Research roundup: Racial disparities in cancer and other care, nursing home closures, extending drugmakers' exclusivity

Jan 14 2011

Journal of the National Cancer Institute: Projections Of The Cost Of Cancer Care In The United States: 2010-2020 - "By combining cancer prevalence with average annual costs of cancer care by phase of care and tumor site for 13 cancers in men and 16 cancers in women" and "all cancer sites combined," the authors project there will be just over 18 million cancer survivors in 2020 compared to 13.8 million survivors in 2010. The cost of the care for those patients will grow from about $125 billion in 2010 to $158 billion in 2020, a 27 percent increase. "The largest increase in cost projected for 2020 was in the continuing care phase for female breast and prostate cancers. ... The national cost of cancer care is substantial and expected to increase because of population changes alone." (Mariotto et al., 1/12).

Cancer: Geographic Variation Of Racial/Ethnic Disparities In Colorectal Cancer Testing Among Medicare Enrollees - Although racial and ethnic disparities in colorectal cancer screening are well-documented, the impact of geography on such disparities is less well-known, according to the authors of this study. Analysis of Medicare enrollee data in eight states revealed while colorectal screening rates varied little among whites, regardless of location, differences in "up-to-date" colorectal screening among non-white patients did differ by location. The authors conclude, "regional disparities largely derive from variation in up-to-date status among nonwhites, suggesting that screening rates may vary as much within racial/ethnic groups as between them" (Semrad et al., 1/10).

Centers for Disease Control and Prevention: CDC Health Disparities and Inequalities Report — United States, 2011 - This annual report details "challenges in the nation's health, with particular focus on reducing gaps between the least and most vulnerable U.S. residents in illness, injury, risk behaviors, use of preventive health services, exposure to environmental hazards, and premature death." Noting that since the 1980s, "our nation has made substantial progress in improving residents' health and reducing health disparities, but ongoing racial/ethnic, economic, and other social disparities in health are both unacceptable and correctable," the report has a number of key findings about suicide, infant mortality, life expectency, heart disease, preventable hospitalizations, hypertension, alcoholism and car crashes (Frieden et al.,  1/14).

Archives of Internal Medicine: Geographic Concentration And Correlates of Nursing Home Closures: 1999-2008 - During that 10-year span "2,902 nursing homes closed, or nearly 16% of all Medicare/Medicaid-certified facilities. The cumulative closure rate was substantially higher in hospital-based facilities than in freestanding ones (50% vs 11%). Urban hospital-based facilities had the highest cumulative closure rate (60%). The closure rate among freestanding facilities was roughly the same in urban (11%) and rural (10%) areas." Additionally, the authors note, "The relative risk of closure was significantly higher in zip code areas with a higher proportion of blacks or Hispanics or a higher poverty rate. Closures tended to be spatially clustered in minority-concentrated zip codes around the urban core, often in pockets of concentrated poverty. ... Since nursing home use among the minority elderly population is growing while it is declining among whites, these findings suggest that disparities in access will increase" (Feng et al., 1/10).

Archives of Internal Medicine: Referral And Consultation Communication Between Primary Care And Specialist Physicians - Effective communication between primary care physicians (PCPs) and specialists regarding patient referrals and consultation "occurs inconsistently," according to this study. Using a survey of 4,720 physicians, the authors found that primary care doctors' and specialists' "reports of the extent that they communicate with one another regarding patient referrals and consultations differed significantly." While 69 percent of primary care doctors report "that they 'always' or 'most of the time' send the specialist notification of a patient's history and reason for consultation at the time of referral, only 34.8% of specialists reported they 'always' or 'most of the time' receive such notification. Similarly, 80.6% of specialists said they 'always' or 'most of the time' send the referring PCP notification of the results of their consultation and advice to patients, whereas only 62.2% of PCPs reported they received such information" (O'Malley and Reschovsky, 1/10).

Health Affairs: The Benefits From Giving Makers Of Conventional 'Small Molecule' Drugs Longer Exclusivity Over Clinical Trial Data -"Pharmaceutical companies and generic drug manufacturers have long been at odds over 'data exclusivity' regulations. These rules require a waiting period of at least five years before generic drug companies can access valuable clinical trial data necessary to bring less expensive forms of innovative drugs to market. Pharmaceutical companies want the data exclusivity period lengthened to protect their investment. Generic manufacturers want the period shortened so that they can bring less expensive versions of drugs to patients sooner." But the new federal health law extended the data exclusivity for large-molecule biologic drugs to 12 years and the authors conclude, "Our research suggests that providing such an extension [to conventional drugs] would spur innovation that would benefit future generations" (Goldman et al., January 2011).

Kaiser Family Foundation/Georgetown University Center for Children and Families: Holding Steady, Looking Ahead: Annual Findings Of A 50-State Survey Of Eligibility Rules, Enrollment and Renewal Procedures, And Cost Sharing Practices in Medicaid and CHIP, 2010-2011 - This annual report, based on a survey of state officials, finds that despite the economic downturn, "nearly all states 'held steady' or made targeted improvements in their (Medicaid and CHIP) eligibility and enrollment rules in 2010, with a total of 13 states expanding eligibility and 14 states making improvements in enrollment and renewal procedures." However, the report notes, "While states have made significant progress in expanding coverage for children, eligibility for their parents continues to lag far behind," with Colorado representing the only state in 2010 to expand eligibility for parents (Heberlein et al., 1/11). KHN summarized news coverage of the report (1/12).