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Magnoni F, Tinterri C, Corso G, Curigliano G, Leonardi MC, Toesca A, Rocco N, Catalano F, Bianchi B, Lauria F, Caldarella P, Pagani G, Galimberti V, Veronesi P. The multicenter experience in the multidisciplinary Italian breast units: a review and update. Eur J Cancer Prev 2024; 33:185-191. [PMID: 37997909 DOI: 10.1097/cej.0000000000000853] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
A breast unit is a multidisciplinary center specialized in the management of women with breast diseases, including breast cancer (BC). It represents a care path, passing from screening activities to diagnostic investigations, from surgery to the definition of the therapeutic strategy, from psychophysical rehabilitation to long-term checks (follow-up), and up to genetic counseling. Since 2006, following a resolution issued by the European Parliament to urge member states to activate multidisciplinary breast centers by 2016, work has been underway throughout Italy to improve the management of women with BC. In Italy, the State-Regions agreement was signed on 18 December 2014, sanctioning the establishment of breast units. These centers must adhere to specific quality criteria and requirements. In 2020, the experts of the EUSOMA group (European Society of Breast Cancer Specialists), in their latest document published, expanded the requirements of the breast units. Furthermore, Senonetwork was founded in 2012 with the aim of allowing BC to be treated in breast units that comply with European requirements to ensure equal treatment opportunities for all Italian women. Indeed, the available data indicate that the BC patient has a greater chance of better treatment in the breast units with a multidisciplinary team, thus increasing the survival rate with a better quality of life, compared to those managed in nonspecialized structures. The present review is a perspective on the current Italian reality of breast units, updated with the available literature and the most recent epidemiological data from Senonetwork and AgeNaS.
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Affiliation(s)
- Francesca Magnoni
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
- European Cancer Prevention Organization (ECP), Milan, Italy
| | - Corrado Tinterri
- Breast Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giovanni Corso
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
- European Cancer Prevention Organization (ECP), Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Giuseppe Curigliano
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Experimental Therapeutics, Division of Medical Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Antonio Toesca
- Division of Breast Surgical Oncology, Candiolo Cancer Institute FPO-IRCCS, Candiolo (To), Italy
| | - Nicola Rocco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Francesca Catalano
- Multidisciplinary Breast Unit, Cannizzaro Hospital of Catania, Catania, Italy
| | - Beatrice Bianchi
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Federica Lauria
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Pietro Caldarella
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gianmatteo Pagani
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Viviana Galimberti
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paolo Veronesi
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2024; 74:229-263. [PMID: 38572751 DOI: 10.3322/caac.21834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 04/05/2024] Open
Abstract
This article presents global cancer statistics by world region for the year 2022 based on updated estimates from the International Agency for Research on Cancer (IARC). There were close to 20 million new cases of cancer in the year 2022 (including nonmelanoma skin cancers [NMSCs]) alongside 9.7 million deaths from cancer (including NMSC). The estimates suggest that approximately one in five men or women develop cancer in a lifetime, whereas around one in nine men and one in 12 women die from it. Lung cancer was the most frequently diagnosed cancer in 2022, responsible for almost 2.5 million new cases, or one in eight cancers worldwide (12.4% of all cancers globally), followed by cancers of the female breast (11.6%), colorectum (9.6%), prostate (7.3%), and stomach (4.9%). Lung cancer was also the leading cause of cancer death, with an estimated 1.8 million deaths (18.7%), followed by colorectal (9.3%), liver (7.8%), female breast (6.9%), and stomach (6.8%) cancers. Breast cancer and lung cancer were the most frequent cancers in women and men, respectively (both cases and deaths). Incidence rates (including NMSC) varied from four-fold to five-fold across world regions, from over 500 in Australia/New Zealand (507.9 per 100,000) to under 100 in Western Africa (97.1 per 100,000) among men, and from over 400 in Australia/New Zealand (410.5 per 100,000) to close to 100 in South-Central Asia (103.3 per 100,000) among women. The authors examine the geographic variability across 20 world regions for the 10 leading cancer types, discussing recent trends, the underlying determinants, and the prospects for global cancer prevention and control. With demographics-based predictions indicating that the number of new cases of cancer will reach 35 million by 2050, investments in prevention, including the targeting of key risk factors for cancer (including smoking, overweight and obesity, and infection), could avert millions of future cancer diagnoses and save many lives worldwide, bringing huge economic as well as societal dividends to countries over the forthcoming decades.
