88 results on '"Yabroff, K. Robin"'
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2. County-level jail and state-level prison incarceration and cancer mortality in the United States.
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Zhao J, Kajeepeta S, Manz CR, Han X, Nogueira LM, Zheng Z, Fan Q, Shi KS, Chino F, and Yabroff KR
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This study examined the association of county-level jail and state-level prison incarceration rates and cancer mortality rates in the United States. Incarceration rates (1995-2018) were sourced from national data and categorized into quartiles. County- and state-level mortality rates (2000-2019) with invasive cancer as the underlying cause of death were obtained from the National Vital Statistics System. Compared with the first quartile (lowest incarceration rate), the second, third, and fourth quartiles (highest incarceration rate) of county-level jail incarceration rate were associated with 1.3%, 2.3%, and 3.9% higher county-level cancer mortality rates, respectively, in adjusted analyses. Compared with the first quartile, the second, third, and fourth quartiles of state-level prison incarceration rate were associated with 1.7%, 2.5%, and 3.9% higher state-level cancer mortality rates, respectively. Associations were more pronounced for liver and lung cancers. Addressing adverse effects of mass incarceration may potentially improve cancer outcomes in affected communities., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2024
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3. Health Insurance Continuity and Mortality in Children and Adolescents/Young Adults with Blood Cancer.
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Ji X, Zhang XE, Yabroff KR, Stock W, Cornwell P, Bai S, Mertens AC, Lipscomb J, and Castellino SM
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Background: Many uninsured patients do not receive Medicaid coverage until a cancer diagnosis, potentially delaying access to care for early cancer detection and treatment. We examine the association of Medicaid enrollment timing and patterns with survival among children and adolescents/young adults (AYAs) diagnosed with blood cancers, where disease onset can be acute and early detection is critical., Methods: We identified 28,750 children and AYAs (0-39 years) newly diagnosed with blood cancers from the 2006-2013 SEER-Medicaid data. Enrollment patterns included continuous Medicaid (preceding through diagnosis), newly gained Medicaid (at/shortly after diagnosis), other noncontinuous Medicaid enrollment, and private/other insurance. We assessed cumulative incidence of death from diagnosis, censoring at last follow-up, five years post-diagnosis, or December 2018, whichever occurred first. Multivariable survival models estimated the association of insurance enrollment patterns with risk of death., Results: One-fourth (26.1%) of the cohort were insured by Medicaid; of these, 41.1% had continuous Medicaid, 34.9% had newly gained Medicaid, and 24.0% had other noncontinuous enrollment. The cumulative incidence of all-cause death five-year post-diagnosis was highest in patients with newly gained Medicaid (30.2%, 95%CI = 28.4-31.9%), followed by other noncontinuous enrollment (23.2%, 95%CI = 21.3-25.2%), continuous Medicaid (20.5%, 95%CI = 19.1-21.9%), and private/other insurance (11.2%; 95%CI = 10.7-11.7%). In multivariable models, newly gained Medicaid was associated with a higher risk of all-cause (hazard ratio = 1.39, 95%CI = 1.27-1.53) and cancer-specific death (hazard ratio = 1.50, 95%CI = 1.35-1.68), compared to continuous Medicaid., Conclusions: Continuous Medicaid coverage is associated with survival benefits among pediatric and AYA patients diagnosed with blood cancers; however, less than half of Medicaid-insured patients have continuous coverage before diagnosis., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2024
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4. The utility of value frameworks in cost communications: making them real for patients.
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Shih YT, Yabroff KR, and Bradley C
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- Humans, Health Care Costs, Cost-Benefit Analysis, Neoplasms economics, Neoplasms therapy, Communication
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- 2024
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5. Health insurance among survivors of childhood cancer following Affordable Care Act implementation.
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Kirchhoff AC, Waters AR, Liu Q, Ji X, Yasui Y, Yabroff KR, Conti RM, Huang IC, Henderson T, Leisenring WM, Armstrong GT, Nathan PC, and Park ER
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- Humans, Female, Male, United States epidemiology, Adult, Cross-Sectional Studies, Adolescent, Child, Young Adult, Medicaid statistics & numerical data, Siblings, Medically Uninsured statistics & numerical data, Middle Aged, Patient Protection and Affordable Care Act, Cancer Survivors statistics & numerical data, Insurance Coverage statistics & numerical data, Insurance, Health statistics & numerical data, Neoplasms therapy, Neoplasms economics, Neoplasms epidemiology
- Abstract
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., (© The Author(s) 2024. Published by Oxford University Press.)
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- 2024
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6. Cancer control co-benefits of the climate-related provisions in the American Inflation Reduction Act.
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Ashad-Bishop KC, Yabroff KR, and Nogueira L
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- Humans, United States, Environmental Exposure adverse effects, Environmental Exposure prevention & control, Neoplasms prevention & control, Climate Change, Air Pollution adverse effects, Air Pollution legislation & jurisprudence, Air Pollution prevention & control
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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., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2024
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7. Housing assistance among patients with cancer: SEER-Medicare US Department of Housing and Urban Development data linkage.
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Pollack CE, Garrison V, Johnson T, Blackford AL, Banks B, Howe W, Yabroff KR, and Enewold L
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- Humans, United States epidemiology, Male, Female, Aged, Aged, 80 and over, Housing statistics & numerical data, Information Storage and Retrieval, Poverty statistics & numerical data, Public Housing statistics & numerical data, SEER Program, Medicare statistics & numerical data, Neoplasms epidemiology, Neoplasms therapy
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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., (Published by Oxford University Press 2024.)
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- 2024
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8. COVID-19 vaccination, infection, and symptoms among cancer survivors in the United States.
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Yang NN, Zhao J, Zheng Z, Yabroff KR, and Han X
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- Humans, United States epidemiology, Female, Male, Middle Aged, Aged, Adult, Neoplasms epidemiology, Young Adult, Comorbidity, COVID-19 prevention & control, COVID-19 epidemiology, Cancer Survivors statistics & numerical data, COVID-19 Vaccines administration & dosage, SARS-CoV-2 immunology, Vaccination statistics & numerical data
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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., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2024
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9. Clinic-based interventions for improving access to care: a good start.
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Bradley CJ, Yabroff KR, and Shih YT
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- Humans, Neoplasms therapy, United States, Ambulatory Care Facilities standards, Ambulatory Care Facilities organization & administration, Health Services Accessibility
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- 2024
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10. Financial hardship and neighborhood socioeconomic disadvantage in long-term childhood cancer survivors.
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Fauer AJ, Qiu W, Huang IC, Ganz PA, Casillas JN, Yabroff KR, Armstrong GT, Leisenring W, Howell R, Howell CR, Kirchhoff AC, Yasui Y, and Nathan PC
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- Humans, Male, Female, Cross-Sectional Studies, Adult, Middle Aged, Child, Neoplasms economics, Neoplasms psychology, Neighborhood Characteristics, Siblings, Socioeconomic Factors, Residence Characteristics, Social Class, Adolescent, Poverty, Self Report, Socioeconomic Disparities in Health, Cancer Survivors psychology, Cancer Survivors statistics & numerical data, Financial Stress
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Background: Long-term survivors of childhood cancer face elevated risk for financial hardship. We evaluate whether childhood cancer survivors live in areas of greater deprivation and the association with self-reported financial hardships., Methods: We performed a cross-sectional analysis of data from the Childhood Cancer Survivor Study between 1970 and 1999 and self-reported financial information from 2017 to 2019. We measured neighborhood deprivation with the Area Deprivation Index (ADI) based on current zip code. Financial hardship was measured with validated surveys that captured behavioral, material and financial sacrifice, and psychological hardship. Bivariate analyses described neighborhood differences between survivors and siblings. Generalized linear models estimated effect sizes between ADI and financial hardship adjusting for clinical factors and personal socioeconomic status., Results: Analysis was restricted to 3475 long-term childhood cancer survivors and 923 sibling controls. Median ages at time of evaluation was 39 years (interquartile range [IQR] = 33-46 years and 47 years (IQR = 39-59 years), respectively. Survivors resided in areas with greater deprivation (ADI ≥ 50: 38.7% survivors vs 31.8% siblings; P < .001). One quintile increases in deprivation were associated with small increases in behavioral (second quintile, P = .017) and psychological financial hardship (second quintile, P = .009; third quintile, P = .014). Lower psychological financial hardship was associated with individual factors including greater household income (≥$60 000 income, P < .001) and being single (P = .048)., Conclusions: Childhood cancer survivors were more likely to live in areas with socioeconomic deprivation. Neighborhood-level disadvantage and personal socioeconomic circumstances should be evaluated when trying to assist childhood cancer survivors with financial hardships., (© The Author(s) 2024. Published by Oxford University Press.)
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- 2024
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11. Climate change and cancer: the Environmental Justice perspective.
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Nogueira LM and Yabroff KR
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- United States epidemiology, Humans, Social Justice, Environmental Justice, Delivery of Health Care, Climate Change, Neoplasms epidemiology, Neoplasms etiology, Neoplasms prevention & control
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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., (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2024
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12. Response to Lin and Lin.
