By Sarah Barr

Higher U.S. spending for cancer care pays off in almost two years of additional life for American cancer patients on average compared to their European counterparts — a value that offsets the higher costs –according to a study in the April issue of the journal Health Affairs.

While previous studies have suggested U.S. cancer patients have better survival prospects than their European counterparts, the researchers wanted to examine whether those prospects justify higher U.S. costs.

To do so, they translated the longer lives of U.S. patients into dollar amounts using a conservative estimate of the value of a human life year — in the context of the tradeoffs people are willing to make to reduce their risk of death — and compared those amounts to U.S. spending on cancer care.  The method does not take into account quality of life or individuals’ earnings.

“We found that the value of the survival gains greatly outweighed the costs, which suggests that the costs of cancer care were indeed ‘worth it,’” the researchers wrote in the study. They cautioned the findings do not prove that all treatments are cost-effective or a that a causal link exists between spending on cancer care and survival gains.

Michael Eber, a senior analyst at Precision Health Economics, a health care consulting company, and a co-author of the study, said that the findings point to the need for further research into what drives the survival differences between U.S. and European patients.

“It calls for a closer look at the value of individual treatments and interventions,” he said.

For the study, the researchers looked at the survival outcomes for U.S. patients compared with those from 10 European countries and found that for most cancer types, U.S. patients lived longer.

Specifically, from 1995 to 1999, U.S. patients lived an average of 11.1 years after diagnosis, while European patients lived 9.3 years.

The researchers used those numbers as a baseline and based their findings on how survival gains improved in each country over time.

They also found that from 1983 through 1999, U.S. spending increased from $47,000 to $70,000 per cancer case, while in the 10 European countries, spending on cancer care increased from $38,000 to $44,000 per case.

The additional U.S. spending during that time period on the kinds of cancer the researchers examined totaled $158 billion.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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According to the latest data on nationwide death rates from cancer, overall mortality from cancer declined from 1999 to 2008, maintaining a trend seen since the early 1990s.

Mortality fell for most cancer types, including the four most common types of cancer in the United States (lung, colorectal, breast, and prostate), although the rate of decline varied by cancer type and across racial and ethnic groups.

The complete Annual Report to the Nation on the Status of Cancer, 1975–2008 appeared March 28 in Cancer.

The declines in cancer death rates (mortality) averaged 1.7 percent per year for men and 1.3 percent per year for women from 1999 through 2008.

Among men, the overall rate of new cancer cases (incidence) fell by an average of 0.6 percent annually from 1999 to 2008.

Among women, incidence dropped by an average of 0.5 percent annually from 1999 to 2006 but held steady from 2006 to 2008.

Cancer incidence in children ages 0 to 14 rose from 1999 to 2008 (by 0.5 percent a year), continuing a trend seen in previous Annual Reports to the Nation.

However, advances in treatment contributed to a steady decline in mortality rates for children with cancer in the last 5 years (an average of 2.8 percent per year).

“Steady progress, as measured by declines in cancer death rates for many cancers, is good because we have an aging, growing population,” said Dr. Brenda K. Edwards, NCI’s senior advisor for surveillance.

“While the number of people diagnosed with cancer or who die of the disease may be increasing, the decline in cancer death rates for more than a decade is the best indicator of progress due to prevention, screening, diagnosis, and treatment,” she added.

NCI, the American Cancer Society, the Centers for Disease Control and Prevention (CDC), and the North American Association of Central Cancer Registries (NAACCR) collaborated on the report. Cancer incidence data came from NCI’s Surveillance, Epidemiology, and End Results (SEER) database and from the CDC, with analyses of pooled data by NAACCR. Mortality data came from the CDC’s National Center for Health Statistics.

Not All Good News

There were some notable exceptions to the overall decreases in incidence and mortality. From 1999 to 2008, death rates rose for pancreatic cancer in men and women, for liver cancer and melanoma in men, and for endometrial cancer in women.

The cervical cancer death rate, which had been falling for decades, showed no further decrease over the last 5 years.

And, although incidence rates fell overall for men and women from 1999 to 2008, the decline was not distributed evenly across racial and ethnic groups.

Cancer incidence rates did not decrease significantly among American Indian/Alaska Native men and women combined or among black, Asian and Pacific Islander, and American Indian/Alaska Native women.

Although incidence rates in black men did decline, this group still had the highest cancer incidence rate of any racial and ethnic group, 15 percent higher than that of white men and nearly double that of Asian and Pacific Islander men.

Major Modifiable Risk Factors

Each Annual Report to the Nation includes a special feature that focuses on a topic of importance to the cancer research community and the public.

This year’s report featured an analysis on the contribution of excess weight (overweight and obesity) and insufficient physical activity to the nation’s cancer burden.

