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Association of Medicaid Expansion With Timely Receipt of Treatment and Survival Among Patients With HR-Negative, HER2-Positive Breast Cancer

Kewei Sylvia Shi, Xu Ji, Changchuan Jiang, Kathryn J. Ruddy, Sharon M. Castellino, K. Robin Yabroff, and Xuesong Han

Background: Hormone receptor (HR)–negative, HER2-positive (also called HER2-enriched) breast cancer has no worse prognosis than other breast cancers if it is treated with HER2-targeted therapy. Medicaid expansion under the Affordable Care Act (ACA) has been shown to be associated with improved access to care and outcomes for many cancers, but its association with receipt of care for HR-negative, HER2-positive breast cancer is unknown. We examined the association of Medicaid expansion with receipt of guideline-concordant treatment, time to treatment initiation, and survival among nonelderly women newly diagnosed with HR-negative, HER2-positive breast cancer. Patients and Methods: Women aged 18 to 62 years newly diagnosed with HR-negative, HER2-positive breast cancer between 2010 and 2018 were identified from the National Cancer Database. Outcomes included receipt of stage-based guideline-concordant treatment, timely initiation of treatment (<30 days, <60 days, <90 days from diagnosis), and stage-specific 2-year overall survival. A difference-in-differences (DID) analytic approach compared outcome changes following Medicaid expansion in expansion versus nonexpansion states. Multivariable linear probability models were used to estimate treatment outcomes, and flexible parametric survival models were used to evaluate survival, adjusting for sociodemographic and clinical confounders. Results: A total of 31,401 patients were included. Medicaid expansion was associated with an increase of 0.58 percentage points (ppt; 95% CI, 0.01–1.16) in receipt of guideline-concordant treatment overall, a 2.43-ppt (95% CI, 0.68–4.18) increase in initiating guideline-concordant treatment <60 days after diagnosis, and a 1.17-ppt (95% CI, 0.02–2.32) increase in 2-year survival rate. The increase in 2-year survival associated with Medicaid expansion was most prominent for patients with stage III disease (DID, 3.81; 95% CI, 0.82–6.80). Conclusions: Medicaid expansion was associated with improved care and survival for patients with HR-negative, HER2-positive breast cancer, an aggressive cancer type for which prognosis largely depends on access to effective treatment.

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Association of Intellectual and Developmental Disabilities With Worse Outcomes After Surgical Treatment of Cancer

Vivian Resende, Selamawit Woldesenbet, Erryk Katayama, Muhammad Musaab Munir, Henrique Araújo Lima, Mujtaba Khalil, Karol Rawicz-Pruszyński, Muhammad Muntazir Mehdi Khan, Usama Waqar, Parit Mavani, Yutaka Endo, and Timothy M. Pawlik

Background: Patients with intellectual and developmental disabilities (IDD) face unique challenges resulting in disparities in their health care. We sought to define the effect that IDD had on achievement of a “textbook outcome” (TO) following a cancer operation among a nationally representative cohort of patients. Methods: Data on patients who underwent surgery for a malignant indication, including lung, breast, liver, biliary tract, pancreas, and colorectal, between 2014 and 2020 were extracted from the 100% Medicare Standard Analytical Files database. The association of IDD with TO (defined as the absence of postoperative complications, extended length of stay, 90-day readmission, and 90-day mortality), expenditures, and discharge status was assessed using multivariable logistic regression. Results: Among 500,472 Medicare beneficiaries, 4,326 (0.9%) with IDD had a cancer diagnosis (breast, n=481; lung, n=419; hepatobiliary, n=194; pancreas, n=145; colorectal, n=3,087). Although overall incidence of TO was 50.5%, patients with IDD were less likely to achieve a TO than those without (37.1% vs 50.6%, respectively; odds ratio [OR], 0.50; 95% CI, 0.46–0.53; P<.001). On multivariable regression, patients with IDD had higher odds of a postoperative complication (OR, 1.53; 95% CI, 1.43–1.64), extended length of stay (OR, 2.06; 95% CI, 1.93–2.21), 90-day readmission (OR, 1.15; 95% CI, 1.07–1.24), 90-day mortality (OR, 1.90; 95% CI, 1.70–2.13), and discharge to a skilled nursing facility (OR, 4.28; 95% CI, 3.97–4.62) (all P<.001). Conclusions: Patients with IDD had a much lower chance of a postoperative TO, as well as discharge to a nonhome setting. The data highlight the need to improve the care of patients with IDD to assure equitable oncologic surgical care.

