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Washington Post
04-08-2025
- Washington Post
After cancer diagnosis, out-of-pocket costs jump, study says
Out-of-pocket costs increased by an average of $592.53 per month in the six months after a cancer diagnosis, according to a recent study published in JAMA Network Open. The study analyzed a sample of over 46,000 patients from the Surveillance, Epidemiology and End Results (SEER) cancer registry, examining responses from 2008 to 2019. The sample consisted of both patients with and without cancer to provide a control group. Within the sample group, breast cancer was the most common form of cancer (74.1 percent), followed by colorectal (14.5 percent) and lung cancer (11.4 percent). On average, out-of-pocket costs rose by a cumulative total of $4,144.71. 'This difference, driven by the onset of cancer diagnosis and its associated treatment, underscores the financial burden of cancer care on patients with insurance who are not yet eligible for Medicare,' the authors write in the study. Cost also increased with stage of diagnosis. Patients with Stage 0 cancer saw an average increase of $462.01 per month, while Stage 4 patients' costs rose an average of $719.97 per month. The authors note that late-stage disease usually is associated with more treatment and higher medical expenditures. This study has implications for policy reform, the researchers argue. 'The variability in [out-of-pocket costs] based on cancer stage underscores the need for policies such as paid sick leave, that address both insurance continuity and financial assistance, especially for patients with more advanced cancer,' they write. — Hannah Docter-Loeb This article is part of The Post's 'Big Number' series, which takes a brief look at the statistical aspect of health issues. Additional information and relevant research are available through the hyperlinks.
Medscape
24-06-2025
- Medscape
Amelanotic Melanoma Tied to Worse Survival
TOPLINE: Patients with amelanotic melanoma showed poorer disease-specific survival (DSS) than those with melanotic melanoma in a Surveillance, Epidemiology, and End Results (SEER) database analysis. METHODOLOGY: Researchers analyzed data on patients with invasive cutaneous amelanotic melanoma (n = 1598) and melanotic melanoma (n = 417,974) from the SEER 17 database between 2000 and 2021. Patients with amelanotic melanoma were older at diagnosis and presented with more advanced-stage disease than those with melanotic melanoma (regional/distant stages: 26.8% vs 12.4%), ulceration (35.6% vs 13.1%), and Breslow thickness > 2 mm (42% vs 17%). The primary outcome was DSS. TAKEAWAY: Five-year DSS was significantly lower in patients with amelanotic melanoma (78.6%) than in those with melanotic melanoma (91.3%; P < .001). Patients with amelanotic melanoma carried a 31% higher risk for mortality after adjusting for sex, age, and stage (P < .001). Among those with amelanotic melanoma, men (hazard ratio [HR], 1.38; P = .014 vs women) had a higher disease-specific mortality, and mortality was higher among adults aged 85 years and older (HR, 1.86; P = .002 vs patients aged 45-64 years). Amelanotic melanoma diagnoses made 2011 onward were associated with a lower mortality risk (HR, 0.55; P < .001) than those diagnosed before 2011, with 2-year DSS for distant metastases more than doubling from 26.4% during 2000-2005 to 58.8% during 2016-2021. IN PRACTICE: 'This study underscores the poorer survival outcomes associated with AM [amelanotic melanoma] compared to MM [melanotic melanoma] and highlights a potential survival improvement following the availability of immunotherapy,' the study authors wrote. They called for prospective trials 'to validate these findings and guide tailored management strategies for AM.' SOURCE: The study was led by Trang M. Nguyen, MD, National Hospital of Dermatology and Venereology, Hanoi, Vietnam, and was published online on June 12 in Journal of the American Academy of Dermatology. LIMITATIONS: Limitations included selection bias and limited follow-up for recent cases. DISCLOSURES: The authors reported having no funding sources or relevant conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
17-06-2025
- Medscape
CRC Outcomes Better When First of Multiple Cancers
Colorectal cancer (CRC) survival is longer when it's the first of multiple primary malignancies than when it's the second or solo, new data suggest. The findings came from a retrospective analysis of data from the Surveillance, Epidemiology, and End Results (SEER) database of more than half a million people in the US with primary CRC. They were divided into three groups: Group A, with CRC as their only malignancy; group B, with CRC as the first with one or more subsequent primary malignancies; and group C, with CRC as the second of multiple primary malignancies. The finding that Group B had the highest 5-year survival of the three groups is novel and surprised the authors, but they have some theories to explain it. 'We potentially thought group A would do the best, seeing as they only had one type of cancer. But what we found…is that [group B] actually had the best survival outcome. It could have something to do with the tumor characteristics at a molecular biological level, or potentially because of increased surveillance from having colorectal cancer first,' first author Anjelli Wignakumar, MD, told Medscape Medical News . On the other hand, those in group A tended to be younger and to present with more aggressive disease, although they still fared better than did those in group C. 'There are lots of potential explanations,' said Wignakumar, a clinical research fellow in Colorectal Department, Cleveland Clinic, Weston, Florida. Clinically, the takeaway is for comprehensive screening for other types of cancer in people with primary cancers, and in particular screening for CRC in people with other primary cancers. 'Depending on the patient's family history and other things, increasing that screening hopefully increases our risk of picking up something earlier,' she said. Of the total 592,063 patients with CRC in SEER from 2000-2020, 71.8% were in group A, 11.9% in group B, and 16.3% in group C. Group B included a higher proportion of men (57.1% vs 51.8% and 53.1% for A and C, respectively; P < .001). Group A was significantly younger at CRC presentation (65.7 years vs 67.3 years and 72.6 years, for B and C, respectively; P < .001). Those in group A were more likely to have elevated pretreatment tumor marker carcinoembryonic antigen (49.7% vs 43.2% and 46.9%, in B and C, respectively; P < .001) and presented more often with liver metastases (17.5% vs 7.4% and 12.1%, respectively; P < .001) or lung metastases (6.3% vs 2.5% and 4.2%, respectively, P < .001). Right-sided CRC, which has been associated with worse survival compared to left-sided, was more common in group C (38.6%), while left-sided colonic cancer, associated with better survival, was more common in group B (37.9%). Both were significant compared to the other groups ( P < .001). Surgical treatment was recommended significantly ( P < .001) more often for group B (20.5%) than for groups A (13.0%) or C (14.3%), while systemic adjuvant therapy was given significantly ( P < .001) more often to those in group A (29.0%) than groups B (27.8%) or C (21.3%). Compared to group B, overall 5-year mortality hazard ratios were 1.26 for group A, which could be attributed to their more advanced disease, the authors said. Those in group C also had higher 5-year mortality (1.66). Those were both statistically significant, with similar trends for cancer-specific mortality. Mean 5-year survival was 50.4 months for group B, significantly ( P < .001) longer than the 41.8 months for group A and 39.2 months for group C. In their discussion in the paper, Wignakumar and colleagues presented a variety of hypotheses about the findings, including that group B might have a distinct immune profile that 'enhances their ability to survive multiple cancers and potentially improve their responsiveness to treatment.' Alternatively, 'Patients who develop a second primary cancer have already demonstrated resilience, having endured the physical and emotional challenges of their initial cancer treatment. This experience may reflect a stronger baseline health status and the benefits of previous successful interventions, contributing to potentially better survival outcomes compared with those facing cancer for the first time.' Wignakumar had no disclosures.