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Jiang C, Yabroff KR, and Han X
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- 2023
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13. The long economic shadow of a cancer diagnosis during adolescence or young adulthood.
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Nathan PC and Yabroff KR
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- Humans, Adolescent, Young Adult, Adult, Registries, Longitudinal Studies, Cancer Survivors, Neoplasms diagnosis, Neoplasms epidemiology
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- 2023
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14. An essential goal within reach: attaining diversity, equity, and inclusion for the Journal of the National Cancer Institute journals.
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Yabroff KR, Boehm AL, Nogueira LM, Sherman M, Bradley CJ, Shih YT, Keating NL, Gomez SL, Banegas MP, Ambs S, Hershman DL, Yu JB, Riaz N, Stockler MR, Chen RC, and Franco EL
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- United States, Humans, Diversity, Equity, Inclusion, Goals, National Cancer Institute (U.S.), Periodicals as Topic, Neoplasms therapy
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- 2023
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15. Mass incarceration and cancer health disparities in the United States: reimagining models of care delivery.
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Bradley CJ, Zhao J, Shih YT, and Yabroff KR
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- United States epidemiology, Humans, Health Services Accessibility, Health Status Disparities, Neoplasms epidemiology, Neoplasms therapy
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- 2023
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16. Medicaid expansion is associated with treatment receipt, timeliness, and outcomes among young adults with breast cancer.
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Ji X, Shi KS, Ruddy KJ, Zhao J, Mertens AC, Yabroff KR, Castellino SM, and Han X
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- United States epidemiology, Humans, Female, Young Adult, Patient Protection and Affordable Care Act, Insurance Coverage, Time-to-Treatment, Medicaid, Breast Neoplasms diagnosis, Breast Neoplasms epidemiology, Breast Neoplasms therapy
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Female breast cancer is a common cancer in young adults, an age group with the highest uninsured rate. Among 51 675 young adult women (ages 18-39 years) diagnosed with breast cancer between 2011 and 2018 in the National Cancer Database, we estimated changes in guideline-concordant treatment receipt, treatment timeliness, and survival associated with the Affordable Care Act Medicaid expansion. Of young adults with stage I-III estrogen receptor-positive or progesterone receptor-positive breast cancer, Medicaid expansion was associated with a net increase of 2.42 percentage points (95% confidence interval [CI] = 0.56 to 4.28 percentage points) in the percentage receiving endocrine therapy. Among all young adults with stage I-III breast cancer, Medicaid expansion was associated with a net reduction of 1.65 percentage points (95% CI = 0.08 to 3.22 percentage points) in treatment delays defined as treatment initiation of at least 60 days after diagnosis and a net increase of 1.00 percentage points (95% CI = 0.21 to 1.79 percentage points) in 2-year overall survival. Our study provides evidence of benefit in cancer care and outcomes from Medicaid expansion among the young adult population., (© The Author(s) 2023. Published by Oxford University Press.)
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- 2023
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17. State policies regulating short-term limited duration insurance plans and cancer stage at diagnosis.
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Barnes JM, Kirchhoff AC, Yabroff KR, and Chino F
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- Humans, United States epidemiology, Neoplasm Staging, Neoplasms diagnosis, Neoplasms epidemiology, Insurance
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Short-term limited duration insurance plans, which proliferated following 2018 federal regulations, may not provide adequate protections for patients with suspected or newly diagnosed cancer and can destabilize insurance markets for comprehensive insurance plan enrollees. Individuals aged 18-64 years with newly diagnosed cancer from 11 states during 2016-2017 and 2019 were identified from the Surveillance, Epidemiology, and End Results program. Difference-in-differences analyses were used to compare changes in early-stage cancer diagnoses from 2016-2017 to 2019 in states that prohibited vs did not regulate short-term limited duration insurance plans. In adjusted difference-in-differences analyses, early-stage diagnoses increased 0.95 percentage points (95% confidence interval = 0.53 to 1.38, P < .001) in states that prohibited short-term limited duration insurance plans vs did not regulate short-term limited duration insurance plans. State policies resulting in unavailability of short-term limited duration insurance plans were associated with an increased percentage of early-stage diagnoses., (© The Author(s) 2023. Published by Oxford University Press.)
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- 2023
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18. Changes in cancer mortality after Medicaid expansion and the role of stage at diagnosis.
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Barnes JM, Johnson KJ, Osazuwa-Peters N, Yabroff KR, and Chino F
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- Female, United States epidemiology, Humans, Patient Protection and Affordable Care Act, Neoplasm Staging, Registries, Insurance Coverage, Medicaid, Neoplasms diagnosis, Neoplasms epidemiology, Neoplasms pathology
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Background: Medicaid expansion is associated with improved survival following cancer diagnosis. However, little research has assessed how changes in cancer stage may mediate improved cancer mortality or how expansion may have decreased population-level cancer mortality rates., Methods: Nationwide state-level cancer data from 2001 to 2019 for individuals ages 20-64 years were obtained from the combined Surveillance, Epidemiology, and End Results National Program of Cancer Registries (incidence) and the National Center for Health Statistics (mortality) databases. We estimated changes in distant stage cancer incidence and cancer mortality rates from pre- to post-2014 in expansion vs nonexpansion states using generalized estimating equations with robust standard errors. Mediation analyses were used to assess whether distant stage cancer incidence mediated changes in cancer mortality., Results: There were 17 370 state-level observations. For all cancers combined, there were Medicaid expansion-associated decreases in distant stage cancer incidence (adjusted odds ratio = 0.967, 95% confidence interval = 0.943 to 0.992; P = .01) and cancer mortality (adjusted odds ratio = 0.965, 95% confidence interval = 0.936 to 0.995; P = .022). This translates to 2591 averted distant stage cancer diagnoses and 1616 averted cancer deaths in the Medicaid expansion states. Distant stage cancer incidence mediated 58.4% of expansion-associated changes in cancer mortality overall (P = .008). By cancer site subgroups, there were expansion-associated decreases in breast, cervix, and liver cancer mortality., Conclusions: Medicaid expansion was associated with decreased distant stage cancer incidence and cancer mortality. Approximately 60% of the expansion-associated changes in cancer mortality overall were mediated by distant stage diagnoses., (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2023
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19. Transportation barriers, emergency room use, and mortality risk among US adults by cancer history.
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Jiang C, Yabroff KR, Deng L, Wang Q, Perimbeti S, Shapiro CL, and Han X
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- Humans, Adult, Proportional Hazards Models, Ethnicity, Comorbidity, Emergency Service, Hospital, Neoplasms
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Background: Lack of safe, reliable, and affordable transportation is a barrier to medical care, but little is known about its association with clinical outcomes., Methods: We identified 28 640 adults with and 470 024 adults without a cancer history from a nationally representative cohort (2000-2018 US National Health Interview Survey) and its linked mortality files with vital status through December 31, 2019. Transportation barriers were defined as delays in care because of lack of transportation. Multivariable logistic and Cox proportional hazards models estimated the associations of transportation barriers with emergency room (ER) use and mortality risk, respectively, adjusted for age, sex, race and ethnicity, education, health insurance, comorbidities, functional limitations, and region., Results: Of the adults, 2.8% (n = 988) and 1.7% (n = 9685) with and without a cancer history, respectively, reported transportation barriers; 7324 and 40 793 deaths occurred in adults with and without cancer history, respectively. Adults with a cancer history and transportation barriers, as compared with adults without a cancer history or transportation barriers, had the highest likelihood of ER use (adjusted odds ratio [aOR] = 2.77, 95% confidence interval [CI] = 2.34 to 3.27) and all-cause mortality risk (adjusted hazard ratio [aHR] = 2.28, 95% CI = 1.94 to 2.68), followed by adults without a cancer history with transportation barriers (ER use aOR = 1.98, 95% CI =1.87 to 2.10; all-cause mortality aHR = 1.57, 95% CI = 1.46 to 1.70) and adults with a cancer history but without transportation barriers (ER use aOR = 1.39, 95% CI = 1.34 to 1.44; all-cause mortality aHR = 1.59, 95% CI = 1.54 to 1.65)., Conclusion: Delayed care because of lack of transportation was associated with increased ER use and mortality risk among adults with and without cancer history. Cancer survivors with transportation barriers had the highest risk., (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2023
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20. Ecological and individualistic fallacies in health disparities research.
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Shih YT, Bradley C, and Yabroff KR
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- 2023
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21. Addressing Transportation Insecurity Among Patients With Cancer.
