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BackgroundColorectal cancer (CRC) screening is underused, particularly among low-income and minoritized populations, for whom the coronavirus disease 2019 (COVID-19) pandemic has challenged progress in achieving equity.MethodsA hub-and-spoke model was used. The hub was a nonacademic organization and the spokes were three community health center (CHC) systems overseeing numerous clinic sites. Via a cluster-randomized trial design, nine clinic sites were randomized to intervention and 16 clinic sites were randomized to usual care. Patient-level interventions included invitation letters, mailed fecal immunochemical tests (FITs), and call/text-based reminders. Year 1 intervention impact, which took place during the COVID-19 pandemic, was assessed as the proportion completing screening among individuals not up to date at baseline, which compared intervention and nonintervention clinics accounting for intraclinic cluster variation; confidence intervals (CIs) around differences not including 0 were interpreted as statistically significant.ResultsAmong 26,736 patients who met eligibility criteria, approximately 58% were female, 55% were Hispanic individuals, and 44% were Spanish speaking. The proportion completing screening was 11.5 percentage points (ppts) (95% CI, 6.1-16.9 ppts) higher in intervention versus usual care clinics. Variation in differences between intervention and usual care clinics was observed by sex (12.6 ppts [95% CI, 7.2-18.0 ppts] for females; 8.8 ppts [95% CI, 4.7-13.9 ppts] for males) and by racial and ethnic group (13.8 ppts [95% CI, 7.0-20.6 ppts] for Hispanic individuals; 13.0 ppts [95% CI, 3.6-22.4 ppts] for Asian individuals; 11.3 ppts [95% CI, 5.8-16.8 ppts] for non-Hispanic White individuals; 6.1 ppts [95% CI, 0.8-10.4 ppts] for Black individuals).ConclusionsA regional mailed FIT intervention was effective for increasing CRC screening rates across CHC systems serving diverse, low-income populations.

BackgroundGuidelines recommend screening for colorectal cancer (CRC), but participation and abnormal test follow up rates are suboptimal, with disparities by demography. Evidence-based interventions exist to promote screening, but community adoption and implementation are limited.MethodsThe San Diego Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS) program is an academic-community partnership testing regional implementation of a Hub-and-Spoke model for increasing CRC screening and follow-up. The "hub" is a non-academic, non-profit organization that includes 17 community health center (CHC) systems, serving over 190 rural and urban clinic sites. The "spokes" are 3 CHC systems that oversee 11-28 clinics each, totaling over 60 clinics. Using a cluster-randomized trial design, 9 clinics were randomized to intervention and 16 to usual care. Within intervention clinics, approximately 5000 eligible patients not up-to-date with CRC screening per year were identified for intervention. Interventions include an invitation primer, a mailed fecal immunochemical test with completion instructions, and phone and text-based reminders (hub) and patient navigation protocol to promote colonoscopy completion after abnormal FIT (spoke). Outcomes include: 1) proportion of patients up-to-date with screening after three years in intervention versus non-intervention clinics; 2) proportion of patients with abnormal FIT completing colonoscopy within six months of the abnormal result. Implementation science measures are collected to assess acceptability, intervention and usual care adaptations, and sustainability of the intervention strategies.ConclusionThis large-scale, regional cluster randomized trial among CHCs serving diverse populations is anticipated to accelerate progress in CRC prevention in underserved populations.Trial registrationNCT04941300.

This systematic review describes difference in patient‐relevant outcomes between comprehensive cancers (CCCs) versus non‐CCCs. Studies were identified in PubMed, Cochrane CENTRAL, Epistemonikos, and gray literature from January 2002 to May 2024. Data were extracted and appraised by two authors. Results were narratively synthesized, and meta‐analyzed where appropriate. Of 2272 records screened, 36 observational studies were included, predominantly from the United States, and focused on adults with solid cancers. Compared to non‐CCCs, studies consistently or predominantly reported superior outcomes at CCCs relating to mortality and survival, quality of peri‐ and postoperative care, rates of cancer recurrence or progression, and impact on symptoms and health‐related quality of life. Meta‐analysis showed a significantly lower overall mortality risk of 23% in CCCs compared to non‐CCCs (hazard ratio, 0.77; 95% confidence interval, 0.74–0.81, p <.001), with medium heterogeneity (I2 = 64.61%; Q‐test = 36.29, p <.01) observed between the studies. Studies reporting on health equity and costs outcomes consistently or predominantly favored non‐CCCs over CCCs. Mixed results were reported for outcomes relating to time to care, palliative and end‐of‐life care, and health care utilization. The literature reports CCCs are associated with superior outcomes in many areas, especially around mortality and survival. Greater focus is needed to explore outcomes that are important to people with cancer including health‐related quality of life, symptoms, and treatment experience, and economic evaluation. Rather than aiming for superior outcomes, CCCs should be striving to enable equitable, high value, patient‐centered outcomes for all people affected by cancer. Literature demonstrates comprehensive cancers (CCCs) are associated with superior outcomes in many areas, especially around mortality and survival—despite CCCs being called to address health equity for all people with cancer. In addition to mortality and survival outcomes, greater focus is needed exploring other concerns that are important to people with cancer including health‐related quality‐of‐life, symptom burden, treatment experience, and economic evaluation. [ABSTRACT FROM AUTHOR]

