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Breast cancer in Bulgaria prior implementation of a national breast cancer screening program and certified breast centers 保加利亚在实施国家乳腺癌筛查计划和认证乳腺中心之前的乳腺癌情况。
IF 2 Q3 HEALTH POLICY & SERVICES
Journal of Cancer Policy
Pub Date : 2024-12-11 DOI: 10.1016/j.jcpo.2024.100531
Mariela Vasileva-Slaveva , Desislava Kostova-Lefterova , Filip Simeonov , Angel Yordanov , Metodi Metodiev

Introduction

Breast cancer (BC) survival has improved globally in the past years. Eastern Europe is a region with lack of epidemiological data and traditionally lower BC overall survival (OS). We aimed to investigate the epidemiology of BC in Bulgaria between 2012 and 2022 and the readiness of the state for implementing population based organized screening program.

Methods and materials

This is a retrospective study of 38 576 invasive BC cases registered in Bulgarian National Cancer Registry. We obtained data from publicly available sources - national institutes and regulatory agencies. We report descriptive statistics of distribution of cases and mammography units among the country and the compared survival of patient’s groups.

Results

75 % of patients are treated in the 9 biggest cities. They are younger, diagnosed earlier and have significantly better OS than the rest of the patients. Patients over 75 years represent 18.7 % of all. The 211 installed mammography systems can secure the implementation of organized BC screening.

Discussion

The survival gap between cities can be due to the limited access to care of older patients living in smaller cities. The model of collaboration between private and state centers can be highly effective in implementing of organized screening since in Bulgaria both can be reimbursed by the National Insurance Fund.

Conclusion

Further centralization of care probably would not have such an impact on treatment outcomes as improvement and monitoring the quality of the provided treatment. Organized BC screening in Bulgaria is needed and technically possible step towards improving survival.
导读：在过去的几年里，乳腺癌（BC）的生存率在全球范围内有所提高。东欧是一个缺乏流行病学数据和传统上较低的BC总生存率（OS）的地区。我们的目的是调查保加利亚2012年至2022年间BC的流行病学，以及该国实施以人口为基础的有组织筛查计划的准备情况。方法和材料：这是一项对保加利亚国家癌症登记处登记的38576例浸润性BC病例的回顾性研究。我们从公开来源获得数据——国家研究所和监管机构。我们报告了全国病例和乳房x光检查单位分布的描述性统计数据，并比较了患者组的生存率。结果：75%的患者在9个最大的城市得到治疗。他们更年轻，诊断更早，比其他患者有明显更好的OS。75岁以上患者占18.7%。211个安装的乳房x光检查系统可以确保有组织的BC筛查的实施。讨论：城市之间的生存差距可能是由于生活在小城市的老年患者获得护理的机会有限。私营和国家中心之间的合作模式在执行有组织的检查方面非常有效，因为在保加利亚，两者都可以由国家保险基金报销。结论：进一步的集中护理可能不会对治疗结果产生影响，如改善和监测所提供治疗的质量。保加利亚需要有组织的BC筛查，这是提高生存率的技术上可行的步骤。
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引用次数: 0
Post-surgical acute care utilization and cost of care among cancer survivors with an ostomy: Findings from three large hospital systems in the United States 造口术后癌症幸存者的术后急性护理利用和护理费用：来自美国三家大型医院系统的调查结果
IF 2 Q3 HEALTH POLICY & SERVICES
Journal of Cancer Policy
Pub Date : 2024-12-09 DOI: 10.1016/j.jcpo.2024.100534
Daniel Maeng , Rebecca L. Hoffman , Virginia Sun , Robert P. Sticca , Robert S. Krouse

Purpose

To describe patterns of 6-month total cost of care and acute care utilization among cancer survivors who received ostomy surgeries in 3 large hospital systems in the United States between 2018 and 2022 and to identify reasons for acute care utilization.

Methods

A retrospective cohort study using electronic medical records and the corresponding hospital revenue data obtained from 3 geographically diverse hospital systems in the United States was performed. 6-month all-cause post-surgical encounters subsequent to respective ostomy surgery dates were included. Clinical reasons for acute care utilization were captured and examined via available diagnosis codes.

