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Ammitzbøll G, Levinsen AKG, Kjær TK, Ebbestad FE, Horsbøl TA, Saltbæk L, Badre-Esfahani SK, Joensen A, Kjeldsted E, Halgren Olsen M, Dalton SO. Socioeconomic inequality in cancer in the Nordic countries. A systematic review. Acta Oncol 2022; 61:1317-1331. [DOI: 10.1080/0284186x.2022.2143278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Gunn Ammitzbøll
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Danish Research Center for Equality in Cancer (COMPAS), Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark
| | | | - Trille Kristina Kjær
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Freja Ejlebæk Ebbestad
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Trine Allerslev Horsbøl
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lena Saltbæk
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Sara Koed Badre-Esfahani
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
| | - Andrea Joensen
- Section of Epidemiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Eva Kjeldsted
- Danish Research Center for Equality in Cancer (COMPAS), Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Maja Halgren Olsen
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Danish Research Center for Equality in Cancer (COMPAS), Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark
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Johansson ALV, Dickman PW, Eloranta S, Björkholm M. Reproductive history, as measured by parity, age at first birth and sex of offspring, and cancer-specific survival after a haematological malignancy. Acta Oncol 2022; 61:764-772. [PMID: 35451928 DOI: 10.1080/0284186x.2022.2064726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Overall, women have better cancer-specific survival than men following haematological malignancies. The effect of reproductive factors on prognosis in women remains unknown and population-based studies are needed. MATERIAL AND METHODS A nationwide cohort of 21,237 Swedish women with a recorded haematological malignancy at ages 18-69 years was identified in the Swedish Cancer Register 1970-2018. Pre-diagnosis childbirths for each woman were linked to the Swedish Multigeneration Register. Net survival and excess hazard ratios for parity, age at first birth, time since the latest birth, and sex of offspring were estimated using flexible parametric models adjusted for age, year, and educational level. RESULTS In unadjusted analyses, parity (p = 0.0012) and high age at first birth (p < 0.0001) were associated with better survival. After co-adjustments for reproductive factors and confounders, the associations were attenuated. The adjusted association with parity was mainly observed among women aged above 40 years at diagnosis (p = 0.0033). The associations with reproductive factors were non-significant across subtypes of haematological malignancy. There was a tendency of higher excess mortality for an increasing number of boys compared to girls, although only significant for women with three or more children (p = 0.0126). CONCLUSION Reproductive factors were in part associated with survival following diagnosis of a haematological malignancy. However, the effect sizes were small with inconsistent association patterns, and thus reproductive factors may only partly contribute to the survival advantage of women over men.
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Affiliation(s)
- Anna L. V. Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Cancer Registry of Norway, Oslo, Norway
| | - Paul W. Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sandra Eloranta
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Björkholm
- Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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3
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Puett RC, Poulsen AH, Taj T, Ketzel M, Geels C, Brandt J, Christensen JH, Sørensen M, Roswall N, Hvidtfeldt U, Raaschou-Nielsen O. Relationship of leukaemias with long-term ambient air pollution exposures in the adult Danish population. Br J Cancer 2020; 123:1818-1824. [PMID: 32939055 PMCID: PMC7722932 DOI: 10.1038/s41416-020-01058-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 08/11/2020] [Accepted: 08/26/2020] [Indexed: 12/24/2022] Open
Abstract
Background Few population-based epidemiological studies of adults have examined the relationship between air pollution and leukaemias. Methods Using Danish National Cancer Registry data and Danish DEHM-UBM-AirGIS system-modelled air pollution exposures, we examined whether particulate matter (PM2.5), black carbon (BC), nitrogen dioxide (NO2) and ozone (O3) averaged over 1, 5 or 10 years were associated with adult leukaemia in general or by subtype. In all, 14,986 adult cases diagnosed 1989–2014 and 51,624 age, sex and time-matched controls were included. Separate conditional logistic regression models, adjusted for socio-demographic factors, assessed exposure to each pollutant with leukaemias. Results Fully adjusted models showed a higher risk of leukaemia with higher 1-, 5- and 10-year-average exposures to PM2.5 prior to diagnosis (e.g. OR per 10 µg/m3 for 10-year average: 1.17, 95% CI: 1.03, 1.32), and a positive relationship with 1-year average BC. Results were driven by participants 70 years and older (OR per 10 µg/m3 for 10-year average: 1.35, 95% CI: 1.15–1.58). Null findings for younger participants. Higher 1-year average PM2.5 exposures were associated with higher risks for acute myeloid and chronic lymphoblastic leukaemia. Conclusion Among older adults, higher risk for leukaemia was associated with higher residential PM2.5 concentrations averaged over 1, 5 and 10 years prior to diagnosis.
