Posts Tagged cancer

Report: Overall Cancer Mortality Continues to Decline

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Report: Overall Cancer Mortality Continues to Decline

The latest Annual Report to the Nation on the Status of Cancer finds that, for all cancer sites combined, cancer death rates continued to decline in men, women and children in the United States from 1999 to 2016. Overall cancer incidence rates, or rates of new cancers, decreased in men from 2008 to 2015, after increasing from 1999 to 2008, and were stable in women from 1999 to 2015. In a special section of the report, researchers looked at cancer rates and trends in adults ages 20 to 49.

The annual report is a collaborative effort among the National Cancer Institute (NCI), part of the National Institutes of Health; the Centers for Disease Control and Prevention (CDC); the American Cancer Society (ACS); and the North American Association of Central Cancer Registries (NAACCR). The report appeared in the Journal of the National Cancer Institute on May 30, 2019.

“We are encouraged by the fact that this year’s report continues to show declining cancer mortality for men, women, and children, as well as other indicators of progress,” said Betsy A. Kohler, executive director of NAACCR. “There are also several findings that highlight the importance of continued research and cancer prevention efforts.”

The special section shows a different picture of cancer incidence and mortality among men and women ages 20 to 49 than among people of all ages. In the main report, from 2011 to 2015, the average annual incidence rate for all cancer sites combined was about 1.2 times higher among men than among women, and from 2012 to 2016, the average annual death rate among men (all ages) was 1.4 times the rate among women. However, when the researchers looked only at men and women ages 20 to 49, they found that both incidence and death rates were higher among women.

The authors reported that, in the 20–49 age group from 2011 to 2015, the average annual incidence rate for all invasive cancers was 115.3 (per 100,000 people) among men, compared with 203.3 among women, with cancer incidence rates decreasing an average of 0.7% per year among men and increasing an average of 1.3% per year among women. During the period from 2012 to 2016, the average annual cancer death rate was 22.8 (per 100,000 people) among men and 27.1 among women in this age group.

The most common cancers and their incidence rates among women ages 20 to 49 were breast (73.2 per 100,000 people), thyroid (28.4), and melanoma of the skin (14.1), with breast cancer incidence far exceeding the incidence of any other cancer. The most common cancers among men ages 20 to 49 were colon and rectum (13.1), testis (10.7), and melanoma of the skin (9.8).

“The greater cancer burden among women than men ages 20 to 49 was a striking finding of this study,” said Elizabeth Ward, Ph.D., lead author of the study and a consultant at NAACCR. “The high burden of breast cancer relative to other cancers in this age group reinforces the importance of research on prevention, early detection, and treatment of breast cancer in younger women.”

In studying this age group, the authors also found that, from 2012 to 2016, death rates decreased 2.3% per year among men and 1.7% per year among women.

“It is important to recognize that cancer mortality rates are declining in the 20-to-49-year-old age group, and that the rates of decline among women in this age group are faster than those in older women,” said Douglas R. Lowy, M.D., acting director of NCI.

The authors also reported in the special section that the incidence rates of in situ breast cancer and nonmalignant central nervous system tumors among women and men ages 20 to 49 are substantial. They wrote that some of the most frequent malignant and nonmalignant tumors that occur in this age group may be associated with considerable long-term and late effects related to the disease or its treatment. The authors conclude that access to timely and high-quality treatment and survivorship care is important to improve health outcomes and quality of life for younger adults diagnosed with cancer.

This year’s report found that, among all ages combined, existing incidence and mortality trends for most types of cancer continue. Rates of new cases and deaths from lung, bladder, and larynx cancers continue to decrease as a result of long-term declines in tobacco smoking. In contrast, rates of new cases of cancers related to excess weight and physical inactivity—including uterine, post-menopausal breast, and colorectal (only in young adults)—have been increasing in recent decades.

Several notable changes in trends were observed in the report. After decades of increasing incidence, thyroid cancer incidence rates in women stabilized from 2013 to 2015. The authors wrote that this could be due to changes in diagnostic processes related to revisions in American Thyroid Association management guidelines for small thyroid nodules.

The report also shows rapid declines in death rates for melanoma of the skin in recent years. Death rates, which had been stable in men and decreasing slightly in women, showed an 8.5% decline per year from 2014 to 2016 in men and a 6.3% decline per year from 2013 to 2016 in women.

“The declines seen in mortality for melanoma of the skin are likely the result of the introduction of new therapies, including immune checkpoint inhibitors, that have improved survival for patients diagnosed with advanced melanoma,” said J. Leonard Lichtenfeld, M.D., M.A.C.P., interim chief medical officer of ACS. “This rapid change shows us how important it is to continue working to find effective treatments for all kinds of cancer.”

