Journal of the National Comprehensive Cancer Network最新文献

Background: Alcohol use disorder (AUD) is associated with cancer recurrence, new malignancies, and mortality among survivors of certain cancers. This study evaluated trends (2012-2021) in prevalence and correlates of AUD diagnoses among adult cancer survivors in the United States.

Methods: This retrospective, serial cross-sectional study used claims data (2011-2021) from a national sample of US individuals with employer-sponsored health insurance. Adults diagnosed with malignant neoplasms who had at least 6 months of continuous health insurance enrollment prior to their cancer diagnosis were included. The primary outcome was a recent AUD diagnosis in each year of the study period identified from inpatient and outpatient records. We assessed AUD prevalence for each year among all cancer survivors and in specific subgroups. Using data from 2021, we compared sociodemographic and clinical characteristics between cancer survivors with and without AUD diagnoses and identified correlates of AUD diagnosis by using multivariable logistic regression.

Results: Of 5,956,137 eligible cancer survivors, 105,778 (1.78%) had received an AUD diagnosis. The annual prevalence of AUD diagnoses increased from 0.78% in 2012 to 1.43% in 2021 (P<.0001). AUD prevalence also increased in specific subgroups, including individuals with alcohol-related cancers (from 0.88% to 1.61%; P<.0001) and those receiving antineoplastic agents (from 0.97% to 1.60%; P<.0001). Multivariable logistic regression analysis demonstrated that male sex, alcohol-related cancers, mental health diagnoses, and other substance use disorders were associated with at least 2 to 5 times greater odds of an AUD diagnosis.

Conclusions: AUD diagnosis among US cancer survivors with private health insurance has increased over time, mirroring trends in the general population. Integrating AUD screening and treatment into cancer care may help mitigate the unique risks associated with alcohol use and misuse in cancer survivors.

Background: We evaluated variations in patient outcomes and financial expenditures following complex cancer surgery across flagship hospitals and their affiliates.

Methods: Using Medicare 100% Standard Analytic Files (2018-2021), we identified patients undergoing resection of lung, esophageal, gastric, hepatopancreatobiliary, or colorectal cancer. Flagship hospitals were defined as the highest-volume major teaching hospital within a system in each region. Propensity score matching was performed to create a 1:1 matched cohort to assess the association between flagship systems, hospitals, affiliates, and outcomes.

Results: Among 110,670 patients, 55,335 treated within a flagship hospital system (median age, 73 years [IQR, 69-79]; including 29,381 [53.1%] women) were matched with 55,335 patients who were not (median age, 73 years [IQR, 69-79]; including 29,274 [52.9%] women) across 35 regions. Patients at flagship system hospitals had lower 30-day mortality rates than matched controls (4.23% vs 4.88%; difference, -0.65% [95% CI, -0.89% to -0.40%]; P<.001). Mortality was also lower at flagship hospitals (2.76% vs 3.82%; difference, -1.06% [95% CI, -1.62% to -0.50%]) and flagship affiliates (4.46% vs 4.79%; difference, -0.32% [95% CI, -0.58 to -0.07]) compared with controls (both P<.001). However, patients who underwent cancer surgery at flagship hospital systems had higher expenditures ($21,011 vs $20,016; difference, +$995 [95% CI, $797 to $1,193]; P<.001).

Conclusions: Flagship hospitals are the primary drivers of decreased postoperative mortality following complex oncologic surgical procedures performed within their systems, although expenditures were higher compared with unaffiliated hospitals.

The last 2 decades have seen a paradigm shift in the treatment landscape of metastatic gastric and gastroesophageal adenocarcinomas, with most of the progress occurring in recent years. Following the pivotal ToGA trial and the approval of trastuzumab for HER2-positive disease, the search for biomarkers has advanced exponentially. Currently, therapies are guided by key biomarkers such as HER2, PD-L1, dMMR/MSI-H, and, most recently, CLDN18.2. FGFR2b is emerging as a potential biomarker in this field. The most recent addition to this therapeutic arsenal is zolbetuximab. Two recent phase III trials have demonstrated survival benefits with the addition of zolbetuximab to frontline chemotherapy. A number of other biomarker-driven clinical trials are in progress, investigating new targeted agents that are expected to further transform the management of gastric or gastroesophageal adenocarcinoma.

Background: The presence of variants of uncertain significance (VUS) should not influence clinical management; however, prior studies on breast cancer-related health care utilization in women with VUS versus negative germline genetic test results have shown conflicting findings. This study evaluated whether receipt of a VUS influences breast cancer-related health care utilization.

Methods: This large study analyzed health care utilization and costs in women who underwent clinical multigene panel testing (MGPT) between 2015 and 2023 at a single commercial laboratory with ≥2 years of health insurance claims data available. Multivariable logistic regression was used to assess differences in the uptake of surgical, therapeutic, risk-reducing, and surveillance modalities, as well as the associated health care costs, between women with VUS or negative MGPT results after the return of test findings.

Results: Of 50,657 eligible women (mean age, 47.7 years), most were White (66.8%), had a family history of cancer (87.0%), and had commercial insurance (71.1%). Among 22,699 patients with breast cancer, those with VUS showed no differences from those with negative results in the uptake of surgical, therapeutic, risk-reducing, and surveillance procedures or in the adjusted cost of surgical procedures after genetic testing. Among 27,958 cancer-free women, those with negative results had modestly lower mammography use (odds ratio, 0.9; 95% CI, 0.8-0.9) compared with those with VUS. Breast cancer screening and treatment costs were no higher for women with VUS versus negative results, but were up to 10 times higher for those with positive results.