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Affiliation(s)
- Robin C Puett
- Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD, USA. .,Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.
| | - Aslak Harbo Poulsen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Tahir Taj
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, P.O. Box. 358, DK-4000, Roskilde, Denmark.,Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford, GU2 7XH, UK
| | - Camilla Geels
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, P.O. Box. 358, DK-4000, Roskilde, Denmark
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, P.O. Box. 358, DK-4000, Roskilde, Denmark
| | - Jesper H Christensen
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, P.O. Box. 358, DK-4000, Roskilde, Denmark
| | - Mette Sørensen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.,Department of Natural Science and Environment, Roskilde University, Roskilde, Denmark
| | - Nina Roswall
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Ulla Hvidtfeldt
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.,Department of Environmental Science, Aarhus University, Frederiksborgvej 399, P.O. Box. 358, DK-4000, Roskilde, Denmark
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Socioeconomic inequalities in cancer incidence in Europe: a comprehensive review of population-based epidemiological studies. Radiol Oncol 2020; 54:1-13. [PMID: 32074075 PMCID: PMC7087422 DOI: 10.2478/raon-2020-0008] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 02/05/2020] [Indexed: 02/08/2023] Open
Abstract
Background Since the end of the previous century, there has not been a comprehensive review of European studies on socioeconomic inequality in cancer incidence. In view of recent advances in data source linkage and analytical methods, we aimed to update the knowledge base on associations between location-specific cancer incidence and individual or area-level measures of socio-economic status (SES) among European adults. Materials and methods We systematically searched three databases (PubMed, Scopus and Web of Science) for articles on cancer incidence and SES. Qualitative synthesis was performed on the 91 included English language studies, published between 2000 and 2019 in Europe, which focused on adults, relied on cancer registry data and reported on relative risk (RR) estimates. Results Adults with low SES have increased risk of head and neck, oesophagogastric, liver and gallbladder, pancreatic, lung, kidney, bladder, penile and cervical cancers (highest RRs for lung, head and neck, stomach and cervix). Conversely, high SES is linked with increased risk of thyroid, breast, prostate and skin cancers. Central nervous system and haematological cancers are not associated with SES. The positive gap in testicular cancer has narrowed, while colorectal cancer shows a varying pattern in different countries. Negative associations are generally stronger for men compared to women. Conclusions In Europe, cancers in almost all common locations are associated with SES and the inequalities can be explained to a varying degree by known life-style related factors, most notably smoking. Independent effects of many individual and area SES measures which capture different aspects of SES can also be observed.
