Risk-adjustment models for breast, lung, and colorectal cancer cost, utilization, and outcomes in a commercially insured population.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18340-e18340
Author(s):  
Bhuvana Sagar ◽  
Yu Shen Lin ◽  
Liana Desharnais Castel
Keyword(s):  
Breast Cancer ◽  
Colorectal Cancer ◽  
Hospital Admissions ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Her2 Positive ◽  
Cost Drivers ◽  
Cancer Breast ◽  
Clinical Biomarkers ◽  
Cost Utilization

e18340 Background: Advances in oncology have led to rising costs which are unsustainable, necessitating value-based arrangements that maximize quality and overall outcomes. Our objective was to identify clinical and patient factors that predict higher costs and utilization among breast, lung, and colorectal cancer in a commercial population. Methods: We conducted a longitudinal analysis of claims in a sample of 9,748 commercially insured patients with breast, lung, and colorectal cancer, to measure costs and utilization based on presence of metastases, proxies for clinical biomarkers, patient demographics, and treatments. Results: Episode Risk Group (ERG) risk score, metastasis, and facility provider affiliation were cost drivers for all three types of cancer (breast, lung, and colorectal). Hypertension and younger age were cost drivers for breast cancer. In addition, HER2 positive status (β = 68,946, SE = 2,104, p < .0001) was significant in breast cancer, and VEGF in both lung (β = 56,975, SE = 10,138, p < .0001) and colorectal (β = 24,400, SE = 5,671, p < .0001) cancers. Metastasis also was associated with greater hospital admissions and hospital length of stay in all three cancers. Chemotherapy and supportive drug therapies accounted for the highest proportions of total medical costs among beneficiaries observed. Conclusions: Value-based reimbursement models in oncology should appropriately risk adjust by accounting for key cost drivers. Although claims-based methodologies may be further augmented with clinical data, we recommend adjusting for the factors we identified in models to predict costs and outcomes in breast, lung, and colorectal cancers.

scholarly journals Function of N6-Methyladenosine Modification in Tumors

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Nan Zhang ◽  
Yuxin Zuo ◽  
Yu Peng ◽  
Lielian Zuo
Keyword(s):  
Breast Cancer ◽  
Colorectal Cancer ◽  
Gastric Cancer ◽  
Nasopharyngeal Carcinoma ◽  
Liver Cancer ◽  
Nuclear Export ◽  
Tumor Proliferation ◽  
Cancer Breast

N6-Methyladenosine (m6A) modification is a dynamic and reversible methylation modification at the N6-position of adenosine. As one of the most prevalent posttranscriptional methylation modifications of RNA, m6A modification participates in several mRNA processes, including nuclear export, splicing, translation, and degradation. Some proteins, such as METTL3, METTL14, WTAP, ALKBH5, FTO, and YTHDF1/2/3, are involved in methylation. These proteins are subdivided into writers (METTL3, METTL14, WTAP), erasers (ALKBH5, FTO), and readers (YTHDF1/2/3) according to their functions in m6A modification. Several studies have shown that abnormal m6A modification occurs in tumors, including colorectal cancer, liver cancer, breast cancer, nasopharyngeal carcinoma, and gastric cancer. The proteins for m6A modification are involved in tumor proliferation, angiogenesis, metastasis, immunity, and other processes. Herein, the roles of m6A modification in cancer are discussed, which will improve the understanding of tumorigenesis, as well as the diagnosis, treatment, and prognosis of tumors.

scholarly journals Lack of Association between Common Polymorphisms in Selenoprotein P Gene and Susceptibility to Colorectal Cancer, Breast Cancer, and Prostate Cancer: A Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Hanjiang Xu ◽  
Fan Mo ◽  
Jun Zhou ◽  
Zongyao Hao ◽  
Xianguo Chen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prostate Cancer ◽  
Colorectal Cancer ◽  
Cancer Susceptibility ◽  
Meta Analysis ◽  
Selenoprotein P ◽  
Tumor Type ◽  
Cancer Breast ◽  
P Gene ◽  
Breast And Prostate Cancer

