A genetic test that helps doctors determine how best to treat breast cancer—and whether chemotherapy is likely to help—is significantly more likely to be administered to white women than blacks or Hispanics, a Yale study has found. The test, called Oncotype Dx (ODx), uses gene expression to gauge how early-stage breast cancer is affecting patients’ gene activity. It uses the information to determine how likely cancer recurrence would be, and physicians and their patients can use that knowledge to decide how to proceed with treatment. Yale researchers retrospectively analyzed a group of more than 8,000 Connecticut women who were diagnosed with hormone receptor positive breast cancer between 2011 and 2013, and found “significant racial and ethnic disparities in use of this new gene test,” said study leader Dr. Cary Gross, a member of Yale Cancer Center and professor of medicine and epidemiology at Yale School of Medicine. “It reinforces that, at the same time we are investing in developing new treatments and new testing strategies and we’re promoting them with great excitement, we really need to double-down our efforts to eliminate disparity,” Gross said.
Federally Qualified Community Health Centers (FQHCs) in Connecticut have expanded services, upped their staffing and renovated their facilities mostly due to increased revenue streams from the Affordable Care Act (ACA). Connecticut and the 30 other states that opted for the ACA Medicaid expansion program have benefitted from billions of dollars in additional core grant funding, with Connecticut receiving $150.7 million from 2011 to 2016, according to a January report by the Congressional Research Service. Health centers in Connecticut used some of that funding to hire professionals to enroll thousands of residents in health insurance—residents who were previously uninsured and used the centers for their health care. Now the centers are serving about 70,000 more insured patients, mostly covered by Husky Health plans. The cost of treating uninsured patients has declined by about $10 million since 2012, according to Deb Polun, director of government affairs and media relations at the Community Health Center Association of Connecticut.
Edith Baker of Plainville faced a devastating reality that patients with advanced cancer inevitably confront. She had stopped responding to conventional treatment. Radiation and chemotherapy could no longer contain her stage 4 bladder cancer. But there was a ray of hope. Baker’s oncologist at Saint Francis Hospital and Medical Center referred her to a clinical trial at UConn Health involving two immunotherapy drugs: the FDA-approved Keytruda (pembrolizumab) from Merck & Co., credited with successfully treating former President Jimmy Carter’s melanoma; and Epacadostat (IDO1 inhibitor), an experimental drug from Incyte Corp.
Nearly 1,400 new cases of lead-poisoned children under age 6 were reported in Connecticut in 2015, a slight drop from the year before, but more children showed higher levels of poisoning. A child whose blood test shows 5 micrograms of lead per deciliter or higher is considered poisoned. The 2015 numbers show 98 new cases of children with lead levels of 20 micrograms or higher, four times the threshold number and a 32 percent jump from 2014. “We cannot, with any certainty, explain why this is the case,” said Krista M. Veneziano, coordinator of the Connecticut Department of Public Health’s (DPH’s) Lead, Radon, and Healthy Homes Program, about the disproportionately larger numbers of higher toxicity. Exposure to lead can damage cognitive ability, including a measurable and irreversible loss in IQ points.
Inside the 60 West nursing home in Rocky Hill, two residents played solitaire to the sound of soul music. Others sat in wheelchairs beneath a simulation of rolling clouds, while one got a haircut in a barbershop decorated with Red Sox posters. From the outside, the 95-bed, single-story facility set back from the road looks like any other nursing home. But many of the elderly and ill residents are actually paroled prisoners, and the home is being watched nationally as a potential game-changer for states grappling for ways to care for their aging inmate populations. 60 West is the first facility in the country to win approval from the Centers for Medicare & Medicaid Services (CMS) for federal nursing home funding—a designation that has national significance, experts say, because it’s a new option for cash-strapped states looking for ways to care for growing populations of older and sicker inmates.
Since 2011, Connecticut has issued more than 39,000 new Medicaid cards to prisoners returning to communities, connecting them to health care services with the goal of keeping them healthy and out of prison. This initiative, which gives ex-offenders the opportunity to see a primary care physician on a regular basis and access critical mental health and drug-abuse treatment programs, exists because of the Affordable Care Act (ACA), and Medicaid pays most of the costs. Recidivism data show that the initiative is working, state officials say. Yearly, the Court Support Services Division (CSSD) refers approximately 20,000 adults on probation to various behavioral health programs and tracks them for 12 months. In 2016, CSSD reported that 23.1 percent of adults who completed their referral program were rearrested, a five-year low since CSSD started tracking in 2012.
It is a windy day in New Haven, and a gust shakes the offices of Fair Haven Community Health Center. The executive director, Dr. Suzanne Lagarde, is in an upstairs meeting room, and she looks around quickly. “I don’t have a generator—another one of my nightmares,” she said. Downstairs is a full waiting room. A loss of power would be disastrous.
Low-income women in Connecticut who have just given birth and know they don’t want to get pregnant again anytime soon are now offered a long-acting birth control option postpartum. Medical providers say the policy by the U.S. Department of Health and Human Services will reduce the number of unplanned pregnancies, as well as lead to better maternal health outcomes by ensuring pregnancies are spaced a healthy length of time apart. Connecticut’s HUSKY program is one of 26 state Medicaid programs nationwide that reimburses hospitals for administering long-acting reversible contraception (LARC)—namely, intrauterine devices (IUDs) and subdermal implants—to Medicaid patients. HUSKY started reimbursing for the devices last year. “It’s a great thing,” said Dr. Elizabeth Purcell, an obstetrician and gynecologist practicing in Hartford.
Connecticut has seen significant reductions in deaths from breast and colon cancer in the last three decades, but the state exceeds the national mortality rate for uterine cancer and three other cancers, as well as for mental health and substance use disorders. An analysis of data compiled by the Institute for Health Metrics and Evaluation at the University of Washington, published in JAMA, also shows wide disparities between Connecticut counties in death rates from certain cancers and other illnesses. Windham County had the highest mortality rates for seven of 10 cancers identified in the study as having the highest disease burden or responsiveness to screening and treatment, including pancreatic, uterine and lung cancer. Tolland County, meanwhile, had the lowest death rates for five cancers, including breast cancer, while Fairfield County was lowest for four. Similarly, deaths from chronic respiratory diseases in Windham County were nearly double the rate in Fairfield County – 63.13 per 100,000, compared to 34.15.
State lawmakers are considering a bill that would prohibit licensed professionals from performing conversion therapy on minors, a practice designed to change a person’s sexual orientation or gender identity. Medical and mental health experts have widely denounced conversion therapy, which also is known as sexual reorientation therapy, as being ineffective and detrimental. Critics of conversion therapy say it is based on the flawed assumption that homosexuality and bisexuality are sicknesses. “It’s disgraceful,” said state Rep. Jeffrey Currey, a Democrat representing the 11th House District. Currey introduced the bill along with Democratic Fifth District Sen. Beth Bye.