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The Use of Optimal Treatment for DLBCL Is Improving in All Age Groups and Is a Key Factor in Overall Survival, but Non-Clinical Factors Influence Treatment. Cancers (Basel) 2019; 11:cancers11070928. [PMID: 31269764 PMCID: PMC6678990 DOI: 10.3390/cancers11070928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 06/17/2019] [Accepted: 06/28/2019] [Indexed: 12/12/2022] Open
Abstract
Introduction: Diffuse large B cell lymphoma (DLBCL) is an aggressive form of non-Hodgkin lymphoma for which a cure is usually the therapeutic goal of optimal treatment. Using a large population-based cohort we sought to examine the factors associated with optimal DLBCL treatment and survival. Methods: DLBCL cases were identified through the population-based Victorian Cancer Registry, capturing new diagnoses for two time periods: 2008–2009 and 2012–2013. Treatment was pre-emptively classified as ‘optimal’ or ‘suboptimal’, according to compliance with current treatment guidelines. Univariable and multivariable logistic regression models were fitted to determine factors associated with treatment and survival. Results: Altogether, 1442 DLBCL cases were included. Based on multivariable analysis, delivery of optimal treatment was less likely for those aged ≥80 years (p < 0.001), women (p = 0.012), those with medical comorbidity (p < 0.001), those treated in a non-metropolitan hospital (p = 0.02) and those who were ex-smokers (p = 0.02). Delivery of optimal treatment increased between 2008–2009 and the 2012–2013 (from 60% to 79%, p < 0.001). Delivery of optimal treatment was independently associated with a lower risk of death (hazard ratio (HR) = 0.60 (95% confidence interval (CI) 0.45–0.81), p = 0.001). Conclusion: Delivery of optimal treatment for DLBCL is associated with hospital location and category, highlighting possible demographic variation in treatment patterns. Together with an increase in the proportion of patients receiving optimal treatment in the more recent time period, this suggests that treatment decisions in DLBCL may be subject to non-clinical influences, which may have implications when evaluating equity of treatment access. The positive association with survival emphasizes the importance of delivering optimal treatment in DLBCL.
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Pálmarsdóttir R, Kiesbye Øvlisen A, Severinsen MT, Glimelius I, Smedby KE, El-Galaly T. Socioeconomic impact of Hodgkin lymphoma in adult patients: a systematic literature review. Leuk Lymphoma 2019; 60:3116-3131. [PMID: 31167589 DOI: 10.1080/10428194.2019.1613538] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Hodgkin lymphoma is a highly curable disease with a peak incidence in young adulthood at times where education, family, and social relations are established. We performed a systematic literature review to assess the impact of Hodgkin lymphoma on the socioeconomic status of adolescent and adult survivors (including educational achievements, occupational aspects, marriage, and parenthood). In total, 39 articles were included. Overall, 26-36% of survivors perceived Hodgkin lymphoma as negatively affecting their socioeconomic status. Studies consistently found educational achievements in line with general population. Employment rates for survivors were comparable to the general population, but lower than before Hodgkin lymphoma diagnosis, with a post-diagnosis increase in disability pension and early retirement. Employed survivors encountered problems related to physical restrictions and recruitment. Marriage and parenthood were not substantially affected. In conclusion, current studies suggest acceptable socioeconomic outcomes following a Hodgkin lymphoma diagnosis but the use of standardized reporting methods hampers comparability across studies.
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Affiliation(s)
| | - Andreas Kiesbye Øvlisen
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Marianne Tang Severinsen
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ingrid Glimelius
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden.,Department of Immunology, Genetics and Pathology, Clinical and Experimental Oncology, Uppsala University and Uppsala Akademiska Hospital, Uppsala, Sweden
| | - Karin E Smedby
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden.,Hematology Center, Karolinska University Hospital, Solna, Sweden
| | - Tarec El-Galaly
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Biasoli I, Castro N, Delamain M, Silveira T, Farley J, Pinto Simões B, Solza C, Praxedes M, Baiocchi O, Gaiolla R, Franceschi F, Bonamin Sola C, Boquimpani C, Clementino N, Fleury Perini G, Pagnano K, Steffenello G, Tabacof J, de Freitas Colli G, Soares A, de Souza C, Chiattone CS, Raggio Luiz R, Milito C, Morais JC, Spector N. Lower socioeconomic status is independently associated with shorter survival in Hodgkin Lymphoma patients-An analysis from the Brazilian Hodgkin Lymphoma Registry. Int J Cancer 2017; 142:883-890. [PMID: 29023692 DOI: 10.1002/ijc.31096] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/29/2017] [Accepted: 10/02/2017] [Indexed: 11/07/2022]
Abstract
Socioeconomic status (SES) is a well-known determinant of outcomes in cancer. The purpose of this study was to analyze the impact of the SES on the outcomes of Hodgkin lymphoma (HL) patients from the Brazilian Prospective HL Registry. SES stratification was done using an individual asset/education-based household index. A total of 624 classical HL patients with diagnosis from January/2009 to December/2014, and treated with ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine), were analyzed. The median follow-up was 35.6 months, and 33% were classified as lower SES. The 3-year progression- free survival (PFS) in higher and lower SES were 78 and 64% (p < 0.0001), respectively. The 3-year overall survival (OS) in higher and lower SES were 94 and 82% (p < 0.0001), respectively. Lower SES patients were more likely to be ≥ 60 years (16 vs. 8%, p = 0.003), and to present higher risk International Prognostic score (IPS) (44 vs. 31%, p = 0.004) and advanced disease (71 vs. 58%, p = 0.003). After adjustments for potential confounders, lower SES remained independently associated with poorer survival (HR = 3.12 [1.86-5.22] for OS and HR = 1.66 [1.19-2.32] for PFS). The fatality ratio during treatment was 7.5 and 1.3% for lower and higher SES (p = 0.0001). Infections and treatment toxicity accounted for 81% of these deaths. SES is an independent factor associated with shorter survival in HL in Brazil. Potential underlying mechanisms associated with the impact of SES are delayed diagnosis and poorer education. Educational and socio-economic support interventions must be tested in this vulnerable population.
