Preventing Chronic Disease (PCD) is a peer-reviewed electronic journal established by the National Center for Chronic Disease Prevention and Health Promotion. PCD provides an open exchange of information and knowledge among researchers, practitioners, policy makers, and others who strive to improve the health of the public through chronic disease prevention.

Objective: The lack of consensus on the benefits and harms of standard therapies, including surgery (SRx), radiotherapy (RTx), chemotherapy (CTx), and their combinations among early‐stage MCC, prompted this study. Methods: A systematic review and meta‐analysis of randomized and non‐randomized studies published between January 01, 1972, and January 31, 2023, and having overall survival (OS), local recurrence (LR), regional recurrence (RR), disease‐specific survival (DSS), and/or disease‐free survival (DFS) as outcomes was conducted using the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed (NCBI), Scopus (ELSEVIER), and Web of Science (CLAVIRATE) databases. Hazard ratios (HRs) and their variances were pooled using the inverse variance heterogeneity model. Results: Forty‐nine studies representing 46,215 participants were included in the meta‐analysis. A statistically significant improvement in OS was observed for groups administered adjuvant RTx (SRx + RTx) compared to SRx only (HR = 0.78, 95% CI, 0.62–0.99), albeit with statistically significant heterogeneity ( Q = 532.30, p < 0.001) and a large amount of inconsistency ( I ² = 94%, 95% CI, 93.0–95.5). Both LR (HR = 1.52, 95% CI, 0.37–6.19) and RR (HR = 0.41, 95% CI, 0.09–1.78) were not statistically significant. In addition, DSS (HR = 0.58, 95% CI, 0.24–1.40) was not statistically significant but DFS was (HR = 0.35, 95% CI, 0.13–0.93). Subgroup analyses revealed that adjuvant radiotherapy was more effective in local than regional MCC. The E‐value suggested that the RTx dose was a confounder of the observed effectiveness of adjuvant RTx; and also, the use of CTx following adjuvant RTx, did not impact the strength of evidence for OS. Conclusions: Although adjuvant RTx improves survival and recurrence outcomes among early‐stage MCC, the safety and effectiveness of standard therapies in MCC remains poorly studied and, thus, affects the synthesis of evidence across important patient and clinical characteristics. Future research on the comparative effectiveness of different therapies is needed.

Purpose: Post‐cancer treatment pain (PCTP) is prevalent among cancer survivors but remains understudied. It is critical to quantify PCTP prevalence over time and to estimate the resulting short and long‐term incremental healthcare expenditures (total, third‐party, and out‐of‐pocket) and out‐of‐pocket burden among cancer survivors.Methods: A longitudinal retrospective cohort design was used. To identify cancer survivors (≥ 18 years) with PCTP, the Medical Expenditure Panel Survey (MEPS) and its supplementary Cancer Self‐Administered Questionnaire (CSAQ)were used. Recycled predictions from generalised linear models (GLM) with log‐link and gamma distribution were used to estimate annual incremental healthcare expenditures at different PCTP gradations over time. To account for covariate imbalance, sensitivity analysis using inverse probability weighting was conducted.Results: 2125 cancer survivors had PCTP. Post‐cancer treatment, 10.5%–24.2% of survivors experienced some form of chronic PCTP, whereas between 21.9%–5.1% experienced acute PCTP. Across the survivorship journey, the adjusted total annual incremental healthcare expenditures were the highest among cancer survivors with moderate chronic PCTP (< 1‐year post‐cancer treatment), and severe chronic PCTP, (≥ 5 years post‐cancer treatment) compared to survivors with no pain, reaching respectively, $27.3 and $40.2 billion nationally. There was a significant high out‐of‐pocket burden among cancer survivors with severe chronic PCTP compared to those with no pain.Conclusion: These findings highlight the persistent financial burden of PCTP but also the critical need for effective pain management alongside the use of patient‐reported outcomes for pain among cancer survivors.

Purpose: In light of the known benefits of physical activity (PA) for cancer survivors, this exploratory study sought to investigate the uptake of PA among this population in the United States. Methods: Using the National Health Interview Survey data from 2009 to 2018, lung, breast, colorectal, prostate, ovarian, and lymphoma cancer survivors were identified, and their PA adherence measured per the standards of the American College of Sports Medicine. Logistic regression and the Fairlie decomposition were used, respectively, to identify correlates of PA and to explain the difference in PA adherence between races. Results: Uptake of PA was significantly different between Whites and minorities. Blacks had lower odds than Whites (adjusted odds ratio: 0.77; 95% confidence interval, 0.66–0.93), whereas Mixed Race had twice the odds of Whites (adjusted odds ratio: 1.94; 95% confidence interval, 0.27–0.98) of adhering to PA recommendations. Decomposition identified education, family income-to-poverty ratio, body mass index, number of chronic conditions, alcohol use, and general health as key factors accounting for the PA disparity between cancer survivors of White and Black or Multiple/Mixed racial group. Conclusion: These findings could help inform behavioral PA interventions to improve their design and targeting to different racial groups of cancer survivors.

Objective: To evaluate chronic conditions as leading predictors of economic burden over time among older adults with incident primary Merkel Cell Carcinoma (MCC) using machine learning methods. Methods: We used a retrospective cohort of older adults (age ≥ 67 years) diagnosed with MCC between 2009 and 2019. For these elderly MCC patients, we derived three phases (pre-diagnosis, during-treatment, and post-treatment) anchored around cancer diagnosis date. All three phases had 12 months baseline and 12-months follow-up periods. Chronic conditions were identified in baseline and follow-up periods, whereas annual total and out-of-pocket (OOP) healthcare expenditures were measured during the 12-month follow-up. XGBoost regression models and SHapley Additive exPlanations (SHAP) methods were used to identify leading predictors and their associations with economic burden. Results: Congestive heart failure (CHF), chronic kidney disease (CKD) and depression had the highest average incremental total expenditures during pre-diagnosis, treatment, and post-treatment phases, respectively ($25,004, $24,221, and $16,277 (CHF); $22,524, $19,350, $20,556 (CKD); and $21,645, $22,055, $18,350 (depression)), whereas the average incremental OOP expenditures during the same periods were $3703, $3,013, $2,442 (CHF); $2,457, $2,518, $2,914 (CKD); and $3,278, $2,322, $2,783 (depression). Except for hypertension and HIV, all chronic conditions had higher expenditures compared to those without the chronic conditions. Predictive models across each of phases of care indicated that CHF, CKD, and heart diseases were among the top 10 leading predictors; however, their feature importance ranking declined over time. Although depression was one of the leading drivers of expenditures in unadjusted descriptive models, it was not among the top 10 predictors. Conclusion: Among older adults with MCC, cardiac and renal conditions were the leading drivers of total expenditures and OOP expenditures. Our findings suggest that managing cardiac and renal conditions may be important for cost containment efforts.