Other notable findings about cancer mortality from the report include that from 2012 to 2016:

  • Overall death rates decreased 1.8% per year in men and 1.4% per year in women.
  • Among men, death rates decreased for 10 of the 19 most common cancers but increased for 6 cancers, with the steepest increases for liver cancer, oral cavity and pharynx cancer, and non-melanoma skin cancer.
  • Among women, death rates decreased for 13 of the 20 most common cancers, including the 3 most common cancers (lung and bronchus, breast, and colorectal), but increased for 5 cancer types, with the steepest increases for cancers of the uterus and liver.

For cancer incidence, from 2011 to 2015:

  • Incidence rates for all cancers combined were stable in women and decreased 2.1% per year in men.
  • Among men, rates of new cancers decreased for 8 of the 17 most common cancers, increased for 7 cancers, and were stable for 2 cancers.
  • Among women, rates of new cancers decreased for 6 of the 18 most common cancers, increased for 9 cancers, and were stable for 3 cancers.

The report also shows continuing racial and ethnic disparities in cancer mortality and incidence. When data for people of all ages were combined and compared by sex, across racial and ethnic groups, black men and black women had the highest cancer death rates, both for all cancer sites combined and for about half of the most common cancers in men and women. Black men and white women had the highest overall cancer incidence rates, and Asian/Pacific Islander men and women had the lowest overall rates. Non-Hispanic men and women had higher overall incidence rates than Hispanic men and women.

“Major declines overall in cancer mortality point in the right direction, yet significant differences remain in cancer cases and deaths based on gender, ethnicity, and race,” said CDC Director Robert R. Redfield, M.D. “A better understanding of these discrepancies improves cancer diagnosis and recovery for all patients and is vital to our public health mission.”

For more about the report, see: https://seer.cancer.gov/report_to_nation/

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SURVEY: Prior Authorization Obstacles Unnecessarily Delay Patient Access to Cancer Treatments

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SURVEY: Prior Authorization Obstacles Unnecessarily Delay Patient Access to Cancer Treatments

ARLINGTON, Va., April 25, 2019 — Restrictive prior authorization practices cause unnecessary delays and interference in care decisions for cancer patients, according to a new survey of nearly 700 radiation oncologists — physicians who treat cancer patients using radiation– released today by the American Society for Radiation Oncology (ASTRO).

Nearly all radiation oncologists (93%) said that their patients are delayed from life-saving treatments, and a third (31%) said the average delay lasts longer than five days – a full week of standard radiation treatments. These delays cause added stress and anxiety to patients already concerned about their health, and they are cause for alarm given research linking each week of delay in starting cancer therapy with a 1.2% to 3.2% increased risk of death.

In addition to prevalent treatment delays, the ASTRO physician survey illuminates other ways prior authorization negatively impacts patient outcomes and takes physicians away from caring for their patients:

Added Patient Stress

  • More than 7 in 10 radiation oncologists (73%) said their patients regularly express concern to them about the delay caused by prior authorization.
  • More than 3 in 10 radiation oncologists (32%) have been forced to use a different therapy for a substantial number of their patients (>10%) due to prior authorizations delays.

Unnecessary Delay Tactics

  • Nearly two-thirds of radiation oncologists (62%) said most denials they receive from prior authorization review are overturned on appeal.
  • Radiation oncology benefit management companies (ROBMs) required 85% of radiation oncologists to generate multiple treatment plans, which require physicians and medical physicists to spend several hours developing alternatives to their recommended course of treatment.
  • More than 4 in 10 respondents (44%) said their peer-reviews typically are not conducted by a licensed radiation oncologist.

Wasting Physician Time

  • Nearly one in five radiation oncologists (17%) said they lose more than 10% of time that they could be caring for their patients focused instead on dealing with prior authorization issues. An additional 39% spend 5-10% of their average workday on prior authorization.
  • More than 4 in 10 radiation oncologists (44%) needed prior authorization for at least half of their treatment recommendations. An additional third (37%) needed it for at least a quarter of their cases.
  • Many radiation oncologists (63%) had to hire additional staff in the last year to manage the prior authorization process.

