Smoking has long been associated with increased risks of cancer, but a research team has now estimated the number of deaths from a wide variety of cancers that are linked to cigarette use.

According to a study published Monday in the journal JAMA Internal Medicine, almost half of the 346,000 deaths from 12 different types of cancers in individuals 35 years of age or older in 2011 were attributable to smoking cigarettes.

The authors cited the 2014 U.S. Surgeon General’s Report as a preface to their study, which provided estimates on the annual number of smoking-related deaths from cancer overall and from lung cancer specifically between 2005 and 2009.

Although other studies have looked at lung cancer deaths related to smoking, the researchers wrote that this was the first study to delineate the number of deaths from 11 other cancers that were associated with cigarettes.

The study was led by Rebecca L. Siegel of the Intramural Research Department at the American Cancer Society.

Siegel and her team demonstrated that smoking behavior as well as the correlation between smoking and cancer have changed over time. Between 2000 and 2012, the number of people who smoked decreased from 23 to 18 percent and the number of deaths for most types of cancer tied to smoking has also fallen.

Despite these positive statistics, the risk for cancer in individuals who smoke may increase over time.

“The bottom line is that despite 50 years of declining smoking prevalence, almost 170,000 cancer deaths each year are still caused by smoking,” Siegel said.

So the researchers sought to define the magnitude of risk for each of the different types of cancer.

Not surprisingly, of the 12 cancers studied in relation to cigarette smoking, lung, bronchus, and trachea cancers were found to be the most closely associated with this habit. However, half of the deaths from oral cavity, esophagus, and urinary bladder cancers were attributed to smoking as well.

The researchers concluded that to reduce the rates of cancer mortality caused by smoking behavior, there needs to be more extensive control of tobacco.

The best way to accomplish this goal, in Siegel’s opinion, is to “focus targeted tobacco control on groups that are most likely to smoke,” such as low-income people, gay and lesbian populations, and residents of Southern states known for tobacco production.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

THURSDAY, JUNE 18TH — 10 AM to 9 PM at AaNA Office
FRIDAY, JUNE 19TH — 2 PM to 9 PM at PAMC West Auditorium
MONDAY, JUNE 22ND — 10 AM to 9 PM at PAMC West Auditorium
TUESDAY, JUNE 23RD — 7:30 AM to 8 PM at AaNA Office



AaNA is located at 3701 E. Tudor Road, Suite 208. (Just West of Elmore)

Please call for directions or with questions: 907-274-0827

The 2015 AaNA/PRN and PAMC negotiating teams have worked very hard to reach what we believe is a fair 3-year contract. Negotiations proceeded with compromises on both sides during these difficult and uncertain times for the healthcare industry.

BIG CHANGES / HIGHLIGHTS OF THE AGREEMENT INCLUDE:

-Changes in Registry language, including scheduling and on-call

-Preceptor vs. Orientor definitions and pay

-New language protecting breastfeeding mothers

-Changes in consecutive shifts

-Continuation of PTO & Sick Time as is

-LEAVE: New language and/or new types of leave for: bereavement leave, personal leave, educational leave of absence, company medical leave

-Parental Leave for non-FMLA-eligible nurses

-New language for injury prevention & safe patient handling

After taking a 10-year break from practicing medicine to raise four sons, Kate Gibson was ready to go back to work.

The family practitioner had been reading about a shortage of primary care doctors and knew she could help. But when Gibson, 51, applied to work at her former hospital near Los Angeles, she was turned away. She’d been out of clinical practice too long.

“I really thought it was not going to be that hard,” she said.

Like many professionals, physicians take time off to raise children, care for sick family members or to recover from their own illnesses. Some want to return from retirement or switch from non-clinical jobs back to seeing patients. But picking up where they left off is more difficult in medicine than in most careers.

In medicine, change occurs quickly. Drugs, devices and surgical techniques that were standard a decade ago may now be obsolete. Or a returning doctor’s skills may simply be rusty.

“My hands feel like those of an intern,” said Molly Carey, 36, an Ivy-League educated doctor who recently enrolled in a Texas retraining program after four years away from patients.

