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PurposeEnd-of-life (EOL) cancer care is costly, with challenges regarding intensity and place of care. We described EOL care and costs for patients with colorectal cancer (CRC) in the United States and the province of Ontario, Canada, to inform better care delivery.MethodsPatients diagnosed with CRC from 2007 to 2013, who died of any cancer from 2007 to 2013 at age ≥ 66 years, were selected from the US SEER cancer registries linked to Medicare claims (n = 16,565) and the Ontario Cancer Registry linked to administrative health data (n = 6,587). We estimated total and resource-specific costs (2015 US dollars) from public payer perspectives over the last 360 days of life by 30-day periods, by stage at diagnosis (0-II, III, IV).ResultsIn all months, especially 30 days before death, higher percentages of SEER-Medicare than Ontario patients received chemotherapy (15.7% v 8.0%), and imaging tests (39.4% v 31.1%). A higher percentage of Ontario patients were hospitalized (62.5% v 51.0%), but 43.2% of hospitalized SEER-Medicare patients had intensive care unit (ICU) admissions versus 17.9% of hospitalized Ontario patients. Cost differences between cohorts were greater for patients with stage IV disease. In the last 30 days, mean total costs for patients with stage IV disease were $15,881 (SEER-Medicare) and $12,034 (Ontario) versus $19,354 and $17,312 for stage 0-II. Hospitalization costs were higher for SEER-Medicare patients ($11,180 v $9,434), with lower daily hospital costs in Ontario ($1,067 v $2,004).ConclusionThese findings suggest opportunities for reducing chemotherapy and ICU use in the United States and hospitalizations in Ontario.

Introduction: In the last decade, melanoma treatment has improved significantly. However, data on population‐level treatment utilization and survival trends among older patients is limited. This study aimed to analyze trends in systemic anticancer therapy (Rx), including the uptake of immune checkpoint inhibitors (ICIs), in conjunction with trends in cause‐specific survival among older patients (66+) diagnosed with advanced melanoma (2008–2019). Methods: We used the Surveillance, Epidemiology, and End Results (SEER)‐Medicare Condensed Resource to assess any Rx utilization among patients first diagnosed with advanced melanoma in 2008–2010, 2011–2014, and 2015–2019, stratified by stage, and type of first‐line Rx among patients receiving Rx. The SEER dataset was used to evaluate trends in cause‐specific survival by year of diagnosis. Results: Rx utilization (any type) almost doubled, from 28.6% (2008–2010) to 55.4% (2015–2019) for stage 3 melanoma, and from 35.5% to 68.0% for stage 4 melanoma. In 2008–2010, the standard first‐line treatment was cytokines/cytotoxic chemotherapy/other. By 2015–2019, only 5.1% (stage 3) and <3.6% (stage 4) of patients receiving Rx received these agents, as ICIs emerged as the dominant treatment. Both 1‐year and 5‐year cause‐specific survival significantly improved since 2010 for stage 4 and since 2013 for stage 3. Conclusions: This study shows a significant rise in Rx utilization and a rapid transition from cytokines/cytotoxic chemotherapy to ICIs, reflecting a rapid uptake of highly effective treatment in a previously challenging disease with limited options before 2011. The documented survival improvement aligns with the adoption of these novel treatments, underscoring their significant impact on real‐world patient outcomes. [ABSTRACT FROM AUTHOR]

BackgroundProstate-specific antigen (PSA) screening for prostate cancer has high risks of overdiagnosis, particularly among older men, and reports from screening trials indicate that it saves few lives after 11 to 13 years of follow-up. New clinical guidelines recommend against PSA screening for all men or for men aged >70 years, but, to the authors' knowledge, the expected population effects of these guidelines have not been studied to date.MethodsTwo models of prostate cancer natural history and diagnosis were previously developed using reconstructed PSA screening patterns and prostate cancer incidence in the United States. Assuming a survival benefit of PSA screening consistent with the screening trials, the authors used the models to predict incidence and mortality rates for the period from 2013 through 2025 under continued PSA screening and under discontinued PSA screening for all men or for men aged >70 years.ResultsThe models predicted that continuation of recent screening rates will overdiagnose 710,000 to 1,120,000 men (range between models) but will avoid 36,000 to 57,000 cancer deaths over the period 2013 through 2025. Discontinued screening for all men eliminated 100% of overdiagnoses but failed to prevent 100% of avoidable cancer deaths. Continued screening for men aged

