The budget impact mainly derived from colonoscopy-related costs incurred for the high-risk group. The effectiveness of FIT to detect CRC was critically dependent on follow-up after positive FIT. Community cancer prevention programs need reliable estimates of the cost of CRC screening promotion and the added budget impact of screening with colonoscopy.

Compared with standard TRUS-BX, the additions of imaging, sedation anesthesia, and transperineal template increase costs significantly, and can be considered along with known improvements in accuracy and side effects. Ongoing efforts to combine imaging and transperineal biopsy, especially in an outpatient/local anesthesia setting may lead to a higher cost/benefit.

Background: The economic burden of renal cell carcinoma (RCC) had been reported to be significant in a previous review published in 2011. The objective of this study is to perform an updated review by synthesizing economic studies related to the treatment of RCC that were published since the previous review. Methods: We performed a literature search in PubMed, EMBASE, and the Cochrane Library, covering English-language studies published between June 2010 and August 2018. We categorized these articles by type of analyses (cost-effectiveness analysis (CEA), cost analysis, and cost of illness (COI)) and treatment setting (cancer status and treatment), discussed findings from these articles, and synthesized information from each article in summary tables. Results: We identified 52 studies from 2,317 abstracts/titles deemed relevant from the initial search, including 21 CEA, 23 cost, and 8 COI studies. For localized RCC, costs were found to be positively associated with the aggressiveness of the local treatment. For metastatic RCC (mRCC), pazopanib was reported to be cost-effective in the 1st-line setting. We also found that the economic burden of RCC has increased over time. Conclusion: RCC continues to impose a substantial economic burden to the healthcare system. Despite the large number of treatment alternatives now available for advanced RCC, the costeffectiveness and budgetary impact of many new agents remain unknown and warrant greater attention in future research.

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PURPOSE: To examine the geographic distribution of physician and pharmacist workforce specialized in oncology in the United States. METHODS: Using the National Provider Identifier data, we identified two types of oncology workforce via the healthcare provider taxonomy codes. Oncologists were physicians self-identified as providing oncologic care to patients. Oncology pharmacists were pharmacists with an oncology subspecialty. We calculated the geographic density of physician and pharmacist oncology workforce and used county-level cancer crude rates to quantify the demand for oncology workforce. We used spatial data to plot the density of oncology workforces relative to county-level cancer rates and compared the county-level density of oncologists and oncology pharmacists. RESULTS: Of the 30,553 members of the oncology workforce in 2019, 28,681 were oncologists and 1,090 were oncology pharmacists. The mean county-level density of oncologists was 2.94 (SD = 7.32) per 100,000 persons. Sixty-four percent of counties had no oncologists with primary practice location in that county and 12% had no oncologists in the local and adjacent counties. Counties in the top quartile of cancer rates had the highest percentage without any oncologists with primary practice location in the county (75%) and with no oncologists in the local as well as adjacent counties (16%). CONCLUSION: Geographically mismatched demand and supply characterized the current oncology workforce. Wide discrepancies in the supply of oncologists across geographic regions highlight the importance of developing core competencies for health professions not specialized in oncology to deliver quality cancer care in areas with unmet need for oncology care.

Purpose There is little data to support the use of varying imaging modalities in evaluating recurrence in non-small cell lung cancer (NSCLC). We compared the efficacy of surveillance PET/CT vs. CT scans of the chest in detecting recurrences following definitive radiation for NSCLC. Materials/Methods We retrospectively analyzed 200 patients treated between 2000–2011 that met the inclusion criteria of stage III NSCLC, completion of definitive radiation treatment, and absence of recurrence within the initial 6 months. These patients were then grouped based on the use of PET/CT imaging during post-radiation surveillance. Patients who received ≥1 PET/CT scans within 6 months of the end of radiation treatment were placed in the PET-group while all others were placed in the CT-group. We compared survival times from the end of treatment to the date of death or last follow-up utilizing log-rank tests. Multivariate analysis was conducted to identify factors associated with decreased survival. Results In the entire cohort, median event-free survival (EFS) was 26.7 months, and median overall survival (OS) was 41.2 months. The CT-group had a median EFS of 21.4 months vs. 29.4 months for the PET-group (p=0.59). There was no difference in OS between the CT- and PET-groups (median OS of 41.2 and 41.3 months, respectively, p=0.59). There was also no difference in local recurrence-free survival or distant metastases-free survival between the CT-only and PET-high groups (p=0.92 and p=0.30, respectively). Similarly, on multivariate analysis, stratification into the PET-group was not associated with improved EFS (HR: 0.90, 95% CI: 0.61–1.34, p=0.60) or OS (HR: 1.2, 95% CI: 0.83–1.7, p=0.34). Conclusions In stage III NSCLC patients treated with definitive radiation and without early recurrence, PET/CT scan surveillance did not result in decreased time to detection of locoregional or distant recurrence or improved survival.

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