Results

Mean six-month total cost of care per patient varied greatly by hospital and by payer type, ranging between $18,000 and $80,000. Inpatient care was the largest driver of these cost, accounting for 70 % of the total cost of care. In the sample, 56 % of the patients experienced one or more post-surgical inpatient admissions over a six-month period. Moreover, 26 % of the acute care events were associated with primary or secondary diagnosis codes potentially attributable to post-surgical ostomy-related complications, accounting for approximately 18 % of the total cost. Patients who received urostomy and/or had metastatic cancer had higher rates of acute care utilization, although statistical significances were not achieved.

Conclusion

The results are indicative of significant financial burdens as well as morbidities associated with post-surgical ostomy care that are common across hospital systems. Some of these cost burdens are potentially avoidable with improved ostomy follow-up care.
目的：描述2018年至2022年期间在美国3家大型医院系统接受造口手术的癌症幸存者6个月总护理成本和急性护理利用模式，并确定急性护理利用的原因。方法：采用美国3个不同地区医院系统的电子病历和相应的医院收入数据进行回顾性队列研究。包括在各自造口手术日期后6个月的全因术后就诊。通过可用的诊断代码捕获和检查急性护理利用的临床原因。结果：每个病人平均六个月的总护理费用因医院和付款人类型而异，在18,000美元到80,000美元之间。住院护理是这些成本的最大驱动因素，占护理总成本的70% %。在样本中，56% %的患者在六个月内经历了一次或多次术后住院。此外，26% %的急性护理事件与可能归因于术后造口相关并发症的初级或二级诊断代码相关，约占总成本的18% %。接受泌尿造口术和/或患有转移性癌症的患者有更高的急性护理利用率，尽管没有统计学意义。结论：研究结果表明，在整个医院系统中，与术后造口护理相关的经济负担和发病率很高。其中一些费用负担是可以通过改善造口术后护理来避免的。
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引用次数: 0
Trend of sales revenue by year for top selling cancer drugs in the US and the effect of loss of market exclusivity 美国最畅销抗癌药物的年度销售收入趋势及市场独占性丧失的影响。
IF 2 Q3 HEALTH POLICY & SERVICES
Journal of Cancer Policy
Pub Date : 2024-12-09 DOI: 10.1016/j.jcpo.2024.100533
Myung Sun Kim , Alyson Haslam , Vinay Prasad
Biosimilars and generics have led to reduced cancer drug prices. The effect of biosimilar or generic drug competition on drug manufacturer revenue has not been previously described. In this study, the majority of top selling cancer drugs had a greater than 50 % decline in sales revenue within 2 years of generic or biosimilar market entry, reflecting both the decline in market share and reduction in unit drug price. This results in important drug manufacturer incentives, which may shape clinical trial agendas. The market structure incentives are unique for pharmaceutical companies due to the relatively short and limited duration of profitability. Policy changes such as patent reform leading to shorter duration of exclusivity may lead to greater incentive to expand low value indications in oncology.
生物仿制药和仿制药降低了抗癌药物的价格。生物仿制药或仿制药竞争对药品制造商收入的影响以前没有描述过。在本研究中，大多数畅销抗癌药物在仿制药或生物仿制药进入市场的2年内，销售收入下降幅度大于50%，反映了市场份额的下降和单位药价的降低。这导致了重要的药品制造商激励，这可能会影响临床试验议程。由于制药公司的盈利能力相对较短，持续时间有限，因此市场结构激励对制药公司来说是独特的。政策变化，如专利改革导致专有权持续时间缩短，可能会导致更大的动机扩大低价值适应症在肿瘤学。
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引用次数: 0
Rethinking public health in wartime: Smoking and long-term health outcomes amidst the war in Ukraine 重新思考战时公共卫生：乌克兰战争中的吸烟和长期健康后果。
IF 2 Q3 HEALTH POLICY & SERVICES
Journal of Cancer Policy
Pub Date : 2024-12-07 DOI: 10.1016/j.jcpo.2024.100532
Paweł Koczkodaj, Irmina Maria Michalek
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引用次数: 0
The impact of conflict on cancer care in Libya 冲突对利比亚癌症治疗的影响。
IF 2 Q3 HEALTH POLICY & SERVICES
Journal of Cancer Policy
Pub Date : 2024-12-06 DOI: 10.1016/j.jcpo.2024.100528
Abeir El-Mogassabi , Ibtisam Gheith Kaziri