Background and Objective. Selenoprotein P (SEPP1) is the major selenoprotein in plasma. Previous studies have demonstrated that SEPP1 expression was reduced in human prostate and colon tumors. Nowadays, studies concerning SEPP1 gene polymorphisms and cancer susceptibility have been extensively investigated, whereas results from these studies remain debatable rather than conclusive. Thus, we performed the present meta-analysis to comprehensively assess the association between two common polymorphisms (rs3877899 and rs7579) in SEPP1 and cancer susceptibility. Method. We search the PubMed, Embase, Google Scholar, and Wanfang (China) databases (up to December 1, 2020) to identify all eligible publications. The pooled odds ratio (OR) correspondence with 95% confidence interval (CI) was calculated to evaluate the associations. Results. Finally, nine eligible studies with 7,157 cases and 6,440 controls and five studies with 2,278 cases and 2,821 controls were enrolled in rs3877899 and rs7579 polymorphisms, individually. However, a null significant association was detected between the two polymorphisms in SEPP1 and susceptibility to colorectal, breast, and prostate cancer in all comparison models. Subsequently, subgroup analysis based on tumor type, no significant association was identified for prostate, breast, and colorectal cancer. In addition, when the stratification analyses were conducted by the source of control, HWE status, and ethnicity, yet no significant association was found. Conclusions. The current meta-analysis shows that SEPP1 rs3877899 and rs7579 polymorphisms may not be associated with susceptibility to colon cancer, breast cancer, and prostate cancer, and further well-designed studies with a larger sample size are warranted to validate our findings.

Survival trends in palliative care patients with cancer: A Mayo Clinic 5-year review

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9592-9592
Author(s):  
A. H. Kamal ◽  
K. M. Swetz ◽  
H. Liu ◽  
S. R. Ruegg ◽  
E. C. Carey ◽  
...  
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Median Time ◽  
Mayo Clinic ◽  
Hospital Admissions ◽  
Cox Model ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Care Plan ◽  
Palliative Care Consultation

9592 Background: Palliative care (PC) is an essential part of the continuum of care for cancer (CA) patients (pts). Little is known about the aggregate characteristics and survival of pts receiving inpatient palliative care consultation (PCC). Methods: We reviewed data prospectively collected on patients seen by the Palliative Care Inpatient Consult Service at Mayo Clinic - Rochester from 2003–2008. Demographics, consult characteristics, and survival were analyzed. Kaplan-Meier survival curves and a Cox model of survival were produced. Results: 1794 total patients were seen over the five year period. Cancer is the most common primary diagnosis (47%). Growth in annual PCC has risen dramatically (113 in 2003 vs. 414 in 2007) despite stable total hospital admissions. Patient are predominantly men (52% vs. 48%, p=0.02); median age is 76. General medicine, medical cardiology, and medical intensive care unit services refer most often. Most frequent issues addressed are goals of care, dismissal planning, and pain control (29%, 19%, 17%). PCC in actively dying pts have increased with 27% of all non-operating room, non-trauma in-hospital deaths being seen. Although CA pts have the highest median survival after PCC vs. other diagnoses (17 days, p = 0.018), we observed a five-year trend of decreasing survival from admission to death and PCC to death. Median time from admission to death in CA pts is 36 days in 2003 and 19 days in 2008 (p<0.01). Median time from PCC to death is 33 versus 11.5 days (p<0.01). Despite this, median hospital length of stay and time from PCC to discharge have remained fixed at 8 and 2.5 days, respectively. A Cox model of survival to discharge and <6 months survival (hospice eligibility) shows hospital length of stay, time from consult to discharge, and dismissal location from hospital are all prognostic factors. Conclusions: Survival window for PC intervention for CA pts is lessening. With the trend of shorter survival after PCC, PC professionals have little over two days to implement a comprehensive, ongoing care plan. This highlights the importance of earlier outpatient palliative care involvement with advanced cancer patients and families. No significant financial relationships to disclose.

scholarly journals Personalized Medicine in Screening for Malignant Disease: A Review of Methods and Applications

2013 ◽  
Vol 8 ◽  
pp. BMI.S11153 ◽  
Author(s):  
F. Schmalfuss ◽  
P.L. Kolominsky-Rabas
Keyword(s):  
Breast Cancer ◽  
Prostate Cancer ◽  
Colorectal Cancer ◽  
Personalized Medicine ◽  
Literature Search ◽  
Malignant Disease ◽  
Decisive Role ◽  
Routine Clinical Practice ◽  
Cancer Breast ◽  
Potential Applications

