Pub Date : 2024-03-18DOI: 10.1016/j.jcpo.2024.100473
Francesco Ferrara , Maurizio Capuozzo , Roberto Langella , Ugo Trama , Eduardo Nava , Andrea Zovi
Background
Biosimilar drugs offer an opportunity for all global healthcare systems because they provide significant cost savings while ensuring equal efficacy and safety in the treatment of chronic diseases. These savings can be allocated to support ongoing innovation.
Methods
An analysis of the usage of major biosimilar drugs across various therapeutic areas has been conducted within an Italian healthcare company serving a population of over one million. Data on consumption, expenditure, and the number of treated patients has been extracted from the company's databases. Finally, a comparison with the year 2021 has been performed to determine if biosimilar drug usage increased in 2022.
Results
In 2022, the data reveals that a substantial portion of the analysed active ingredients are being used as biosimilar drugs, except in a few residual cases. However, among the most consumed drugs, resistance still exists in the case of Adalimumab and Etanercept, for which expenditure on originator drugs exceeds 2 million euros.
Conclusion
The 2022–2021 comparison highlights the increasing use of biosimilar drugs. This data is encouraging and suggests that in the coming months, we may achieve total utilization, which would be to the benefit of the National Health System (NHS) and the citizens who can rely on an efficient and sustainable healthcare policy that is continually improving.
{"title":"The use of the biosimilar drug can lead to large health care savings that can be reinvested for continued innovation: Analysis of consumption of an Italian health care company","authors":"Francesco Ferrara , Maurizio Capuozzo , Roberto Langella , Ugo Trama , Eduardo Nava , Andrea Zovi","doi":"10.1016/j.jcpo.2024.100473","DOIUrl":"10.1016/j.jcpo.2024.100473","url":null,"abstract":"<div><h3>Background</h3><p>Biosimilar drugs offer an opportunity for all global healthcare systems because they provide significant cost savings while ensuring equal efficacy and safety in the treatment of chronic diseases. These savings can be allocated to support ongoing innovation.</p></div><div><h3>Methods</h3><p>An analysis of the usage of major biosimilar drugs across various therapeutic areas has been conducted within an Italian healthcare company serving a population of over one million. Data on consumption, expenditure, and the number of treated patients has been extracted from the company's databases. Finally, a comparison with the year 2021 has been performed to determine if biosimilar drug usage increased in 2022.</p></div><div><h3>Results</h3><p>In 2022, the data reveals that a substantial portion of the analysed active ingredients are being used as biosimilar drugs, except in a few residual cases. However, among the most consumed drugs, resistance still exists in the case of Adalimumab and Etanercept, for which expenditure on originator drugs exceeds 2 million euros.</p></div><div><h3>Conclusion</h3><p>The 2022–2021 comparison highlights the increasing use of biosimilar drugs. This data is encouraging and suggests that in the coming months, we may achieve total utilization, which would be to the benefit of the National Health System (NHS) and the citizens who can rely on an efficient and sustainable healthcare policy that is continually improving.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"40 ","pages":"Article 100473"},"PeriodicalIF":1.3,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140176963","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}
Pub Date : 2024-03-11DOI: 10.1016/j.jcpo.2024.100470
Klaus Puschel , Beti Thompson , Andrea Rioseco , Augusto Leon , Carolina Goic , Isabella Fuentes , Zdenka Vescovi
Introduction
The global cancer burden is increasing. Current global evidence indicates there will be a 47% rise of cancer cases for the period 2020–2040. The cancer rate differential also is evident within countries and regions. Efforts have been used to reduce the health disparities; however, the inequity prevails. One potential way to help reduce the disparity is through advocacy by physicians.
Methods
Two recent systematic review articles on advocacy among physicians note that physicians are unlikely to be taught advocacy in medical education, and also note there are no advocacy competencies or skill sets that are either taught or valued in medical education. We explore literature and develop a model to understand the components of advocacy in medical education, specifically in resident training. We follow the model’s main components by examining principles of advocacy, relevant domains of advocacy, and competencies and values for advocacy education.
Results
Four ethical principles of advocacy education are identified: beneficence, non-maleficence, autonomy, and justice. These principles must be applied in meaningful, culturally sensitive, respectful, and promotion of the well-being ways.
Three domains are identified: the practice domain (provider-patient interaction), the community domain (provider-community collaboration), and the health policy domain (the larger social environment). Advocacy occurs differently within each domain.
Finally, competencies in the form of knowledge, skills, and values are described. We present a table noting where each competency occurs (by domain) as well as the value of each knowledge and skill.
Policy summary
The significance of including advocacy instruction in medical education requires a change in the current medical education field. Besides valuing the concept of including advocacy, principles, domains, and competencies of inclusion are critical. In summary, we encourage the inclusion of advocacy education in resident medical programs so physicians become competent medical providers at diverse levels of society.