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Affiliation(s)
- Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Mathieu Laversanne
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Hyuna Sung
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Jacques Ferlay
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Rebecca L Siegel
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | | | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
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Sterpetti AV, Gabriele R, Iannone I, Borrelli V. Underdiagnosed cancer during COVID-19 pandemic and return to normality. Int J Cancer 2024. [PMID: 38682297 DOI: 10.1002/ijc.34983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/05/2024] [Accepted: 04/17/2024] [Indexed: 05/01/2024]
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Niemenoja O, Ämmälä AJ, Riihijärvi S, Lillrank P, Bono P, Taimela S. The impact of COVID-19 on healthcare booking and cancellation patterns: time series analysis of private healthcare service utilisation in Finland. BMC Health Serv Res 2024; 24:483. [PMID: 38637794 PMCID: PMC11027366 DOI: 10.1186/s12913-024-10987-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 04/12/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND COVID-19 has had wide-reaching effects on healthcare services beyond the direct treatment of the pandemic. Most current studies have reported changes in realised service usage, but the dynamics of how patients engage with healthcare services are less well understood. We analysed the effects of COVID-19 on healthcare bookings and cancellations for various service channels between January 2020 and July 2021. METHODS Our data includes 7.3 million bookings, 11.0 million available appointments, and 405.1 thousand cancellations by 900.6 thousand individual patients between the ages of 18 and 65 years. The data were collected from electronic health record data, including laboratory and imaging services as well as inpatient stays, between January 2017 and July 2021. The patients were Finnish private and occupational healthcare customers in the capital region of Finland. We fitted an autoregressive moving average (ARIMA) model on data between 2017 and 2019 to predict the expected numbers of bookings, available appointments, and cancellations, which were compared to observed time series data between 2020 and 2021. RESULTS Utilisation of physical, in-person primary care physician appointments decreased by up to 50% during the first 18 months of the pandemic. At the same time, digital care channels experienced a rapid, multi-fold increase in service usage. Simultaneously, the number of bookings for laboratory and imaging services decreased by 50% below the pre-pandemic projections. The number of specialist and hospital service bookings remained at the predicted level during the study period. Cancellations for most health services increased sharply by up to three times the pre-COVID levels during the first weeks of the pandemic but returned to the pre-pandemic levels for the rest of the study period. CONCLUSIONS The reduction in in-person appointments and the increase in the utilisation of digital services was likely a contributing factor in the decrease of the utilisation of diagnostic and imaging services throughout the study period. Utilisation of specialist care and hospital services were not affected. Cancellations contributed to the changes in service utilisation only during the first weeks of the pandemic.
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Affiliation(s)
- Oskar Niemenoja
- Terveystalo Plc, Helsinki, Finland.
- Aalto University, Espoo, Finland.
| | | | | | | | - Petri Bono
- Terveystalo Plc, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Simo Taimela
- Terveystalo Plc, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
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Agulnik J, Kasymjanova G, Pepe C, Friedmann J, Small D, Sakr L, Wang H, Spatz A, Sultanem K, Cohen V. Real-World Evidence of the Impact of the COVID-19 Pandemic on Lung Cancer Survival: Canadian Perspective. Curr Oncol 2024; 31:1562-1571. [PMID: 38534952 PMCID: PMC10969224 DOI: 10.3390/curroncol31030119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/07/2024] [Accepted: 03/15/2024] [Indexed: 05/26/2024] Open
Abstract
Background: The effect of COVID-19 on treatment outcomes in the literature remains limited and is mostly reported either as predictive survival using prioritization and modeling techniques. We aimed to quantify the effect of COVID-19 on lung cancer survival using real-world data collected at the Jewish General Hospital, Montreal. Methods: This is a retrospective chart review study of patients diagnosed between March 2019 and March 2022. We compared three cohorts: pre-COVID-19, and 1st and 2nd year of the pandemic. Results: 417 patients were diagnosed and treated with lung cancer at our centre: 130 in 2019, 103 in 2020 and 184 in 2021. Although the proportion of advanced/metastatic-stage lung cancer remained the same, there was a significant increase in the late-stage presentation during the pandemic. The proportion of M1c (multiple extrathoracic sites) cases in 2020 and 2021 was 57% and 51%, respectively, compared to 31% in 2019 (p < 0.05). Median survival for early stages of lung cancer was similar in the three cohorts. However, patients diagnosed in the M1c stage had a significantly increased risk of death. The 6-month mortality rate was 53% in 2021 compared to 47% in 2020 and 29% in 2019 (p = 0.004). The median survival in this subgroup of patients decreased significantly from 13 months in 2019 to 6 months in 2020 and 5 months in 2021 (p < 0.001). Conclusions: This study is, to our knowledge, the largest single-institution study in Canada looking at lung cancer survival during the COVID-19 pandemic. Our study looks at overall survival in the advanced/metastatic setting of NSCLC during the COVID-19 pandemic. We have previously reported on treatment pattern changes and increased wait times for NSCLC patients during the pandemic. In this study, we report that the advanced/metastatic subgroup had both an increase in the 6-month mortality rate and worsening overall survival during this same time period. Although there was no statistical difference in the proportion of patients with advanced disease, there was a concerning trend of increased M1c disease in cohorts 2 and 3. The higher M1c disease during the COVID-19 pandemic (cohorts 2 and 3) likely played a crucial role in increasing the 6-month mortality rate and leading to a reduced overall survival of lung cancer patients during the pandemic. These findings are more likely to be better identified with longer follow-up.
