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Background The Affordable Care Act (ACA) increased private nonemployer health insurance options, expanded Medicaid eligibility, and provided preexisting health condition protections. We evaluated insurance coverage among long-term adult survivors of childhood cancer pre- and post-ACA implementation. Methods Using the multicenter Childhood Cancer Survivor Study, we included participants from 2 cross-sectional surveys: pre-ACA (2007-2009; survivors: n = 7505; siblings: n = 2175) and post-ACA (2017-2019; survivors: n = 4030; siblings: n = 987). A subset completed both surveys (1840 survivors; 646 siblings). Multivariable regression models compared post-ACA insurance coverage and type (private, public, uninsured) between survivors and siblings and identified associated demographic and clinical factors. Multinomial models compared gaining and losing insurance vs staying the same among survivors and siblings who participated in both surveys. Results The proportion with insurance was higher post-ACA (survivors pre-ACA 89.1% to post-ACA 92.0% [+2.9%]; siblings pre-ACA 90.9% to post-ACA 95.3% [+4.4%]). Post-ACA insurance increase in coverage was higher among those aged 18-25 years (survivors: +15.8% vs +2.3% or less ages 26 years and older; siblings +17.8% vs +4.2% or less ages 26 years and older). Survivors were more likely to have public insurance than siblings post-ACA (18.4% vs 6.9%; odds ratio [OR] = 1.7, 95% confidence interval [CI] = 1.1 to 2.6). Survivors with severe chronic conditions (OR = 4.7, 95% CI = 3.0 to 7.3) and those living in Medicaid expansion states (OR = 2.4, 95% CI = 1.7 to 3.4) had increased odds of public insurance coverage post-ACA. Among the subset completing both surveys, low- and mid-income survivors (<$40 000 and <$60 000, respectively) experienced insurance losses and gains in reference to highest household income survivors (≥$100 000), relative to odds of keeping the same insurance status. Conclusions Post-ACA, more childhood cancer survivors and siblings had health insurance, although disparities remain in coverage. [ABSTRACT FROM AUTHOR]

The American Inflation Reduction Act (IRA) of 2022 contains climate-related provisions that may have noteworthy implications for cancer control and prevention. This commentary assesses the potential co-benefits of the IRA for cancer control efforts, specifically policies and programs to reduce carcinogen exposure via air quality monitoring and air pollution reduction. Allocations through the IRA for air quality improvement, paired with its environmental justice provisions, hold promise for advancing cancer prevention by targeting resources to communities most susceptible to environmental hazards. Moreover, climate resilience measures dictated by the IRA are crucial for oncology professionals grappling with the dual challenges of climate change and cancer care. Climate-driven extreme weather events can exacerbate carcinogen exposure and disrupt access to cancer care, underscoring the need for resilient health-care infrastructure. The IRA's provisions for clean energy incentives and infrastructure upgrades offer oncology care institutions opportunities to mitigate emissions and bolster resilience against climate-related disruptions, ultimately improving cancer outcomes. Climate-related initiatives funded by the IRA present a unique and timely avenue to advance equitable cancer control efforts. This commentary underscores the critical intersection between climate resilience policy and oncology care, highlighting the potential to promote a healthier and more resilient future for all. [ABSTRACT FROM AUTHOR]

Background Lack of stable, affordable housing is an important social determinant of health. Federal housing assistance may buffer against housing vulnerabilities among low-income households, but research examining the association of housing assistance and cancer care has been limited. We introduce a new linkage of Surveillance, Epidemiology, and End Results (SEER) program-Medicare and US Department of Housing and Urban Development (HUD) administrative data. Methods Individuals enrolled in HUD public and assisted housing programs between 2006 and 2021 were linked with cancer diagnoses between 2006 and 2019 identified in the SEER-Medicare data from 16 states using Match*Pro (National Institutes of Health, Bethesda, MD) probabilistic linkage software. HUD administrative data include timing and type of housing assistance as well as verified household income. Medicare administrative data are available through 2020. Results A total of 335 490 unique individuals who received housing assistance at any time point, including 156 794 who received housing assistance around the time of their diagnosis (at least 6 months before diagnosis until 6 months after diagnosis or death), were matched to SEER-Medicare data. A total of 63 251 individuals receiving housing assistance at the time of their diagnosis were aged 66 years and older and continuously enrolled in Medicare parts A and B fee for service; 12 035 had a diagnosis of lung cancer, 8866 of breast cancer, 7261 of colorectal cancer, and 4703 of prostate cancer. Conclusions This novel data linkage will be available through the National Cancer Institute and can be used to explore the ways in which housing assistance is associated with cancer diagnosis, care, and outcomes, including the role of housing assistance status in potentially reducing or contributing to inequities across racialized and ethnic groups. [ABSTRACT FROM AUTHOR]