Background

The ongoing Libyan Civil Conflict, initiated in 2011, has had a devastating impact on the country's healthcare system, particularly cancer care. This review delves into the challenges faced by cancer patients and healthcare providers in Libya.

Methods

A comprehensive literature review was conducted to identify relevant studies, reports, and news articles relating to cancer care in Libya. The review focused on the impact of the conflict on cancer prevention, diagnosis, treatment, and palliative care.

Results

The conflict has significantly disrupted cancer care in Libya. Key challenges include limited access to care due to infrastructure damage and security concerns. Shortages of essential medications and medical equipment have hindered cancer treatment. Inadequate healthcare infrastructure, resulting from damage and destruction, limits the availability of diagnostic and treatment services. The shortage of skilled healthcare professionals exacerbates the situation. Additionally, the absence of reliable data on cancer incidence and mortality hinders effective planning and resource allocation.

Policy summary

To improve cancer care in Libya, urgent action is needed to address the challenges posed by the conflict. This includes increasing investment in healthcare infrastructure, providing adequate funding for cancer control programmes, and strengthening the capacity of healthcare workers. Additionally, international cooperation and support are essential to help Libya rebuild its healthcare system and provide quality cancer care to its citizens.
背景：2011年开始的持续不断的利比亚内战对该国的医疗保健系统，特别是癌症治疗产生了破坏性影响。本综述深入探讨了利比亚癌症患者和医疗保健提供者面临的挑战。方法：进行全面的文献综述，以确定有关利比亚癌症治疗的相关研究、报告和新闻文章。这篇综述的重点是冲突对癌症预防、诊断、治疗和姑息治疗的影响。结果：冲突严重破坏了利比亚的癌症治疗。主要挑战包括由于基础设施受损和安全问题，获得医疗服务的机会有限。基本药物和医疗设备的短缺阻碍了癌症的治疗。由于破坏和破坏，保健基础设施不足，限制了诊断和治疗服务的提供。缺乏熟练的保健专业人员使情况更加恶化。此外，缺乏关于癌症发病率和死亡率的可靠数据妨碍了有效的规划和资源分配。政策摘要：为了改善利比亚的癌症治疗，需要采取紧急行动，应对冲突带来的挑战。这包括增加对卫生保健基础设施的投资，为癌症控制规划提供充足的资金，以及加强卫生保健工作者的能力。此外，国际合作和支持对于帮助利比亚重建其医疗体系并为其公民提供高质量的癌症治疗至关重要。
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引用次数: 0
Financial conflicts among physician speakers at the April 12, 2024 Oncology Drug Advisory Meeting: Who decided that MRD can be a novel regulatory endpoint in myeloma? 在2024年4月12日的肿瘤药物咨询会议上，医生发言人之间的财务冲突：谁决定MRD可以成为骨髓瘤的新监管终点？
IF 2 Q3 HEALTH POLICY & SERVICES
Journal of Cancer Policy
Pub Date : 2024-12-06 DOI: 10.1016/j.jcpo.2024.100529
Noah J. Carr , Alyson Haslam , Vinay Prasad

Background

In April 2024, the Oncology Drug Advisory Committee (ODAC) voted to approve minimal residual disease (MRD) as a new regulatory endpoint for multiple myeloma (MM) despite its poor trial-level surrogacy. This is expected to result in faster MM drug approvals, a potential boon for the pharmaceutical companies that make them. This study investigates the prevalence of financial conflicts of interest (FCOIs) with these companies among United States (US)-based physician speakers at the meeting.