{"title":"Cancer advocacy in residency education: From principles to competencies","authors":"Klaus Puschel , Beti Thompson , Andrea Rioseco , Augusto Leon , Carolina Goic , Isabella Fuentes , Zdenka Vescovi","doi":"10.1016/j.jcpo.2024.100470","DOIUrl":"10.1016/j.jcpo.2024.100470","url":null,"abstract":"<div><h3>Introduction</h3><p>The global cancer burden is increasing. Current global evidence indicates there will be a 47% rise of cancer cases for the period 2020–2040. The cancer rate differential also is evident within countries and regions. Efforts have been used to reduce the health disparities; however, the inequity prevails. One potential way to help reduce the disparity is through advocacy by physicians.</p></div><div><h3>Methods</h3><p>Two recent systematic review articles on advocacy among physicians note that physicians are unlikely to be taught advocacy in medical education, and also note there are no advocacy competencies or skill sets that are either taught or valued in medical education. We explore literature and develop a model to understand the components of advocacy in medical education, specifically in resident training. We follow the model’s main components by examining principles of advocacy, relevant domains of advocacy, and competencies and values for advocacy education.</p></div><div><h3>Results</h3><p>Four ethical principles of advocacy education are identified: beneficence, non-maleficence, autonomy, and justice. These principles must be applied in meaningful, culturally sensitive, respectful, and promotion of the well-being ways.</p><p>Three domains are identified: the practice domain (provider-patient interaction), the community domain (provider-community collaboration), and the health policy domain (the larger social environment). Advocacy occurs differently within each domain.</p><p>Finally, competencies in the form of knowledge, skills, and values are described. We present a table noting where each competency occurs (by domain) as well as the value of each knowledge and skill.</p></div><div><h3>Policy summary</h3><p>The significance of including advocacy instruction in medical education requires a change in the current medical education field. Besides valuing the concept of including advocacy, principles, domains, and competencies of inclusion are critical. In summary, we encourage the inclusion of advocacy education in resident medical programs so physicians become competent medical providers at diverse levels of society.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"40 ","pages":"Article 100470"},"PeriodicalIF":1.3,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140120950","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}
Pub Date : 2024-02-02DOI: 10.1016/j.jcpo.2024.100468
Ethna McFerran , Sarah Donaldson , Olivia Dolan , Mark Lawler
Background
Skin cancer is a prevalent cancer in the UK. Its rising incidence and mortality rates are expected to result in substantial financial implications, particularly on diagnostic and treatment services for skin cancer management in Northern Ireland (NI). Such anticipated disease increases underscore the need for prevention and control measures that should help guide policymaking and planning efforts.
Methods
We conducted a cost of illness study to assess the economic impact of skin cancer in NI from the healthcare system's perspective, using a bottom-up method, employing NHS reference costs (UK£) for skin cancer diagnosis and treatment patient pathways in 2021/22. Sensitivity analyses varied diagnostic volumes by applying multipliers for benign cases, assuming a diagnostic conversion rate of 6.8%, and examined an alternative chemotherapy regimen compliance rate of 75%. Additionally, proportional cost increases were projected based on future estimated increases of 9% and 28% to malignant melanoma (MM) cases for diagnostic, treatment, and follow-up volumes.
Results
Significant numbers of non-melanoma skin cancers (NMSC) and MM cases were recorded, 4289 NMSCs and 439 MM cases. The total cost for managing NMSC was £ 3,365,350. Total costs for MM skin cancer were £ 13,740,681, including £ 8,753,494 for procurement, administration, and chemotherapy drug use. Overall healthcare spending on skin cancer care totalled £ 21,167,651. Sensitivity analysis suggested diagnostic cost may increase significantly to £ 12,374,478 based on referral volume assumptions. If base case rates rise by 9 or 28% estimated total costs of treating skin cancer will increase to £ 22.3 million and £ 24.9 million, respectively.
Conclusions
Skin cancer management costs in NI totalled ∼£ 21.1 million to £ 32.1 million, depending on diagnostic referral assumptions. Costs have risen ∼10-fold over the past decade for MM due largely to chemotherapy costs. A predicted 28% increase in MM cases by 2040 would lead to ∼£ 3.8 million of additional expenditures, providing a significant challenge for cancer health systems.