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Affiliation(s)
- Irene Biasoli
- School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nelson Castro
- Hospital de Cancer de Barretos, Barretos, São Paulo, Brazil
| | - Marcia Delamain
- Hematology and Hemotherapy Center, University of Campinas, Campinas, São Paulo, Brazil
| | - Talita Silveira
- São Paulo Santa Casa Medical School, São Paulo, São Paulo, Brazil
| | - James Farley
- Liga Norte Rio Grandense contra o câncer, Natal, Rio Grande do Norte, Brazil
| | | | - Cristiana Solza
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Monica Praxedes
- Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil
| | | | | | | | | | | | - Nelma Clementino
- Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Kátia Pagnano
- Hematology and Hemotherapy Center, University of Campinas, Campinas, São Paulo, Brazil
| | - Giovana Steffenello
- Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Jacques Tabacof
- ESHO- Centro Paulistano de Oncologia, São Paulo, São Paulo, Brazil
| | | | - Andrea Soares
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carmino de Souza
- Hematology and Hemotherapy Center, University of Campinas, Campinas, São Paulo, Brazil
| | | | | | - Cristiane Milito
- School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - José Carlos Morais
- School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nelson Spector
- School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
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Boslooper K, Hoogendoorn M, van Roon EN, Kibbelaar RE, Storm H, Hovenga S, Woolthuis G, van Rees BP, Klijs B, Veeger NJ, Kluin-Nelemans HC, de Bock GH. No outcome disparities in patients with diffuse large B-cell lymphoma and a low socioeconomic status. Cancer Epidemiol 2017; 48:110-116. [DOI: 10.1016/j.canep.2017.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/22/2017] [Accepted: 04/18/2017] [Indexed: 10/19/2022]
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9
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Comber H, De Camargo Cancela M, Haase T, Johnson H, Sharp L, Pratschke J. Affluence and Private Health Insurance Influence Treatment and Survival in Non-Hodgkin's Lymphoma. PLoS One 2016; 11:e0168684. [PMID: 27992551 PMCID: PMC5167407 DOI: 10.1371/journal.pone.0168684] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 12/05/2016] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate inequalities in survival for non-Hodgkin's lymphoma (NHL), distinguishing between direct and indirect effects of patient, social and process-of-care factors. METHODS All cases of NHL diagnosed in Ireland in 2004-2008 were included. Variables describing patient, cancer, stage and process of care were included in a discrete-time model of survival using Structural Equation Modelling software. RESULTS Emergency admissions were more common in patients with co-morbid conditions or with more aggressive cancers, and less frequent for patients from more affluent areas. Aggressive morphology, female sex, emergency admission, increasing age, comorbidity, treatment in a high caseload hospital and late stage were associated with increased hazard of mortality. Private patients had a reduced hazard of mortality, mediated by systemic therapy, admission to high caseload hospitals and fewer emergency admissions. DISCUSSION The higher rate of emergency presentation, and consequent poorer survival, of uninsured patients, suggests they face barriers to early presentation. Social, educational and cultural factors may also discourage disadvantaged patients from consulting with early symptoms of NHL. Non-insured patients, who present later and have more emergency admissions would benefit from better access to diagnostic services. Older patients remain disadvantaged by sub-optimal treatment, treatment in non-specialist centres and emergency admission.
