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SEER*Stat Tools Webinars

A series of webinars highlighting SEER data, software and web tools, and statistical methods.

2022

Lung cancer rates decrease in people living with HIV, according to SEER dataExternal Web Site Policy

October, 2022 – The Lancet

Infection with the human immunodeficiency virus (HIV) makes a person more vulnerable to other infections, diseases, and cancers according to the National Cancer Institute (NCI). However, advances in treatments for HIV, in addition to extending lifetimes, may help lower the risk of cancer. Investigators, including researchers at the NCI’s Division of Cancer Epidemiology and Genetics, used data from the Surveillance, Epidemiology, and End Results (SEER) Program and the HIV/AIDS Cancer Match study to explore how rates of lung cancer in HIV-positive people have changed from 2001 to 2016.

The investigators found that rates of lung cancer in HIV-positive people decreased by 6% each year from 2001 to 2016. However, compared with the rest of the population, rates of lung cancer were 48% higher for HIV-positive people between 2013 and 2016. Smoking is one of the primary risk factors for lung cancer, and the researchers note smoking rates in HIV-positive people are higher than the general population. However, the decreased immunity and increased inflammation associated with HIV infection may also be responsible for these higher overall risks. They add that the risk of lung cancer for this group will continue to increase with age as more HIV-positive people live longer due to effective HIV treatment programs. The investigators call for more prevention and early detection strategies to reduce lung cancer disparities for people living with HIV.

Oral Anticancer Medication Costs Increasing for Medicare BeneficiariesExternal Web Site Policy

September 13, 2022 – JCO Oncology Practice

Targeted oral anticancer medicines are therapies that patients can take at home, instead of at a hospital, to treat cancer. According to the National Cancer Institute (NCI), these medications target proteins in cancer cells that affect how the cell grows, divides, and spreads. In a recent JCO Oncology Practice publication, researchers at the University of Texas MD Anderson—who were partially funded by NCI’s Surveillance Research Program—explored how costs for these medications changed from 2011 to 2016.

The researchers used the Surveillance, Epidemiology, and End Results (SEER) – Medicare linked dataset to study the trends in costs of targeted oral anticancer medicines from 2011 to 2016. This linked dataset combines SEER’s cancer data, such as new case rates, survival, and mortality, with Medicare’s cost information for health services. From the entire de-identified SEER-Medicare dataset, the researchers studied only those patients who met all the following criteria: 1) aged 65 or older, 2) diagnosed with cancer between 2011 and 2016, 3) enrolled in Medicare Part D coverage, 4) did not receive low-income subsidies, and 5) received oral anticancer therapy.

The investigators found rates of patients treated with these medications more than doubled between 2011 and 2016, from 3.6% to 8.9%. The number of patients taking these medications who reached catastrophic Medicare coverage after meeting an out-of-pocket spending threshold (for example, $4,850 out-of-pocket in 2016) increased from 54.6% to 60.3%. In this coverage phase, Medicare will pay 95% of the cost of the drug for the rest of the year. However, even after receiving catastrophic coverage, average patient out-of-pocket costs increased from $596 in 2011 to $2,549 in 2016. The investigators call for caps on patient out-of-pocket drug spending and control of drug prices.

Costs of cancer increased for first year of diagnosis between 2009-2016External Web Site Policy

September 13, 2022 – Journal of the National Cancer Institute

A cancer diagnosis can be a long-term burden for patients on multiple fronts, including both health and finances. According to the 2021 Annual Report to the Nation on the Status of Cancer, the total cost of cancer in 2019 was $21 billion. Costs related to cancer are expected to increase with both growing and aging populations in the United States. To understand how those costs might increase in the future, researchers at the University of Texas MD Anderson Cancer Center, partially funded by NCI’s Surveillance Research Program, studied trends in total and out-of-pocket costs for privately-insured and nonelderly breast, colorectal, lung, and prostate cancer patients between 2009 and 2016 who were within their first year since diagnosis.

