The Inflation Reduction Act, enacted in 2022, included establishing a cap on out-of-pocket spending for those enrolled in Medicare Part D prescription drug plans.

Researchers from the University of Michigan’s Institute for Healthcare Policy and Innovation and Rogel Cancer Center used the online Medicare Part D Plan Finder tool to assess how much patients were paying for the most commonly prescribed oral chemotherapies. They compared data from 2023, when no out-of-pocket cap was in place, to 2024, when the policy first took effect.

For Medicare Part D beneficiaries, annual out-of-pocket costs for oral cancer medications averaged $11,284 in 2023. In 2024, the average annual cost for the same medications is estimated to be $3,927. The median cost saving from 2023 to 2024 is estimated to be $7,260, demonstrating the policy’s effect on decreasing costs for patients. The study is published in JAMA Network Open.

“People with cancer are already vulnerable to financial distress and medical debt. Our analysis suggests that legislative policy can have a big impact on the cost of cancer care. This is especially critical as lawmakers now consider extending an out-of-pocket cap to commercial insurance,” said lead study author Benjamin Pockros, M.D., M.B.A., a urology resident at Michigan Medicine.

In 2025, an out-of-pocket cap will be set at $2,000, which the researchers predict will result in even greater savings for patients.

Additional authors: Chad Ellimoottil, M.D.; Belal Sbei; Megan Caram, M.D.; Kristian Stensland, M.D., M.P.H., M.S.

Funding for this work is from the University of Michigan Institute for Healthcare Policy and Innovation.

Disclosure: None

Paper cited: “Changes in Out-of-Pocket Spending for Common Oral Cancer Medications After the Inflation Reduction Act,” JAMA Network Open. DOI: 10.1001/jamanetworkopen.2024.32456

It is often important to get cancer patients to quit smoking, but it is not always that easy.

“Data suggest that between 15 and 60 per cent of people who smoked before they were diagnosed with cancer continue to smoke after their diagnosis. It is crucial to help people with cancer quit smoking, because it will lead to better cancer treatment prognoses, prevent secondary cancer, and increase quality of life,” says Rubén Rodríguez-Cano, an associate professor at the Norwegian University of Science and Technology (NTNU’s) Department of Psychology.

Degree of addiction

Because smoking and cancer often go hand-in-hand, it is especially useful to determine how addicted people are to smoking. That makes it possible to estimate how likely it is that people will manage to quit, and consequently predict cancer patients’ chances of surviving.

The researchers may also be able to use a similar approach to estimate the risk that smokers who are still healthy have of developing cancer at a later date.

“We are currently conducting another study on the risk of developing lung cancer, which is being led by Professor Oluf Dimitri Røe. Among the variables are nicotine addiction, smoking history and BMI,” says Rodríguez-Cano.

However, investigating smoking addiction requires considerable resources. Therefore, Rodríguez-Cano wanted to find out whether there is a more efficient way of measuring the degree of a smoker’s addiction.

He collaborated with people from one of the foremost cancer hospitals in the world, the University of Texas MD Anderson Cancer Center in Houston, Texas.

Long and short tests

Several tests can be used to ascertain smoking addiction. The gold standard is the Fagerström Test for Cigarette Dependence (FTCD).

“But this test is too extensive when we want to check a large number of patients to assess smoking risk at group level,” says Rodríguez-Cano.

So, is a longer test really necessary? A simplified version called the Heaviness of Smoking Index (HSI) comprises only two questions:

• How many cigarettes do you smoke per day?
• How soon after you wake up do you smoke your first cigarette?

And these two questions are sufficient. Try it yourself.

A simplified test is often sufficient

“We investigated nearly 6000 cancer patients to see if it made any difference whether they took the full test or the simplified one,” says Rodríguez-Cano.

It generally did not make a difference.

“The results in predicting cigarette addiction were equally good for both the full and the simplified tests.

In addition, the simplified test is just as good at predicting the smoking abstinence at 3, 6, and 9 months after quitting smoking following specialised treatment,” says Rodríguez-Cano. However, it is not that straight forward.

…but not for all smokers

For some reason, the simplified test does not work as well for everyone.

“The effectiveness of the simplified test for men and women depends on the patient’s race,” Rodríguez-Cano explains.

Basically, the shortest test did not work as well for Non-Hispanic Black people with a cancer diagnosis. The researchers do not know whether this is due to social or genetic factors – or a combination of both.

“Both the full test and the simplified test are useful tools, but our research shows that it may be necessary to tailor the tests for different groups,” says Rodríguez-Cano.

