Importance To be effective in reducing deaths from lung cancer among high-risk current and former smokers, screening with low-dose computed tomography must be performed periodically. Objective To examine lung cancer screening (LCS) adherence rates reported in the US, patient characteristics associated with adherence, and diagnostic testing rates after screening. Data sources Five electronic databases (MEDLINE, Embase, Scopus, CINAHL, and Web of Science) were searched for articles published in the English language from January 1, 2011, through February 28, 2020. Study selection Two reviewers independently selected prospective and retrospective cohort studies from 95 potentially relevant studies reporting patient LCS adherence. Data extraction and synthesis Quality appraisal and data extraction were performed independently by 2 reviewers using the Newcastle-Ottawa Scale for quality assessment. A random-effects model meta-analysis was conducted when at least 2 studies reported on the same outcome. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guideline. Main outcomes and measures The primary outcome was LCS adherence after a baseline screening. Secondary measures were the patient characteristics associated with adherence and the rate of diagnostic testing after screening. Results Fifteen studies with a total of 16 863 individuals were included in this systematic review and meta-analysis. The pooled LCS adherence rate across all follow-up periods (range, 12-36 months) was 55% (95% CI, 44%-66%). Regarding patient characteristics associated with adherence rates, current smokers were less likely to adhere to LCS than former smokers (odds ratio [OR], 0.70; 95% CI, 0.62-0.80); White patients were more likely to adhere to LCS than patients of races other than White (OR, 2.0; 95% CI, 1.6-2.6); people 65 to 73 years of age were more likely to adhere to LCS than people 50 to 64 years of age (OR, 1.4; 95% CI, 1.0-1.9); and completion of 4 or more years of college was also associated with increased adherence compared with people not completing college (OR, 1.5; 95% CI, 1.1-2.1). Evidence was insufficient to evaluate diagnostic testing rates after abnormal screening scan results. The main source of variation was attributable to the eligibility criteria for screening used across studies. Conclusions and relevance In this study, the pooled LCS adherence rate after a baseline screening was far lower than those observed in large randomized clinical trials of screening. Interventions to promote adherence to screening should prioritize current smokers and smokers from minority populations.

/pdf/patient-adherence-to-screening-for-lung-cancer-in-the-us-a-gq1lbjisc5.pdf

Patient Adherence to Screening for Lung Cancer in the US: A Systematic Review and Meta-analysis

Background
Laparoscopic surgery has several advantages when compared to open surgery, including faster postoperative recovery and lower pain scores. However, for laparoscopy, a pneumoperitoneum is required to create workspace between the abdominal wall and intraabdominal organs. Increased intraabdominal pressure may also have negative implications on cardiovascular, pulmonary, and intraabdominal organ functionings. To overcome these negative consequences, several trials have been performed comparing low- versus standard-pressure pneumoperitoneum.

/pdf/what-is-the-evidence-for-the-use-of-low-pressure-btehlmrnoa.pdf

What is the evidence for the use of low-pressure pneumoperitoneum? A systematic review

Importance Targeted drug delivery (TDD) has potential for cost savings compared with conventional medical management (CMM). Despite positive clinical and economic evidence, TDD remains underused to treat cancer pain. Objective To assess the cost of TDD and CMM in treating cancer-related pain. Design, Setting, and Participants This retrospective economic evaluation using propensity score–matched analysis was conducted using MarketScan commercial claims data on beneficiaries receiving TDD and CMM or CMM only for cancer pain from January 1, 2009, to September 30, 2015. Participants were matched on age, sex, cancer type, comorbidity score, and pre-enrollment characteristics. Data analysis was performed from June 1 to September 30, 2017. Main Outcomes and Measures Total 2-, 6-, and 12-month costs, number of health care encounters, length of hospital stay, additional components of cost, and health care utilization. Results A total of 376 TDD and CMM patients (mean [SD] age, 51.88 [9.98] years; 216 [57.5%] female) and 4839 CMM only patients (mean [SD] age, 51.52 [11.16] years; 3005 [62.1%] female) were identified for study inclusion. After matching, 536 patients were included in the study: 268 patients in the TDD and CMM group and 268 in the CMM only group. Compared with CMM only, TDD and CMM was associated with mean total cost savings of $15 142 (95% CI, $3690 to $26 594;P = .01) at 2 months and $63 498 (95% CI, $4620 to $122 376;P = .03) at 12 months; cost savings at 6 months were not statistically different ($19 577; 95% CI, −$12 831 to $51 984;P = .24). The TDD and CMM group had fewer inpatient visits (2-month mean difference [MD], 1.0; 95% CI, 0.8-1.2;P  Conclusions and Relevance Compared with CMM alone, TDD and CMM together were associated with significantly lower cost and health care utilization. The findings suggest that TDD is a cost-saving therapy that should be considered in patients with cancer for whom oral opioids are inadequate or produce intolerable adverse effects and should be expanded as health care systems transition to value-based models.

https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2729801/stearns_2019_oi_190079.pdf

Assessment of Health Care Utilization and Cost of Targeted Drug Delivery and Conventional Medical Management vs Conventional Medical Management Alone for Patients With Cancer-Related Pain

