scholarly journals Initial assessment of a cancer genomic profile test for patients with metastatic breast cancer: a retrospective study

2021 ◽  
Author(s):  
Ippei Fukada ◽  
Seiichi Mori ◽  
Naomi Hayashi ◽  
Mari Hosonaga ◽  
Masumi Yamazaki ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Insurance ◽  
Metastatic Breast Cancer ◽  
Gene Mutations ◽  
Metastatic Breast ◽  
Initial Assessment ◽  
Universal Health Insurance ◽  
Genomic Profile ◽  
Health Insurance System ◽  
Universal Health

Abstract Comprehensive cancer genomic profile (CGP) tests are being implemented under Japanese universal health insurance system. However, the clinical usefulness of CGP test for breast cancer patients has not been evaluated. Of the 310 patients who underwent CGP testing at our institution between November 2019 and April 2021, 35 patients with metastatic breast cancer whose treatment strategy was discussed by our molecular tumor board within the study period were investigated after exclusion of 2 cases that could not be analyzed. The turn-around time, drug accessibility, and germline identification detection were evaluated. The subtype was luminal in 20 patients (57.1%), triple-negative in 12 patients (34.3%), and luminal-HER2 in 3 patients (8.6%). Actionable gene mutations were detected in 30 patients (85.7%), and 7 patients (20.0%) were recommended for clinical trial participation, with the drug administered to 2 patients (5.7%). Three patients (8.6%) died due to disease progression before the test results were disclosed. We report the results of an initial assessment of the utility of CGP testing for patients with metastatic breast cancer under Japanese universal health insurance system. Conducting CGP tests at a more appropriate time could provide patients with greater benefit from treatments based on their specific gene mutations.

Universal Health Insurance

2017 ◽  
Author(s):  
George Klosko
Keyword(s):  
Health Insurance ◽  
Middle Class ◽  
National Health Insurance ◽  
National Health ◽  
Affordable Care Act ◽  
Major Theme ◽  
Universal Health Insurance ◽  
Health Insurance System ◽  
The Poor ◽  
Universal Health

Continuation of the struggle for national health insurance. Bill Clinton’s attempt to reform national health insurance, a cause taken up by Barack Obama, who in large part succeeded with his Affordable Care Act, passed in 2010. A major theme of the chapter is how the aim of universal health insurance, and so serving the poor, came to be overshadowed by the need to address abuses in the health insurance system and the concerns of the middle class.

Morphologic variation of circulating tumor cells in metastatic breast cancer patients visualized by immunofluorescent stain pattern.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e21079-e21079
Author(s):  
Daniel Adams ◽  
Stuart S Martin ◽  
Monica Charpentier ◽  
Olga V Makarova ◽  
Peixuan Zhu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Cancer Patients ◽  
Tumor Cells ◽  
Circulating Tumor Cells ◽  
Peripheral Blood ◽  
Metastatic Breast ◽  
Immunofluorescent Staining ◽  
Initial Assessment ◽  
Breast Cancer Patients

e21079 Background: Isolation of circulating tumor cells (CTCs) using microfiltration is a growing utility in the field of CTC detection. The microfiltration approach can be used on peripheral blood as a non-invasive liquid biopsy for cancer detection and subtyping. We present a utilization of the CellSieve microfilter to subtype CTCs based on immunofluorescent staining pattern of cytokeratin filamentation and EpCAM surface marker expression. Our initial study on CTCs in patient blood indicates that disseminated CTC populations have high rates of phenotypic heterogeneity. Further detailed molecular analysis and patient tracking of these phenotypes may lead to individualized patient assessment based on CTC characterization. Methods: 7.5 mL of whole blood collected from metastatic breast cancer patients were diluted in a fixative solution. An 8 µm CellSieve precision microfilter was placed into a filter holder and the samples were passed through the filter (~ 90 seconds). The cells captured on the filter were fixed, permeabilized, and stained with DAPI, cytokeratin (FITC), EpCAM (PE), and CD45 (Cy5). Cells without CD45 staining were classified by their morphology, nuclear integrity and the presence of cytokeratin and EpCAM staining. Results: In our initial assessment, patient samples were found to have a number of phenotypic CTC subtypes. Cytokeratin filamentation was clearly seen on a number of CTCs while other cells presented with spotted patterns, implying CTCs in various stages of apoptosis. Later stage apoptosis, with segmented nuclear signature, was also seen in various samples. Cell clusters and cells in division were DAPI positive, while EpCAM positivity was negligible, 0-3 cells/sample, correlating with established data from the CellSearch CTC assay. Conclusions: In addition to enumeration, phenotypic variation of CTCs may be a valuable tool for the personalized care of cancer patients. We have shown that individual breast cancer patients have overlapping phenotypes of CTCs circulating in their peripheral blood. We have begun categorizing patients based on these phenotypes and plan to correlate them with overall prognosis.

Health Insurance Literacy and Financial Hardship in Women Living With Metastatic Breast Cancer

2020 ◽  
Vol 16 (6) ◽  
pp. e529-e537 ◽  
Author(s):  
Courtney P. Williams ◽  
Maria Pisu ◽  
Andres Azuero ◽  
Kelly M. Kenzik ◽  
Ryan D. Nipp ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Insurance ◽  
Metastatic Breast Cancer ◽  
Private Insurance ◽  
Metastatic Breast ◽  
Lifestyle Changes ◽  
Financial Hardship ◽  
Financial Toxicity ◽  
Medical Test ◽  
Health Insurance Literacy

PURPOSE: In patients with metastatic breast cancer (MBC), low health insurance literacy may be associated with adverse material conditions, psychological response, and coping behaviors because of financial hardship (FH). This study explored the relationship between health insurance literacy and FH in women with MBC. METHODS: This cross-sectional study used data collected from 84 women receiving MBC treatment at 2 southeastern cancer centers. Low health insurance literacy was defined as not knowing premium or deductible costs. FH was defined by lifestyle changes as a result of medical expenses, financial toxicity, and medical care modifications attributable to cost. Mean differences were calculated using Cramer’s V. Associations between health insurance literacy and FH were estimated with adjusted linear models. RESULTS: Half of the surveyed patients had low health insurance literacy, 26% were underinsured, 45% had private insurance, 39% had Medicare, and 15% had Medicaid. Patients with low health insurance literacy more often reported borrowing money (19% v 4%; V = 0.35); an inability to pay for basic necessities like food, heat, or rent (10% v 4%; V = 0.18); and skipping a procedure (8% v 1%; V = 0.21), medical test (7% v 0%; V = 0.30), or treatment (4% v 0%; V = 0.20) compared with patients with high health insurance literacy. Median Comprehensive Score for Financial Toxicity was 23 (interquartile range, 17-29). In adjusted models, health insurance literacy was not associated with financial toxicity. CONCLUSION: Low health insurance literacy was common in women receiving MBC treatment. Additional research to increase health insurance literacy could lessen undesirable material FH and unnecessary behavioral FH associated with cancer-related care.

Colombia’s Universal Health Insurance System

2009 ◽  
Vol 28 (3) ◽  
pp. 853-863 ◽  
Author(s):  
Ursula Giedion ◽  
Manuela Villar Uribe
Keyword(s):  
Health Insurance ◽  
Universal Health Insurance ◽  
Health Insurance System ◽  
Insurance System ◽  
Universal Health
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