More than 60 percent of the U.S. adult population is estimated to be overweight or obese, and a similar percentage of adults do not get the recommended amount of physical activity.

The rates of insufficient physical activity are even worse for children; for example, up to 90 percent of high school girls do not engage in recommended levels of physical activity.

Excess weight “is a major modifiable risk factor for cancer and other diseases—probably second only to tobacco use in terms of its impact on cancer incidence and mortality,” said Dr. Edwards. “The risk may be modest but it’s so pervasive that we felt this was the time to look at [cancer] incidence in this context.” Physical inactivity not only contributes to excess weight but is itself a risk factor for several cancer types.

The report was not designed to quantitatively link the trends in excess weight and lack of physical activity to the national trends for cancer, explained Dr. Rachel Ballard-Barbash, associate director of the Applied Research Program in NCI’s Division of Cancer Control and Population Sciences.

Many other studies have shown convincing links between excess weight and several cancer types, including endometrial, postmenopausal breast, colorectal, kidney, esophageal, and pancreatic cancer.

The point of the special feature, she noted, “is to highlight specific types of cancer that are related to [excess weight and lack of sufficient physical activity], show how these behaviors relate to these cancers in terms of their relative risks, and briefly describe some of the mechanisms by which they relate.”

The special feature also highlights national- and state-level prevention strategies in policy and environmental change that are intended to help people achieve recommended changes in their diets and physical activity levels.

As the nation’s weight has risen, so has the incidence of some, although not all, types of cancer related to excess weight and lack of sufficient physical activity. From 1999 to 2008, incidence rates of kidney cancer and of adenocarcinoma of the esophagus each rose about 3 percent per year for men and women, while incidence of pancreatic cancer rose 1.2 percent per year among men and women.

In addition, incidence rates of endometrial cancer rose significantly among black, Asian and Pacific Islander, and Hispanic women. Incidence of postmenopausal breast cancer stabilized from 2005 to 2008, after a period of decline.

“Although all of these cancers are influenced by multiple factors, the high prevalence of excess weight and insufficient physical activity likely contributed to these observed increases and to the lack of decline in breast cancer,” the authors wrote. “Continued progress in reducing cancer incidence and mortality rates will be difficult without success in promoting healthy weight and physical activity, particularly among youth.”

Excess weight and lack of physical activity also influence cancer survivorship, explained Dr. Ballard-Barbash, as both can negatively affect outcomes after a cancer diagnosis, further increasing the need for these risk factors to be addressed on a personal and societal level.

The NCI Cancer Bulletin is an award-winning biweekly online newsletter designed to provide useful, timely information about cancer research to the cancer community. The newsletter is published approximately 24 times per year by the National Cancer Institute (NCI), with day-to-day operational oversight conducted by federal and contract staff in the NCI Office of Communications and Education. The material is entirely in the public domain and can be repurposed or reproduced without permission. Citation of the source is appreciated.

By Michelle Andrews

Seventy percent of smokers say they’d like to quit, and now, just three days into the new year, many may already be struggling to stick to their resolution to make 2012 a smoke-free year.

If quitting were easy, after all, chances are good that nearly one in five adults wouldn’t still be smokers, a figure that hasn’t budged much in several years.

Smoking is such a familiar health hazard that some experts say it doesn’t get the attention it deserves; the focus is often on other lifestyle-related conditions, especially obesity.

But smoking is still the No. 1 cause of preventable death in this country. Nearly half a million people die prematurely because of smoking-related illnesses, including lung cancer, heart disease and chronic obstructive pulmonary disease, according to the Centers for Disease Control and Prevention.

Scrambling to address budget problems, states this year will spend less than 2 percent of their tobacco-tax and tobacco-settlement billions on programs to help people quit smoking or prevent them from starting, according to a recent report by a coalition of public-health organizations.

Local Smoking cessation resources:

• King County’s Tobacco Prevention Web page.
• Seattle Cancer Care Alliance’s Smoke Free Life.
• Washington State Department of Health Tobacco Prevention and Control Program.
• Washington’s Tobacco Quite Line: Free Help for Tobacco Users.
• American Lung Association of Washington.
• American Cancer Society.

In the past four years, state spending on tobacco prevention and cessation has declined by 36 percent, to $457 million.

Tobacco-related health-care spending is nearly $100 billion annually, according to the CDC.

“It’s a travesty,” says Danny McGoldrick, vice president for research at the Campaign for Tobacco-Free Kids. “These programs more than pay for themselves.”

Carrots And Sticks

While public funding falters, a growing number of companies offer smoking-cessation programs to their workers. Last year, two-thirds of companies with 200 or more workers offered such programs, while 31 percent of smaller companies did so, according to the Kaiser Family Foundation’s annual survey of employer-sponsored health benefits. (Kaiser Health News is an editorially independent program of the foundation.)