Methods

Public data regarding the past 3 years of pharmaceutical company payments to US-based physician speakers at the ODAC meeting discussing MRD (available at https://openpaymentsdata.cms.gov/) were collected. For each general payment (GP), we recorded the amount, company payor, reason for payment, and associated products. Descriptive analyses were performed on payments from companies who manufacture MM therapeutics (MM payments).

Results

12 of the 20 physician speakers (60 %) eligible to have FCOIs recorded on the OpenPayments database received MM payments from 2021 to 2023, totaling more than $792,200. A majority of both voting and non-voting members had MM payments (median $11,800 and $764), most of which were consulting fees. Speakers earned more than 3.7 times as much from GPs associated with MM-related products compared to those associated with non-MM-related products.

Conclusion

Most US-based physician speakers at the April 2024 ODAC meeting had FCOIs from MM companies, including those with voting power.

Policy summary

Our findings highlight the need for greater policing of FCOIs among US-based physicians involved in cancer drug regulatory policy.
背景：2024年4月，肿瘤药物咨询委员会（ODAC）投票批准最小残留病（MRD）作为多发性骨髓瘤（MM）的新监管终点，尽管其试验级替代治疗效果不理想。预计这将导致更快的MM药物批准，这对生产这些药物的制药公司来说是一个潜在的福音。本研究调查了在会议上的美国（US）医生发言人与这些公司的财务利益冲突（FCOIs）的普遍性。方法：收集过去3年制药公司向在ODAC会议上讨论MRD的美国医生发言人支付的公开数据（可在https://openpaymentsdata.cms.gov/上获得）。对于每笔一般付款，我们记录了金额、付款人、付款原因和相关产品。描述性分析进行了支付的公司谁制造MM治疗（MM支付）。结果：有资格在OpenPayments数据库中记录fcoi的20名医生发言人中有12名（60%）在2021年至2023年期间收到MM付款，总额超过792,200美元。大多数有投票权和无投票权的成员都有MM付款（中位数为11,800美元和764美元），其中大部分是咨询费。演讲者从与mm相关产品相关的普通合伙人那里获得的收入是与非mm相关产品相关的普通合伙人的3.7倍以上。结论：在2024年4月的ODAC会议上，大多数美国医生演讲者都有来自MM公司的fcoi，包括那些有投票权的fcoi。政策摘要：我们的研究结果强调了在参与癌症药物监管政策的美国医生中加强fcoi监管的必要性。
{"title":"Financial conflicts among physician speakers at the April 12, 2024 Oncology Drug Advisory Meeting: Who decided that MRD can be a novel regulatory endpoint in myeloma?","authors":"Noah J. Carr ,&nbsp;Alyson Haslam ,&nbsp;Vinay Prasad","doi":"10.1016/j.jcpo.2024.100529","DOIUrl":"10.1016/j.jcpo.2024.100529","url":null,"abstract":"<div><h3>Background</h3><div>In April 2024, the Oncology Drug Advisory Committee (ODAC) voted to approve minimal residual disease (MRD) as a new regulatory endpoint for multiple myeloma (MM) despite its poor trial-level surrogacy. This is expected to result in faster MM drug approvals, a potential boon for the pharmaceutical companies that make them. This study investigates the prevalence of financial conflicts of interest (FCOIs) with these companies among United States (US)-based physician speakers at the meeting.</div></div><div><h3>Methods</h3><div>Public data regarding the past 3 years of pharmaceutical company payments to US-based physician speakers at the ODAC meeting discussing MRD (available at <span><span>https://openpaymentsdata.cms.gov/</span><svg><path></path></svg></span>) were collected. For each general payment (GP), we recorded the amount, company payor, reason for payment, and associated products. Descriptive analyses were performed on payments from companies who manufacture MM therapeutics (MM payments).