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Affiliation(s)
| | | | - Trutz Haase
- Social and Economic Consultant, Dublin, Ireland
| | - Howard Johnson
- Health & Wellbeing Directorate Health Intelligence Unit, Health Service Executive, Dublin, Ireland
| | - Linda Sharp
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jonathan Pratschke
- Department of Economics and Statistics, University of Salerno, Salerno, Italy
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Le Guyader-Peyrou S, Orazio S, Dejardin O, Maynadié M, Troussard X, Monnereau A. Factors related to the relative survival of patients with diffuse large B-cell lymphoma in a population-based study in France: does socio-economic status have a role? Haematologica 2016; 102:584-592. [PMID: 27909221 PMCID: PMC5394966 DOI: 10.3324/haematol.2016.152918] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/24/2016] [Indexed: 12/24/2022] Open
Abstract
The survival of patients with diffuse large B-cell lymphoma has increased during the last decade as a result of addition of anti-CD20 to anthracycline-based chemotherapy. Although the trend is encouraging, there are persistent differences in survival within and between the USA and European countries suggesting that non-biological factors play a role. Our aim was to investigate the influence of such factors on relative survival of patients with diffuse large B-cell lymphoma. We conducted a retrospective, multicenter, registry-based study in France on 1165 incident cases of diffuse large B-cell lymphoma between 2002 and 2008. Relative survival analyses were performed and missing data were controlled with the multiple imputation method. In a multivariate analysis, adjusted for age, sex and International Prognostic Index, we confirmed that time period was associated with a better 5-year relative survival. The registry area, the medical specialty of the care department (onco-hematology versus other), the time to travel to the nearest teaching hospital, the place of treatment (teaching versus not-teaching hospital -borderline significance), a comorbidity burden and marital status were independently associated with the 5-year relative survival. Adjusted for first-course treatment, inclusion in a clinical trial and treatment discussion in a multidisciplinary meeting were strongly associated with a better survival outcome. In contrast, socio-economic status (determined using the European Deprivation Index) was not associated with outcome. Despite therapeutic advances, various non-biological factors affected the relative survival of patients with diffuse large B-cell lymphoma. The notion of lymphoma-specific expertise seems to be essential to achieve optimal care management and reopens the debate regarding centralization of these patients’ care in hematology/oncology departments.
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Affiliation(s)
- Sandra Le Guyader-Peyrou
- Registre des Hémopathies Malignes de la Gironde, Institut Bergonie, Bordeaux, France .,University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team EPICENE, UMR 1219, F-33000, France
| | - Sébastien Orazio
- Registre des Hémopathies Malignes de la Gironde, Institut Bergonie, Bordeaux, France.,University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team EPICENE, UMR 1219, F-33000, France
| | - Olivier Dejardin
- University Hospital of Caen, U1086 INSERM UCBN «Cancers & Préventions», France
| | - Marc Maynadié
- Registre des Hémopathies Malignes de Côte d'Or, EA4184, Université de Bourgogne, Dijon, France
| | - Xavier Troussard
- Registre des Hémopathies Malignes de Basse Normandie, Caen, France.,Laboratoire d'Hématologie, CHU de Caen, France
| | - Alain Monnereau
- Registre des Hémopathies Malignes de la Gironde, Institut Bergonie, Bordeaux, France.,University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team EPICENE, UMR 1219, F-33000, France
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11
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Hung CL, Ou CY, Lai HC, Chen YT, Lee CC, Li SC, Su YC. High combined individual and neighborhood socioeconomic status correlated with better survival of patients with lymphoma in post-rituximab era despite universal health coverage. JOURNAL OF CANCER RESEARCH AND PRACTICE 2016. [DOI: 10.1016/j.jcrpr.2016.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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12
