Comparative study of prevalence and costs of depression and anxiety among elderly cancer patients.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6595-6595
Author(s):  
Stacey DaCosta Byfield ◽  
Kae Tanudtanud ◽  
John Rich Barrientos ◽  
Kiesha Mae Lasquite ◽  
Kierstin Catlett
Keyword(s):  
Cancer Patients ◽  
Healthcare Spending ◽  
Healthcare Services ◽  
Medical Professional ◽  
Cancer Type ◽  
Depression And Anxiety ◽  
Cancer Breast ◽  
Pharmacy Claims ◽  
Cost Categories ◽  
The Impact

6595 Background: Depression and anxiety are common among cancer patients and can worsen outcomes. We studied the occurrence of depression and anxiety in three common cancers to investigate whether healthcare costs were greater for cancer patients with two mental health disorders (MHD), depression and anxiety, compared to patients without MHD. Methods: This retrospective analysis used deidentified medical and pharmacy claims from a large national U.S. health insurer. Patients were Medicare Advantage enrollees ≥65 years diagnosed with breast, colorectal, or prostate cancer and continuously enrolled from 1/2018–12/2019. We determined statistically whether the annual prevalence of the two MHDs varied by cancer types. Total costs and costs exclusive of MHD-related expenses in five sub-categories were compared: inpatient, emergency room, non-inpatient medical, professional, and pharmacy. Costs from 2019 claims were presented as per-patient per-month (PPPM). Direct depression- and anxiety-related costs were from claims with depression/anxiety diagnoses or drugs. The impact of MHDs on 2019 healthcare spending was examined using multiple linear regression, controlling for demographic and clinical characteristics. LASSO was used for variable selection. Mann-Whitney U tests compared differences in costs by service types between patients with and without MHDs. Results: Of 19,304 study patients, 8,916 (46%) had coexisting depression or anxiety: (i) 4% depression only; (ii) 27% anxiety only; (iii) 7% depression and anxiety; and (iv) 8% were on antidepressant without MHDs diagnoses. There were significant differences in the rates of MHDs between the three cancer groups, with the highest frequency in breast cancer ( breast vs colorectal. 56% vs 49%, p < 0.0005 ; breast vs prostate. 56% vs 38%, p < 0.0005; colorectal vs prostate. 49% vs 38%, p < 0.0005). After excluding the MHDs-related costs (PPPM mean = $44), the monthly spending was 54% higher for patients with MHDs ($2,184 MHDs vs. $1,406 non-MHDs). After adjusting for covariates, the PPPM costs were 23%–58% higher for the MHD-cohort vs. the non-MHD cohort for each cancer type ( non-MHD vs. with depression only, CI 13%–34%, p < 0.0001; non-MHD vs. with anxiety only, CI 40%-52%, p < 0.0001; non-MHD vs. with depression and anxiety, CI 48%-70%, p < 0.0001; non-MHD vs. with antidepressant only, CI 28%-45%, p < 0.0001). Higher costs in MHD-cohort were observed in all cost categories (p < 0.0001). Conclusions: We found high prevalence of MHDs in patients diagnosed with cancer. Analyses showed that total spending was significantly higher in individuals with cancer and MHD for all cost categories. Explanations for higher costs are unclear, as costs remain high even after adjusting for MHD-related care costs. Research on specific healthcare services driving higher costs and the risk factors for depression and anxiety is needed to address broader MHDs to improve cancer care.

Write to recover: The impact of group led creative writing on behavioral health outcomes in cancer patients.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11536-11536
Author(s):  
Darya Nesterova ◽  
Junjia Zhu ◽  
Courtney Kramer ◽  
Monali K. Vasekar ◽  
Jolene Collins ◽  
...  
Keyword(s):  
Creative Writing ◽  
Cancer Patients ◽  
Statistical Significance ◽  
Mental Wellbeing ◽  
Cancer Type ◽  
Depression And Anxiety ◽  
Emotional Wellbeing ◽  
Post Intervention ◽  
Significance Level ◽  
The Impact