Personalized medicine (PM) is currently a hot topic in the professional world. It is often called the medicine of the future and has already achieved resounding success in the area of targeted therapy. Nevertheless, integration of the concepts of PM into routine clinical practice is slow. This review is intended to give an overview of current and potential applications of PM in oncology. PM could soon play a decisive role, especially in screening. The relevance of PM in screening was examined in the case of four common cancers (colorectal cancer, lung cancer, breast cancer, and prostate cancer). A literature search was performed. This showed that biomarkers in particular play a crucial role in screening. In summary, it can be emphasized that there are already numerous known promising biomarkers in malignant disease. This results in several possibilities for individualizing and revolutionizing screening.

scholarly journals Limitation of life-sustaining treatment and patient involvement in decision-making: a retrospective study of a Danish COVID-19 patient cohort

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Hanne Irene Jensen ◽  
Sevim Ozden ◽  
Gitte Schultz Kristensen ◽  
Mihnaz Azizi ◽  
Siri Aas Smedemark ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Patient Involvement ◽  
Hospital Admissions ◽  
Primary Diagnosis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Patient Cohort ◽  
Hospitalised Patients ◽  
Treatment Limitation ◽  
Life Sustaining Treatment

Abstract Background The coronavirus (COVID-19) pandemic and the risk of an extensive overload of the healthcare systems have elucidated the need to make decisions on the level of life-sustaining treatment for patients requiring hospitalisation. The purpose of the study was to investigate the proportion and characteristics of COVID-19 patients with limitation of life-sustaining treatment decisions and the degree of patient involvement in the decisions. Methods A retrospective observational descriptive study was conducted in three Danish regional hospitals, looking at all patients ≥ 18 years of age admitted in 2020 with COVID-19 as the primary diagnosis. Lists of hospitalised patients admitted due to COVID-19 were extracted. The data registration included age, gender, comorbidities, including mental state, body mass index, frailty, recent hospital admissions, COVID-19 life-sustaining treatment, ICU admission, decisions on limitations of life-sustaining treatment before and during current hospitalisation, hospital length of stay, and hospital mortality. Results A total of 476 patients were included. For 7% (33/476), a decision about limitation of life-sustaining treatment had been made prior to hospital admission. At the time of admission, one or more limitations of life-sustaining treatment were registered for 16% (75/476) of patients. During the admission, limitation decisions were made for an additional 11 patients, totaling 18% (86/476). For 40% (34/86), the decisions were either made by or discussed with the patient. The decisions not made by patients were made by physicians. For 36% (31/86), no information was disclosed about patient involvement. Conclusions Life-sustaining treatment limitation decisions were made for 18% of a COVID-19 patient cohort. Hereof, more than a third of the decisions had been made before hospital admission. Many records lacked information on patient involvement in the decisions.

scholarly journals Post-vaccination COVID-19: A case-control study and genomic analysis of 119 breakthrough infections in partially vaccinated individuals

2021 ◽  
Author(s):  
Ioannis Baltas ◽  
Florencia A T Boshier ◽  
Charlotte A Williams ◽  
Nadua Bayzid ◽  
Marius Cotic ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Admissions ◽  
Genomic Analysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Escape Mutation ◽  
Number Needed To Treat ◽  
Sequencing Analysis ◽  
Full Genome Sequencing ◽  
Post Vaccination

