Data Stream
A Shrinking Safety Net? Cancer’s Second Wind
Since 2016, the U.S. uninsured rate has risen steadily,
reaching a 4-year high in 2018, according to a Gallup
survey. Despite advances in chemotherapy regimens in the previous
two decades (like new agents and neoadjuvant and adjuvant
therapy), the risk of therapy-related myelodysplastic
syndromes or acute myeloid leukemia (tMDS/AML) remains
high among patients who received chemotherapy for a wide
range of solid tumor cancers.
At the end of 2018, the
uninsured rate was 13.7%, up
from 10.9% in November 2016,
when efforts to “repeal and replace” the Affordable
Care Act began.
15%
In a study of 700,612 patients diagnosed with a primary cancer
between 2000 and 2013, 1,619 developed tMDS/AML.
That translated to a 1.5-fold to
10-fold higher risk for tMDS/
AML per 10,000 patient years,
compared with the general population.
This study also demonstrates that MDS/AML risk increases
after chemotherapy across a range of solid tumor cancers, when
previously, it was only known to increase risk for cancers of
the lung, ovary, breast, soft tissue, testis, and brain or central
nervous system.
12%
Source: Morton LM, Dores GM, Schonfeld SJ, et al. Association of chemotherapy for
solid tumors with development of therapy-related myelodysplastic syndrome or acute
myeloid leukemia in the modern era. JAMA Oncol. 2018 December 20. [Epub ahead of print]
9%
Double Jeopardy
6%
The epidemic of physician burnout negatively affects
doctors’ quality of life, and a new meta-analysis shows
it may have dangerous implications for patient safety.
3%
0%
2016
2018
The 2.8% increase represents about 7 million adults
without health insurance. The highest increases in the
uninsured rates were among women, people with lower
incomes, and younger adults.
Of 47 studies including
42,473 physicians,
reporting burnout nearly
doubled the odds of
unsafe care compared
with those not reporting
burnout, with a 96% higher
risk of patient safety
incidents.
With patient safety in jeopardy, the authors
wrote, “reversal of this risk has to be viewed as a
fundamental health-care policy goal across the globe.”
Source: Panagioti M, Geraghty K, Johnson J, et al. Association between
physician burnout and patient safety, professionalism, and patient
satisfaction: a systematic review and meta-analysis. JAMA Intern
Med. 2018;178:1317-30.
Source: Gallup National Health and Well-Being Index report, January 23, 2019.
20
ASH Clinical News
March 2019