Nevertheless, the research may make it easier to investigate smoking addiction than before. This can reduce the burden on the healthcare system as well as on cancer patient treatment.

Reference: Rubén Rodríguez-Cano, George Kypriotakis, Jason D Robinson, Maher Karam-Hage, Janice A Blalock, Jennifer A Minnix, Diane Beneventi, Paul M Cinciripini, Comparing the Fagerström Test and Heaviness of Smoking Index in Predicting Smoking Abstinence in Cancer Patients, Nicotine & Tobacco Research, 2024; ntae120, https://doi.org/10.1093/ntr/ntae120

“We sought to identify individuals who are more likely to benefit from aspirin to facilitate more personalized prevention strategies,” said co-senior author Andrew Chan, MD, MPH, Director of Epidemiology for the Mass General Cancer Center and gastroenterology Director of the Center for Young Adult Colorectal Cancer at Massachusetts General Hospital (MGH). Colorectal cancer is the second-leading cause of cancer death in the United States, according to the National Cancer Institute.

The U.S. Preventive Services Task Force previously recommended daily low-dose aspirin to prevent cardiovascular events and colorectal cancer in all adults ages 50 to 59 (the highest risk age group for colorectal cancer). In 2016, they withdrew the recommendation in part due to concerns about aspirin increasing the risk of gastrointestinal bleeding.

For the study, researchers analyzed the health data from 107,655 participants from the Nurses’ Health Study and Health Professionals Follow-Up Study. They compared the colorectal cancer rates in those who took aspirin regularly with those who did not take aspirin regularly. Regular aspirin use was defined as either two or more standard dose (325 mg) tablets per week or daily low-dose (81 mg) aspirin.

Study participants were followed starting from an average age of 49.4 years. Those who regularly took aspirin had a colorectal cancer 10-year cumulative incidence of 1.98 percent, compared to 2.95 percent among those who did not take aspirin.

The benefit of aspirin was largest among those with the unhealthiest lifestyles. Those with the lowest healthy lifestyle scores (unhealthiest) had a 3.4 percent chance of getting colorectal cancer if they did not take regular aspirin and a 2.12 percent chance of getting colorectal cancer if they took aspirin regularly. By contrast, in those with the highest healthy lifestyle scores (healthiest), the colorectal cancer rates were 1.5 percent in regular aspirin-taking group and 1.6% in the non-regular aspirin group. This means that in the least healthy group, treating 78 patients with aspirin would prevent one case of colorectal cancer over a 10-year period, while it would take treating 909 patients to prevent one case for the healthiest group. Lifestyle scores were calculated based on body mass index, frequency of cigarette and alcohol use, physical activity, and adherence to a high-quality diet.

“Our results show that aspirin can proportionally lower the markedly elevated risk in those with multiple risk factors for colorectal cancer,” said Daniel Sikavi, MD, lead author of the paper and a gastroenterologist at MGH. “In contrast, those with a healthier lifestyle have a lower baseline risk of colorectal cancer, and, therefore, their benefit from aspirin was still evident, albeit less pronounced.”

One outcome of the study could be that “healthcare providers might more strongly consider recommending aspirin to patients who have less healthy lifestyles,” said co-senior author Long H. Nguyen, MD, MS, a physician investigator in the Clinical and Translational Epidemiology Unit and Division of Gastroenterology at MGH and a Chen Institute Department of Medicine Transformative Scholar at MGH.

While the study included those who took regular standard-dose (325-mg) aspirin two times a week in the regular-aspirin using category, Sikavi noted that “based on prior studies, the best evidence supports daily low-dose (81-mg) aspirin for prevention.”

Previous studies have found evidence to suggest aspirin can reduce the production of pro-inflammatory proteins, known as prostaglandins, that can promote the development of cancer. Aspirin may also block signaling pathways that cause cells to grow out of control, influence the immune response against cancer cells, and block the development of blood vessels that supply nutrients to cancer cells. “Aspirin likely prevents colorectal cancer through multiple mechanisms,” Chan said.

The study did not assess potential side effects of daily aspirin use, such as bleeding. In addition, while the study tried to control for a wide range of risk factors for colorectal cancer, in comparing non-aspirin and aspirin-taking groups with the same level of risk factors, because this was an observational study, it is possible there may have been additional factors that influenced the findings.

Authorship: In addition to Sikavi, Chan, and Nguyen, Mass General Brigham authors include Wenjie Ma (MGH), David A. Drew (MGH), Shuji Ogino (BWH), Edward L. Giovannucci (BWH), and Mingyang Song (MGH). Additional authors include Kai Wang and Yin Cao.

