The battle against pediatric cancer has made impressive gains in the past 40 years, but new challenges abound and the fight continues, says a study in CA: A Cancer Journal for Clinicians. “Death rates for all childhood and adolescent cancers combined declined steadily by an average of 2.1% per year since 1975, resulting in an overall decline of more than 50%,” say the authors of “Childhood and Adolescent Cancer Statistics, 2014.”

Nonetheless, an estimated 1,960 young people will die from the disease in 2014. Cancer is the second leading cause of death for this group, behind accidents.

Also this year, roughly 15,780 children and adolescents will be diagnosed with cancer.

The study states that “for the most part children who survived five years after diagnosis of their primary tumor had a high probability of subsequent survival.” About 1 in 530 people ages 20–39 is a survivor of childhood cancer. And survivors are vulnerable to a host of problems as they get older.

“For example, the increased use of dexamethasone in contemporary ALL [acute lymphoblastic leukemia] therapy has resulted in higher prevalence of osteonecrosis and spurred research to identify clinical and genetic factors predisposing patients to this complication and its long-term functional limitations,” the study states. It adds that “survivors of HL [Hodgkin’s lymphoma] who are treated with chest irradiation have an increased risk of developing lung cancer, and tobacco use increases this risk 20-fold.”

Researchers cannot pinpoint what causes most childhood cancers. “In contrast to cancers in adults, only a relatively small percentage of all childhood cancers have known preventable causes,” the study states. “Although numerous epidemiologic studies have investigated potential environmental causes of childhood cancers, few strong or consistent associations have been found.”

In addition, not all childhood cancers have seen significant improvement in survival rates. For instance, the median survival time is less than a year for people diagnosed with diffuse intrinsic pontine glioma.

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.