treatment is anti-PD1 monotherapy. The real-world outcomes for BMs after ICIs in NZ are unknown.

Methodology: Medical records of patients with melanoma BMs in seven cancer centers across NZ between September 1, 2016, and September 1, 2020, were evaluated. Clinicopathologic characteristics, treatment, intracranial (IC) tumor response rates, IC progression-free survival, and overall survival (OS) are reported.

Results: One hundred and forty-four patients received at least one dose of ICI. One hundred and thirty-three (93%) patients received anti-PD1 monotherapy. Almost a quarter of patients had poor baseline PS, 56% were symptomatic, and 33% had corticosteroids. Patients also received local therapies: 61 (42%) patients underwent surgery, 42 (29%) received whole brain radiation, and 47 (33%) received stereotactic radiation. The median OS was 15 months, and a third of patients were alive at 2 years. The toxicity of ICIs was at 28% and 15% for Common Terminology Criteria for Adverse Events grade 1-2 and 3-4 events, respectively. Of the patients who are still alive, 76% of patients remained symptomatic neurologically at last follow-up.

Conclusion: Most patients in this NZ real-world study were symptomatic and received anti-PD1 monotherapy. Approximately one-third of treated patients are alive at 2 years, but most patients remained symptomatic. This highlights the need for more effective treatment and prospective management of their neurologic rehabilitation needs.

目的:黑色素瘤脑转移(BMs)与生存率低有关。抗-PD1和抗-CTLA-4联合免疫检查点抑制剂(ICIs)是国际标准治疗方法。大多数具有里程碑意义的临床试验都排除了现实世界中患有无症状疾病、表现状态不佳(PS)和使用类固醇的患者。尽管新西兰(NZ)的黑色素瘤发病率很高,但唯一由政府资助的系统性治疗是抗PD1单药治疗。新西兰接受 ICIs 治疗后的 BMs 真实世界结果尚不清楚:方法:评估了 2016 年 9 月 1 日至 2020 年 9 月 1 日期间新西兰七个癌症中心的黑色素瘤 BM 患者的医疗记录。报告了临床病理特征、治疗、颅内(IC)肿瘤反应率、IC无进展生存期和总生存期(OS):结果:144 名患者至少接受了一次 ICI 治疗。133名患者(93%)接受了抗PD1单药治疗。近四分之一的患者基线PS较差,56%的患者有症状,33%的患者使用皮质类固醇。患者还接受了局部治疗:61 例(42%)患者接受了手术,42 例(29%)接受了全脑放射治疗,47 例(33%)接受了立体定向放射治疗。中位生存期为15个月,三分之一的患者在2年内存活。在不良事件通用术语标准1-2级和3-4级事件中,ICIs的毒性分别为28%和15%。在仍存活的患者中,76%的患者在最后一次随访时仍有神经症状:在这项新西兰真实世界研究中,大多数患者都有症状,并接受了抗PD1单药治疗。约三分之一接受治疗的患者在 2 年后仍然存活,但大多数患者仍无症状。这凸显了对更有效治疗和前瞻性神经康复管理的需求。
{"title":"Real-World Outcomes of Immunotherapy for Melanoma Brain Metastases in New Zealand.","authors":"Niamh Walsh, Rosalie Stephens, Alvin Tan, Vanessa Durandt, Jennifer McLachlan, Jody Jordan, Kate Gregory, Sean Sutton, Catherine Barrow, Annie N M Wong","doi":"10.1200/OP.24.00208","DOIUrl":"10.1200/OP.24.00208","url":null,"abstract":"<p><strong>Purpose: </strong>Melanoma brain metastases (BMs) are associated with poor survival. Combination immune checkpoint inhibitors (ICIs) with anti-PD1 and anti-CTLA-4 are the international standard-of-care treatment. Most landmark clinical trials excluded real-world patients with symptomatic disease, poor performance status (PS), and steroid use. Despite the high incidence of melanoma in New Zealand (NZ), the only publicly funded systemic treatment is anti-PD1 monotherapy. The real-world outcomes for BMs after ICIs in NZ are unknown.</p><p><strong>Methodology: </strong>Medical records of patients with melanoma BMs in seven cancer centers across NZ between September 1, 2016, and September 1, 2020, were evaluated. Clinicopathologic characteristics, treatment, intracranial (IC) tumor response rates, IC progression-free survival, and overall survival (OS) are reported.</p><p><strong>Results: </strong>One hundred and forty-four patients received at least one dose of ICI. One hundred and thirty-three (93%) patients received anti-PD1 monotherapy. Almost a quarter of patients had poor baseline PS, 56% were symptomatic, and 33% had corticosteroids. Patients also received local therapies: 61 (42%) patients underwent surgery, 42 (29%) received whole brain radiation, and 47 (33%) received stereotactic radiation. The median OS was 15 months, and a third of patients were alive at 2 years. The toxicity of ICIs was at 28% and 15% for Common Terminology Criteria for Adverse Events grade 1-2 and 3-4 events, respectively. Of the patients who are still alive, 76% of patients remained symptomatic neurologically at last follow-up.</p><p><strong>Conclusion: </strong>Most patients in this NZ real-world study were symptomatic and received anti-PD1 monotherapy. Approximately one-third of treated patients are alive at 2 years, but most patients remained symptomatic. This highlights the need for more effective treatment and prospective management of their neurologic rehabilitation needs.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"358-364"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Three Versus Six Months of Adjuvant Oxaliplatin-Containing Chemotherapy for Patients With Stage III Colorectal Cancer: A Contemporary Real-World Analysis. III 期结直肠癌患者接受含奥沙利铂辅助化疗三个月还是六个月?当代真实世界分析
IF 4.7 3区 医学 Q1 ONCOLOGY Pub Date : 2025-03-01 Epub Date: 2024-10-09 DOI: 10.1200/OP-24-00492
Tharani Krishnan, Emily Leung, Joao Paulo Solar Vasconcelos, Howard Lim, Jonathan M Loree, Janine Davies, Karamjit Gill, Sharlene Gill

