Millions more smokers and ex-smokers should receive free annual screenings for lung cancer, a federally appointed task force says

Millions more smokers and ex-smokers should receive free annual screenings  for lung cancer, a federally appointed task force says - The Washington Post

The recommendation would double the number of people eligible, but some experts worry about possible false positives and follow-up tests.

A federally appointed task force recommended a major increase in the number of Americans eligible for free screening for lung cancer, saying expanded testing will save lives and especially benefit Black people and women.

The U.S. Preventive Services Task Force, an independent group of 16 physicians and scientists who evaluate preventive tests and medications, said people with a long history of smoking should begin getting annual low-dose CT scans at age 50, five years earlier than the group recommended in 2013. The group also broadened the definition of people it considers at high risk for the disease.

The changes mean that 15 million people, nearly twice the current number, will be eligible for the scans to detect the No. 1 cancer killer in the United States. Under the Affordable Care Act, private insurers must cover services, without patient cost-sharing, that receive “A” or “B” recommendations from the task force. The lung-cancer screening recommendation received a “B” rating. Medicare also generally follows the group’s guidance.

The recommendation was welcomed by many lung-cancer specialists but drew a more cautious reaction from some physicians who noted that the test can produce false positives — flagging a spot or growth that is benign — and lead to potentially costly and invasive follow-up tests such as biopsies.

Lung cancer killed more than 135,000 people in the United States last year, according to the National Cancer Institute. Smoking and increasing age are the biggest risk factors, although nonsmokers also develop the disease, sometimes as a result of genetic mutations.

Overall, the five-year survival rate for lung cancer is about 20 percent, but it is higher when the disease is caught at the earliest stages. In recent years, the death rate for non-small cell lung cancer — the most common form — has declined, partly reflecting decreases in smoking but also new treatments targeted at specific genetic mutations or alterations.

To update its 2013 recommendation, the task force commissioned a study of the latest data on lung-cancer screening and did modeling on the best age to start the screening.

The conclusion was that broadening eligibility would save a substantial number of lives, the task force said in an article Tuesday in the Journal of the American Medical Association.

The new recommendation applies to adults ages 50 to 80 who have smoked about a pack of cigarettes a day for 20 years. The 2013 version, which had the higher age threshold, was for those who smoked the equivalent of a pack a day for 30 years. In both cases, the policy applies to current smokers or those who have quit within the past 15 years. Someone who stopped smoking 20 years ago would not be eligible.

The task force said the changes will increase the number of Black people and women who will be eligible for screening and who tend to smoke fewer cigarettes than White men yet still are vulnerable to lung cancer. African Americans, the group said, have a higher risk of lung cancer than White men even with lower levels of smoking exposure. It said it hopes the new recommendation will increase the use of the test; estimates are that fewer than 5 percent of eligible Americans have been screened for lung cancer.

Roy S. Herbst, a lung-cancer specialist at the Yale Cancer Center, was enthusiastic about the recommendation. He said more screening would mean more cancer caught at an earlier stage, when there is a better chance of treating or curing it.

“We have to find these lung cancers early,” he said. “It’s a very minimal test.”

Some physicians and researchers were more cautious. Daniel S. Reuland, a professor of medicine at the University of North Carolina School of Medicine, co-wrote an updated analysis of benefits and harms that also ran in JAMA. Screening high-risk people with low-dose CT, the article said, “can reduce lung cancer mortality but also causes false-positive results leading to unnecessary tests and invasive procedures, overdiagnosis, incidental findings, increases in distress, and, rarely, radiation-induced cancers.”

Reuland noted that follow-up tests can be nerve-racking and costly. For that reason, he and other physicians, in a third JAMA article, called on the Centers for Medicare and Medicaid Services to continue to require doctors and patients to undergo “shared decision-making” — an in-depth discussion about the pluses and minuses of the screening.

Otis Brawley, an oncologist at Johns Hopkins University who has raised questions about lung-cancer screening, said he does not object to expanding the criteria but argued that all the tests should be performed at hospitals with extensive experience, to minimize the likelihood of false positives.

“You have to have a good program,” Brawley said. “A number of centers that are offering it should not be offering it. So those centers are perpetuating disparities, not reducing them.”