The experiences of cancer survivors with the COVID-19 pandemic in the United States during 2021 and 2022, when vaccinations became widely available, are largely undocumented. Using nationally representative survey data in 2021 and 2022, we found that compared with adults without a cancer history, cancer survivors were more likely to have at least 2 COVID-19 vaccines (2021: 66.6% vs 62.3%, P  =  .003; 2022: 77.0% vs 72.4%, P  <  .001) and as likely to have a COVID-19 infection history (2021: 14.1% vs 14.2%, P  =  .93; 2022: 39.9% vs 39.3%, P  =  .55) but, once infected, were more likely to develop moderate to severe symptoms (2021: 62.5% vs 54.2%, P  =  .02; 54.5% vs 61.3%; P =.13). Among cancer survivors, younger age, lower educational attainment, lack of health insurance, and more comorbidities were statistically significantly associated with lower vaccination rates (P  <  .001). Among infected cancer survivors, being female and younger were associated with higher likelihood of developing moderate to severe symptoms (P  <  .001). Our findings suggest tailored efforts to prevent and control COVID-19 infections for cancer survivors. [ABSTRACT FROM AUTHOR]

The article discusses the use of value frameworks in cost communications in the field of oncology. Value frameworks are tools that synthesize the benefits and harms of different treatment options to help compare and identify high-value treatments. The article focuses on three commonly used value frameworks: the Net Health Benefit (NHB) from the American Society of Clinical Oncology (ASCO), the Evidence Block from the National Comprehensive Cancer Network (NCCN), and the Magnitude of Clinical Benefit Scale (MCBS) from the European Society for Medical Oncology (ESMO). The study also examines the application of the NHB framework to targeted oral anticancer medications (TOAMs) and their associated costs. The findings suggest that low-value TOAMs are prescribed less frequently, and the uptake of these medications is driven by those with medium and high NHB scores. However, there are concerns about the scoring criteria of the NHB framework and its ability to accurately represent "high value." The article also highlights the importance of incorporating patient out-of-pocket expenses and other financial burdens into value frameworks to facilitate cost communication between clinicians and patients. The study reveals that the median total spending for the first 28-day supply of TOAMs is over $10,000, with some patients spending more than $1,000 out-of-pocket. The article emphasizes the need to consider insurance benefit design and patient characteristics when analyzing the financial burden of TOAMs. It also discusses the differences in cost-sharing requirements between Medicare Part D and private [Extracted from the article]

A study published in the Journal of the National Cancer Institute examines the impact of clinic-based interventions on reducing treatment inequities between Black and White women diagnosed with breast cancer. The interventions, including patient navigation, provider bias training, and real-time tracking dashboards, aim to improve equitable treatment. While the interventions successfully addressed treatment inequities, they did not eliminate survival differences between the two groups. The study suggests that additional efforts are needed to eliminate racial disparities in breast cancer outcomes, including addressing factors such as screening, social determinants of health, and systemic racism. [Extracted from the article]

Despite advances in cancer control—prevention, screening, diagnosis, treatment, and survivorship—racial disparities in cancer incidence and survival persist and, in some cases, are widening in the United States. Since 2020, there's been growing recognition of the role of structural racism, including structurally racist policies and practices, as the main factor contributing to historical and contemporary disparities. Structurally racist policies and practices have been present since the genesis of the United States and are also at the root of environmental injustices, which result in disproportionately high exposure to environmental hazards among communities targeted for marginalization, increased cancer risk, disruptions in access to care, and worsening health outcomes. In addition to widening cancer disparities, environmental injustices enable the development of polluting infrastructure, which contribute to detrimental health outcomes in the entire population, and to climate change, the most pressing public health challenge of our time. In this commentary, we describe the connections between climate change and cancer through an Environmental Justice perspective (defined as the fair treatment and meaningful involvement of people of all racialized groups, nationalities, or income, in all aspects, including development, implementation, and enforcement, of policies and practices that affect the environment and public health), highlighting how the expertise developed in communities targeted for marginalization is crucial for addressing health disparities, tackling climate change, and advancing cancer control efforts for the entire population. [ABSTRACT FROM AUTHOR]