Purpose: Based on the International Duration Evaluation of Adjuvant Chemotherapy analysis, 3 months of adjuvant chemotherapy with capecitabine and oxaliplatin (CAPOX) is an option for stage III colorectal cancer (colorectal cancer [CRC]), with cost and toxicity benefits. We examined the patterns of uptake of CAPOX versus fluorouracil, leucovorin, and oxaliplatin (FOLFOX) and chemotherapy duration in a contemporary real-world cohort of patients in Canada.

Methods: The provincial pharmacy database was used to identify patients with resected stage III CRC receiving adjuvant chemotherapy between January 2021 and December 2022. Demographic, tumor, and treatment information was collected and compared.

Results: Of 452 patients, 234 (52%) and 218 (48%) were planned to receive 3 and 6 months of chemotherapy, respectively. Within the 3-month group, 226 (97%) received CAPOX. Within the 6-month group, there was a 51%-49% split between CAPOX and FOLFOX. Age >70 years (P = .039), well/moderately differentiated (P = .005), and low-risk disease (P < .0001) were significantly associated with 3 months. Performance status, ileostomy, or preexisting neuropathy did not affect treatment choice. Of patients planned for 6 months, 29% had low-risk disease, with 52% of these receiving CAPOX. Patients receiving 6 months were more likely to report neuropathy (68 v 36%, P < .0001) and to stop oxaliplatin early (54 v 31%, P < .0001). The most likely reason for early adjuvant discontinuation was neuropathy in the 6-month group and gastrointestinal toxicity in the 3-month group (P < .0001). Irrespective of duration, mean time from consult to starting chemotherapy was longer for FOLFOX versus CAPOX (24 v 19 days, P = .007).

Conclusion: In this contemporary cohort, 6 months chemotherapy is still being offered to patients with low-risk disease and is associated with more neuropathy. Exploration of patient preferences and resource costs may improve adoption of reduced duration adjuvant CAPOX in stage III CRC.

