Cost of care for cancer patients in England: evidence from population-based patient-level data

background: Health systems are facing the challenge of providing care to an increasing population of patients with cancer. However, evidence on costs is limited due to the lack of large longitudinal databases. methods: We matched cost of care data to population-based, patient-level data on cancer patients in England. We conducted a retrospective cohort study including all patients age 18 and over with a diagnosis of colorectal (275 985 patients), breast (359 771), prostate (286 426) and lung cancer (283 940) in England between 2001 and 2010. Incidence costs, prevalence costs, and phase of care costs were estimated separately for patients age 18–64 and greater than or equal to65. Costs of care were compared by patients staging, before and after diagnosis, and with a comparison population without cancer. results: Incidence costs in the first year of diagnosis are noticeably higher in patients age 18–64 than age greater than or equal to65 across all examined cancers. A lower stage diagnosis is associated with larger cost savings for colorectal and breast cancer in both age groups. The additional costs of care because of the main four cancers amounts to £1.5 billion in 2010, namely 3.0% of the total cost of hospital care. conclusions: Population-based, patient-level data can be used to provide new evidence on the cost of cancer in England. Early diagnosis and cancer prevention have scope for achieving large cost savings for the health system

Advanced practice registered nurses, physician assistants and cancer prevention and screening: a systematic review

BACKGROUND: For more than two decades, integration of team-based approaches in primary care, including physicians, advanced practice registered nurses and physician assistants (APRN/PA), have been recommended for improving healthcare delivery, yet little is known about their roles in cancer screening and prevention. This study aims to review the current literature on the participation and roles of APRN/PAs in providing cancer screening and prevention recommendations in primary care settings in the United States. METHODS: We searched MEDLINE and CINAHL to identify studies published in 1990–2011 reporting on cervical, breast, and colorectal cancer screening and smoking cessation, diet, and physical activity recommendations by APRN/PAs in the United States. A total of 15 studies met all of our eligibility criteria. Key study, provider, and patient characteristics were abstracted as were findings about APRN/PA recommendations for screening and prevention. RESULTS: Most studies were cross-sectional, showed results from within a single city or state, had relatively small sample sizes, reported non-standardized outcome measures. Few studies reported any patient characteristics. APRN/PAs are involved in recommending cancer screening and prevention, although we found variation across screening tests and health behavior recommendations. CONCLUSIONS: Additional research on the cancer prevention and screening practices of APRN/PAs in primary care settings using standardized outcome measures in relation to evidence-based guidelines may help strengthen primary care delivery in the United States

From Form to Dysfunction? Disconnect within Language Planning Policy of No Child Left Behind

The following textual study aims to review the strengths and weaknesses of current second language policy and legislation within the United States education system, and argue for the benefits of pro bilingual education legislation in regards to the science of second language acquisition. Highlighting the disconnect between language planning and policy and the reality of how language instruction and acquisition actually functions, the following study analyses the current language in education legislation found within the policies of No Child Left Behind in the United States. With theories of language-in-education planning and policy lending support to the top-down method of how language acquisition in education should function, No Child Left Behind is reviewed in terms of scientific data from second language acquisition in order to view the legislation as effective or ineffective with regards to how second language learning and bilingual education actually does function. Although the current language legislation within Title III of No Child Left Behind is determined to be ineffective as a means of ensuring proficient English language acquisition or preferred bilingualism, and these discrepancies between policy goals and the reality of implementation within the policy highlight the disconnect between theory and actuality, simple solutions to this dilemma of language plurality in schools have yet to be discovered

Advancing the science of cancer cost measurement: challenges and opportunities

Cancer accounts for a major proportion of national health expenditures, which are expected to increase in the future. This paper aims to identify major challenges with estimating cancer related costs, and discuss international comparisons, and recommendations for future research. Methods. It starts from the experience of an international workshop aimed at comparing cancer burden evaluation methods, improving results comparability, discussing strengths and criticisms of different approaches. Results. Three methodological themes necessary to inform the analysis are identified and discussed: data availability; costs definition; epidemiological measures. Conclusions. Cost evaluation is applied to cancer control interventions and is relevant for public health planners. Despite their complexity, international comparisons are fundamental to improve, generalize and extend cost evaluation to different contexts

The Economic Cost of Community-Based Interventions to Improve Breast Cancer Control among African-American Women

A number of intervention strategies to improve the rate of early stage breast cancer detection have been proposed and evaluated. Though good effectiveness data exist, policymakers and medical administrators may be reluctant to implement such interventions because of cost considerations. Few cost-effectiveness analyses have been conducted on culturally-sensitive interventions that increase mammography screening rates or reduce barriers to receiving timely diagnostic testing and treatment for African-American women. This paper discusses an innovative cost effectiveness model, funded by the National Cancer Institute, and presents microeconomic estimates the cost of twelve community-based intervention strategies designed to improve early stage breast cancer detection rates and appropriate follow-up after an abnormal mammogram among African-American women. An innovation in the estimates is to include the value of women’s time. Community-based program costs range from $47 to$161 per patient on an ongoing basis. Same day scheduling of a mammogram with or without patient transportation, public service announcements, physician education, physician audit with feedback, and same day scheduling of a biopsy cost $47-$53 per patient per year on an ongoing basis. Interventions that require fulltime personnel to maintain the program, such as patient reminder letters, theory-based education, physician reminders, and telephone counseling, are more expensive and cost approximately $54-$57 per patient on an ongoing basis. The three most expensive interventions are the mobile mammography van, lay health workers, and church based navigators, costing approximately $67-$161 per patient In conclusion, the added costs of community-based cancer control programs for vulnerable African-American women are small and have the potential to be offset by the gains in quality-adjusted life years saved as a result of detection at an earlier stage of diagnosis and improved follow-up and treatment, particularly among high-risk communities