PurposeWe examined associations between experiences of care and adherence to surveillance guidelines among Medicare Fee-For-Service beneficiaries with colorectal cancer (CRC).MethodsUsing linked data from the National Cancer Institute's Surveillance, Epidemiology, and End results (SEER) cancer registry program and the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS®) patient experience surveys (SEER-CAHPS), we identified local/regional CRC survivors diagnosed in 1999-2009 aged 65+, who underwent surgical resection and completed a CAHPS survey

Background: Costs of cancer care can result in patient financial hardship; many professional organizations recommend provider discussions about treatment costs as part of high‐quality care. In this pilot study, the authors examined patient–provider cost discussions documented in the medical records of individuals who were diagnosed with advanced non–small cell lung cancer (NSCLC) and melanoma—cancers with recently approved, high‐cost treatment options. Methods: Individuals who were newly diagnosed in 2017–2018 with stage III/IV NSCLC (n = 1767) and in 2018 with stage III/IV melanoma (n = 689) from 12 Surveillance, Epidemiology, and End Results regions were randomly selected for the National Cancer Institute Patterns of Care Study. Documentation of cost discussions was abstracted from the medical record. The authors examined patient, treatment, and hospital factors associated with cost discussions in multivariable logistic regression analyses. Results: Cost discussions were documented in the medical records of 20.3% of patients with NSCLC and in 24.0% of those with melanoma. In adjusted analyses, privately insured (vs. publicly insured) patients were less likely to have documented cost discussions (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.37–0.80). Patients who did not receive systemic therapy or did not receive any cancer‐directed treatment were less likely to have documented cost discussions than those who did receive systemic therapy (OR, 0.39 [95% CI, 0.19–0.81] and 0.46 [95% CI, 0.30–0.70], respectively), as were patients who were treated at hospitals without residency programs (OR, 0.64; 95% CI, 0.42–0.98). Conclusions: Cost discussions were infrequently documented in the medical records of patients who were diagnosed with advanced NSCLC and melanoma, which may hinder identifying patient needs and tracking outcomes of associated referrals. Efforts to increase cost‐of‐care discussions and relevant referrals, as well as their documentation, are warranted. The authors examined patient–provider cost discussions documented in the medical records of individuals who were diagnosed with advanced non–small cell lung cancer and melanoma—cancers with high‐cost treatment options. Cost discussions were infrequently documented, which may hinder identifying patient cost barriers to care and tracking outcomes of associated referrals. [ABSTRACT FROM AUTHOR]

Background Quality indicators are essential for measuring and benchmarking the quality of cancer care. Although there are well-established metrics for early-stage colorectal cancer (CRC), few exist for advanced CRC. This scoping review aimed to collate and review all quality indicators for metastatic CRC. Methods A dedicated search was performed of Web of Science, PubMed, CINAHL, and relevant gray literature to identify quality indicators for metastatic CRC, evaluating the diagnostic workup, systemic anticancer treatments, surgical approaches, radiation approaches, supportive care, and palliative or terminal care provided to patients. Results We identified 11 articles, of which 5 were systematized reviews and 6 concerned the development, validation, or operationalization of quality indicators. Thirty-five distinct quality indicators for metastatic CRC were extracted across 6 domains of care: 1) diagnosis, staging, and treatment planning; 2) systemic anticancer treatment; 3) radiation oncology; 4) surgical approaches; 5) supportive care; and 6) palliative and end-of-life care, with a general quality indicator of overall survival. Of the 35 quality indicators extracted, 8 (23%) were unique to metastatic CRC and 27 (77%) were generic quality indicators across different tumor types but applicable to metastatic CRC. Conclusion There are few quality indicators specifically relevant to metastatic CRC. Those that do exist are generally generic process measures used across tumor types and do not measure the nuance or complexity of current multidisciplinary treatment of patients with metastatic CRC. [ABSTRACT FROM AUTHOR]