目的:根据国际辅助化疗持续时间评估分析,3 个月的卡培他滨和奥沙利铂辅助化疗(CAPOX)是 III 期结直肠癌(colorectal cancer [CRC])的一种选择,具有成本和毒性优势。我们研究了加拿大当代真实世界患者队列中 CAPOX 与氟尿嘧啶、亮菌素和奥沙利铂(FOLFOX)的使用模式以及化疗持续时间:方法:利用省级药房数据库来识别2021年1月至2022年12月期间接受辅助化疗的切除III期CRC患者。收集并比较了人口统计学、肿瘤和治疗信息:在452名患者中,分别有234人(52%)和218人(48%)计划接受3个月和6个月的化疗。在 3 个月组中,226 人(97%)接受了 CAPOX 化疗。在 6 个月组中,CAPOX 和 FOLFOX 的比例为 51%-49%。年龄大于 70 岁(P = .039)、分化良好/中度(P = .005)和低风险疾病(P < .0001)与 3 个月的疗程显著相关。表现状态、回肠造口术或已有的神经病变并不影响治疗选择。在计划接受 6 个月治疗的患者中,29% 患有低风险疾病,其中 52% 接受了 CAPOX 治疗。接受 6 个月治疗的患者更有可能报告神经病变(68 对 36%,P < .0001)和提前停用奥沙利铂(54 对 31%,P < .0001)。6个月组患者最有可能提前停用辅助药物的原因是神经病变,3个月组患者最有可能提前停用辅助药物的原因是胃肠道毒性(P < .0001)。无论疗程长短,FOLFOX与CAPOX相比,从就诊到开始化疗的平均时间更长(24天对19天,P = .007):结论:在这一现代队列中,6 个月的化疗仍在提供给低风险疾病患者,并且与更多的神经病变相关。对患者偏好和资源成本的探讨可能会改善 CAPOX 辅助化疗在 III 期 CRC 中的应用。
{"title":"Three Versus Six Months of Adjuvant Oxaliplatin-Containing Chemotherapy for Patients With Stage III Colorectal Cancer: A Contemporary Real-World Analysis.","authors":"Tharani Krishnan, Emily Leung, Joao Paulo Solar Vasconcelos, Howard Lim, Jonathan M Loree, Janine Davies, Karamjit Gill, Sharlene Gill","doi":"10.1200/OP-24-00492","DOIUrl":"10.1200/OP-24-00492","url":null,"abstract":"<p><strong>Purpose: </strong>Based on the International Duration Evaluation of Adjuvant Chemotherapy analysis, 3 months of adjuvant chemotherapy with capecitabine and oxaliplatin (CAPOX) is an option for stage III colorectal cancer (colorectal cancer [CRC]), with cost and toxicity benefits. We examined the patterns of uptake of CAPOX versus fluorouracil, leucovorin, and oxaliplatin (FOLFOX) and chemotherapy duration in a contemporary real-world cohort of patients in Canada.</p><p><strong>Methods: </strong>The provincial pharmacy database was used to identify patients with resected stage III CRC receiving adjuvant chemotherapy between January 2021 and December 2022. Demographic, tumor, and treatment information was collected and compared.</p><p><strong>Results: </strong>Of 452 patients, 234 (52%) and 218 (48%) were planned to receive 3 and 6 months of chemotherapy, respectively. Within the 3-month group, 226 (97%) received CAPOX. Within the 6-month group, there was a 51%-49% split between CAPOX and FOLFOX. Age >70 years (<i>P</i> = .039), well/moderately differentiated (<i>P</i> = .005), and low-risk disease (<i>P</i> < .0001) were significantly associated with 3 months. Performance status, ileostomy, or preexisting neuropathy did not affect treatment choice. Of patients planned for 6 months, 29% had low-risk disease, with 52% of these receiving CAPOX. Patients receiving 6 months were more likely to report neuropathy (68 <i>v</i> 36%, <i>P</i> < .0001) and to stop oxaliplatin early (54 <i>v</i> 31%, <i>P</i> < .0001). The most likely reason for early adjuvant discontinuation was neuropathy in the 6-month group and gastrointestinal toxicity in the 3-month group (<i>P</i> < .0001). Irrespective of duration, mean time from consult to starting chemotherapy was longer for FOLFOX versus CAPOX (24 <i>v</i> 19 days, <i>P</i> = .007).</p><p><strong>Conclusion: </strong>In this contemporary cohort, 6 months chemotherapy is still being offered to patients with low-risk disease and is associated with more neuropathy. Exploration of patient preferences and resource costs may improve adoption of reduced duration adjuvant CAPOX in stage III CRC.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"365-372"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Risk Without Reward: Differing Patterns of Chemotherapy Use Do Not Improve Outcomes in Stage II Early-Onset Colon Cancer. 没有回报的风险:化疗的不同使用模式并不能改善 II 期早发结肠癌的预后。
IF 4.7 3区 医学 Q1 ONCOLOGY Pub Date : 2025-03-01 Epub Date: 2024-07-24 DOI: 10.1200/OP.24.00159
Jacob B Leary, Junxiao Hu, Alexis Leal, S Lindsey Davis, Sunnie Kim, Robert Lentz, Tyler Friedrich, Whitney Herter, Wells A Messersmith, Christopher H Lieu

Purpose: Rising rates of early-onset colon cancer (EOCC) present challenges in deciding how to optimally treat patients. Although standard of care for stage II CC is surgical resection, adding chemotherapy for high-risk disease, evidence suggests treatment selection may differ by age. We investigated whether adjuvant chemotherapy (AC) administration rates differ between patients with early- and later-onset stage II CC.

Methods: Data originated from the nationwide Flatiron Health electronic health record (EHR)-derived deidentified database spanning January 1, 2003, to August 1, 2021. Adults with stage II CC were grouped as age 18-49 years (EOCC) and those age 50 years or older (later-onset colon cancer [LOCC]). Demographics, Eastern Cooperative Oncology Group score, tumor stage and site, and chemotherapy were included. Primary outcomes included rates of AC administration by age and ethnicity; secondary outcomes included overall survival (OS) and time to metastatic disease (TTMD). Univariate and multivariable logistic regression models evaluated relationships between chemotherapy administration, age, and ethnicity, adjusting for significant covariates.

