JustCare

Tag: Cancer

  • Why do Americans die younger than people in other wealthy nations?

    Why do Americans die younger than people in other wealthy nations?

    Americans have shorter life expectancies than people in other wealthy nations, even though we spend more on health care than other nations. The Peterson-KFF Health System Tracker looks at why it is that Americans die younger than people outside the US.

    KFF studied mortality rates in the US as well as Austria, Belgium, Canada, France, Germany, Japan, Netherlands, Sweden, Switzerland and the United Kingdom. Americans have a premature death rate of 408 deaths for 100,000 people under 70. The other countries had 228 premature deaths, close to half as many as people in the US.

    Unlike other wealthy nations, which have seen a reduction in the number of their premature deaths, the US has faced an uptick since 2010. Americans had a similar life expectancy as people in peer nations 45 years ago. We saw some increase in life expectancy with scientific advancements, but other countries saw greater increases in life expectancy by 1990. Moreover, peer countries did not see as great a reduction in life expectancy from COVID-19 as the US.

    Heart disease and cancer are the two leading causes of death in each of the countries studied, particularly for older adults. New medicines have reduced the number of premature deaths from heart disease. But, since 2010, Americans have seen an increase in premature deaths from heart disease, while other countries have seen a decrease.

    Americans suffer more from heart disease, chronic respiratory diseases, and chronic kidney diseases, which are collectively responsible for about 105 of the 408 premature deaths. COVID-19 was responsible for 64 of the 408 premature deaths in the US, and substance abuse was responsible for 29 of the premature deaths.

    Today twice as many Americans die of heart disease before the age of 70 than people in peer countries, likely because of more substance abuse and obesity in the US. Moreover, people with chronic heart conditions need ongoing medical care to remain healthy. But, Americans face much larger barriers to care than people in other countries.

    Cancer death rates declined by 40 percent in the US since 1988 for people under 70. And, the US cancer death rates remain comparable to those in peer countries over the last 40 years. Older Americans are less likely to die of cancer than people in peer nations. Some believe that’s because more Americans have died prematurely of other conditions than people in peer nations.

    Younger Americans suffer more from chronic conditions, substance abuse, injuries and communicable diseases than people in peer nations. Fifteen to 49 year olds in the US suffer two and half times more premature deaths than 15-49 year olds in peer nations. The premature death rate for this population in the US has not changed much in the last 45 years. In peer nations, it has dropped by half!

    The US has also seen higher numbers of childhood deaths than other wealthy nations. Over the last 45 years, the number of deaths of 0 to 14 year olds in the US has declined some, but it’s still higher than peer nations, 20 more deaths per 100,000 American kids. Some attribute this difference to racial disparities leading to worse health of babies at birth, more of whom are born premature or with congenital birth defects. In addition, three to four times more American kids died from killings, travel fatalities (we drive bigger cars and have less public transportation) and choking.

    Thankfully, medical advances have reduced death rates a lot. Many fewer people die of neonatal conditions, birth defects and HIV/AIDS. Deaths resulting from heart conditions also have dropped considerably. And, because fewer people smoke, fewer people are dying of cancer and heart disease. But, we are the richest country in the world, and there’s no excuse for our continuing to have shorter life expectancies than people in ever other wealthy country.

    Here’s more from Just Care:

  • New research finds link between drinking alcohol and cancer

    New research finds link between drinking alcohol and cancer

    Americans continue to drink a lot of alcohol. To quantify it in economic terms, we spend about $250 billion a year on our liquor. But, it’s probably time we cut down our alcohol consumption. The latest research supports the mounting evidence that drinking alcohol is linked to cancer, reports Robert Shmerling, MD for Harvard Health.

    NB: Moderate drinking comes with risks, but less than half of Americans know this. More research is needed on alcohol’s clear risks. No research shows that drinking alcohol has a causal effect on our health. It simply shows an association between those who drink and higher mortality and morbidity risks.