From a de-identified dataset representing approximately 28% of Americans with employer-sponsored private insurance, the investigators found 105,255 cases of breast cancer, 23,571 cases of colorectal cancer, 11,321 cases of lung cancer, and 59,197 cases of prostate cancer were diagnosed between 2009 and 2016. The average total cost—the sum of insurance and out-of-pocket payments—increased by 29% for breast cancer, 11% for lung cancer, and 4% for prostate cancer during this period. The out-of-pocket costs paid by patients with these four cancers increased to over $6,000, which is more than a 15% increase from 2009 to 2016. The researchers note that in 2018, 40% of adults had high-deductible employee-based health insurance and some deductibles were as high as $6,750. A cancer diagnosis, especially for those with high-deductible insurance plans, could bring financial hardship. The investigators call for changes to cost-sharing in insurance to address rising cancer costs.

SEER data shows disparities with distant cervical cancerExternal Web Site Policy

August 18, 2022 – International Journal of Gynecological Cancer

Cervical cancer can be effectively prevented through the human papillomavirus (HPV) vaccine, which protects against most high-risk strains of HPV that are linked to multiple different cancers. Routine screening for cervical cancer can detect the disease in its early—and more treatable—stages. Despite these strategies, 16% of all new cervical cancer cases are diagnosed at the distant stage, meaning the cancer has spread to organs and tissues far away from the cervix, and the rate is increasing. Researchers at the University of California, Los Angeles, used the Surveillance, Epidemiology, and End Results (SEER) Program to explore these trends in distant cervical cancer between 2001 and 2018 by factors like race and ethnicity, age, and geographic region.

During the 18-year period, the researchers found more detailed evidence of cancer health disparities—the disproportionate burden of cancer on certain groups—for distant cervical cancer. 29,715 women were diagnosed during this time, with higher rates for Black (1.55 cases per 100,000) and Hispanic (1.01 cases per 100,000) women compared to White women (0.92 cases per 100,000). The researchers found that Black women living in the South between 55-59 years of age had the highest overall rate of new cases at 2.61 cases per 100,000, compared to White women in the same region and age group (1.39 cases per 100,000). However, White women between 40-44 years who lived in the South during this time had the fastest increase in distant cervical cancer diagnoses at 4.5% per year.

Between 2001 and 2018, overall rates of distant cervical cancer increased by 1.3% per year. Screening and prevention varied by race. Teenaged White women have the lowest rate of HPV vaccination—66.1%–while teenaged Hispanic and Black women have the highest rates. White women were also twice as likely to go longer than 5 years between cervical cancer screenings compared to Black women. Despite better implementation of screening and prevention strategies, Black women still suffer from higher rates of distant cervical cancer.

Years of life and income lost due to smoking-related cancer deathExternal Web Site Policy

August 10, 2022 – International Journal of Cancer

Smoking is one of the leading causes of cancer of the lung, esophagus, larynx, mouth, throat, kidney, bladder, liver, pancreas, stomach, cervix, colon, and rectum. Despite smoking rates falling in the United States, about 30% of all cancer deaths are still associated with smoking, according to a study that used Surveillance, Epidemiology, and End Results (SEER) Program data. The researchers estimated the total number of life-years—or the amount of time a person would have lived had they not died prematurely—and earnings lost due to these smoking-related cancer deaths. They also examined these rates by state, including the weaker control policy and higher smoking prevalence “Tobacco Nation” states of Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Oklahoma, South Carolina, Tennessee, and West Virginia.

Of 418,563 cancer deaths among people between the ages of 25-79 in 2019, 122,951 deaths were linked to smoking. The researchers estimated these deaths added up to over 2.1 million years of life lost and nearly $21 billion in lost earnings. On average, each smoking-related cancer death meant $170,000 in lost earnings. Lung cancer was responsible for most of the lost life-years (68.7%) and earnings (61.7%). Losses in life-years and income were also higher for men than women. The combined lost earning rate in all 13 “Tobacco Nation” states was 44% higher compared to the lost earning rates from all other states and DC combined. The rate of lost life-years was also 47% higher in these Tobacco Nation states. The investigators call for more smoke-free laws, smoking prevention and cessation policies, and expanded access to cancer screening and care to reduce the amount of earnings and life-years lost to smoking-related cancer deaths.