Results: One thousand sixty-five patients were included. Median age of patients with EOCC was 45.0 years versus 69.0 years for patients with LOCC. Adjusted multivariate analysis showed patients with EOCC received AC significantly more often than patients with LOCC. Non-Hispanic patients received AC at significantly lower rates than Hispanic patients in both cohorts. Subanalysis of stage IIA patients showed that patients with EOCC were more likely to receive AC than patients with LOCC. No significant differences in OS or TTMD were observed by age regardless of AC administration in stage II overall; however, patients with stage IIA EOCC receiving AC had significantly longer TTMD than those not receiving AC.

Conclusion: AC was given preferentially in stage II EOCC, even in stage IIA, despite deviation from guidelines. This may expose low-risk patients to unnecessary toxicities and suggests bias toward treating younger patients more aggressively, despite unclear evidence for better outcomes.

目的:早发性结肠癌(EOCC)发病率的上升给决定如何对患者进行最佳治疗带来了挑战。虽然II期结肠癌的标准治疗方法是手术切除,并对高风险疾病进行化疗,但有证据表明,不同年龄段的患者选择的治疗方法可能不同。我们研究了早期和晚期II期CC患者的辅助化疗(AC)使用率是否存在差异:数据来源于全国性的 Flatiron Health 电子健康记录(EHR)衍生的去标识数据库,时间跨度为 2003 年 1 月 1 日至 2021 年 8 月 1 日。II期结肠癌患者分为18-49岁(EOCC)和50岁或以上(晚发结肠癌[LOCC])两组。研究对象包括人口统计学、东部合作肿瘤学组评分、肿瘤分期和部位以及化疗。主要结果包括不同年龄和种族的 AC 使用率;次要结果包括总生存期 (OS) 和转移性疾病发生时间 (TTMD)。单变量和多变量逻辑回归模型评估了化疗用药、年龄和种族之间的关系,并对重要的协变量进行了调整:共纳入 165 名患者。EOCC患者的中位年龄为45.0岁,而LOCC患者的中位年龄为69.0岁。调整后的多变量分析显示,EOCC 患者接受 AC 治疗的频率明显高于 LOCC 患者。在两个队列中,非西班牙裔患者接受 AC 治疗的比例明显低于西班牙裔患者。对 IIA 期患者进行的子分析显示,EOCC 患者比 LOCC 患者更有可能接受 AC 治疗。在II期患者中,无论是否接受AC治疗,按年龄划分的OS或TTMD均无明显差异;但接受AC治疗的IIA期EOCC患者的TTMD明显长于未接受AC治疗的患者:结论:尽管偏离了指南,但在 II 期 EOCC 中,即使是 IIA 期,也优先给予 AC。这可能会使低风险患者遭受不必要的毒副作用,并表明对年轻患者的治疗偏向于更积极,尽管没有明确的证据表明这样做能获得更好的疗效。
{"title":"Risk Without Reward: Differing Patterns of Chemotherapy Use Do Not Improve Outcomes in Stage II Early-Onset Colon Cancer.","authors":"Jacob B Leary, Junxiao Hu, Alexis Leal, S Lindsey Davis, Sunnie Kim, Robert Lentz, Tyler Friedrich, Whitney Herter, Wells A Messersmith, Christopher H Lieu","doi":"10.1200/OP.24.00159","DOIUrl":"10.1200/OP.24.00159","url":null,"abstract":"<p><strong>Purpose: </strong>Rising rates of early-onset colon cancer (EOCC) present challenges in deciding how to optimally treat patients. Although standard of care for stage II CC is surgical resection, adding chemotherapy for high-risk disease, evidence suggests treatment selection may differ by age. We investigated whether adjuvant chemotherapy (AC) administration rates differ between patients with early- and later-onset stage II CC.</p><p><strong>Methods: </strong>Data originated from the nationwide Flatiron Health electronic health record (EHR)-derived deidentified database spanning January 1, 2003, to August 1, 2021. Adults with stage II CC were grouped as age 18-49 years (EOCC) and those age 50 years or older (later-onset colon cancer [LOCC]). Demographics, Eastern Cooperative Oncology Group score, tumor stage and site, and chemotherapy were included. Primary outcomes included rates of AC administration by age and ethnicity; secondary outcomes included overall survival (OS) and time to metastatic disease (TTMD). Univariate and multivariable logistic regression models evaluated relationships between chemotherapy administration, age, and ethnicity, adjusting for significant covariates.