After extended leaves, doctors must convince medical boards to reissue their licenses, hospitals to grant admitting privileges and malpractice insurers to provide coverage. Only a handful of programs around the country are set up to help physicians brush up on their skills, and they can cost doctors thousands of dollars.

“Medical schools do a fantastic job graduating brand new medical students,” said Humayun J. Chaudhry, president of the Federation of State Medical Boards. “But what about people who have already graduated and need to get some retraining? There is a clearly a dearth of those kind of training programs.”

Policymakers and professional organizations are pushing to make the process less burdensome and costly – in part because it may help ease shortages of primary care doctors.

Getting experienced doctors to dust off their white coats is cheaper than starting from scratch, said Robert Steele, director of KSTAR physician programs at Texas A&M Health Science Center. He oversees a mini-residency program at the University of Texas Medical Branch, Galveston, in which returning doctors divide their time between seeing patients and attending classes. The three-month training includes the latest on medications, procedures, disease management and treatments.

“They just need polishing up to practice safely and competently,” Steele said.

Patient safety advocates argue that minimum standards should be set to ensure that doctors coming back after a hiatus are providing the best care possible. As it stands, no nationwide standards or requirements exist, and states have different requirements.

“Patients would like to think that any doctor who is seeing them or doing procedures on them is at the height of their career,” said Joe Kiani, founder of the Patient Safety Movement Foundation. “If a doctor has been out for a while, they are not.”

Carey, 36, had a great education, graduating from medical school at the University of Pennsylvania and completing a residency in 2011 in obstetrics and gynecology at Brown University and a Providence hospital. But after taking just four years off to care for a sick grandmother and another relative, she felt she needed to freshen her clinical skills. So she moved from Rhode Island to Texas to take part in the KSTAR program, hoping to gain more confidence as a surgeon and become more marketable.

Setting Standards and Removing Obstacles

Reliable numbers of how many doctors suspend their practices aren’t available, but the American Medical Association estimated in 2011 that 10,000 doctors could reenter practice each year.

The Federation of State Medical Boards wants states to create a standard process for physicians to show they have the skills to return to medicine. It is asking licensing agencies to track whether doctors are still practicing and whether it is in their area of training.

The American Academy of Pediatrics and the AMA also are trying to remove obstacles for doctors who want to return to work after taking time off. And John Sarbanes, a Maryland congressman, has proposed legislation to help expand re-entry programs for primary care doctors and help cover physicians’ costs if they agree to practice in high-need areas.

After hitting a wall with her former employer and others, Gibson enrolled in an online retraining program in San Diego, which cost her $7,000. She spent four months completing the courses last year and a week shadowing a family physician. Then she took a written exam and was evaluated during mock visits with “patients” played by actors.

In the end, she received two certificates — one from the program and one from UC San Diego School of Medicine for 180 hours of continuing medical education.

“I definitely felt more confident,” Gibson said. But she still wanted more hands-on clinical training. So she recently started a paid fellowship at the USC Department of Family Medicine, seeing patients under the oversight of other doctors.

Former medical school professor Leonard Glass created the San Diego program, called the Physician Retraining & Reentry Program, in 2013. Besides retraining primary care doctors, the online program has attracted specialists who wanted to switch to primary care and restless retirees.

“Some are simply tired of being retired,” he said. “It’s sort of an itch to go back to taking care of people.”

‘Expensive And Time-Consuming’

Several retraining programs are run by hospitals, including Cedars Sinai Medical Center. There, participants spend between six weeks and three months seeing patients under the supervision of other physicians, then discuss their cases in an exit interview to demonstrate what they learned. They leave with a letter that can be submitted to employers or hospitals.

The Cedars program costs $5,000 a month. Leo A. Gordon, who runs it, said some doctors who call to inquire are angry about having to spend the time and money when they already have so much education and experience. But he said others are simply appreciative that “there is a way to get back in the game.”

One of the Cedars graduates, Maria DiMeglio decided she wanted to return to practice as an OB/GYN after taking off almost six years to care for her children and her ill mother.

