{"doi":"10.1093/tbm/ibaa006","title":"Profits, public health, and patient care: caring for childhood cancer survivors","abstract":"Practice: Caution in using survivorship care models that leverage industry profits. Policy: Investments are needed to develop and evaluate interventions focused on improving clinical and behavioral outcomes of childhood cancer survivors. Research: There is a paucity of evidence on the feasibility, effectiveness, and cost-effectiveness of childhood cancer survivorship care models. Advances in therapy over the last several decades have contributed to dramatic growth in the population of childhood cancer survivors [1]. Unfortunately, cancer treatments can harm developing organs, leaving some childhood survivors at high risk for subsequent chronic illness, including heart failure, lung disease, cognitive problems, reproductive health issues, and secondary cancers [2]. These long-term adverse effects can reduce the life expectancy of survivors compared to their age-matched noncancer peers and reduce their quality of life over the course of survivorship [3, 4]. The burden of chronic disease, psychosocial concerns together with the growing numbers of adult and young adult survivors of childhood cancer has led to a critical need for evidence-based models of care to improve clinical and behavioral outcomes for this population [5]. Benedict et al. (see this issue) [6] present the case for hospital-based specialty clinics as a care model for childhood cancer survivors. This work is very timely given shortages in institutional resources for survivorship care [7] and requirements for survivorship programs new accreditation standards by the American College of Surgeons Commission on Cancer, which include the delivery of a Survivorship Care Plan to cancer patients at the conclusion of their treatment [8]. The authors are to be lauded for their use of an interesting economic approach to provide data to motivate hospital administrators to invest in a survivorship clinic. The study presents a retrospective financial accounting analysis of procedures recommended by the “Children’s Oncology Group (COG) guidelines” at a single nonprofit institution in New York. The researchers report a potential “profit opportunity loss” of $348,700 (in 2019 dollars) over a period of 3 years from 2010 to 2012 due to nonuniversal use of recommended procedures and care. Further, they found that nonuniversal use of guideline care occurred among individuals who were uninsured and underinsured and racial minorities, arguably the most vulnerable groups. Motivating providers and patients to routinely undergo office visits and procedures to potentially detect disease that led to additional services (e.g., breast cancer screening with MRI generating biopsies and surgeries) was projected to increase hospital profits. The authors argue that the ability to capture this potential profit would lead to increased investment to support clinical operations, and this investment could then improve survivors’ outcomes. This study takes an important first step in tackling difficult issues in the financing of cancer care for the rapidly growing population of individuals living after cancer [9, 10]. However, this research also raises several potentially troubling issues. First, and most concerning, is the potential for profit maximization approaches to collide with principles of public health and health equity. The goal of the former is to maximize profit regardless of outcomes, whereas public health perspectives are founded on the principle of maximizing the health of all individuals. The finding by Benedict et al. [6] that vulnerable populations have low adherence to COG guidelines, thereby generating the least profits, also raises a serious concern about the potential for profit maximization approaches to increase inequity in health outcomes. The authors posit that having more survivorship services would increase access for vulnerable groups. But the opposite could also occur if providers systematically were to deliver less care to uninsured and underinsured patients because they gene","journal":"Translational Behavioral Medicine","year":2021,"id":223220,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9576,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":463741,"name":"Jennifer M. Yeh","orcid":"0000-0002-2724-7404","position":1,"is_corresponding":false},{"id":107668,"name":"Kristi D. Graves","orcid":"0000-0001-8808-1631","position":2,"is_corresponding":false},{"id":292842,"name":"Jeanne S. Mandelblatt","orcid":"0000-0002-2490-005X","position":3,"is_corresponding":false},{"id":292840,"name":"Jinani Jayasekera","orcid":"0000-0001-9212-7225","position":0,"is_corresponding":true}],"reference_count":19,"raw_metadata":null,"created_at":"2026-07-18T23:54:11.061295Z","pmid":"33595065","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}