A steady decline over more than two decades has resulted in a 25% drop in the overall cancer death rate in the United States. The reduction equates to 2.1 million fewer cancer deaths between 1991 and 2014. The findings come from Cancer Statistics 2017, the American Cancer Society’s annual report on cancer incidence, mortality, and survival. The report was published in CA: A Cancer Journal for Clinicians.

The report estimates that in 2017 there will be 1,688,780 new cancer cases and 600,920 cancer deaths in the U.S. During the past decade of available data, the overall cancer incidence rate was stable in women and declined by approximately 2% per year in men, whereas the cancer death rate declined by approximately 1.5% annually in both men and women.

The cancer death rate dropped from its peak of 215.1 per 100,000 population in 1991 to 161.2 per 100,000 population in 2014, the latest year for which data were available for analysis. The drop is the result of steady reductions in smoking and advances in early cancer detection and treatment, and is driven by decreasing death rates for the four major cancer sites: lung (–43% between 1990 and 2014 among males and –17% between 2002 and 2014 among females); breast (–38% from 1989 to 2014); prostate (–51% from 1993 to 2014); and colorectal (–51% from 1976 to 2014).

The report also finds significant gender disparities in incidence and mortality. For all sites combined, the cancer incidence rate is 20% higher in men than in women, while the cancer death rate is 40% higher in men.

The gender gap in cancer mortality largely reflects variations in the distribution of cancers that occur in men and women, much of which is due to differences in the prevalence of cancer risk factors, the report says. For example, liver cancer, a highly fatal cancer, is three times more common in men than in women, partly reflecting higher hepatitis C virus infection, historical smoking prevalence, and excess alcohol consumption in men. The largest sex disparities are for cancers of the esophagus, larynx, and bladder, for which incidence and death rates are approximately fourfold higher in men. Melanoma incidence rates are approximately 60% higher in men than in women, whereas melanoma death rates are more than double in men compared with women.

Racial disparities in cancer death rates continue to decline, according to the report. The excess risk of cancer death in black men dropped from 47% in 1990 to 21% in 2014. The black/white disparity declined similarly in women, from a peak of 20% in 1998 to 13% in 2014.

Sources: ACS; January 5, 2017; and Cancer Statistics 2017; December 2016.

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.