Abstract Background Post-vaccination infections challenge the control of the COVID-19 pandemic. Methods We matched 119 cases of post-vaccination SARS-CoV-2 infection with BNT162b2 mRNA, or ChAdOx1 nCOV-19, to 476 unvaccinated patients with COVID-19 (Sept 2020-March 2021), according to age and sex. Differences in 60-day all-cause mortality, hospital admission, and hospital length of stay were evaluated. Phylogenetic, single nucleotide polymorphism (SNP) and minority variant allele (MVA) full genome sequencing analysis was performed. Results 116/119 cases developed COVID-19 post first vaccination dose (median 14 days, IQR 9 – 24 days). Overall, 13/119 (10∙9%) cases and 158/476 (33∙2%) controls died (p&lt;0.001), corresponding to 4∙5 number needed to treat (NNT). Multivariably, vaccination was associated with 69∙3% (95%CI 45∙8 – 82∙6) relative risk (RR) reduction in mortality. Similar results were seen in subgroup analysis for patients with infection onset ≥14 days after first vaccination (RR reduction 65∙1%, 95%CI 27∙2 – 83∙2, NNT 4∙5), and across vaccine subgroups (BNT162b2: RR reduction 66%, 95%CI 34∙9 – 82∙2, NNT 4∙7, ChAdOx1: RR reduction 78∙4%, 95%CI 30∙4 – 93∙3, NNT 4∙1). Hospital admissions (OR 0∙80, 95%CI 0∙51 – 1∙28), and length of stay (-1∙89 days, 95%CI -4∙57 – 0∙78) were lower for cases, while Ct values were higher (30∙8 versus 28∙8, p = 0.053). B.1.1.7 was the predominant lineage in cases (100/108, 92.6%) and controls (341/446, 76.5%). Genomic analysis identified one post-vaccination case harboring the E484K vaccine escape mutation (B.1.525 lineage). Conclusions Previous vaccination reduces mortality when B.1.1.7 is the predominant lineage. No significant lineage-specific genomic changes during phylogenetic, SNP and MVA analysis were detected.

scholarly journals MP44: TEC4Home heart failure: using home telemonitoring to decrease ED readmissions and clinical flow

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S56-S57
Author(s):  
H. Novak Lauscher ◽  
K. Ho ◽  
J. L. Cordeiro ◽  
A. Bhullar ◽  
R. Abu Laban ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Hospital Admissions ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Total Hospital ◽  
Home Telemonitoring ◽  
Patient Health ◽  
Ed Visits ◽  
Improve Patient

Introduction: Patients with Heart failure (HF) experience frequent decompensation necessitating multiple emergency department (ED) visits and hospitalizations. If patients are able to receive timely interventions and optimize self-management, recurrent ED visits may be reduced. In this feasibility study, we piloted the application of home telemonitoring to support the discharge of HF patients from hospital to home. We hypothesized that TEC4Home would decrease ED revisits and hospital admissions and improve patient health outcomes. Methods: Upon discharge from the ED or hospital, patients with HF received a blood pressure cuff, weight scale, pulse oximeter, and a touchscreen tablet. Participants submitted measurements and answered questions on the tablet about their HF symptoms daily for 60 days. Data were reviewed by a monitoring nurse. From November 2016 to July 2017, 69 participants were recruited from Vancouver General Hospital (VGH), St. Pauls Hospital (SPH) and Kelowna General Hospital (KGH). Participants completed pre-surveys at enrollement and post-surveys 30 days after monitoring finished. Administrative data related to ED visits and hospital admissions were reviewed. Interviews were conducted with the monitoring nurses to assess the impact of monitoring on patient health outcomes. Results: A preliminary analysis was conducted on a subsample of participants (n=22) enrolled across all 3 sites by March 31, 2017. At VGH and SPH (n=14), 25% fewer patients required an ED visit in the post-survey reporting compared to pre-survey. During the monitoring period, the monitoring nurse observed seven likely avoided ED admissions due to early intervention. In total, admissions were reduced by 20% and total hospital length of stay reduced by 69%. At KGH (n=8), 43% fewer patients required an ED visit in the post-survey reporting compared to the pre-survey. Hospital admissions were reduced by 20% and total hospital length of stay reduced by 50%. Overall, TEC4Home participants from all sites showed a significant improvement in health-related quality of life and in self-care behaviour pre- to 90 days post-monitoring. A full analysis of the 69 patients will be complete in February 2018. Conclusion: Preliminary findings indicate that home telemonitoring for HF patients can decrease ED revisits and improve patient experience. The length of stay data may also suggest the potential for early discharge of ED patients with home telemonitoring to avoid or reduce hospitalization. A stepped-wedge randomized controlled trial of TEC4Home in 22 BC communities will be conducted in 2018 to generate evidence and scale up the service in urban, regional and rural communities. This work is submitted on behalf of the TEC4Home Healthcare Innovation Community.

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