This cross-sectional study analyzes patterns in the rates of routine screening and diagnosis for breast, cervical, and colorectal cancer before and after the COVID-19 pandemic.
Flare frequency distributions represent a key approach to addressing one of the largest problems in solar and stellar physics: determining the mechanism that counterintuitively heats coronae to temperatures that are orders of magnitude hotter than the corresponding photospheres. It is widely accepted that the magnetic field is responsible for the heating, but there are two competing mechanisms that could explain it: nanoflares or Alfvén waves. To date, neither can be directly observed. Nanoflares are, by definition, extremely small, but their aggregate energy release could represent a substantial heating mechanism, presuming they are sufficiently abundant. One way to test this presumption is via the flare frequency distribution, which describes how often flares of various energies occur. If the slope of the power law fitting the flare frequency distribution is above a critical threshold, α = 2 as established in prior literature, then there should be a sufficient abundance of nanoflares to explain coronal heating. We performed >600 case studies of solar flares, made possible by an unprecedented number of data analysts via three semesters of an undergraduate physics laboratory course. This allowed us to include two crucial, but nontrivial, analysis methods: preflare baseline subtraction and computation of the flare energy, which requires determining flare start and stop times. We aggregated the results of these analyses into a statistical study to determine that α = 1.63 ± 0.03. This is below the critical threshold, suggesting that Alfvén waves are an important driver of coronal heating.
10573 Background: The COVID-19 pandemic caused significant disruptions to healthcare delivery in the US due to mandatory stay-at-home orders and patient fears about visiting healthcare facilities. A logical consequence, many forms of healthcare use, including cancer screenings, sharply decreased in early 2020. Early studies suggest that cancer screening rebounded through the summer of 2020; however, > 2 years removed from the start of the pandemic, the long-term impact of missed screenings is unknown. The objective of this study was to examine trends in breast, cervical, and colorectal cancer screening from 2017-2022. Methods: This cross-sectional study used the Trilliant Health national all-payer claims database to analyze calendar year quarterly medical claims from Q1 2017- Q2 2022. We limited the study sample to those aged 21-85, the guideline-concordant target populations for the screening procedures. For breast and cervical cancer, we limited our sample to women. Using Current Procedural Terminology (CPT) codes, we calculated the quarterly number of individuals, per 100,000 eligible beneficiaries, who received screening for breast cancer, cervical cancer, and colorectal cancer. Percentage change in screening tests was compared. Results: In total, the analysis included > 300M unique individuals. For breast cancer, the median quarterly rate of pre-pandemic screening mammography was 8013 per 100k beneficiaries, which declined to 4,884 in Q2 of 2020—a 39% decrease. Screening mammography rebounded to pre-pandemic levels by Q3 and Q4 of 2020 but declined to a median rate of 7,314 per 100,000 beneficiaries in Q2 2022, with quarterly deficits ranging from 4-16%. For cervical cancer, the median quarterly rate of pre-pandemic screening was 5,469 per 100k beneficiaries. The rate of cervical cancer screening fell to 3,550 in Q2 of 2020—a 35% decline. By Q3 2020, cervical cancer screening rebounded toward the pre-pandemic median, then progressively declined to 4,557 per 100k beneficiaries by Q2 2022. Over the same time period, colorectal cancer screening decreased from a pre-pandemic median of 3,111 per 100k beneficiaries to 1,731 in Q2 of 2020—a 44% difference. From Q3 2020 to Q1 2022, the quarterly colorectal cancer screening rate remained 10-17% below pre-pandemic levels, but returned to 3,047 per 100k in Q2 2022, only 2% below the pre-pandemic median. Conclusions: Across the three studied cancer types, population-based screening remains below pre-pandemic levels. In agreement with other research, we find that screening quickly rebounded following the initial stages of the pandemic; however, the longer follow-up time reveals that gaps in preventive cancer screening returned and worsened. Underutilization of recommended cancer screenings will likely result in an increase in later-stage initial diagnoses and excess mortality from cancer in the future.
1542 Background: Spurred by the pandemic, chemotherapy treatments provided by alternate site infusion providers have been increasing. This diversification has the potential to increase access to care and improve patient satisfaction. However, it is currently unknown how equitably distributed these non-traditional infusion settings are, and whether these newer entrants are entering markets with need or markets with ample supply. In addition, many community oncologists are concerned about the ability to retain control over a patient’s treatment and preserve the profits earned from drug infusions. Further, there are concerns regarding the lack of robust data on the safety of alternate site chemotherapy infusions. Industry analysts anticipate steady expansion in US markets for alternate site infusion with chemotherapy being a strong driver of growth. The objective of this study was to examine the distribution of alternate site infusion services across the US. Methods: Leveraging the Medicare home health infusion (MHHI) provider database from CMS, we calculated the rate of MHHI providers per 1000 Medicare beneficiaries in each US state. We reviewed company information to determine the geographic footprint of 3 alternate site infusion providers. Results: The median MHHI rate was 0.013 per 1000 beneficiaries (CO), the average rate was 0.031, with a minimum of 0 (ND, SD, WY) and a maximum of 0.202 (IL). ND, SD, WY, IN, KY, and OK have the lowest concentration of MHHI providers, whereas OR, KS, WA, NE, CA, and IL have the highest concentration. 3 alternate site infusion providers are Option Care, UnitedHealth’s Optum Infusion Pharmacy, and Coram, CVS Specialty Infusion Services. Option Care has 162 in-person infusion centers located in 45 states. Option Care’s presence is highest in CA (24), FL (9), WA (9), OH (8), VA (8), and TX (7). UnitedHealth’s Optum Infusion Pharmacy has 30 in-person infusion suites located in 20 states, primarily concentrated in FL (6) and CA (4), but also provides home infusions in all 50 states. Like MHHI providers, neither of these alternate-site providers have locations in ND, SD, or WY. Coram announced a pilot with Cancer Treatment Centers of America in 2021 to provide home chemotherapy to patients in GA, but it is unclear if that pilot is ongoing; Coram provides home infusion therapy in 49 states. Conclusions: MHHI and alternate site infusion providers are in markets across the US. If alternate site chemotherapy infusion continues to grow, health system-owned and 3rd party entrant alternate site infusion providers are likely to prosper. Conversely, physician-owned practices could face competition and loss of important drug infusion revenue leading to increased consolidation among independent oncology providers. More research is needed to determine the impact on cost and patient outcomes of alternate site chemotherapy infusions – insights that will impact reimbursement and the rate at which these services continue to grow.
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