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Graboyes EM, Chaiyachati KH, Sisto Gall J, Johnson W, Krishnan JA, McManus SS, Thompson L, Shulman LN, and Yabroff KR
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- United States epidemiology, Humans, Housing, Delivery of Health Care, Transportation, Government Programs, Food Supply, Neoplasms epidemiology, Neoplasms therapy
- Abstract
Health-care-related transportation insecurity is common in the United States. Patients with cancer are especially vulnerable because cancer care is episodic in nature, occurs over a prolonged period, is marked by frequent clinical encounters, requires intense treatments, and results in substantial financial hardship. As a result of transportation insecurity, patients with cancer may forego, miss, delay, alter, and/or prematurely terminate necessary care. Limited data suggest that these alterations in care have the potential to increase the rates of cancer recurrence and mortality and exacerbate disparities in cancer incidence, severity, and outcomes. Transportation insecurity also negatively impacts at the informal caregiver, provider, health system, and societal levels. Recognizing that transportation is a critical determinant of outcomes for patients with cancer, there are ongoing efforts to develop evidence-based protocols to identify at-risk patients and address transportation insecurity at federal policy, health system, not-for-profit, and industry levels. In 2021, the National Cancer Policy Forum of the National Academies of Science, Engineering, and Medicine sponsored a series of webinars addressing key social determinants of health including food, housing, and transportation among patients with cancer. This commentary summarizes the formal presentations and discussions related to transportation insecurity and will 1) discuss the heterogeneous nature of transportation insecurity among patients with cancer; 2) characterize its prevalence along the cancer continuum; 3) examine its multilevel consequences; 4) discuss measurement and screening tools; 5) highlight ongoing efforts to address transportation insecurity; 6) suggest policy levers; and 7) outline a research agenda to address critical knowledge gaps., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2022
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22. Housing and Cancer Care and Outcomes: A Systematic Review.
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Fan Q, Nogueira L, Yabroff KR, Hussaini SMQ, and Pollack CE
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- United States epidemiology, Humans, Housing, Neoplasms epidemiology, Neoplasms therapy
- Abstract
Background: Access to stable and affordable housing is an important social determinant of health in the United States. However, research addressing housing and cancer care, diagnosis, and outcomes has not been synthesized., Methods: We conducted a systematic review of studies examining associations of housing and cancer care and outcomes using PubMed, Embase, Scopus, and CINAHL. Included studies were conducted in the United States and published in English between 1980 and 2021. Study characteristics and key findings were abstracted and qualitatively synthesized., Results: A total of 31 studies were identified. Housing-related measures were reported at the individual level in 20 studies (65%) and area level in 11 studies (35%). Study populations and housing measures were heterogeneous. The most common housing measures were area-level housing discrimination (8 studies, 26%), individual-level housing status (8 studies, 26%), and individual-level housing concerns (7 studies, 23%). The most common cancer outcomes were screening (12 studies, 39%) and mortality (9 studies, 29%). Few studies assessed multiple dimensions of housing. Most studies found that exposure to housing insecurity was statistically significantly associated with worse cancer care (11 studies) or outcomes (10 studies)., Conclusions: Housing insecurity is adversely associated with cancer care and outcomes, underscoring the importance of screening for housing needs and supporting systemic changes to advance equitable access to care. Additional research is needed to develop and test provider- and policy-level housing interventions that can effectively address the needs of individuals throughout the cancer care continuum., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2022
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23. Housing Insecurity Among Patients With Cancer.
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Fan Q, Keene DE, Banegas MP, Gehlert S, Gottlieb LM, Yabroff KR, and Pollack CE
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- United States epidemiology, Humans, Housing, Ethnicity, Food Supply, Neoplasms diagnosis, Neoplasms epidemiology, Neoplasms therapy
- Abstract
Social determinants of health are the economic and environmental conditions under which people are born, live, work, and age that affect health. These structural factors underlie many of the long-standing inequities in cancer care and outcomes that vary by geography, socioeconomic status, and race and ethnicity in the United States. Housing insecurity, including lack of safe, affordable, and stable housing, is a key social determinant of health that can influence-and be influenced by-cancer care across the continuum, from prevention to screening, diagnosis, treatment, and survivorship. During 2021, the National Cancer Policy Forum of the National Academies of Science, Engineering, and Medicine sponsored a series of webinars addressing social determinants of health, including food, housing, and transportation insecurity, and their associations with cancer care and patient outcomes. This dissemination commentary summarizes the formal presentations and panel discussions from the webinar devoted to housing insecurity. It provides an overview of housing insecurity and health care across the cancer control continuum, describes health system interventions to minimize the impact of housing insecurity on patients with cancer, and identifies challenges and opportunities for addressing housing insecurity and improving health equity. Systematically identifying and addressing housing insecurity to ensure equitable access to cancer care and reduce health disparities will require ongoing investment at the practice, systems, and broader policy levels., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2022
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24. Unpaid Caregiving: What are the Hidden Costs?
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Bradley CJ, Schulick RD, and Yabroff KR
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- Humans, Costs and Cost Analysis, Employment, Caregivers
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- 2022
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25. Costs Around the First Year of Diagnosis for 4 Common Cancers Among the Privately Insured.
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Shih YT, Xu Y, Bradley C, Giordano SH, Yao J, and Yabroff KR
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- Adult, Health Care Costs, Health Expenditures, Humans, Insurance, Health, Male, Colorectal Neoplasms diagnosis, Colorectal Neoplasms epidemiology, Colorectal Neoplasms therapy, Prostatic Neoplasms diagnosis, Prostatic Neoplasms epidemiology, Prostatic Neoplasms therapy
- Abstract
Background: We estimated trends in total and out-of-pocket (OOP) costs around the first year of diagnosis for privately insured nonelderly adult cancer patients., Methods: We constructed incident cohorts of breast, colorectal, lung, and prostate cancer patients diagnosed between 2009 and 2016 using claims data from the Health Care Cost Institute. We identified cancer-related surgery, intravenous (IV) systemic therapy, and radiation and calculated associated total and OOP costs (in 2020 US dollars). We assessed trends in health-care utilization and cost by cancer site with logistic regressions and generalized linear models, respectively., Results: The cohorts included 105 255 breast, 23 571 colorectal, 11 321 lung, and 59 197 prostate cancer patients. For patients diagnosed between 2009 and 2016, total mean costs per patient increased from $109 544 to $140 732 for breast (29%), $151 751 to $168 730 for lung (11%) or $53 300 to $55 497 for prostate (4%) cancer were statistically significant. Increase for colorectal cancer (1%, $136 652 to $137 663) was not statistically significant (P = .09). OOP costs increased to more than 15% for all cancers, including colorectal, to more than $6000 by 2016. Use of IV systemic therapy and radiation statistically significantly increased, except for lung cancer. Cancer surgeries statistically significantly increased for breast and colorectal cancer but decreased for prostate cancer (P < .001). Total costs increased statistically significantly for nearly all treatment modalities, except for IV systemic therapy in colorectal and radiation in prostate cancer., Conclusions: Rising costs of cancer treatments, compounded with greater cost sharing, increased OOP costs for privately insured, nonelderly cancer patients. Policy initiatives to mitigate financial hardship should consider cost containment as well as insurance reform., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2022
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26. Subsequent Primary Cancer Risk Among 5-Year Survivors of Adolescent and Young Adult Cancers.
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Sung H, Siegel RL, Hyun N, Miller KD, Yabroff KR, and Jemal A
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- Adolescent, Female, Humans, Incidence, Registries, Risk Factors, Survivors, United States epidemiology, Young Adult, Hodgkin Disease, Neoplasms, Second Primary epidemiology, Neoplasms, Second Primary etiology
- Abstract
Background: A comprehensive examination of the incidence and mortality of subsequent primary cancers (SPCs) among adolescent and young adult (AYA) cancer survivors in the United States is lacking., Methods: Cancer incidence and mortality among 170 404 cancer survivors of 5 or more years who were aged 15-39 years at first primary cancer diagnosis during 1975-2013 in 9 Surveillance, Epidemiology, and End Results registries were compared with those in the general population using standardized incidence ratio (SIR), absolute excess incidence (AEI), standardized mortality ratio (SMR), and absolute excess mortality (AEM)., Results: During a mean follow-up of 14.6 years, 13 420 SPC cases and 5008 SPC deaths occurred among survivors (excluding the same site as index cancer), corresponding to 25% higher incidence (95% confidence interval [CI] = 1.23 to 1.27, AEI = 10.8 per 10 000) and 84% higher mortality (95% CI = 1.79 to 1.89, AEM = 9.2 per 10 000) than that in the general population. Overall, SPC risk was statistically significantly higher for 20 of 29 index cancers for incidence and 26 for mortality, with the highest SIR among female Hodgkin lymphoma survivors (SIR = 3.05, 95% CI = 2.88 to 3.24, AEI = 73.0 per 10 000) and the highest SMR among small intestine cancer survivors (SMR = 6.97, 95% CI = 4.80 to 9.79, AEM = 64.1 per 10 000). Type-specific SPC risks varied substantially by index cancers; however, SPCs of the female breast, lung, and colorectum combined constituted 36% of all SPC cases and 39% of all SPC deaths, with lung cancer alone representing 11% and 24% of all cases and deaths, respectively., Conclusion: AYA cancer survivors are almost twice as likely to die from a new primary cancer as the general population, highlighting the need for primary care clinicians to prioritize cancer prevention and targeted surveillance strategies in these individuals., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2022
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27. Association Between Medicaid Expansion Under the Affordable Care Act and Survival Among Newly Diagnosed Cancer Patients.