Control of societal costs can be addressed through clinician education, value‐based guidelines and pathways, formulary restrictions, payment reform, and government regulatory decisions but should not be imposed on patients at the point of decision‐making in the cancer clinic.

https://theoncologist.onlinelibrary.wiley.com/doi/pdf/10.1634/theoncologist.2016-0301

Financial Toxicity and Societal Costs of Cancer Care: Distinct Problems Require Distinct Solutions

Background: Laparoscopic cholecystectomy (LC) requires the creation of a pneumoperitoneum via insufflations of carbon dioxide; resulting in increased partial pressure of carbon dioxide (CO 2 ) and intraperitoneal pressure which leads to the changes in pulmonary function and hemodynamic measurements. Hypercarbia leads to visceral organ ischemia including liver and venous stasis/thromboembolism or both due to impaired flow. The present study has been undertaken to see the changes in liver function tests (LFTs) after laparoscopic/open cholecystectomy (OC), the incidences of such change, their relation to age, sex, duration of surgery and to know the clinical significances of such disturbances. Aims and objectives: To compare and correlate the serum level of bilirubin, alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP) in patients who underwent LC to those who underwent OC. Material and methods: The present study was conducted in the Department of Surgery at MMIMSR, MM University, Mullana, Ambala. A total number of 200 patients diagnosed as cholelithiasis were included in the study from May 2012 to May 2014. These cases were randomly divided into two groups (A and B) consisting of 100 cases each. LC was performed in group A patients and OC was done in group B patients. Three blood samples were taken: (I) pre-operatively; (II) after 24 hours of surgery; and (III) after 72 hours of surgery for comparison of the enzyme level alterations. Results: In LC patients, there were rise in the levels of serum bilirubin, AST and ALT after 24 hrs of surgery from the preoperative value and then again fall was noted (near to normal value) after 72 hrs of surgery except in that of ALP. ALP levels showed slight fall after 24 hrs of surgery and then slight rise after 72 hrs which was within the normal limit. Whereas in OC patients, there were slight variations in the liver enzymes (which were within the normal range). Conclusions: Transient elevation of serum bilirubin, AST and ALT occurs after LC or after OC. The alteration in the liver enzymes can be attributed to CO2 pneumoperitoneum, surgical manipulations, diathermy, patient position, and arterial injury may also other factors. These changes return to normal in 3-4 days after procedure and they have no clinical consequences in patients with normal hepatic function but they may still cause worry to the surgeon regarding the integrity of biliary tree.

Evaluation and comparison of postoperative levels of serum bilirubin, serum transaminases and alkaline phosphatase in laparoscopic cholecystectomy versus open cholecystectomy

Background: Laparoscopic cholecystectomy at standard-pressure pneumoperitoneum uses a pressure of 12–14 mm Hg, which may cause a variety of adverse physiological changes involving the respiratory, cardiovascular, and hepatorenal systems reflected as subclinical abnormalities in biochemical parameters. The use of low-pressure pneumoperitoneum in the range of 8–10 mm Hg has been shown to reduce the adverse physiological changes without affecting the outcome of surgery. Subjects and Methods: This study was done in a randomized controlled manner. Patients with gallstone disease (n=101) underwent laparoscopic cholecystectomy. Patients were randomly assigned to high-pressure laparoscopic cholecystectomy (HPLC) (n=51) and low-pressure laparoscopic cholecystectomy (LPLC) (n=50) and underwent surgery at pressures of 14 mm Hg and 8 mm Hg, respectively. Liver function tests, including total bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase, were obtained p...

Effects of varying intraperitoneal pressure on liver function tests during laparoscopic cholecystectomy.

33Background: In the current climate of health care reimbursement, coverage reform, and escalating health care costs, navigating cancer care becomes increasingly complex for patients and caregivers. Given the truly fluid marketplace and many payment and care models being established sans engagement with or even information from the patient, it is imperative to assess the ongoing reality of patient access to comprehensive, quality cancer care: care that includes biomedical as well as psychosocial care. Methods: We launched an online research survey project to further explore the cancer patient experience as it relates to accessing health care and living within a new and evolving system of health care. The analysis is based upon a cross-sectional survey of adults (18 years old and older) affected by cancer. The survey was conducted online between June and August of 2016. 1,218 cancer survivors completed survey questions regarding access to insurance, services, and providers as well as direct and indirect co...

Access to care in cancer: Barriers and challenges.

9588Background: Melanoma survivors are at risk for significant financial burden due to cancer care and out of pocket costs. We explored 1) the financial impact of melanoma and its relationship to c...

Financial toxicity and cancer-related distress among melanoma survivors.

e18259Background: Value in health care is the nexus of best care and lowest cost How patients define value is key to measuring health care value in this era of shared decision making Very little 

Definitions of value among patients with breast cancer.

e12529 Background: National Lung Screening Trial (NLST) establisehd the role of lung ca screening in high-risk individuals. Annual screening with a low dose CT-chest for 3 years resulted in a 20% r...

Lung cancer screening in high-risk individuals with annual low-dose chest CT in a community setting.

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