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Seidelin UH, Ibfelt E, Andersen I, Steding-Jessen M, Høgdall C, Kjær SK, Dalton SO. Does stage of cancer, comorbidity or lifestyle factors explain educational differences in survival after endometrial cancer? A cohort study among Danish women diagnosed 2005-2009. Acta Oncol 2016; 55:680-5. [PMID: 27144961 DOI: 10.3109/0284186x.2015.1136750] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Several studies have documented an association between socioeconomic position and survival from gynaecological cancer, but the mechanisms are unclear. OBJECTIVE The aim of this study was to examine the association between level of education and survival after endometrial cancer among Danish women; and whether differences in stage at diagnosis and comorbidity contribute to the educational differences in survival. METHODS Women with endometrial cancer diagnosed between 2005 and 2009 were identified in the Danish Gynaecological Cancer Database, with information on clinical characteristics, surgery, body mass index (BMI) and smoking status. Information on highest attained education, cohabitation and comorbidity was obtained from nationwide administrative registries. Logistic regression models were used to determine the association between level of education and cancer stage and Cox proportional hazards model for analyses of overall survival. RESULTS Of the 3638 patients identified during the study period, 787 had died by the end of 2011. The group of patients with short education had a higher odds ratio (OR) for advanced stage at diagnosis, but this was not statistically significant (adjusted OR 1.20; 95% CI 0.97-1.49). The age-adjusted hazard ratio (HR) for dying of patients with short education was 1.47 (CI 95% 1.17-1.80). Adjustment for cohabitation status, BMI, smoking and comorbidity did not change HRs, but further adjustment for cancer stage yielded a HR of 1.36 (1.11-1.67). CONCLUSION Early detection in all educational groups might reduce social inequalities in survival, however, the unexplained increased risk for death after adjustment for prognostic factors, warrants increased attention to patients with short education in all age groups throughout treatment and rehabilitation.
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Affiliation(s)
| | - Else Ibfelt
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Research Centre for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark
| | - Ingelise Andersen
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Claus Høgdall
- The Gynecologic Clinic, The Juliane Marie Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Susanne Krüger Kjær
- Danish Cancer Society Research Center, Copenhagen, Denmark
- The Gynecologic Clinic, The Juliane Marie Centre, Copenhagen University Hospital, Copenhagen, Denmark
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Raaschou-Nielsen O, Ketzel M, Harbo Poulsen A, Sørensen M. Traffic-related air pollution and risk for leukaemia of an adult population. Int J Cancer 2015; 138:1111-7. [DOI: 10.1002/ijc.29867] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 08/25/2015] [Accepted: 09/10/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Ole Raaschou-Nielsen
- Danish Cancer Society Research Center; Copenhagen Denmark
- Department of Environmental Science; Aarhus University; Roskilde Denmark
| | - Matthias Ketzel
- Department of Environmental Science; Aarhus University; Roskilde Denmark
| | | | - Mette Sørensen
- Danish Cancer Society Research Center; Copenhagen Denmark
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Glaser SL, Clarke CA, Keegan THM, Chang ET, Weisenburger DD. Time Trends in Rates of Hodgkin Lymphoma Histologic Subtypes: True Incidence Changes or Evolving Diagnostic Practice? Cancer Epidemiol Biomarkers Prev 2015; 24:1474-88. [PMID: 26215294 PMCID: PMC4592457 DOI: 10.1158/1055-9965.epi-15-0281] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 07/20/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Histologic subtypes of classical Hodgkin lymphoma [cHL; e.g., nodular sclerosis, mixed cellularity, not otherwise specified (NOS)] are epidemiologically and prognostically distinctive. Therefore, unexplained, ongoing incidence rate declines for mixed cellularity and increases for NOS require examination. METHODS We analyzed detailed histology-specific Hodgkin lymphoma incidence rates in 1992 through 2011 U.S. SEER data (n = 21,372) and reviewed a regional subset of 2007 through 2011 NOS pathology reports for insight into diagnostic practices. RESULTS cHL rates were stable until 2007, then decreased for whites [annual percent change (APC) and 95% confidence interval (CI), -3.6% (-5.6% to -1.5%)]. Nodular sclerosis rates declined after 2007 by 5.9% annually, with variation by