</div></div><div><h3>Results</h3><div>12 of the 20 physician speakers (60 %) eligible to have FCOIs recorded on the OpenPayments database received MM payments from 2021 to 2023, totaling more than $792,200. A majority of both voting and non-voting members had MM payments (median $11,800 and $764), most of which were consulting fees. Speakers earned more than 3.7 times as much from GPs associated with MM-related products compared to those associated with non-MM-related products.</div></div><div><h3>Conclusion</h3><div>Most US-based physician speakers at the April 2024 ODAC meeting had FCOIs from MM companies, including those with voting power.</div></div><div><h3>Policy summary</h3><div>Our findings highlight the need for greater policing of FCOIs among US-based physicians involved in cancer drug regulatory policy.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"43 ","pages":"Article 100529"},"PeriodicalIF":2.0,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Towards promoting a legal framework for ending discrimination against cancer survivors. A human rights-centered approach 促进消除对癌症幸存者歧视的法律框架。以人权为中心的方针。
IF 2 Q3 HEALTH POLICY & SERVICES
Journal of Cancer Policy
Pub Date : 2024-12-06 DOI: 10.1016/j.jcpo.2024.100527
Françoise Meunier , Grazia Scocca , Françoise Tulkens
The article explores the development of the right to be forgotten (RTBF) for cancer survivors, with a focus on preventing discrimination based on their medical history. It discusses legal progress in European Union (EU) countries, including national laws and EU initiatives such as Europe’s Beating Cancer Plan and the Consumer Credits Directive, which aim to protect survivors from financial and social obstacles. These measures are designed to standardize protection across member states and ensure that cancer survivors are not unfairly treated due to their past illness. The article advocates for continued progress in fully reintegrating cancer survivors into society, which involves eliminating the stigma associated with their medical history, and promoting justice, equality, and respect for their human dignity.
本文探讨了癌症幸存者被遗忘权（RTBF）的发展，重点是防止基于其病史的歧视。它讨论了欧盟国家的法律进展，包括国家法律和欧盟倡议，如欧洲战胜癌症计划和消费者信贷指令，旨在保护幸存者免受经济和社会障碍。这些措施旨在使成员国之间的保护标准化，并确保癌症幸存者不会因过去的疾病而受到不公平对待。这篇文章倡导在癌症幸存者完全重新融入社会方面继续取得进展，这包括消除与他们的病史有关的耻辱，促进正义、平等和尊重他们的人格尊严。
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引用次数: 0
Socioeconomic inequalities in kidney and renal pelvis cancer mortality in Canada: Trends over three decades 加拿大肾癌和肾盂癌死亡率的社会经济不平等：30年来的趋势。
IF 2 Q3 HEALTH POLICY & SERVICES
Journal of Cancer Policy
Pub Date : 2024-12-03 DOI: 10.1016/j.jcpo.2024.100524
Mohammad Hajizadeh , Nazanin Nasiri , Grace Johnston

