The prognostic role of sex, race, and human papillomavirus in oropharyngeal and nonoropharyngeal head and neck squamous cell cancerBACKGROUND: Human papillomavirus (HPV) is a well-established prognostic marker for oropharyngeal squamous cell cancer (OPSCC). Because of the limited numbers of women and nonwhites in studies to date, sex and racial/ethnic differences in prognosis have not been well explored. In this study, survival differences were explored by the tumor HPV status among 1) patients with OPSCCs by sex and race and 2) patients with nonoropharyngeal (non-OP) head and neck squamous cell cancers (HNSCCs). METHODS: This retrospective, multi-institution study included OPSCCs and non-OP HNSCCs of the oral cavity, larynx, and nasopharynx diagnosed from 1995 to 2012. Race/ethnicity was categorized as white non-Hispanic, black non-Hispanic, Asian non-Hispanic, and Hispanic of any race. Tumors were centrally tested for p16 overexpression and the presence of HPV by HPV16 DNA and high-risk HPV E6/E7 messenger RNA in situ hybridization. Kaplan-Meier and Cox proportional hazards models were used to evaluate overall survival (OS). RESULTS: The study population included 239 patients with OPSCC and 621 patients with non-OP HNSCC with a median follow-up time of 3.5 years. After adjustments for the tumor HPV status, age, current tobacco use, and stage, the risk of death was lower for women versus men with OPSCC (adjusted hazard ratio, 0.55; P = .04). The results were similar with p16. In contrast, for non-OP HNSCCs, HPV positivity, p16 positivity, and sex were not associated with OS. CONCLUSIONS: For OPSCC, there are differences in survival by sex, even after the tumor HPV status has been taken into account. For non-OP HNSCC, the HPV status and the p16 status are not of prognostic significance. Cancer 2017;123:1566-1575. © 2017 American Cancer Society.
The Limitations of Poor Broadband Internet Access for Telemedicine Use in Rural America: An Observational StudyLetters3 September 2019The Limitations of Poor Broadband Internet Access for Telemedicine Use in Rural America: An Observational StudyColeman Drake, PhD, Yuehan Zhang, ScM, Krisda H. Chaiyachati, MD, MPH, MSHP, and Daniel Polsky, PhDColeman Drake, PhDUniversity of Pittsburgh, Pittsburgh, Pennsylvania (C.D.), Yuehan Zhang, ScMUniversity of Pennsylvania, Philadelphia, Pennsylvania (Y.Z., K.H.C.), Krisda H. Chaiyachati, MD, MPH, MSHPUniversity of Pennsylvania, Philadelphia, Pennsylvania (Y.Z., K.H.C.), and Daniel Polsky, PhDJohns Hopkins University, Baltimore, Maryland (D.P.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-0283 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Fewer than 10% of U.S. physicians practice in rural communities, where 25% of Americans live (1). Yet, rural Americans may need more health care as they become increasingly older and sicker relative to their urban counterparts (2). Telemedicine has been proposed as a solution to improve access to care (3). Federal and state policymakers have enacted policies to expand telemedicine use among publicly and commercially insured beneficiaries. However, whether Americans with the poorest access to care have the necessary broadband Internet capability to fully benefit from telemedicine is unknown.Objective: To identify whether Americans with inadequate access to primary ...References1. Sharp D, Bond M, Cheek K, Wolff H. Quality of Life Impacts the Recruitment and Retention of Rural Health Care Providers. National Rural Health Association Policy Brief. Accessed at www.ruralhealthweb.org/getattachment/Advocate/Policy-Documents/QualityofLifeRecruitmentRetentionProvidersFeb2015.pdf.aspx?lang=en-US on 20 December 2018. Google Scholar2. University of North Carolina, Cecil G. Sheps Center for Health Services Research. NC Rural Health Research Program. Accessed at www.shepscenter.unc.edu/programs-projects/rural-health on 23 December 2018. Google Scholar3. Mehrotra A, Jena AB, Busch AB, Souza J, Uscher-Pines L, Landon BE. Utilization of telemedicine among rural medicare beneficiaries. JAMA. 2016;315:2015-6. [PMID: 27163991] doi:10.1001/jama.2016.2186 CrossrefMedlineGoogle Scholar4. Gresenz CR, Auerbach DI, Duarte F. Opportunities and challenges in supply-side simulation: physician-based models. Health Serv Res. 2013;48:696-712. [PMID: 23347041] doi:10.1111/1475-6773.12029 CrossrefMedlineGoogle Scholar5. Federal Communications Commission, Connect2HealthFCC. Data. Accessed at www.fcc.gov/reports-research/maps/connect2health/data.html on 23 January 2019. Google Scholar Author, Article, and Disclosure InformationAffiliations: University of Pittsburgh, Pittsburgh, Pennsylvania (C.D.)University of Pennsylvania, Philadelphia, Pennsylvania (Y.Z., K.H.C.)Johns Hopkins University, Baltimore, Maryland (D.P.)See Also: Editorial commentDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-0283.Reproducible Research Statement: Study protocol, statistical code, and data set: Not available.This article was published at Annals.org on 21 May 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoLeveraging Telehealth to Improve Health Care Access in Rural America: It Takes More Than Bandwidth Bruce Baird Struminger and Sanjeev Arora Metrics Cited byImpact of Reducing Data Plan Costs on the Digital Divide in China: A Digital Lifestyles PerspectiveLeveraging Every Door Direct Mail for remote recruitment of a rural Appalachian study Sample: Response rate and representativenessDisparities in Telemedicine Use Among Louisiana Medicaid Beneficiaries During the COVID-19 PandemicUsing data analytics for telehealth utilization: A case study in ArkansasRates of Primary Care and Integrated Mental Health Telemedicine Visits Between Rural and Urban Veterans Affairs Beneficiaries Before and After the Onset of the COVID-19 PandemicRemote patient monitoring using artificial intelligence: Current state, applications, and challengesDo Americans Lacking a Local Orthopaedic Surgeon Have Adequate Broadband for Telehealth?Neurotology Workforce in the United States: Gender Diversity and Geographic DistributionBroadband access within Medically Underserved Areas and its implication for telehealth utilizationAccess to technology to support telehealth in areas without specialty care for liver diseaseBroadband access and telemedicine adoption for opioid use disorder treatment in the United StatesAssociation of internet access and inability to access health care during the COVID-19 pandemic 2020–2021Racial and ethnic disparities in outcomes after NICU discharge: An equity-focused modelAssociation Between Broadband Capacity and Social Vulnerability Factors in the United States: A County-Level Spatial AnalysisAssessing Telehealth Through the Lens of the Provider: Considerations for the Post-COVID-19 EraThe Rural Opioid Initiative Consortium description: providing evidence to Understand the Fourth Wave of the Opioid CrisisTelemedicine Satisfaction and Preferences in an Orthopaedic Spine ClinicFraming Disparities in Access to Medical Speech-Language Pathology Care in Rural AlabamaAre Mobile Applications in Laryngology Designed for All Patients?Testosterone replacement therapy in the era of telemedicineAdapting a Telehealth Network for Emergency COVID-19 Pandemic Response, 2020-2021Implications of video chat use for young children's learning and social–emotional development: Learning words, taking turns, and fostering familial relationshipsSustainability of Network Infrastructure in a Geospatial Resilience ContextPrevalence of Alzheimer's disease and related dementias among veterans experiencing housing insecurityThe effect of broadband access on electronic patient engagement activities: Assessment of urban‐rural differencesDeterminants of Telehealth Service Use among Mental Health Patients: A Case of Rural LouisianaAttitudes toward telemedicine among urban and rural residentsInternet use and subsequent health and well-being in older adults: An outcome-wide analysisProtocol for the IMPACT Trial: Improving Healthcare Outcomes in American Transplant Recipients Using Culturally-Tailored Novel TechnologyTelehealthPolicy Considerations To Ensure Telemedicine EquityAssessment of a Student-Run Free Gender-Affirming Care Clinic's Transition to TelehealthTelehealth experiences of vulnerable clients living in TasmaniaPerceptions of the impact of COVID-19 on healthcare communication in a nationally representative cross-sectional survey of family caregiversUsing the technology acceptance model to examine acceptance of telemedicine by cancer patients in an ambulatory care settingFactors supporting availability of home-based Neuromodulation using remote supervision in middle-income countries; Brazil experienceTraditional Versus Digital Media–Based Hand Therapy After Distal Radius FractureSocial Work Answers the (Video) Call: Tele-Behavioral Health Use During COVID-19The environmental impacts of telemedicine in place of face-to-face patient care: a systematic reviewTelehealth in cancer care during COVID-19: disparities by age, race/ethnicity, and residential statusPractice Patterns, Work Environments, and Job Outcomes of Rural and Urban Primary Care Nurse PractitionersDo Not Give Up Your Stethoscopes Yet—Telemedicine for Chronic Respiratory Diseases in the Era of COVID-19Age and Medicare Insurance are Barriers to