Disproportionate Impact on Patients at Community-Based Clinics

  • Patients treated at community-based, private practices experience longer delays than those seen at academic centers. For example, average treatment delays lasting longer than a week were reported by 34% of private practitioners vs. 28% of academic physicians (p=0.005).
  • Radiation oncologists in private practice are almost twice as likely to spend more than 10% of their day focused on prior authorization, compared to physicians at academic centers (23% vs. 13%, p=0.003)

“This survey makes clear that restrictive prior authorization practices can cause unnecessary, stressful and potentially life-threatening delays for cancer patients,” said Paul Harari, MD, FASTRO, Chair of the ASTRO Board of Directors and professor and Chairman of human oncology at the University of Wisconsin-Madison. “While the system may have been designed as a path to streamline and strengthen health care, it is in fact frequently harmful to patients receiving radiation therapy. In its current form, prior authorization causes immense anxiety and wastes precious time for cancer patients.”

“Radiation oncology and cancer patients have been particularly hard hit by prior authorization’s unnecessary burden and interference in care decisions,” said Vivek Kavadi, MD, Vice Chair of ASTRO’s Payer Relations Subcommittee and a radiation oncologist at Texas Oncology. “Radiation oncologists increasingly are restricted from exercising our clinical judgment in what is in the best interest of the patient, yet we are held accountable for the outcomes of treatments where decisions have been taken out of our hands.”

In the 2018 annual ASTRO member survey, radiation oncologists named prior authorization as the greatest challenge facing the field. The burden was especially prominent among private practitioners in community-based settings, where the majority of cancer patients receive care.

The findings from ASTRO’s new physician survey align with recent reports from the American Medical Association (AMA), American Cancer Society Cancer Action Network (ACS CAN) and others, demonstrating the pervasiveness of prior authorization obstacles throughout the American health care system.

ASTRO recently signed onto a letter with the AMA and other medical societies calling for CMS to require Medicare Advantage plans to align their prior authorization requirements with a Consensus Statement on Improving the Prior Authorization Process authored jointly by leading provider and payer organizations.

Survey Methodology

An online survey was sent by email to all 3,882 U.S. based, practicing radiation oncologists in ASTRO’s member database, and 620 physicians completed the survey online. Invitations were sent in December 2018, with one email reminder in January 2019, and the survey closed in February 2019. ASTRO staff also administered paper surveys at the ASTRO Annual Meeting in October 2018 and collected 53 responses. Findings reflect the combined total of 673 radiation oncologist responses. For more information about respondent demographics, view the executive summary.

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ABOUT ASTRO

The American Society for Radiation Oncology (ASTRO) is the world’s largest radiation oncology society, with more than 10,000 members who are physicians, nurses, biologists, physicists, radiation therapists, dosimetrists and other health care professionals who specialize in treating patients with radiation therapies. The Society is dedicated to improving patient care through professional education and training, support for clinical practice and health policy standards, advancement of science and research, and advocacy. ASTRO publishes three medical journals,International Journal of Radiation Oncology • Biology • Physics, Practical Radiation Oncology andAdvances in Radiation Oncology; developed and maintains an extensive patient website, RT Answers; and created the nonprofit foundation Radiation Oncology Institute. To learn more about ASTRO, visit our website, sign up to receive our news and follow us on our blog, Facebook, Twitterand LinkedIn.

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‘Through With Chew Week’ Highlights Dangers of Smokeless Tobacco Use

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‘Through With Chew Week’ Highlights Dangers of Smokeless Tobacco Use

Smokeless tobacco may not be getting as much press as e-cigarettes and vaping, but it is as addictive and has many harmful side effects. The Medical Association is joining with the Alabama Department of Public Health to encourage smokeless tobacco users to quit the spit during “Through With Chew Week,” Feb. 18-22.

The education campaign to decrease smokeless tobacco use and increase awareness of the negative health effects of using these products is an annual event begun in 1989 by the American Academy of Otolaryngology-Head and Neck Surgery.

In Alabama, 6.3 percent of adults surveyed were current smokeless tobacco users, according to the 2017 Behavioral Risk Factor Surveillance Survey. More than 9 percent of Alabama teens overall cited smokeless tobacco use in the past 30 days, according to the 2016 Alabama Youth Tobacco Survey, with 20.4 percent of high school students saying they had tried smokeless tobacco. Middle school students’ use of smokeless tobacco decreased from 6.7 percent in 2014 to 4.0 percent in 2016.

“Smokeless does not mean harmless,” said Julie Hare, Alabama Tobacco Quitline director. “Smokeless tobacco use can cause oral, esophageal and pancreatic cancers, and lead to tooth loss and gum recession,” she said. At least 28 cancer-causing chemicals have been found in smokeless tobacco, according to the Centers for Disease Control and Prevention.

Young people who use smokeless tobacco can become addicted to the nicotine it contains, making them more likely to also become cigarette smokers, Hare said.