Paper cited: Sikavi, D et al. “Aspirin Use and Incidence of Colorectal Cancer According to Lifestyle Risk” JAMA Oncology DOI: 10.1001/jamaoncol.2024.2503

Doxorubicin is a top choice for oncologists as a first line of defense against various cancers because of its ability to slow or stop cell division and thus tumor growth. It has been shown that the drug can induce a pro-inflammatory response in the heart, but there is no intervention that is broadly effective at preventing this, and it’s not clear how it happens or why, so Tufts scientists are trying to close these gaps.

Their investigation found elevated levels of potent virus-killing CD8+ cytotoxic T-cells—a type of immune cell—and their molecular attractors in the blood of healthy mice after beginning doxorubicin. This observation was further confirmed in dozens of canine and human lymphoma patients. Further mouse model work showed that these T-cells not only moved to the heart and directly interacted with heart tissue but that removing them relieved cardiac inflammation and fibrosis—the scarring of the heart muscles due to injury.

“Our study is the first to show that a specific cell type can cause chronic inflammation in the heart after doxorubicin treatment and the first time T-cells have been implicated in this disease,” says first author Abe Bayer, a student in the Tufts MD/PhD immunology program. “This suggests that blocking T-cells from going into the heart might be a strategy to make a medication to prevent the cardiac damage associated with the drug.”

Bayer and his colleagues figured out that something about doxorubicin is causing CD8+ T-cells to become dysfunctional by making them recognize something in the heart as foreign, leading them to become overactive. The reason the chemotherapy drug draws the T-cells from the blood to attack cardiac tissue has yet to be defined, but that will be the focus of future work.

The research team found that, once in the heart, the CD8+ T-cells can cause changes to the organ, leaving the cardiac tissue scarred, highly fibrotic, and less able to perform. Their research showed that in mice the T-cells are releasing molecules that are meant to cause cell death, which are normally intended to combat viruses and other invaders, but these molecules cause fibrosis and stiffen the heart, preventing it from contracting well.

“This work aims to prevent people from dying, whether from heart disease or cancer, and that means ensuring that people can take these powerful chemotherapy drugs safely,” says senior author Pilar Alcaide, Kenneth and JoAnn G. Wellner Professor at the School of Medicine. “While we don’t know what the solutions will look like, this study opens many doors to potential prevention strategies that protect the heart while permitting this drug to be effective for cancer cells.”

In addition to investigating how to block CD8+ T-cells from entering the heart without affecting doxorubicin’s ability to fight cancer, future research from the team will also explore whether the molecules that attract T-cells to the heart, called chemokines, could serve as biomarkers to monitor or predict cardiac damage, allowing for more personalized and safer treatment plans for patients.

The Tufts team was able to conduct such an in-depth, cross-species study due to the availability of canine and human cancer patient samples on campus as well as in the wider network of Boston hospitals, particularly the Beth Israel Deaconess Medical Center. Dogs experience the same side-effects to doxorubicin as people, and the researchers are working closely with co-author Cheryl London, associate dean for research and graduate education and the Anne Engen and Dusty Professor of Comparative Oncology at Cummings School of Veterinary Medicine at Tufts University, to apply what they learn to the treatment of our animal companions.

“I’m really excited about this paper because it’s something brand new in a very old field,” says Bayer. “It’s hard to do, but I hope it inspires more people to not look at a pile of literature and be afraid to add something on top. Science is too complicated to say we’ve figured it all out.”

Research reported in this article was supported by the National Institutes of Health, the American Heart Association, and a Tufts Springboard grant. Complete information on authors, funders, methodology, and conflicts of interest is available in the published paper.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.

Cervical cancer screening is essential for early detection and prevention. Most countries have a very extensive screening program that starts with testing for different variants of the human papillomavirus (HPV) that causes cervical cancer. In the case of an HPV-positive test, this is followed by so-called cytological analysis, the examination of gynaecological cell samples by microscopy, which is dependent on human interpretation.

The new molecular test WID-qCIN, which could replace the cytological analysis, can automatically analyse epigenetic changes in cells – changes that affect which genes are active and which are not. These changes are influenced by factors such as environment, lifestyle, and aging, and can increase the risk of cancer and other diseases.

The study included more than 28,000 women over the age of 30 who underwent screening in Stockholm between January and March 2017. The researchers analysed a total of 2,377 HPV-positive samples with the WID-qCIN test combined with a test for two high-risk HPV types (HPV 16 and 18). In this way, they were able to detect 100 per cent of all invasive cervical cancer and 93 per cent of all serious precancerous lesions that occurred within a year of sampling.