More From This Series: Insuring Your Health

At the same time that they offer a helping hand to quit, more companies are also penalizing employees who don’t kick the habit by hitting them with higher health insurance premiums.

At firms with more than 20,000 employees, 24 percent vary premiums based on whether someone smokes, as do 12 percent of companies with 500 or more workers, according to the 2011 survey of employer-sponsored health plans by human resources consultant Mercer.

Public-health advocates generally agree that this punitive approach isn’t ideal. “The issue isn’t smokers, it’s smoking,” says McGoldrick. Charging people higher premiums may just make smokers drop their coverage, he says.

But employers argue that charging smokers more is only fair. “The cost of medical care for smokers is considerably higher,” says Helen Darling, chief executive of the National Business Group on Health, an employer group. “Employers are increasingly saying that if someone costs the pool more, they should pay more.”

Darling points out that companies that go this route typically offer free smoking-cessation services and give employees plenty of notice before implementing the change.

A Quitter’s Story

For Tommy Piver, 59, the combination of pricier cigarettes and looming health insurance penalties finally motivated the two-pack-a-day smoker to give up the habit he’d started at age 13. Increased taxes had caused the price of a pack of cigarettes at the gas station near his home in Naples, Fla., to double within a year, to $5. Then he got a notice that his insurance carrier was going to triple the health insurance premium and reduce the amount it covered for all sorts of care from 90 percent to 70 percent for smokers.

“Kicking and screaming,” Piver quit on Jan. 1, 2010. About a week later, he saw a television ad for an online stop-smoking program developed by Legacy, a nonprofit created under the settlement between the states and the tobacco industry. Piver joined the free EX program and hasn’t had a cigarette in two years.

The EX campaign is an “excellent, science-based tool” for smokers who want to quit, says Thomas Glynn, director of cancer science and trends for the American Cancer Society.

Another option is a national toll-free line, 1-800-QUIT-NOW, which routes callers to free support services, including free medication in the handful of states that provide it, says Glynn.

The 2010 federal health law expanded coverage for smoking cessation, though not to the degree that advocates wanted. Under the law, states must provide tobacco-cessation coverage for all pregnant women in their Medicaid programs at no cost.

But anti-smoking activists would like broader Medicaid coverage requirements: Although 19 percent of adults smoke overall, 31 percent of adults living below the poverty line are smokers.

The health law also requires that new health plans – those that have either just begun or have changed their benefits sufficiently to lose grandfathered status under the law – screen adults for tobacco use and provide free stop-smoking interventions.

Exactly how much intervention is required isn’t spelled out in the law; that will be up to federal rulemakers to decide. Smokers typically make several attempts to quit before they succeed.

Advocates hope that federal guidelines will provide coverage for more than a single four-session counseling module, for example, or a standard 12-week round of medication. “Data is accumulating that 12 weeks is not enough,” says Glynn.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

In the previous five years, the 7 percent of retailers were caught selling tobacco to underage teens. This year the number caught jumped to 15 percent of the time.

Overall, there were 70 sales (from 63 establishments) to minors across Seattle over 468 retailer inspections this year, Public Health – Seattle King County officials said.

King County saw a similar jump in illegal sales to minors, from an average of six percent between 2006 and 2010 to 12 percent in 2011, officials said.

The Law

In Washington State, selling tobacco to a minor is prohibited by law and results in a fine for retailers of $100 for the first offense, the officials said. The fine for a clerk is $50.

Repeat offenders within a two year window are fined up to $1,500 and may have their license to sell tobacco products suspended.

Retailer compliance checks are conducted throughout the year by Public Health and the Washington State Liquor Control Board, as well as the U.S. Food and Drug Administration (FDA) due to new federal laws around tobacco and cigarettes.

Fast Facts About Teen Smoking:

• 90 percent of current smokers became addicted before they were 19 years old.

• About a third of all kids who become regular smokers before adulthood will eventually die from smoking.

• Tobacco use is the leading cause of death in King County, leading to 1,990 deaths per year and $343 million in medical care costs, lost productivity and other expenses.

Public health officials encourage anyone who witnesses a merchant or other adults providing tobacco to a minor is encouraged to call Public Health’s Tobacco Prevention Program at 206-296-7613 to file a confidential complaint or text the information to 206-745-2548.

To learn more:

• Visit Public Health – Seattle & King County’s web site at www.kingcounty.gov/health/tobacco

Cancer often takes a heavy toll not only on people’s bodies but on their finances as well. And just as some types of cancer are more deadly than others, some types cause more financial pain, as recent research from Seattle’s Fred Hutchinson Cancer Research Center shows.