</p><p><strong>Results: </strong>One thousand sixty-five patients were included. Median age of patients with EOCC was 45.0 years versus 69.0 years for patients with LOCC. Adjusted multivariate analysis showed patients with EOCC received AC significantly more often than patients with LOCC. Non-Hispanic patients received AC at significantly lower rates than Hispanic patients in both cohorts. Subanalysis of stage IIA patients showed that patients with EOCC were more likely to receive AC than patients with LOCC. No significant differences in OS or TTMD were observed by age regardless of AC administration in stage II overall; however, patients with stage IIA EOCC receiving AC had significantly longer TTMD than those not receiving AC.</p><p><strong>Conclusion: </strong>AC was given preferentially in stage II EOCC, even in stage IIA, despite deviation from guidelines. This may expose low-risk patients to unnecessary toxicities and suggests bias toward treating younger patients more aggressively, despite unclear evidence for better outcomes.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"333-340"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Importance of Identifying Physical Manifestations That Are Associated With Hereditary Cancer Predisposition: AXIN2 Mutation in an African American Patient. 识别与遗传性癌症易感性相关的体征的重要性:非裔美国人患者的 AXIN2 基因突变
IF 4.7 3区 医学 Q1 ONCOLOGY Pub Date : 2025-03-01 Epub Date: 2024-10-16 DOI: 10.1200/OP-24-00609
Al-Hafis Adegun, Reid Schalet, Ivan Berezowski, Marie L Borum
{"title":"Importance of Identifying Physical Manifestations That Are Associated With Hereditary Cancer Predisposition: AXIN2 Mutation in an African American Patient.","authors":"Al-Hafis Adegun, Reid Schalet, Ivan Berezowski, Marie L Borum","doi":"10.1200/OP-24-00609","DOIUrl":"10.1200/OP-24-00609","url":null,"abstract":"","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"440-441"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pregnancy-Associated Breast Cancer: Key Concepts for Optimizing Diagnosis and Treatment. 妊娠相关性乳腺癌:优化诊断和治疗的关键概念》。
IF 4.7 3区 医学 Q1 ONCOLOGY Pub Date : 2025-03-01 Epub Date: 2024-11-18 DOI: 10.1200/OP-24-00867
Meghana Kesireddy, Jairam Krishnamurthy
{"title":"Pregnancy-Associated Breast Cancer: Key Concepts for Optimizing Diagnosis and Treatment.","authors":"Meghana Kesireddy, Jairam Krishnamurthy","doi":"10.1200/OP-24-00867","DOIUrl":"10.1200/OP-24-00867","url":null,"abstract":"","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"275-277"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Subcutaneous vs Intravenous Trastuzumab/Pertuzumab: A Time and Motion Substudy of a Phase II Trial of Adjuvant Trastuzumab/Pertuzumab for Stage I HER2+ Breast Cancer (ADEPT trial). 皮下注射与静脉注射曲妥珠单抗/帕妥珠单抗:曲妥珠单抗/帕妥珠单抗辅助治疗 I 期 HER2+ 乳腺癌 II 期试验(ADEPT 试验)的时间与运动子研究。
IF 4.7 3区 医学 Q1 ONCOLOGY Pub Date : 2025-03-01 Epub Date: 2024-07-19 DOI: 10.1200/OP.24.00021
Adrienne G Waks, Emily L Chen, Noah Graham, Anna Mae Frey, Kenneth Almeida, Victoria Attaya, Cari Ryding, Ibrahim Abbass, Anita Fung, Jesse Sussell, Patricia Cortazar, Caroline Harvey, Denise Leth, Meredith Faggen, Natalie Sinclair, Jeanna Walsh, Nadine Tung, Sarah Sinclair, Steve Lo, Denise Yardley, Vicente Valero, Jane Meisel, Tarah J Ballinger, Sylvia Adams, Lisa A Carey, Julia K Rauch, Vandana G Abramson, Nicole O Williams, Wendy Y Chen, Jose P Leone, Susan T Schumer, Nabihah Tayob, Sara M Tolaney

Purpose: The time required for in-clinic drug administration can substantially affect breast cancer patients' quality of life. Subcutaneous (SC) drug administration, as opposed to intravenous (IV), may reduce this time commitment. This study sought to estimate the difference in time burden between IV and SC administration of trastuzumab and pertuzumab (HP).