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Affiliation(s)
- Jason Agulnik
- Department of Internal Medicine, Division of Pulmonary Diseases, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (J.A.); (C.P.); (D.S.); (L.S.)
- Department of Medical Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (J.F.); (V.C.)
| | - Goulnar Kasymjanova
- Department of Internal Medicine, Division of Pulmonary Diseases, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (J.A.); (C.P.); (D.S.); (L.S.)
| | - Carmela Pepe
- Department of Internal Medicine, Division of Pulmonary Diseases, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (J.A.); (C.P.); (D.S.); (L.S.)
| | - Jennifer Friedmann
- Department of Medical Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (J.F.); (V.C.)
| | - David Small
- Department of Internal Medicine, Division of Pulmonary Diseases, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (J.A.); (C.P.); (D.S.); (L.S.)
| | - Lama Sakr
- Department of Internal Medicine, Division of Pulmonary Diseases, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (J.A.); (C.P.); (D.S.); (L.S.)
| | - Hangjun Wang
- Department of Pathology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (H.W.); (A.S.)
| | - Alan Spatz
- Department of Pathology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (H.W.); (A.S.)
| | - Khalil Sultanem
- Department of Radiation Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada;
| | - Victor Cohen
- Department of Medical Oncology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (J.F.); (V.C.)
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Pedersen BT, Pedersen H, Serizawa R, Sonne SB, Andreasen EK, Bonde J. Cervical cancer screening activity in the Capital Region of Denmark before, during and after the COVID-19 pandemic. Prev Med 2024; 180:107888. [PMID: 38325609 DOI: 10.1016/j.ypmed.2024.107888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/25/2024] [Accepted: 02/04/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Denmark went through various COVID-19 pandemic restrictions including periodic lockdowns from March 2020 to January 2022. All cancer screening programs were kept operational, yet access to clinicians for cervical screening was at times limited. We assessed the impact of the pandemic on cervical cancer screening activity in the Capital Region of Denmark. METHODS Cervical screening activity was defined as regular screening by invitation, opportunistic screening, and screening participation by HPV self-sampling. Activity was monitored during and post-pandemic and compared relatively to a 3-year pre-pandemic reference. RESULTS AND CONCLUSIONS The activity of cervical cancer screening was initially affected by the pandemic lockdowns, but increased activity during summer 2020 partly compensated this effect. Regular screening activity decreased 8.4% in 2020 and returned to pre-pandemic levels in 2021. During 2022 restrictions were removed and the decrease in activity was recorded to be 2.3%. Opportunistic screening activity was reduced by 14.3% in 2020 and 12.6% in 2021. A continued post-pandemic opportunistic screening activity reduction of 18.5% was observed, possibly related to changed patterns of primary health care use introduced during the pandemic. Screening by HPV self-sampling increased from 17.1% in the pre-pandemic period to 21.2% during the pandemic. Significantly more acceptance was recorded amongst older women (p < 0.0001). This increase mirrors the decrease in total clinician collected sample activity during the pandemic, where an increased reduction by age was observed. Post-pandemic HPV self-sampling participation decreased to 12.8%, possible reflecting a temporarily changed composition and motivation in the group of women invited for self-sampling.
