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PREPUBLICATION COPY: UNCORRECTED PROOFS Selected Health Conditions and Likelihood of Improvement with Treatment Committee on Identifying Disabling Medical Conditions Likely to Improve with Treatment Board on Health Care Services Health and Medicine Division A Consensus Study Report of
PREPUBLICATION COPY: UNCORRECTED PROOFS THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 This activity was supported by a contract between the National Academy of Sciences and the U.S. Department of Veterans Affairs (Contract No. 36C24518N3884). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Numberâ13: 978-0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/25662 Library of Congress Control Number: XXXXXXXXXX Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2020 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2020. Selected health conditions and likelihood of improvement with treatment. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25662.
PREPUBLICATION COPY: UNCORRECTED PROOFS The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private nongovernment institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public-policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.
PREPUBLICATION COPY: UNCORRECTED PROOFS Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on studiesâ statements of task by committees of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committees and the committeesâ deliberations. Each report has been subjected to a rigorous and independent peer-review process and represents the position of the National Academies on its statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at workshops, symposia, or other events convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.
PREPUBLICATION COPY: UNCORRECTED PROOFS v COMMITTEE ON IDENTIFYING DISABLING MEDICAL CONDITIONS LIKELY TO IMPROVE WITH TREATMENT JUDITH GREEN-MCKENZIE (Chair), Professor and Chief, Division of Occupational and Environmental Medicine, University of Pennsylvania Perelman School of Medicine AMY BERNSTEIN, Policy Director and Contracting Officer (Retired), Medicaid and CHIP Payment and Access Commission CHARLES H. BOMBARDIER, Professor, Department of Rehabilitation Medicine, University of Washington JOSEPH A. BUCKWALTER, Professor and Steindler Chair, Department of Orthopedics and Rehabilitation, University of Iowa College of Medicine ANDREA L. CHEVILLE, Professor, Physical Medicine and Rehabilitation, Mayo Clinic LISA B. DIXON, Professor, Department of Psychiatry, Columbia University ANNETTE FITZPATRICK, Research Professor, Department of Epidemiology, University of Washington School of Public Health and Community Medicine JAIMIE L. GRADUS, Associate Professor, Epidemiology and Psychiatry, Boston University School of Public Health STEPHEN S. GRUBBS, Vice President Clinical Affairs, American Society of Clinical Oncology ERIN E. KREBS, Associate Professor of Medicine, University of Minnesota KNASHAWN H. MORALES, Associate Professor of Biostatistics, University of Pennsylvania Perelman School of Medicine PATRICIA M. OWENS, Consultant, Health and Disability Policy and Programs NINA A. SAYER, Deputy Director, Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System TISAMARIE B. SHERRY, Associate Physician Policy Researcher, RAND Corporation MICHAEL STUBBLEFIELD, Clinical Professor, Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School Study Staff CAROLYN FULCO, Scholar MARIA ORIA, Senior Program Officer BERNICE CHU, Program Officer BLAKE REICHMUTH, Associate Program Officer JOSEPH GOODMAN, Senior Program Assistant ANNE MARIE HOUPPERT, Senior Research Librarian SHARYL NASS, Director, Board on Health Care Services Consultant NANETTE WENGER, Professor of Medicine, Department of Cardiology, Emory University School of Medicine
PREPUBLICATION COPY: UNCORRECTED PROOFS vii Reviewers This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following individuals for their review of this report: RICHARD N. ASLIN, Yale University JENNIFER BOGNER, The Ohio State University Wexner Medical Center DEBORAH W. BRUNER, Emory University School of Nursing ROBERT M. CARNEY, Washington University School of Medicine JIE DENG, University of Pennsylvania School of Nursing PHILIP D. HARVEY, University of Miami School of Medicine VAN LEWIS KING, University of Texas Health Science Center NANCY E. LANE, University of California, Davis, Health System RACHEL L. YUNG, University of Washington School of Medicine JENNIFER M. ZUMSTEG, University of Washington Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by HAROLD C. SOX, Dartmouth Geisel School of Medicine, and BRADFORD H. GRAY, The Urban Institute. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.