John Wong, a member of the task force and an internist at Tufts Medical Center in Boston, countered that the benefits of screening — and of finding a potentially lethal malignancy at an early, curable stage — far outweigh the harms.

Although follow-up tests involving what turns out to be a benign growth might cause short-term anxiety and be costly, he said, “if you miss a lung cancer, then it might spread and shorten your life.”

Lawsuit accuses Aetna of systematically denying coverage for cancer treatment

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A Florida man filed a class-action lawsuit against Aetna Life Insurance Co., claiming it systematically denied coverage for a cancer treatment called proton beam radiation therapy, according to court documents.

The lawsuit, which has been moved to the District Court for the Middle District of Florida, was filed by Scott Lake. Mr. Lake claims Aetna wrongfully denied coverage for proton beam radiation therapy to treat his prostate cancer. The denial, which deemed the treatment experimental, came despite recommendations from oncologists, he claims. 

While some insurers have begun covering proton beam radiation therapy for certain cancers — for example, Medicare generally covers the treatment — it is not uniform across the commercial insurance industry. In 2019, UnitedHealthcare found itself in court over its denial of coverage to one of its members who also sought the treatment for prostate cancer. 

Aetna’s proton beam radiotherapy policy, last updated in November, outlines when the insurer considers the treatment medically necessary. In the bulletin, Aetna said it considers proton beam radiotherapy “experimental and investigational” for prostate cancer in adults over age 21 “because its effectiveness for these indications has not been established.”

Becker’s reached out to Aetna for comment on this lawsuit. This article will be updated as more information becomes available. 

COVID-19 More Deadly Than Cancer Itself?

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During the recent months of the pandemic, cancer patients undergoing active treatment saw their risk for death increase 15-fold with a COVID-19 diagnosis, real-world data from two large healthcare systems in the Midwest found.

Among nearly 40,000 patients who had undergone treatment for their cancer at some point over the past year, 15% of those diagnosed with COVID-19 died from February to May 2020, as compared to 1% of those not diagnosed with COVID-19 during this same timeframe, reported Shirish Gadgeel, MD, of the Henry Ford Cancer Institute in Detroit.

And in more than 100,000 cancer survivors, 11% of those diagnosed with COVID-19 died compared to 1% of those not diagnosed with COVID-19, according to the findings presented at the American Association for Cancer Research (AACR) COVID-19 and Cancer meeting.

“Certain comorbidities were more commonly seen in patients with COVID-19,” said Gadgeel. “This included cardiac arrhythmias, renal failure, congestive heart failure, and pulmonary circulation disorders.”

For their study, Gadgeel and colleagues examined data on 154,585 malignant cancer patients from 2015 to the present day with active cancer or a history of cancer treated at two major Midwestern health systems. Among the 39,790 patients with active disease, 388 were diagnosed with COVID-19 from February 15 through May 13, 2020. For the 114,795 patients with a history of cancer, 412 were diagnosed with COVID-19.

After adjusting for multiple variables, older age (70-99 years) and several comorbid conditions were significantly associated with increased mortality among COVID-19 patients with active cancer:

  • Older age: OR 3.4 (95% CI 1.3-9.3)
  • Diabetes: OR 3.0 (95% CI 1.5-6.0)
  • Renal failure: OR 2.3 (95% CI 1.1-4.9)
  • Pulmonary circulation disorders: OR 3.9 (95% CI 1.4-10.5)

In COVID-19 patients with a history of cancer, an increased risk for death was seen for those ages 60 to 69 years (OR 6.3, 95% CI 1.1-35.3), 70 to 99 years (OR 18.2, 95% CI 3.9-84.3), and those with a history of coagulopathy (OR 3.0, 95% CI 1.2-7.6).

Despite Black patients consisting of less than 10% of the total study population, Gadgeel noted that 39.4% of COVID-19 diagnoses in the active cancer group were among Black patients, as were a third of diagnoses in the cancer survivor group.

And the proportion of COVID-19 patients with a median household income below $30,000 was also higher in COVID-19 patients in both groups, he added.

