MSD (Canada)

Detecting and treating cancer at an early stage is critical for improving patient survival, quality of life, and health system efficiency. Early diagnosis offers substantial clinical benefits, reduces the need for aggressive treatments associated with advanced disease, and lowers healthcare costs. Despite these benefits, disparities in early-stage detection persist across tumor types due to challenges in screening, public awareness, and the aggressive nature of certain cancers. While early-stage diagnosis generally offers a better prognosis than late-stage detection, disease recurrence remains a significant reality and concern. Many patients experience a relapse of cancer despite initial curative treatment, which adversely affects their survival, quality of life, and financial stability. While effective new treatments for early-stage cancers have emerged, including immunotherapy and targeted therapies, barriers to reimbursement and access persist. One challenge is the absence of mature overall survival data at the time of regulatory and reimbursement approvals for most tumor types, which can result in delayed decision-making, reduced patient access, and worse outcomes. This policy paper combines insights from clinicians, health economists, outcomes researchers, and policy experts to address gaps in early-stage cancer care and provide recommendations to enhance diagnosis rates, reduce the burden of recurrence, and optimize access to innovative treatments. Central to these recommendations is the integration of early cancer care into national cancer control plans, including robust data collection and monitoring, as well as improvements in health literacy. A key factor is the use of early clinical endpoints that measure key outcomes in addition to overall survival, providing timely insights into treatment effectiveness that can guide early regulatory and reimbursement decisions prior to reaching overall survival maturity. This paper is a call to action for relevant stakeholders to take a coordinated approach that optimizes outcomes for cancer patients by promoting early detection and treatment.

In many ways, the early twenty-first century is strikingly different from the early twentieth; but in more than few respects, it is radically the same.Wealth inequality and the concentration of corporate power mirror or exceed their peaks in the 1920s, 1 dislocating person from place, fraying social bonds, and destroying prior land stewardship. 2Union participation is stymied at every corner, depressing wages. 3 Authoritarianism is rising around the globe. 4 The "united" states are engaged in a vitriolic cultural battle over how to deal with their bloody history of racialized violence. 5A pandemic has taken millions of lives and exposed global health inequities. 6 And war rages in continental Europe.

Background: The impact of cervical dystonia (CD) severity on presentation subtype and onabotulinumtoxinA utilization was examined in the completer population from CD PROBE (CD Patient Registry for Observation of BOTOX® Efficacy). Methods: In this multicenter, prospective, observational registry, patients with CD were treated with onabotulinumtoxinA according to injectors’ standard of care. Completers were patients that completed all 3 treatment sessions and had accompanying data. Results: Of N=1046 patients enrolled, n=350 were completers. Completers were on average 57.3 years old, 74.9% female, 94.6% white, and 60.6% toxin-naïve. Baseline severity was mild in 32.6%, moderate in 54.3%, and severe in 13.1%. Torticollis was the most common presentation at baseline (mild: 44.7%, moderate: 55.8%, severe: 63.0%), followed by laterocollis (mild: 42.1%, moderate: 32.6%, severe: 26.1%). Median onabotulinumtoxinA dose increased over time; 160U–200U for torticollis and 170U–200U for laterocollis. For all severities, median total dose increased from injection 1 to injection 3 (mild: 138U–165U, moderate: 183U–200U, severe: 200U–285U). Eighty-one patients (23.1%) reported 139 treatment-related adverse events. There were no treatment-related serious adverse eventsand no new safety signals. Conclusions: CD severity impacted presentation subtype frequency and onabotulinumtoxinA utilization in CD PROBE, with higher and tailored dosing observed over time and with increasing disease severity.