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Affiliation(s)
| | - Helle Pedersen
- Department of Pathology, Copenhagen University Hospital AHH-Hvidovre, Hvidovre, Denmark
| | - Reza Serizawa
- Department of Pathology, Copenhagen University Hospital AHH-Hvidovre, Hvidovre, Denmark
| | - Si Brask Sonne
- Department of Pathology, Copenhagen University Hospital AHH-Hvidovre, Hvidovre, Denmark
| | | | - Jesper Bonde
- Department of Pathology, Copenhagen University Hospital AHH-Hvidovre, Hvidovre, Denmark
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Trojanowski M, Radomyski P, Kycler W, Michalek IM. Decrease in the number of new cancer diagnoses during the first year of the COVID-19 pandemic - cohort study of 3.5 million individuals in western Poland. Front Oncol 2023; 13:1230289. [PMID: 38179170 PMCID: PMC10765942 DOI: 10.3389/fonc.2023.1230289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/13/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction The COVID-19 pandemic has considerably affected healthcare systems worldwide and is expected to influence cancer incidence, mortality, stage at diagnosis, and survival. This study aimed to assess COVID-19-related changes in cancer incidence observed in 2020 in the Greater Poland region. Materials and methods Data from the Greater Poland Cancer Registry on cancer patients diagnosed between 2010 and 2020 were analysed. To quantify the change in the number of incident cancer cases during the COVID-19 pandemic, we calculated the standardized incidence ratio (SIR) and the incidence rate difference (IRD) to assume the pandemic-attributable gap in cancer incidence. Results In 2020, in Greater Poland, the expected number of new cancer cases was 18 154 (9 226 among males and 8 927 among females), while the observed number was 14 770 (7 336 among males and 7 434 among females). The registered number of cancer cases decreased in 2020 by 20% (SIR 0·80, 95% CI 0·78 to 0·81) and 17% (SIR 0·83, 95% CI 0·81 to 0·85) in males and females, respectively. Among men, the most significant difference was reported for myeloma (SIR 0·59, 95% CI 0·45 to 0·77), among women for bone cancer (SIR 0·47, 95% CI 0·20 to 0·93). In females the observed incidence was higher than expected for cancer of an unspecified site (SIR 1·19, 95% CI 1·01 to 1·38). In our study, the decrease in new cancer cases was greater in males than in females. Discussion The observed incidence was affected in most cancer sites, with the most significant deviation from the expected number in the case of myeloma. An increase in the observed incidence was reported only in women diagnosed with cancer of an unspecified site, which might reflect shortages in access to oncological diagnostics.
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Affiliation(s)
- Maciej Trojanowski
- Greater Poland Cancer Registry, Greater Poland Cancer Centre, Poznan, Poland
| | - Piotr Radomyski
- Radiology Department, Greater Poland Cancer Centre, Poznan, Poland
- Electroradiology Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Witold Kycler
- Gastrointestinal Surgical Department, Greater Poland Cancer Centre, Poznan, Poland
| | - Irmina Maria Michalek
- Cancer Epidemiology and Primary Prevention Department, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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Lauridsen GB, Jarbøl DE, Thye-Rønn P, Rasmussen S, Balasubramaniam K, Lykkegaard J. Exploring GPs' assessments of their patients' cancer diagnostic processes: a questionnaire study. Br J Gen Pract 2023; 73:e941-e948. [PMID: 37903641 PMCID: PMC10633666 DOI: 10.3399/bjgp.2022.0651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/16/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Most cancer diagnostic pathways start from primary care and several factors affect the diagnostic processes. AIM To analyse the associations between patient characteristics, symptom presentation, and cancer type and the GP's assessment of the diagnostic processes. DESIGN AND SETTING General practices in the North, Central, and Southern regions of Denmark were invited to participate in a questionnaire survey. METHOD Participating GPs received a list of patients with incident cases of cancer in the period between 1 March 2019 and 28 February 2021 based on administrative hospital data. A questionnaire was completed for each patient, addressing symptom presentation and the GP's assessment of the diagnostic process both overall and in four subcategories (the patient's role, the GP's role, the transition between primary and secondary care, and the secondary sector's role). RESULTS A total of 187 general practices informed on 8240 patients. For 5868 patients, diagnostic pathways started in general practice. Almost half (48.3%, 2837/5868) presented with specific cancer symptoms. GPs assessed 55.6% (3263) and 32.3% (1897) of the diagnostic processes as 'very good' and 'predominantly good', respectively; 11.9% (700) were 'predominantly poor' or 'very poor' for these 5868 patients. Long symptom duration of ≥2 months prior to GP contact and presenting with non-specific or a combination of non-specific and specific symptoms were associated with a poor overall assessment of the diagnostic process. Assessment in the four subcategories showed that the patient's role was assessed less positively than the other three categories. CONCLUSION A longer symptom duration and presenting without cancer-specific symptoms were associated with GPs assessing the diagnostic process as poor.
