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Gold Standard Research & Evidence for Quality Treatment & Survivorship


Mariotto, Angela B.; Lindsey Enewold; Jingxuan Zhao; Christopher A. Zeruto; K. Robin Yabroff. "Medical Care Costs Associated with Cancer Survivorship in the United States." Cancer Epidemiology, Biomarkers & Prevention, June 10, 2020.

Background: The prevalence of cancer survivorship is increasing. In this study, we provide contemporary population–based estimates and projections of the overall and site-specific cancer-attributable medical care costs in the United States.


Advances in cancer diagnosis and treatment have resulted in declining cancer mortality rates during the past 20 years [1], resulting in high rates of return to work following a cancer diagnosis [2]. Cancer survivors report that work provides a sense of normalcy, necessary financial support, and in some cases, social support [3]. Cancer survivors who work after diagnosis have unique needs to ensure optimal outcomes for both the individual and the employer. A supportive work environment is an important factor for success [4]. Work-related factors significantly associated with a greater likelihood of employment or return to work after cancer diagnosis include perceived employer accommodation, flexible work arrange-ments, and supportive services such as counseling, training, and rehabilitation [4].

Warren, MD, PhD, Graham W.; Kathleen B. Cartmell, PhD; Elizabeth Garrett-Mayer, PhD. "Attributable Failure of First-line Cancer Treatment and Incremental Costs Associated With Smoking by Patients With Cancer." JAMA, April 5, 2019.

The cost of cancer treatment is increasingly associated with unfavorable financial outcomes in cancer care,but whether increased costs reflect increased value is unknown. Principles for value-based care in oncology include patient-centered solutions, optimal care, and cost-containment strategies that do not limit patient access or innovation. Guidelines have been developed to define clinically meaningful outcomes in cancer care, but a recent analysis of drug approvals by the US Food and Drug Administration between 2014 and 2016 showed that many drugs did not meet survival goals.  Whereas drug cost and efficacy have been the primary focus for considering value in cancer care, relatively little consideration has been given to other potentially modifiable factors that could affect cancer treatment costs, including health behaviors such as smoking.

The US 2014 Surgeon General’s report concluded that continued smoking among patients with cancer caused adverse outcomes including increased overall- and cancer-specific mortality, risk for second primary cancer, and associations with increased toxic effects from cancer treatment. Smoking cessation in the general population is known to improve health outcomes and create significant reductions in health expenditures. Whereas many studies found that smoking cessation after a cancer diagnosis can improve survival, to our knowledge, there have been no evaluations of the association between continued smoking among patients with cancer and the costs of cancer treatment. Understanding the financial effects of smoking among patients with cancer is needed to develop value-based approaches that could lead to improved cancer treatment outcomes. The objective of this study was to model the additional attributable first-line cancer treatment failures associated with continued smoking and to estimate the attributable incremental cost associated with the need to treat first-line cancer treatment failures attributed to continued smoking.


Aiuppa, Laura; Maria Hewitt; Sharyl J. Nass. "Long-Term Survivorship Care After Cancer Treatment." The National Academies of Sciences, 2018.

The 2006 Institute of Medicine (IOM) consensus study report From Cancer Patient to Cancer Survivor: Lost in Transition made recommendations to improve the quality of care that cancer survivors receive, in recognition that cancer survivors are at risk for significant physical, psychosocial, and financial repercussions from cancer and its treatment (IOM and NRC, 2006). Since then, efforts to recognize and address the unique needs of cancer survivors have increased, including an emphasis on improving the evidence base for cancer survivorship care and identifying best practices in the delivery of high-quality cancer survivorship care.


Commissioned by Bristol-Myers Squibb. "Cancer in the Workplace." The Economist Intelligence Unit , February 17, 2017.

The impact of cancer looks set to continue to grow for organisations in the decades ahead. Experts predict continued growth in the numbers of the working population affected by cancer as populations age and earlier diagnosis and better treatment of the disease lead to improved survival rates. If employers are to continue to provide an environment in which they can attract and retain talented staff, they must take action.


Donatus U. Ekwueme, PhD, K. Robin Yabroff, PhD, Gery P. Guy, Jr., PhD, Matthew P. Banegas, PhD, Janet S. de Moor, PhD, Chunyu Li, PhD, MD, Xuesong Han, PhD, Zhiyuan Zheng, PhD, Anita Soni, PhD, Amy Davidoff, PhD, Ruth Rechis, PhD, Katherine S. Virgo, PhD. "Medical Costs and Productivity Losses of Cancer Survivors — United States, 2008–2011." CDC Morbidity and Mortality Weekly Report, June 13, 2014.

The number of persons in the United States with a history of cancer has increased from 3 million in 1971 to approximately 13.4 million in 2012, representing 4.6% of the population. Given the advances in early detection and treatment of cancer and the aging of the U.S. population, the number of cancer survivors is projected to increase by >30% during the next decade, to approximately 18 million. ...The results indicate that the economic burden of cancer survivorship is substantial among all survivors. 


Mehnert, Anja. "Employment and work-related issues in cancer survivors." Critical Reviews in Oncology and Hematology, January 6, 2010.

Purpose of this systematic literature review was to identify current knowledge about employment in cancer survivors. Sixty-four studies met inclusion criteria that were original papers published between 01/2000 and 11/2009. Overall, 63.5% of cancer survivors (range 24–94%) returned to work. The mean duration of absence from work was 151 days. Factors significantly associated with a greater likelihood of being employed or return to work were perceived employer accommodation, flexible working arrangements, counseling, training and rehabilitation services, younger age and cancer sites of younger individuals, higher levels of education, male gender, less physical symptoms, lower length of sick leave and continuity of care. Cancer survivors had a significantly increased risk for unemployment, early retirement and were less likely to be re-employed. Between 26% and 53% of cancer survivors lost their job or quit working over a 72-month period post diagnosis. Between 23% and 75% of patients who lost their job were re-employed. A high proportion of patients experienced at least temporary changes in work schedules, work hours, wages and a decline in work ability compared to non-cancer groups. 


"A National Action Plan for Cancer Survivorship: Advancing Public Health Strategies ." Centers for Disease Control and Prevention, April 2004.

Cancer is the second leading cause of death among adults in the United States and affects an estimated 1 in 3 individuals in their lifetime, either through their own diagnosis or that of a loved one (ACS, 2003). Increasing innovations in medical technology have led to earlier diagnoses and improved treatment of many cancers, resulting in more people diagnosed with cancer surviving each year. Currently, approximately 62% of cancer survivors are expected to live at least 5 years after diagnosis (ACS, 2003). As of January 2000, there were approximately 9.6 million cancer survivors in the United States (NCI, 2003a). This estimate includes people diagnosed with cancer but does not include others affected by a diagnosis, such as family members and friends.