{"title":"Skin in the game: The cost consequences of skin cancer diagnosis, treatment and care in Northern Ireland","authors":"Ethna McFerran , Sarah Donaldson , Olivia Dolan , Mark Lawler","doi":"10.1016/j.jcpo.2024.100468","DOIUrl":"10.1016/j.jcpo.2024.100468","url":null,"abstract":"<div><h3>Background</h3><p>Skin cancer is a prevalent cancer in the UK. Its rising incidence and mortality rates are expected to result in substantial financial implications, particularly on diagnostic and treatment services for skin cancer management in Northern Ireland (NI). Such anticipated disease increases underscore the need for prevention and control measures that should help guide policymaking and planning efforts.</p></div><div><h3>Methods</h3><p>We conducted a cost of illness study to assess the economic impact of skin cancer in NI from the healthcare system's perspective, using a bottom-up method, employing NHS reference costs (UK£) for skin cancer diagnosis and treatment patient pathways in 2021/22. Sensitivity analyses varied diagnostic volumes by applying multipliers for benign cases, assuming a diagnostic conversion rate of 6.8%, and examined an alternative chemotherapy regimen compliance rate of 75%. Additionally, proportional cost increases were projected based on future estimated increases of 9% and 28% to malignant melanoma (MM) cases for diagnostic, treatment, and follow-up volumes.</p></div><div><h3>Results</h3><p>Significant numbers of non-melanoma skin cancers (NMSC) and MM cases were recorded, 4289 NMSCs and 439 MM cases. The total cost for managing NMSC was £ 3,365,350. Total costs for MM skin cancer were £ 13,740,681, including £ 8,753,494 for procurement, administration, and chemotherapy drug use. Overall healthcare spending on skin cancer care totalled £ 21,167,651. Sensitivity analysis suggested diagnostic cost may increase significantly to £ 12,374,478 based on referral volume assumptions. If base case rates rise by 9 or 28% estimated total costs of treating skin cancer will increase to £ 22.3 million and £ 24.9 million, respectively.</p></div><div><h3>Conclusions</h3><p>Skin cancer management costs in NI totalled ∼£ 21.1 million to £ 32.1 million, depending on diagnostic referral assumptions. Costs have risen ∼10-fold over the past decade for MM due largely to chemotherapy costs. A predicted 28% increase in MM cases by 2040 would lead to ∼£ 3.8 million of additional expenditures, providing a significant challenge for cancer health systems.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"39 ","pages":"Article 100468"},"PeriodicalIF":1.3,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S221353832400002X/pdfft?md5=2502e6aab6d7f24d637ebb15efb47100&pid=1-s2.0-S221353832400002X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139708138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-24DOI: 10.1016/j.jcpo.2024.100469
Mohit Pandey, Mahadev Bramhankar, Abhishek Anand
Background
Cancer imposes a substantial economic burden due to treatment costs, supportive care, and loss of productivity. Besides all the affecting factors, major concerns lead to significant financial burdens of cancer treatment, bringing unwanted huge unbearable direct and indirect treatment costs. The aim was to explore the nature of additional mobility/travel required for accessing health care for cancer patients and also to assess financial burden due to additional mobility/travel costs for cancer treatment.
Methods
This study employed unit-level cross-sectional data from the 75th round (2017–18) of India's National Sample Survey (NSS). The primary analysis commenced with descriptive and bivariate analyses to explore mean health spending and out-of-pocket expenses. Subsequently, multivariable logistic regression models were utilized to estimate the associations between catastrophic health expenditure, distress financing, and the treatment location.
Results
The findings highlight distinct healthcare utilization patterns: inpatient treatments predominantly occur within the same district (50.4 %), followed by a different district (38.8 %), and a smaller share in other states (10.8 %). Outpatients largely receive treatment in the same district (65.5 %), followed by a different district (26.8 %), and around 8 % percent in other states. Urban areas show higher inpatient visits within the same district (41.8 %) and different districts (33.5 %). Outpatients, particularly those seeking treatment in other states, experience higher total expenditures, notably with higher out-of-pocket expenses. Distress financing is more common among inpatients (20.6 %) and combined inpatient/outpatient cases (23.9 %), while outpatients exhibit a lower rate (6.8 %).
Conclusion
The findings collectively suggest the importance of developing local healthcare infrastructures to reduce the additional mobility of cancer patients. The policy should focus to train and deploy oncologists in non-urban areas can help bridge the gap in cancer care proficiency and reduce the need for patients to travel long distances for treatment.
{"title":"Exploring the financial burden due to additional mobility among cancer patients: A cross-sectional study based on National Sample Survey","authors":"Mohit Pandey, Mahadev Bramhankar, Abhishek Anand","doi":"10.1016/j.jcpo.2024.100469","DOIUrl":"10.1016/j.jcpo.2024.100469","url":null,"abstract":"<div><h3>Background</h3><p><span>Cancer imposes a substantial economic burden due to treatment costs, supportive care, and loss of productivity. Besides all the affecting factors, major concerns lead to significant financial burdens </span>of cancer treatment<span>, bringing unwanted huge unbearable direct and indirect treatment costs. The aim was to explore the nature of additional mobility/travel required for accessing health care for cancer patients and also to assess financial burden due to additional mobility/travel costs for cancer treatment.</span></p></div><div><h3>Methods</h3><p>This study employed unit-level cross-sectional data from the 75th round (2017–18) of India's National Sample Survey (NSS). The primary analysis commenced with descriptive and bivariate analyses to explore mean health spending and out-of-pocket expenses. Subsequently, multivariable logistic regression models were utilized to estimate the associations between catastrophic health expenditure, distress financing, and the treatment location.</p></div><div><h3>Results</h3><p>The findings highlight distinct healthcare utilization patterns: inpatient treatments predominantly occur within the same district (50.4 %), followed by a different district (38.8 %), and a smaller share in other states (10.8 %). Outpatients largely receive treatment in the same district (65.5 %), followed by a different district (26.8 %), and around 8 % percent in other states. Urban areas show higher inpatient visits within the same district (41.8 %) and different districts (33.5 %). Outpatients, particularly those seeking treatment in other states, experience higher total expenditures, notably with higher out-of-pocket expenses. Distress financing is more common among inpatients (20.6 %) and combined inpatient/outpatient cases (23.9 %), while outpatients exhibit a lower rate (6.8 %).</p></div><div><h3>Conclusion</h3><p>The findings collectively suggest the importance of developing local healthcare infrastructures to reduce the additional mobility of cancer patients. The policy should focus to train and deploy oncologists in non-urban areas can help bridge the gap in cancer care proficiency and reduce the need for patients to travel long distances for treatment.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"39 ","pages":"Article 100469"},"PeriodicalIF":1.3,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139567431","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}
Pub Date : 2024-01-21DOI: 10.1016/j.jcpo.2024.100467
Biplab Kumar Datta , Aneesha Gummadi , Steven S. Coughlin
Background
Psychosocial factors can play important roles in promoting preventive health behaviors. This study aimed to assess how life satisfaction, receipt of emotional support, and feeling of social isolation were associated with adherence to the USPSTF recommendation of breast cancer screening in a nationally representative US population.