gender, age, and race/ethnicity. In 1992 through 2011, mixed cellularity rates declined [APC -4.0% (-4.7% to -3.3%)], whereas NOS rates rose [5.3% (4.5%-6.2%)] overall and in most patient groups. The 2007-2011 NOS age-specific rates were more similar to mixed cellularity rates for 1992-1996 than 2007-2011. Trends in combined rates were minimal, supporting increasing misclassification of mixed cellularity, lymphocyte depletion, and specific nodular sclerosis subtypes as NOS. Eighty-eight of 165 reviewed NOS pathology reports addressed classification choice. Twenty (12.1%) justified the classification, 21 (12.7%) described insufficient biopsy material, and coders missed specific subtype information for 27 (16.4%). CONCLUSION Recent nodular sclerosis rate declines largely represent true incidence changes. Long-term rate decreases for mixed cellularity and other less common subtypes, and increases for NOS (comprising ∼30% of cHL cases in 2011), likely reflect changes in diagnostic and/or classification practice. IMPACT Diminishing histologic subtyping undermines future surveillance and epidemiologic study of Hodgkin lymphoma. Guideline-based use of excisional biopsies and more coding quality control are warranted.
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Affiliation(s)
- Sally L Glaser
- Cancer Prevention Institute of California, Fremont, California. Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, California.
| | - Christina A Clarke
- Cancer Prevention Institute of California, Fremont, California. Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, California
| | - Theresa H M Keegan
- Cancer Prevention Institute of California, Fremont, California. Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, California
| | - Ellen T Chang
- Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, California. Health Sciences Practice, Exponent, Inc., Menlo Park, California
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15
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Borel C, Lamy S, Compaci G, Récher C, Jeanneau P, Nogaro JC, Bauvin E, Despas F, Delpierre C, Laurent G. A longitudinal study of non-medical determinants of adherence to R-CHOP therapy for diffuse large B-cell lymphoma: implication for survival. BMC Cancer 2015; 15:288. [PMID: 25884669 PMCID: PMC4403884 DOI: 10.1186/s12885-015-1287-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 03/30/2015] [Indexed: 12/21/2022] Open
Abstract
Background Adherence to therapy has been established for years as a critical parameter for clinical benefit in medical oncology. This study aimed to assess, in the current practice, the influence of the socio-demographical characteristics and the place of treatment on treatment adherence and overall survival among diffuse large B-cell lymphoma patients. Methods We analysed data from 380 patients enrolled in a French multi-centre regional cohort, with diffuse large B-cell lymphoma receiving first-line treatment with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) or R-CHOP-like regimens. Direct examination of administrative and medical records yielded the date of death. We studied the influence of patients’ socio-demographic characteristics and place of treatment on the treatment adherence and overall survival, adjusted for baseline clinical characteristics. Treatment adherence was measured by the ratio between received and planned dose Intensity (DI), called relative DI (RDI) categorized in “lesser than 85%” and “at least 85%”. Results During the follow-up, among the final sample 70 patients had RDI lesser than 85% and 94 deceased. Multivariate models showed that advanced age, poor international prognosis index (IPI) and treatment with R-CHOP 14 favoured RDI lesser than 85%. The treatment in a public academic centre favoured RDI greater than or equal to 85%. Poor adherence to treatment was strongly associated with poor overall survival whereas being treated in private centres was linked to better overall survival, after adjusting for confounders. No socioeconomic gradient was found on both adherence to treatment and overall survival. Conclusions These results reinforce adherence to treatment as a critical parameter for clinical benefit among diffuse large B-cell lymphoma patients under R-CHOP. The place of treatment, but not the socioeconomic status of these patients, impacted both RDI and overall survival
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Affiliation(s)
- Cécile Borel
- Department of Haematology, Toulouse University Hospital, Toulouse, France. .,University of Toulouse III Paul Sabatier, Toulouse, France.