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Affiliation(s)
- Gitte Bruun Lauridsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense
| | - Dorte Ejg Jarbøl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense
| | - Peter Thye-Rønn
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, and Diagnostic Center, Svendborg Hospital, Svendborg
| | - Sanne Rasmussen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense
| | | | - Jesper Lykkegaard
- Department of Public Health and Audit Project Odense, Research Unit of General Practice, University of Southern Denmark, Odense
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Walkowiak MP, Domaradzki J, Walkowiak D. Unmasking the COVID-19 pandemic prevention gains: excess mortality reversal in 2022. Public Health 2023; 223:193-201. [PMID: 37672832 DOI: 10.1016/j.puhe.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 07/11/2023] [Accepted: 08/02/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVES The purpose of this study was to assess the long-term effectiveness of COVID-19 pandemic prevention measures in saving lives after European governments began to lift restrictions. STUDY DESIGN Excess mortality interrupted time series. METHODS Country-level weekly data on deaths were fitted to the Poisson mixed linear model to estimate excess deaths. Based on this estimate, the percentage of excess deaths above the baseline during the pandemic (week 11 in 2020 to week 15 in 2022) (when public health interventions were in place) and during the post-pandemic period (week 16 in 2022 to week 52 in 2022) were calculated. These results were fitted to the linear regression model to determine any potential relationship between mortality during these two periods. RESULTS The model used in this study had high predictive value (adjusted R2 = 59.4%). Mortality during the endemic (post-pandemic) period alone increased by 7.2% (95% confidence interval [CI]: 5.7, 8.6) above baseline, while each percentage increase in mortality during the pandemic corresponded to a 0.357% reduction (95% CI: 0.243, 0.471) in mortality during the post-pandemic period. CONCLUSIONS The most successful countries in terms of protective measures also experienced the highest mortality rates after restrictions were lifted. The model used in this study clearly shows a measure of bidirectional mortality displacement that is sufficiently clear to mask any impact of long COVID on overall mortality. Results from this study also seriously impact previous cost-benefit analyses of pandemic prevention measures, since, according to the current model, 12.2% (95% CI: 8.3, 16.1) of the gains achieved in pandemic containment were lost after restrictions were lifted.
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Affiliation(s)
- M P Walkowiak
- Department of Preventive Medicine, Poznan University of Medical Sciences, Poznań, Poland.
| | - J Domaradzki
- Department of Social Sciences and Humanities, Poznan University of Medical Sciences, Poznań, Poland.
| | - D Walkowiak
- Department of Organization and Management in Health Care, Poznan University of Medical Sciences, Poznań, Poland.
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Voigtländer S, Hakimhashemi A, Grundmann N, Radespiel-Tröger M, Inwald EC, Ortmann O, Gerken M, Klug SJ, Klinkhammer-Schalke M, Meyer M, Müller-Nordhorn J. Impact of the COVID-19 pandemic on reported cancer diagnoses in Bavaria, Germany. J Cancer Res Clin Oncol 2023; 149:7493-7503. [PMID: 36964405 PMCID: PMC10038367 DOI: 10.1007/s00432-023-04707-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/17/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE The aim of our study was to explore the impact of the COVID-19 pandemic on reported cancer cases in Bavaria, Germany, by comparing pre-pandemic (March 2019 to February 2020) and pandemic period (March 2020 to February 2021). METHODS Data on incident cases were retrieved from the Bavarian Cancer Registry (until 22nd April 2022). We included patients with malignant and in situ neoplasms reported by pathology departments with consistent reporting. We calculated the number of incident cases during the COVID-19 pandemic and the pre-pandemic period with 95% confidence intervals (CI) with Bonferroni correction (α = 0.0018) based on a Poisson approach. We stratified for malignancy (malignant, in situ), tumor site, and month of year. RESULTS Data was available for 30 out of 58 pathology departments (51.7%) from Bavaria. Incident malignant neoplasms dropped from 42,857 cases in the pre-pandemic period to 39,980 cases in the pandemic period (- 6.7%; 95% CI - 8.7%, - 4.7%). Reductions were higher for colon, rectum, skin/melanoma as well as liver (> 10.0% reduction) and less for breast cancer (4.9% reduction). No case reductions were observed for pancreas, esophagus, ovary, and cervix. Percent changes were largest for April 2020 (- 20.9%; 95% CI - 24.7%, - 16.8%) and January 2021 (- 25.2%; 95% CI - 28.8%, - 21.5%) compared to the previous year. Declines tended to be larger for in situ compared to malignant neoplasms. CONCLUSION Detection and diagnosis of cancer were substantially reduced during the COVID-19 pandemic. Potential effects, e.g. a stage shift of tumors or an increase of cancer mortality, need to be monitored.