Those who want to be “Through With Chew” can call the Quitline (1-800-Quit-Now) for help in quitting. Quitline coaching services are available seven days a week from 6 a.m. to midnight. Services are offered online at www.quitnowalabama.com.

The Quitline provides free, individualized coaching to help any type of smoker and smokeless tobacco user, including e-cigarettes and vape, to quit. In addition, the Quitline offers up to eight weeks of free nicotine patches to those medically eligible enrolled in the coaching program.

For free help to be “Through With Chew,” call the Quitline at 1-800-784-8669 or visit www.quitnowalabama.com.

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Report: Deaths from Cancer Higher in Rural America

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Report: Deaths from Cancer Higher in Rural America

Despite decreases in cancer death rates nationwide, a new report shows slower reduction in cancer death rates in rural America (a decrease of 1.0 percent per year) compared with urban America (a decrease of 1.6 percent per year), according to data released today in CDC’s Morbidity and Mortality Weekly Report. The report is part of a series of MMWR studies on rural heath.

The report is the first complete description of cancer incidence and mortality in rural and urban America. Researchers found that rates of new cases for lung cancer, colorectal cancer, and cervical cancer were higher in rural America. In contrast, rural areas were found to have lower rates of new cancers of the female breast and prostate. Rural counties had higher death rates from lung, colorectal, prostate, and cervical cancers.

“While geography alone can’t predict your risk of cancer, it can impact prevention, diagnosis and treatment opportunities – and that’s a significant public health problem in the U.S.,” said CDC Acting Director Anne Schuchat, M.D. “Many cancer cases and deaths are preventable and with targeted public health efforts and interventions, we can close the growing cancer gap between rural and urban Americans.”

In the study, researchers analyzed cancer incidence data from CDC’s National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End Results program. Cancer deaths were calculated from CDC’s National Vital Statistics System. Counties were grouped by urbanization and population size.

Key findings from analysis of cancer rates

  • Death rates were higher in rural areas (180 deaths per 100,000 persons) compared with urban areas (158 deaths per 100,000 persons). Cancer deaths in rural areas decreased at a slower pace, increasing the differences between rural and urban areas.
  • While overall cancer incidence rates were somewhat lower in rural areas (442 cases per 100,000 persons) than in urban areas (457 cases per 100,000 persons), incidence rates were higher in rural areas for several cancers, including those related to tobacco use such as lung cancer and those that can be prevented by cancer screening such as colorectal and cervical cancers.
  • While rural areas have lower incidence of cancer than urban areas, they have higher cancer death rates. The differences in death rates between rural and urban areas are increasing over time.

“Cancer – its causes, its prevention, and its treatment – is complicated,” said Lisa C. Richardson, M.D., oncologist and director of CDC’s Division of Cancer Prevention and Control. “When I treat cancer patients, I don’t do it alone – other healthcare professionals and family members help the patient during and after treatment. The same is true for community-level preventive interventions. Partnerships are key to reducing cancer incidence and the associated disparities.”

The CDC researchers identify a number of proven strategies that can reduce the gaps in new cancer cases and deaths. Healthcare providers in rural areas can:

    • Promote healthy behaviors that reduce cancer risk. Prevent tobacco initiation, promote tobacco cessation, and eliminate secondhand smoke exposure. Limit excessive exposure to ultraviolet rays from the sun and tanning beds. Encourage physical activity and healthy eating to prevent and reduce obesity, which is associated with several types of cancer.
    • Increase cancer screenings and vaccinations that prevent cancer or detect it early. Recommend patients receive vaccination against cancer-related infectious diseases such as HPV and hepatitis B virus. Recommend appropriate cancer screening tests such as Pap tests and colonoscopy.
    • Participate in the state-level comprehensive control coalitions. Comprehensive cancer control programs focus on cancer prevention, education, screening, access to care, support for cancer survivors, and overall pursuit of good health.

These data from CDC provide a clear direction for the work that needs to be done to reduce cancer disparities throughout the U.S., and provide the foundation for proven strategies that could be implemented. Proven strategies to improve health-related behaviors, increased use of vaccinations that prevent infections that can cause cancer, and use of cancer screening tests – particularly among people that live in rural and underserved areas – can help reduce the rates of cancer and cancer deaths across America.

For more information on rural health: www.cdc.gov/ruralhealth.

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Law Allows Alabama Students to Apply Sunscreen at School

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Law Allows Alabama Students to Apply Sunscreen at School

A new law allows Alabama school students to apply personal sunscreen at school without the need for special permission from a doctor or parent. The law includes public and private schools and went into effect immediately.