COVID-19 carried a far greater chance for hospitalization, both for patients with active cancer (81% vs 15% for those without COVID-19) as well as those with a history of cancer (68% vs 6%), with higher hospitalization rates among Black individuals and those with a median income below $30,000. Even younger COVID-19 patients (<50 years) saw high rates of hospitalization, at 79% for those with active cancer and 49% for those with a history of the disease.

While few cancer patients without COVID-19 required mechanical ventilation (≤1%) during the study period, 21% of patients with active disease and COVID-19 needed ventilation, as did 14% of those with a history of cancer, with higher rates among those with a history of coagulopathy (36% and 23%, respectively).

CCC-19 Data Triples in Size

Another study presented during the meeting again showed higher mortality rates for cancer patients with COVID-19, with lung cancer patients appearing to be especially vulnerable.

Among 2,749 cancer patients diagnosed with COVID-19, 60% required hospitalization, 45% needed supplemental oxygen, 16% were admitted to the intensive care unit, and 12% needed mechanical ventilation, and 16% died within 30 days, reported Brian Rini, MD, of Vanderbilt-Ingram Cancer Center in Nashville, Tennessee.

“When COVID first started there was a hypothesis that cancer patients could be at adverse outcome risk due to many factors,” said Rini, noting their typically “advanced age, presence of comorbidities, increased contact with the healthcare system, perhaps immune alterations due to their cancer and/or therapy, and decreased performance status.”

Rini was presenting an updated analysis of the COVID-19 and Cancer Consortium (CCC-19), which now includes 114 sites (includes comprehensive cancer centers and community sites) collecting data on cancer patients and their outcomes with COVID-19.

Initial data from the consortium, of about 1,000 patients, were presented earlier this year at the American Society of Clinical Oncology (ASCO) annual meeting and published in The Lancet. The early analysis showed that use of hydroxychloroquine and azithromycin to treat COVID-19 in cancer patients was associated with a nearly threefold greater risk of dying within 30 days.

Notably, in the new analysis, decreased all-cause mortality at 30 days was observed among the 57 patients treated with remdesivir alone, when compared to patients that received other investigational therapies for COVID-19, including hydroxychloroquine (adjusted odds ratio [aOR] 0.41, 95% CI 0.17-0.99) and a trend toward lower mortality when compared to patients that received no other investigational therapies (aOR 0.76, 95% CI 0.31-1.85).

Cancer status was associated with a greater mortality risk. Compared to patients in remission, those with stable (aOR 1.47, 95% CI 1.07-2.02) or progressive disease (aOR 2.96, 95% CI 2.05-4.28) were both at increased risk of death at 30 days.

Mortality at 30 days reached 35% for patients with an Eastern Cooperative Oncology Group (ECOG) performance status of 2 or higher, as compared to 4% (aOR 4.22, 95% CI 2.92-6.10).

“As you start to combine these adverse risk factors you get into really high mortality rates,” said Rini, with highest risk seen among intubated patients who were either 75 and older (64%) or had poor performance status (75%).

“There are several factors that are starting to emerge as relating to COVID-19 mortality in cancer patients,” said Rini during his presentation at the AACR COVID-19 and Cancer meeting. “Some are cancer-related, such as the status of their cancer and perhaps performance status, and others are perhaps unrelated, such as age or gender.”

Other factors that were significantly associated with higher mortality included older age, male sex, Black race, and being a current or former smoker, and having a hematologic malignancy.

Findings from the study were simultaneously published in Cancer Discovery.

“Importantly, there were some factors that did not reach statistical significance,” said Rini, including obesity.

“Patients who received recent cytotoxic chemotherapy or other types of anti-cancer therapy, or who had recent surgery were not in the present analysis of almost 3,000 patients at increased risk,” he continued. “I think this provides some reassurance that cancer care can and should continue for these patients.”

For specific cancer types, mortality was highest in lung cancer patients (26%), followed by those with lymphoma (22%), colorectal cancer (19%), plasma cell dyscrasias (19%), prostate cancer (18%), breast cancer (8%), and thyroid cancer (3%).

“The COVID mortality rate in cancer patients appears to be higher than the general population,” said Rini. “Lung cancer patients appear especially vulnerable by our data, as well as TERAVOLT‘s.”