In addition, the new test, in combination with the HPV 16/18 test, was able to predict 69 per cent of all cancers and precancerous lesions up to six years after the sample was taken. This can be compared with only 18 per cent with today’s screening method.

‘By integrating the WID-qCIN test into our screening programmes, we would be able to identify more cancer cases while reducing the need for invasive procedures,’ says Prof Joakim Dillner, Karolinska Institutet and co-author of the study.

When cell changes are detected in today’s screening programme, the woman undergoes a vaginal examination, a so-called colposcopy, where the gynaecologist looks at the cervix with the help of a microscope and, if necessary, takes a biopsy. The study suggests that implementation of the WID-qCIN test could reduce the number of colposcopy examinations by 40 per cent.

‘This would mean a significant improvement compared to today’s screening methods, which were introduced in the 1960s,’ says Prof Martin Widschwendter, University of Innsbruck and visiting Professor at the Karolinska Institutet. ‘With its simplicity and objective assessment, the WID-qCIN test can improve the effectiveness of these programs and support the global strategy to eliminate cervical cancer.’

Acute myeloid leukemia is the most common type of leukemia in adults and the resulting chemotherapy treatment can put patients at an increased risk for cardiac damage. Associate Professor of Medicine Dr. Xunlei Kang and PhD students Yi Pan and Chen Wang led a study looking at similarities between leukemia and cardiovascular disease. They found a shared target — AGTR1, a receptor responsible for cell reproduction, was overabundant in the blood cells of patients with leukemia.

The researchers used losartan, a common medicine for treating high blood pressure, to inhibit the AGTR1 receptor in mice. This disrupted cancer growth, slowing the development of leukemia and led to longer survival. The next step is to further investigate losartan’s effectiveness in treating human leukemia patients.

“Mouse models of leukemia differ from human disease in several ways, including differences in the immune system, the bone marrow microenvironment and responses to treatments,” Pan said. “We will now carefully interpret and validate these findings in human studies to ensure translational relevance,” Pan said.

If these findings are confirmed in human clinical trials, the approval process to use losartan would be shorter compared to other medications, since it’s already FDA-approved and will not require comprehensive data about the drug.

“When we treated mice with the AGTR1 inhibitor losartan, we observed that this commercially available drug shows great promise in reducing AML development while protecting against chemotherapy-induced cardiotoxicity,” Kang said. “This finding shows great potential to both enhance the success of chemotherapy while protecting the heart.”

Dr. Xunlei Kang, MD, PhD is an associate professor of medicine at the MU School of Medicine and focuses his research on blood conditions and stem cell study. He received his medical degree and doctorate from Shanghai Jiao Tong University in China.

“Inhibiting AGTR1 reduces AML burden and protects the heart from cardiotoxicity in mouse models” was recently published in the journal of Science Translational Medicine. In addition to Kang, Pan and Chen, authors include research specialists Wenxuan Zhou and Yao Shi; PhD student XiaDuo Meng, Hematology and Medical Oncology fellow Yasir Muhammad, MD; Richard D. Hammer, MD, professor of clinical pathology and anatomical sciences; De-Pei Li, MD, professor of medicine and associate director of the Center for Precision Medicine; Zhenguo Liu, MD, professor of medicine and chief of cardiology; and Gerhard Hildebrandt, MD, Chief of the Division of Hematology and Medical Oncology. Bei Jia and Hong Zheng from Penn State University College of Medicine also contributed to the paper.

Skin cancer now accounts for half of all cancers in England and Wales, though many, including 86% of melanomas, can be prevented with safer sun exposure.

Despite continuing advice to avoid intentional sunbathing, the public, including children, often has positive views of tanned skin for health or appearance.

Skin and cancer specialists agree there is no such thing as a ‘safe tan’, highlighting the importance of understanding and addressing the reasons behind this misconception.

To date, no work has been done in Wales to study the thoughts of children, their parents and educators on tanning and how healthier attitudes can be encouraged and adopted from a young age.

SunChat: SUN Safety Conversations about Healthy Attitudes to Tanning is using existing networks and school partners to explore this subject through:

1. Workshops with schoolchildren aged 5 to 8 in Healthy School Clubs to understand their perceptions of tanning and their existing sun-safety habits. Activities include colouring, role-play, drawing, collage techniques, videos and posters.
2. An online multiple-choice survey with parents and carers of primary school children to better understand their perceptions, attitudes, and behaviours towards tanning, both for themselves and their children.
3. An informal online focus group with primary school educators to not only understand their current perceptions of tanning but also explore challenges in engaging with the school community in the Curriculum for Wales.