11536 Background: The diagnosis of cancer can adversely affect mental wellbeing. In addition to treating cancer, the emotional wellbeing of patients must simultaneously be addressed. A previous pilot exploring the feasibility of creative writing workshop (CWW) in cancer patients showed apositive effect on patients’ mental health. Methods: To longitudinally evaluate the efficacy of CWW on mood, we conducted a phase II study with cancer patients (any stage, any cancer type); randomized 2:1 to CWW vs. active control (AC). Patients in the CWW arm attended at least 4, 1.5-hour bi-monthly CWW x 8 wks, whereas AC patients completed independent writing at home with the help of a book (bi-monthly x 8wks). We used validated tools, [Emotional Thermometer Scales (ETS), PHQ-9, GAD-7] to assess changes in overall mood, depression, and anxiety. Primary end point: a) ETS scores before and after intervention b) Changes in depression and anxiety based on PHQ-9 and GAD-7 scores. We present results from ETS scores. Descriptive statistics were generated for these quantitative scales measured in each group, pre and post intervention. Comparisons between groups (gp) were made using Wilcoxon Rank-sum tests. All tests were two sided and the statistical significance level used was 0.05. Results: Amongst evaluable patients, N of 50 (demographics in table below), twenty-six patients in the CWW gp attended at least one class and 19 attended at least 4 classes. Patients in CWW showed significant mood improvement vs. AC when comparing the final overall ETS (p=0.0063). Three of the five sub-scale ETS scores were significantly lower for the CWW vs. AC gp: anxiety (p=0.0027), depression (p=0.0009), and anger (p=0.0027). Conclusions: Group led CWW have a positive effect on mood. Our results suggest potential therapeutic benefit of this intervention on the emotional wellbeing of cancer patients. Larger studies are needed to evaluate the effect of CWW in cancer patients. Clinical trial information: NCT03536702. [Table: see text]

Impact of cancer on the risk of unplanned 30-day readmissions.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6581-6581
Author(s):  
Alexander Qian ◽  
Edmund Qiao ◽  
Vinit Nalawade ◽  
Nikhil V. Kotha ◽  
Rohith S. Voora ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Hospital Admissions ◽  
Reference Group ◽  
Cancer Site ◽  
Cancer Type ◽  
Logistic Regression Models ◽  
Increased Risk ◽  
Initial Hospitalization ◽  
The Impact

6581 Background: Hospital readmission are associated with unfavorable patient outcomes and increased costs to the healthcare system. Devising interventions to reduce risks of readmission requires understanding patients at highest risk. Cancer patients represent a unique population with distinct risk factors. The purpose of this study was to define the impact of a cancer diagnosis on the risks of unplanned 30-day readmissions. Methods: We identified non-procedural hospital admissions between January through November 2017 from the National Readmission Database (NRD). We included patients with and without a cancer diagnosis who were admitted for non-procedural causes. We evaluated the impact of cancer on the risk of 30-day unplanned readmissions using multivariable mixed-effects logistic regression models. Results: Out of 18,996,625 weighted admissions, 1,685,099 (8.9%) had record of a cancer diagnosis. A cancer diagnosis was associated with an increased risk of readmission compared to non-cancer patients (23.5% vs. 13.6%, p < 0.001). However, among readmissions, cancer patients were less likely to have a preventable readmission (6.5% vs. 12.1%, p < 0.001). When considering the 10 most common causes of initial hospitalization, cancer was associated with an increased risk of readmission for each of these 10 causes (OR range 1.1-2.7, all p < 0.05) compared to non-cancer patients admitted for the same causes. Compared to patients aged 45-64, a younger age was associated with increased risk for cancer patients (OR 1.29, 95%CI [1.24-1.34]) but decreased risk for non-cancer patients (OR 0.65, 95%CI [0.64-0.66]). Among cancer patients, cancer site was the most robust individual predictor for readmission with liver (OR 1.47, 95%CI [1.39-1.55]), pancreas (OR 1.36, 95%CI [1.29-1.44]), and non-Hodgkin’s lymphoma (OR 1.35, 95%CI [1.29-1.42]) having the highest risk compared to the reference group of prostate cancer patients. Conclusions: Cancer patients have a higher risk of 30-day readmission, with increased risks among younger cancer patients, and with individual risks varying by cancer type. Future risk stratification approaches should consider cancer patients as an independent group with unique risks of readmission.

