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Search and Breast Cancer: On Disruptive Shifts of Attention over Life Histories of an Illness

November 24, 2014 Comments off

Search and Breast Cancer: On Disruptive Shifts of Attention over Life Histories of an Illness
Source: Microsoft Research

We seek to understand the evolving needs of people who are faced with a life-changing medical diagnosis based on analyses of queries extracted from an anonymized search query log. Focusing on breast cancer, we manually tag a set of Web searchers as showing disruptive shifts in focus of attention and long-term patterns of search behavior consistent with the diagnosis and treatment of breast cancer. We build and apply probabilistic classifiers to detect these searchers from multiple sessions and to detect the timing of diagnosis, using a variety of temporal and statistical features. We explore the changes in information-seeking over time before and after an inferred diagnosis of breast cancer by aligning multiple searchers by the likely time of diagnosis. We automatically identify 1700 candidate searchers with an estimated 90% precision, and we predict the day of diagnosis within 15 days with an 88% accuracy. We show that the geographic and demographic attributes of searchers identified with high probability are strongly correlated with ground truth of reported incidence rates. We then analyze the content of queries over time from searchers for whom diagnosis was predicted, using a detailed ontology of cancerrelated search terms. Our analysis reveals the rich temporal structure of the evolving queries of people likely diagnosed with breast cancer. Finally, we focus on subtypes of illness based on inferred stages of cancer and show clinically relevant dynamics of information seeking based on dominant stage expressed by searchers.

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Trends in Use and Expenditures for Cancer Treatment among Adults 18 and Older, U.S. Civilian Noninstitutionalized Population, 2001 and 2011

November 21, 2014 Comments off

Trends in Use and Expenditures for Cancer Treatment among Adults 18 and Older, U.S. Civilian Noninstitutionalized Population, 2001 and 2011
Source: Agency for Healthcare Research and Quality

Highlights

  • In 2011, approximately 15.8 million adults or 6.7 percent of the adult U.S. population received treatment for cancer. This represents an increase from 2001, when 10.2 million adults or 4.8 percent of the population reported receiving treatment for cancer.
  • Medical spending to treat cancer increased from $56.8 billion in 2001 (in 2011 dollars) to $88.3 billion in 2011.
  • Ambulatory expenditures for care and treatment of cancer increased from $25.5 billion in 2001 to $43.8 billion in 2011.
  • Expenditures on retail prescription medications for cancer increased from $2.0 billion in 2001 to $10.0 billion in 2011.
  • Mean annual retail prescription drug expenditures for those with an expense related to cancer increased more than three times, from $201 per person in 2001 (in 2011 dollars) to $634 per person in 2011.
  • Inpatient hospital expenditures accounted for 47 percent of total spending for cancer treatment in 2001, but fell to 35 percent of the total by 2011.

Millions of US women are not getting screened for cervical cancer

November 7, 2014 Comments off

Millions of US women are not getting screened for cervical cancer
Source: Centers for Disease Control and Prevention

Key findings:

  • In 2012, 11.4 percent of women reported they had not been screened for cervical cancer in the past five years; the percentage was larger for women without health insurance (23.1 percent) and for those without a regular health care provider (25.5 percent).
  • The percentage of women not screened as recommended (www.cdc.gov/cancer/cervical/basic_info/screening.htm) was higher among older women (12.6 percent), Asians/Pacific Islanders (19.7 percent), and American Indians/Alaska Natives (16.5 percent).
  • From 2007 to 2011, the cervical cancer incidence rate decreased by 1.9 percent per year while the death rate remained stable.
  • The Southern region had the highest rate of cervical cancer (8.5 per 100,000), the highest death rate (2.7 per 100,000), and the largest percentage of women who had not been screened in the past five years (12.3 percent).

New WHO guidelines for mammography screening and referral

October 31, 2014 Comments off

New WHO guidelines for mammography screening and referral
Source: World Health Organization

A new WHO position paper examines the balance of benefits and harms in offering mammography screening to women after the age of 40 in a variety of settings. WHO is also issuing new guidelines for the referral of suspected breast cancer cases in low-resources settings, applicable to primary care.

These two guidelines are part of a broader set of comprehensive breast cancer guidance that will be developed in the coming years.

Combined impact of healthy lifestyle factors on colorectal cancer: a large European cohort study

October 16, 2014 Comments off

Combined impact of healthy lifestyle factors on colorectal cancer: a large European cohort study
Source: BMC Medicine

Background
Excess body weight, physical activity, smoking, alcohol consumption and certain dietary factors are individually related to colorectal cancer (CRC) risk; however, little is known about their joint effects. The aim of this study was to develop a healthy lifestyle index (HLI) composed of five potentially modifiable lifestyle factors – healthy weight, physical activity, non-smoking, limited alcohol consumption and a healthy diet, and to explore the association of this index with CRC incidence using data collected within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.

Methods
In the EPIC cohort, a total of 347,237 men and women, 25- to 70-years old, provided dietary and lifestyle information at study baseline (1992 to 2000). Over a median follow-up time of 12 years, 3,759 incident CRC cases were identified. The association between a HLI and CRC risk was evaluated using Cox proportional hazards regression models and population attributable risks (PARs) have been calculated.

Results
After accounting for study centre, age, sex and education, compared with 0 or 1 healthy lifestyle factors, the hazard ratio (HR) for CRC was 0.87 (95% confidence interval (CI): 0.44 to 0.77) for two factors, 0.79 (95% CI: 0.70 to 0.89) for three factors, 0.66 (95% CI: 0.58 to 0.75) for four factors and 0.63 (95% CI: 0.54 to 0.74) for five factors; P-trend <0.0001. The associations were present for both colon and rectal cancers, HRs, 0.61 (95% CI: 0.50 to 0.74; P for trend <0.0001) for colon cancer and 0.68 (95% CI: 0.53 to 0.88; P-trend <0.0001) for rectal cancer, respectively (P-difference by cancer sub-site = 0.10). Overall, 16% of the new CRC cases (22% in men and 11% in women) were attributable to not adhering to a combination of all five healthy lifestyle behaviours included in the index.

Conclusions
Combined lifestyle factors are associated with a lower incidence of CRC in European populations characterized by western lifestyles. Prevention strategies considering complex targeting of multiple lifestyle factors may provide practical means for improved CRC prevention.

Imaging Tests for the Diagnosis and Staging of Pancreatic Adenocarcinoma

September 29, 2014 Comments off

Imaging Tests for the Diagnosis and Staging of Pancreatic Adenocarcinoma (PDF)
Source: Agency for Healthcare Research and Quality

Objectives
Our objectives were to synthesize the available information on the diagnostic accuracy and clinical utility of commonly used imaging tests for the diagnosis and staging of pancreatic adenocarcinoma , as well as screening for pancreatic adenocarcinoma in high risk individuals .

Data sources
We searched Embase , MEDLINE, PubMed, and The Cochrane Library from 1980 through November 1, 2013 , for English – la nguage, full – length articles on the role of m ultidetector computed tomography ( MD CT), endoscopic ultrasound with fine – needle aspiration (EUS – FNA), magnetic resonance imaging (MRI), and positron emission tomography – computed tomography ( PET/CT ) in screening, diagnosis, and staging pancreatic adenocarcinoma. The searches identified 9, 776 citations; after screening against the inclusion criteria, we included 15 systematic reviews and 108 primary studies.

Methods
We extracted data from the included studies and constructed evidence tables. Comparative o utcomes of interest included diagnostic accuracy (sensitivity and specificity) , staging accuracy, screening accuracy, clinical management, quality of life, survival, and harms of imaging tests. For studies of a single imaging test, the key outcomes were accuracy and procedural harms. Where possible, we pooled the data using bivariate binomial regression models for comparative accuracy. For each pair of tests and each assessed aspect (e.g., determination of metastase s), we determined whether the evidence was sufficient to permit a conclusion of a difference, a conclusion of similar accuracy , or neither (i.e., insufficient ). We rated the risk of bias of individual studies using an internal validity instrument and grade d the overall strength of evidence of conclusions using Evidence – based Practic e Center methods . For dat a on single – test accuracy, procedural harms, patient tolerance, and screening accuracy, we tabulated the important information and summarized the evidenc e qualitatively.

Results
We included 15 systematic reviews and 108 primary studies. Regarding comparative accuracy, the evidence was sufficient to conclude that MDCT and EUS – FNA have similar accuracy in assess ing resectability in patients whose disease is unstaged , and that EUS – FNA has a slight advantage over MDCT with respect to T (tumor) staging (specifically, a lower chance of undersizing the tumor) . Further, we concluded that MDCT and MRI are similarly accurate with respect to both diagnos ing and asses s ing vessel involvement. For PET/CT , evidence was generally inconclusive, but we f ound low – strength evidence to conclude that PET/CT is more accurate than MDCT in assessing distant metastases (slight advantages in both sensitivity and specificity) . No ne of the included studies reported comparative data on clinical management, survival, quality, or the impact on comparative accuracy of patient characteristics , tumor characteristics , or operator experience. Many studies have reported procedural harms, but har ms are generally rare and are different for different imaging modalities. In the screening of people at high risk of developing pancreatic adenocarcinoma , a vailable studies do not correlate the results of a given imagin g test to subsequent diagnoses.

Conclusions.
Current evidence permits some tentative conclusions about the comparative assessment of imaging tests for diagnosing and staging pancreatic adenocarcinoma, but many gaps remain. The conclusions we did draw are as follows: MDCT and EUS – FNA have similar accuracy in assessing resectability in patients whose disease is unstaged ; EUS – FNA has a slight advantage over MDCT with respect to T (tumor) staging (specifically, a lower chance of undersizing the tumor) ; MDCT and MRI are similarly accurate with respect to both diagnos ing and assess ing vessel involvement ; and PET/CT is more accurate than MDCT in assessing distant metastases (slight advantages in both sensitivity and specificity). The prominent gaps include minimal information on MDCT angiography , impr ecis e data on other imaging techniques, a lack of comparative data on patient – oriented outco mes and factors that could influence comparative accuracy, and test – specific data on screening accuracy.

Transforming Cancer Care and the Role of Payment Reform

September 17, 2014 Comments off

Transforming Cancer Care and the Role of Payment Reform
Source: Brookings Institution

According to the National Cancer Institute there are more than 13 million people living with cancer in the United States; it is the second leading cause of death in the U.S. It is expected that 41% of Americans will be diagnosed with cancer at some point during their lives. More than 1.6 million new cases of cancer will be diagnosed in 2014; a nearly 22% increase over the last decade.

Cancer care is also expensive. In 2010 it accounted for $125 billion in health care spending and is expected to cost at least $158 billion by 2020, due to population increase. In 2011 Medicare alone spent nearly $35 billion in fee-for-service (FFS) payments for cancer care, representing almost 9% of all Medicare FFS payments overall.

Broadly speaking, problems in complex clinical care fall into two categories: deficits in knowledge (for example, lack of any effective treatment for certain brain tumors) and deficits in execution (for example, failure to treat breast cancer with a standard-of-care protocol). Delivery reform seeks to find opportunity in the latter problem type. Considering cancer care through this lens, there are many opportunities to improve outcomes and potentially lower costs, including better coordination of care, eliminating duplication of services and reducing fragmentation of care. In addition, almost two-thirds of oncology revenue derives from drug sales, and pricing for drugs (calculated by the average sale price plus 6% profit for providers) may incentivize the use of the most expensive drugs rather than equally effective, lower-cost alternatives.

Promising approaches are being developed to deliver high quality care, improve the patient experience, and reduce costs for this condition and other chronic diseases. Care redesign strategies such as adopting team-based models, offering extended practice hours, providing triage to keep patients out of the emergency room, and implementing care pathways help providers address avoidable costs and maximize the value of care. Many of these strategies are not currently reimbursed in the FFS, volume-based payment system.

Consequently, much policy attention is focusing on payment reform. On the heels of the Affordable Care Act (ACA), and numerous quality and payment focused initiatives in the private sector, health care organizations need to enhance the competitiveness and efficiency of their system in the marketplace. Alternative payment models (APMs) such as Accountable Care Organizations (ACOs), bundled payments, and patient-centered oncology medical homes (PCOMH) are just a few of the initiatives supported by public and private payers to align care redesign and payment reform and encourage continuous improvement. This paper provides a comprehensive overview of the complex care associated with oncology and the alternate payment models which help support optimal care and encourage continuous improvement.

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