Funded by the Morgan Advanced Studies Institute (MASI), SunChat is a collaboration between Swansea University’s Department of Education and Childhood Studies, the Swansea Trials Unit, and Cardiff and Vale University Health Board.

Dr Julie Peconi of Swansea University Medical School, one of the lead researchers for SunChat, said: “We know that overexposure to the sun as a child greatly increases the risk of skin cancer in later life, making early and accessible sun safety education and promotion of sun-safe behaviours key.

“Through SunChat, we hope to raise awareness of the importance of challenging and changing the common assumption that having a tan is desirable. The Curriculum for Wales, with its designated area for Health and Well-being and autonomy for schools in designing curriculum, is the ideal opportunity to support schools in empowering and educating children to become healthy and informed adults, alleviating unnecessary pressure on future NHS dermatology services and care.”

Project co-lead Dr Gisselle Tur Porres of Swansea University School of Social Sciences added: “We take the known problem of skin cancer and address it in a novel way by engaging directly with children through creative activities to facilitate and prioritise their participation.”

More details of the SunChat project have recently been published in the journal PLOS ONE – “Exploring perceptions of and attitudes towards tanning with school children, parents/carers and educators in Wales: A mixed methods study protocol for the SunChat study”.

Marina Walther-Antonio, Ph.D., and colleagues at Mayo Clinic’s Center for Individualized Medicine are on a mission to catch these cancers early.

Their research dives deep into the microbiome, a community of trillions of microorganisms — including bacteria, fungi and viruses — that influence health and disease. Through their investigations, they have uncovered specific microbial signatures linked to endometrial and ovarian cancers and are working toward developing innovative home swab tests for women to assess their susceptibility.

“Screening the microbiome for early detection may improve patient outcomes,” says Dr. Walther-Antonio, also a researcher at the Departments of Surgery and Obstetrics and Gynecology, and the Mayo Clinic Comprehensive Cancer Center.

The team discovered a cluster of 17 bacterial microbes associated with the presence of endometrial cancer, with a “lightning rod” in the group: Porphyromonas somerae.

To validate this connection, they drew parallels between Porphyromonas somerae and its closest relative, which is known to be linked to oral cancer. The team hypothesized that Porphyromonas somerae might play a similarly invasive role in endometrial cancer. After extensive testing, they confirmed the ability of this microbe to invade endometrial cells and alter their function, especially under estrogen exposure — a common risk factor for endometrial cancer.

In their research on ovarian cancer, the team found a distribution of microbes in the reproductive tract of women with the disease. They also revealed changes in the microbiome compositions that are correlated with patient treatment outcomes. These findings may open investigation avenues into applicability of these markers to detecting and predicting treatment response.

According to World Cancer Research Fund International, endometrial cancer ranks as the sixth most common cancer among women globally, with 417,367 new cases and 97,370 deaths reported in 2020. Ovarian cancer follows as the eighth most common, recording 313,959 new cases and 207,252 deaths in the same year.

The Mayo scientists are also collaborating with the Waitematā District Health Board officials on Pacific Islander and Māori populations in New Zealand, which has one of the highest incidences of endometrial cancer globally. Factors such as high obesity rates, a known risk factor, are a likely contributor, but the high incidence rates among younger women remain unresolved.

In the U.S., there is a long-term initiative designed to engage Black women, particularly those who are postmenopausal. “Black women don’t have a higher incidence rate of endometrial cancer, but they have a higher mortality rate and morbidity rates. This is influenced by several factors, including limited access to healthcare.  Symptoms frequently go unrecognized or are mistakenly attributed to other conditions, such as fibroids, which are common among Black women,” Dr. Walther-Antonio says.

Through the long-term study, Mayo’s scientists hope to engage participants to contribute samples every six months for three years, including vaginal swabs and environmental samples to identify potential risk factors.

Ultimately, Dr. Walther-Antonio and her team hope to use these microbiome signatures to predict and intervene in the development of cancer before it materializes.

Mayo Clinic has a financial interest in the swabs mentioned in this article.

A study published today in JAMA Network Open compared the outcomes of patients treated by oncologists whose practices integrated with pharmacies, to those of oncologists that did not integrate. Researchers found a slight increase in utilization of oral oncology drugs, but no significant change in expenditures on the drugs.

