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Hurricane disasters affect patient care

Lung cancer patients who had a hurricane disaster declared during radiotherapy had worse overall survival than those who completed treatment in normal circumstances. The finding comes from a report by American Cancer Society investigators published in JAMA, which suggests several mitigation strategies, including arranging for transferring treatment and eliminating patient out-of-network insurance charges during disasters.

Natural disasters such as hurricanes can interrupt the provision of oncology care. Radiotherapy is particularly vulnerable because it requires dependable electrical power and daily presence of specialized teams and patients for treatment delivery. Disruptions are especially concerning for patients undergoing treatment for locally advanced non-small cell lung cancer (NSCLC) because treatment delays as little as two days can impact survival.

"While we could not analyze every potentially explanatory factor for the poorer outcomes in our study, treatment delay is one of the few hurricane-related disruptions that can actually be prevented," said Dr. Leticia Nogueira, lead ACS investigator. "Cancer patients receiving radiotherapy are a vulnerable population, and right now, there are no recommended strategies to mitigate treatment delays, so disaster management efforts that include tactics to identify patients, arrange for their treatment to be transferred, and to eliminate out-of-network insurance charges should be considered."

The authors say research is needed to evaluate the potential impact of other types of natural disasters on cancer and other diseases and their treatments.

Learn more on cancer.org.


  • ACS research finds more screening doesn’t fully explain the rise in colorectal cancer cases

    ​Colorectal cancer (CRC) is being diagnosed more often in the United States among adults younger than age 55. Does this mean more of them are getting colorectal cancer? Or are doctors finding it more often because more younger adults are having colonoscopies? In a study published in the Journal of Medical Screening, researchers at the American Cancer Society (ACS) found that colonoscopy trends don’t completely line up with the rates of colorectal cancer diagnosis by age, so more screening doesn’t fully explain the rise in CRC cases.

    ​Fewer people 55 and older in the United States are being diagnosed with colorectal cancer, in part because more of them are having colonoscopies. With this screening tool, doctors can find and remove growths before they become cancerous. But it’s a different story for younger adults: Among people in their 40s, for example, colon cancer rates have increased by 1.3% per year since the mid-1990s, and rectal cancer rates have gone up by 2.3% per year since the early 1990s.

    ​To better understand the increased colorectal cancer rates, ACS researchers looked at US data from 2000 to 2015 for 53,175 adults aged 40 to 54. The researchers looked at the percentage of people who said they’d had a they’d had a colonoscopy in the past year. They also looked at the percentage of people who were diagnosed with colorectal cancer during the 15-year period.

    ​The study divided people into three age ranges: 40 to 44, 45 to 49, and 50 to 54. Colonoscopy rates didn’t increase for every age group, but CRC rates did. Specifically, colonoscopy rates went up for the 45 to 49 and 50 to 54 age groups but were fairly stable for the 40 to 44 group. Colorectal cancer rates increased in every group. 

    ​“In this study, some patterns in colorectal cancer diagnoses were consistent with colonoscopy trends, like the rise in both colonoscopy and early-stage cancer among 50- to 54-year-olds, whereas others weren’t,” said Stacey Fedewa, PhD, lead author of the study. “For example, there was no increase in colonoscopy among people in their early 40s to match the increasing rates of colorectal cancer in this age group.”

    ​If the increase in CRC rates was only because colonoscopies were finding more tumors, then researchers would expect to see large increases in early-stage cancers. That’s because screening is most likely to find cancer when it is localized or limited to the place where it started with no sign of spreading. But only some age groups had increased diagnoses at an earlier stage.

    ​However, ACS researchers did find that the number of people diagnosed with later stage colorectal cancer increased for all age groups, with people ages 40 to 44 having the steepest increase.

    ​“This study only addressed one hypothesis—increasing colonoscopy—as to why colorectal diagnoses are increasing in younger adults,” Fedewa said. “It’s thought that changes in established risk factors for colorectal cancer could also be contributing to the increase. Those risks include obesity, drinking too much alcohol, poor diet (such as eating too little fiber and too much red/processed meat), physical inactivity, and smoking.”