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Volume 22 (2024): Issue 8 (Oct 2024)

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Acute Lymphoblastic Leukemia, Version 2.2024, NCCN Clinical Practice Guidelines in Oncology

Bijal Shah, Ryan J. Mattison, Ramzi Abboud, Peter Abdelmessieh, Ibrahim Aldoss, Patrick W. Burke, Daniel J. DeAngelo, Shira Dinner, Amir T. Fathi, Jordan Gauthier, Michael Haddadin, Nitin Jain, Brian Jonas, Suzanne Kirby, Michaela Liedtke, Mark Litzow, Aaron Logan, Meixiao Long, Selina Luger, James K. Mangan, Stephanie Massaro, William May, Olalekan Oluwole, Jae Park, Amanda Przespolewski, Sravanti Rangaraju, Caner Saygin, Marc Schwartz, Paul Shami, Benjamin Tomlinson, Jonathan Webster, Ajibola Awotiwon, and Katie Stehman

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for acute lymphoblastic leukemia (ALL) provide recommendations for management of ALL, with a focus on the classification of ALL subtypes based on immunophenotype and cytogenetic/molecular markers; risk assessment and stratification for risk-adapted therapy; treatment strategies for Philadelphia chromosome (Ph)-positive and Ph-negative ALL for both adolescent and young adult and adult patients; and supportive care considerations. This selection from the NCCN Guidelines for ALL focuses on treatment recommendations for adults with newly diagnosed Ph-negative ALL based on current evidence.

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Authors’ Reply to the Letter to the Editor by Suarez-Kurtz: Tailoring and Standardizing DPYD Genotyping Tests to Promote Equity in Pharmacogenomics

Jai N. Patel, Sarah A. Morris, and D. Grace Nguyen

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Highlights of the NCCN Oncology Research Program

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Impact of a Comprehensive Financial Navigation Intervention to Reduce Cancer-Related Financial Toxicity

Stephanie B. Wheeler, Michelle L. Manning, Mindy Gellin, Neda Padilla, Lisa P. Spees, Caitlin B. Biddell, Victoria Petermann, Allison Deal, Cindy Rogers, Julia Rodriguez-O’Donnell, Cleo Samuel-Ryals, Katherine Reeder-Hayes, and Donald L. Rosenstein

Background: Although the need to reduce the impact of financial toxicity among patients with cancer is widely acknowledged, few interventions have been developed to address this issue. We tested a novel, multiphase, patient-centered financial navigation (FN) intervention at a large academic medical center. Methods: We developed a financial toxicity screening tool consisting of the Comprehensive Score for Financial Toxicity (COST) measure plus several additional items based on patient feedback. After systematizing the screening process, 50 patients from the North Carolina Basnight Cancer Hospital were enrolled in the FN intervention following a positive screen for financial distress (COST score <23). The FN intervention involved one-on-one consultations with a trained financial navigator and included an initial comprehensive intake appointment to determine patient eligibility for financial assistance and follow-up appointments to discuss paperwork and application(s) status. We assessed preliminary intervention effectiveness (preintervention and postintervention COST scores) and implementation (ie, fidelity, uptake, acceptability). Results: All 50 patients assessed for study eligibility screened positive for financial distress. A total of 46 patients completed both the preintervention and postintervention COST instrument and other measures. Postintervention mean COST scores improved from 6.4 at baseline to 13.3 post-FN (P<.0001), indicating a significant decrease in perceived financial toxicity. Fidelity to the intervention was high and 96% of participants received financial assistance. Conclusions: A patient-centered FN intervention fully integrated into an existing care coordination model can help to decrease the burden of cancer-related financial toxicity among patients with cancer experiencing financial distress. Further studies are needed to test FN interventions in various oncology settings and among targeted populations.

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Is it Time to Forget the 5-Fluorouracil Bolus?

E. Gabriela Chiorean

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Letter to the Editor: Variant Coverage and Diagnostic Performance of Commercially Available DPYD Genotyping Tests in Brazil

Guilherme Suarez-Kurtz

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NCCN Guidelines® Insights: Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer, Version 3.2024

Featured Updates to the NCCN Guidelines

Joyce Liu, Andrew Berchuck, Floor J. Backes, Joshua Cohen, Rachel Grisham, Charles A. Leath III, Lainie Martin, Daniela Matei, David S. Miller, Sharon Robertson, Lisa Barroilhet, Shitanshu Uppal, Andrea Wahner Hendrickson, David M. Gershenson, Heidi J. Gray, Ardeshir Hakam, Angela Jain, Gottfried E. Konecny, John Moroney, Elena Ratner, John Schorge, Premal H. Thaker, Theresa L. Werner, Emese Zsiros, Kian Behbakht, Lee-May Chen, Marie DeRosa, Eric L. Eisenhauer, Gary Leiserowitz, Babak Litkouhi, Michael McHale, Sanja Percac-Lima, Kerry Rodabaugh, Roberto Vargas, Frankie Jones, Emily Kovach, Lisa Hang, Swathi Ramakrishnan, Ronald D. Alvarez, and Deborah K. Armstrong

The NCCN Guidelines for Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer provide multidisciplinary diagnostic workup, staging, and treatment recommendations for this disease. These NCCN Guidelines Insights detail how the evolution of the use of PARP inhibitors as maintenance and single-agent regimens for the treatment of ovarian cancer informed panel recommendations in the guidelines.