Background

Kidney and renal pelvis cancer (KCa) presents significant health challenges that require investigation. This study measured and examined trends in socioeconomic inequalities in the mortality of KCa in Canada over the period 1990–2019.

Methods

We constructed a census division level dataset pooled from the Canadian Vital Death Statistics Database (CVSD), the Canadian Census of the Population (CCP), and the National Household Survey (NHS) to measure income and education inequalities in the mortality rate of KCa in Canada over the study period. The age-standardized Concentration index (C), which measures inequality across all socioeconomic groups, was used to quantify income and education inequalities in the mortality of KCa in Canada. Trend analyses evaluated changes in these inequalities over time.

Results

The average crude KCa mortality rates were found to be 5.97 and 3.40 per 100,000 for the male and female populations, respectively. The crude KCa mortality consistently increased over time in eastern but not western Canada. Statistically negative values of the age-standardized C index showed higher KCa mortality in the lower-income and less-educated population, particularly among females, with no changes observed over the 30-year study period.

Conclusion

The higher KCa mortality in socioeconomically disadvantaged groups in Canada indicates the continuing need for primary prevention through lowering smoking rates, reducing obesity, and controlling hypertension. Additionally, promoting greater use of abdominal imaging for the incidental early KCa detection can enable more effective treatment and improved survival rates, especially for females of lower socioeconomic status.
背景：肾癌和肾盂癌（KCa）提出了重大的健康挑战，需要调查。因此，本研究测量并检查了1990年至2019年期间加拿大KCa死亡率的社会经济不平等趋势。方法：我们构建了一个来自加拿大重要死亡统计数据库（CVSD）、加拿大人口普查（CCP）和全国家庭调查（NHS）的人口普查级别数据集，以衡量在研究期间加拿大KCa死亡率的收入和教育不平等。年龄标准化的集中指数(C)衡量了所有社会经济群体的不平等，用于量化加拿大KCa死亡率的收入和教育不平等。趋势分析评估了这些不平等随着时间的变化。结果：男性和女性的KCa平均粗死亡率分别为5.97 / 10万和3.40 / 10万。随着时间的推移，加拿大东部的KCa粗死亡率持续上升，而西部则没有。年龄标准化C指数的统计负值表明，在低收入和受教育程度较低的人群中，尤其是女性，KCa死亡率较高，这在30年的研究期间没有变化。结论：加拿大社会经济弱势群体中较高的KCa死亡率表明，继续需要通过降低吸烟率、减少肥胖和控制高血压来进行一级预防，同时重视对偶然的KCa早期检测进行更大的腹部成像的好处，从而更有效地治疗和提高生存率，特别是对社会经济地位较低的女性。
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引用次数: 0
The burden of metastatic breast cancer on caregiver productivity and quality of life: A survey study in the United States, United Kingdom, and Germany 转移性乳腺癌对护理人员生产力和生活质量的负担：美国、英国和德国的一项调查研究。
IF 2 Q3 HEALTH POLICY & SERVICES
Journal of Cancer Policy
Pub Date : 2024-12-02 DOI: 10.1016/j.jcpo.2024.100526
Erin Comerford , Sukyung Chung , Marlon Graf , Natalie Land , Anh-Thy Nguyen , Medha Sasane , Ying Zheng , Suepattra G. May

Background

Caring for a patient with metastatic breast cancer (mBC) can impose a substantial burden and can lead to significant productivity losses. However, the extent to which productivity loss impacts caregiver well-being has not been well-elucidated. This study examined the relationship between productivity and other characteristics with quality of life (QoL) to illuminate the multifaceted challenges faced by caregivers in the context of mBC.

Methods

We conducted a one-time, cross-sectional survey of 345 informal caregivers of people living with mBC in the United States, United Kingdom, and Germany in December 2021. Caregivers were asked about their QoL using the Caregiver Quality of Life Index-Cancer (CQOLC) and pre-/post-caregiving productivity impacts. Heterogeneity in reported burden was assessed across a variety of caregiver characteristics.

Results

One in three caregivers changed work status after onset of caregiving, either reducing working hours (12 %), stopping work altogether (13 %), or increasing working hours (8 %). Caregivers who reduced hours or stopped working reported better QoL overall with total CQOLC scores of 71.8 and 65.3, compared to those who maintained or increased work hours (CQOLC scores of 61.3 and 54.4, respectively, [p < 0.001]). While there were no differences in caregiver QoL by patients’ disease status (p = 0.48), longer time spent caregiving was associated with lower burden (p = 0.002).

Conclusions

Caregiver productivity and QoL scores indicate leaving the workforce may ease the challenges associated with caregiving, suggesting a need for workplace flexibility to better support caregivers. Our study emphasizes the importance of supporting caregivers alongside patients, acknowledging caregiver well-being can significantly influence patient outcomes.

