{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T04:54:45Z","timestamp":1781585685605,"version":"3.54.5"},"reference-count":30,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["T32 TR004928"],"award-info":[{"award-number":["T32 TR004928"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Cancer care in the U.S. exceeds $200B, with patients paying over $16B out\u2010of\u2010pocket. We examined whether insurance network status (in\u2010network [IN] vs. out\u2010of\u2010network [OON]) at prostate cancer diagnosis was associated with subsequent OON care use and patient spending within 1\u2009year of diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using the MarketScan database (2010\u20132021), we identified patients aged 40\u201364 with a new outpatient prostate cancer diagnosis. Patients who received definitive local treatment (radical prostatectomy or radiotherapy) were excluded. The exposure was network status at diagnosis. Outcomes were the proportion of OON claims and patient spending for prostate cancer\u2010related care and\/or non\u2010definitive treatments during 1\u2009year of follow\u2010up. Results were stratified by insurance type.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 67,271 patients, 5% were diagnosed OON. Compared with IN diagnosis, OON diagnosis was associated with greater OON follow\u2010up claims (aIRR 29.0, 95% CI 25.0, 33.5), lower odds of prostate cancer\u2010related spending (aOR 0.55, 95% CI 0.49, 0.61), and lower outpatient costs (% difference\u2009=\u2009\u22128.6, 95% CI \u221213.4, \u22123.6). In stratified analyses, patients with HMO (aOR 0.54, 95% CI 0.44, 0.67) and PPO (aOR 0.47, 95% CI 0.41, 0.54) plans had lower odds of any spending. Patients with HMO (% difference\u2009=\u2009\u221222.3, 95% CI \u221230.9, \u221212.5) and CDHP (% difference\u2009=\u2009\u221226.5, 95% CI \u221243.6, \u22124.3) plans had lower costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>OON diagnosis was associated with continued OON care. Some patients diagnosed OON had lower liability, likely reflecting differences in plan design and adjudicated claims. Claims\u2010based estimates may underestimate the financial impact of OON non\u2010definitive prostate cancer care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.71983","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T04:34:47Z","timestamp":1779338087000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Insurance Network Status and 1\u2010Year Health Care Utilization and Outpatient Costs Among Commercially Insured Patients With Newly Diagnosed and Non\u2010Definitively Treated Prostate Cancer, 2010\u20132021"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8162-826X","authenticated-orcid":false,"given":"Aurora J.","family":"Grutman","sequence":"first","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"},{"name":"James Buchanan Brady Urological Institute Johns Hopkins School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark N.","family":"Alshak","sequence":"additional","affiliation":[{"name":"James Buchanan Brady Urological Institute Johns Hopkins School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle I.","family":"Higgins","sequence":"additional","affiliation":[{"name":"James Buchanan Brady Urological Institute Johns Hopkins School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian P.","family":"Pavlovich","sequence":"additional","affiliation":[{"name":"James Buchanan Brady Urological Institute Johns Hopkins School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5878-5101","authenticated-orcid":false,"given":"Derek K.","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2022.1229"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1158\/1055\u20109965.EPI\u201019\u20101534"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djq495"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djab192"},{"issue":"2","key":"e_1_2_11_6_1","first-page":"80","article-title":"Financial Toxicity, Part I: A New Name for a Growing Problem","volume":"27","author":"Zafar S. 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