Data Stream
A Third-Place Victory
For once, the United States is not the world’s
leader in health-care spending – at least when it
comes to end-of-life care.
In a study of hospital resource use and spending
among cancer patients >65 years in the last 180
days of their lives, the United States actually ranked
third out of seven North American and European
countries in per-capita hospital expenditures:
Bankruptcy: A Cancer Treatment Side
Effect
Patients with cancer are more likely to file for bankruptcy
than the general population, and, according to recent
research, that severe financial distress appears to be a risk
factor for mortality.
In a population of
231,596
PATIENTS
2% (4,728
PATIENTS)
who were diagnosed with cancer,
filed for bankruptcy within 5 years.
Compared with those who did not file for
bankruptcy, these patients had a
79% HIGHER
RISK
for mortality at 5 years.
Exactly how this extreme financial distress influences
survival after cancer diagnosis requires further research,
the authors noted.
Source: Ramsey SD, Bansal A, Fedorenko CR, et al. Financial insolvency as a
risk factor for early mortality among patients with cancer. J Clin Oncol. 2016
January 25. [Epub ahead of print]
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ASH Clinical News
1. Canada:
$21,840
2. Norway:
$19,783
3. United States:
$18,500
4. Germany:
$16,221
5. Belgium:
$15,699
6. The Netherlands:
$10,936
7. England:
$9,342
“There’s this idea that if you look at European
countries, their attitude toward death is so much
more normal, they must be doing this right; just
look at our high health-care costs at the end of
life,” co-author Ezekiel Emanuel, MD, said. “But
if you look at the data, you start to see that’s just
not the case.”
The U.S. is also better at keeping patients out of
the hospital during their last days – a common
wish among patients at the end of their lives: just
22.2% of U.S. cancer patients died in the hospital, compared with 51.2% of Belgian patients, for
example.
Source: Bekelman JE, Halpern SD, Blankart CR, et al. Comparison
of site of death, health care utilization, and hospital expenditures for patients dying with cancer in 7 developed countries.
JAMA. 2016;315:272-83.
Losing the Popularity Contest
Clinical trials are essential to establish new standards of care in medicine, but to provide researchers with
answers to their clinical questions, these trials need patients. Unfortunately, according to an analysis of
National Cancer Institute–sponsored clinical trials from 2000 to 2011, low patient accrual is stalling science.
Of 787 trials, 18% closed with low accrual or were accruing at >50% of target enrollment.
What types of trials are most likely to accrue the desired number of patients? The odds of reaching target
accrual were higher if the trial was:
Studying a new
investigational agent
66% greater chance
Studying a targeted
therapy
Not requiring a tissue
sample or biopsy to
determine eligibility
43% greater chance
26% greater chance
20
40
60
80
100
Source: Bennette CS, Ramsey SD, McDermott CL, et al. Predicting low accrual in the National Cancer Institute’s Cooperative Group clinical
trials. J Natl Cancer Inst. 2015;108:1-7.
April 2016