Policy Summary

Although the burden associated with cancer caregiving has been well-documented, policies supporting caregivers, such as flexible employment leave and mental health support resources, are urgently needed to improve QoL and health outcomes for both patients and their informal caregivers.
背景：转移性乳腺癌（mBC）患者的护理可能会带来巨大的负担，并可能导致显著的生产力损失。然而，生产力损失对护理人员福祉的影响程度尚未得到很好的阐明。本研究考察了生产力和其他特征与生活质量（QoL）之间的关系，以阐明护理人员在mBC背景下面临的多方面挑战。方法：我们于2021年12月对美国、英国和德国的345名mBC患者的非正式护理人员进行了一次性横断面调查。使用护理者生活质量指数-癌症（CQOLC）和护理前/后的生产力影响来询问护理者的生活质量。报告负担的异质性通过各种照顾者特征进行评估。结果：三分之一的照顾者在开始照顾后改变工作状态，减少工作时间（12%），完全停止工作（13%）或增加工作时间（8%）。与维持或增加工作时间的护理人员（CQOLC得分分别为61.3和54.4）相比，减少工作时间或停止工作的护理人员报告了更好的总体生活质量，其CQOLC得分分别为71.8和65.3。[p]结论：护理人员的生产力和生活质量得分表明，离开工作岗位可能会缓解与护理相关的挑战，这表明需要工作场所的灵活性来更好地支持护理人员。我们的研究强调了支持护理人员和患者的重要性，承认护理人员的健康可以显著影响患者的预后。政策概述：尽管与癌症护理相关的负担已被充分记录，但迫切需要支持护理者的政策，如灵活的就业假和心理健康支持资源，以改善患者及其非正式护理者的生活质量和健康结果。
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引用次数: 0
Impact of medicaid expansion on screenable versus non-screenable gastrointestinal cancers 医疗补助扩大对可筛查性和非筛查性胃肠道癌症的影响。
IF 2 Q3 HEALTH POLICY & SERVICES
Journal of Cancer Policy
Pub Date : 2024-12-02 DOI: 10.1016/j.jcpo.2024.100525
Omid Salehi , Kanishka Uttam Chandani , Cara J. Sammartino , Ponnandai Somasundar , N.Joseph Espat , Abdul Saied Calvino , Steve Kwon

Background

Medicaid expansion afforded increased healthcare access to low-income Americans contributing to a positive impact on cancer outcomes. However, it is unclear if these benefits were mainly due to enhanced access to cancer screening and earlier diagnosis versus access to cancer treatment

Methods

The National Cancer Database (NCDB) was queried between 2010 and 2021 for Medicaid and uninsured patients with GI malignancies. Patients were stratified by screenable (SGI) and non-screenable (NGI) cancers and expansion state (ES) categories: early (EES) and late (LES) adopters, and non-expansion state (NES) cohorts. Statistical analyses, including difference-in-difference (DiD) and adjusted models, assessed the impact of Medicaid expansion on stage at diagnosis.

Results

There were 230,159 pre-expansion and 539,028 post-expansion patients. There was an increase in Medicaid coverage (14.8 % vs. 11.1 %) and a concomitant decline in the uninsured population (5.3 % vs. 8.2 %) in the post-expansion era. For SGI cancers, Medicaid expansion was associated with significantly lower mean stage at diagnosis (DiD Coef. −0.12; p < 0.01). For NGI cancers, Medicaid expansion was associated with a lower mean stage at diagnosis but with much smaller coefficient (DiD Coef. −0.015; p < 0.01). Comparing EES and LES to NES, EES had more impact on lower mean stage at diagnosis (vs NES DiD Coef. −0.16; p < 0.01) compared to LES (vs NES DiD Coef. −0.02; p = 0.04) for SGI cancers. For NGI cancers, there was a modest reduction in mean stage at diagnosis only for EES (vs NES DiD Coef. −0.04; p < 0.01).

Conclusion

Medicaid expansion, particularly for SGI cancers and early adopters, had a profound impact in lowering the mean stage at diagnosis. This emphasizes that long-term advantages of providing access to preventive care and screening, and thus earlier treatment, may be one of the main mechanisms of Medicaid expansion on improving cancer outcomes for GI malignancies.