    ​The ACS recommends that most people – those at average risk – start regular screening at 45. People can choose from among several types of tests, including stool-based tests, colonoscopy, CT colonography (virtual colonoscopy), and sigmoidoscopy. People with an increased risk may need to start screening before age 45. Learn more by reading the full ACS guidelines for colorectal cancer screening.

    What to know about colorectal cancer

    ​Use these links to do all you can to lower your risk for getting colorectal cancer.

    Article written by Sandy McDowell, Senior Editor, Research and appears on cancer.org.


  • The costs of cancer in 2015: 8.7 million years of life and $94 billion in lost earnings

    ​New analysis identifies which cancers and which states are associated with the greatest cost

    Cancer took more than 8.7 million years of life and $94.4 billion in lost earnings among people ages 16 to 84 in the United States in 2015. The calculation comes from a new report by American Cancer Society researchers that appears early online in JAMA Oncology.

    Cancer is the second-leading cause of death in the U.S., expected to cause more than 606,880 deaths in 2019. Cancer deaths impose significant economic burden in the U.S. because of productivity losses due to premature death. Accurate information on the economic burden of cancer mortality can help in setting policies and prioritizing resources for cancer prevention and control. However, contemporary data are lacking for the U.S. nationally and by state. 

    To update estimated lost earnings due to death from cancer, investigators led by Farhad Islami, MD, PhD, (pictured here) calculated person-years of life lost using numbers of cancer deaths and life expectancy data in individuals aged 16 to 84 years who died from cancer in the U.S. in 2015. They created estimates for cancer deaths overall and for the major cancers in the U.S. nationally and by state. The estimates are for lost earnings alone, and do not include other costs associated with cancer, including costs of treatment and caregiving. 

    A total of 492,146 cancer deaths occurred in people ages 16 to 84 in the U.S. in 2015, translating to a total of 8,739,939 life years lost. Overall lost earnings were $94.4 billion, and $191,900 per cancer death. Lost earnings were $29.0 million per 100,000 population overall.  

    Lung cancer cost the most in lost earnings ($21.3 billion; 22.5% of total), followed by colorectal ($9.4 billion; 10.0%), female breast ($6.2 billion; 6.5%), and pancreatic ($6.1 billion; 6.5%) cancers. By age, lost earnings were highest for leukemia in ages 16 to 39 while lung cancer was highest in ages 40 and over. 

    Lost earnings per 100,000 population varied considerably by state, ranging from $19.6 million per 100,000 in Utah to $35.3 million per 100,000 in Kentucky. States with the highest age-standardized lost earning rates were in the South, followed by states in the Midwest. States with the lowest age-standardized lost earning rates were in the West, Northeast, and Hawaii. 

    If all states had Utah’s lost earnings rate in 2015, lost earnings in the U.S. would have been reduced by 29.3%, or $27.7 billion, and life years lost nationwide in 2015 would be reduced by 2.4 million. 

    “Years of life lost and lost earnings were high for many cancers for which there are modifiable risk factors and effective screening and treatment, which suggests that a substantial proportion of our current national mortality burden is potentially avoidable,” said Farhad. “Applying comprehensive cancer prevention interventions and ensuring equitable access to high-quality care across all states could reduce the burden of cancer and associated geographic and other differences in the country. Health care professionals can contribute to achieving this goal because they play a central role in the delivery of cancer prevention, screening, and treatment.” 

    Robin Yabroff, PhD, senior author of the study, added, “These findings have implications for health policy makers. Health insurance coverage, which varies substantially by state, is one of the strongest predictors of access to care. Ensuring equitable access to high-quality care through increased health insurance coverage options could reduce differences in the burden of cancer across states. Medicaid expansion, in particular, helps the most disadvantaged populations.”