“I thought I was retiring, said DiMeglio, “but I kept my options open.”

She had retained her medical license and kept up with continuing education courses. But she needed to persuade her old hospital, Cedars-Sinai, to give her privileges so she could perform surgeries. The Cedars retraining program, she said, “wasn’t difficult, but it was expensive and time-consuming. Not everyone can do that.”

Hospitals set their own requirements for doctors to get credentials and privileges, but doctors who have been out of practice for more than two years generally must show that they are competent to see patients. Having a certificate from a reentry program helps, said David Perrott, chief medical officer of the California Hospital Association.

Jeff Petrozzino, a 50-year old doctor who trained in pediatrics and neonatology, knows all about that. He ran into difficulty returning to clinical practice after spending several years doing health economics research.

“I was a double board-certified physician licensed in several states,” he said. “You would think I would be able to get a job.”

When he finally did get an offer at a medical center in New Jersey, he said both the job and the state medical license were contingent on him getting retrained. He completed a three-month program at Drexel University College of Medicine in 2013, where he was surprised to discover many other doctors in a similar situation.

Petrozzino said he was grateful for the program — but given the hassles of re-entry he would advise doctors to plan carefully before taking breaks from their practice.

“Careers are interrupted or derailed for various reasons,” he said. “The system does not readily allow for re-entry.”

agorman@kff.org

Blue Shield of California Foundation helps fund KHN coverage in California.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Almost no one disputes that the implementation of the federal health law has helped Americans who were previously uninsured gain coverage. But exactly how much has the uninsured rate dropped?

A whole lot, says President Barack Obama.

“Nearly one in three uninsured Americans have already been covered — more than 16 million people -– driving our uninsured rate to its lowest level ever,” he told a cheering crowd at the Catholic Health Association’s annual conference earlier this week.  “Ever,” he added for emphasis.

But is the uninsured rate really the lowest ever? Maybe, say experts. But you can’t really tell.

Many pundits and others have been citing periodic polling by the Gallup organization. The 11.9 percent uninsured rate (among adults) it reported in April for this year’s first quarter is the lowest measured since it’s been keeping track. But Gallup has been measuring only since 2008.

A survey with a longer history – the one conducted by the National Center for Health Statistics at the Centers for Disease Control and Prevention – also found an uninsured rate of 11.9 percent for the first three-quarters of 2014. That was down from 16 percent in 2010, the year the Affordable Care Act became law.

But even that survey changed its methodology back in 1997, which was well after employers had begun shedding coverage for workers and families.

“I would say that we have definitive evidence that the uninsured rate for the nonelderly is the lowest it has been since 1997,” said Genevieve Kenney, a policy researcher at the Urban Institute and co-director of its Health Policy Center. (Most surveys only measure the nonelderly because nearly everyone over age 65 has Medicare.) “Before that we are on less solid ground because of data limitations.”

“Some of the surveys being used now to determine the rate weren’t even around or weren’t asking health insurance questions a decade ago,” agreed Paul Fronstin, who’s been studying the uninsured at the Employee Benefit Research Institute since 1993. “The surveys that have been around have changed.”

Indeed, the administration’s own numbers suggest that in the 1970s and 1980s, the uninsured rate might have been almost the same as it is now or even lower. A December report by the President’s Council of Economic Advisers noted that that the uninsured rate at the end of 2014 was “at or near historic lows.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Some health insurance companies are asking for big price increases next year and that has again riled critics of the federal health care law.

The numbers released last week came out of an Affordable Care Act requirement that insurance companies tell government regulators by June 1 if they’re requesting price hikes of more than 10 percent. But not all of the story is yet reported. Take, for example, Montana.

Some officials opposed to the law, like U.S. Sen. Steve Daines, R-Mont., decried the increases in a speech on the Senate floor. “Blue Cross Blue Shield, which is Montana’s largest insurer, is asking for an average increase of 23 percent for Montanans enrolled in individual plans,” he told colleagues last week.

While that sounds scary, it turns out that Blue Cross Blue Shield in Montana is actually asking for large price hikes on just two plans it wants to offer in the state. While it’s not yet public how many they’ll offer in 2016, they currently offer 50 plans.

