Accreditation Standards-An Untapped Lever for Cancer Equity.

This Viewpoint describes how the Commission on Cancer and the National Cancer Institute can incorporate health equity benchmarks into existing standards to improve care and outcomes for all patients with cancer.

Venture capital investment in urology, 2011 to mid-2021.

INTRODUCTION: To characterize venture capital (VC) investments in urology in the past decade that represent promising innovations in early-stage companies. MATERIALS AND METHODS: A retrospective analysis of deals made between VC investors and urologic companies from January 1, 2011, through June 28, 2021, was conducted by using a financial database (PitchBook Platform, PitchBook Data Inc). Data on urologic company and investor names; company information and funding categories (surgical device, therapeutic device, drug discovery/pharmaceutical, and health care technology companies); and deal sizes (in US dollars) and dates were abstracted and aggregated. Descriptive and linear regression analyses were conducted. RESULTS: Urology-related VC funding fluctuated from 2011 through mid-2021, but no substantial change was observed in funding over time. In total, 191 distinct deals were made involving urologic companies, totaling $1.1 billion. The four largest funding categories together accounted for $848 million and comprised therapeutic devices ($373 million), surgical devices ($187 million), drug discovery/pharmaceuticals ($185 million), and health care technology ($102 million). At least $450 million (41% of total investments) was invested in companies developing minimally invasive surgical devices. CONCLUSIONS: Urologic VC investments did not increase in the past decade and were allocated more toward devices than pharmaceuticals or health care technology. Given relative patterns within urology, VC investments may shift toward health care technology and away from pharmaceuticals but remain stable for devices. Further investments in promising technologies may help urologists more effectively manage urologic disease while optimizing outcomes.

Association Between Pharmaceutical Industry Marketing Payments to Physicians and Intra-articular Hyaluronic Acid Administration to Medicare Beneficiaries.

This cross-sectional study assesses the physician and financial factors associated with the use of hyaluronic acid to treat knee osteoarthritis.

Individuals' experiences in U.S. immigration detention during the early period of the COVID-19 pandemic: major challenges and public health implications.

BACKGROUND: Individuals held in carceral settings were significantly impacted by the COVID-19 pandemic. However, limited research exists of the direct experiences of individuals detained by the United States (U.S.) Immigration and Customs Enforcement (ICE). This study illustrates the major challenges described by individuals held in ICE's immigration detention centers during the initial spread of COVID-19. METHODS: We interviewed 50 individuals who were released from ICE detention between March 15, 2020 until August 31, 2020. Participants were recruited through immigration attorneys. Responses to a semi-structured interview were documented. Quotes from these interviews were thematically analyzed. RESULTS: Study participants were detained in 22 different ICE detention centers, which were located across 12 states, in both county (41%) and privately-contracted facilities (59%). The major themes that emerged from interviews included inadequate protections against COVID-19, denial of physical and mental healthcare, and experiences of retaliation in response to self-advocacy. These issues perpetuated emotions of fear, distrust, and helplessness in individuals in immigration detention centers. CONCLUSIONS: This study represents the largest analysis of experiences of ICE-detained immigrants during the early months of the COVID-19 pandemic. To ensure the rights to health and wellbeing for this population, further actions should include improving public health conditions, protecting against human rights violations, addressing barriers to healthcare access, ensuring transparency about conditions in detention centers, and moving toward decarceration.

Thyroid nodules: Global, economic, and personal burdens.

Thyroid nodules have garnered attention due to changes in population surveillance systems and rising concerns about the associated financial burden on healthcare systems, payers, and patients. In this review, we find that prevalence rates vary widely based on method of detection and may particularly pronounced in asymptomatic patients undergoing routine screening. Incidence rates may be particularly rising in lower-income and middle-income countries and may be declining in higher-income countries. Despite high incidence rates, survival rates continue to be as high as 97% for papillary thyroid cancer. Over the last few decades, thyroid nodule workup and management has grown more sophisticated with the advent of fine-needle aspiration biopsy, specialized biomarkers, and molecular testing. However, gaps remain in risk stratification that can lead to substantial costs of care. Certain molecular tests, such as the Afirma Gene Sequencing Classifier can lead to a cost per diagnosis of $17,873 while achieving only mild decreases in diagnostic lobectomies for patients (11.6% to 9.7% in one study). Out-of-pocket costs associated with thyroid nodule management continue to drive significant financial toxicity for patients, especially for individuals with thyroid cancer. Financial toxicity has been defined as a term that describes how direct and indirect medical costs of cancer care strain patients and households via decreased income, assets, and spending on basic necessities. Recent studies suggest that such toxicity can lead to adverse financial outcomes, such as foreclosure and bankruptcy. Additional cost-effectiveness analyses are needed to improve existing thyroid nodule management systems and new clinical tools are needed to avoid unnecessary workup and management.