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Affiliation(s)
- Sven Voigtländer
- Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Schweinauer Hauptstraße 80, 90441 Nuremberg, Germany
| | - Amir Hakimhashemi
- Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Schweinauer Hauptstraße 80, 90441 Nuremberg, Germany
| | - Nina Grundmann
- Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Schweinauer Hauptstraße 80, 90441 Nuremberg, Germany
| | - Martin Radespiel-Tröger
- Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Schweinauer Hauptstraße 80, 90441 Nuremberg, Germany
| | - Elisabeth C. Inwald
- Department of Gynecology and Obstetrics, University Medical Center, Landshuter Straße 65, 93053 Regensburg, Germany
| | - Olaf Ortmann
- Department of Gynecology and Obstetrics, University Medical Center, Landshuter Straße 65, 93053 Regensburg, Germany
| | - Michael Gerken
- Institute for Quality Assurance and Health Services Research, University of Regensburg, Am BioPark 9, 93053 Regensburg, Germany
| | - Stefanie J. Klug
- Chair of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 56, 80992 Munich, Germany
| | - Monika Klinkhammer-Schalke
- Institute for Quality Assurance and Health Services Research, University of Regensburg, Am BioPark 9, 93053 Regensburg, Germany
| | - Martin Meyer
- Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Schweinauer Hauptstraße 80, 90441 Nuremberg, Germany
| | - Jacqueline Müller-Nordhorn
- Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Schweinauer Hauptstraße 80, 90441 Nuremberg, Germany
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Olesen TB, Rasmussen TR, Jakobsen E, Engberg H, Hilberg O, Møller H, Jensen JW, Jensen H. Diagnosis and treatment of lung cancer in Denmark during the COVID-19 pandemic. Cancer Epidemiol 2023; 85:102373. [PMID: 37172520 PMCID: PMC10123358 DOI: 10.1016/j.canep.2023.102373] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND We examined the number of lung cancers diagnosed, the quality of care and the socio-economic and clinical characteristics among patients with lung cancer during the COVID-19 pandemic compared to previous years. METHODS We included all patients ≥ 18 years old diagnosed with lung cancer from 01 January 2018 to 31 August 2021 as registered in the Danish Lung Cancer Registry. Using a generalised linear model, we estimated prevalence ratios (PR) and 95% confidence intervals (CI) of the associations between the pandemic and socioeconomic and clinical factors, and indicators of quality. RESULTS We included 18,113 patients with lung cancer (82.0% non-small cell lung cancer (NSCLC)), which was similar to the preceding years, although a decline in NSCLC cases occurred during the first lockdown period in 2020. No difference in distribution of income or educational level was observed. No difference was observed in the quality of treatment - as measured by curative intent, proportion of patients resected or who died within 90 days of diagnosis. CONCLUSION Using nationwide population-based data, our study reassuringly shows no adverse effects of the COVID-19 pandemic on the diagnosis, socio-economic characteristics nor quality of treatment of lung cancer, as compared to the preceding years.
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Affiliation(s)
- Tina Bech Olesen
- The Danish Clinical Quality Program, National Clinical Registries (RKKP), Denmark
| | - Torben Riis Rasmussen
- Department of Clinical Medicine, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Erik Jakobsen
- Department of Thoracic, Cardiac and Vascular Surgery, Odense University Hospital (OUH), Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Henriette Engberg
- The Danish Clinical Quality Program, National Clinical Registries (RKKP), Denmark
| | - Ole Hilberg
- Department of Internal Medicine, Lillebaelt Hospital, Vejle, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Henrik Møller
- The Danish Clinical Quality Program, National Clinical Registries (RKKP), Denmark
| | - Jens Winther Jensen
- The Danish Clinical Quality Program, National Clinical Registries (RKKP), Denmark
| | - Henry Jensen
- The Danish Clinical Quality Program, National Clinical Registries (RKKP), Denmark.