  • Nearly 5.4 million cancer survivors suffer chronic pain

    ​1 in 6 survivors reported pain restricting daily functioning

    A new report finds about 1 in 3 cancer survivors (34.6%) reported having chronic pain, representing nearly 5.4 million cancer survivors in the United States. The report, appearing as a Research Letter in JAMA Oncology, finds 1 in 6 survivors (16%), representing about 2.5 million people in the U.S., reported suffering from high impact chronic pain that restricts daily functioning. Those rates are about double the rates in the general population.

    Time since diagnosis was not significantly associated with the prevalence of either chronic pain, but a higher prevalence of chronic and high impact chronic pain was reported among survivors with:

    • Less than a high school education (39.2% for chronic pain and 18.5% for high impact chronic pain)
    • Low household income (44.6% and 22.8%, respectively)
    • Public insurance among those aged 18-64 years (43.6% and 27.1%, respectively)
    • No paid employment (38.5% and 20.4%, respectively)

    “Because socioeconomic status and employment are associated with insurance coverage and access to care in the United States, the patterns of chronic pain that we observed in cancer survivors may be explained by barriers to cancer care and pain management as well as by the type and extent of cancer treatment received,” said Xuesong Han, PhD, an ACS investigator and co-author of the report. “The prevalence of chronic pain and high impact chronic pain among cancer survivors in our study was almost double that in the general population, suggesting there are important unmet needs in the large and growing community of people with a history of cancer.”

    Chronic pain is one of the most common long-term effects of cancer treatment and has been linked with an impaired quality of life, lower adherence to treatment, and higher health care costs. Nevertheless, there is a paucity of information regarding the prevalence of, and risk factors for, the development of chronic pain among cancer survivors.

    To gain a better understanding of the epidemiology of pain in cancer survivors and help inform future health care priorities and policies, investigators led by Changchuan (Charles) Jiang, MD MPH of Mount Sinai Hospital, New York, with researchers from Memorial Sloan-Kettering Cancer Center, University of Virginia, and the American Cancer Society investigated the prevalence of chronic pain among cancer survivors in the U.S. using data from the National Health Interview Survey (2016-2017). The survey collects information related to chronic pain (pain on most days or every day in the past six months) and high impact chronic pain (chronic pain limiting life or work activities on most days or every day in the past six months).

    Overall, 1,648 of the 4,526 cancer survivors identified in the survey (34.6%) reported having chronic pain; 768 of the survivors (16.1%) reported having high impact chronic pain. Applied to the nation as a whole, those rates equal approximately 5.39 million and 2.51 million cancer survivors, respectively, in the U.S.


  • ACS researchers make presentations at ASCO

    ​More than 39,000 cancer specialists from around the world - and ACS - gathered in Chicago May 31 - June 4 for the 55th annual meeting of the American Society of Clinical Oncology (ASCO). It is the largest cancer conference in the world, where investigators and drug companies unveil the latest advances in clinical cancer research to researchers, clinicians, and others.

    This year's meeting focused on addressing the need to provide every patient with equal access to the highest quality of care.

    American Cancer Society investigators and grantees were among those presenting, while other staff attended to learn, participate, and create new working relationships. 

    Below are some highlights of ACS's activities at ASCO 2019:

    Presentations:

    Robin Yabroff, PhD, co-chaired and spoke at a two-day educational session, "(Re)defining Value in Cancer Care: Priorities for Patients, Providers and Health Systems," which included panels on financial toxicity, international experiences with health technology assessment, paying for innovative treatments, and innovation and incentives. 

    Tenbroeck Smith, MA, held a "Meet the Professor" session on using Big Data in clinical settings, titled "Incorporating PROs in Big Data and in Everyday Clinical Use."

    Catherine Alfano, PhD, chaired a session presenting the results of the 2018 ACS/ASCO Summit outlining strategies needed to build out stratified cancer follow-up care pathways to better address survivors' needs while dealing with workforce shortages and controlling costs. The presentation built on the results of the 2018 Summit by breaking down the Summit recommendations into actionable next steps clinical systems should take.

    Posters: 

    News Coverage

    Len Lichtenfeld, MD, our interim chief medical officer, was a key source for news media, with Forbes, AP, and STAT News all highlighting his reaction to breaking news. 

    He also posted two blogs reflecting on data presented at the meeting. In an AP story on the progress of blood tests to detect cancer, reprinted in many outlets including the Minneapolis Star-Tribune, Chicago Tribune, USA Today, and NY Post, to name a few, Dr. Len noted that the tests' low rate of false alarms was "remarkable." 

    "I have little doubt that in the next several years we're going to have what is probably a true early detection test," but the technology still needs to improve and to be tried in large groups of people without known cancers, where the detection rate may not be as good, he said. The biggest question, he said, is "will it make a difference in outcomes," such as whether it helps people live longer, the ultimate measure of a screening test's worth.

    Robin Yabroff, PhD, was interviewed by Laurie McGinley of The Washington Post for a story titled ACA Linked To Reduced Racial Disparities, Earlier Diagnosis And Treatment In Cancer Care:

    Other experts noted that the racial-disparities study, while good news, highlighted the emergence of a different kind of inequality. "There's increasing concern about greater disparities" between states that chose to expand Medicaid and those that did not, said Robin Yabroff, an epidemiologist at the American Cancer Society. The Supreme Court made expansion of that program optional when it upheld the ACA's constitutionality in 2012.

     ACS Grantees also presented:

    Lailea Noel, PhD, (ACS Doctoral Training Grant in Oncology Social Work from 2014-2016), discussed examples of successful community-academic partnerships focused on cancer prevention and control.

    Gabrielle Rocque, MD, MPSH (Mentored Research Scholar Grant, 2017-2022) did a poster presentation on the Impact of Travel Time on Healthcare Costs and Resource Utilization by Phase of Care for Older Cancer Patients and an education session on Electronic Capture: Changing the Landscape of Quality Measurement.

    More news from ASCO 2019 can be found at CURE, WebMD,  the ASCO Post, and on Twitter using the hashtag #ASCO19.

    Top photo: Robin Yabroff, PhD (left), senior scientific director, Health Services Research, talks to Laure McGinley of The Washington Post.



  • Study underscores financial hardship experienced by cancer survivors

    ​Four of nine co-authors are ACS researchers

     A CDC-led study with four co-authors from the American Cancer Society finds that 25% of cancer survivors ages 18-64 years have financial hardships, and 34% have psychological hardships. 

    Today, more than 16.9 million Americans are cancer survivors, and that number is growing. In a year, cancer survivors ages 18-64 years will incur average out-of-pocket costs of $1,000 in medical care, while people without a cancer history will incur average out-of-pocket costs of $622. 

    Cancer survivors were more likely to suffer material hardships (such as having to borrow money, going into debt, filing for bankruptcy, or being unable to pay their medical bills) and psychological hardships (worrying about large medical bills). 

    Survivors without insurance coverage have more financial hardships than those with private insurance coverage, but even many cancer survivors with private insurance coverage reported borrowing money, being unable to cover their share of medical care costs, going into debt, or filing for bankruptcy..

    The study — Annual Out-of-Pocket Expenditures and Financial Hardship Among Cancer Survivors Aged 18–64 Years - United States, 2011–2016 — was published in the June 7 Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention. ACS authors are Jingxuan Zhao, MPH,  Zhiyuan Zheng, PhD,  Xuesong Han, PhD, and Robin Yabroff, PhD, all from our Surveillance and Health Services Research department within Intramural Research.

    The number of Americans with a history of cancer is projected to increase in the next decade, and the economic burden associated with living with a cancer diagnosis will likely increase, as well.

