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PURPOSE: Mental health comorbidities are commonplace among patients with cancer and have been associated with adverse health outcomes and elevated health care costs. Given the rapidly evolving cancer care landscape, an updated understanding of the prevalence and costs of mental health conditions among patients with cancer is needed. This study assessed the incremental costs of anxiety and depression among Medicare beneficiaries with cancer. METHODS: This retrospective cohort study used the SEER-Medicare database. Patients diagnosed with melanoma, breast, lung, prostate, or colorectal cancer between July 2013 and December 2017 were followed for at least 12 months and up to 36 months after cancer diagnosis. Patients were categorized on the basis of anxiety/depression (AD) diagnosis: (1) predating cancer, (2) onset after cancer, or (3) no AD. Multivariable regression was used to estimate differences in all-cause incremental costs (before v after cancer) between the three groups. RESULTS: Of 230,626 patients, 10% had AD before their cancer diagnosis and 22% were diagnosed after cancer. In the first year after cancer diagnosis, average monthly health care costs were $5,750 in US dollars (USD) for patients with newly onset, $5,208 (USD) for patients with preexisting, and $3,919 (USD) for patients without a diagnosis of AD. The incremental cost of cancer was the greatest among patients with newly onset AD—$1,458 (USD) per month greater than those with no AD. Similar patterns were observed across cancer types and stages. CONCLUSION: One in three Medicare beneficiaries with cancer in this study had a diagnosis of anxiety or depression. Newly onset AD is associated with an increase in health care costs of $17,496 (USD) per year. Screening and management of mental health conditions for patients with cancer should be part of coordinated oncology care.

Previous research has found that increased physical activity may provide a protective effect on depression status; however, these studies do not account for cognitive function. This study's aim was to determine whether cognitive function mediates the association between physical activity depression status in older adults. Data from 501 older adults were used for this analysis. Physical activity had a significant protective effect on depression (OR = 0.761, 95% CI [0.65, 0.89], p = .001). Adjusted analysis yielded an attenuated association (OR = 0.81, 95% CI [0.69, 0.95], p = .01) with a significant interaction for physical activity and cognitive function (OR = 0.991, 95% CI [0.985, 0.997], p = .005). MoCA performance also had a significant mediating effect on the relationship between physical activity and depression status (p = .04). These findings suggest that cognitive function is associated with, and does mediate, the relationship between physical activity and depression status.

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Alcohol misuse on college campuses is an ongoing national public health concern. For many young adults, the transition to college is a high-risk period for the initiation or continuation of problem drinking behaviors. Contrary to assertions of diminishing influence of parents on their children once they enter college, a substantial body of recent research supports the continuing protective influence of parents on the drinking behavior of college students. This chapter reviews the empirical research literature examining parental influences on college student drinking. Recent studies on parental influence on college drinking include parenting styles, parental monitoring, parent–child communication, parental modeling and attitudes toward drinking, and parental relationship quality. Recently developed parent-based interventions designed to reduce problem drinking on college campuses are described and reviewed. Recommendations for parents of college-bound children are provided to help reduce the risk for the development of problem drinking during this important developmental transition.

BACKGROUND: U.S. value framework developers such as the Institute for Clinical and Economic Review (ICER) use cost-effectiveness analysis to value new health care technologies. Often, these value assessment frameworks use a health system perspective without fully accounting for societal and broader benefits and costs of an intervention. Although there is ongoing debate about the most appropriate methods for including broader value elements in value assessment, it remains unclear whether the inclusion of these value elements is likely to affect the quantitative estimates of treatment value. OBJECTIVE:To assess variations in the relevance of broader value elements to costeffectiveness analysis across diseases.METHODS: Thirty-two broader value elements (e.g., caregiver burden, health equity, real option value, productivity) not traditionally included in health technology assessments were identified through a targeted literature review. Evidence reports published by ICER between July 2017 and January 2020 were evaluated to identify which broader value elements were discussed as relevant to each disease in the report text. The study examined whether there were associations among ICER's discussion of broader value elements, rare disease status, treatment cost, estimated treatment cost-effectiveness, and ICER committee voting results for contextual considerations and additional benefits/disadvantages. RESULTS:The most commonly cited broader value element category in the ICER evidence reports was household and leisure (e.g., absenteeism from normal activities and caregiver burden). More value elements were cited for inherited retinal disease (19 elements) and sickle cell disease (18 elements) than for other diseases. Cardiovascular disease and diabetes had the fewest number of value elements cited (7 elements). Rare diseases were more likely to have broader value elements cited compared with nonrare What is already known about this subject • Policymakers, payers, and other stakeholders in the health care sector are increasingly using cost-effectiveness analysis (CEA) to quantify the value of new interventions.• Historically, CEAs have used a health system perspective in measuring value, without fully accounting for potential societal benefits and novel value elements. What this study adds• The current study reviewed and analyzed evidence reports from the U.S.-based Institute for Clinical and Economic Review to identify the degree to which broader value elements (e.g., caregiver burden, productivity loss) may be relevant for evaluation of treatments for various diseases.• The results aim to provide guidance to stakeholders regarding which disease areas should be prioritized for future research to quantify these broader elements for inclusion in value assessments.

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