In addition, there were no discernible benefits for patients as measured by out-of-pocket expenditures, medication adherence, and the amount of time before treatment of cancer started.

The study’s lead author Genevieve Kanter, a senior fellow at the USC Schaeffer Center for Health Policy & Economics and associate professor at the USC Sol Price School of Public Policy, said the results were surprising, given the negative effects observed from other types of integration in health care. The growth of physician-pharmacy integration over the last 15 years had raised concerns about potentially increased drug utilization and spending and a shift towards more profitable and expensive oral cancer therapies.

On the other hand, the potential benefits of integration were also not observed in this study. Earlier, small-scale studies have suggested that pharmacy integration can reduce waste and help patients stay more adherent to their therapies by enabling closer patient monitoring.

For example, physicians with an on-site pharmacy could, in theory, prescribe drugs covering fewer days because patients would not need to wait as long for a new drug if an adverse event arises and there is a need to switch therapies.

But the current study’s authors say that with integration, they actually observed an increase in days’ supply of drugs instead of a decrease. Since reimbursements increase with each additional pill, oncologists may have been responding more to the additional revenues from increasing days’ supply instead of the increased flexibility permitted by on-site pharmacies. In addition, there was no change in patients’ adherence to medications.

“Overall, we find that integration of oncology practices with pharmacies has not resulted in changes in expenditures, which is a good signal for regulators, but it also has not resulted in significant benefits for patients, which is disappointing,” said Kanter. “Although there do not appear to be regulatory restraints required at the moment, our findings of different impacts on patients with different types of cancer, and emerging gaps for some patient outcomes, underscore the importance of continued study of pharmacy integration.”

Study examined outcomes for a range of cancer patients

Researchers conducted an observational study of oncologists and commercially insured patients treated by these oncologists between 2011-2019. Oncologists were tracked longitudinally through the study period, and patients were followed for 6 months after their initial diagnosis.

Study participants were patients aged 18-64 who had been diagnosed with advanced stage breast cancer, colorectal cancer, kidney cancer, lung cancer, melanoma, or prostate cancer.

The study focused on community oncologists who owned their own practice and were not part of a hospital or academic or medical teaching institution. Researchers noted this group experienced the most rapid increases in integration during the study period and likely derived the greatest financial benefit from pharmacy integration because of their direct ownership stakes in on-site pharmacies.

The authors found no changes in either oral drug spending or intravenous (IV) drug spending when they looked at all the cancers combined. However, when they examined the subsample of patients with breast cancer – the biggest group of cancer patients in the study sample – they found substitution between oral and IV drugs. Researchers found a 69% increase in oral drug expenditures, and concurrently a 34% decline in IV drug expenditures. But on net, there was no statistically significant change in total oral and IV drug expenditures.

“As we see most clearly with the breast cancer patients in our study, cancer treatment is shifting from intravenous drugs to oral drugs, and there are a ton of new oral drugs in the drug development pipeline,” said Kanter. “Meanwhile, physicians who used to be paid for administering IV drugs are now seeing their practices losing some revenues, as oral drugs are dispensed at the pharmacy.”

In 2012, 4.2% of community oncologists in the sample worked in practices with on-site pharmacies. By 2019, the final year studied, that percentage had increased to 27.6% of oncologists in pharmacy-integrated practices. Researchers say the underlying incentive to open integrated on-site pharmacies is to retain some of that drug revenue they used to get through physician-administered drugs.

Future research should focus on hospital-based oncology practices

“Proponents of medically integrated pharmacies in oncology practices believe the benefits include improved safety and quality, decreased time to fill prescriptions, and decreased waste.  Others are concerned that these pharmacies may increase inappropriate use of expensive oral cancer therapies,” said David Debono, Carelon’s national medical director for oncology and a co-author of the paper. “Our study didn’t find evidence for either of these positions, but it was not designed to identify very specific details of care quality and safety. Further studies will be necessary.”

Study authors say future research should look at how hospital-based oncology practices, which have also rapidly increased their on-site dispensing, have adapted to pharmacy integration.

Researchers noted that hospital-based practices tend to be larger and may face a different set of financial incentives than community practices, and that the impact of integration may be different for Medicare-insured patients and vulnerable racial/ethnic and economic populations.

About the study

In addition to Kanter and Debono, the study’s authors include Pelin Ozluk, Winnie Chi, Michael J. Fisch, and Andrea DeVries of Carelon, Inc.; Ravi B. Parikh and Justin E. Bekelman of Perelman School of Medicine at the University of Pennsylvania; Mireille Jacobson of the Schaeffer Center and the USC Leonard Davis School of Gerontology.