The impact of chronic conditions on the economic burden of cancer survivorship: a systematic review

This systematic review examines the excess cost of chronic conditions on the economic burden of cancer survivorship among adults in the US

Associations of Medicaid Expansion with Insurance Coverage, Stage at Diagnosis, and Treatment among Patients with Genitourinary Malignant Neoplasms

Importance: Health insurance coverage is associated with improved outcomes in patients with cancer. However, it is unknown whether Medicaid expansion through the Patient Protection and Affordable Care Act (ACA) was associated with improvements in the diagnosis and treatment of patients with genitourinary cancer. Objective: To assess the association of Medicaid expansion with health insurance status, stage at diagnosis, and receipt of treatment among nonelderly patients with newly diagnosed kidney, bladder, or prostate cancer. Design, Setting, and Participants: This case-control study included adults aged 18 to 64 years with a new primary diagnosis of kidney, bladder, or prostate cancer, selected from the National Cancer Database from January 1, 2011, to December 31, 2016. Patients in states that expanded Medicaid were the case group, and patients in nonexpansion states were the control group. Data were analyzed from January 2020 to March 2021. Exposures: State Medicaid expansion status. Main Outcomes and Measures: Insurance status, stage at diagnosis, and receipt of cancer and stage-specific treatments. Cases and controls were compared with difference-in-difference analyses. Results: Among a total of 340552 patients with newly diagnosed genitourinary cancers, 94033 (27.6%) had kidney cancer, 25770 (7.6%) had bladder cancer, and 220749 (64.8%) had prostate cancer. Medicaid expansion was associated with a net decrease in uninsured rate of 1.1 (95% CI, -1.4 to -0.8) percentage points across all incomes and a net decrease in the low-income population of 4.4 (95% CI, -5.7 to -3.0) percentage points compared with nonexpansion states. Expansion was also associated with a significant shift toward early-stage diagnosis in kidney cancer across all income levels (difference-in-difference, 1.4 [95% CI, 0.1 to 2.6] percentage points) and among individuals with low income (difference-in-difference, 4.6 [95% CI, 0.3 to 9.0] percentage points) and in prostate cancer among individuals with low income (difference-in-difference, 3.0 [95% CI, 0.3 to 5.7] percentage points). Additionally, there was a net increase associated with expansion compared with nonexpansion in receipt of active surveillance for low-risk prostate cancer of 4.1 (95% CI, 2.9 to 5.3) percentage points across incomes and 4.5 (95% CI, 0 to 9.0) percentage points among patients in low-income areas. Conclusions and Relevance: These findings suggest that Medicaid expansion was associated with decreases in uninsured status, increases in the proportion of kidney and prostate cancer diagnosed in an early stage, and higher rates of active surveillance in the appropriate, low-risk prostate cancer population. Associations were concentrated in population residing in low-income areas and reinforce the importance of improving access to care to all patients with cancer

Economic Burden of Cancer in the United States: Estimates, Projections, and Future Research

The economic burden of cancer in the US is substantial and expected to increase significantly in the future due to expected growth and aging of the population and improvements in survival as well as trends in treatment patterns and costs of care following cancer diagnosis. In this paper, we describe measures of the economic burden of cancer and present current estimates and projections of the national burden of cancer in the US. We discuss ongoing efforts to characterize the economic burden of cancer in the US and identify key areas for future work, including developing and enhancing research resources, improving estimates and projections of economic burden, evaluating targeted therapies, and assessing the financial burden for patients and their families. This work will inform efforts by health care policy makers, healthcare systems, and employers to improve the cancer survivorship experience in the US

Wage losses in the year after breast cancer: Extent and determinants among Canadian women

This article is available open access through the publisher’s website at the link below. © The Author 2008.Background - Wage losses after breast cancer may result in considerable financial burden. Their assessment is made more urgent because more women now participate in the workforce and because breast cancer is managed using multiple treatment modalities that could lead to long work absences. We evaluated wage losses, their determinants, and the associations between wage losses and changes for the worse in the family's financial situation among Canadian women over the first 12 months after diagnosis of early breast cancer. Methods - We conducted a prospective cohort study among women with breast cancer from eight hospitals throughout the province of Quebec. Information that permitted the calculation of wage losses and information on potential determinants of wage losses were collected by three pretested telephone interviews conducted over the year following the start of treatment. Information on medical characteristics was obtained from medical records. The main outcome was the proportion of annual wages lost because of breast cancer. Multivariable analysis of variance using the general linear model was used to identify personal, medical, and employment characteristics associated with the proportion of wages lost. All statistical tests were two-sided. Results - Among 962 eligible breast cancer patients, 800 completed all three interviews. Of these, 459 had a paying job during the month before diagnosis. On average, these working women lost 27% of their projected usual annual wages (median = 19%) after compensation received had been taken into account. Multivariable analysis showed that a higher percentage of lost wages was statistically significantly associated with a lower level of education (Ptrend = .0018), living 50 km or more from the hospital where surgery was performed (P = .070), lower social support (P = .012), having invasive disease (P = .086), receipt of chemotherapy (P < .001), self-employment (P < .001), shorter tenure in the job (Ptrend < .001), and part-time work (P < .001). Conclusion - Wage losses and their effects on financial situation constitute an important adverse consequence of breast cancer in Canada.The Canadian Breast Cancer Research Alliance, Canadian Institutes of Health Research, and Fondation de l’Université Laval