“Students will now be able to apply sunscreen to protect themselves from sunburn before going outside. We know that sunburn, particularly in childhood, increases your risk of skin cancer. Applying sunscreen before outside school activities will prevent overexposure to the sun’s UVA and UVB rays, thus preventing many forms of skin cancer, including melanoma, the deadliest form of skin cancer,” Dr. Tom Miller, State Health Officer at the Alabama Department of Public Health, said.

According to the Centers for Disease Control and Prevention, application of sunscreen while outdoors is a simple step to protect yourself from the harm of overexposure to sunlight’s UVA and UVB rays. A sunscreen with an SPF of 30 or higher should be applied at least every two hours, especially after swimming or sweating. For parents with babies less than 6 months old, please follow directions on the sunscreen’s package for its use.

Aside from sunscreen, other steps to protection from the sun’s harmful UV rays include the following:

  • Avoiding use of sunbathing and tanning beds
  • Covering up with protective clothing and wide-brimmed hats
  • Seeking shade, especially during midday hours (between 10 a.m. and 4 p.m.)

Previously, students were unable to use sunscreen unless prescribed by a physician. With the passage of this law, no rules of the State Board of Education or the Alabama Board of Nursing will apply to Food and Drug Administration-approved over-the-counter sunscreen.

Melanoma is the most commonly diagnosed cancer in the U.S. and is responsible for about 78 percent of all skin cancer deaths. Melanoma occurs when the pigment-producing cells that give color to the skin become cancerous. Cases of melanoma are 6 percent higher in Alabama than the national average. It is the most common type of skin cancer in children.

Alabama is among a growing number of states — like Arizona, California, New York, Oregon, Texas, Utah and Washington State — that lawfully permit students’ use of sunscreen at school.

For more information about sun safety, visit http://www.adph.org/skincancer/ or https://www.cdc.gov/cancer/skin/.

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New CDC Study: Changes in Breast Cancer Death Rates by Age Group

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New CDC Study: Changes in Breast Cancer Death Rates by Age Group

Breast cancer death rates among women decreased during 2010-2014, but racial differences persisted, according to a new study by the Centers for Disease Control and Prevention. The findings show changes for death rates from breast cancer by age group for black and white women, the groups with the highest death rates in the United States.

“Our latest data suggest some improvement for black women when it comes to disparities,” said Lisa Richardson, MD, Director of CDC’s Division of Cancer Prevention and Control. “First, the decline in deaths suggests that white and black women under 50 are benefiting equally from cancer treatments. Second, we’re hopeful the lack of difference in death rates between black and white women under 50 will start to be seen in older women.”

Data Highlights

  • There was a faster decrease in breast cancer death rates for white women (1.9% per year) than black women (1.5 percent per year) between 2010 and 2014.
  • Among women under age 50, breast cancer death rates decreased at the same pace for black and white women.
  • The largest difference by race was among women ages 60-69 years: breast cancer death rates dropped 2.0 percent per year among white women, compared with 1.0 percent per year among black women.

The authors noted that the drop in death rates among women may be due to improved education about the importance of appropriate breast cancer screening and treatment, as well as women having access to personalized and cutting-edge treatment.

“The good news is that overall rates of breast cancer are decreasing among black women. However, when compared with white women, the likelihood that a black woman will die after a breast cancer diagnosis is still considerably higher,” said Jacqueline Miller, M.D., and medical director of CDC’s National Breast and Cervical Cancer Early Detection Program.

What Can be Done to Reduce Breast Cancer Risk

Personalized medical treatments combined with community-based cancer control efforts that ensure adequate follow-up and treatment after a cancer diagnosis could help decrease breast cancer death rates faster and reduce differences among black and white women.

Women can take steps to help reduce their breast cancer risk by knowing their family history of cancer, being physically active, eating a healthy diet, maintaining a healthy weight, and getting recommended cancer screenings.

CDC’s National Breast and Cervical Cancer Early Detection Program provides access to timely breast and cervical cancer screening and diagnostic services for low-income, uninsured, and underserved women. It is the largest organized cancer screening program in the U.S. and offers free or low-cost mammograms to women who qualify.

CDC’s Bring Your Brave campaign provides information about breast cancer to women younger than age 45 by sharing real stories about young women whose lives have been affected by breast cancer.

The United States Cancer Statistics web-based report contains the official federal statistics on newly diagnosed cancer cases. CDC and the National Cancer Institute have combined their cancer incidence data sources to produce these statistics. Mortality data are from CDC’s National Vital Statistics System. CDC provides support for states and territories to maintain registries that provide high-quality data through the National Program of Cancer Registries.

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