Methods
Using data on 71,583 women aged 50 to 74 years, from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) survey, we estimated multivariable logistic regressions to assess the odds of adherence across different categories of the respective psychosocial constructs. We accounted for various demographic and socioeconomic correlates and checked the robustness of the relationship within income and educational sub-groups.
Results
We found that women who were dissatisfied with their life were 52.0% less likely to adhere compared to women who reported to be very satisfied. Similarly, women who rarely/never got emotional support and who always/usually felt socially isolated were 51.6% and 39.9% less likely to adhere, compared to women who always got support and never felt isolated, respectively. These results were robust across different levels of income and educational attainment.
Conclusion
Our findings demonstrated a strong association between social environment, psychological wellbeing, and adherence to breast cancer screening, and thus suggested scope of potential psychosocial interventions to improve adherence.
Policy summary
Efforts to improve women’s psychosocial wellbeing could facilitate compliance with breast cancer screening recommendations.
{"title":"Role of life satisfaction, emotional support, and feeling of social isolation on adherence to breast cancer screening recommendations among US women","authors":"Biplab Kumar Datta , Aneesha Gummadi , Steven S. Coughlin","doi":"10.1016/j.jcpo.2024.100467","DOIUrl":"10.1016/j.jcpo.2024.100467","url":null,"abstract":"<div><h3>Background</h3><p>Psychosocial factors can play important roles in promoting preventive health behaviors. This study aimed to assess how life satisfaction, receipt of emotional support, and feeling of social isolation were associated with adherence to the USPSTF recommendation of breast cancer screening in a nationally representative US population.</p></div><div><h3>Methods</h3><p>Using data on 71,583 women aged 50 to 74 years, from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) survey, we estimated multivariable logistic regressions to assess the odds of adherence across different categories of the respective psychosocial constructs. We accounted for various demographic and socioeconomic correlates and checked the robustness of the relationship within income and educational sub-groups.</p></div><div><h3>Results</h3><p>We found that women who were dissatisfied with their life were 52.0% less likely to adhere compared to women who reported to be very satisfied. Similarly, women who rarely/never got emotional support and who always/usually felt socially isolated were 51.6% and 39.9% less likely to adhere, compared to women who always got support and never felt isolated, respectively. These results were robust across different levels of income and educational attainment.</p></div><div><h3>Conclusion</h3><p>Our findings demonstrated a strong association between social environment, psychological wellbeing, and adherence to breast cancer screening, and thus suggested scope of potential psychosocial interventions to improve adherence.</p></div><div><h3>Policy summary</h3><p>Efforts to improve women’s psychosocial wellbeing could facilitate compliance with breast cancer screening recommendations.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"39 ","pages":"Article 100467"},"PeriodicalIF":1.3,"publicationDate":"2024-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139521999","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}
Pub Date : 2024-01-04DOI: 10.1016/j.jcpo.2023.100465
David Nelson , Peter Selby , Ros Kane , Ava Harding-Bell , Amanda Kenny , Kathie McPeake , Samuel Cooke , Todd Hogue , Kathy Oliver , Mark Gussy , Mark Lawler
Existing evidence often indicates higher cancer incidence and mortality rates, later diagnosis, lower screening uptake and poorer long-term survival for people living in rural compared to more urbanised areas. Despite wide inequities and variation in cancer care and outcomes across Europe, much of the scientific literature explicitly exploring the impact of rurality on cancer continues to come from Australia and North America. The European Code of Cancer Practice or “The Code” is a citizen and patient-centred statement of the most salient requirements for good clinical cancer practice and has been extensively co-produced by cancer patients, cancer professionals and patient advocates. It contains 10 key overarching Rights that a cancer patient should expect from their healthcare system, regardless of where they live and has been strongly endorsed by professional and patient cancer organisations as well as the European Commission. In this article, we use these 10 fundamental Rights as a framework to argue that (i) the issues and needs identified in The Code are generally more profound for rural people with cancer; (ii) addressing these issues is also more challenging in rural contexts; (iii) interventions and support must explicitly account for the unique needs of rural residents living with and affected by cancer and (iv) new innovative approaches are urgently required to successfully overcome the challenges faced by rural people with cancer and their caregivers. Despite equitable healthcare being a key European policy focus, the needs of rural people living with cancer have largely been neglected.