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Han X, Zhao J, Yabroff KR, Johnson CJ, and Jemal A
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- Humans, Insurance Coverage, Medicaid, Rural Population, United States epidemiology, Neoplasms diagnosis, Neoplasms epidemiology, Neoplasms therapy, Patient Protection and Affordable Care Act
- Abstract
Background: Medicaid expansion under the Affordable Care Act (ACA) is associated with increased insurance coverage among patients with cancer. Whether these gains translate to improved survival is largely unknown. This study examines changes in 2-year survival among patients newly diagnosed with cancer following the ACA Medicaid expansion., Methods: Patients aged 18-62 years from 42 states' population-based cancer registries diagnosed pre (2010-2012) and post (2014-2016) ACA Medicaid expansion were followed through September 30, 2013, and December 31, 2017, respectively. Difference-in-differences (DD) analysis of 2-year overall survival was stratified by sex, race and ethnicity, census tract-level poverty, and rurality., Results: A total of 2 555 302 patients diagnosed with cancer were included from Medicaid expansion (n = 1 523 585) and nonexpansion (n = 1 031 717) states. The 2-year overall survival increased from 80.58% pre-ACA to 82.23% post-ACA in expansion states and from 78.71% to 80.04% in nonexpansion states, resulting in a net increase of 0.44 percentage points (ppt) (95% confidence interval [CI] = 0.24ppt to 0.64ppt) in expansion states after adjusting for sociodemographic factors. By cancer site, the net increase was greater for colorectal cancer (DD = 0.90ppt, 95% CI = 0.19ppt to 1.60ppt), lung cancer (DD = 1.29ppt, 95% CI = 0.50ppt to 2.08ppt), non-Hodgkin lymphoma (DD = 1.07ppt, 95% CI = 0.14ppt to 1.99ppt), pancreatic cancer (DD = 1.80ppt, 95% CI = 0.40ppt to 3.21ppt), and liver cancer (DD = 2.57ppt, 95% CI = 1.00ppt to 4.15ppt). The improvement in 2-year overall survival was larger among non-Hispanic Black patients (DD = 0.72ppt, 95% CI = 0.12ppt to 1.31ppt) and patients residing in rural areas (DD = 1.48ppt, 95% CI= -0.26ppt to 3.23ppt), leading to narrowing survival disparities by race and rurality., Conclusions: Medicaid expansion was associated with greater increase in 2-year overall survival, and the increase was prominent among non-Hispanic Blacks and in rural areas, highlighting the role of Medicaid expansion in reducing health disparities. Future studies should monitor changes in longer-term health outcomes following the ACA., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2022
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28. Cancer's Lasting Financial Burden: Evidence From a Longitudinal Assessment.
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Shih YT, Owsley KM, Nicholas LH, Yabroff KR, and Bradley CJ
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- Health Expenditures, Humans, Insurance Coverage, Poverty, Financial Stress, Neoplasms epidemiology, Neoplasms therapy
- Abstract
Background: The purpose of this study was to conduct a longitudinal analysis of out-of-pocket expenditure (OOPE) trajectories for the assessment of cancer's lasting financial impact., Methods: We identified newly diagnosed cancer patients and constructed matched control group of noncancer participants from the 2002-2018 Health and Retirement Study. Outcomes included monthly OOPE for prescription drugs (RX-OOPE_MONTHLY) and OOPE for medical services other than drugs in the past 2 years (non-RX-OOPE_2YR), consumer debt, and new individual retirement account (IRA) withdrawals. Generalized linear models were used to compare OOPEs between cancer and matched control groups. Logistic regressions were used to compare household-level consumer debt or early IRA withdrawal. Subgroup analysis stratified patients by age, health status, and household income, with the low-income group stratified by Medicaid coverage. All statistical tests were 2-sided., Results: The study cohort included 2022 cancer patients and 10 110 participants in the matched noncancer control group. Mean non-RX-OOPE_2YR of cancer patients was similar to that of participants in the matched control group before diagnosis but statistically significantly higher at diagnosis ($1157, P < .001), 2 ($511, P < .001) years, 4 ($360, P = .006) years, and 6 ($430, P = .01) years after diagnosis. A similar pattern was observed in RX-OOPE_MONTHLY. A statistically significantly higher proportion of cancer patients incurred consumer debt at diagnosis (34.5% vs 29.9%; P < .001) and 2 years after (32.5% vs 28.2%; P = .002). There was no statistically significant difference in new IRA withdrawals. Patients experienced lasting financial consequences following cancer diagnosis that were most pronounced among patients aged 65 years and older, in good-to-excellent health at baseline, and with low income, but without Medicaid coverage., Conclusions: Policies to reduce costs and expand insurance coverage options while reducing cost-sharing are needed., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2022
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29. A History of Health Economics and Healthcare Delivery Research at the National Cancer Institute.
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Doria-Rose VP, Breen N, Brown ML, Feuer EJ, Geiger AM, Kessler L, Lipscomb J, Warren JL, and Yabroff KR
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- Economics, Medical, Health Resources, Health Services Research, Humans, National Cancer Institute (U.S.), United States epidemiology, Medicine, Neoplasms diagnosis, Neoplasms epidemiology, Neoplasms therapy
- Abstract
With increased attention to the financing and structure of healthcare, dramatic increases in the cost of diagnosing and treating cancer, and corresponding disparities in access, the study of healthcare economics and delivery has become increasingly important. The Healthcare Delivery Research Program (HDRP) in the Division of Cancer Control and Population Sciences at the National Cancer Institute (NCI) was formed in 2015 to provide a hub for cancer-related healthcare delivery and economics research. However, the roots of this program trace back much farther, at least to the formation of the NCI Division of Cancer Prevention and Control in 1983. The creation of a division focused on understanding and explaining trends in cancer morbidity and mortality was instrumental in setting the direction of cancer-related healthcare delivery and health economics research over the subsequent decades. In this commentary, we provide a brief history of health economics and healthcare delivery research at NCI, describing the organizational structure and highlighting key initiatives developed by the division, and also briefly discuss future directions. HDRP and its predecessors have supported the growth and evolution of these fields through the funding of grants and contracts; the development of data, tools, and other research resources; and thought leadership including stimulation of research on previously understudied topics. As the availability of new data, methods, and computing capacity to evaluate cancer-related healthcare delivery and economics expand, HDRP aims to continue to support this growth and evolution., (Published by Oxford University Press 2022. This work is written by (a) US Government employee(s) and is in the public domain in the US.)
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- 2022
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30. Health Economics Research in Cancer Treatment: Current Challenges and Future Directions.
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Yu JB, Schrag D, and Yabroff KR
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- Delivery of Health Care, Humans, Prospective Studies, Research Personnel, Economics, Medical, Neoplasms diagnosis, Neoplasms therapy
- Abstract
The National Cancer Institute Division of Cancer Control and Population Science hosted a virtual conference on the Future of Cancer Health Economics Research and included a presentation from a workgroup that considered current challenges and future directions in health economics research centered on cancer treatment. The workgroup identified 3 broad categories of focus: data limitations, opportunities for training for clinicians and health economists interested in collaboration, and the need for prospective economic study of cancer treatment. Within these areas of focus, the workgroup recommended the following: improvement of the availability of key economic measures in data available to researchers, creation of more comprehensive datasets robust to insurance type or coverage, development of cancer care health economics research-focused symposia, instituting clear mechanisms to support integration of economic analyses alongside clinical trials, development of standardized methods to measure the cost of cancer care to health-care systems and patients, and development of standardized evaluations that include measures of social determinants of health., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2022
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31. Cancer Survivorship and Supportive Care Economics Research: Current Challenges and Next Steps.
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Nicholas LH, Davidoff AJ, Howard DH, Keating NL, Ritzwoller DP, Yabroff KR, and Bradley CJ
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- Humans, Research, Survivors, Survivorship, Cancer Survivors, Neoplasms therapy
- Abstract
Background: Rapid growth in the number of cancer survivors raises numerous questions about health and economic outcomes among survivors along with their families, caregivers, and employers. Health economics theory and methods can contribute to many open questions to improve survivorship., Methods: In this paper, we review key areas where more research is needed and describe strategies for improving data infrastructure, research funding, and capacity building to strengthen survivorship health economics research., Conclusions: Health economics has broadened an understanding of key supply- and demand-side factors that promote cancer survivorship. To ensure necessary research in survivorship health economics moving forward, we recommend dedicated funding, inclusion of health economics outcomes in primary data collection, and investments in secondary data sets., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2022
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32. Cancer Health Economics Research: The Future Is Now.