    Here are some of the many reasons we should consider stopping drinking altogether. Alcohol is linked to:

    • Cancer: In particular, liver, breast, colon, mouth, throat and esophagus cancer
    • Liver disease: Cirrhosis of the liver as well as liver failure
    • High blood pressure: Heart failure and dementia
    • Injury: Falls and drunk driving
    • Depression and anxiety
    • Alcohol poisoning: Physical harm and even death
    • Harm to social networks

    The Surgeon General’s most recent advisory from earlier this year recommended that all alcoholic drinks should bear the warning that alcohol can cause cancer. There is no amount of alcohol you can drink safely. But, Congress would need to pass legislation for this to happen. Today, alcohol labels warn of general risks to your health.

    The benefits of drinking alcohol? The jury’s still out on whether drinking a little is any more harmful than abstaining completely from drinking. Of note, some studies show that drinking a little–one to three drinks each week–reduced cancer and death rates over not drinking at all. And, a recent study found similar death rates between nondrinkers and light drinkers. Drinking alcohol can put people at ease and make them more likely to be engaged socially.

    Bottom line: It’s no longer clear that alcohol offers any health benefits. Whatever the benefits of alcohol–and they vary based on people’s lifestyle and genes–the harms are of serious concern. So consider skipping the alcohol, try a nonalcoholic drink.

    Here’s more from Just Care:

  • Oncologists report excessive deaths from prior authorization

    Oncologists report excessive deaths from prior authorization

    A new survey from the American Society of Radiation Oncology illustrates the dangers of prior authorization. Prior authorization kills an “inordinate number” of people and harms others. Insurers often deny care to the detriment of patients when physicians first ask for authorization; when denials are appealed, insurers then approve care the vast majority of the time.

    About 225 of the 750 radiation oncologists polled reported adverse health outcomes from prior authorization.  Their patients ended up in the emergency room or hospitalized or with a permanent disability. One in fourteen of the oncologists polled said that one or more of their patients had died as a result of prior authorization.

    Prior authorization can have benefits, particularly in cases in which physicians are not well trained. Prior authorization can ensure physicians are treating patients appropriately, based on evidence. Prior authorization can also keep costs down.

    But, insurers use prior authorization without regard to its effects on quality of life for patients. And, while prior authorization can help protect against unnecessary treatment, there is no one protecting patients from insurers that use prior authorization inappropriately, in ways that harm patients.

    The oncologists polled suggested insurers’ use of prior authorization is only increasing. Moreover, it increases staff burnout.

    • More than nine in ten oncologists (92 percent) reported treatment delays from prior authorization and nearly seven in ten (68 percent) reported delays of at least 5 days;
    • More than eight in ten oncologists (82 percent) blamed prior authorization for patients receiving less than the best care;
    • Nearly six in ten (58 percent) oncologists said prior authorization kept them from following recommended guidelines;

    Those polled made clear that it’s critical to appeal prior authorization denials because more than 70 percent are reversed on appeal. But, patients and physicians sometimes do not have the resources to appeal. In some instances, the tradeoffs of appealing care denials, in terms of time spent, means physicians are unable to do their jobs.

    Moreover, insurers still have 72 hours to review an expedited appeal. For some patients with health insurance, the harm from such a delay is significant.  One doctor said that in that time, “I’ve had patients who’ve literally had a tumor growing out of their chest. Waiting 3 days for an appeal means there’s more cancer to treat, even just in the time between when I made the plan for them initially, and when I actually get to start their treatment. Sometimes it means the plan has to change because the tumor has gotten that much bigger in that time period. Every day matters.”

    Insurers shouldn’t be allowed to continue doing prior authorization for treatments that are virtually always approved on appeal.

    Here’s more from Just Care:

  • New physician survey finds prior authorization harms cancer patients

    New physician survey finds prior authorization harms cancer patients

    Here’s yet another reason to opt for traditional Medicare over insurer-run Medicare Advantage plans. A new survey by the American Society for Radiation Oncology (ASTRO) finds that insurers’ use of prior authorization can harm cancer patients, reports Renal+Urology News. Prior authorization also makes it hard for oncologists to do their job.

    Your insurance plan should provide good coverage for you today and in the future, whatever your health care needs. Sadly, as we get older, it becomes increasingly likely we will be diagnosed with cancer or some other serious health conditions. So, it’s not wise to gamble with your health insurance.

