Managed care and cancer outcomes for Medicare beneficiaries with disabilities.

Objective: To determine if the type of insurance arrangement, specifically health maintenance organization (HMO) vs fee-for-service (FFS), affects cancer outcomes for Medicare beneficiaries with disabilities.

Study Design: Retrospective cohort.

Methods: We used the Surveillance, Epidemiology, and End Results-Medicare linked dataset to identify beneficiaries older and younger than 65 years entitled to Medicare benefits because of disability (Social Security Disability Insurance) who subsequently were diagnosed as having breast cancer (n = 6839) or non-small cell lung cancer (n = 10,229) from 1988 through 1999.

Cost disparities in lung cancer treatment by disability status, sex, and race.

Background: The recent literature contains numerous reports of disparities in the diagnosis, treatment, and outcomes of lung cancer across a growing list of population subgroups, including disability status. A common assumption is that disparities stem mainly from variations in the level and type of treatment resources available to specific subgroups. Few studies, however, have directly measured resource differentials.

Clinical trials and tribulations: lessons learned from recruiting pregnant ex-smokers for relapse prevention.

The development of smoking cessation and relapse prevention interventions for pregnant and postpartum women is a public health priority. However, researchers have consistently reported substantial difficulty in recruiting this population into clinical trials. The problem is particularly acute for relapse prevention studies, which must recruit women who have already quit smoking because of their pregnancy.

Cancer stage at diagnosis and survival among persons with Social Security Disability Insurance on Medicare.

Objective: To examine stage at diagnosis and survival for disabled Medicare beneficiaries diagnosed with cancer under age 65 and compare their experiences with those of other persons diagnosed under age 65.

Data Sources: Surveillance, Epidemiology, and End Results (SEER) Program data and SEER-Medicare linked data for 1988-1999. SEER-11 Program includes 11 population-based tumor registries collecting information on all incident cancers in catchment areas.

Evaluation of breast cancer care under Puerto Rico's Health Care Reform.

Puerto Rico has implemented Health Care Reform legislation that shifted medically indigent and underserved persons from direct care by public sector institutions to managed care arrangements through the private sector. Our aim is to assess how previously underserved women with breast cancer have fared during the first three years of the Reform. Medical claims data were obtained on breast cancer cases in San Juan who were either enrolled in the capitated Reform plan or in a commercial policy offered by the same insurer.

Disparities in breast cancer treatment and survival for women with disabilities.

Background: Breast-conserving surgery combined with axillary lymph node dissection and radiotherapy or mastectomy are definitive treatments for women with early-stage breast cancer. Little is known about breast cancer treatment for women with disabilities.

Objective: To compare initial treatment for early-stage breast cancer between women with and without disabilities and to examine the association of treatment differences and survival.

Effect of concomitant use of benzodiazepines and other drugs on the risk of injury in a veterans population.

Background: Benzodiazepines comprise a class of drugs that when used as monotherapy are generally acknowledged to pose a risk for injury by increasing the likelihood of falls, fall-related injuries, adverse drug events and car accidents. Benzodiazepines may also be used concomitantly with other high risk medications that may further exacerbate the risk of injury. The aim of this study is to examine the occurrence of the concomitant use of benzodiazepines and other drugs and then quantify the indirect effect of these drug combinations on the likelihood of an injury-related health care episode.

Cost-effectiveness analysis of a complementary health intervention: the case of smoking relapse prevention.

Objectives: We assess the cost-effectiveness of smoking relapse prevention interventions designed to keep quitters from resuming the use of cigarettes. Because relapse prevention is complementary to smoking cessation efforts, the appropriate test of its cost-effectiveness is whether it reduces the incremental cost-effectiveness ratio (ICER) of smoking cessation. The major goal of the study is to carry out such a test.

Efficacy and cost-effectiveness of a minimal intervention to prevent smoking relapse: dismantling the effects of amount of content versus contact.

Relapse prevention remains a major challenge to smoking cessation efforts. T. H.

A randomized controlled trial to increase cancer screening among attendees of community health centers.

Background: We assessed the efficacy of the Cancer Screening Office Systems (Cancer SOS), an intervention designed to increase cancer screening in primary care settings serving disadvantaged populations.

Methods: Eight primary care clinics participating in a county-funded health insurance plan in Hillsborough County, Fla, agreed to take part in a cluster-randomized experimental trial. The Cancer SOS had 2 components: a cancer-screening checklist with chart stickers that indicated whether specific cancer-screening tests were due, ordered, or completed; and a division of office responsibilities to achieve high screening rates.

Cost-effectiveness of an intervention to increase cancer screening in primary care settings.

Background: The main goal was to conduct a cost-effectiveness analysis of an intervention designed to increase cancer screening rates in primary care settings serving disadvantaged populations. The Cancer Screening Office Systems intervention reminded clinicians whether screening mammography, Pap smears, and/or fecal occult blood tests were up-to-date in eligible patients and then established a division of office responsibilities to ensure that tests were ordered and completed.

Methods: The cost-effectiveness analysis was predicated on data generated from a cluster-randomized controlled trial of Cancer Screening Office Systems conducted at eight clinics participating in a county-funded health insurance plan in Florida.

Current and evolving strategies for colorectal cancer screening.

Background: Colorectal cancer is a major cause of cancer mortality and morbidity. Screening can potentially prevent most colorectal cancers by detection and removal of precursor adenomas.

Methods: The literature and clinical practice guidelines are reviewed, with an emphasis on advances of the last 10 years and evolving screening methods.

Appraising the economic efficiency of cancer treatment: an exploratory analysis of lung cancer.

This paper tests whether the measured cost-effectiveness of treating different subgroups of an incident population of lung cancer patients differs significantly and, by implication, whether the provision of care to these patients is tolerably efficient in economic terms. Data from administrative records and Registry follow-up on 544 non-small cell lung cancer patients diagnosed at a single NCI-designated Comprehensive Cancer Center are used to conduct the empirical analysis. The main results show statistically significant differences in cumulative costs and patient outcomes across subgroups differing by disease stage and treatment modality.

Breast cancer detection and outcomes in a disability beneficiary population.

Women with disabilities may be at higher risk of late-stage breast cancer. Using the 1991-93 Medicare-Surveillance Epidemiology and End Results (SEER)-linked data set, the authors compared stage at diagnosis and mortality, for Social Security Disability Insurance (SSDI)-qualifying women and similarly aged non-SSDI qualifying women. Disabled patients were diagnosed at a later American Joint Committee on Cancer stage.

Indirect economic effects of long-term breast cancer survival.

Purpose: The indirect morbidity/disability costs of breast cancer may be rising as a consequence of the growth in the population of long-term survivors. This study was conducted to test whether women who have survived breast cancer for at least 5 years experience long-lasting or continuing economic consequences that are attributable to their disease.

Description Of Study: A group of 105 women who initially had been treated for breast cancer approximately 5 years before were interviewed to obtain data on economic, demographic, and health changes in the period since diagnosis.

Functional impairment and the economic consequences of female breast cancer.

Recent trends in breast cancer diagnosis and mortality suggest that long-term survivors are now more likely to be functionally impaired and, hence, more likely to experience adverse economic outcomes. This study tests whether women who have survived breast cancer for at least five years exhibit more, or more severe, functional impairments than otherwise similar women without breast cancer. It also tests whether women with more severe impairments experience poorer economic outcomes attributable to their functional status.

Efficacy and costs of two forms of stress management training for cancer patients undergoing chemotherapy.

Purpose: Professionally administered psychosocial interventions have been shown to improve the quality of life of cancer patients undergoing chemotherapy. The present study sought to improve access to psychosocial interventions during chemotherapy treatment by evaluating the efficacy and costs of a patient self-administered form of stress management training that requires limited professional time or experience to deliver.

Patients And Methods: Four hundred eleven patients about to start chemotherapy were randomly assigned to receive usual psychosocial care only, a professionally administered form of stress management training, or a patient self-administered form of stress management training.

Screening for lung cancer with CT: a preliminary cost-effectiveness analysis.

Study Objective: To appraise the potential cost-effectiveness of lung cancer screening with CT.

Study Design: Incremental cost-effectiveness ratios are estimated for two hypothetical cohorts followed up over time. One cohort was screened over the first 5 years of the study period; the other cohort received usual care.