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Greene GJ, Thomson CS, Donnelly D, Chung D, Bhatti L, Gavin AT, Lawler M, Huws DW, Rolles MJ, Bennée F, Morrison DS. Whole-population trends in pathology-confirmed cancer incidence in Northern Ireland, Scotland and Wales during the SARS-CoV-2 pandemic: A retrospective observational study. Cancer Epidemiol 2023; 84:102367. [PMID: 37119604 PMCID: PMC10121133 DOI: 10.1016/j.canep.2023.102367] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 05/01/2023]
Abstract
INTRODUCTION The COVID-19 epidemic interrupted normal cancer diagnosis procedures. Population-based cancer registries report incidence at least 18 months after it happens. Our goal was to make more timely estimates by using pathologically confirmed cancers (PDC) as a proxy for incidence. We compared the 2020 and 2021 PDC with the 2019 pre-pandemic baseline in Scotland, Wales, and Northern Ireland (NI). METHODS Numbers of female breast (ICD-10 C50), lung (C33-34), colorectal (C18-20), gynaecological (C51-58), prostate (C61), head and neck (C00-C14, C30-32), upper gastro-intestinal (C15-16), urological (C64-68), malignant melanoma (C43), and non-melanoma skin (NMSC) (C44) cancers were counted. Multiple pairwise comparisons generated incidence rate ratios (IRR). RESULTS Data were accessible within 5 months of the pathological diagnosis date. Between 2019 and 2020, the number of pathologically confirmed malignancies (excluding NMSC) decreased by 7315 (14.1 %). Scotland experienced early monthly declines of up to 64 % (colorectal cancers, April 2020 versus April 2019). Wales experienced the greatest overall change in 2020, but Northern Ireland experienced the quickest recovery. The pandemic's effects varied by cancer type, with no significant change in lung cancer diagnoses in Wales in 2020 (IRR 0.97 (95 % CI 0.90-1.05)), followed by an increase in 2021 (IRR 1.11 (1.03-1.20). CONCLUSION PDC are useful in reporting cancer incidence quicker than cancer registrations. Temporal and geographical differences between participating countries mirrored differences in responses to the COVID-19 pandemic, indicating face validity and the potential for quick cancer diagnosis assessment. To verify their sensitivity and specificity against the gold standard of cancer registrations, however, additional research is required.
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Affiliation(s)
- Giles J Greene
- Welsh Cancer Intelligence & Surveillance Unit, Public Health Wales Knowledge Directorate, Floor 5, Capital Quarter 2, Tyndall Street, Cardiff CF10 4BZ, UK.
| | - Catherine S Thomson
- Scottish Cancer Registry, Public Health Scotland, Edinburgh, Gyle Square, 1 South Gyle Crescent, Edinburgh EH12 9EB, UK
| | - David Donnelly
- Northern Ireland Cancer Registry, Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast UK
| | - David Chung
- Welsh Cancer Intelligence & Surveillance Unit, Public Health Wales Knowledge Directorate, Floor 5, Capital Quarter 2, Tyndall Street, Cardiff CF10 4BZ, UK
| | - Lesley Bhatti
- Scottish Cancer Registry, Public Health Scotland, Edinburgh, Gyle Square, 1 South Gyle Crescent, Edinburgh EH12 9EB, UK
| | - Anna T Gavin
- Northern Ireland Cancer Registry, Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast UK
| | - Mark Lawler
- Patrick G Johnston Centre for Cancer Research, Queens University Belfast, Belfast UK; DATA-CAN, the UK's Health Data Research Hub for Cancer, UK
| | - Dyfed Wyn Huws
- Welsh Cancer Intelligence & Surveillance Unit, Public Health Wales Knowledge Directorate, Floor 5, Capital Quarter 2, Tyndall Street, Cardiff CF10 4BZ, UK
| | - Martin J Rolles
- South West Wales Cancer Centre, Swansea Bay University Health Board, Swansea SA2 8QA, UK
| | - Felicity Bennée
- Welsh Cancer Intelligence & Surveillance Unit, Public Health Wales Knowledge Directorate, Floor 5, Capital Quarter 2, Tyndall Street, Cardiff CF10 4BZ, UK
| | - David S Morrison
- Scottish Cancer Registry, Public Health Scotland, Edinburgh, Gyle Square, 1 South Gyle Crescent, Edinburgh EH12 9EB, UK
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Onesti CE, Vari S, Nardozza F, Maggi G, Minghelli D, Rossi B, Sperati F, Checcucci E, Faltyn W, Cercato MC, Cosimati A, Biagini R, Ciliberto G, Ferraresi V. The impact of the COVID-19 pandemic on diagnosis and treatment of patients with soft tissue and bone sarcomas or aggressive benign musculoskeletal diseases: A single-center retrospective study (SarCorD study). Front Oncol 2022; 12:1000056. [PMID: 36249051 PMCID: PMC9559379 DOI: 10.3389/fonc.2022.1000056] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background The COVID-19 pandemic led to a rapid reorganization of healthcare activities, leading to reduced access to clinics, interruption of screenings, and treatment schedule modifications in several cancer types. Few data are available on sarcomas. We analyzed COVID-19-related diagnostic delay in a sarcoma referral center in Italy. Methods We retrospectively enrolled in this study patients with histological diagnosis of soft tissue or bone sarcoma and aggressive benign musculoskeletal diseases obtained during the first year of the pandemic (Covid group) or the year before (Control group) and followed at the Regina Elena National Cancer Institute in Rome. The primary endpoint was the time from the first symptom to histological diagnosis. Results We evaluated 372 patients, 185 of whom were eligible for primary endpoint analysis (92 patients in the Control group and 93 patients in the Covid group). The patients were affected by soft tissue sarcoma in most cases (63.0% and 66.7% in Covid and Control groups, respectively). We observed a diagnostic delay in the Covid group with a median time from the first symptom to the definitive histological diagnosis of 103.00 days (95% CI 92.77–113.23) vs. 90.00 days (95% CI 69.49–110.51) in the Control group (p = 0.024), but not a delay in treatment beginning (151 days, 95% CI 132.9–169.1 vs. 144 days, 95% CI 120.3–167.7, respectively, p = 0.208). No differences in stage at diagnosis were observed (12% vs. 16.5% of patients with metastatic disease at diagnosis in the Covid and Control groups, respectively, p = 0.380). Progression-free survival (p = 0.897) and overall survival (p = 0.725) were comparable in the subgroup of patients affected by soft tissue sarcoma. Conclusions A delay in sarcoma diagnosis but not in starting treatment has been observed during the first year of the COVID-19 pandemic. Nevertheless, no difference in stage at diagnosis or in terms of survival has been observed.