 

 

 

Temple will sell Fox Chase Cancer Center

https://www.beckershospitalreview.com/hospital-transactions-and-valuation/temple-will-sell-fox-chase-cancer-center.html?origin=CFOE&utm_source=CFOE&utm_medium=email

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Philadelphia-based Temple University has signed a binding definitive agreement to sell the Fox Chase Cancer Center and its bone marrow transplant program to Thomas Jefferson University in Philadelphia.

The announcement comes after nearly a year of negotiations. Temple expects to complete the sale of the cancer center and bone marrow transplant program in the spring of 2020.

Temple also entered into an agreement to sell its membership interest in Health Partners Plan, a Philadelphia-based managed care program, to Jefferson. A closing date for the transaction has not yet been determined.

With the agreements in place, Temple and Jefferson are looking for other ways to collaborate. The two organizations are exploring a broad affiliation that would help them address social determinants of health, enhance education for students at both universities, collaborate on healthcare innovation, and implement a long-term oncology agreement that would expand access to resources for Temple residents, fellows and students.

“Healthcare is on the cusp of a revolution and it will require creative partnerships to have Philadelphia be a center of that transformation,” Stephen Klasko, MD, president of Thomas Jefferson University and CEO of Jefferson Health, said in a news release. “For Jefferson, our relationship with Temple will accelerate our mission of improving lives and reimagining health care and education to create unparalleled value.”

 

 

 

Doctors try CRISPR gene editing for cancer, a 1st in the US

https://apnews.com/40211902a28946fe89f3f92b3c084e51

The first attempt in the United States to use a gene editing tool called CRISPR against cancer seems safe in the three patients who have had it so far, but it’s too soon to know if it will improve survival, doctors reported Wednesday.

The doctors were able to take immune system cells from the patients’ blood and alter them genetically to help them recognize and fight cancer, with minimal and manageable side effects.

The treatment deletes three genes that might have been hindering these cells’ ability to attack the disease, and adds a new, fourth feature to help them do the job.

“It’s the most complicated genetic, cellular engineering that’s been attempted so far,” said the study leader, Dr. Edward Stadtmauer of the University of Pennsylvania in Philadelphia. “This is proof that we can safely do gene editing of these cells.”

After two to three months, one patient’s cancer continued to worsen and another was stable. The third patient was treated too recently to know how she’ll fare. The plan is to treat 15 more patients and assess safety and how well it works.

“It’s very early, but I’m incredibly encouraged by this,” said one independent expert, Dr. Aaron Gerds, a Cleveland Clinic cancer specialist.

Other cell therapies for some blood cancers “have been a huge hit, taking diseases that are uncurable and curing them,” and the gene editing may give a way to improve on those, he said.

Gene editing is a way to permanently change DNA to attack the root causes of a disease. CRISPR is a tool to cut DNA at a specific spot. It’s long been used in the lab and is being tried for other diseases.

This study is not aimed at changing DNA within a person’s body. Instead it seeks to remove, alter and give back to the patient cells that are super-powered to fight their cancer — a form of immunotherapy.

Chinese scientists reportedly have tried this for cancer patients, but this is the first such study outside that country. It’s so novel that it took more than two years to get approval from U.S. government regulators to try it.

The early results were released by the American Society of Hematology; details will be given at its annual conference in December.

The study is sponsored by the University of Pennsylvania, the Parker Institute for Cancer Immunotherapy in San Francisco, and a biotech company, Tmunity Therapeutics. Several study leaders and the university have a financial stake in the company and may benefit from patents and licenses on the technology.

Two of the patients have multiple myeloma, a blood cancer, and the third has a sarcoma, cancer that forms in connective or soft tissue. All had failed multiple standard treatments and were out of good options.

Their blood was filtered to remove immune system soldiers called T cells, which were modified in the lab and then returned to the patients through an IV. It’s intended as a one-time treatment. The cells should multiply into an army within the body and act as a living drug.

So far, the cells have survived and have been multiplying as intended, Stadtmauer said.

“This is a brand new therapy” so not it’s not clear how soon any anti-cancer effects will be seen. Following these patients longer, and testing more of them, will tell, he said.