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This Week in Managed Care: October 23, 2020


This week, the top managed care news included COVID-19 delays in breast cancer surgery; targeted therapies associated with decreased mortality risk for non–small cell lung cancer; an inside look at a patient’s perspective of early-onset Parkinson disease.

COVID-19 delays in breast cancer surgery could mean more deaths over the next decade, targeted therapies associated with decreased mortality risk for non-small-cell lung cancer, and an inside look on a patient’s perspective of early-onset Parkinson disease.

Welcome to This Week in Managed Care, I’m Matthew Gavidia.

Cancer Care Delays in COVID-19 Could Lead to Higher Morbidity, Mortality

With the COVID-19 pandemic causing widespread delays and cancellations in the health care world, an analysis published this week predicts close to 3000 additional deaths over a 10-year period in patients who faced delays in breast cancer treatment.

Based on Kantar Health’s CancerMPact Patient Metrics database, a tool used to provide data and insight to drug developers and investors, the analysis estimates that there will be 335,779 new breast cancer cases in the United States in 2020, 319,700 of which will be nonmetastatic.

Patients with nonmetastatic breast cancer typically have good potential for positive outcomes when treated quickly and appropriately, but delays in care can make a significant difference. Based on a JAMA Oncology study, which was highlighted in the analysis’ accompanying press release, it’s estimated that a 60-day delay in breast cancer surgery will cause a 4% increase in the number of deaths after 5 years and 7% more deaths at 10 years.

With those percentages and the estimated number of new cases over the entire year in mind, Kantar Health expects that 79,925 new nonmetastatic breast cancer cases were diagnosed in the first 3 months of the pandemic when elective surgery was temporarily suspended in hospitals bogged down by patients with COVID-19. That would lead to 1598 deaths 5 years after diagnosis and 2797 deaths at 10 years.

“The effects of the pandemic will be felt deeply in many disease areas, but none more so than in oncology,” said Jeremy Brody, chief strategy officer at Kantar Health, in the press release. “It is important that patients continue to maintain their regular appointments and screenings to detect and treat breast cancer. The COVID-19 global pandemic needs to be a catalyst for the health care system to seek new ways to reach patients and ensure early detection screenings continue.”

For more, visit ajmc.com.

Propelled by Targeted Therapies, NSCLC Mortality Fell Between 2013 to 2016

Driven by treatment advances and a reduction in incidence, US population-level mortality from non–small cell lung cancer fell sharply from 2013 to 2016, according to researchers writing in The New England Journal of Medicine.

Using the Surveillance, Epidemiology, and End Results database, researchers examined mortality trends by cancer subtype, an approach that researchers highlight has not been extensively investigated.

Among men, incidence-based mortality from non–small cell lung cancer decreased 6.3% annually from 2013 through 2016, with incidence also shown to have declined by 3.1% annually from 2008 through 2016.

In women, non–small cell lung cancer incidence was flat from 2001 through 2006 and then started decreasing by 1.5% annually from 2006 through 2016. Incidence-based mortality fell slowly, by 2.3% from 2006 through 2014, but picked up after 2014, dropping nearly 6% through 2016.

This greater reduction in mortality rather than in incidence between 2014 and 2016 means an estimated 6800 male patients and 3200 female patients likely had delayed deaths.

However, researchers note that while deaths additionally declined for small-cell lung cancer, they fell only because of a reduction in incidence, signifying a lack of treatment breakthroughs for this subtype of lung cancer.

Non–small cell lung cancer accounts for 76% of all US lung cancer cases, with small cell lung cancer making up 13% as well.

For more, visit ajmc.com.

A Patient Perspective on Early-Onset Parkinson Disease

While typically associated with older populations, 10 to 20% of people with Parkinson disease, or PD, experience symptoms before age 50, known as early-onset PD.

In an interview with The American Journal of Managed Care®, Michael S. Fitts, assistant dean for user access and diversity for The University of Alabama at Birmingham, described his initial shock nearly 10 years ago when diagnosed at the age of 38 with PD.

“As far as my knowledge of Parkinson disease at that particular time, the only thing that I really knew about it was that Michael J. Fox had it and Muhammad Ali had it, and I'm no boxing champion,” said Fitts.

Now a member of the Michael J. Fox Foundation Patient Council, Fitts spoke on the challenges and misconceptions associated with the condition, primarily its perception as a condition for older people and the lack of representation for people of color.

“It's definitely a process in trying to get yourself trained and see how you can kind of like maneuver around it. All Parkinson patients or people living with Parkinson disease don't necessarily experience the same difficulties and challenges, but they all have their own issues–we all have our own issues and challenges.”

For the full interview, visit ajmc.com.

AJMC® Covers AMCP Nexus 2020, Kidney Week 2020, CHEST Annual Meeting 2020

This week, The American Journal of Managed Care® is covering 3 conferences, AMCP Nexus 2020, Kidney Week 2020, and CHEST Annual Meeting 2020, all in a virtual format.

AJMC.com has provided full coverage of each virtual meeting, with highlights including:

  • The keynote address at AMCP Nexus 2020 by Dr Marty Makary
  • An interview with the CEO of AMCP, Susan Cantrell
  • An interview with John Kazianis on what we have learned, and can continue to learn, from tele-intensive care units for CHEST 2020
  • And a panel discussion featuring the nation’s top infectious disease expert, Dr Anthony Fauci, on the ongoing challenges of the COVID-19 pandemic

For full conference coverage, visit ajmc.com/conference/amcp-nexus, ajmc.com/conference/asn, and ajmc.com/conference/chest.

Paper of the Week

And, now our paper of the week, which looks back at some of the most important papers over the past 25 years of The American Journal of Managed Care® and why they matter today.

This week’s paper comes from 2016 and the early days of the patient-centered medical home, an early effort at practice transformation. Authors from Brigham and Women’s evaluated 12 clinics that were remodeled along as medical homes based on criteria from the National Committee for Quality Assurance.

Unfortunately, the findings showed that the recent efforts at transformation were negatively associated with up to date breast cancer screening.

For the full paper, visit ajmc.com.

For all of us at AJMC®, I’m Matthew Gavidia. Thanks for joining us!

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