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Affiliation(s)
- Concetta Elisa Onesti
- Sarcomas and Rare Tumors Unit, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Sabrina Vari
- Sarcomas and Rare Tumors Unit, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
- *Correspondence: Sabrina Vari,
| | - Francesca Nardozza
- Unità Operativa Semplice Dipartimentale (UOSD) Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Gabriella Maggi
- Psychology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Denise Minghelli
- Psychology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Barbara Rossi
- Oncological Orthopaedics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Sperati
- UOSD Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS San Gallicano Dermatological Institute, Rome, Italy
| | - Elisa Checcucci
- Epidemiology and Tumor Registry Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Wioletta Faltyn
- Oncological Orthopaedics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Maria Cecilia Cercato
- Epidemiology and Tumor Registry Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Antonella Cosimati
- Sarcomas and Rare Tumors Unit, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Roberto Biagini
- Oncological Orthopaedics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Virginia Ferraresi
- Sarcomas and Rare Tumors Unit, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
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Trächsel B, Rapiti E, Feller A, Rousson V, Locatelli I, Bulliard JL. Predicting the burden of cancer in Switzerland up to 2025. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001112. [PMID: 36962605 PMCID: PMC10021406 DOI: 10.1371/journal.pgph.0001112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/20/2022] [Indexed: 03/26/2023]
Abstract
Predicting the short-term evolution of the number of cancers is essential for planning investments and allocating health resources. The objective of this study was to predict the numbers of cancer cases and of the 12 most frequent cancer sites, and their age-standardized incidence rates, for the years 2019-2025 in Switzerland. Projections of the number of malignant cancer cases were obtained by combining data from two sources: forecasts of national age-standardized cancer incidence rates and population projections from the Swiss Federal Statistical Office. Age-standardized cancer incidence rates, approximating the individual cancer risk, were predicted by a low-order Autoregressive Integrated Moving Average (ARIMA) model. The contributions of changes in cancer risk (epidemiological component) and population aging and growth (demographic components) to the projected number of new cancer cases were each quantified. Between 2018 and 2025, age-standardized cancer incidence rates are predicted to stabilize for men and women at around 426 and 328/100,000, respectively (<1% change). These projected trends are expected for most cancer sites. The annual number of cancers is expected to increase from 45,676 to 52,552 (+15%), more so for men (+18%) than for women (+11%). These increases are almost entirely due to projected changes in population age structure (+12% for men and +6% for women) and population growth (+6% for both sexes). The rise in numbers of expected cancers for each site is forecast to range from 4.15% (thyroid in men) to 26% (bladder in men). While ranking of the three most frequent cancers will remain unchanged for men (1st prostate, 2nd lung, 3rd colon-rectum), colorectal cancer will overtake by 2025 lung cancer as the second most common female cancer in Switzerland, behind breast cancer. Effective and sustained prevention measures, as well as infrastructural interventions, are required to counter the increase in cancer cases and prevent any potential shortage of professionals in cancer care delivery.
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Affiliation(s)
- Bastien Trächsel
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | | | - Anita Feller
- Foundation National Institute for Cancer Epidemiology and Registration (NICER), Zurich, Switzerland
- National Agency for Cancer Registration (NACR) Operated by NICER, Zurich, Switzerland
| | - Valentin Rousson
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Isabella Locatelli
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Jean-Luc Bulliard
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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