Methods: We prospectively enrolled a subcohort of patients participating in the ADEPT trial (ClinicalTrials.gov identifier: NCT04569747, investigating adjuvant HP plus endocrine therapy for stage I human epidermal growth factor receptor 2-positive breast cancer) to this single-arm crossover time and motion substudy. Patients received two cycles of IV HP followed by two cycles of SC HP. During each cycle, time points in drug preparation and administration were captured. The primary end point was total patient time in the treatment chair. Additional end points included total patient treatment experience time and total pharmacy workflow time. A sample size of 22 patients was estimated to provide 90.7% power with two-sided alpha .05 to detect a difference of 70 minutes in the primary end point by treatment arm (IV v SC).

Results: Twenty-two patients were enrolled. The mean total patient time in the treatment chair was 61.8 minutes shorter with SC versus IV HP (22.5 v 84.3 minutes; P < .0001). The mean total patient treatment experience time (incorporating time spent waiting for treatment initiation and time spent in the treatment chair) was 81.8 minutes shorter for SC administration (96 v 177.8 minutes; P < .0001). The pharmacy workflow time was 78.2 minutes shorter for SC versus IV formulation (41 v 119.2 minutes; P < .0001).

Conclusion: SC administration of HP shortened patient time burden by approximately 1 hour. SC drug administration can facilitate faster workflows for health care professionals and improve patients' breast cancer treatment experience.

目的:门诊给药所需的时间会严重影响乳腺癌患者的生活质量。皮下注射(SC)给药与静脉注射(IV)给药相比,可以减少这种时间负担。本研究旨在估算曲妥珠单抗和百妥珠单抗(HP)静脉注射和皮下注射给药在时间负担上的差异:我们对参与 ADEPT 试验(ClinicalTrials.gov identifier:NCT04569747,研究I期人表皮生长因子受体2阳性乳腺癌的辅助HP加内分泌治疗)的患者参加这项单臂交叉时间和运动子研究。患者先接受两个周期的静脉注射 HP,然后再接受两个周期的 SC HP。在每个周期中,药物准备和给药的时间点都被记录下来。主要终点是患者在治疗椅上的总时间。其他终点包括患者治疗体验总时间和药房工作流程总时间。据估计,22 名患者的样本量可提供 90.7% 的功率(双侧α值为 0.05),以检测治疗臂(静脉注射 v SC)在主要终点上 70 分钟的差异:结果:22 名患者接受了治疗。患者在治疗椅上的平均总时间为 SC 对 IV HP(22.5 对 84.3 分钟;P < .0001),缩短了 61.8 分钟。静脉注射给药的患者总治疗时间(包括等待开始治疗的时间和在治疗椅上的时间)平均缩短了 81.8 分钟(96 分钟对 177.8 分钟;P < .0001)。药房工作流程时间为:皮下注射制剂比静脉注射制剂缩短 78.2 分钟(41 分钟对 119.2 分钟;P < .0001):结论:经皮给药可将患者的时间负担缩短约 1 小时。经皮给药可加快医护人员的工作流程,改善患者的乳腺癌治疗体验。
{"title":"Subcutaneous vs Intravenous Trastuzumab/Pertuzumab: A Time and Motion Substudy of a Phase II Trial of Adjuvant Trastuzumab/Pertuzumab for Stage I HER2+ Breast Cancer (ADEPT trial).","authors":"Adrienne G Waks, Emily L Chen, Noah Graham, Anna Mae Frey, Kenneth Almeida, Victoria Attaya, Cari Ryding, Ibrahim Abbass, Anita Fung, Jesse Sussell, Patricia Cortazar, Caroline Harvey, Denise Leth, Meredith Faggen, Natalie Sinclair, Jeanna Walsh, Nadine Tung, Sarah Sinclair, Steve Lo, Denise Yardley, Vicente Valero, Jane Meisel, Tarah J Ballinger, Sylvia Adams, Lisa A Carey, Julia K Rauch, Vandana G Abramson, Nicole O Williams, Wendy Y Chen, Jose P Leone, Susan T Schumer, Nabihah Tayob, Sara M Tolaney","doi":"10.1200/OP.24.00021","DOIUrl":"10.1200/OP.24.00021","url":null,"abstract":"<p><strong>Purpose: </strong>The time required for in-clinic drug administration can substantially affect breast cancer patients' quality of life. Subcutaneous (SC) drug administration, as opposed to intravenous (IV), may reduce this time commitment. This study sought to estimate the difference in time burden between IV and SC administration of trastuzumab and pertuzumab (HP).</p><p><strong>Methods: </strong>We prospectively enrolled a subcohort of patients participating in the ADEPT trial (ClinicalTrials.gov identifier: NCT04569747, investigating adjuvant HP plus endocrine therapy for stage I human epidermal growth factor receptor 2-positive breast cancer) to this single-arm crossover time and motion substudy. Patients received two cycles of IV HP followed by two cycles of SC HP. During each cycle, time points in drug preparation and administration were captured. The primary end point was total patient time in the treatment chair. Additional end points included total patient treatment experience time and total pharmacy workflow time. A sample size of 22 patients was estimated to provide 90.7% power with two-sided alpha .05 to detect a difference of 70 minutes in the primary end point by treatment arm (IV <i>v</i> SC).</p><p><strong>Results: </strong>Twenty-two patients were enrolled. The mean total patient time in the treatment chair was 61.8 minutes shorter with SC versus IV HP (22.5 <i>v</i> 84.3 minutes; <i>P</i> < .0001). The mean total patient treatment experience time (incorporating time spent waiting for treatment initiation and time spent in the treatment chair) was 81.8 minutes shorter for SC administration (96 <i>v</i> 177.8 minutes; <i>P</i> < .0001). The pharmacy workflow time was 78.2 minutes shorter for SC versus IV formulation (41 <i>v</i> 119.2 minutes; <i>P</i> < .0001).</p><p><strong>Conclusion: </strong>SC administration of HP shortened patient time burden by approximately 1 hour. SC drug administration can facilitate faster workflows for health care professionals and improve patients' breast cancer treatment experience.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"351-357"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141727201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Adjuvant Chemotherapy for Early-Onset Stage II Colon Cancer. 早期 II 期结肠癌的辅助化疗。
IF 4.7 3区 医学 Q1 ONCOLOGY Pub Date : 2025-03-01 Epub Date: 2024-09-13 DOI: 10.1200/OP-24-00611
Frank A Sinicrope