Changes in Industry Marketing and Research Payments to US Physicians and Teaching Hospitals During the COVID-19 Pandemic.

This cross-sectional study explores ways that the COVID-19 pandemic was associated with changes in research and marketing payments from pharmaceutical and medical device companies before and during the pandemic.

The Cost and Financial Burden of Thyroid Cancer on Patients in the US: A Review and Directions for Future Research.

Importance: In the US, thyroid cancer has been identified as a cancer type with a high degree of associated financial burden on patients, and survivors of thyroid cancer report higher rates of bankruptcy than those of other cancer types. However, the available literature on the financial burden of thyroid cancer has not yet been described. Observations: Estimates of the out-of-pocket costs of initial thyroid cancer diagnosis and treatment range widely ($1425-$17 000) and are influenced by age, surgical treatment type, and health insurance coverage. The rates of patient-reported financial burden are heterogeneous (16%-50%) and are rarely compared with those of other cancer types. Independent risk factors of financial burden have included younger age, lack of health insurance, and annual household income of less than $49 000. Two studies measured medical debt associated with thyroid cancer diagnosis and treatment at notably different rates (2.1% vs 18.7%). The bankruptcy incidence at 1 year after cancer diagnosis is highest for thyroid cancer (9.3 per 1000 person-years) than other studied cancer types (ie, lung, uterine, leukemia/lymphoma, colorectal, melanoma, breast, prostate) and 4.39-fold higher than control individuals among those aged 35 to 49 years. Conclusions and Relevance: Current estimates of the financial burden of thyroid cancer are methodologically limited and are based on cross-sectional analyses of patient-reported data. We propose novel frameworks for new research by improvements in (1) data sourcing and utilization, (2) study design, and (3) pilot interventions. To understand how out-of-pocket thyroid cancer-related expenditures transition to various forms of debt, how households finance ongoing costs of care, and rates at which debts are sent to collection agencies, future research should focus on integrating underutilized sources of primary data, including credit reports, public records, and mortgage-backed securities loan-level data. Improvements in study design, such as the development of prospective cohorts, can allow for more objectively measured estimates of out-of-pocket costs, and robust covariate analysis can further reveal the influence of demographic factors, including age, sex, race, income, and health insurance coverage. Finally, new pilot interventions on cost controls can both enable further study and alleviate financial burden.

Breaking the cycle: A public-private partnership to combat the American opioid epidemic.

There has been an increased focus on the opioid epidemic in the United States, yet policy-based interventions such as prescription limits, restrictions on doctor shopping, and notification programs for high-volume prescribers have had no significant impact. In this paper, the authors explore a novel public health policy: a joint public-private partnership between the federal government and hospitals to establish long-term treatment centers for patients admitted to the emergency department after an overdose. These centers would provide medication for opioid use disorder, give individuals the necessary support for recovery, and reduce healthcare expenditures. Similar longitudinal strategies may be used in other areas of public health.

Suicide rates of migrants in United States immigration detention (2010-2020).

OBJECTIVE: We determined the annual suicide rate of migrants detained by U.S. Immigration and Customs Enforcement (ICE) in the past decade. METHODS: We performed a retrospective cohort analysis of the annual suicide rates for ICE detainees from federal fiscal years (FY) 2010-2020. Death date and cause of death were directly extracted from publicly available ICE Freedom of Information Act (FOIA) Library, ICE death reports, and ICE press releases. Annual suicide rates were calculated as suicides per 100,000 person-years and suicides per 100,000 admissions. RESULTS: From 2010-2019, the mean number of suicides per 100,000 person-years was 3.3 (standard deviation (SD): 2.6). In 2020, the suicide rate increased 5.3 times the prior 10-year average to 17.4 suicides per 100,000 person-years. When calculating suicide rate based on admissions per FY, the mean number of suicides from 2010-2019 per 100,000 admissions was 0.3 (SD: 0.3). In 2020, the suicide rate increased 11.0 times the prior 10-year average to 3.4 suicides per 100,000 admissions. CONCLUSION: In 2020, the detainee suicide rate increased substantially compared to the past decade. This may point to a worsening mental health crisis in ICE detention.