Mood disorders and outcomes in lung cancer patients undergoing surgery: a brief summery

2020 ◽  
Author(s):  
Maria Salvina Signorelli ◽  
Teresa Surace ◽  
Marcello Migliore ◽  
Eugenio Aguglia
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Mood Disorders ◽  
Psychiatric Symptoms ◽  
Depression And Anxiety ◽  
Lung Cancer Patients ◽  
Patients With Cancer ◽  
Treatment Of Depression ◽  
The Impact

Cancer is a leading cause of death worldwide. Literature reports depression and anxiety are the most common psychiatric symptoms in cancer patients. Notably, lung cancer is associated with major depressive disorder in 5–13% of cases. The present article aims to give an overview regarding the impact of mood disorders on the outcomes of patients affected by lung cancer. Our review showed that pharmacological treatment and psychotherapy can be useful to improve the quality of life of patients with lung cancer. Moreover, the treatment of depression and anxiety can be associated with a reduced mortality. In conclusion, it is important to consider psychiatric care as important as other adjuvant oncologic therapies in patients with cancer.

scholarly journals Cognitive impairment after cytotoxic chemotherapy

2019 ◽  
Vol 7 (1) ◽  
pp. 11-21 ◽  
Author(s):  
Petra Huehnchen ◽  
Antonia van Kampen ◽  
Wolfgang Boehmerle ◽  
Matthias Endres
Keyword(s):  
Breast Cancer ◽  
Colon Cancer ◽  
Cognitive Impairment ◽  
Cancer Patients ◽  
Cytotoxic Chemotherapy ◽  
Cytotoxic Drugs ◽  
Cytotoxic Agents ◽  
Cancer Type ◽  
Breast Cancer Patients ◽  
The Impact

Abstract Background Neurotoxicity is a frequent side effect of cytotoxic chemotherapy and affects a large number of patients. Despite the high medical need, few research efforts have addressed the impact of cytotoxic agents on cognition (ie, postchemotherapy cognitive impairment; PCCI). One unsolved question is whether individual cytotoxic drugs have differential effects on cognition. We thus examine the current state of research regarding PCCI. Neurological symptoms after targeted therapies and immunotherapies are not part of this review. Methods A literature search was conducted in the PubMed database, and 1215 articles were reviewed for predefined inclusion and exclusion criteria. Thirty articles were included in the systematic review. Results Twenty-five of the included studies report significant cognitive impairment. Of these, 21 studies investigated patients with breast cancer. Patients mainly received combinations of 5-fluorouracil, epirubicin, cyclophosphamide, doxorubicin, and taxanes (FEC/FEC-T). Five studies found no significant cognitive impairment in chemotherapy patients. Of these, 2 studies investigated patients with colon cancer receiving 5-fluorouracil and oxaliplatin (FOLFOX). Independent risk factors for PCCI were patient age, mood alterations, cognitive reserve, and the presence of apolipoprotein E e4 alleles. Conclusions There is evidence that certain chemotherapy regimens cause PCCI more frequently than others as evidenced by 21 out of 23 studies in breast cancer patients (mainly FEC-T), whereas 2 out of 3 studies with colon cancer patients (FOLFOX) did not observe significant changes. Further studies are needed defining patient cohorts by treatment protocol in addition to cancer type to elucidate the effects of individual cytotoxic drugs on cognitive functions.