Caroline Pearson, vice president for health reform at the consulting firm Avalere Health, has been digging into available numbers on insurance pricing across several states. She said such price hikes are not the norm. She’s not seeing anything like a 20 percent average increase in the price of monthly premiums.

“Those are not necessarily the plans that hold the bulk of enrollment,” she says. “So, while some of those plans may be going up a lot in price, that doesn’t mean a lot of enrollees are necessarily affected.”

In the handful of states where data is available (Connecticut, Maryland, Michigan, Oregon, Virginia, Vermont, Washington state and Washington, D.C.), Pearson says the majority of people buying health coverage on exchanges won’t face serious sticker shock.

“We have seen that about 6 percent average rate increases are expected for 2016,” Pearson says.

As Avalere looks at the less expensive plans, she adds, “We’re seeing anywhere from a 5 percent increase for the lowest-cost plan available, to a 1 percent increase for the second-lowest-cost plan available. So we’re really looking at very modest increases — very consistent with what we saw from 2014 to 2015.”

Pearson also points out that the price increases — big or small — are by no means final. They’re requests from insurance companies. And, in some states, insurance commissioners have the ability to negotiate with the companies to moderate rate increases. The actual prices of health plans being sold on the exchanges will be final this fall.

This story is part of a reporting partnership that includes Montana Public Radio, NPR and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

The abuse of prescription painkillers is a growing problem for seniors, as it is for other age groups. But Medicare drug plans are cutting back on coverage for a specially designated type of painkiller that deters abuse in favor of cheaper generics that don’t have the same deterrent qualities, a new study found.

Overall, Medicare coverage for long-acting prescription opioids declined from an average 46 percent of plans in 2012 to 36 percent of plans in 2015, the study by Avalere Health found.

But coverage of OxyContin, a brand-name drug that has received “abuse-deterrent labeling” from the Food and Drug Administration, fell off more sharply than other long-acting opioids that didn’t receive the deterrent labeling during that time period.

OxyContin, originally introduced in 1995, gained notoriety because people soon realized that the extended release oxycodone hydrochloride tablets could be crushed and then injected or snorted for a euphoric rush. Sometimes called “hillbilly heroin,” the drug was reformulated in 2010 by the manufacturer, Purdue Pharma, to make it harder to manipulate.

The abuse-deterrent labeling approval means a drug is formulated to make it tougher for patients to snort, inject or otherwise misuse. OxyContin received the designation in 2013; the FDA announcement noted the pills were difficult to crush, break or dissolve, forming a “viscous hydrogel” when tampered with that can’t be easily injected.

Three other extended release opioid drugs were approved for abuse-deterrent labeling in 2014, outside the timeframe of the Avalere study.

Despite its abuse-deterrent labeling, OxyContin’s coverage rate in the Medicare drug plans, sometimes called Part D plans, dropped from 61 percent in 2012 to 33 percent in 2015, the study found.

Although there’s no generic equivalent for OxyContin, the Avalere analysis found that generic oxycodone, which contains the same active ingredient as OxyContin but lacks its special abuse-deterrent labeling, was covered by nearly 100 percent of plans in each of the years studied.

The coverage decisions “suggest that the Part D plans are not considering abuse deterrents as any meaningful part of the coverage decision,” says Caroline Pearson, a senior vice president at Avalere and co-author of the study.

OxyContin is significantly more expensive than generic hydrocodone. A 120-day supply of generic hydrocodone might cost $28, according to Healthcare bluebook, which estimates prices based on a nationwide database of payment data. [A similar prescription of OxyContin, on the other hand, might cost $632, more than 20 times the generic price.

Pearson notes that as more drugs receive the abuse-deterrent labeling, competition may bring prices down somewhat.

“But they’re never going to be the same price as a generic,” she says. “At some point, payers or policymakers need to decide whether they’re willing to pay a premium to avoid abuse.”

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

HHS selects nine regional Ebola and other special pathogen treatment centers

HHS pursues fast, easy test to detect Ebola virus infections