    According to the 754 oncologists surveyed in the last few months, in more than nine and out ten (92 percent) instances, prior authorization means that patients don’t get care as quickly as they otherwise could. Consequently, about one in ten patients end up forgoing treatment. Some patients end up in the ER or the hospital. Some end up with disabilities, which can be permanent. And, seven percent of respondents said that their patients died.

    More than half of patient radiation oncology services require prior authorization, even though insurers approve them more than seven in ten times initially. On appeal, nearly three quarters of denials are approved.

    Nearly six in ten (58 percent) physicians surveyed said that prior authorization kept them from being able to follow treatment protocols. More than eight in ten (82 percent) said that in some cases they ended up providing their patients with less good treatment as a result of prior authorization.

    Not only can prior authorization seriously harm patients’ primary treatment, it can also prevent them from or pose a significant barrier to their receiving treatment for side effects. For example, they might not be able to get pain or antinausea medicines.

    According to respondents, insurers are ramping up prior authorization requirements, not easing them. A typical delay is at least five days. It also requires more administrative staff.

    Howard M. Sandler, MD, chair of the ASTRO board of directors, sums up the survey findings: “These survey findings confirm what radiation oncologists witness daily: prior authorization policies are failing people with cancer, causing avoidable delays that are dangerous and, in too many cases, deadly.”

    Here’s more from Just Care: 

  • Lower income Medicare cancer patients less likely to get optimal care

    Lower income Medicare cancer patients less likely to get optimal care

    A new study of Medicare cancer patients published in the Journal of Clinical Oncology finds that patients with lower incomes who receive a Medicare Part D Low-Income Subsidy (LIS) through the Extra Help program, are less likely to get optimal care, reports Medscape. These lower income individuals too often do not get systemic cancer therapy as compared to individuals with higher incomes not in the LIS program. People in the LIS program are more likely to get treatment that is not recommended.

    The goal of the Medicare Low-Income Subsidy or Extra Help program is to promote health equity. However, many people with low incomes who qualify for the program either do not know it exists or face too many barriers applying for it. As a result, around half of all people eligible are not enrolled in it.

    To qualify for Extra Help, you must apply through your state Medicaid office. However, you will be automatically enrolled if you have Medicaid, receive Supplemental Security Income benefits or are enrolled in a Medicare Savings Program.

    This new observational study of cancer patients suggests that those who are enrolled in the LIS program still face financial barriers to care that prevent them from getting the systemic cancer treatment they need. The LIS program helps offset the cost of oral prescription drugs under Medicare Part D for people with incomes up to 150 percent of the federal poverty level. The LIS program does not help offset the costs of drugs administered by physicians under Medicare Part B.

    However, many people in the LIS program also qualify for a Medicare Savings Program. There are a few programs to help with Medicare Part A and Part B out-of-pocket costs, depending upon your income. Some pay the deductibles and coinsurance. To apply, contact your state Medicaid office.

    Also, as of January 1, 2023, a new Medicare prescription drug law could help offset coinsurance costs for some drugs and biologicals under Medicare Part B.

    Of the group studied, more than 40 percent did not receive systemic therapy for their cancer. Those who did not receive systemic therapy were more likely to be among those in the LIS program. Moreover, of those who did receive systemic therapy, those in the LIS program were more likely to receive inferior care.

    The study authors posit that the inferior care for the LIS cohort stems from financial barriers.

    Here’s more from Just Care:

  • 3D mammograms outperform 2D mammograms

    3D mammograms outperform 2D mammograms

    A new study reveals the benefits of 3D mammograms over 2D mammograms, reports Ronnie Cohen for NPR. With a 3D mammogram, digital breast tomosynthesis, you are less likely to be asked to come back for additional testing. The 3D machine also appears to detect some cancers sooner.

    The study by Liane Philpotts, MD, published in the journal, Radiology, found fewer misdiagnoses from the 3D imaging. She sees it as a “win, win, win.”

    With 3D imaging–DBT machines–providers are able to see many more layers and angles of the breast. Radiologists can look at each layer of tissue. For people with dense breasts, the technology is of particular benefit.