Medication Use in the Management of Comorbidities Among Individuals With Autism Spectrum Disorder From a Large Nationwide Insurance Database.

Importance: Although there is no pharmacological treatment for autism spectrum disorder (ASD) itself, behavioral and pharmacological therapies have been used to address its symptoms and common comorbidities. A better understanding of the medications used to manage comorbid conditions in this growing population is critical; however, most previous efforts have been limited in size, duration, and lack of broad representation. Objective: To use a nationally representative database to uncover trends in the prevalence of co-occurring conditions and medication use in the management of symptoms and comorbidities over time among US individuals with ASD. Design, Setting, and Participants: This retrospective, population-based cohort study mined a nationwide, managed health plan claims database containing more than 86 million unique members. Data from January 1, 2014, to December 31, 2019, were used to analyze prescription frequency and diagnoses of comorbidities. A total of 26 722 individuals with ASD who had been prescribed at least 1 of 24 medications most commonly prescribed to treat ASD symptoms or comorbidities during the 6-year study period were included in the analysis. Exposures: Diagnosis codes for ASD based on International Classification of Diseases, Ninth Revision, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. Main Outcomes and Measures: Quantitative estimates of prescription frequency for the 24 most commonly prescribed medications among the study cohort and the most common comorbidities associated with each medication in this population. Results: Among the 26 722 individuals with ASD included in the analysis (77.7% male; mean [SD] age, 14.45 [9.40] years), polypharmacy was common, ranging from 28.6% to 31.5%. Individuals' prescription regimens changed frequently within medication classes, rather than between classes. The prescription frequency of a specific medication varied considerably, depending on the coexisting diagnosis of a given comorbidity. Of the 24 medications assessed, 15 were associated with at least a 15% prevalence of a mood disorder, and 11 were associated with at least a 15% prevalence of attention-deficit/hyperactivity disorder. For patients taking antipsychotics, the 2 most common comorbidities were combined type attention-deficit/hyperactivity disorder (11.6%-17.8%) and anxiety disorder (13.1%-30.1%). Conclusions and Relevance: This study demonstrated considerable variability and transiency in the use of prescription medications by US clinicians to manage symptoms and comorbidities associated with ASD. These findings support the importance of early and ongoing surveillance of patients with ASD and co-occurring conditions and offer clinicians insight on the targeted therapies most commonly used to manage co-occurring conditions. Future research and policy efforts are critical to assess the extent to which pharmacological management of comorbidities affects quality of life and functioning in patients with ASD while continuing to optimize clinical guidelines, to ensure effective care for this growing population.

Time to Surgery and Thyroid Cancer Survival in the United States.

BACKGROUND: Longer time to surgery worsens survival in multiple malignancies, including lung, colorectal, and breast cancers, but limited data exist for well-differentiated thyroid cancer. We sought to investigate the impact of time to surgery on overall survival in patients with papillary thyroid cancer. METHODS: In a retrospective cohort study of the National Cancer Database, we used Cox proportional hazard models to investigate overall survival as a function of time between diagnosis and surgery for adults with papillary thyroid cancer, adjusting for demographic, patient, and cancer-related variables. Time to surgery was investigated both as a continuous variable and as intervals of 0-90 days, 90-180 days, and > 180 days. Subgroup analyses were conducted by T stage. RESULTS: Overall, 103,812 adults with papillary thyroid cancer were included from 2004 to 2016. Median follow-up was 55.2 months (interquartile range 28.4-89.5). Increasing time to surgery was associated with increased mortality: delaying by 91-180 days increased the risk by 30% (adjusted hazard ratio [aHR] 1.30, 95% CI 1.19-1.43) and delaying by over 180 days increased the risk by 94% (aHR 1.94, 95% CI 1.68-2.24). Five-year overall survival was 95.7% for 0-90 days, 93.0% for 91-180 days, and 87.9% for over 180 days. On subgroup analysis, increasing delay was associated with worse overall survival for T1, T2, and T3 tumors, but not T4 tumors. CONCLUSIONS: Increasing time to surgery in papillary thyroid cancer is associated with reduced overall survival. Further research is necessary to assess the impact of surgical delay on disease-specific survival.