Risk for ovarian cancer reduced by frequent aspirin useExternal Web Site Policy

July 22, 2022 – Journal of Clinical Oncology

Chemoprevention is the use of drugs or other substances to help lower a person’s risk of developing cancer or to keep cancer from returning, according to the National Cancer Institute Dictionary. A new study in the Journal of Clinical Oncology shows frequent aspirin use may be a chemoprevention method for ovarian cancer.

The researchers combined data—including data from the Surveillance, Epidemiology, and End Results (SEER) Program—from 17 studies to investigate the relationship between frequent aspirin use and ovarian cancer risk. Overall, the researchers found that women who took aspirin at least six days a week for six months or more reduced their risk of ovarian cancer by 13%. Women both at higher and lower risk for ovarian cancer, which includes factors such as obesity, family history, and oral contraceptive use, saw reduced risk for ovarian cancer associated with frequent aspirin use. The researchers suggest future studies should examine how frequent aspirin use could complement current ovarian cancer prevention strategies.

Systemic and Structural Racism with Breast Biopsy DelaysExternal Web Site Policy

June 23, 2022 – JAMA Network

When cancer is diagnosed in its early stages, it is usually easier to treat and results in better outcomes for the patient, such as a higher survival rate and fewer complications from treatment. Screening mammography can detect breast cancer in early stages. However, even if a potential cancer is detected, there may be delays between detection and diagnosis that can result in later-stage disease.

In a study partially funded by the Surveillance Research Program (SRP), researchers examined the cases of over 45,000 women who had mammograms that required biopsy follow-up visits. They compared these cases with demographic, socioeconomic, and residential data for the women to understand whether systemic racism influenced biopsy delays. The investigators found that, compared to White women, Asian, Black, and Hispanic women had an increased risk of not having a biopsy within 30 to 60 days after their suspicious mammogram. Black women also had a risk of no follow-up biopsy within 90 days. The researchers suggest that systemic racism—which includes factors such as health insurance coverage and reimbursement policies—in addition to structural racism outside the health care system, may have contributed to their findings.

New study finds over 18 million cancer survivors in US in 2022External Web Site Policy

June 23, 2022 – American Cancer Society

Every three years, the American Cancer Society and National Cancer Institute collaborate on a report to better understand the population of cancer survivors in the United States. Two DCCPS scientists—Dr. Theresa Devasia and Dr. Angela Mariotto—contributed to this study, which also included data from the Surveillance, Epidemiology, and End Results (SEER) Program and other cancer registries.

The investigators found that over 18 million Americans with a history of cancer were alive on January 1, 2022. Among men, the three cancers with the most cases were prostate (3.5 million cases), melanoma of the skin (760,000 cases), and colon and rectum (726,000 cases). Among women, the three most common cancers were breast (4 million cases), uterine (891,000 cases), and thyroid (823,000 cases). Overall, two-thirds of cancer survivors were 65 years or older and more than half of survivors were diagnosed in the last 10 years.

The investigators also explored racial disparities and examined whether COVID-19 negatively affected cancer care. The investigators found that Black patients had lower 5-year survival rates than White patients for most cancers. This disparity is likely driven by unequal access to care as well as a lack of diversity in the health care workforce and in clinical trials. About one in four cancer patients experienced treatment delays due to the COVID-19 pandemic and many survivors experienced reduced contact with health care providers. Cancer survivors also delayed their own care during the pandemic, either for fear of contracting COVID-19 or because of financial difficulties.

SEER study examines survival increases from colorectal cancer clinical trialsExternal Web Site Policy

May 24, 2022 – JAMA Network

The 5-year survival rate, which measures how many patients have not died 5 years after diagnosis is highest for cancers diagnosed in the localized stage. Localized disease, meaning the cancer has not spread from the organ it was first detected in, is usually the easiest to treat. When cancer has metastasized—or spread to other distant organs and tissues in the body—the 5-year survival rate decreases. At these late stages, clinical trials may be the best option for treating cancer. Researchers from Penn State College of Medicine and MD Anderson Cancer Center used the Surveillance, Epidemiology, and End Results (SEER) Program datasets to study if clinical trials increased survival rates for patients with metastatic colorectal cancer between 1986 and 2016.

