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Insurance Types May Affect Access to Quality Cancer Care

The type of medical insurance a person has can affect their ability to access high-quality cancer care, according to a recent study in JAMA Otolaryngology-Head & Neck Surgery. The study, which used data from the California Cancer Registry and the California Department of Health Care Access and Information, identified 23,933 adults diagnosed with head and neck cancer between 2010 and 2019. Compared with people on commercial insurance, those with Medicare, Medicaid or no insurance were, respectively, 22%, 40% and 62% less frequently treated at high-quality hospitals—meaning facilities ranked in the top third of the studied hospitals in quality measures set by the researchers. The study found that getting care at a high-quality hospital was associated with improved overall survival compared with hospitals ranked in the lowest third for quality. “Our study showed that insurance status affects quality of care, as well as where people receive care,” Uchechukwu C. Megwalu, a professor of otolaryngology at Stanford Health Care and an author on the study, said in a story in Healio. “The Affordable Care Act has done a good job increasing access to health insurance. However, part of what we need to look at is improving the quality of the insurance coverage that is available,” Megwalu said.

Researchers Warn of Growing ‘Digital Toxicity’ for Patients

Advancing technology has allowed for the development of many helpful tools in arranging and managing cancer care as well as tracking patient symptoms and side effects, but the proliferation of online apps, portals and questionnaires may be adding another burden for patients. An Aug. 6 commentary in JCO Clinical Cancer Informatics argued that the increasing volume of technologies patients are asked to use is leading to more demands on a patient’s time and additional anxiety, an effect the authors termed, “digital toxicity.” “While many digital tools were deployed for very good reason and with good intentions, particularly to facilitate care during the pandemic, the full functionality, value, and coordination of all these tools need to be evaluated,” Caroline Chung, vice president and chief data officer at the University of Texas MD Anderson Cancer Center’s Institute for Data Science in Oncology in Houston and one of the authors of the commentary, told Oncology News Central in an Aug. 27 article. Factors the paper identified as contributing to digital toxicity included insufficient efforts at user experience testing, lack of integration between programs, and the overall proliferation of technologies patients are asked to work with. Chung emphasized that digital tools can be beneficial and useful to reduce this kind of burden, but that health care providers need to think more carefully about the burden they add for patients when they ask for information or introduce a new program or app and how specifically that information will improve their care.

Upfront Treatment May Allow Some to Avoid Rectal Cancer Surgery

Giving the full complement of chemotherapy and radiation upfront may allow some patients with rectal cancer to avoid surgery, according to a recent study in eClinicalMedicine. Surgery to remove parts of the rectum affected by cancer can lead to permanent issues, including problems with bowel movements and sometimes the need for a colostomy bag. While it is common in rectal cancer care to give radiation or some combination of chemo and radiation before surgery along with chemotherapy after surgery, this study looked into giving all the chemotherapy and radiation that would be given during standard care and then pursuing surgery only if there were still signs of cancer. In the study of 461 patients in Sweden, 28% of patients had a complete response, doubling the complete response rate seen in shorter courses of presurgical treatment, according to an article in HealthDay. The rate of recurrence after three years was 6%. “If the tumour disappears completely during treatment, surgery is not required. This means that the rectum is preserved and the need for a stoma and a new rectum is eliminated,” Bengt Glimelius, an oncology consultant at Uppsala University Hospital in Sweden, said about the method in a press release. The results further support the findings of an earlier randomized study called RAPIDO, but an increase in the levels of local recurrence observed in the RAPIDO trial was not seen in the current trial.