Conclusions: In a large, real-world sample of women with breast cancer and without any cancer, use of cancer treatments, surveillance, and risk-reducing measures did not differ between patients with VUS versus negative results, except for modestly higher mammography use. These findings offer reassurance that VUS results do not lead to overutilization or increased cost of health care.

Background: Parents face mental health challenges following their child's cancer diagnosis. However, it is unknown whether parental mental illness following a childhood cancer diagnosis influences the child's mortality.

Patients and methods: Using several nationwide registers in Sweden, we identified children diagnosed with cancer between ages 0 to 14 from 2005 to 2016. Parental mental illness was determined from the National Patient Register, Prescribed Drug Register and primary health care data, which was based on hospitalization records, specialist clinic visits, or prescribed medication for mental disorders after the child's diagnosis. Time-dependent Cox regression models were used to examine the association between parental mental illness and child survival, adjusting for potential confounders.

Results: Among 2,867 children diagnosed with cancer, 1,801 (62.8%) had parents who experienced mental disorders following the diagnosis. Children with affected parents had a 47% higher mortality risk (adjusted HR, 1.47; 95% CI, 1.18-1.84) compared with children whose parents remained free of mental illness. The risk increased to 2.16 (95% CI, 1.58-2.97) for children with both parents affected. Notably, children whose parents had no prior history of mental disorders but developed newly onset mental illness after the diagnosis had a 77% higher risk of mortality risk (adjusted HR, 1.77; 95% CI, 1.33-2.36) compared with those whose parents remained free of mental illness throughout the follow-up period. Landmark analysis findings were consistent with primary results.

Conclusions: Parental mental well-being following a child's cancer diagnosis can significantly impact the child's survival. Addressing parental mental illness, particularly when it emerges after the diagnosis, is crucial for improving child prognosis. These findings strengthen the call to action for targeted interventions that support parental mental health as an integral component of pediatric cancer care to improve child outcome.

Background: Cardiotoxicity and cardiovascular (CV) adverse events associated with CDK4/6 inhibitors have raised concerns in the treatment of advanced breast cancer, impacting patient safety and increasing health care costs. This study compares the incidence of hypertension and major adverse cardiovascular events (MACE) in patients with breast cancer receiving CDK4/6 inhibitors and estimates the incremental health care costs associated with these conditions.

Methods: This retrospective cohort study utilized the 2017-2021 Merative MarketScan Research Database. Women with breast cancer who initiated CDK4/6 inhibitors (palbociclib, ribociclib, or abemaciclib) were included in 2 cohorts. The hypertension cohort comprised patients with no prior hypertension in the 12 months before initiating CDK4/6 inhibitors, whereas the MACE cohort included those with no prior hypertension or MACE during the same period. The primary outcomes were the incidence of hypertension and MACE, with secondary outcomes being the incremental health care costs associated with these conditions.

Results: A total of 2,780 patients were included in the hypertension cohort and 2,043 in the MACE cohort. Compared with ribociclib, neither abemaciclib (hazard ratio [HR], 0.791; 95% CI, 0.507-1.232) nor palbociclib (HR, 0.723; 95% CI, 0.493-1.060) showed a statistically significant difference in hypertension risk. For MACE, palbociclib was associated with a statistically significant lower risk (HR, 0.636; 95% CI, 0.454-0.892), whereas abemaciclib was not (HR, 0.795; 95% CI, 0.540-1.169). Patients who developed hypertension and MACE incurred higher health care costs, averaging $2,964 and $4,010 per patient per month, respectively.

Conclusions: Palbociclib was associated with a significantly lower risk of MACE compared with ribociclib in patients with breast cancer. Patients who developed hypertension or MACE incurred substantially higher health care costs. These findings underscore the importance of minimizing CV adverse events in patients with breast cancer treated with CDK4/6 inhibitors.

Background: Financial toxicity has been increasingly recognized as a major driver of negative outcomes for patients with cancer, with prior interventions focused primarily on patient-level support. The Financial Toxicity Tumor Board (FTTB), established in 2019, is the first institutional-level intervention addressing these challenges. We report on its function and outcomes over 5 years of operation.

Methods: Drawing on expertise from across the cancer center, the FTTB was designed to operate similarly to traditional, disease-focused multidisciplinary tumor boards but with a focus on issues related to financial distress. Over time, this system-level intervention has evolved, with major changes including a shift to disease-focused meetings and the developing refinement of process to an Archetype system-categorizing cases as Immediate Assistance Required, System-Level Issue Identified, or Policy/Legislative Issue Identified-which has enhanced its function and effectiveness. In tandem, the pharmacy-based patient assistance program (PAP) arm of the FTTB, formerly focused only on drug approvals, has expanded to address routine financial challenges associated with broader cancer care.

Results: Over the past 5 years, >70 cases have been presented to the tumor board, with most resulting in immediate solutions for the individual patient as well as numerous systemic changes. The PAP arm of the FTTB has provided 9,321 patients with copay assistance, totalling >$10,316,695. Furthermore, 16,495 patients have received free medications, amounting to $392,895,101 in patient benefits.

Conclusions: The success of the FTTB-both through the tumor board and PAP arms-demonstrates that focused systemic intervention can lead to sustained, substantial improvements in financial toxicity. This model should be further developed as a new standard of care.