Screening may decrease cancer mortality and treatment costs, but the annual cost of cancer screening in the United States is unknown. This study used national health care survey and cost resources data to estimate the annual medical care cost of cancer screening in the United States in 2021. Visual Abstract. The Annual Cost of Cancer Screening in the United States: Screening may decrease cancer mortality and treatment costs, but the annual cost of cancer screening in the United States is unknown. This study used national health care survey and cost resources data to estimate the annual medical care cost of cancer screening in the United States in 2021. Background: Cancer has substantial health, quality-of-life, and economic impacts. Screening may decrease cancer mortality and treatment costs, but the cost of screening in the United States is unknown. Objective: To estimate the annual cost of initial cancer screening (that is, screening without follow-up costs) in the United States in 2021. Design: Model using national health care survey and cost resources data. Setting: U.S. health care systems and institutions. Participants: People eligible for breast, cervical, colorectal, lung, and prostate cancer screening with available data. Measurements: The number of people screened and associated health care system costs by insurance status in 2021 dollars. Results: Total health care system costs for initial cancer screenings in the United States in 2021 were estimated at $43 billion. Approximately 88.3% of costs were attributable to private insurance; 8.5% to Medicare; and 3.2% to Medicaid, other government programs, and uninsured persons. Screening for colorectal cancer represented approximately 64% of the total cost; screening colonoscopy represented about 55% of the total. Facility costs (amounts paid to facilities where testing occurred) were major drivers of the total estimated costs of screening. Limitations: All data on receipt of cancer screening are based on self-report from national health care surveys. Estimates do not include costs of follow-up for positive or abnormal screening results. Variations in costs based on geography and provider or health care organization are not fully captured. Conclusion: The $43 billion estimated annual cost for initial cancer screening in the United States in 2021 is less than the reported annual cost of cancer treatment in the United States in the first 12 months after diagnosis. Identification of cancer screening costs and their drivers is critical to help inform policy and develop programmatic priorities, particularly for enhancing access to recommended cancer screening services. Primary Funding Source: None. [ABSTRACT FROM AUTHOR]

BackgroundSince 1990, the National Cancer Institute (NCI) and Centers for Medicare and Medicaid Services (CMS) have collaborated to create linked data resources to improve our understanding of patterns of care, health care costs, and trends in utilization. However, existing data linkages have not included measures of patient experiences with care.ObjectiveTo describe a new resource for quality of care research based on a linkage between the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS®) patient surveys and the NCI's Surveillance, Epidemiology and End Results (SEER) data.DesignThis is an observational study of CAHPS respondents and includes both fee-for-service and Medicare Advantage beneficiaries with and without cancer. The data linkage includes: CAHPS survey data collected between 1998 and 2010 to assess patient reports on multiple aspects of their care, such as access to needed and timely care, doctor communication, as well as patients' global ratings of their personal doctor, specialists, overall health care, and their health plan; SEER registry data (1973-2007) on cancer site, stage, treatment, death information, and patient demographics; and longitudinal Medicare claims data (2002-2011) for fee-for-service beneficiaries on utilization and costs of care.ParticipantsIn total, 150,750 respondents were in the cancer cohort and 571,318 were in the non-cancer cohort.Main measuresThe data linkage includes SEER data on cancer site, stage, treatment, death information, and patient demographics, in addition to longitudinal data from Medicare claims and information on patient experiences from CAHPS surveys.Key resultsSizable proportions of cases from common cancers (e.g., breast, colorectal, prostate) and short-term survival cancers (e.g., pancreas) by time since diagnosis enable comparisons across the cancer care trajectory by MA vs. FFS coverage.ConclusionsSEER-CAHPS is a valuable resource for information about Medicare beneficiaries' experiences of care across different diagnoses and treatment modalities, and enables comparisons by type of insurance.

PURPOSE Little is known about the role of social determinants of health (SDOH) in the utilization of novel treatments among patients with newly diagnosed multiple myeloma (NDMM). METHODS This retrospective cohort study used Taussig Cancer Center's Myeloma Patient Registry to identify adults with NDMM between January 1, 2017, and December 31, 2021. Electronic health records data captured treatment with (1) triplet or quadruplet regimen and (2) lenalidomide during the first year after NDMM, and (3) stem-cell transplant (SCT) through December 31, 2022. Multivariable logistic regression models examined associations of demographic/clinical characteristics and SDOH with care patterns. RESULTS We identified 569 patients with median age at diagnosis of 66 years (IQR, 59-73); 55% were male, 76% White, 23% Black, 1.1% other races, insured by Medicare (51%), private payer (38%), Medicaid (8.3%), and self-pay/other (1.8%). In the multivariable models, self-pay/other payers (adjusted odds ratio [AOR], 0.15 [95% CI, 0.03 to 0.54]) was associated with lower odds of triplet or quadruplet regimen, compared with Medicare. Private insurance (AOR, 0.48 [95% CI, 0.27 to 0.86]) and self-pay/other payers (AOR, 0.16 [95% CI, 0.04 to 0.74]) had lower odds of lenalidomide. Black patients (v White; AOR, 0.47 [95% CI, 0.26 to 0.85]) and patients treated at regional hospitals (v Taussig Cancer Center; AOR, 0.27 [95% CI, 0.12 to 0.57]) had lower odds of SCT. The odds of receiving triplet or quadruplet regimen, lenalidomide, and SCT also varied by the year of NDMM. CONCLUSION Care for NDMM varied based on race, insurance type, year of diagnosis, and treatment facility. It may be useful to examine the impact of insurance-related characteristics and recent policy initiatives on care disparities. [ABSTRACT FROM AUTHOR]