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Purpose: Clinical trials have not demonstrated that adjuvant chemotherapy improves survival for patients with resected stage II colon cancer. Nevertheless, patients may receive this treatment despite its uncertain benefit. The objective of this study was to determine the extent to which adjuvant chemotherapy is used for patients with stage II colon cancer., Patients and Methods: Using the Surveillance, Epidemiology, and End Results-Medicare linked database, we identified 3,151 patients aged 65 to 75 with resected stage II colon cancer and no adverse prognostic features. The primary outcome was chemotherapy use within 3 months of surgery ascertained from claims submitted to Medicare. Relationships between patient characteristics and adjuvant chemotherapy use were measured and their significance was assessed using multivariable logistic regression. Survival for treated and untreated patients was compared using a Cox model., Results: Twenty-seven percent of patients received chemotherapy during the 3 postoperative months. Younger age at diagnosis, white race, unfavorable tumor grade, and low comorbidity were each associated with a greater likelihood of receiving treatment. Sex, the number of examined lymph nodes in the tumor specimen, the urgency of the surgical admission, and median income was each unrelated to treatment. Five-year survival was 75% for untreated patients and 78% for treated patients. After adjusting for known between-group differences, the hazard ratio for survival associated with adjuvant treatment was 0.91 (95% confidence interval, 0.77 to 1.09)., Conclusion: A substantial percentage of Medicare beneficiaries with resected stage II colon cancer receive adjuvant chemotherapy despite its uncertain benefit.

National spending on health care presents a central fiscal challenge for the United States. Expenditures for cancer care are expected to increase substantially because of a rapid rise in new cancer diagnoses associated with the aging of the population. In addition, innovations in cancer treatment are expected to increase spending on cancer care. To examine the drivers of rising cancer costs and to evaluate potential strategies to provide affordable, high-quality cancer care to all patients, the Institute of Medicine's National Cancer Policy Forum convened a workshop in October 2012, Delivering Affordable Cancer Care in the 21st Century. This article summarizes presentations and discussion from the workshop, and focuses on the practice-changing strategies that workshop speakers proposed to improve the affordability of cancer care while maintaining or improving the quality of care. [ABSTRACT FROM AUTHOR]

The article reports on a 2015 study on the variation in use of long-term central venous catheters (CVC) in insured women with breast cancer and on its complication risks. Results show that two-thirds of cohorts had a long-term CVC, with varied rates across regions, health plans, and insurance coverage. The article states that the benefits of long-term CVCs is offset by its association with increased morbidity, and that some of their use are provider- or institution-driven.

Purpose: The use of anticancer drugs (chemotherapies) is an important determinant of national spending trends. Recent policies have aimed to accelerate generic entry among chemotherapies to generate cost savings. Methods: We examined the effects of generic entry on the choice of chemotherapy for the treatment of metastatic colorectal cancer (MCRC) between 2006 and 2009 using autoregressive-moving average modeling with case control. A nationally representative sample of oncologists and patients with cancer (age ≥ 65 years) was employed to estimate the magnitude and significance of the impact of the generic entry of irinotecan in February 2008 on the number of administrations of irinotecan compared with oxaliplatin. Results: The generic entry of irinotecan resulted in a 17% to 19% decrease (P < .001) in use among elderly patients with MCRC compared with oxaliplatin. The results were robust to multiple sensitivity checks. Conclusion: This study provides novel and robust estimates of the decline in use of a chemotherapy to treat a common cancer in the elderly after patent expiration. The results suggest estimates from a previous Office of the Inspector General report of the potential savings derived from the generic entry of irinotecan for public payers are an overestimate, likely confounded by oncologists' response to financial incentives, changes in scientific evidence, and promotional activities. As calls for improving the quality and cost efficiency of oncology increase, future empirical work is needed to examine the responsiveness of oncologists' treatment decision making to incentives among patients of all ages and insurance types. [ABSTRACT FROM AUTHOR]