Objective To determine whether radiation therapy (RT) is denied to patients with lupus and cancer and whether RT causes unusual toxicity in those receiving it. Methods We included patients with lupus followed at the University of Toronto Lupus Clinic between 1972 and 2001 who had developed cancer. Demographic, clinical, and laboratory information were collected prospectively. Pathologic proof of cancer was obtained. Three radiation oncologists blinded for the diagnosis of lupus, the modalities of cancer treatment, and the hypothesis of the study reviewed patient data independently. They assessed the indication for RT and whether it should be curative or symptomatic. Recommendation for RT was considered when at least 2 of the 3 radiation oncologists concurred. A review of the literature was conducted. Results Forty cases of cancer in 38 patients were identified. Most frequent cancer sites were breast (8), skin (8), digestive (7), and hematologic (7). Median patient age was 58 years. The radiation oncologists recommended RT in 26 cases, either with a curative (14) or a symptomatic intent (12). Only 4 patients received RT, 3 with a curative intent and 1 with a symptomatic intent. None of these 4 patients developed any unusual toxicity. The literature review did not support the fact that lupus patients do not tolerate RT. Conclusion Sixty‐five percent of our lupus patients with cancer could have received curative or symptomatic RT but only 10% received it. No patient developed any toxicity. RT may be inappropriately withheld from lupus patients with cancer.

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We compare employment and usual hours of work for prime-age cancer survivors from the Penn State Cancer Survivor Survey to a comparison group drawn from the Panel Study of Income Dynamics using cross-sectional and difference-in-differences regression and matching estimators. Because earlier research has emphasized workers diagnosed at older ages, we focus on employment effects for younger workers. We find that as long as two to six years after diagnosis, cancer survivors have lower employment rates and work fewer hours than other similarly-aged adults.

SummaryThe long-term effects of cancer and its treatment on employment and productivity are a major concern for the 40% of cancer survivors in the U.S. who are working age. This study's objectives were (1) to quantify the increase in work disability attributable to cancer in a cohort of adult survivors who were an average of 46 months post-diagnosis and (2) to compare disability rates in cancer survivors to individuals with other chronic conditions. Data from the Penn State Cancer Survivor Study (PSCSS) and the Health and Retirement Study (HRS) were compared. The PSCSS sample included 647 survivors age 55-65, diagnosed at four medical centers in Pennsylvania and Maryland. There were 5988 similarly aged subjects without cancer in the HRS. Adjusted odds ratios for work disability were estimated for cancer survivorship, heart disease, stroke, diabetes, lung disease, and arthritis/rheumatism with multivariate logistic regression. Even for cancer-free survivors, the disability rate was significantly higher in comparison to adults with no chronic conditions (female OR=1.94; male OR=1.89). There were few significant differences between disability rates for cancer and other conditions. The elevated disability rate is another argument for viewing cancer survivorship as a chronic condition potentially requiring a broad range of psychosocial services.

Objective. To assess the effects of CAHPS health plan performance information on plan choices and decision processes by New Jersey Medicaid beneficiaries.Data Sources/Study Setting. The study sample was a statewide sample of all new Medicaid cases that chose Medicaid health plans during April 1998. The study used state data on health maintenance organization (HMO) enrollments and survey data for a subset of these cases. StudyDesign. An experimental design was used, with new Medicaid cases randomly assigned to experimental or control groups. The experimental group received a CAHPS report along with the standard enrollment materials, and the control group did not.Data Collection. The HMO enrollment data were obtained from the state in June 1998, and evaluation survey data were collected from July to October 1998. Principal Findings.No effects of CAHPS information on HMO choices were found for the total sample. Further examination revealed that only about half the Medicaid cases said they received and read the plan report and there was an HMO with dominant Medicaid market share but low CAHPS performance scores. The subset of cases who read the report and did not choose this dominant HMO chose HMOs with higher CAHPS scores, on average, than did those in an equivalent control group. Conclusions. Health plan performance information can influence plan choices byMedicaid beneficiaries, but will do so only if they actually read it. These findings suggest a need for enhancing dissemination of the information as well as further education to encourage informed choices.As the move to managed care has limited the set of providers available through each health plan and introduced strong incentives to alter the process of health care, the stakes associated with health plan choices have increased enormously for consumers. In this context, both having a choice of plans and making the right choice are important to consumers. At the same time, policymakers and 985

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This study assesses the stability of Americans' health insurance status over a four-year period. Relatively few Americans were continuously uninsured for the four years 1996 to 1999, but a sizable number of the uninsured lacked a stable source of coverage. At least as many people were repeatedly uninsured as experienced a single gap in otherwise stable coverage. Given these dynamics, policymakers should think of "uninsured" as referring not to people, but rather to gaps in coverage over time. Reforms that stop short of universal coverage should be evaluated in terms of their likely effects on the continuity and stability of coverage.

Background This is the first study to provide national estimates of medical expenditures for all adult cancer survivors under age 65. Most studies of expenditures for cancer survivors in this age group have been based on the Medical Expenditure Panel Survey and limited to “affected survivors.” Methods MEPS expenditure data for 2001 to 2007 were linked to data identifying all survivors from the National Health Interview Survey, the MEPS sampling frame. The sample was adults 25–64 years old. Propensity-score matching was used to estimate the effects of cancer on average total and out-of-pocket expenditures for all services, and prescriptions separately. Probit models were used to estimate effects on the probability of exceeding different expenditure thresholds. Results Mean annual expenditures on all services in 2007 were $16,910 ± $3911 for survivors newly diagnosed with cancer, $7992 ± $972 for survivors diagnosed in previous years, and $3303 ± $103 for other adults. Fifty-three percent of survivors were not identified in MEPS, but only by linking to NHIS. Expenditures for all survivors averaged about $9300, compared to $13,600 for “affected survivors.” For previously diagnosed survivors, the increase in mean expenditures attributable to cancer was about $4000-$5000 annually. On average, relatively little of the increase was paid out of pocket, but cancer nearly doubled the risk of high out-of-pocket expenditures. Conclusions Previous MEPS analyses overstated average expenditures for all survivors. Nevertheless, the increase in expenditures attributable to cancer is substantial, even for longer term survivors. Cancer increases the relative risk of high out-of-pocket expenditures.