Rates of adjuvant chemotherapy in patients with early-onset versus later-onset stage II colon cancer.

早期与晚期 II 期结肠癌患者的辅助化疗率。
{"title":"Adjuvant Chemotherapy for Early-Onset Stage II Colon Cancer.","authors":"Frank A Sinicrope","doi":"10.1200/OP-24-00611","DOIUrl":"10.1200/OP-24-00611","url":null,"abstract":"<p><p>Rates of adjuvant chemotherapy in patients with early-onset versus later-onset stage II colon cancer.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"273-274"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association Between Medicaid Coverage Continuity and Survival in Patients With Newly Diagnosed Pediatric and Adolescent Cancers. 新确诊的儿童和青少年癌症患者的医疗补助覆盖连续性与存活率之间的关系》(Medicaid Coverage Continuity and Survival in Patients with Newly Diagnosed Pediatric and Adolescent Cancers)。
IF 4.7 3区 医学 Q1 ONCOLOGY Pub Date : 2025-03-01 Epub Date: 2024-09-30 DOI: 10.1200/OP.24.00268
Xin Hu, Sharon M Castellino, Anne C Kirchhoff, Rebecca S Williamson Lewis, Nicholas P DeGroote, Patricia Cornwell, Ann C Mertens, Joseph Lipscomb, Xu Ji

Purpose: Many patients with cancer do not gain Medicaid coverage until a cancer diagnosis, which can reduce access to early cancer detection and timely treatment, potentially driving inferior survival. Little is known about whether continuous Medicaid coverage prediagnosis through postdiagnosis (v gaining Medicaid at/after diagnosis) provides survival benefits for pediatric/adolescent oncology patients.

Materials and methods: We identified patients newly diagnosed with cancer at age 21 years or younger in a large pediatric health system between 2007 and 2016. Electronic medical records (EMRs) were linked to Medicaid administrative data to differentiate insurance continuity patterns during the 6 months preceding through the 6 months after cancer diagnosis (assessment window): continuous Medicaid, newly gained Medicaid (at or after diagnosis), and other Medicaid enrollment patterns. For patients not linked to Medicaid data, we used EMR-reported insurance types at diagnosis. We followed patients from 6 months postdiagnosis up to 5 years, death, or December 2020, whichever came first. Multivariable regressions estimated all-cause and cancer-specific survival, controlling for sociodemographic and cancer-related factors.

Results: Among 1,800 patients included in the analysis, 1,293 (71.8%) had some Medicaid enrollment during the assessment window; among them, 47.6% had continuous Medicaid and 36.3% had newly gained Medicaid. Patients not linked with Medicaid data had private (26.9%) or other/no insurance (1.2%) at diagnosis. Compared with patients with continuous Medicaid, those with newly gained Medicaid had higher risks of all-cause death (hazard ratio [HR], 1.41 [95% CI, 1.10 to 1.81]; P = .008) and cancer-specific death (HR, 1.46 [95% CI, 1.12 to 1.90]; P = .005).

Conclusion: Continuous Medicaid coverage throughout cancer diagnosis is associated with survival benefits for pediatric/adolescent patients. This finding has critical implications as millions of American individuals have been losing coverage since the unwinding of the Medicaid Continuous Enrollment Provision.