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Halpern MT, Lipscomb J, and Yabroff KR
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- Health Policy, Humans, Economics, Medical, Neoplasms diagnosis, Neoplasms epidemiology, Neoplasms therapy
- Abstract
The goals of the "Future of Cancer Health Economics Research" virtual conference were to identify challenges, gaps, and unmet needs for conducting cancer health economics research; and develop suggestions and ideas to address these challenges and to support the development of this field. The conference involved multiple presentations and panels featuring several key themes, including data limitations and fragmentation; improving research methods; role and impacts of structural and policy factors; and the transdisciplinary nature of this field. The conference also highlighted emerging areas such as communicating results with nonresearchers; balancing data accessibility and data security; emphasizing the needs of trainees; and including health equity as a focus in cancer health economics research. From this conference, it is clear that cancer health economics research can have substantial impacts on how cancer care is delivered and how related health-care policies are developed and implemented. To support further growth and development, this field should continue to welcome individuals from multiple disciplines and enhance opportunities for training in economics and in analytic methods and perspectives from across the social and clinical sciences. Researchers should continue to engage with diverse stakeholders throughout the cancer community, building collaborations and focusing on the goal of improving health and well-being., (Published by Oxford University Press 2022. This work is written by (a) US Government employee(s) and is in the public domain in the US.)
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- 2022
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33. Workforce Caring for Cancer Survivors in the United States: Estimates and Projections of Use.
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Mariotto AB, Enewold L, Parsons H, Zeruto CA, Yabroff KR, and Mayer DK
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- Aged, Humans, Medicare, Survivors, Survivorship, United States epidemiology, Workforce, Cancer Survivors, Neoplasms epidemiology, Neoplasms therapy
- Abstract
Background: This study aims to quantify the extent and diversity of the cancer care workforce, beyond medical oncologists, to inform future demand because the number of cancer survivors is expected to grow in the United States., Methods: Surveillance, Epidemiology, and End Results-Medicare data were used to evaluate health-care use of cancer survivors diagnosed between 2000 and 2014, enrolled in fee-for-service Medicare Parts A and B, and 65 years or older in 2008-2015. We calculated percentage of cancer survivors who saw each clinician specialty and their average annual number of visits in each phase of care. We projected the national number of individuals receiving care and number of annual visits by clinician specialty and phase of care through 2040., Results: Cancer survivors had higher care use in the first year after diagnosis and last year of life phases. During the initial year after cancer diagnosis, most survivors were seen for cancer-related care by a medical oncologist (59.1%), primary care provider (55.9%), and/or other cancer-treating physicians (42.2%). The percentage of survivors with cancer-related visits to each specialty declined after the first year after diagnosis, plateauing after year 6-7. However, at 10 or more years after diagnosis, approximately 20% of cancer survivors had visits to medical oncologists and an average of 4 visits a year., Conclusions: Cancer survivors had higher care use in the first year after diagnosis and last year of life. High levels of care use across specialties in all phases of care have important implications for models of survivorship care coordination and workforce planning., (Published by Oxford University Press 2022. This work is written by US Government employees and is in the public domain in the US.)
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- 2022
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34. Association of the COVID-19 Pandemic With Patterns of Statewide Cancer Services.
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Yabroff KR, Wu XC, Negoita S, Stevens J, Coyle L, Zhao J, Mumphrey BJ, Jemal A, and Ward KC
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- Adolescent, Child, Humans, Pandemics, Population Surveillance, Registries, United States epidemiology, COVID-19 epidemiology, Neoplasms diagnosis, Neoplasms epidemiology, Neoplasms therapy
- Abstract
The coronavirus disease 2019 (COVID-19) pandemic led to delayed medical care in the United States. We examined changes in patterns of cancer diagnosis and surgical treatment between January 1 and December 31 in 2020 and 2019 with real-time electronic pathology report data from population-based Surveillance, Epidemiology, and End Results cancer registries from Georgia and Louisiana. During 2020, there were 29 905 fewer pathology reports than in 2019, representing a 10.2% decline. Declines were observed in all age groups, including children and adolescents younger than 18 years. The nadir was early April 2020, with 42.8% fewer reports than in April 2019. Numbers of reports through December 2020 never consistently exceeded those in 2019 after first declines. Patterns were similar by age group and cancer site. Findings suggest substantial delays in diagnosis and treatment services for cancers during the pandemic. Ongoing evaluation can inform public health efforts to minimize any lasting adverse effects of the pandemic on cancer diagnosis, stage, treatment, and survival., (Published by Oxford University Press 2021. This work is written by US Government employees and is in the public domain in the US.)
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- 2022
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35. Association of Medical Financial Hardship and Mortality Among Cancer Survivors in the United States.
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Yabroff KR, Han X, Song W, Zhao J, Nogueira L, Pollack CE, Jemal A, and Zheng Z
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- Adolescent, Adult, Aged, Cost of Illness, Financial Stress, Health Expenditures, Humans, Insurance, Health, Medicare, Middle Aged, United States epidemiology, Young Adult, Cancer Survivors, Neoplasms
- Abstract
Background: Cancer survivors frequently experience medical financial hardship in the United States. Little is known, however, about long-term health consequences. This study examines the associations of financial hardship and mortality in a large nationally representative sample of cancer survivors., Methods: We identified cancer survivors aged 18-64 years (n = 14 917) and 65-79 years (n = 10 391) from the 1997-2014 National Health Interview Survey and its linked mortality files with vital status through December 31, 2015. Medical financial hardship was measured as problems affording care or delaying or forgoing any care because of cost in the past 12 months. Risk of mortality was estimated with separate weighted Cox proportional hazards models by age group with age as the timescale, controlling for the effects of sociodemographic characteristics. Health insurance coverage was added sequentially to multivariable models., Results: Among cancer survivors aged 18-64 years and 65-79 years, 29.6% and 11.0%, respectively, reported financial hardship in the past 12 months. Survivors with hardship had higher adjusted mortality risk than their counterparts in both age groups: 18-64 years (hazard ratio [HR] = 1.17, 95% confidence interval [CI] = 1.04 to 1.30) and 65-79 years (HR = 1.14, 95% CI = 1.02 to 1.28). Further adjustment for health insurance reduced the magnitude of association of hardship and mortality among survivors aged 18-64 years (HR = 1.09, 95% CI = 0.97 to 1.24). Adjustment for supplemental Medicare coverage had little effect among survivors aged 65-79 years (HR = 1.15, 95% CI = 1.02 to 1.29)., Conclusion: Medical financial hardship was associated with mortality risk among cancer survivors in the United States., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2022
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36. Treating the Whole Patient With Cancer: The Critical Importance of Understanding and Addressing the Trajectory of Medical Financial Hardship.
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Yabroff KR, Shih YT, and Bradley CJ
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- Cost of Illness, Financial Stress, Humans, Cancer Survivors, Neoplasms therapy
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- 2022
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37. Prevalence of Underlying Medical Conditions Associated With Severe COVID-19 Illness in Adult Cancer Survivors in the United States.
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Jiang C, Yabroff KR, Deng L, Perimbeti S, and Han X
- Subjects
- Adult, Humans, Prevalence, SARS-CoV-2, Sociodemographic Factors, United States epidemiology, COVID-19, Cancer Survivors, Neoplasms epidemiology
- Abstract
Cancer, and other underlying medical conditions including chronic obstructive pulmonary disease, heart diseases, diabetes, chronic kidney disease, and obesity, are associated with increased risk of severe coronavirus disease 2019 (COVID-19) illness. We identified 6411 cancer survivors and 77 748 adults without a cancer history from the 2016-2018 National Health Interview Survey and examined the prevalence and sociodemographic factors associated with these conditions in the United States. Most survivors reported having 1 or more of the conditions (56.4%, 95% confidence interval [CI] = 54.8% to 57.9%, vs 41.6%, 95% CI = 40.9% to 42.2%, in adults without a cancer history), and nearly one-quarter (22.9%, 95% CI = 21.6% to 24.3%) reported 2 or more, representing 8.7 million and 3.5 million cancer survivors, respectively. These conditions were more prevalent in survivors of kidney, liver, and uterine cancers as well as Black survivors and those with low socioeconomic status and public insurance. Findings highlight the need to protect survivors against COVID-19 transmission in health-care facilities and to prioritize cancer patients, survivors, caregivers, and their health-care providers in vaccine allocation., (© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2022
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38. Narrowing Insurance Disparities Among Children and Adolescents With Cancer Following the Affordable Care Act.