Telemedicine Access—A Quality Improvement ProjectTelehealth: Reaching Out to Patients and ProvidersTechnology, Equity, and Inclusion in the Virtual Education SpaceArtificial Intelligence in Telemedicine: A Brief SurveyImproving Sexual Health in U.S. Rural Communities: Reducing the Impact of StigmaDisparities in telehealth utilization in patients with pain during COVID-19Health Care Disparities Across the Urban‐Rural Divide: A National Study of Individuals with COPDPromoting Whole Health and Well-Being at Home: Veteran and Provider Perspectives on the Impact of Tele-Whole Health ServicesUse and impact of virtual primary care on quality and safety: The public's perspectives during the COVID-19 pandemicEvaluating factors of greater patient satisfaction with outpatient cardiology telehealth visits during the COVID-19 pandemicEvaluating barriers to and promoters of telehealth during the COVID-19 pandemic at U.S. cystic fibrosis programsThe Association of Broadband Internet Access and Telemedicine Utilization in rural Western Tennessee: an observational studyThe Fourth Industrial Revolution: Exploring the Determinants of Internet Access in Emerging EconomiesThe fourth wave of the US opioid epidemic and its implications for the rural US: A federal perspectivePromise and Perils of Telehealth in the Current EraUse of telehealth in home nutrition support: Challenges and advantagesSocial-ecological considerations for the sleep health of rural mothersPre-existing Disparities and Potential Implications for the Rapid Expansion of Telemedicine in Response to the Coronavirus Disease 2019 PandemicThe Unique Challenges Facing Rural Providers in the COVID-19 PandemicRapid Implementation of Outpatient Teleneurology in Rural AppalachiaEffects of telemedicine triage on efficiency and cost-effectiveness in spinal careProvider Perceptions of Virtual Care During the Coronavirus Disease 2019 PandemicImproving Access to Care: Telemedicine Across Medical DomainsExploring Pediatric Tele-Rheumatology Practices During COVID-19: A Survey of the PRCOIN NetworkA Blueprint for the Conduct of Large, Multisite Trials in TelemedicineDifferences in Secure Messaging, Self-management, and Glycemic Control Between Rural and Urban Patients: Secondary Data AnalysisDeterminants of rural-urban differences in health care provider visits among women of reproductive age in the United StatesImplementation and Patient Satisfaction of Telemedicine in Spine Physical Medicine and Rehabilitation Patients During the COVID-19 ShutdownDesigning Futuristic Telemedicine Using Artificial Intelligence and Robotics in the COVID-19 EraQualitative Assessment of Rapid System Transformation to Primary Care Video Visits at an Academic Medical CenterMalathi Srinivasan, MD, Steven Asch, MD, MPH, Stacie Vilendrer, MD, MBA, Samuel Crandall Thomas, MD, MS, Rika Bajra, MD, Linda Barman, MD, MPH, Lauren Michelle Edwards, MD, Heather Filipowicz, MS, Lena Giang, MPH, Olivia Jee, MD, Megan Mahoney, MD, Ian Nelligan, MD, Anuradha Jayant Phadke, MD, Elise Torres, MD, and Maja Artandi, MDExpanded use of teleservices in otology and neurotology in response to the COVID ‐19 ( SARS‐Cov ‐2) pandemicState broadband policy: Impacts on availabilityTelehealth, Rural America, and the Digital DivideCOVID-19 and US Health Financing: Perils and PossibilitiesTelehealth in urology after the COVID-19 pandemicPatient Characteristics Associated With Choosing a Telemedicine Visit vs Office Visit With the Same Primary Care CliniciansTechnology-facilitated care coordination in rural areas: What is needed?Telehealth: Is It Only for the Rural Areas? A Review of Its Wider UseMarket Share of US Catholic Hospitals and Associated Geographic Network Access to Reproductive Health ServicesConnected Subspecialty Care: Applying Telehealth Strategies to Specific Referral BarriersPerformance Analysis of Mobile Broadband Networks With 5G Trends and Beyond: Rural Areas Scope in MalaysiaPractice-Level Variation in Telemedicine Use in a Pediatric Primary Care Network During the COVID-19 Pandemic: Retrospective Analysis and Survey StudyLeveraging Telehealth to Improve Health Care Access in Rural America: It Takes More Than BandwidthBruce Baird Struminger, MD, MA and Sanjeev Arora, MD 3 September 2019Volume 171, Issue 5Page: 382-384KeywordsDisclosureHealth care facilitiesInternetMedicarePopulation densityPrimary care physiciansPublic policyRural areasStatistical dataTelemedicine ePublished: 12 May 2019 Issue Published: 3 September 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