{"title":"Implementing the European code of cancer practice in rural settings","authors":"David Nelson , Peter Selby , Ros Kane , Ava Harding-Bell , Amanda Kenny , Kathie McPeake , Samuel Cooke , Todd Hogue , Kathy Oliver , Mark Gussy , Mark Lawler","doi":"10.1016/j.jcpo.2023.100465","DOIUrl":"10.1016/j.jcpo.2023.100465","url":null,"abstract":"<div><p>Existing evidence often indicates higher cancer incidence and mortality rates, later diagnosis, lower screening uptake and poorer long-term survival for people living in rural compared to more urbanised areas. Despite wide inequities and variation in cancer care and outcomes across Europe, much of the scientific literature explicitly exploring the impact of rurality on cancer continues to come from Australia and North America<strong>.</strong> The European Code of Cancer Practice or “The Code” is a citizen and patient-centred statement of the most salient requirements for good clinical cancer practice and has been extensively co-produced by cancer patients, cancer professionals and patient advocates. It contains 10 key overarching Rights that a cancer patient should expect from their healthcare system, regardless of where they live and has been strongly endorsed by professional and patient cancer organisations as well as the European Commission. In this article, we use these 10 fundamental Rights as a framework to argue that (i) the issues and needs identified in The Code are generally more profound for rural people with cancer; (ii) addressing these issues is also more challenging in rural contexts; (iii) interventions and support must explicitly account for the unique needs of rural residents living with and affected by cancer and (iv) new innovative approaches are urgently required to successfully overcome the challenges faced by rural people with cancer and their caregivers. Despite equitable healthcare being a key European policy focus, the needs of rural people living with cancer have largely been neglected.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"39 ","pages":"Article 100465"},"PeriodicalIF":1.3,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213538323000826/pdfft?md5=041eb7a84e9498cb5febb9240951844f&pid=1-s2.0-S2213538323000826-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139111275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-02DOI: 10.1016/j.jcpo.2023.100466
Rachel J. Keogh , Harry Harvey , Claire Brady , Edel Hassett , Seán J. Costelloe , Martin J. O’Sullivan , Maria Twomey , Mary Jane O’Leary , Mary R. Cahill , Aideen O’Riordan , Caroline M. Joyce , Ger Moloney , Aileen Flavin , Richard M Bambury , Deirdre Murray , Kathleen Bennett , Maeve Mullooly , Seamus O’Reilly
<div><h3>Introduction</h3><p>Cyberattacks represent a growing threat for healthcare delivery globally. We assess the impact and implications of a cyberattack on a cancer center in Ireland.</p></div><div><h3>Methods</h3><p>On May 14th 2021 (day 0) Cork University Hospital (CUH) Cancer Center was involved in the first national healthcare ransomware attack in Ireland. Contingency plans were only present in laboratory services who had previously experienced information technology (IT) failures. No hospital cyberattack emergency plan was in place. Departmental logs of activity for 120 days after the attack were reviewed and compared with historical activity records. Daily sample deficits (routine daily number of samples analyzed – number of samples analyzed during cyberattack) were calculated. Categorical variables are reported as median and range. Qualitative data were collected via reflective essays and interviews with key stakeholders from affected departments in CUH.</p></div><div><h3>Results</h3><p><span><span>On day 0, all IT systems were shut down. Radiotherapy (RT) treatment and cancer surgeries stopped, outpatient activity fell by 50%. </span>hematology<span>, biochemistry and radiology<span> capacity fell by 90% (daily sample deficit (DSD) 2700 samples), 75% (DSD 2250 samples), and 90% (100% mammography/PET scan) respectively. Histopathology reporting times doubled (7 to 15 days). Radiotherapy (RT) was interrupted for 113 patients in CUH. The median treatment gap duration was six days for category 1 patients and 10 for the remaining patients. Partner organizations paused all IT links with CUH. Outsourcing of radiology and radiotherapy commenced, alternative communication networks and national conference calls in RT and </span></span></span>Clinical Trials were established. By day 28 Email communication was restored. By day 210 reporting and data storage backlogs were cleared and over 2000 computers were checked/replaced.</p></div><div><h3>Conclusion</h3><p>Cyberattacks have rapid, profound and protracted impacts. While laboratory and diagnostic deficits were readily quantified, the impact of disrupted/delayed care on patient outcomes is less readily quantifiable. Cyberawareness and cyberattack plans need to be embedded in healthcare.</p></div><div><h3>Policy Summary</h3><p>Cyberattacks pose significant challenges for healthcare systems, impacting patient care, clinical outcomes, and staff wellbeing. This study provides a comprehensive review of the impact of the Conti ransomware attack on cancer services in Cork University Hospital (CUH), the first cyberattack on a national health service. Our study highlights the widespread disruption caused by a cyberattack including shutdown of information technology (IT) services, marked reduction in outpatient activity, temporary cessation of essential services such as radiation therapy. We provide a framework for other institutions for mitigating the impact of a cyberattack, underscoring the need for a
