The population of cancer survivors in the United States is growing rapidly.¹ In 2016, the number of survivors was 15.5 million; with the aging of the population and advances in early detection and treatment methods, this number is expected to reach 26.1 million by 2040.¹ Chronic pain is one of the most common long-term effects of cancer treatment and has been linked with an impaired quality of life, lower adherence to treatment, and higher health care costs.² Nevertheless, there is a paucity of information regarding the prevalence of, and risk factors for, the development of chronic pain among cancer survivors. A better understanding of the epidemiology of pain in cancer survivors can help inform future health care educational priorities and policies. Accordingly, the objective of this study was to investigate the prevalence of chronic pain and high-impact chronic pain (HICP, chronic pain with major activity restriction) among cancer survivors in the United States by using data from the National Health Interview Survey (2016-2017).

In 2019, there were 16.9 million cancer survivors in the US; prevalence is projected to reach 22.1 million by 2031.¹ Cancer survivors have increased health care needs, given their elevated risk of comorbid illnesses and subsequent cancers,² and timely access to care is critical to optimize health outcomes. Transportation barriers can impede timely access and treatment adherence.³ Nevertheless, little is known about delays in care due to transportation barriers affecting survivors. To inform future interventions, this cross-sectional study assessed self-reported transportation barriers among cancer survivors and the general population and examined correlates of transportation barriers among survivors.

Background: Lack of safe, reliable, and affordable transportation is a barrier to medical care, but little is known about its association with clinical outcomes.Methods: We identified 28 640 adults with and 470 024 adults without a cancer history from a nationally representative cohort (2000-2018 US National Health Interview Survey) and its linked mortality files with vital status through December 31, 2019. Transportation barriers were defined as delays in care because of lack of transportation. Multivariable logistic and Cox proportional hazards models estimated the associations of transportation barriers with emergency room (ER) use and mortality risk, respectively, adjusted for age, sex, race and ethnicity, education, health insurance, comorbidities, functional limitations, and region.Results: Of the adults, 2.8% (n = 988) and 1.7% (n = 9685) with and without a cancer history, respectively, reported transportation barriers; 7324 and 40 793 deaths occurred in adults with and without cancer history, respectively. Adults with a cancer history and transportation barriers, as compared with adults without a cancer history or transportation barriers, had the highest likelihood of ER use (adjusted odds ratio [aOR] = 2.77, 95% confidence interval [CI] = 2.34 to 3.27) and all-cause mortality risk (adjusted hazard ratio [aHR] = 2.28, 95% CI = 1.94 to 2.68), followed by adults without a cancer history with transportation barriers (ER use aOR = 1.98, 95% CI =1.87 to 2.10; all-cause mortality aHR = 1.57, 95% CI = 1.46 to 1.70) and adults with a cancer history but without transportation barriers (ER use aOR = 1.39, 95% CI = 1.34 to 1.44; all-cause mortality aHR = 1.59, 95% CI = 1.54 to 1.65).Conclusion: Delayed care because of lack of transportation was associated with increased ER use and mortality risk among adults with and without cancer history. Cancer survivors with transportation barriers had the highest risk.

The development of novel anti-HER2 drugs opens new treatment options for women with breast cancers, including lower expression of HER2. The epidemiology and clinical outcome of metastatic HER2-low breast cancer remain not well described. We designed a retrospective cohort study of the 2010–2017 National Cancer Database (NCDB) was designed to compare the overall survival of HER2-low and HER2-zero de novo metastatic breast cancer with systemic therapy. Multivariable Cox regression models were performed to estimate hazard ratios (HR), adjusting for sociodemographic and clinical factors. A total of 20,636 of 30,929 (66.7%) patients were HER2-low and 10,293 (33.3%) were HER2-zero. When stratified by hormonal receptor status, HER2-low tumors account for 18,066 (69.7%) cases in HR+/HER2− population and 2570 (51.4%) cases in HR−/HER2− population. The prevalence of HER2-low tumors was similar across racial groups with a slightly lower prevalence among the Hispanic population. Women with HER2-low tumors had longer overall survival (OS) than women with Her2-zero tumors in both HR-positive (median OS 39.0 months vs. 37.1 months; adjusted HR: 0.95, 95%CI (0.91–0.98)) and HR-negative groups (median OS 15.8 months vs. 14.1 months; adjusted HR: 0.92 95%CI (0.86–0.98)). The survival advantage was primarily observed in patients who received chemotherapy as their first line of treatment (HR 0.92 95%CI (0.88–0.96) vs. 0.99 95%CI (0.94–1.04), p-interaction = 0.04). In summary, HER2-low tumors, irrespective of hormone receptor status, have better survival than HER2-zero tumors in the de-novo metastatic setting. The survival advantage was primarily observed in patients who received chemotherapy in the first line.