Lung cancer treatment costs, including patient responsibility, by disease stage and treatment modality, 1992 to 2003

AbstractObjectivesThe objective of this analysis was to estimate costs for lung cancer care and evaluate trends in the share of treatment costs that are the responsibility of Medicare beneficiaries.MethodsThe Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 1991–2003 for 60,231 patients with lung cancer were used to estimate monthly and patient-liability costs for clinical phases of lung cancer (prediagnosis, staging, initial, continuing, and terminal), stratified by treatment, stage, and non-small- versus small-cell lung cancer. Lung cancer-attributable costs were estimated by subtracting each patient's own prediagnosis costs. Costs were estimated as the sum of Medicare reimbursements (payments from Medicare to the service provider), co-insurance reimbursements, and patient-liability costs (deductibles and “co-payments” that are the patient's responsibility). Costs and patient-liability costs were fit with regression models to compare trends by calendar year, adjusting for age at diagnosis.ResultsThe monthly treatment costs for a 72-year-old patient, diagnosed with lung cancer in 2000, in the first 6 months ranged from $2687 (no active treatment) to$9360 (chemo-radiotherapy); costs varied by stage at diagnosis and histologic type. Patient liability represented up to 21.6% of care costs and increased over the period 1992–2003 for most stage and treatment categories, even when care costs decreased or remained unchanged. The greatest monthly patient liability was incurred by chemo-radiotherapy patients, which ranged from $1617 to$2004 per month across cancer stages.ConclusionsCosts for lung cancer care are substantial, and Medicare is paying a smaller proportion of the total cost over time

The impact of overdiagnosis on the selection of efficient lung cancer screening strategies

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136362/1/ijc30602_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136362/2/ijc30602.pd

Impact of Reduced Tobacco Smoking on Lung Cancer Mortality in the United States During 1975–2000

Background: Considerable effort has been expended on tobacco control strategies in the United States since the mid-1950s. However, we have little quantitative information on how changes in smoking behaviors have impacted lung cancer mortality. We quantified the cumulative impact of changes in smoking behaviors that started in the mid-1950s on lung cancer mortality in the United States over the period 1975–2000. Methods: A consortium of six groups of investigators used common inputs consisting of simulated cohort-wise smoking histories for the birth cohorts of 1890 through 1970 and independent models to estimate the number of US lung cancer deaths averted during 1975–2000 as a result of changes in smoking behavior that began in the mid-1950s. We also estimated the number of deaths that could have been averted had tobacco control been completely effective in eliminating smoking after the Surgeon General’s first report on Smoking and Health in 1964. Results: Approximately 795,851 US lung cancer deaths were averted during the period 1975–2000: 552,574 among men and 243,277 among women. In the year 2000 alone, approximately 70,218 lung cancer deaths were averted: 44,135 among men and 26,083 among women. However, these numbers are estimated to represent approximately 32% of lung cancer deaths that could have potentially been averted during the period 1975–2000, 38% of the lung cancer deaths that could have been averted in 1991–2000, and 44% of lung cancer deaths that could have been averted in 2000. Conclusions: Our results reflect the cumulative impact of changes in smoking behavior since the 1950s. Despite a large impact of changing smoking behaviors on lung cancer deaths, lung cancer remains a major public health problem. Continued efforts at tobacco control are critical to further reduce the burden of this disease

Defendant characteristics and judgment behaviors of adolescent mock jurors

Fictitious court cases involving child abuse were presented to 140 male undergraduates and 140 male junior high school students to determine if the tendency to deal harshly with alleged criminals is dependent upon certain defendant characteristics. Results indicate that younger adolescent jurors give longer sentences than older adolescent jurors, and male defendants receive longer sentences than female defendants. While no significant main effects for case content were found, younger jurors gave longer sentences and attributed more responsibility to a parent who beat his/her child, while older adolescent jurors attributed more responsibility and prescribed longer sentences to a parent who burned the child. Implications for future research with adolescent jurors are discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45262/1/10964_2005_Article_BF02089106.pd

Comparing Benefits from Many Possible Computed Tomography Lung Cancer Screening Programs: Extrapolating from the National Lung Screening Trial Using Comparative Modeling

Background: The National Lung Screening Trial (NLST) demonstrated that in current and former smokers aged 55 to 74 years, with at least 30 pack-years of cigarette smoking history and who had quit smoking no more than 15 years ago, 3 annual computed tomography (CT) screens reduced lung cancer-specific mortality by 20% relative to 3 annual chest X-ray screens. We compared the benefits achievable with 576 lung cancer screening programs that varied CT screen number and frequency, ages of screening, and eligibility based on smoking. Methods and Findings: We used five independent microsimulation models with lung cancer natural history parameters previously calibrated to the NLST to simulate life histories of the US cohort born in 1950 under all 576 programs. ‘Efficient’ (within model) programs prevented the greatest number of lung cancer deaths, compared to no screening, for a given number of CT screens. Among 120 ‘consensus efficient’ (identified as efficient across models) programs, the average starting age was 55 years, the stopping age was 80 or 85 years, the average minimum pack-years was 27, and the maximum years since quitting was 20. Among consensus efficient programs, 11% to 40% of the cohort was screened, and 153 to 846 lung cancer deaths were averted per 100,000 people. In all models, annual screening based on age and smoking eligibility in NLST was not efficient; continuing screening to age 80 or 85 years was more efficient. Conclusions: Consensus results from five models identified a set of efficient screening programs that include annual CT lung cancer screening using criteria like NLST eligibility but extended to older ages. Guidelines for screening should also consider harms of screening and individual patient characteristics

Association studies of up to 1.2 million individuals yield new insights into the genetic etiology of tobacco and alcohol use.

