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In This Issue of JAMA Oncology
June 2017


JAMA Oncol. 2017;3(6):719. doi:10.1001/jamaoncol.2016.4439

Financial toxicity is increasingly causing hardship for our patients. Narang and Nicholas evaluated the effect of cancer treatment costs by surveying 1409 Medicare beneficiaries and assessing out-of-pocket (OOP) costs and factors contributing to those costs. Costs varied with the type of supplementary insurance. Patients with a new cancer diagnosis and Medicare alone spent roughly one-quarter of household income on OOP cancer costs; 10% of patients’ OOP costs were more than 60% of household income. Elderly and disabled patients are at risk for treatment-induced financial toxicity and should be a focus for assistance. De Souza and Conti provide an Invited Commentary.

Invited Commentary

Evaluating FinXX trial data, Joensuu et al questioned whether the integration of capecitabine into a taxane- and anthracycline-containing chemotherapy regimen would improve survival as adjuvant treatment of early breast cancer at 10-year follow-up. Half of the 1500 women received docetaxel followed by cyclophosphamide, epirubicin, and fluorouracil (T+CEF), while the other half received docetaxel plus capecitabine followed by cyclophosphamide, epirubicin, and capecitabine (TX+CEX). There was no difference in relapse-free or overall survival. In an exploratory subgroup analysis, however, TX+CEX was more effective in patients with triple-negative breast cancer at 10-year follow-up, indicating a potential new approach.

Most studies of genital human papillomavirus (HPV) focus on women, yet men are also responsible for the spread of the disease and subsequent cancer risk. In a cross-sectional study of National Health and Nutrition Examination Survey data, Han et al evaluated the prevalence of genital HPV infection and the HPV vaccination rate among 1868 US men aged 18 to 59 years. The genital HPV infection prevalence was 45.2%. Among vaccine-eligible men, HPV vaccination coverage was 10.7%. We thus must prioritize controlling genital HPV infection in men in the United States.

Lay navigators are often used in cancer centers, but do they reduce care costs? In this observational study, Rocque et al used regression analysis to compare changes in quarterly Medicare costs and health care use between 6214 patients enrolled in a navigation program and a propensity score–matched group of nonnavigated patients. For navigated patients, mean total, inpatient, and outpatient costs per quarter were lower, as were emergency department use and intensive care unit admissions. These findings indicate that lay navigation programs have significant impact on cancer care costs. Paskett et al provide an Invited Commentary.

Invited Commentary

Lawler and colleagues provide a review of oncolytic virus therapy, a novel modality that is being used to treat melanoma and is being evaluated for clinical efficacy in many other solid tumors. Oncolytic viruses induce tumor-specific cell lysis, as well as immune stimulation, acting as in situ tumor vaccines. Oncolytic viruses can be engineered for optimization of tumor selectivity and enhanced immune stimulation and can be readily combined with other agents. The review discusses oncolytic viruses that are currently in preclinical and clinical trials.

Continuing Medical Education