When Does an Episode of Care for Cancer Begin?

Little is known about the medical care resources devoted to diagnosing and treating cancer-related symptoms prior to a definitive cancer diagnosis. Previous research using SEER-Medicare data to measure incremental costs and utilization associated with cancer started with the date of diagnosis. We hypothesized that health care use increases prior to diagnosis of a new primary cancer

Positron Emission Tomography and Stage Migration in Head and Neck Cancer

IMPORTANCE: Since 2001, there has been a rapid adoption of positron emission tomography (PET) for diagnosis and American Joint Committee on Cancer (AJCC) staging of head and neck cancer (HNC) without data describing improved clinical outcomes. OBJECTIVE: To determine the association between increased use of PET and stage and/or survival for patients with HNC in the managed care environment. DESIGN, SETTING, AND PARTICIPANTS: Adult patients diagnosed as having HNC (n = 958) from 2000 to 2008 at 4 integrated health systems were identified via tumor registries linked to administrative data. The AJCC stage distribution, patient and treatment characteristics, and survival between pre-PET era (2000-2004) vs PET era (2005-2008) and use of PET vs no use of PET during the PET era were compared. The AJCC stages were categorized to represent localized (stage I or II), locally advanced (stage III, IVA, or IVB), and metastatic (stage IVC) disease. INTERVENTIONS: Treatments were determined by billing codes for surgery, radiation treatment, and chemotherapy. MAIN OUTCOMES AND MEASURES: The primary outcome for this study was the use of PET. Secondary outcomes included treatment received and 2-year survival. A logit model estimated the effects of PET on diagnosis of locally advanced disease. Kaplan-Meier estimates described overall survival differences between PET and non-PET. Cox regression evaluated the association of PET on survival in patients with locally advanced disease. RESULTS: An association between PET and locally advanced disease was found (odds ratio, 2.86 [95% CI, 1.90-4.29) (P < .001). Two-year overall survival for patients with locally advanced disease with and without PET was 52% and 32%, respectively (P = .004), but there was no difference for all stages (P = .69). On Cox proportional hazard regression, PET had no association with survival in patients with locally advanced disease (hazard ratio, 1.208 [95% CI, 0.778-1.877]) (P = .40). CONCLUSIONS AND RELEVANCE: The increasing use of PET among patients with HNC is associated with a greater number of patients with higher-stage disease and a dilution of the population with higher-stage disease with patients who have a better prognosis. Thus, the improved survival in patients with locally advanced disease likely reflects selection bias and stage migration. Further research on PET use among patients with HNC is necessary to determine if it results in improved treatment for individual patients

Visual search and autism symptoms: What young children search for and co-occurring ADHD matter.

Superior visual search is one of the most common findings in the autism spectrum disorder (ASD) literature. Here, we ascertain how generalizable these findings are across task and participant characteristics, in light of recent replication failures. We tested 106 3-year-old children at familial risk for ASD, a sample that presents high ASD and ADHD symptoms, and 25 control participants, in three multi-target search conditions: easy exemplar search (look for cats amongst artefacts), difficult exemplar search (look for dogs amongst chairs/tables perceptually similar to dogs), and categorical search (look for animals amongst artefacts). Performance was related to dimensional measures of ASD and ADHD, in agreement with current research domain criteria (RDoC). We found that ASD symptom severity did not associate with enhanced performance in search, but did associate with poorer categorical search in particular, consistent with literature describing impairments in categorical knowledge in ASD. Furthermore, ASD and ADHD symptoms were both associated with more disorganized search paths across all conditions. Thus, ASD traits do not always convey an advantage in visual search; on the contrary, ASD traits may be associated with difficulties in search depending upon the nature of the stimuli (e.g., exemplar vs. categorical search) and the presence of co-occurring symptoms

Initial sequencing and analysis of the human genome

The human genome holds an extraordinary trove of information about human development, physiology, medicine and evolution. Here we report the results of an international collaboration to produce and make freely available a draft sequence of the human genome. We also present an initial analysis of the data, describing some of the insights that can be gleaned from the sequence.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/62798/1/409860a0.pd

When Does an Episode of Care for Cancer Begin?

BACKGROUND: Little is known about the medical care resources devoted to diagnosing and treating cancer-related symptoms prior to a definitive cancer diagnosis. Previous research using SEER-Medicare data to measure incremental costs and utilization associated with cancer started with the date of diagnosis. We hypothesized that health care use increases prior to diagnosis of a new primary cancer. METHODS: We used a longitudinal case-control design to estimate incremental medical care utilization rates. Cases were 121,293 persons enrolled between January, 2000 and December, 2008 with one or more primary cancers. We selected 522,839 controls randomly from among all health plan members who had no tumor registry evidence of cancer prior to January, 2009, and we frequency matched controls to cancer cases on a five-to-one ratio by age group, gender, and having health plan eligibility in the year of diagnosis of the index cancer case. Utilization data were extracted for all cases and controls for the period 2000-2008 from standardized distributed data warehouses. To determine when and the extent to which patterns of medical care use change preceding a cancer diagnosis, we compute hospitalization rates, hospital days, emergency department visits, same-day surgical procedures, ambulatory medical office visits, imaging procedures, laboratory tests, and ambulatory prescription dispensings per 1,000 persons per month within integrated delivery systems. RESULTS: One- to three-fold increases in monthly utilization rates were observed during the three to five months prior to a cancer diagnosis, compared to matched non-cancer control groups. This pattern was consistent for both aged and non-aged cancer patients. Aged cancer patients had higher utilization rates than non-aged cancer patients throughout the year prior to a cancer diagnosis. CONCLUSION: The pre-diagnosis phase is a resource-intensive component of cancer care episodes and should be included in cost of cancer estimates. More research is needed to determine whether reliable prognostic markers can be identified as the start of a cancer episode prior to a pathology-based diagnosis