Continuum of care: Establishment of a comprehensive cardio-oncology program.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 74-74
Author(s):  
Olexiy Aseyev ◽  
Nina Gosh ◽  
Jeffrey Allen Sulpher ◽  
Christopher Johnson ◽  
Ellamae Stadnick ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Clinical Outcomes ◽  
Continuum Of Care ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cancer Type ◽  
Cardiac Outcomes ◽  
Large Breast ◽  
The Impact

74 Background: Cardiac disease in individuals with cancer is common, impacts survival, the ability to tolerate cancer treatments and quality of life. Cardio-oncology is a novel interdisciplinary approach to the management of cancer patients with treatment-induced cardiotoxicity. The goal of our program is two-fold: a) establishment of a hospital based cardio-oncology clinic to rapidly assess and manage cancer patients with cardiotoxicity related to their cancer treatment and b) provide continuum of care for these patients with the establishment of a cardiovascular survivorship program. Methods: In 2008, in collaboration with oncologists, cardiologists, pharmacy and nursing we established a multidisciplinary cardio-oncology clinic at The Ottawa Hospital. Referrals are primarily form treating oncologists. The clinics take place 3-4 half days per month and are conducted by 3 dedicated cardiologists. Patient data including demographics, cancer type and treatment, cardiovascular risk factors, treatment and clinical outcomes of each patient are being collected. Results: We have seen over 800 patients with solid and hematological malignancies. Clinical outcomes of patients referred from 10/2008 to 01/2013 have previously been reported (Sulpher J. et al 2014). The majority of patients referred were able to successfully complete their cancer therapy (79.7%), reflective of the large breast cancer population seen in this clinic. A third of patients achieved stable left ventricular ejection fractions with cardiac intervention and 41% received cardiac medications. Overall survival and long term cardiac outcomes will be reported. Conclusions: While these initial results are encouraging the impact of cardiotoxicity experienced by cancer patients and long term cardiac outcomes are unknown. In an effort to improve the cardiovascular care of cancer survivors we are currently developing a Cardiovascular Survivorship Program; patients will be referred from our hospital based cardio-oncology clinic to a specialized community clinic, for long-term surveillance and optimization of cardiovascular health. This initiative represents a continuum of care from hospital to community and is the first such program in Canada.

Do rural cancer patients receive lower quality cancer care? Assessing the impact of rurality on oncology practice performance measures.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 166-166
Author(s):  
Catherine R. Fedorenko ◽  
Laura Elizabeth Panattoni ◽  
Qin Sun ◽  
Li Li ◽  
Karma L. Kreizenbeck ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Cancer Patients ◽  
Cancer Care ◽  
Performance Measure ◽  
Area Deprivation ◽  
Cancer Type ◽  
Quality Cancer Care ◽  
Practice Performance ◽  
The Impact

166 Background: Rural residents are diagnosed at later stages of cancer compared to urban residents, have poorer survival, and face distinct barriers to receiving quality cancer care. ASCO has developed policy initiatives to address rural cancer care; however, little is known about quality of cancer care among patients residing in rural areas. This study examined the impact of rurality on performance metrics, controlling for socioeconomic status and insurance type. Methods: We linked Washington state cancer registry records from 2015-2017 with claims records for two large commercial insurers, Medicare, and Medicaid. Using claims from this database, we generated eight nationally recognized quality measures. Rurality was measured by the Rural-Urban Commuting Area Codes (RUCAs) categorized into 4 levels (Metro, Metro with commute, Micropolitan, Small Town/Rural). Process and outcome measures were adjusted for age, sex, race, comorbidity score, stage, cancer type, marital status, the Area Deprivation Index, and treatment factors where appropriate. Results were stratified by payer type. Results: The table below lists the effect of a patient’s rurality on the quality metric where significant (p<0.05). Where rurality did not impact the performance measure, results are left blank. Conclusions: After controlling for socioeconomic status and payer type, quality of cancer care for rural cancer patients was not consistently poorer compared to urban patients. These results suggest that lower survival among rural patients may be due to factors beyond quality of care.[Table: see text]

scholarly journals A magánkiadások hatása a hazai egészségügyi diagnosztikai szolgáltatók pénzügyi helyzetére : The Impact of Private Healthcare Spending on the Hungarian Medical Diagnostic Companies

2021 ◽  
Vol 16 (4) ◽  
pp. 115-132
Author(s):  
Gábor Dávid Kiss ◽  
Andreász Kosztopulosz ◽  
Dániel Szládek
Keyword(s):  
Regression Models ◽  
Annual Report ◽  
Healthcare Spending ◽  
Healthcare Services ◽  
Public Healthcare ◽  
Technological Environment ◽  
Financial Conditions ◽  
Medical Diagnostic ◽  
Report Data ◽  
The Impact