{"title":"Dealing with digital paralysis: Surviving a cyberattack in a National Cancer center","authors":"Rachel J. Keogh , Harry Harvey , Claire Brady , Edel Hassett , Seán J. Costelloe , Martin J. O’Sullivan , Maria Twomey , Mary Jane O’Leary , Mary R. Cahill , Aideen O’Riordan , Caroline M. Joyce , Ger Moloney , Aileen Flavin , Richard M Bambury , Deirdre Murray , Kathleen Bennett , Maeve Mullooly , Seamus O’Reilly","doi":"10.1016/j.jcpo.2023.100466","DOIUrl":"10.1016/j.jcpo.2023.100466","url":null,"abstract":"<div><h3>Introduction</h3><p>Cyberattacks represent a growing threat for healthcare delivery globally. We assess the impact and implications of a cyberattack on a cancer center in Ireland.</p></div><div><h3>Methods</h3><p>On May 14th 2021 (day 0) Cork University Hospital (CUH) Cancer Center was involved in the first national healthcare ransomware attack in Ireland. Contingency plans were only present in laboratory services who had previously experienced information technology (IT) failures. No hospital cyberattack emergency plan was in place. Departmental logs of activity for 120 days after the attack were reviewed and compared with historical activity records. Daily sample deficits (routine daily number of samples analyzed – number of samples analyzed during cyberattack) were calculated. Categorical variables are reported as median and range. Qualitative data were collected via reflective essays and interviews with key stakeholders from affected departments in CUH.</p></div><div><h3>Results</h3><p><span><span>On day 0, all IT systems were shut down. Radiotherapy (RT) treatment and cancer surgeries stopped, outpatient activity fell by 50%. </span>hematology<span>, biochemistry and radiology<span> capacity fell by 90% (daily sample deficit (DSD) 2700 samples), 75% (DSD 2250 samples), and 90% (100% mammography/PET scan) respectively. Histopathology reporting times doubled (7 to 15 days). Radiotherapy (RT) was interrupted for 113 patients in CUH. The median treatment gap duration was six days for category 1 patients and 10 for the remaining patients. Partner organizations paused all IT links with CUH. Outsourcing of radiology and radiotherapy commenced, alternative communication networks and national conference calls in RT and </span></span></span>Clinical Trials were established. By day 28 Email communication was restored. By day 210 reporting and data storage backlogs were cleared and over 2000 computers were checked/replaced.</p></div><div><h3>Conclusion</h3><p>Cyberattacks have rapid, profound and protracted impacts. While laboratory and diagnostic deficits were readily quantified, the impact of disrupted/delayed care on patient outcomes is less readily quantifiable. Cyberawareness and cyberattack plans need to be embedded in healthcare.</p></div><div><h3>Policy Summary</h3><p>Cyberattacks pose significant challenges for healthcare systems, impacting patient care, clinical outcomes, and staff wellbeing. This study provides a comprehensive review of the impact of the Conti ransomware attack on cancer services in Cork University Hospital (CUH), the first cyberattack on a national health service. Our study highlights the widespread disruption caused by a cyberattack including shutdown of information technology (IT) services, marked reduction in outpatient activity, temporary cessation of essential services such as radiation therapy. We provide a framework for other institutions for mitigating the impact of a cyberattack, underscoring the need for a","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"39 ","pages":"Article 100466"},"PeriodicalIF":1.3,"publicationDate":"2024-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139098905","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}
Pub Date : 2023-12-15DOI: 10.1016/j.jcpo.2023.100464
Ivana Nikčević Kovačević , Adrijana Vujović , Milica Stanišić , Jovana Vuković-Leković , Iris Lansdorp-Vogelaar , Dominika Novak Mlakar , Carlo Senore , Judit Józwiak-Hagymásy , György Széles , Zoltán Vokó , Marcell Csanádi
Background
Implementation of organized cancer screening programs comes with many challenges and barriers, which may inhibit the achievement of the screening activities’ desired benefits. In this paper we outline a plan for improving the colorectal cancer (CRC) screening system in Montenegro.
Methods
We formulated a roadmap, which was generally defined as a country-specific strategic plan to improve cancer screening programs. The roadmap development was an iterative, step-by-step process. First, we described the current screening program, then identified and described key barriers, and finally proposed actions to overcome them. Multiple sources of information (e.g., documents, expert opinions) were collected and processed by local and international stakeholders.
Results
The CRC screening program was implemented between 2013–2019 by gradually increasing the invitation of the target population. Key barriers of the implementation were defined: 1) Lack of colonoscopy capacity in the northern part of the country; 2) Inadequate information technology systems; 3) Inadequate public promotion of screening. The defined actions were related to overcoming lack of available resources (e.g., financial, human and technological), to improve the policy environment and the knowledge, and to facilitate information sharing.
Conclusion
The collaboration between local stakeholders of CRC screening and researchers experienced in planning and evaluating screening programs resulted in the first comprehensive description of CRC screening in Montenegro, detailed understanding of key barriers that emerged during implementation and a carefully designed list of actions. The implementation of these actions and the evaluation of whether barriers were solved will be captured in the upcoming period by maintaining this collaboration.