    To be clear, this study does not answer with certainty the question as to whether 3D imaging detects breast cancers earlier than 2D imaging or is more likely to save lives. The 3D imaging is more expensive, so how much value it adds is important to understand.

    It will take another six or so years before we know for sure the value of DBT. That’s when a large clinical trial will end that actually studies and compares 3D and 2D technology. For now, there is only “indirect evidence suggesting the potential of DBT screening in improving survival outcomes.” 

    3D imaging has only been in use since 2011, when the Food and Drug Administration first approved it. Already, though, more than nine in ten facilities that do mammography have one or more DBT machines. Almost half of all machines are DBT.

    The study looked at more than 250,000 screenings to determine the breast cancer cases found with screening mammograms over the course of 13 years. Over the last ten years, it looked at 3D screenings.

    Here’s more from Just Care:

  • New report finds alcohol is likely responsible for rise in cancer rates

    New report finds alcohol is likely responsible for rise in cancer rates

    Roni Caryn Rabin reports for The New York Times on the increase in rates of colorectal and breast cancer and a new report from the American Association for Cancer Research that finds a possible link between these cancers and alcohol consumption. Drinking alcohol increases your likelihood of getting cancer.

    Cancer rates are falling. But, more people are getting certain types of cancer for reasons yet unknown. Of note, 40 percent of cancer cases are linked to behaviors that can be changed.

    The report urges people to drink less alcohol, stop smoking, eat a healthy diet, exercise, avoid ultraviolet radiation and stay away from pollutants. It recommends adding warning labels to alcohol products. Drinking alcohol affects the bacteria in your gut, which in turn can lead to cancer growing and spreading.

    New data is showing that people who drink small amounts or in moderation do not reduce their risk of heart disease relative to people who drink occasionally. In fact moderate and light drinkers are more likely to die from cancer than occasional drinkers.

    Put differently, it’s a myth that drinking red wine will help your heart. Whatever benefits you get from drinking red wine are outweighed by your risk of getting cancer.

    More than one in 20 cancer (5.4 percent) diagnoses today are attributed to drinking alcohol. What types of cancer are you most likely to get from drinking alcohol? Esophageal squamous cell carcinoma as well as some types of head, neck, breast, colorectal, liver and stomach cancers.

    Here’s more from Just Care:

  • Over 65? Eat more salmon and less cheese!

    Over 65? Eat more salmon and less cheese!

    As you age, you want more high-quality fatty proteins in your diet, Leigh Weingus reports for The Huffington Post. These proteins reduce inflammation and promote brain health. Eating more salmon should help a lot.

    Of course, different foods deliver different health benefits. Some foods boost energy levels. Some prevent disease, often caused by inflammation. But eating too much saturated fat is linked to heart disease and high LDL cholesterol. It also reduces your fiber intake which can lead to constipation.

    The benefits of an anti-inflammatory diet: Experts advise to eat an anti-inflammatory diet, as we get older, in order to stay in good physical and mental health. Including a fatty fish in your diet, such as salmon, at least twice each week, will help your muscles and strength. It will also increase your omega-3 consumption, promote brain health, and reduce inflammation.

    Eat protein-rich foods and foods with antioxidants: If you don’t like salmon, chicken or duck without the skin, eggs and tofu are also rich in protein. And, kale and spinach are good antioxidants, as are pomegranates. They also provide folic acid, niacin and other B vitamins that help to promote healthy brains.

    As for dairy products: Experts are now thinking you need less cheese and other dairy products than previously advised and possibly none at all, reports Andrea Petersen for the Wall Street Journal. There’s a new-found link between dairy products and cardiovascular disease as well as some cancers, including prostate cancer. But, some experts disagree, claiming that dairy products reduce the risk of heart disease and colon cancer.

    And, the jury’s still out as to the value of drinking fat-free milk over whole milk or two percent milk. Whatever you do, the new thinking is that one serving of dairy products a day is all you need. Dairy is primarily good for calcium, and you can get your calcium from other foods, such as tofu, edamame, kale and bok choy.