A magánfinanszírozás modellje a kilencvenes évek kezdete óta része a hazai egészségügynek. A 2000-es évektől azonban komolyan előtérbe kerültek ezek a csatornák, különösen a képalkotó diagnosztika és laborszolgáltatások területén, ami az itt szolgáltató vállalkozások közelebbi vizsgálatát teszi szükségessé. Elsőként az Ohlson-féle O csődkockázati mutatók által adott jelzéseket vizsgáljuk meg egy öt vállalkozásból álló mintán 2006 és 2017 között. Ezt követően az Ohlson-féle O csődkockázati mutató változásának magyarázhatóságát vizsgáljuk az egészségügyi finanszírozási környezet, a tőkepiaci helyzet és a technológiai környezetet lefedő modellek keretében, panelregressziós eljárásokkal. Megállapítható, hogy az egészségügyi finanszírozás GDP-arányos változása, illetve a kórházi ágyszám változásai gyakorolták a legkomolyabb hatást a mintában szereplő vállalatok pénzügyi helyzetének alakulására. The Hungarian healthcare services are partially financed on private basis since the 1990s. This channel gained increasing popularity in the 2000s especially on the fields of medical imaging and labour diagnostics – what motivates a deeper corporate analysis on annual report data between 2006 and 2017. Financial conditions were studied with the assumption of the Ohlson O bankruptcy ratio, and their changes were monitored trough three different panel regression models: one focused on general and public healthcare spending and hospital capacities, while the second contained the financial market-related variables as the third referred on the technological environment. The changes of healthcare funding to GDP ratios and hospital bed numbers surpassed all other variables on the financial conditions of the sample companies.

scholarly journals Risk of Alzheimer’s Disease in Cancer Patients: Analysis of Mortality Data from the US SEER Population-Based Registries

Cancers ◽  
2020 ◽  
Vol 12 (4) ◽  
pp. 796 ◽  
Author(s):  
Roman Mezencev ◽  
Yury O. Chernoff
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cancer Patients ◽  
Molecular Mechanisms ◽  
White Women ◽  
Mortality Data ◽  
Time Interval ◽  
Cancer Type ◽  
Inverse Association ◽  
The Impact

Previous studies have reported an inverse association between cancer and Alzheimer’s disease (AD), which are leading causes of human morbidity and mortality. We analyzed the SEER (Surveillance, Epidemiology, and End Results) data to estimate the risk of AD death in (i) cancer patients relative to reference populations stratified on demographic and clinical variables, and (ii) female breast cancer (BC) patients treated with chemotherapy or radiotherapy, relative to those with no/unknown treatment status. Our results demonstrate the impact of race, cancer type, age and time since cancer diagnosis on the risk of AD death in cancer patients. While the risk of AD death was decreased in white patients diagnosed with various cancers at 45 or more years of age, it was increased in black patients diagnosed with cancers before 45 years of age (likely due to early onset AD). Chemotherapy decreased the risk of AD death in white women diagnosed with BC at the age of 65 or more, however radiotherapy displayed a more complex pattern with early decrease and late increase in the risk of AD death during a prolonged time interval after the treatment. Our data point to links between molecular mechanisms involved in cancer and AD, and to the potential applicability of some anti-cancer treatments against AD.