{"title":"Roadmap to improve the organized cancer screening programs – The case of colorectal cancer screening in Montenegro","authors":"Ivana Nikčević Kovačević , Adrijana Vujović , Milica Stanišić , Jovana Vuković-Leković , Iris Lansdorp-Vogelaar , Dominika Novak Mlakar , Carlo Senore , Judit Józwiak-Hagymásy , György Széles , Zoltán Vokó , Marcell Csanádi","doi":"10.1016/j.jcpo.2023.100464","DOIUrl":"10.1016/j.jcpo.2023.100464","url":null,"abstract":"<div><h3>Background</h3><p>Implementation of organized cancer screening programs comes with many challenges and barriers, which may inhibit the achievement of the screening activities’ desired benefits. In this paper we outline a plan for improving the colorectal cancer (CRC) screening system in Montenegro.</p></div><div><h3>Methods</h3><p>We formulated a roadmap, which was generally defined as a country-specific strategic plan to improve cancer screening programs. The roadmap development was an iterative, step-by-step process. First, we described the current screening program, then identified and described key barriers, and finally proposed actions to overcome them. Multiple sources of information (e.g., documents, expert opinions) were collected and processed by local and international stakeholders.</p></div><div><h3>Results</h3><p>The CRC screening program was implemented between 2013–2019 by gradually increasing the invitation of the target population. Key barriers of the implementation were defined: 1) Lack of colonoscopy capacity in the northern part of the country; 2) Inadequate information technology systems; 3) Inadequate public promotion of screening. The defined actions were related to overcoming lack of available resources (e.g., financial, human and technological), to improve the policy environment and the knowledge, and to facilitate information sharing.</p></div><div><h3>Conclusion</h3><p>The collaboration between local stakeholders of CRC screening and researchers experienced in planning and evaluating screening programs resulted in the first comprehensive description of CRC screening in Montenegro, detailed understanding of key barriers that emerged during implementation and a carefully designed list of actions. The implementation of these actions and the evaluation of whether barriers were solved will be captured in the upcoming period by maintaining this collaboration.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"39 ","pages":"Article 100464"},"PeriodicalIF":1.3,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213538323000814/pdfft?md5=5fd89540d0273730f231299d7e1c03e2&pid=1-s2.0-S2213538323000814-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138795610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-06DOI: 10.1016/j.jcpo.2023.100463
Peter R. Scholten , Lukas J.A. Stalpers , Iris Bronsema , Rob M. van Os , Henrike Westerveld , Luc R.C.W. van Lonkhuijzen
Objectives
patients with cancer who smoke have more side effects during and after treatment, and a lower survival rate than patients with cancer who quit smoking. Supporting patients with cancer to quit smoking should be standard care. The aim of this systematic review was to determine the most effective smoking cessation method for patients diagnosed with cancer.
Methods
PubMed, Embase, Web of Science and Google Scholar were systematically searched. Included were randomized controlled trials and observational studies published after January 2000 with any smoking cessation intervention in patients with any type of cancer. Result of these studies were evaluated in a meta-analysis.
Results
A total of 18,780 papers were retrieved. After duplicate removal and exclusion based on title and abstract, 72 publications were left. After full text screening, 19 (randomized) controlled trials and 20 observational studies were included. The overall methodological quality of the included studies, rated by GRADE criteria, was very low. Two out of 21 combined intervention trials showed a statistical significant effect. Meta-analysis of 18 RCTs and 3 observational studies showed a significant benefit of combined modality interventions (OR 1.67, 95% C.I.: 1.24–2.26, p = 0.0008) and behavioural interventions (OR 1.33, 95% C.I.: 1.02 – 1.74, p = 0.03), but not for single modality pharmacological interventions (OR 1.11; 95% C.I.: 0.69–1.78, p = 0.66).
Conclusion
A combination of pharmacological and behavioural interventions may be the most effective intervention for smoking cessation in patients with cancer.
{"title":"The effectiveness of smoking cessation interventions after cancer diagnosis: A systematic review and meta-analysis","authors":"Peter R. Scholten , Lukas J.A. Stalpers , Iris Bronsema , Rob M. van Os , Henrike Westerveld , Luc R.C.W. van Lonkhuijzen","doi":"10.1016/j.jcpo.2023.100463","DOIUrl":"https://doi.org/10.1016/j.jcpo.2023.100463","url":null,"abstract":"<div><h3>Objectives</h3><p>patients with cancer who smoke have more side effects during and after treatment, and a lower survival rate than patients with cancer who quit smoking. Supporting patients with cancer to quit smoking should be standard care. The aim of this systematic review was to determine the most effective smoking cessation method for patients diagnosed with cancer.</p></div><div><h3>Methods</h3><p>PubMed, Embase, Web of Science and Google Scholar were systematically searched. Included were randomized controlled trials and observational studies published after January 2000 with any smoking cessation intervention in patients with any type of cancer. Result of these studies were evaluated in a meta-analysis.</p></div><div><h3>Results</h3><p>A total of 18,780 papers were retrieved. After duplicate removal and exclusion based on title and abstract, 72 publications were left. After full text screening, 19 (randomized) controlled trials and 20 observational studies were included. The overall methodological quality of the included studies, rated by GRADE criteria, was very low. Two out of 21 combined intervention trials showed a statistical significant effect. Meta-analysis of 18 RCTs and 3 observational studies showed a significant benefit of combined modality interventions (OR 1.67, 95% C.I.: 1.24–2.26, p = 0.0008) and behavioural interventions (OR 1.33, 95% C.I.: 1.02 – 1.74, p = 0.03), but not for single modality pharmacological interventions (OR 1.11; 95% C.I.: 0.69–1.78, p = 0.66).</p></div><div><h3>Conclusion</h3><p>A combination of pharmacological and behavioural interventions may be the most effective intervention for smoking cessation in patients with cancer.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"39 ","pages":"Article 100463"},"PeriodicalIF":1.3,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213538323000802/pdfft?md5=30bd12ea2dd2c95fa8f0af9078874086&pid=1-s2.0-S2213538323000802-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138558918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-05DOI: 10.1016/j.jcpo.2023.100461
Abdel-Azez Abusamak , Mohammad Abusamak , Mohammed Al-Abbadi , Abdallah Rayyan , Omar Oran , Ghulam Rehman Mohyuddin , Amar H. Kelkar , Aaron M. Goodman , Rajshekhar Chakraborty , Edward R.Scheffer Cliff , Samer Al Hadidi
Background
Subjective minimizing language in oncology conferences may undermine patient-centered care and hinder comprehensive treatment strategies. Subjective terms like "safe," "tolerable," and "well-tolerated" can vary in interpretation among individuals, making it difficult to compare results across trials and potentially downplaying significant risks and limitations associated with treatments.