Tobacco and alcohol use are leading causes of mortality that influence risk for many complex diseases and disorders1. They are heritable2,3 and etiologically related4,5 behaviors that have been resistant to gene discovery efforts6-11. In sample sizes up to 1.2 million individuals, we discovered 566 genetic variants in 406 loci associated with multiple stages of tobacco use (initiation, cessation, and heaviness) as well as alcohol use, with 150 loci evidencing pleiotropic association. Smoking phenotypes were positively genetically correlated with many health conditions, whereas alcohol use was negatively correlated with these conditions, such that increased genetic risk for alcohol use is associated with lower disease risk. We report evidence for the involvement of many systems in tobacco and alcohol use, including genes involved in nicotinic, dopaminergic, and glutamatergic neurotransmission. The results provide a solid starting point to evaluate the effects of these loci in model organisms and more precise substance use measures

<b>Message Journal, Issue 4</b>: DESIGN POLITICS What are the politics of your design and what is the design of your politics?

In the Message journal issue 4 we wanted to create an arena where our discipline could discuss the nature and context of its role from an overtly political perspective. Whilst we felt in our bones there was an appetite for this, we were far from certain about its nature, scope and size. Consequently, the call for Message 4 was, to say the least, somewhat of a gamble. Thankfully, our hunches and speculations seem to have been close to the mark. We received more submissions for this call than the previous three issues combined. There was also an anticipation (albeit in hindsight a rather naive one) that some submissions might be positioned around conventional left, right and/or sustainable ecological perspectives. This did not really transpire. Nonetheless, we are very happy to say that the creative, eclectic and diverse nature of the responses has resulted in a range of exemplars that reflect the varied nature, concerns and foci of our vibrant discipline. These extend from John Calvelli’s philosophical dialectic on the fundamental nature and origin of images, their use and effects, to Elizabeth Herrmann’s self-initiated craft-based approach, to do good locally and make a social contribution. Both of these papers are also examples of the higher than usual number of submissions from North America, a substantial proportion of which relate to the politics of cultural and/or racial identity, such as Omari Souza’s, ‘Racist Motifs in Everyday Branding’. Message is dedicated to the development of Graphic Communication Design research. Particularly (although not exclusively) through authors’ analysis of and reflection on their own practice-based research. Through peer reviewed submissions and occasional commissioned essays, Message explores, discusses and challenges the boundaries, roles, practices and outputs of Graphic Communication Design. Past, present and future.Introduction – Peter Jones Rethinking Graphic Design and the Design of Historical Arguments– Camila Afanador-Llach The Intersection of Electoral Politics and Design Education - Anne Berry & Sarah Rutherford Ecological Mourning and the Work of Graphic Communication Design – John Calvelli From High to Low and High Again – Kristen Coogan Speculative Graphic Design: The Idiot’s-Eye-View – James Dyer Free!* Reclaiming ‘freedom’ from the neoliberal lexicon - Cathy Gale Countering ‘Fake News’ in the Design Classroom - Anne M. Giangiulio Cards for Humanity: Constructing Meaningful Communities Through Unsolicited Do-Good Design - Elizabeth Herrmann Political Awareness and Engagement Through Banknote Design - Chae Ho Lee Personal value thinking in graphic communication design education – The introduction of a clarification tool for students - Gwen Lettis, Pamela Napier, Adam de Eyto & Muireann McMahon Passive, Brutish, or Civil? Racist Motifs in Everyday Branding - Omari Souza Countering the Othering of Others: Illustration Facilitating Empathy - Dave Wood Re-contextualising Illustration to Inform Sexual Consent – #JustSoYouKnow - Dave Woo

Genome-Wide Association of Bipolar Disorder Suggests an Enrichment of Replicable Associations in Regions near Genes

Although a highly heritable and disabling disease, bipolar disorder's (BD) genetic variants have been challenging to identify. We present new genotype data for 1,190 cases and 401 controls and perform a genome-wide association study including additional samples for a total of 2,191 cases and 1,434 controls. We do not detect genome-wide significant associations for individual loci; however, across all SNPs, we show an association between the power to detect effects calculated from a previous genome-wide association study and evidence for replication (P = 1.5×10−7). To demonstrate that this result is not likely to be a false positive, we analyze replication rates in a large meta-analysis of height and show that, in a large enough study, associations replicate as a function of power, approaching a linear relationship. Within BD, SNPs near exons exhibit a greater probability of replication, supporting an enrichment of reproducible associations near functional regions of genes. These results indicate that there is likely common genetic variation associated with BD near exons (±10 kb) that could be identified in larger studies and, further, provide a framework for assessing the potential for replication when combining results from multiple studies

Applying polygenic risk scores to postpartum depression

The etiology of major depressive disorder (MDD) is likely to be heterogeneous, but postpartum depression (PPD) is hypothesized to represent a more homogenous subset of MDD. We use genome-wide SNP data to explore this hypothesis