Background: Cancer is becoming more of a chronic disease due to improvements in treatment and early detection for multiple cancer sites. To gain insight on increased life expectancy due to these improvements, we quantified trends in the loss in expectation of life (LEL) due to a cancer diagnosis for six cancer sites from 1975 through 2018. Methods: We focused on patients diagnosed with female breast cancer, chronic myeloid leukemia (CML), colon and rectum cancer, diffuse large B-cell lymphoma (DLBCL), lung cancer, or melanoma between 1975 and 2018 from nine Surveillance, Epidemiology, and End Results cancer registries. Life expectancies for patients with cancer ages 50+ were modeled using flexible parametric survival models. LEL was calculated as the difference between general population life expectancy and life expectancy for patients with cancer. Results: Over 2 million patients were diagnosed with one of the six cancers between 1975 and 2018. Large increases in life expectancy were observed between 1990 and 2010 for female breast, DLBCL, and CML. Patients with colon and rectum cancer and melanoma had more gradual improvements in life expectancy. Lung cancer LEL only began decreasing after 2005. Increases in life expectancy corresponded with decreases in LEL for patients with cancer. Conclusions: The reported gains in life expectancy largely correspond to progress in the screening, management, and treatment of these six cancers since 1975. [ABSTRACT FROM AUTHOR]

Background The COVID-19 pandemic has had a profound global impact on health-care systems and patient outcomes. However, the specific effects of the pandemic on cancer incidence rates in the United States during its initial year remain unknown. Methods In this study, we analyzed data from the Surveillance, Epidemiology, and End Results–22 registries, which encompass approximately 50% of the US population. We investigated changes in monthly incidence rates stratified by various factors, including cancer type, stage, age group, sex, race and ethnicity, socioeconomic status, rural-urban status, and registry locations. We compared the incidence rates observed during the pandemic with those from the previous year. Results Our findings revealed a decline in incidence rates for all cancer sites combined starting in March 2020, coinciding with the implementation of stay-at-home orders. This decline reached its lowest point in April 2020 and persisted at a lower level until May 2020. Notably, compared with April 2019, the incidence rates in April 2020 dropped by 48.1% and did not consistently return to prepandemic levels. The reduction in cancer rates was more pronounced in urban and affluent counties. Across all cancer types, there was a statistically significant decrease in incidence rates during the pandemic, with the largest declines observed in thyroid (71.2%), prostate (57.9%), breast (54.9%), and colon and rectum cancers (54.1%). Furthermore, these decreases were primarily observed in early stage rather than late-stage disease. Conclusions The COVID-19 pandemic had a statistically significant impact on cancer outcomes. Monitoring long-term consequences of the pandemic on cancer incidence, stage at diagnosis, and mortality trends will be crucial. [ABSTRACT FROM AUTHOR]

Introduction: Pembrolizumab, an anticancer immunotherapy agent, has received multiple approvals since its first approval by the U.S. Food and Drug Administration (FDA) in 2014. Limited data exist on its real‐world use and shifts post tumor‐agnostic approval in 2017 for the treatment of patients with any microsatellite instability‐high/mismatch repair deficient (MSI‐H/dMMR) solid tumors. This study analyzes pembrolizumab's pre and post‐tumor‐agnostic approval use among older U.S. adults, revealing its evolving role in oncology practice. Methods: Using the Surveillance, Epidemiology and End Results (SEER)‐Medicare data (2014–2019), we examined the cancer sites of pembrolizumab recipients before and after tumor‐agnostic approval. Cancer sites were classified based on the timing of site‐specific approvals (before/after tumor‐agnostic approval) or no site‐specific approval, and inclusion in MSI‐H/dMMR clinical trials. Results: The total number of pembrolizumab recipients increased from 4221 in the pre‐agnostic period to 20 479 in the post‐agnostic period. Pembrolizumab was used for a broad range of cancer types, including cancers that had no FDA‐approved site‐specific indications at the time of use (25.8% in pre‐ and 24.6% in post‐agnostic periods). The proportion of pembrolizumab recipients receiving pembrolizumab for cancers with site‐specific approvals before tumor‐agnostic approval decreased from 77.3% to 70.8%. The proportion of pembrolizumab recipients receiving pembrolizumab for cancers that gained site‐specific approvals following tumor‐agnostic approval almost doubled (6.8% to 13.0%). The proportion of pembrolizumab recipients with cancers included in MSI‐H/dMMR trials also doubled (12.3% to 25.5%) following tumor‐agnostic approval. Conclusions: Pembrolizumab use has expanded over time among older adults with cancer, extending beyond those with FDA‐approved site‐specific indications. [ABSTRACT FROM AUTHOR]