CONTENTS PREPUBLICATION COPY: UNCORRECTED PROOFS ix Contents ACRONYMS AND ABBREVIATIONS xv SUMMARY S-1 1 INTRODUCTION 1-1 Statement of Task, 1-2 The Social Security Disability Insurance Program, 1-3 The Social Security Supplemental Security Income Program (SSI), 1-3 Social Security Administrationâs Disability Determination Process, 1-4 The Social Security Administrationâs Continuing Disability Review, 1-7 Approach to the Task, 1-9 Evolving Concepts of Disability, 1-10 Organization of the Report, 1-13 References, 1-14 2 CROSS-CUTTING ISSUES 2-1 Approach to Pain and Pain Treatment, 2-1 Comorbidities and Return to Work, 2-2 Variation in Availability and Use of Effective Treatment, 2-4 References, 2-7 3 CANCER 3-1 Epidemiology of Cancer in the United States, 3-2 Cross-Cutting Issues for Selected Cancers, 3-10 Breast Cancer, 3-19 Cutaneous Melanoma, 3-24 Renal Cancer, 3-26 Head and Neck Squamous Cell Cancers, 3-28 Advanced Epithelial Ovary Cancer, 3-31 Non-Small-Cell Lung Cancer, 3-34 Diffuse Large B-Cell Lymphoma, 3-38 Disabling Impairments Related to the Selected Cancers and Cancer Treatments, 3-40 Pain, 3-44 Cancer-Related Fatigue, 3-47 Cardiotoxicity, 3-49 Chemotherapy-Induced Peripheral Neuropathy, 3-50 Lymphedema, 3-54 Pulmonary Dysfunction, 3-58 Cognitive Dysfunction, 3-60 New and Developing Cancer Treatments, 3-61 Variations in Treatment Response, 3-64 Return to Work After Cancer, 3-66 Summary and Conclusions, 3-67 References, 3-70
PREPUBLICATION COPY: UNCORRECTED PROOFS x 4 MENTAL HEALTH DISORDERS 4-1 Cross-Cutting Issues for Selected Mental Health Disorders, 4-2 Major Depressive Disorder, 4-5 Bipolar Disorders, 4-12 Obsessive Compulsive Disorder, 4-21 Posttraumatic Stress Disorder, 4-28 Anxiety Disorders, 4-35 Summary and Conclusions, 4-51 References, 4-54 5 MUSCULOSKELETAL DISORDERS 5-1 Epidemiology of Musculoskeletal Disorders in the United States, 5-2 Cross-Cutting Issues for Musculoskeletal Disorders, 5-2 Chronic Low Back Pain, 5-6 Osteoarthritis, 5-10 Inflammatory Arthropathies, 5-18 New and Developing Treatments for Musculoskeletal Disorders, 5-31 Summary and Conclusions, 5-32 References, 5-34 APPENDIX A MENTAL HEALTH DISORDERS: ADDITIONAL INFORMATION A-1
PREPUBLICATION COPY: UNCORRECTED PROOFS xi Acronyms and Abbreviations ACR American College of Rheumatology ACS American Cancer Society ADA Americans with Disabilities Act ADHD/ADD attention deficit hyperactivity disorder/attention deficit disorder AHRQ Agency for Healthcare Research and Quality ALK anaplastic lymphoma kinase APA American Psychiatric Association ASCO American Society of Clinical Oncology BDI-II Beck Depression Inventory II BEP brief eclectic psychotherapy BPI Brief Pain Inventory BRCA1 breast cancer type 1 susceptibility gene BRCA2 breast cancer type 2 susceptibility gene CA-125 carbohydrate antigen 125 CAL compassionate allowance CANMAT Canadian Network for Mood and Anxiety Treatments CBT cognitive behavioral therapy CD cognitive dysfunction CDC Centers for Disease Control and Prevention CDK cyclin-dependent kinase CDR continuing disability review CDT complex decongestive therapy CFR Code of Federal Regulation CGI-I Clinical Global ImpressionâImprovement CGI-S Clinical Global ImpressionâSeverity CIPN chemotherapy-induced peripheral neuropathy CPT cognitive processing therapy CR controlled release CRF cancer-related fatigue CRP c-reactive protein CT computed tomography CTCAE Common Terminology Criteria for Adverse Events CTLA-4 cytotoxic T-lymphocyte-associated protein 4 DCIS ductal carcinoma in situ DMARD disease-modifying antirheumatic drug DoD U.S. Department of Defense DSM Diagnostic and Statistical Manual of Mental Disorder DSM-III Diagnostic and Statistical Manual of Mental Disorder, 3rd Edition DSM-IV Diagnostic and Statistical Manual of Mental Disorders, 4th Edition DSM-IV-TR Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision
PREPUBLICATION COPY: UNCORRECTED PROOFS xii DSM-5 Diagnostic and Statistical Manual of Mental Disorders, 5th Edition EBV Epstein-Barr virus ECT electroconvulsive therapy EGFR epidermal growth factor receptor EMDR eye movement desensitization therapy ER/PR/HER2 tumor markers ERP exposure and response prevention ESR erythrocyte sedimentation rate EULAR European League Against Rheumatism EX/RP exposure and response prevention FACT Functional Assessment of Cancer Therapy (questionnaire) FDA U.S. Food and Drug Administration FDG fluorodeoxyglucose FISH fluorescence in situ hybridization FNA fine needle aspiration GAD generalized anxiety disorder HAM-D Hamilton Depression Rating Scale HAQ Health Assessment Questionnaire Disability Index HDRS Hamilton Depression Rating Scale HER2 human epidermal growth factor receptor 2 HGSOC high-grade serious ovarian cancer HIV human immunodeficiency virus HNC head and neck cancer HPV human papillomavirus IASP International Association for the Study of Pain ICD International Classification of Disease ICF International Classification of Functioning, Disability and Health ICI immune checkpoint inhibitor IFNÎ± interferon alpha IFNÎ² interferon beta IFNÎ³ interferon gamma IGH immunoglobulin heavy chain IL-2 interleukin-2 IMPACT Initiative for Molecular Profiling and Advanced Cancer Therapy IOM Institute of Medicine IPT interpersonal therapy ISTSS Society for Traumatic Stress Studies KC keratinocyte carcinoma KPS Karnofsky Performance Scale Li/DVP lithium/divalproex LSAS Liebowitz Social Anxiety Scale MADRS Montgomery Asberg Depression Rating Scale MAOI monoamine oxidase inhibitor MDD major depressive disorder MIE medical improvement expected
CONTENTS PREPUBLICATION COPY: UNCORRECTED PROOFS xiii MINE medical improvement not expected MIP medical improvement possible MRI magnetic resonance imaging NCCN National Comprehensive Cancer Network NCI National Cancer Institute NCS-R National Comorbidity Survey NET narrative exposure therapy NHIS National Health Interview Survey NICE National Institute for Health and Care Excellence NIH National Institutes of Health NMDA N-methyl-D-aspartate receptor NPRM notice of proposed rule making NSAID non-steroidal anti-inflammatory drug NSCLC non-small-cell lung cancer OA osteoarthritis OCD obsessive compulsive disorder ODT orally dissolving tablet OIG Office of Inspector General OMB Office of Management and Budget OR odds ratio PARP poly (ADP-ribose) polymerase PCT present-centered therapy PD panic disorder PD-1 programmed cell death protein 1 PD-L1 programmed death-ligand 1 PE prolonged exposure PET positron emission tomography PHQ Patient Health Questionnaire PHQ-9 Patient Health Questionnaire-9 PIK3ca a protein coding gene PR pulmonary rehabilitation PsA psoriatic arthritis PT physical therapy PTSD posttraumatic stress disorder QDD Quick Disability Determination QoL quality of life RA rheumatoid arthritis RAI radioactive iodine ablation RCT randomized controlled trial RT radiation therapy SAD social anxiety disorder SCLC small-cell lung cancer SEER Surveillance, Epidemiology and End Result SGA substantial gainful activity SNRI serotonin-norepinephrine reuptake inhibitor
PREPUBLICATION COPY: UNCORRECTED PROOFS xiv SOT Statement of Task SRI serotonin reuptake inhibitor SSA Social Security Administration SSDI Social Security Disability Insurance SSI Social Security Insurance SSRI selective serotonin reuptake inhibitor STAR*D Sequenced Treatment Alternatives to Relieve Depression (study) TG thyroglobulin TMS transcranial magnetic stimulation TNF tumor necrosis factor TNM tumor, lymph nodes, metastasis TSH thyroid-stimulating hormone UCSD University of California, San Diego VA U.S. Department of Veterans Affairs VA/DoD U.S. Department of Veterans Affairs and U.S. Department of Defense VO2peak volume of oxygen uptake during peak exercise WFSBP World Federation of Societies of Biological Psychiatry WHO World Health Organization XR extended release YBOCS YaleâBrown Obsessive Compulsive Scale