In brief: Cancer survival | Difficult patients | IVF moms | Murderous surgeon

People diagnosed with cancer in the 2020s have a much greater chance of beating the disease than they would have had in decades past.

In fact, the all-cancer 5-year survival rate reached a round milestone—70%—sometime between 2015 and 2021. And the gains were seen even in patients with cancers long considered death sentences. (In the 1970s the odds of surviving vs. dying from cancer were right around 50-50.) The American Cancer Society is calling attention to the momentum of success, which is detailed in a study published online Jan. 13 in the society’s flagship journal, CA: A Cancer Journal for Clinicians. 

• Decades of scientific investment have translated to longer lives for patients with even the most fatal cancers, report corresponding author Rebecca Siegel, MPH, and colleagues. Unfortunately, the team is quick to point out, continued progress is “threatened by proposed federal cuts to cancer research and health insurance, which provides access to life-saving cancer treatment.” The threat is amplified by the sobering news that, according to ACS forecasting, the U.S. will record approximately 2.1 million new cancer cases and 626,000 cancer deaths this year.
   
  • Other key findings from the new study, which represents the latest in the ACS’s series of annual reports on cancer occurrence in the U.S.: 
     
• People with high-mortality cancers and advanced diagnoses had the largest gains across the study period. The improvements included 5-year survival increases from 32% to 62% for myeloma, 7% to 22% for liver cancer, 16% to 35% for metastatic melanoma, 8% to 18% for metastatic rectal cancer, 20% to 37% for regional lung cancer and 2% to 10% for metastatic lung cancer. 
   
• Despite the significant bounces in lung cancer survival, that disease will cause more deaths in 2026 than second-ranking colorectal cancer and third-ranking pancreatic cancer—combined. “Among American Indian and Alaska Native people, who have the highest lung cancer rates, incidence has yet to decline in women, underscoring the need to redouble culturally sensitive, targeted tobacco-control efforts,” Siegel and co-authors remark. 
   
• U.S. cancer mortality continued to decline through 2023, resulting in 4.8 million deaths averted since 1991. The researchers chalk up this victory to reductions in smoking, earlier detection for some cancers and improved treatment. These interventions are also evident in rising 5-year relative survival reaching 69% for regional-stage disease and 35% for metastatic disease. Those figures are up from 54% and 17%, respectively, in the mid-1990s.   
   
• For decades, the federal government has been the largest funder of cancer research, which has translated to longer lives for people with even the most fatal cancers. The point is emphasized by the American Cancer Society’s CEO, Shane Jacobson, in a news release publicizing the research. “But now, threats to cancer research funding and significant impact to access to health insurance could reverse this progress and stall future breakthroughs,” Jacobsen says. “We can’t stop now. There is still much work to be done.” 

About 1 of every 6 primary-care visits is perceived by the provider as ‘difficult.’ 

So report researchers at the Medical College of Wisconsin who conducted a meta-analysis and systematic review of recent and relevant studies. Annals of Internal Medicine published their findings Jan. 13. Among the most illuminating: 

• The researchers used several measures to define a difficult one-on-one. One was subjective but probably resonant with many PCPs: a patient encounter that produces in the clinician “a feeling of ‘heart-sink,’ a knot in the stomach, distress, discomfort or frustration.” 
   
• The team found higher rates of difficulty in encounters involving patients with undiagnosed health complaints. The presence of depression and/or anxiety in patients emerged as the strongest predictor of a difficult primary care episode. Not far behind were abrasive personality traits and chronic pain—again, in the patient, not the provider. Another characteristic common to patients considered difficult was a tendency to later report dashed expectations and lower satisfaction with the patient experience. 
   
• The literature showed women more likely to be described by PCPs as difficult. Interestingly, this association was flattened when patient depression was adjusted for. 
   
• The study report doesn’t explore or recommend interventions PCPs might take when dealing with difficult patients. It does, however, show that less-experienced providers are more likely to rate encounters as difficult than those with longer work histories. The authors surmise that job dissatisfaction in the provider may also make him or her more likely to label a patient encounter as difficult. 
   
  • Journal study available here, indepth coverage by MedPage Today here.

In vitro fertilization has produced a sizable subpopulation of single moms. 

Many are in their 40s, NPR reports in an informative package heavy on first-person stories and adorned with warm photos. Eye-opening data from the text:

• The nation’s first IVF newborn entered the world in 1981, when the process was such a novelty that she was referred to as a ‘test tube’ baby. “Since then, its use has surged in the United States,” NPR reports. “Today IVF accounts for almost 100,000 births each year. That’s up 50% from 10 years ago.”
   
• The number of unmarried women in their 40s who are having babies has grown by 250% in the last 30 years. “A portion of these women have partners,” NPR notes, “but many don’t.”
   
• The odds of conceiving a child with just one try of IVF are below 50% after a woman turns 35. “And the chances drop rapidly each year after that. Many women try multiple cycles of IVF with no guarantee that they'll get pregnant.”
   
• In the U.S., 1.8% of births in 2023 were conceived via IVF or other reproductive technologies. “For women with doctorate or professional degrees, who tend to be older, these technologies helped 6.4% of births.”
   
• An IVF episode of care can cost from $15,000 to more than $30,000. For that reason, NPR points out, the option is “out of reach for many.”
   
  • Get the rest and enjoy the pics. 

Also worthwhile:

• Vascular surgeon charged in murder of ex-wife, new husband. What to know about Michael McKee (USA Today) 
   
• NYC hospitals make major adjustments as nurses’ strike continues (WPIX Channel 11) 
   
• AI’s memorization crisis: Large language models don’t ‘learn’—they copy. And that could change everything for the tech industry. (The Atlantic)

From HealthExec’s sibling news outlets:

• Cardiovascular health in the United States: Exploring the good, the bad and the ugly (Cardiovascular Business)
   
• MRI technique reduces low-value surgeries for patients with colorectal cancer (Radiology Business)