目的:许多癌症患者在确诊癌症之前并没有获得医疗补助保险,这可能会减少早期癌症检测和及时治疗的机会,从而降低生存率。至于在诊断前到诊断后持续享受医疗补助(即在诊断时/后获得医疗补助)是否会为儿科/青少年肿瘤患者带来生存方面的益处,人们知之甚少:我们确定了 2007 年至 2016 年间在一个大型儿科医疗系统中新确诊的 21 岁或以下癌症患者。电子病历(EMR)与医疗补助(Medicaid)管理数据相链接,以区分癌症诊断前 6 个月至诊断后 6 个月(评估窗口)期间的保险连续性模式:连续医疗补助、新获得的医疗补助(诊断时或诊断后)以及其他医疗补助注册模式。对于未链接到医疗补助计划数据的患者,我们使用 EMR 报告的诊断时的保险类型。我们对患者进行了从诊断后 6 个月到 5 年、死亡或 2020 年 12 月(以先到者为准)的随访。多变量回归估算了全因生存率和癌症特异性生存率,并对社会人口学因素和癌症相关因素进行了控制:在纳入分析的 1,800 名患者中,1,293 人(71.8%)在评估窗口期间加入了一些医疗补助计划;其中 47.6% 持续加入了医疗补助计划,36.3% 新加入了医疗补助计划。未与医疗补助计划数据关联的患者在确诊时拥有私人保险(26.9%)或其他/无保险(1.2%)。与连续享受医疗补助的患者相比,新获得医疗补助的患者全因死亡风险更高(危险比 [HR],1.41 [95% CI,1.10 至 1.81];P = .008),癌症特异性死亡风险更高(HR,1.46 [95% CI,1.12 至 1.90];P = .005):结论:在癌症诊断期间持续享受医疗补助与儿童/青少年患者的生存益处相关。这一发现具有重要意义,因为自医疗补助连续参保规定解除以来,已有数百万美国人失去了医保。
{"title":"Association Between Medicaid Coverage Continuity and Survival in Patients With Newly Diagnosed Pediatric and Adolescent Cancers.","authors":"Xin Hu, Sharon M Castellino, Anne C Kirchhoff, Rebecca S Williamson Lewis, Nicholas P DeGroote, Patricia Cornwell, Ann C Mertens, Joseph Lipscomb, Xu Ji","doi":"10.1200/OP.24.00268","DOIUrl":"10.1200/OP.24.00268","url":null,"abstract":"<p><strong>Purpose: </strong>Many patients with cancer do not gain Medicaid coverage until a cancer diagnosis, which can reduce access to early cancer detection and timely treatment, potentially driving inferior survival. Little is known about whether continuous Medicaid coverage prediagnosis through postdiagnosis (<i>v</i> gaining Medicaid at/after diagnosis) provides survival benefits for pediatric/adolescent oncology patients.</p><p><strong>Materials and methods: </strong>We identified patients newly diagnosed with cancer at age 21 years or younger in a large pediatric health system between 2007 and 2016. Electronic medical records (EMRs) were linked to Medicaid administrative data to differentiate insurance continuity patterns during the 6 months preceding through the 6 months after cancer diagnosis (assessment window): continuous Medicaid, newly gained Medicaid (at or after diagnosis), and other Medicaid enrollment patterns. For patients not linked to Medicaid data, we used EMR-reported insurance types at diagnosis. We followed patients from 6 months postdiagnosis up to 5 years, death, or December 2020, whichever came first. Multivariable regressions estimated all-cause and cancer-specific survival, controlling for sociodemographic and cancer-related factors.</p><p><strong>Results: </strong>Among 1,800 patients included in the analysis, 1,293 (71.8%) had some Medicaid enrollment during the assessment window; among them, 47.6% had continuous Medicaid and 36.3% had newly gained Medicaid. Patients not linked with Medicaid data had private (26.9%) or other/no insurance (1.2%) at diagnosis. Compared with patients with continuous Medicaid, those with newly gained Medicaid had higher risks of all-cause death (hazard ratio [HR], 1.41 [95% CI, 1.10 to 1.81]; <i>P</i> = .008) and cancer-specific death (HR, 1.46 [95% CI, 1.12 to 1.90]; <i>P</i> = .005).</p><p><strong>Conclusion: </strong>Continuous Medicaid coverage throughout cancer diagnosis is associated with survival benefits for pediatric/adolescent patients. This finding has critical implications as millions of American individuals have been losing coverage since the unwinding of the Medicaid Continuous Enrollment Provision.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"380-390"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
JCO oncology practice
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1