Methods
This study evaluates subjective minimizing language in major oncology conferences and its use in adverse event reporting. We conducted a search of three electronic databases, ASCO, ASH, and ESMO, for published abstracts from January 1, 2019, to December 31, 2021. This study included prospective cohort studies or clinical trials in humans that used safety terms like "safe," "well-tolerated," "tolerable," "no new safety signal," or "no new safety concern" in the abstract text.
Results
Out of 34,975 reviewed records, 5299 (15.2%) abstracts used subjective minimizing language terms. The analysis included 2797 (52.8%) abstracts meeting the inclusion criteria. The majority of studies were Phase 1 trials (45.5%), followed by Phase 2 (29.6%) and Phase 3 trials (7.4%). Solid tumors accounted for the most common disease category (56.5%), followed by malignant hematology following (37.1%). Subjective minimizing terms like "safe" (69.2%), "well-tolerated" (53.2%), "tolerable" (25.6%), and "no new safety signal/concerns" (10%) were used frequently. Of the abstracts using subjective minimizing language (n = 2797), 81.9% reported data on any grade adverse events (AEs). Grade I/II AEs were reported in 62.6% of abstracts, Grade III/IV AEs in 78%, and Grade V AEs (death related to AEs) in 8.8%. Discontinuation due to AEs occurred in 11.4% (SD 9.5%) of studies using subjective minimizing language terms.
Conclusions
Frequent use of subjective minimizing language in major oncology conferences' abstracts may obscure interpretation of study results and the safety of novel treatments. Researchers and clinicians should provide precise and standardized information to avoid overstatement of benefits and understand the true impact of interventions on patients' safety and well-being.
{"title":"Use of subjective minimizing language at hematology and oncology conferences: A systematic review","authors":"Abdel-Azez Abusamak , Mohammad Abusamak , Mohammed Al-Abbadi , Abdallah Rayyan , Omar Oran , Ghulam Rehman Mohyuddin , Amar H. Kelkar , Aaron M. Goodman , Rajshekhar Chakraborty , Edward R.Scheffer Cliff , Samer Al Hadidi","doi":"10.1016/j.jcpo.2023.100461","DOIUrl":"https://doi.org/10.1016/j.jcpo.2023.100461","url":null,"abstract":"<div><h3>Background</h3><p>Subjective minimizing language in oncology<span> conferences may undermine patient-centered care and hinder comprehensive treatment strategies. Subjective terms like \"safe,\" \"tolerable,\" and \"well-tolerated\" can vary in interpretation among individuals, making it difficult to compare results across trials and potentially downplaying significant risks and limitations associated with treatments.</span></p></div><div><h3>Methods</h3><p><span><span>This study evaluates subjective minimizing language in major oncology conferences and its use in adverse event reporting. We conducted a search of three electronic databases, ASCO, </span>ASH<span>, and ESMO<span>, for published abstracts from January 1, 2019, to December 31, 2021. This study included prospective cohort studies or </span></span></span>clinical trials in humans that used safety terms like \"safe,\" \"well-tolerated,\" \"tolerable,\" \"no new safety signal,\" or \"no new safety concern\" in the abstract text.</p></div><div><h3>Results</h3><p>Out of 34,975 reviewed records, 5299 (15.2%) abstracts used subjective minimizing language terms. The analysis included 2797 (52.8%) abstracts meeting the inclusion criteria. The majority of studies were Phase 1 trials (45.5%), followed by Phase 2 (29.6%) and Phase 3 trials (7.4%). Solid tumors<span> accounted for the most common disease category (56.5%), followed by malignant hematology following (37.1%). Subjective minimizing terms like \"safe\" (69.2%), \"well-tolerated\" (53.2%), \"tolerable\" (25.6%), and \"no new safety signal/concerns\" (10%) were used frequently. Of the abstracts using subjective minimizing language (n = 2797), 81.9% reported data on any grade adverse events (AEs). Grade I/II AEs were reported in 62.6% of abstracts, Grade III/IV AEs in 78%, and Grade V AEs (death related to AEs) in 8.8%. Discontinuation due to AEs occurred in 11.4% (SD 9.5%) of studies using subjective minimizing language terms.</span></p></div><div><h3>Conclusions</h3><p>Frequent use of subjective minimizing language in major oncology conferences' abstracts may obscure interpretation of study results and the safety of novel treatments. Researchers and clinicians should provide precise and standardized information to avoid overstatement of benefits and understand the true impact of interventions on patients' safety and well-being.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"39 ","pages":"Article 100461"},"PeriodicalIF":1.3,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138581974","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}