| | - Sébastien Lamy
- University of Toulouse III Paul Sabatier, Toulouse, France. .,INSERM UMR1027 (The French National Institute of Health and Medical Research), Toulouse, France. .,Department of Clinical Pharmacology, Toulouse University Hospital, Toulouse, France.
| | - Gisèle Compaci
- Department of Haematology, Toulouse University Hospital, Toulouse, France.
| | - Christian Récher
- Department of Haematology, Toulouse University Hospital, Toulouse, France. .,University of Toulouse III Paul Sabatier, Toulouse, France. .,INSERM UMR1037 (The French National Institute of Health and Medical Research), Cancer Research Centre of Toulouse, Toulouse, France.
| | - Pauline Jeanneau
- Department of Clinical Pharmacology, Toulouse University Hospital, Toulouse, France.
| | - Jean Claude Nogaro
- Department of Haematology, Toulouse University Hospital, Toulouse, France.
| | - Eric Bauvin
- INSERM UMR1027 (The French National Institute of Health and Medical Research), Toulouse, France. .,Health care cancer network Oncomip, Toulouse, France.
| | - Fabien Despas
- University of Toulouse III Paul Sabatier, Toulouse, France. .,INSERM UMR1027 (The French National Institute of Health and Medical Research), Toulouse, France. .,Department of Clinical Pharmacology, Toulouse University Hospital, Toulouse, France.
| | - Cyrille Delpierre
- University of Toulouse III Paul Sabatier, Toulouse, France. .,INSERM UMR1027 (The French National Institute of Health and Medical Research), Toulouse, France.
| | - Guy Laurent
- Department of Haematology, Toulouse University Hospital, Toulouse, France. .,University of Toulouse III Paul Sabatier, Toulouse, France. .,INSERM UMR1037 (The French National Institute of Health and Medical Research), Cancer Research Centre of Toulouse, Toulouse, France.
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16
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Horsboel TA, Nielsen CV, Andersen NT, Nielsen B, de Thurah A. Risk of disability pension for patients diagnosed with haematological malignancies: a register-based cohort study. Acta Oncol 2014; 53:724-34. [PMID: 24456498 DOI: 10.3109/0284186x.2013.875625] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Patients with haematological malignancies are at increased risk of experiencing work-related problems. The aims of this study were to compare the risk of disability pension (DP) among patients diagnosed with eight subtypes of haematological malignancies to a reference cohort, and to determine if relative risks differ between these subtypes; to evaluate the influence of socioeconomic factors, demographic factors, and clinical factors on the risk of DP; and to investigate if these associations differ between the reference cohort and the patient cohort. MATERIAL AND METHODS We combined data from national registers on Danish patients diagnosed with haematological malignancies between 2000 and 2007 and a reference cohort without a history of these diseases. A total of 3194 patients and 28 627 reference individuals were followed until DP, emigration, old age pension or anticipatory pension, death or 26 February 2012, whichever came first. RESULTS A total of 550 (17%) patients and 1511 (5%) reference individuals were granted DP. Age- and gender-adjusted relative risks differed significantly between the subgroups of haematological malignancies and ranged from 2.64 (95% CI 1.84-3.78) for patients with Hodgkin lymphoma to 12.53 (95% CI 10.57-14.85) for patients with multiple myeloma. In the patient cohort we found that gender, age, comorbidity, ethnicity, educational level, household income, history of long-term sick leave, and need of treatment with anxiolytics or antidepressants after diagnosis were associated with receiving DP. However, most of these associations were stronger in the reference cohort. CONCLUSION All eight subtypes of haematological malignancies were associated with an increased risk of DP compared to the reference cohort. The relative risks differed according to subtype, and patients with multiple myeloma had the highest risk of DP. Furthermore, most socioeconomic, demographic and clinical factors had a stronger impact on the risk of DP in the reference cohort than in the patient cohort.
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17
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Keegan THM, Moy LM, Foran JM, Alizadeh AA, Chang ET, Shema SJ, Schupp CW, