Workforce Caring for Cancer Survivors in the United States: Estimates and Projections of Use.

BACKGROUND: This study aims to quantify the extent and diversity of the cancer care workforce, beyond medical oncologists, to inform future demand because the number of cancer survivors is expected to grow in the United States. METHODS: Surveillance, Epidemiology, and End Results-Medicare data were used to evaluate health-care use of cancer survivors diagnosed between 2000 and 2014, enrolled in fee-for-service Medicare Parts A and B, and 65 years or older in 2008-2015. We calculated percentage of cancer survivors who saw each clinician specialty and their average annual number of visits in each phase of care. We projected the national number of individuals receiving care and number of annual visits by clinician specialty and phase of care through 2040. RESULTS: Cancer survivors had higher care use in the first year after diagnosis and last year of life phases. During the initial year after cancer diagnosis, most survivors were seen for cancer-related care by a medical oncologist (59.1%), primary care provider (55.9%), and/or other cancer-treating physicians (42.2%). The percentage of survivors with cancer-related visits to each specialty declined after the first year after diagnosis, plateauing after year 6-7. However, at 10 or more years after diagnosis, approximately 20% of cancer survivors had visits to medical oncologists and an average of 4 visits a year. CONCLUSIONS: Cancer survivors had higher care use in the first year after diagnosis and last year of life. High levels of care use across specialties in all phases of care have important implications for models of survivorship care coordination and workforce planning.

Medical Care Costs Associated with Cancer Survivorship in the United States.

BACKGROUND: The prevalence of cancer survivorship is increasing. In this study, we provide contemporary population-based estimates and projections of the overall and site-specific cancer-attributable medical care costs in the United States. METHODS: We identified survivors aged ≥65 years diagnosed with cancer between 2000 and 2012 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database and used 2007 to 2013 claims to estimate costs by cancer site, phases of care, and stage at diagnosis. Annualized average cancer-attributable costs for medical care (Medicare Parts A and B) and oral prescription drugs (Medicare Part D) were estimated by subtracting costs between patients with cancer and matched controls. Costs are reported in 2019 U.S. dollars. We combined phase-specific attributable costs with prevalence projections to estimate national costs from 2015 through 2030. RESULTS: Overall annualized average costs were highest in the end-of-life-cancer death phase, followed by the initial and continuing phases (medical care: $105,500, $41,800, and $5,300 and oral prescription drugs: $4,200, $1,800, $1,100, respectively). There was considerable variation in costs by cancer site and stage. Overall national costs in 2015 were $183 billion and projected to increase 34% to $246 billion by 2030, based only on population growth. CONCLUSIONS: Phase of care cancer-attributable cost estimates by cancer site and stage are key inputs for simulation models and cost-effectiveness analyses. IMPACT: The national cancer-attributed medical care costs in the United States are substantial and projected to increase dramatically by 2030, due to population changes alone, reflecting the rising burden of cancer care among cancer survivors.

Interrelationships of added sugars intake, socioeconomic status, and race/ethnicity in adults in the United States: National Health Interview Survey, 2005.

BACKGROUND: The consumption of added sugars (eg, white sugar, brown sugar, and high-fructose corn syrup) displaces nutrient-dense foods in the diet. The intake of added sugars in the United States is excessive. Little is known about the predictors of added sugar intake. OBJECTIVE: To examine the independent relationships of socioeconomic status and race/ethnicity with added sugar intake, and to evaluate the consistency of relationships using a short instrument to those from a different survey using more precise dietary assessment. DESIGN: Cross-sectional, nationally representative, interviewer-administered survey. SUBJECTS/SETTING: Adults (aged > or = 18 years) participating in the 2005 US National Health Interview Survey Cancer Control Supplement responding to four added sugars questions (n=28,948). STATISTICAL ANALYSES PERFORMED: The intake of added sugars was estimated using validated scoring algorithms. Multivariate analysis incorporating sample weights and design effects was conducted. Least squares means and confidence intervals, and significance tests using Wald F statistics are presented. Analyses were stratified by sex and controlled for potential confounders. RESULTS: The intake of added sugars was higher among men than women and inversely related to age, educational status, and family income. Asian Americans had the lowest intake and Hispanics the next lowest intake. Among men, African Americans had the highest intake, although whites and American Indians/Alaskan Natives also had high intakes. Among women, African Americans and American Indians/Alaskan Natives had the highest intakes. Intake of added sugars was inversely related to educational attainment in whites, African Americans, Hispanic men, and American Indians/Alaskan Native men, but was unrelated in Asian Americans. These findings were generally consistent with relationships in National Health and Nutrition Examination Survey 2003-2004 (using one or two 24-hour dietary recalls). CONCLUSIONS: Race/ethnicity, family income, and educational status are independently associated with intake of added sugars. Groups with low income and education are particularly vulnerable to diets with high added sugars. Differences among race/ethnicity groups suggest that interventions to reduce intake of added sugars should be tailored. The National Health Interview Survey added sugars questions with accompanying scoring algorithms appear to provide an affordable and useful means of assessing relationships between various factors and added sugars intake.

Patterns of care in a population-based sample of soft tissue sarcoma patients in the United States.

BACKGROUND: Soft tissue sarcomas (STS) are relatively uncommon tumors. Data regarding the patterns of care of patients with STS and its consistency with available guidelines are relatively sparse. The authors conducted a detailed analysis of STS patients diagnosed in 2002 and sampled from the Surveillance, Epidemiology, and End Results registries. METHODS: The authors sampled 1369 patients with invasive sarcomas. Hospital records were reabstracted, and treating physicians were contacted to verify the therapy provided to each patient. RESULTS: The median age of patients was 60 years. There was a slight male predominance among the patients with nongynecologic sarcomas. Fifty percent of the patients had localized stage sarcoma. Most patients received surgery, but negative margins were obtained in only 50% of patients. Complete resection was less frequent in patients >or=50 years old. Radiation therapy was used in 53% of patients with extremity sarcomas but in only 20% to 30% of the patients with sarcomas at other sites. About 27% of all patients received chemotherapy. Tumor grade was significantly associated with the use of radiation and chemotherapy. Surgical resection, tumor grade, tumor size, use of radiation therapy, and age significantly influenced survival. CONCLUSIONS: Patterns of care of STS differ based on the site of the tumor. The patterns of care for extremity sarcomas are fairly consistent with the available recommendations, but the patterns of care for other sites are less consistent. In addition to certain tumor characteristics, age of the patient was significantly associated with therapy and patient outcome.