Policy summary

To establish the benefits of Medicaid expansion under the Affordable Care Act 2010 for gastrointestinal cancer patients particularly in screening.
背景：医疗补助扩大为低收入美国人提供了更多的医疗保健机会，对癌症治疗结果产生了积极影响。然而，目前尚不清楚这些益处是否主要是由于癌症筛查和早期诊断的增加，而不是癌症治疗的增加。方法：在2010-2021年期间，对国家癌症数据库（NCDB）中医疗补助和未投保的胃肠道恶性肿瘤患者进行了查询。患者按可筛查（SGI）和不可筛查（NGI）癌症和扩展状态（ES）类别进行分层：早期（EES）和晚期（LES）采用者，以及非扩展状态（NES）队列。统计分析，包括差异中的差异（DiD）和调整模型，评估了医疗补助扩大对诊断阶段的影响。结果：扩术前230159例，扩后539028例。在后经济扩张时代，医疗补助覆盖率有所增加（14.8%对11.1%），未参保人口也随之下降（5.3%对8.2%）。对于SGI癌症，医疗补助扩大与较低的平均诊断期（DiD系数）显著相关。-0.12;结论：医疗补助的扩大，特别是对于SGI癌症和早期患者，对降低诊断的平均阶段有深远的影响。这强调了提供预防保健和筛查的长期优势，从而早期治疗，可能是医疗补助扩大改善胃肠道恶性肿瘤癌症结局的主要机制之一。政策总结：根据《2010年平价医疗法案》，确定医疗补助扩大对胃肠道癌症患者的好处，特别是在筛查方面。
{"title":"Impact of medicaid expansion on screenable versus non-screenable gastrointestinal cancers","authors":"Omid Salehi ,&nbsp;Kanishka Uttam Chandani ,&nbsp;Cara J. Sammartino ,&nbsp;Ponnandai Somasundar ,&nbsp;N.Joseph Espat ,&nbsp;Abdul Saied Calvino ,&nbsp;Steve Kwon","doi":"10.1016/j.jcpo.2024.100525","DOIUrl":"10.1016/j.jcpo.2024.100525","url":null,"abstract":"<div><h3>Background</h3><div>Medicaid expansion afforded increased healthcare access to low-income Americans contributing to a positive impact on cancer outcomes. However, it is unclear if these benefits were mainly due to enhanced access to cancer screening and earlier diagnosis versus access to cancer treatment</div></div><div><h3>Methods</h3><div>The National Cancer Database (NCDB) was queried between 2010 and 2021 for Medicaid and uninsured patients with GI malignancies. Patients were stratified by screenable (SGI) and non-screenable (NGI) cancers and expansion state (ES) categories: early (EES) and late (LES) adopters, and non-expansion state (NES) cohorts. Statistical analyses, including difference-in-difference (DiD) and adjusted models, assessed the impact of Medicaid expansion on stage at diagnosis.</div></div><div><h3>Results</h3><div>There were 230,159 pre-expansion and 539,028 post-expansion patients. There was an increase in Medicaid coverage (14.8 % vs. 11.1 %) and a concomitant decline in the uninsured population (5.3 % vs. 8.2 %) in the post-expansion era. For SGI cancers, Medicaid expansion was associated with significantly lower mean stage at diagnosis (DiD Coef. −0.12; p &lt; 0.01). For NGI cancers, Medicaid expansion was associated with a lower mean stage at diagnosis but with much smaller coefficient (DiD Coef. −0.015; p &lt; 0.01). Comparing EES and LES to NES, EES had more impact on lower mean stage at diagnosis (vs NES DiD Coef. −0.16; p &lt; 0.01) compared to LES (vs NES DiD Coef. −0.02; p = 0.04) for SGI cancers. For NGI cancers, there was a modest reduction in mean stage at diagnosis only for EES (vs NES DiD Coef. −0.04; p &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>Medicaid expansion, particularly for SGI cancers and early adopters, had a profound impact in lowering the mean stage at diagnosis. This emphasizes that long-term advantages of providing access to preventive care and screening, and thus earlier treatment, may be one of the main mechanisms of Medicaid expansion on improving cancer outcomes for GI malignancies.</div></div><div><h3>Policy summary</h3><div>To establish the benefits of Medicaid expansion under the Affordable Care Act 2010 for gastrointestinal cancer patients particularly in screening.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"43 ","pages":"Article 100525"},"PeriodicalIF":2.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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