The investigators reviewed 150 phase III clinical trials, which are trials to explore if a treatment or therapy is better than the current standard treatment. Only 35 of 132 trials improved overall survival by 2 months or more. The researchers found that overall survival increased by 5.7 months every 10 years, from a median of 12 months between 1986-1996 to 21 months between 2007-2015. Trials that were funded by pharmaceutical companies were less likely to be associated with 2 or more months of overall survival improvement, while trials funded solely by nonprofit organizations had a higher chance of positive outcomes. However, the researchers note that all improvements observed in these trials were incremental. They call for future clinical trials to aim for larger gains with novel drugs, more sophisticated research tools, and application of new understandings of metastatic colorectal cancer biology.

Veterans more likely to develop regional and distant melanomaExternal Web Site Policy

May 17, 2022 – Journal of the American Academy of Dermatology

Melanoma is the fifth most common cancer in the United States. When melanoma is diagnosed at the localized stage, meaning the disease has not spread from where it first developed, the five-year survival rate is 99.5%. This survival rate means that over 99% of people diagnosed with localized melanoma will not have died from the disease five years after diagnosis (excluding the risk of death from other causes). However, the survival rate drops for melanoma diagnosed at regional and distant stages.

Cancer cases among veterans may be underrepresented in SEER data, as the Veterans Health Administration—which provides cancer care to many veterans—has often been underrepresented in national datasets. Compared to the rest of the population, veterans are exposed to higher levels of ultraviolet (UV) and ionizing radiation—major risk factors for melanoma—during service. Researchers from Harvard Medical School analyzed data from SEER and the Veterans Affairs Cancer Registry (VACR) to compare the statistics for melanoma among veterans to melanoma among the general population.

The researchers found that, compared with patients in SEER, veterans in VACR were more likely to be diagnosed with advanced-stage disease and those younger than 80 years were also less likely to survive 5 years. However, the researchers also found that new immunotherapy treatments for melanoma increased the survival rate for veterans more than they did for the general population.

SEER study explores uterine cancer mortality by stage, subtype, race, and ethnicityExternal Web Site Policy

May 5, 2022 – JAMA Network

Cancer health disparities are differences between population groups on cancer measures such as incidence, prevalence, mortality, and survival. For example, the mortality rate for uterine cancer is twice as high for Black women compared to White women. However, previous studies of uterine cancer have not investigated stage- and subtype-specific mortality rates stratified by race and ethnicity. A recent publication in JAMA Oncology from the National Cancer Institute’s Division of Cancer Epidemiology and Genetics used data from the Surveillance, Epidemiology, and End Results (SEER) Program to explore these mortality rates.

The investigators analyzed de-identified uterine cancer incidence data from 2000 to 2017 and mortality data from 2010 to 2017. Stage and subtype data were included as well. Overall, the uterine cancer mortality rate increased by 1.8% per year from 2010 to 2017. While the mortality rate for the nonendometrioid subtype—which is more aggressive—increased by 2.7% per year over the same period, the mortality rate for the less-aggressive endometrioid subtype remained stable.

Disparities emerge with the analysis of uterine cancer mortality by race and ethnicity. The mortality rate for uterine cancer overall (both subtypes combined), as well as the nonendometrioid subtype, was twice as high for Black women compared to other racial and ethnic groups. For both subtypes, the mortality rate was higher for Black women across all stages compared to other racial and ethnic groups. Between 2010 and 2017, mortality rates for the nonendometrioid subtype increased fastest for Hispanic women, followed by Black, Asian, and White women. The rising rates of this subtype may explain rising uterine cancer mortality overall; however, the disparities experienced by Black women are due to more than higher rates of aggressive disease. The investigators call for further research into the nonendometrioid subtype, treatment and screening strategies, and mitigation of factors at the health care system and patient levels that contribute to uterine cancer disparities.

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