    The study notes: "The findings in this report might lead to increased awareness in all sectors of the public health and medical community that the rising cost of cancer care is a major barrier to survivors’ well-being. Efforts at the provider, practice, employer, payer, state, and federal levels are needed to develop and implement evidence-based and sustainable interventions (e.g., including systematic screening for financial hardship at cancer diagnosis and throughout the cancer care trajectory, integrating discussions about the potential for adverse financial consequences of treatments in shared treatment decision-making, and linking patients and survivors to available resources) to minimize financial hardship for cancer survivors."

    Read the full study here.

  • ACS and Ovarian Cancer Research Alliance announce new collaboration

    In a new collaboration, ACS and Ovarian Cancer Research Alliance have joined forces to fund multidisciplinary research projects to explore new ways of detecting, treating, and preventing ovarian cancer relapse, and for improving quality of life among those diagnosed with ovarian cancer. The two organizations are committing to a total investment of $8 million to sustain four research teams over four years.

    Ovarian cancer accounts for more deaths than any other cancer of the female reproductive system and is the fifth leading cause of cancer death overall among women. ACS estimates that in 2019, about 22,530 women in the U.S. will be diagnosed with ovarian cancer and about 13,980 women will die from the disease.

    Four out of five women diagnosed with ovarian cancer have advanced disease, which is associated with an increased risk of persistent and recurrent cancer following initial treatment. While advanced ovarian cancer can be treatable, it is rarely curable. There is currently no way to predict which women in remission will experience short-term versus long-term survival from ovarian cancer, or which women are at risk for high symptom burden during survivorship.

    This joint initiative seeks to raise funds to support four multidisciplinary research teams to investigate biological, clinical, and psychosocial factors associated with ovarian cancer outcomes.  A better understanding of these factors will lead to new avenues for detecting, treating, and preventing ovarian cancer relapse, and for improving quality of life. Once initial funding is acquired, a request for proposal/critical peer review process will select the four research teams.

    “More and more, scientists and organizations are recognizing the need to break down barriers and work together to find answers,” said William Phelps, PhD, our senior vice president of Extramural Research. “This approach is particularly important in ovarian cancer, a disease for which new innovative treatments are urgently needed.”

    “We are excited to accelerate breakthroughs in the fight against high grade serous ovarian carcinoma—the deadliest form of the disease— by collaborating with American Cancer Society,” said Audra Moran, president and CEO, Ovarian Cancer Research Alliance. “Together our two organizations have supported over $135 million in ovarian cancer research since the 1990s, but this new partnership will allow us to multiply our impact.”

    Ovarian Cancer Research Alliance (OCRA) is the largest non-government funder of ovarian cancer research and has invested more than $85 million in research since 1998.  

  • Number of cancer survivors predicted to jump from 16.9M to 22M by 2030

    There were more than 16.9 million Americans with a history of cancer on January 1, 2019, a number that is projected to reach more than 22.1 million by 2030 based on the growth and aging of the population alone, according to estimates from our just released Cancer Treatment and Survivorship Statistics, 2019. 

    The report is produced every three years by ACS in collaboration with the National Cancer Institute to help the public health community better serve this growing population. It appears in CA: A Cancer Journal for Clinicians, with a companion consumer edition published as Cancer Treatment and Survivorship Facts & Figures 2019-2021, available on cancer.org.

    The number of cancer survivors continues to increase in the U.S. even as incidence rates are stable in women and declining in men. This is due to a growing and aging population, as well as increases in cancer survival due to advances in treatment and early detection. 

    The report uses the term “cancer survivor” to describe a person who has a history of cancer, from the time of diagnosis through the remainder of their life. However, it is important to note that many people with a history of cancer do not embrace this term.

    The report estimates there are:

    • 8.1 million males and 8.8 million females in the U.S. with a history of cancer. About two out of three cancer survivors (68%) were diagnosed five or more years ago, and nearly 1 in 5 (18%) was diagnosed 20 or more years ago. Nearly two-thirds (64%) are age 65 years or older. 
    • 65,850 cancer survivors are 14 years and under, and 47,760 are ages 15 to 19.

    The three most prevalent cancers among men in 2019 are prostate (3,650,030), colon and rectum (776,120), and melanoma of the skin (684,470). 

    Among women, the top three prevalent cancers are breast (3,861,520), endometrium (uterine corpus) (807,860), and colon and rectum (768,650). 

    Cancer prevalence figures differ from those for cancer incidence because prevalence reflects not only occurrence but also survival and median age at diagnosis. For example, lung cancer is the second most commonly diagnosed cancer in men, but ranks eighth in prevalence, largely because of the disease’s poor overall survival.

    The authors’ estimate of the number of cancer survivors in 2030 (22.1 million) is based on population projections produced by the United States Census Bureau, using current incidence, mortality, and survival rates. Changes in cancer occurrence and survival due to advances in treatment and early detection could further impact cancer prevalence.

    Many survivors cope with long-term physical effects of treatment, as well as psychological and socioeconomic issues. Challenges also remain for survivors and their caregivers with regard to navigating the health care system, including poor integration of survivorship care between oncology and primary care settings, as well as financial and other barriers to quality care, particularly among the medically underserved.

    “People with a history of cancer have unique medical, psychosocial, and economic needs that require proactive assessment and management by health care providers,” said Robin Yabroff, PhD., senior scientific director of Health Services Research and co-author of the report. “Although there are growing numbers of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based resources are needed to optimize care.”

    The report says identification of the best practices for delivering quality rehabilitation and post-treatment cancer care is needed, and points to ongoing efforts by the American College of Surgeons, the Alliance for Quality Psychosocial Cancer Care, and the American Cancer Society. To this end, we recently released a cancer survivorship blueprint to establish priority areas for care delivery, research, education, and policy. In addition, ACS has produced guidelines for selected cancer types to assist primary care and other clinicians in the provision of post-treatment care for people with a history of cancer.


  • Early onset colorectal cancer rising fastest in the West

    ​Surprising finding suggests obesity epidemic may not fully explain increasing rates

    Early-onset colorectal cancer — cancer occurring before age 50 — is rising most rapidly in Western states, where healthy behaviors are prominent, according to a new ACS study. The authors of the study, which appears today in the Journal of the National Cancer Institute, say the findings indicate the need for further etiologic studies to explore early-life colorectal carcinogenesis.

    Early-onset colorectal cancer (CRC) has been on the rise for several decades in the U.S. for unknown reasons. Because geographic differences could help uncover potential causes for the trend, investigators at the American Cancer Society and The Ohio State University analyzed changes in CRC incidence and risk factors among adults under 50 during 1995-2015 by state and race/ethnicity.

    Based on cancer registries representing 95% of the U.S. population, the study found early-onset CRC incidence increased over the most recent 10 data years (2006-2015) by 1.1% per year. Rates rose faster for rectal tumors (1.7% per year) than for colon tumors (0.7% per year).

    The increase was mostly confined to whites, among whom rates rose in 40 out of 47 states (with available data) and were otherwise stable. The rise varied in magnitude across states, with average increases exceeding 2.5% per year in 10 states, six of which are in the West. For example, over the past two decades CRC incidence increased by 73% in Washington, from 6.7 (per 100,000) during 1995-1996 to 11.5 during 2014-2015, and by 57% in Colorado, from 6.0 to 9.5. Increases were generally steeper for rectal than for colon cancer, with rates doubling in some states (e.g. in Colorado, from 1.9 to 4.2), converging with rates for colon cancer.

    “Although early-onset colorectal cancer incidence is currently lowest in Western states and highest in Southern states, consistent with the prevalence of established risk factors, like obesity, physical inactivity, and smoking, this pattern may change because the steepest increases are in Western states,” said Rebecca L. Siegel, MPH (pictured in the smaller image above), our scientific director of surveillance research and lead author of the study. “This finding suggests that early life exposures in addition to the ‘usual suspects’ may be contributing to the rise in early onset disease. Future studies should explore novel risk factors for colorectal cancer in young adults.”
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