Diffusion of New Technologies for Patients With Prostate Cancer

Background/Aims: Prostate cancer is the most common and costly cancer among U.S. men and offers a portfolio of case studies and clinical problems. Among these, the documented increases in use of robotic radical prostatectomy (RRP) and intensity-modulated radiotherapy (IMRT) are illustrative of rapid diffusion of costly, unproven technological innovations. Evidence of these case studies has been limited to the traditional Medicare fee-for-service (FFS) aged population and may provide a potentially biased view of the universe of cancer care in the U.S. To address this issue, we examine treatment patterns among prostate cancer patients enrolled in two integrated health care delivery systems. Methods: The sample included a retrospective cohort of patients diagnosed with nonmetastatic prostate cancer between 2000 and 2008 at the Northwest and Colorado regions of Kaiser Permanente. Choice of radiation therapy was defined as the receipt of external beam radiotherapy (three-dimensional [3D] conformal radiation therapy vs. IMRT) as primary treatment within one year of diagnosis. Choice of prostatectomy was defined as the receipt of surgery as primary treatment (open radical prostatectomy vs. minimally-invasive/robotic radical prostatectomy). A pooled time-series cross-section design was used to analyze the medical care resource use for treating prostate cancer. Results: Both RRP and IMRT were introduced in the two health systems in 2003, and their use has been steadily increasing since then. Use of traditional treatments has either remained stable: open radical prostatectomy; or decreased: 3D conformal radiation therapy. Discussion: We hypothesize that diffusion rates of RRP and IMRT have been slower among HMO enrollees compared with FFS patients. This study improves our understanding of patterns of prostate cancer care in the U.S. by using a large sample of managed care enrollees across the age spectrum, including men younger than 65 relative to men older than 65 years

Long-Term Medical Care Costs of Breast, Prostate, Lung and Colorectal Cancer for HMO Members

Background/Aims: The rising economic burden of cancer in the United States has become a significant public policy issue. Current knowledge of cancer care costs is largely limited to Medicare fee-for-service patients age ≥ 65 years, based on linked Surveillance, Epidemiology, and End Results (SEER) Medicare data. Accordingly, estimates that reflect care costs across the cancer experience, from diagnosis to end-of-life and among individuals \u3c 65 years of age, are needed. This study estimated total and incremental long-term costs of care for individuals age ≥ 18 years diagnosed with breast, colorectal, lung and prostate cancer in integrated health care settings. Methods: We used administrative and electronic medical record data linked with tumor registry information for individuals who were enrolled in one of four nonprofit integrated health care systems and diagnosed with primary breast, colorectal, lung or prostate cancer between 1/1/2000–12/31/2008 (cases). We also identified age-/sex-matched cancer-free individuals (controls). Participating health systems included Group Health Cooperative, Henry Ford Health System, Kaiser Permanente Northwest and Kaiser Permanent Colorado. Long-term costs (at 5, 10 and 20 years) of care were based on the Phases-of-Care approach (Initial, Continuing and End-of-life phases) and measured using the Kaplan-Meier Sample Average estimator, incorporating cost data from the standardized relative resource cost algorithm and cancer site-, age- and stage-specific survival probabilities from SEER. Costs were calculated for both cases and controls to estimate total and incremental care costs, stratified by cancer site, age group (≥65 years) and stage at diagnosis (advanced vs. not advanced). Results: Total and incremental long-term costs of cancer care were significantly higher among individuals age \u3c 65 years at diagnosis compared to those ≥ 65 years. There was considerable variability in total and incremental long-term costs by cancer site and stage at diagnosis. Discussion: Estimates reported in this study improve our understanding of the magnitude of long-term economic resources needed to provide cancer care in the United States by describing cancer care costs among patients in integrated care settings and those age \u3c 65 years. Our results will be directly applicable to future analyses of cancer care costs, serving as a foundation for cost comparisons across different health care systems

PS2-35: Variation in Capture of Chemotherapy Data: Preliminary Findings From the CRN Economic Rx Burden Pilot Study

Background: A number of high-cost chemotherapy agents, including targeted biologic and genetic therapies, have been introduced to the U.S. in recent years. Much of the literature on use and costs of these new agents has been derived from clinical trials and Medicare/SEER-based studies. To date, few studies have been published describing diffusion and costs of new cancer therapies within or across health plan populations