The impact of routine ESAS use on overall survival: Results of a population-based retrospective matched cohort analysis.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6509-6509 ◽  
Author(s):  
Lisa Catherine Barbera ◽  
Rinku Sutradhar ◽  
Craig Earle ◽  
Nicole Mittmann ◽  
Hsien Seow ◽  
...  
Keyword(s):  
Overall Survival ◽  
Cancer Patients ◽  
Cox Regression ◽  
Cohort Analysis ◽  
Symptom Assessment ◽  
Assessment System ◽  
Cancer Type ◽  
Matched Cohort ◽  
Study Objective ◽  
The Impact

6509 Background: The study objective was to examine the impact of routine Edmonton Symptom Assessment System (ESAS) use on overall survival among adult cancer patients. We hypothesized that patients exposed to ESAS would have better overall survival rates than those who didn’t have ESAS. Methods: The effect of ESAS screening on survival was evaluated in a retrospective matched cohort study. The cohort included all Ontario patients aged 18 or older who were diagnosed with cancer between 2007 and 2015. Patients completing at least one ESAS assessment during the study were considered exposed. The index date was the day of their first ESAS assessment. Follow up time for each patient was segmented into one of three phases: initial, continuing, or palliative care. Exposed and unexposed patients were matched 1:1 using hard (birth year ± 2 years, cancer diagnosis date ± 1 year, cancer type and sex) and propensity-score matching (14 measures including cancer stage, treatments received, and comorbidity). Matched patients were followed until death or the end of study at Dec 31, 2015. Kaplan-Meier curves and multivariable Cox regression were used to evaluate the impact of ESAS on survival. Results: There were 128,893 pairs well matched on all baseline characteristics (standardized difference < 0.1). The probability of survival within the first 5 years was higher among those exposed to ESAS compared to those who were not (73.8% vs. 72.0%, P-value < 0.0001). In the multivariable Cox regression model, ESAS assessment was significantly associated with a decreased mortality risk (HR: 0.49, 95% CI: 0.48-0.49) and this protective effect was seen across all phases. Conclusions: ESAS exposure is associated with improved survival in cancer patients, in all phases of care. To the extent possible, extensive matching methods have mitigated biases inherent to observational data. This provides real world evidence of the impact of routine symptom assessment in cancer care.

The effect of medical home enrollment on cardiometabolic medication adherence among Medicaid-insured cancer patients.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 279-279
Author(s):  
Lisa Spees ◽  
Stephanie B. Wheeler ◽  
Xi Zhou ◽  
Krutika B Amin ◽  
Chris Baggett ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Medication Adherence ◽  
Cancer Patients ◽  
Care Coordination ◽  
Medical Home ◽  
Metastatic Breast ◽  
Treatment Phase ◽  
Cancer Type ◽  
Improve Medication Adherence ◽  
The Impact

279 Background: Medical homes, developed to increase care coordination among vulnerable patient populations, have been successful in improving outcomes of patients with multiple chronic comorbidities, but have not been evaluated among cancer survivors. We determined the impact of medical home enrollment on adherence to anti-diabetics, anti-lipidemics, and anti-hypertensives among Medicaid patients diagnosed with non-metastatic breast, colorectal, or lung cancer. Methods: Using linked cancer registry and claims data from North Carolina, we included Medicaid-insured adults diagnosed from 2004-2012 with breast, colorectal, or lung cancer who had at least one cardiometabolic condition (i.e., hyperlipidemia, hypertension, and diabetes mellitus). For each cardiometabolic condition, we measured medication adherence using ambulatory proportion of days covered (PDC). We examined the impact of medical home enrollment on PDC across the phases of cancer care (i.e., pre-cancer diagnosis, treatment, and survivorship phases) using a differences-in-differences model. All models adjusted for age, sex, race/ethnicity, dual enrollment, cancer type, comorbidity index, and number of cardiometabolic conditions. Results: We included, respectively, 765, 1079, and 1634 cancer patients with diabetes, hyperlipidemia, and hypertension. Overall, adherence to anti-lipidemics was lower than adherence to anti-diabetics and anti-hypertensives. In the pre-diagnosis phase, mean PDC across all cardiometabolic conditions was slightly lower for cancer patients enrolled in a medical home than those not enrolled in a medical home. However, medication adherence improved 3-5% in the treatment phase and 7% in the survivorship phase for cancer patients in a medical home compared to cancer patients not in a medical home during the pre-diagnosis phase. Conclusions: These results provide evidence that enrollment in a medical home can improve medication adherence, even among vulnerable cancer patients with complex health needs. The medical home model is an effective healthcare system intervention through which to provide better care coordination and improve patient outcomes.

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