The study was funded by the National Institute of Health Care Management Foundation.

“There is no such thing as a healthy tan, as it’s really just a visual manifestation of damage to the skin,” said Rajesh Nair, MD, an oncology surgeon at the Orlando Health Cancer Institute. “But we’re fighting against a perceived positive image and health benefits of something that actually has a totally opposite reality, which is that suntanned skin represents an increased risk of a deadly disease.”

The survey, conducted by Ipsos, also found that young adults are likely to believe myths and misinformation on sun protection that may lead them away from proven methods of skin cancer prevention. About one in seven (14%) adults under 35 think daily sunscreen use is more harmful to the skin than direct sun exposure and nearly a quarter (23%) believe drinking water and staying hydrated prevents a sunburn.

“There is no scientific data suggesting that drinking water provides any protection from the sun,” Nair said. “As for sunscreens, the protective benefits far outweigh any known risks, but if you’re concerned about chemicals or ingredients in a sunscreen, mineral sunscreens like zinc oxide that offer a physical barrier to the sun are proven to be safe, as well as clothing with SPF protection.”

Nair says, with so many sources of information—and misinformation—these days, it’s difficult to decipher good advice from the bad.

“We have really hectic and busy lives, and we’re trying to find information to guide us on healthy choices and decision-making to the best of our ability. But the overwhelming number of people and organizations claiming to have the right answers makes it really hard to know what to believe,” Nair said. “Our fear is that people buy into a lot of really dangerous ideas that put them at added risk.”

It’s something Brianna Starr, 29, sees a lot of, with trends on social media spreading quickly and easily.

“I think a lot of people get their information from TikTok, Instagram, Twitter, that might not be actually legit,” Starr said. “And you’re very influenced by your friends and peers, so you see a video or hear something from your friend, you’re like, ‘Oh, yes. I need to try that,’ and you believe it.”

Starr admits that skin cancer was not top of mind in her teens and twenties and was more concerned with getting a golden tan as she laid out in the sun sans sunscreen. But after her sister was diagnosed with melanoma at the age of 19, she got serious about protecting herself.

“There is a history of melanoma in my family, and so I started seeing a dermatologist every six months and actually flagged two separate moles, one on my neck and one on my shoulder, that were dysplastic and could have developed into melanoma.”

Starr is now diligent about applying and reapplying sunscreen whenever she’s outdoors. Experts recommend using sunscreens with an SPF of 30 or higher and reapplying it every two hours, especially if you are sweating or are in the water.

Regular skin cancer screenings with a dermatologist or your primary care physician are also critical to catch any developing skin cancer early.

“Unfortunately we’re seeing skin cancer more and more in patients of a young age. And because it’s something that’s often not on their radar, it tends to be diagnosed in more advanced stages,” Nair said. “We don’t want to discourage people from being outside and being active because there are so many health benefits to that, but it’s also important to know that sun protection can be lifesaving, and the only effective way of protecting yourself is limiting the effects of UV radiation on the skin.”

IMAGE: RAJESH NAIR, MD, PERFORMS A ROUTINE SKIN CANCER SCREENING ON A PATIENT AT THE ORLANDO HEALTH CANCER INSTITUTE. NAIR SAYS HE’S SEEN AN INCREASE IN SKIN CANCER CASES AMONG YOUNG ADULTS AND THAT SUN PROTECTION IS CRITICAL TO PREVENTION.

view more CREDIT: ORLANDO HEALTH CANCER INSTITUTE

The theme of the 28^th EAHP congress was Sustainable healthcare – opportunities and strategies and several posters addressed different approaches to avoiding or minimising wastage of medicines in hospital pharmacy.

Pousada-Fonseca and colleagues (Móstoles, Spain; poster 6ER-005)  undertook a retrospective study to estimate the costs of wastage due to dose modifications and discontinuation of oral anti-cancer treatment. A total of 1239 prescriptions were identified for enzalutamide, ribociclib, niraparib and lenvatinib. Of these, 63 were interrupted and on 34 occasions patients had tablets remaining.  The total cost of drugs wasted in this way amounted to €56,459 – a sum that would have covered the cost of 17 prescriptions, the authors calculated.  Although only a small number of prescriptions were discontinued, the costs were considerable because of the price of the medicines.  At present Spanish law bans the return of dispensed medicines to the pharmacy services and therefore this represents a hidden cost of cancer care. One option might be for hospital pharmacists to be permitted to decide whether unused medicines could be returned for re-dispensing, they suggest.