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Ji X, Hu X, Castellino SM, Mertens AC, Yabroff KR, and Han X
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- Adolescent, Aged, Child, Humans, Insurance Coverage, Medicaid, Medically Uninsured, United States epidemiology, Neoplasms epidemiology, Patient Protection and Affordable Care Act
- Abstract
Despite advances toward universal health insurance coverage for children, coverage gaps remain. Using a nationwide sample of pediatric and adolescent cancer patients from the National Cancer Database, we examined effects of the Affordable Care Act (ACA) implementation in 2014 with multinomial logistic regressions to evaluate insurance changes between 2010-2013 (pre-ACA) and 2014-2017 (post-ACA) in patients aged younger than 18 years (n = 63 377). All statistical tests were 2-sided. Following the ACA, the overall percentage of Medicaid and Children's Health Insurance Program-covered patients increased (from 35.1% to 36.9%; adjusted absolute percentage change [APC] = 2.01 percentage points [ppt], 95% confidence interval [CI] = 1.31 to 2.71; P < .001), partly offset by declined percentage of privately insured (from 62.7% to 61.2%; adjusted APC = -1.67 ppt, 95% CI = -2.37 to -0.97; P < .001), leading to a reduction by 15% in uninsured status (from 2.2% to 1.9%; adjusted APC = -0.34 ppt, 95% CI = -0.56 to -0.12 ppt; P = .003). The largest declines in uninsured status were observed among Hispanic patients (by 23%; adjusted APC = -0.95 ppt, 95% CI = -1.67 to -0.23 ppt; P = .009) and patients residing in low-income areas (by 35%; adjusted APC = -1.22 ppt, 95% CI = -2.22 to -0.21 ppt; P = .02). We showed nationwide insurance gains among pediatric and adolescent cancer patients following ACA implementation, with greater gains in racial and ethnic minorities and those living in low-income areas., (© The Author(s) 2022. Published by Oxford University Press.)
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- 2022
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39. Annual Report to the Nation on the Status of Cancer, Part 2: Patient Economic Burden Associated With Cancer Care.
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Yabroff KR, Mariotto A, Tangka F, Zhao J, Islami F, Sung H, Sherman RL, Henley SJ, Jemal A, and Ward EM
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- Adult, Humans, United States epidemiology, Aged, Cost of Illness, Financial Stress, Health Care Costs, Death, Medicare, Neoplasms epidemiology, Neoplasms therapy
- Abstract
Background: The American Cancer Society, National Cancer Institute, Centers for Disease Control and Prevention, and North American Association of Central Cancer Registries provide annual information about cancer occurrence and trends in the United States. Part 1 of this annual report focuses on national cancer statistics. This study is part 2, which quantifies patient economic burden associated with cancer care., Methods: We used complementary data sources, linked Surveillance, Epidemiology, and End Results-Medicare, and the Medical Expenditure Panel Survey to develop comprehensive estimates of patient economic burden, including out-of-pocket and patient time costs, associated with cancer care. The 2000-2013 Surveillance, Epidemiology, and End Results-Medicare data were used to estimate net patient out-of-pocket costs among adults aged 65 years and older for the initial, continuing, and end-of-life phases of care for all cancer sites combined and separately for the 21 most common cancer sites. The 2008-2017 Medical Expenditure Panel Survey data were used to calculate out-of-pocket costs and time costs associated with cancer among adults aged 18-64 years and 65 years and older., Results: Across all cancer sites, annualized net out-of-pocket costs for medical services and prescriptions drugs covered through a pharmacy benefit among adults aged 65 years and older were highest in the initial ($2200 and $243, respectively) and end-of-life phases ($3823 and $448, respectively) and lowest in the continuing phase ($466 and $127, respectively), with substantial variation by cancer site. Out-of-pocket costs were generally higher for patients diagnosed with later-stage disease. Net annual time costs associated with cancer were $304.3 (95% confidence interval = $257.9 to $350.9) and $279.1 (95% confidence interval = $215.1 to $343.3) for adults aged 18-64 years and ≥65 years, respectively, with higher time costs among more recently diagnosed survivors. National patient economic burden, including out-of-pocket and time costs, associated with cancer care was projected to be $21.1 billion in 2019., Conclusions: This comprehensive study found that the patient economic burden associated with cancer care is substantial in the United States at the national and patient levels., (© The Author(s) 2021. Published by Oxford University Press.)
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- 2021
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40. Association of Medicaid Expansion With Cancer Stage and Disparities in Newly Diagnosed Young Adults.
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Ji X, Castellino SM, Mertens AC, Zhao J, Nogueira L, Jemal A, Yabroff KR, and Han X
- Subjects
- Male, United States epidemiology, Young Adult, Humans, Patient Protection and Affordable Care Act, Insurance Coverage, Medically Uninsured, Medicaid, Testicular Neoplasms
- Abstract
Background: Young adults (YAs) experience higher uninsurance rates and more advanced stage at cancer diagnosis than older counterparts. We examined the association of the Affordable Care Act Medicaid expansion with insurance coverage and stage at diagnosis among YAs newly diagnosed with cancer., Methods: Using the National Cancer Database, we identified 309 413 YAs aged 18-39 years who received a first cancer diagnosis in 2011-2016. Outcomes included percentages of YAs without health insurance at diagnosis, with stage I (early-stage) diagnoses, and with stage IV (advanced-stage) diagnoses. We conducted difference-in-difference (DD) analyses to examine outcomes before and after states implemented Medicaid expansion compared with nonexpansion states. All statistical tests were 2-sided., Results: The percentage of uninsured YAs decreased more in expansion than nonexpansion states (adjusted DD = -1.0 percentage points [ppt], 95% confidence interval [CI] = -1.4 to -0.7 ppt, P < .001). The overall percentage of stage I diagnoses increased (adjusted DD = 1.4 ppt, 95% CI = 0.6 to 2.2 ppt, P < .001) in expansion compared with nonexpansion states, with greater improvement among YAs in rural areas (adjusted DD = 7.2 ppt, 95% CI = 0.2 to 14.3 ppt, P = .045) than metropolitan areas (adjusted DD = 1.3 ppt, 95% CI = 0.4 to 2.2 ppt, P = .004) and among non-Hispanic Black patients (adjusted DD = 2.2 ppt, 95% CI = -0.03 to 4.4 ppt, P = .05) than non-Hispanic White patients (adjusted DD = 1.4 ppt, 95% CI = 0.4 to 2.3 ppt, P = .008). Despite the non-statistically significant change in stage IV diagnoses overall, the percentage declined more (adjusted DD = -1.2 ppt, 95% CI = -2.2 to -0.2 ppt, P = .02) among melanoma patients in expansion relative to nonexpansion states., Conclusions: We provide the first evidence, to our knowledge, on the association of Medicaid expansion with shifts to early-stage cancer at diagnosis and a narrowing of rural-urban and Black-White disparities in YA cancer patients., (© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2021
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41. Annual Report to the Nation on the Status of Cancer, Part 1: National Cancer Statistics.
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Islami F, Ward EM, Sung H, Cronin KA, Tangka FKL, Sherman RL, Zhao J, Anderson RN, Henley SJ, Yabroff KR, Jemal A, and Benard VB
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- Young Adult, Adolescent, Child, Male, Female, United States epidemiology, Humans, American Cancer Society, National Cancer Institute (U.S.), Incidence, Registries, SEER Program, Neoplasms therapy, Breast Neoplasms epidemiology, Lung Neoplasms epidemiology, Melanoma epidemiology
- Abstract
Background: The American Cancer Society, Centers for Disease Control and Prevention, National Cancer Institute, and North American Association of Central Cancer Registries collaborate to provide annual updates on cancer incidence and mortality and trends by cancer type, sex, age group, and racial/ethnic group in the United States. In this report, we also examine trends in stage-specific survival for melanoma of the skin (melanoma)., Methods: Incidence data for all cancers from 2001 through 2017 and survival data for melanoma cases diagnosed during 2001-2014 and followed-up through 2016 were obtained from the Centers for Disease Control and Prevention- and National Cancer Institute-funded population-based cancer registry programs compiled by the North American Association of Central Cancer Registries. Data on cancer deaths from 2001 to 2018 were obtained from the National Center for Health Statistics' National Vital Statistics System. Trends in age-standardized incidence and death rates and 2-year relative survival were estimated by joinpoint analysis, and trends in incidence and mortality were expressed as average annual percent change (AAPC) during the most recent 5 years (2013-2017 for incidence and 2014-2018 for mortality)., Results: Overall cancer incidence rates (per 100 000 population) for all ages during 2013-2017 were 487.4 among males and 422.4 among females. During this period, incidence rates remained stable among males but slightly increased in females (AAPC = 0.2%, 95% confidence interval [CI] = 0.1% to 0.2%). Overall cancer death rates (per 100 000 population) during 2014-2018 were 185.5 among males and 133.5 among females. During this period, overall death rates decreased in both males (AAPC = -2.2%, 95% CI = -2.5% to -1.9%) and females (AAPC = -1.7%, 95% CI = -2.1% to -1.4%); death rates decreased for 11 of the 19 most common cancers among males and for 14 of the 20 most common cancers among females, but increased for 5 cancers in each sex. During 2014-2018, the declines in death rates accelerated for lung cancer and melanoma, slowed down for colorectal and female breast cancers, and leveled off for prostate cancer. Among children younger than age 15 years and adolescents and young adults aged 15-39 years, cancer death rates continued to decrease in contrast to the increasing incidence rates. Two-year relative survival for distant-stage skin melanoma was stable for those diagnosed during 2001-2009 but increased by 3.1% (95% CI = 2.8% to 3.5%) per year for those diagnosed during 2009-2014, with comparable trends among males and females., Conclusions: Cancer death rates in the United States continue to decline overall and for many cancer types, with the decline accelerated for lung cancer and melanoma. For several other major cancers, however, death rates continue to increase or previous declines in rates have slowed or ceased. Moreover, overall incidence rates continue to increase among females, children, and adolescents and young adults. These findings inform efforts related to prevention, early detection, and treatment and for broad and equitable implementation of effective interventions, especially among under resourced populations., (© The Author(s) 2021. Published by Oxford University Press.)
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- 2021
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42. Trends of Cancer-Related Suicide in the United States: 1999-2018.
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Han X, Hu X, Zhao J, Ma J, Jemal A, and Yabroff KR
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- Databases, Factual, Humans, Male, Psycho-Oncology, Risk Factors, United States epidemiology, Hospices, Neoplasms epidemiology, Neoplasms therapy, Suicide
- Abstract
The suicide rate has steadily increased in the United States during the past 2 decades. Cancer patients have elevated suicide risk because of prevalent psychological distress, treatment side effects, and potentially uncontrolled pain. Efforts to promote psychosocial and palliative care may reduce this risk. Using the 1999-2018 Multiple Cause of Death database, we found a decreasing trend of cancer-related suicide during the past 2 decades with an average annual percentage change (AAPC) of age-adjusted suicide rates of -2.8% (95% confidence interval [CI] = -3.5% to -2.1%) in contrast to an increasing trend of overall suicide rate (AAPC = 1.7%, 95% CI = 1.5% to 1.8%). We also observed the largest declines in cancer-related suicide rates among high-risk populations including male, older age, and certain cancer types, suggesting an evolving role of psycho-oncology and palliative and hospice care during this period., (© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2021
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43. Medical Financial Hardship in Survivors of Adolescent and Young Adult Cancer in the United States.
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Lu AD, Zheng Z, Han X, Qi R, Zhao J, Yabroff KR, and Nathan PC
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- Adolescent, Adult, Financial Stress, Health Expenditures, Humans, Survivors, United States epidemiology, Young Adult, Cancer Survivors, Neoplasms epidemiology, Neoplasms therapy
- Abstract
Background: Cancer and its treatment can result in lifelong medical financial hardship, which we aimed to describe among adult survivors of adolescent and young adult (AYA) cancers in the United States., Methods: We identified adult (aged ≥18 years) survivors of AYA cancers (diagnosed ages 15-39 years) and adults without a cancer history from the 2010-2018 National Health Interview Surveys. Proportions of respondents reporting measures in different hardship domains (material [eg, problems paying bills], psychological [eg, distress], and behavioral [eg, forgoing care due to cost]) were compared between groups using multivariable logistic regression models and hardship intensity (cooccurrence of hardship domains) using ordinal logistic regression. Cost-related changes in prescription medication use were assessed separately., Results: A total of 2588 AYA cancer survivors (median = 31 [interquartile range = 26-35] years at diagnosis; 75.0% more than 6 years and 50.0% more than 16 years since diagnosis) and 256 964 adults without a cancer history were identified. Survivors were more likely to report at least 1 hardship measure in material (36.7% vs 27.7%, P < .001) and behavioral (28.4% vs 21.2%, P < .001) domains, hardship in all 3 domains (13.1% vs 8.7%, P < .001), and at least 1 cost-related prescription medication nonadherence (13.7% vs 10.3%, P = .001) behavior., Conclusions: Adult survivors of AYA cancers are more likely to experience medical financial hardship across multiple domains compared with adults without a cancer history. Health-care providers must recognize this inequity and its impact on survivors' health, and multifaceted interventions are necessary to address underlying causes., (© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2021
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44. Employment Outcomes Among Cancer Survivors in the United States: Implications for Cancer Care Delivery.
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de Moor JS, Kent EE, McNeel TS, Virgo KS, Swanberg J, Tracy JK, Banegas MP, Han X, Qin J, and Yabroff KR
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- Adult, Communication, Employment, Female, Humans, Prevalence, United States epidemiology, Young Adult, Cancer Survivors, Neoplasms diagnosis, Neoplasms epidemiology, Neoplasms therapy
- Abstract
The national prevalence of employment changes after a cancer diagnosis has not been fully documented. Cancer survivors who worked for pay at or since diagnosis (n = 1490) were identified from the 2011, 2016, and 2017 Medical Expenditure Panel Survey and Experiences with Cancer supplement. Analyses characterized employment changes due to cancer and identified correlates of those employment changes. Employment changes were made by 41.3% (95% confidence interval [CI] = 38.0% to 44.6%) of cancer survivors, representing more than 3.5 million adults in the United States. Of these, 75.4% (95% CI = 71.3% to 79.2%) took extended paid time off and 46.1% (95% CI = 41.6% to 50.7%) made other changes, including switching to part-time or to a less demanding job. Cancer survivors who were younger, female, non-White, or multiple races and ethnicities, and younger than age 20 years since last cancer treatment were more likely to make employment changes. Findings highlight the need for patient-provider communication about the effects of cancer and its treatment on employment., (Published by Oxford University Press 2020.)
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- 2021
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45. Factors Associated With Health-Related Quality of Life Among Cancer Survivors in the United States.
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Han X, Robinson LA, Jensen RE, Smith TG, and Yabroff KR
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- Adolescent, Adult, Aged, Cancer Survivors statistics & numerical data, Comorbidity, Exercise, Female, Humans, Life Style, Linear Models, Male, Middle Aged, Non-Smokers psychology, Smokers psychology, Socioeconomic Factors, Time Factors, United States, Young Adult, Cancer Survivors psychology, Health Status, Mental Health, Quality of Life
- Abstract
Background: With increasing prevalence of cancer survivors in the United States, health-related quality of life (HRQOL) has become a major priority. We describe HRQOL in a nationally representative sample of cancer survivors and examine associations with key sociodemographic, clinical, and lifestyle characteristics., Methods: Cancer survivors, defined as individuals ever diagnosed with cancer (N = 877), were identified from the 2016 Medical Expenditure Panel Survey-Experiences with Cancer Survivorship Supplement, a nationally representative survey. Physical and mental health domains of HRQOL were measured by the Global Physical Health (GPH) and Global Mental Health (GMH) subscales of the Patient-Reported Outcomes Measurement Information System Global-10. Multivariable linear regression was used to examine associations of sociodemographic, clinical, and lifestyle factors with GPH and GMH scores. All statistical tests were 2-sided., Results: Cancer survivors' mean GPH (49.28, SD = 8.79) and mean GMH (51.67, SD = 8.38) were similar to general population means (50, SD = 10). Higher family income was associated with better GPH and GMH scores, whereas a greater number of comorbidities and lower physical activity were statistically significantly associated with worse GPH and GMH. Survivors last treated 5 years ago and longer had better GPH than those treated during the past year, and current smokers had worse GMH than nonsmokers (all β > 3 and all P < .001)., Conclusions: Cancer survivors in the United States have generally good HRQOL, with similar physical and mental health scores to the general US population. However, comorbidities, poor health behaviors, and recent treatment may be risk factors for worse HRQOL. Multimorbidity management and healthy behavior promotion may play a key role in maximizing HRQOL for cancer survivors., (Published by Oxford University Press 2021.)
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- 2021
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46. Personalized Cancer Follow-Up Care Pathways: A Delphi Consensus of Research Priorities.
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Leach CR, Alfano CM, Potts J, Gallicchio L, Yabroff KR, Oeffinger KC, Hahn EE, Shulman LN, and Hudson SV
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- Adult, Aged, Biomedical Research organization & administration, Biomedical Research standards, Cancer Survivors statistics & numerical data, Consensus, Continuity of Patient Care organization & administration, Continuity of Patient Care standards, Critical Pathways standards, Delivery of Health Care methods, Delivery of Health Care organization & administration, Delivery of Health Care standards, Delphi Technique, Female, Humans, Male, Middle Aged, Monitoring, Physiologic methods, Monitoring, Physiologic standards, Patient-Centered Care organization & administration, Surveys and Questionnaires, Survivorship, United States, Aftercare methods, Aftercare organization & administration, Critical Pathways organization & administration, Health Priorities organization & administration, Health Priorities standards, Health Priorities statistics & numerical data, Neoplasms therapy, Precision Medicine methods
- Abstract
Development of personalized, stratified follow-up care pathways where care intensity and setting vary with needs could improve cancer survivor outcomes and efficiency of health-care delivery. Advancing such an approach in the United States requires identification and prioritization of the most pressing research and data needed to create and implement personalized care pathway models. Cancer survivorship research and care experts (n = 39) participated in an in-person workshop on this topic in 2018. Using a modified Delphi technique-a structured, validated system for identifying consensus-an expert panel identified critical research questions related to operationalizing personalized, stratified follow-up care pathways for individuals diagnosed with cancer. Consensus for the top priority research questions was achieved iteratively through 3 rounds: item generation, item consolidation, and selection of the final list of priority research questions. From the 28 research questions that were generated, 11 research priority questions were identified. The questions were categorized into 4 priority themes: determining outcome measures for new care pathways, developing and evaluating new care pathways, incentivizing new care pathway delivery, and providing technology and infrastructure to support self-management. Existing data sources to begin answering questions were also identified. Although existing data sources, including cancer registry, electronic medical record, and health insurance claims data, can be enhanced to begin addressing some questions, additional research resources are needed to address these priority questions., (© The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2020
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47. Colorectal Cancer Care Among Young Adult Patients After the Dependent Coverage Expansion Under the Affordable Care Act.
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Nogueira L, Chawla N, Han X, Jemal A, and Yabroff KR
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- Adult, Chemotherapy, Adjuvant economics, Chemotherapy, Adjuvant statistics & numerical data, Colorectal Neoplasms diagnosis, Colorectal Neoplasms epidemiology, Cytoreduction Surgical Procedures economics, Cytoreduction Surgical Procedures statistics & numerical data, Early Detection of Cancer economics, Early Detection of Cancer statistics & numerical data, Female, Humans, Male, Proportional Hazards Models, United States epidemiology, Young Adult, Colorectal Neoplasms economics, Colorectal Neoplasms therapy, Patient Protection and Affordable Care Act statistics & numerical data
- Abstract
The effect of the Dependent Coverage Expansion (DCE) under the Affordable Care Act (ACA) on receipt of colorectal cancer treatment has yet to be determined. We identified newly diagnosed DCE-eligible (aged 19-25 years, n = 1924) and DCE-ineligible (aged 27-34 years, n = 8313) colorectal cancer patients from the National Cancer Database from 2007 to 2013. All statistical tests were two-sided. Post-ACA, there was a statistically significant increase in early-stage diagnosis among DCE-eligible (15 percentage point increase, confidence interval = 9.8, 20.2; P < .001), but not DCE-ineligible (P = .09), patients. DCE-eligible patients resected for IIB-IIIC colorectal cancer were more likely to receive timely adjuvant chemotherapy (hazard ratio = 1.34, 95% confidence interval = 1.05 to 1.71; 7.0 days' decrease in restricted mean time from surgery to chemotherapy, P = .01), with no differences in DCE-ineligible patients (hazard ratio = 1.10, 95% confidence interval = 0.98 to 1.24; 2.1 days' decrease, P = .41) post-ACA. Our findings highlight the role of the ACA in improving access to potentially lifesaving cancer care, including a shift to early-stage diagnosis and more timely receipt of adjuvant chemotherapy., (© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2020
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48. Changes in Noninsurance and Care Unaffordability Among Cancer Survivors Following the Affordable Care Act.
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Han X, Jemal A, Zheng Z, Sauer AG, Fedewa S, and Yabroff KR
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- Adolescent, Adult, Female, Humans, Male, Middle Aged, Neoplasms mortality, Socioeconomic Factors, United States, Young Adult, Cancer Survivors statistics & numerical data, Insurance Coverage statistics & numerical data, Insurance, Health statistics & numerical data, Medically Uninsured statistics & numerical data, Neoplasms economics, Patient Protection and Affordable Care Act statistics & numerical data
- Abstract
Background: Little is known about changes in socioeconomic disparities in noninsurance and care unaffordability among nonelderly cancer survivors following the Affordable Care Act (ACA)., Methods: Cancer survivors aged 18-64 years nationwide were identified from the Behavioral Risk Factor Surveillance System. Trend and difference-in-differences analyses were conducted to examine changes in percent uninsured and percent reporting care unaffordability pre-(2011 to 2013) and post-(2014 to 2017) ACA Medicaid expansion, by sociodemographic factors., Results: A total of 118 631 cancer survivors were identified from Medicaid expansion (n = 72 124) and nonexpansion (n = 46 507) states. Following the ACA, percent uninsured and percent reporting care unaffordability decreased nationwide. Medicaid expansion was associated with a 1.8 (95% confidence interval [CI] = 0.1 to 3.5) percentage points (ppt) net decrease in noninsurance and a 2.9 (95% CI = 0.7 to 5.1) ppt net decrease in care unaffordability. In stratified analyses by sociodemographic factors, substantial decreases were observed in female survivors, those with low or medium household incomes, the unemployed, and survivors with multiple comorbidities. However, we observed slightly increased percentages in reporting noninsurance (ppt = 1.7; 95% CI = -1.2 to 4.5) and care unaffordability (ppt = 3.1, 95% CI = -0.4 to 6.5) in nonexpansion states between 2016 and 2017, translating to 67 163 and 124 160 survivors, respectively., Conclusion: We observed reductions in disparities by sociodemographic factors in noninsurance and care unaffordability among nonelderly cancer survivors following the ACA, with largest decreases in women, those with low or medium income, multiple comorbid conditions, the unemployed, and those residing in Medicaid expansion states. However, the uptick of 82 750 uninsured survivors in 2017, mainly from nonexpansion states, is concerning. Ongoing monitoring of the effects of the ACA is warranted, especially in evaluating health outcomes., (© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2020
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49. Health Insurance Coverage Disruptions and Cancer Care and Outcomes: Systematic Review of Published Research.
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Yabroff KR, Reeder-Hayes K, Zhao J, Halpern MT, Lopez AM, Bernal-Mizrachi L, Collier AB, Neuner J, Phillips J, Blackstock W, and Patel M
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- Early Detection of Cancer statistics & numerical data, Humans, Insurance, Health statistics & numerical data, Medicaid statistics & numerical data, Medically Uninsured statistics & numerical data, Neoplasms diagnosis, Observational Studies as Topic, Patient Protection and Affordable Care Act statistics & numerical data, Poverty statistics & numerical data, Publications statistics & numerical data, United States, Health Services Accessibility statistics & numerical data, Insurance Coverage statistics & numerical data, Neoplasms economics, Neoplasms therapy
- Abstract
Background: Lack of health insurance coverage is associated with poor access and receipt of cancer care and survival in the United States. Disruptions in coverage are common among low-income populations, but little is known about associations of disruptions with cancer care, including prevention, screening, and treatment, as well as outcomes of stage at diagnosis and survival., Methods: We conducted a systematic review of studies of health insurance coverage disruptions and cancer care and outcomes published between 1980 and 2019. We used the PubMed, EMBASE, Scopus, and CINAHL databases and identified 29 observational studies. Study characteristics and key findings were abstracted and synthesized qualitatively., Results: Studies evaluated associations between coverage disruptions and prevention or screening (31.0%), treatment (13.8%), end-of-life care (10.3%), stage at diagnosis (44.8%), and survival (20.7%). Coverage disruptions ranged from 4.3% to 32.8% of patients age-eligible for breast, cervical, or colorectal cancer screening. Between 22.1% and 59.5% of patients with Medicaid gained coverage only at or after cancer diagnosis. Coverage disruptions were consistently statistically significantly associated with lower receipt of prevention, screening, and treatment. Among patients with cancer, those with Medicaid disruptions were statistically significantly more likely to have advanced stage (odds ratios = 1.2-3.8) and worse survival (hazard ratios = 1.28-2.43) than patients without disruptions., Conclusions: Health insurance coverage disruptions are common and adversely associated with receipt of cancer care and survival. Improved data infrastructure and quasi-experimental study designs will be important for evaluating the associations of federal and state policies on coverage disruptions and care and outcomes., (Published by Oxford University Press 2020. This work is written by US Government employees and is in the public domain in the US.)
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- 2020
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50. Racial/Ethnic Disparities in Lost Earnings From Cancer Deaths in the United States.
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Zhao J, Miller KD, Islami F, Zheng Z, Han X, Ma J, Jemal A, and Yabroff KR
- Abstract
Background: Little is known about disparities in economic burden due to premature cancer deaths by race or ethnicity in the United States. This study aimed to compare person-years of life lost (PYLLs) and lost earnings due to premature cancer deaths by race/ethnicity., Methods: PYLLs were calculated using recent national cancer death and life expectancy data. PYLLs were combined with annual median earnings to generate lost earnings. We compared PYLLs and lost earnings among individuals who died at age 16-84 years due to cancer by racial/ethnic groups (non-Hispanic [NH] White, NH Black, NH Asian or Pacific Islander, and Hispanic)., Results: In 2015, PYLLs due to all premature cancer deaths were 6 512 810 for NH Whites, 1 196 709 for NH Blacks, 279 721 for NH Asian or Pacific Islanders, and 665 968 for Hispanics, translating to age-standardized lost earning rates (per 100 000 person-years) of $34.9 million, $43.5 million, $22.2 million, and $24.5 million, respectively. NH Blacks had higher age-standardized PYLL and lost earning rates than NH Whites for 13 of 19 selected cancer sites. If age-specific PYLL and lost earning rates for NH Blacks were the same as those of NH Whites, 241 334 PYLLs and $3.2 billion lost earnings (22.6% of the total lost earnings among NH Blacks) would have been avoided. Disparities were also observed for average PYLLs and lost earnings per cancer death for all cancers combined and 18 of 19 cancer sites., Conclusions: Improving equal access to effective cancer prevention, screening, and treatment will be important in reducing the disproportional economic burden associated with racial/ethnic disparities., (© The Author(s) 2020. Published by Oxford University Press.)
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- 2020
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