“It still affects our economic situation”: long-term economic burden of breast cancer and lymphedemaPURPOSE: Financial toxicity after breast cancer may be exacerbated by adverse treatment effects, like breast cancer-related lymphedema. As the first study of long-term out-of-pocket costs for breast cancer survivors in the USA with lymphedema, this mixed methods study compares out-of-pocket costs for breast cancer survivors with and without lymphedema. METHODS: In 2015, 129 breast cancer survivors from Pennsylvania and New Jersey completed surveys on demographics, economically burdensome events since cancer diagnosis, cancer treatment factors, insurance, and comorbidities; and prospective monthly out-of-pocket cost diaries over 12 months. Forty participants completed in-person semi-structured interviews. GLM regression predicted annual dollar amount estimates. RESULTS: 46.5% of participants had lymphedema. Mean age was 63 years (SD = 8). Average time since cancer diagnosis was 12 years (SD = 5). Over 98% had insurance. Annual adjusted health-related out-of-pocket costs excluding productivity losses totaled $2306 compared to $1090 (p = 0.006) for those without lymphedema, or including productivity losses, $3325 compared to $2792 (p = 0.55). Interviews suggested that the cascading nature of economic burden on long-term savings and work opportunities, and insufficiency of insurance to cover lymphedema-related needs drove cost differences. Higher costs delayed retirement, reduced employment, and increased inability to access lymphedema care. CONCLUSIONS: Long-term cancer survivors with lymphedema may face up to 112% higher out-of-pocket costs than those without lymphedema, which influences lymphedema management, and has lasting impact on savings and productivity. Findings reinforce the need for actions at policy, provider, and individual patient levels, to reduce lymphedema costs. Future work should explore patient-driven recommendations to reduce economic burden after cancer.
Projected Association of Human Papillomavirus Vaccination With Oropharynx Cancer Incidence in the US, 2020-2045IMPORTANCE: Oropharynx cancer (OPC) incidence has increased for several decades in the US. It is unclear when and how this trend will be affected by current HPV vaccination trends. OBJECTIVE: To assess the association of HPV vaccination with future OPC incidence in the US. DESIGN, SETTING, AND PARTICIPANTS: This population-based age-period-cohort analysis obtained OPC incidence data from the Surveillance, Epidemiology, and End Results program from 69 562 patients 34 to 83 years of age diagnosed with OPC. The HPV vaccination data were obtained from the National Immunization Survey-Teen (60 124 participants) and National Health Interview Survey (16 904 participants). Data were collected from January 1, 1992, to December 31, 2017. Age-period-cohort forecasting models projected expected 2018 to 2045 OPC incidence under a counterfactual scenario of no HPV vaccination and current levels of HPV vaccination, stratifying by sex. Data analyses were completed by December 2020. EXPOSURES: Age- and sex-specific cumulative prevalence of HPV vaccination in 2016 to 2017 projected forward. MAIN OUTCOMES AND MEASURES: Projected OPC incidence and number of OPC cases expected to be prevented by HPV vaccination. RESULTS: Under current HPV vaccination rates, between 2018 and 2045, OPC incidence is projected to decrease in younger individuals (36-45 years of age: from 1.4 to 0.8 per 100 000 population; 46-55 years of age: from 8.7 to 7.2 per 100 000 population) but continue to increase among older individuals (70-83 years of age: from 16.8 to 29.0 per 100 000 population). The association of HPV vaccination with overall OPC incidence through 2045 will remain modest (no vaccination vs vaccination: 14.3 vs 13.8 per 100 000 population in 2045). By 2045 HPV vaccination is projected to reduce OPC incidence among individuals 36 to 45 years of age (men: 48.1%; women: 42.5%) and 46 to 55 years of age (men: 9.0%; women: 22.6%), but among those 56 years or older, rates are not meaningfully reduced. Between 2018 and 2045, a total of 6334 OPC cases will be prevented by HPV vaccination, of which 88.8% of such cases occur in younger age (≤55 years) groups. CONCLUSIONS AND RELEVANCE: According to the projections of this population-based age-period-cohort study, current HPV vaccination rates will have a limited association with overall OPC incidence through 2045 because older individuals who have not yet been vaccinated remain at high risk for OPC. However, reductions in OPC incidence should occur among young and middle-aged adults, the group at lowest risk of diagnosis. These findings forecast a continued shift in the landscape of OPC to an older population.