Re-dispensing of oral anti-cancer medicines (OAM) is exactly what Akgöl and colleagues (Amsterdam, The Netherlands;) described in their poster.  They calculated that the average monthly expenditure on OAM was €3200 per patient. Approximately 33% pf patients discontinue treatment and 50% pf these have redundant medicines at home.  The authors developed a rigorous procedure to identify and assess the quality of these ‘left over’ OAM. Implementation of this procedure over a one-year period resulted showed that 79% of returned medicines were suitable for re-dispensing and the value of these was €483,301.  The authors concluded that wider implementation of this scheme would result in a significant reduction in financial waste and environmental burden.

Reducing wastage at ward level

Sørensen and colleagues (Central Region, Denmark) described how a mobile phone app had been developed to scan medicine packs on wards and speed up the process of expiry-date checking.  In 2020 a sustainability project had shown that manual expiry-checking was a particularly time-consuming task for pharmacy staff.  Once scanned, packs can be marked as ‘used’, ‘discarded’ or ‘released’.  ‘Released’ medicines are then available for use on other wards in the hospital. Lead author Charlotte Sørensen explained that this is important because many wards hold large stocks of medicines which are delivered from a central (remote) unit.

The app was progressively implemented in four hospitals starting in Spring 2023.  It has given pharmacy staff a useful overview of medicines nearing expiry. So far, medicines to the value of €147,000 have been moved and some 215 packages (value €20,000) have been exchanged between hospitals.  The full potential of the app has yet to be reached but it is expected that for wards ‘to go shopping’ in the app before ordering from the pharmacy will probably reduce medicines’ wastage even further, the authors suggest.

The 28^th EAHP Congress took place in Bordeaux, France 20^th-22^nd March 2024. The congress theme was: Sustainable healthcare – opportunities and strategies.

The 340B Drug Pricing Program is a federal program that requires the pharmaceutical industry to provide a discount on the cost of drugs to participating hospitals who serve a disproportionate number of Medicare and Medicaid patients. The program was started to enable hospitals to stretch scarce resources, reach more patients and provide more comprehensive services.

“In the field of advanced prostate cancer, there’s been a paradigm shift to using newer targeted oral treatments. But these drugs are expensive, and cost can limit access to these drugs, particularly among those who are socioeconomically disadvantaged. We wanted to see if the 340B program could help mitigate this disparity,” said study first author Kassem Faraj, M.D., a urologic oncology fellow at Michigan Medicine.

The team looked back at a 20% sample of Medicare beneficiaries diagnosed with advanced prostate cancer and assessed who was treated with these targeted therapies at a hospital-based program. They identified 2,237 men treated at 340B-participating hospitals and 1,100 treated at non-participating hospitals.

They then looked at the social vulnerability index, a measure developed by the U.S. Centers for Disease Control and Prevention that characterizes socioeconomic, racial and household characteristics at the community-level. They found that patients from areas with greater social vulnerability were less likely to use the oral drugs. There was no difference in use between 340B and non-340B hospitals.

However, patients receiving treatment at 340B hospitals were more likely to continue treatment. The researchers saw that in non-340B hospitals, as social vulnerability increased, adherence dropped. But in 340B hospitals, adherence remained flat regardless of social vulnerability. Results were published in Cancer.

“There are many reasons why adherence to these drugs can drop. We suspect that 340B hospitals potentially have some resources or mechanisms that are helping these vulnerable patients maintain adherence,” Faraj said. This could include medication management programs or financial help for out-of-pocket drug costs.

“While 340B participation didn’t increase the number of patients using this therapy, it was associated with better treatment adherence among patients from socially vulnerable areas,” Faraj said.

Additional authors: Samuel R. Kaufman, Mary Oerline, Lindsey Herrel, Avinash Maganty, Megan E.V. Caram, Vahakn B. Shahinian, Brent K. Hollenbeck

Funding for this work is from National Cancer Institute grants T32 CA180984, R01 CA275993, R01 CA269367.

Disclosure: Michigan Medicine participates in the 340B program. Learn more about how the hospital provides community support.

Paper cited: “The 340B Program and oral specialty drugs for advanced prostate cancer,” Cancer. DOI: 10.1002/cncr.35262

Resources:

University of Michigan Rogel Cancer Center, www.rogelcancercenter.org

University of Michigan Institute for Healthcare Policy and Innovation, www.ihpi.umich.edu

Michigan Medicine Cancer AnswerLine, 800-865-1125