    If possible, avoid ultra-processed foods and supplements. Food that is fresh and not ultra-processed offers nutrients that are far easier to absorb into your body.

    Here’s more from Just Care:

  • Cancer screenings bring benefits at substantial cost

    Cancer screenings bring benefits at substantial cost

    We’ve come a long way in being able to screen for a variety of cancers and less far in curing people with mid- to late-stage cancer. We still need to make sure everyone takes advantage of these cancer screenings; they are important for ensuring survival from cancer. Fortunately, people with Medicare can get several cancer screenings at no cost.

    Many people with Medicare don’t yet benefit from these free cancer screenings. One recent study found that only about 50-60 percent of people with Medicare get breast and colorectal cancer screenings as recommended.

    The cost of screening Americans for five different types of cancer is now $43 billion a year, according to a new estimate published in the Annals of Internal Medicine, reports Gina Kolata for The New York Times. The researchers estimated the cost of breast, cervical, colorectal, lung and prostate cancer screenings.

    Of the $43 billion spent each year on cancer, more than $22 billion is to cover the cost of colonoscopies. But, colonoscopies can both detect and prevent cancer. Physicians can remove growths on the colon that can become cancer over time.

    How beneficial are screenings? The U.S. Preventive Services Task Force, an independent entity that grades the value of screenings, recommends lung, breast, cervical and colorectal screenings as a way to reduce the likelihood of death. It does not take a position on the value of prostate screenings.

    Cancer death rates have dropped significantly in the last 40 or so years, some say because many people have stopped smoking, improved their diets and otherwise take better care of themselves than in the past. The death rate from colon cancer has dropped by half. Today, about half of all eligible individuals are screened for colon cancer.

    One clinical trial found that screening possibly reduced the likelihood of death from colorectal cancer by one third over 30 years.  That sounds like a lot, and I don’t want to minimize it. Yet, it’s important to note that the overall risk fell to two percent from three percent.

    Here’s more from Just Care:

  • Medicare Advantage insurers increasingly use step therapy for cancer drugs, delaying care

    Medicare Advantage insurers increasingly use step therapy for cancer drugs, delaying care

    A study by Avalere reveals that health insurers are increasingly delaying and denying drugs to cancer patients through the use of step therapy, reports Noah Tong for Fierce Healthcare.

    The American Cancer Society Cancer Action Network (ACSCAN) released a paper that demonstrates Medicare Advantage insurers are weaving step therapy into their prior authorization requirements. Sometimes, enrollees don’t even realize it. Step therapy is a means by which insurers require patients to use a less costly treatment before receiving a more costly one, such as requiring an X-ray before approving a CT scan or MRI.

    Some say that requiring prior authorization for cancer drugs helps ensure safety. Prior authorization can also save patients money. But, what the Medicare Advantage insurers are doing is troubling. Patients and doctors are too often unaware of what the insurers are requiring. In particular, delays in treatment are concerning.

    Kisqali and Verzenio are two breast cancer drugs for which Medicare Advantage insurers often require step therapy. They won’t cover these drugs unless other less costly drugs are shown to be ineffective. One concern is “embedded step therapy,” which could hide an insurer’s use of step therapy. It might not be included in an insurer’s Part D list of covered drugs.

    In the year between 2023 and 2024, overall, Medicare Advantage insurers used step therapy more often for breast cancer drugs and hepatocellular carcinoma, according to the American Cancer Society.  Medicare Advantage insurers required step therapy as much as 95 percent of the time. They did not appear to require it for biosimilar drugs Kanjinti and Trazimera.

    The bigger insurers tend to require step therapy more of the time than the smaller insurers. If the issue is truly safety, they should be using step therapy with the same frequency.

    To date, the Centers for Medicare and Medicaid Services, CMS, which oversees the Medicare Advantage plans, has allowed insurers to decide for themselves when to use prior authorization. Some use it a lot more than others, at times delaying and denying urgently needed care inappropriately.

    Prior authorization determinations should be standardized across all Medicare Advantage plans. Without standardization, people cannot meaningfully distinguish among MA plans. Moreover, MA plans can wrongly deny or delay care with little if any accountability.

    Here’s more from Just Care: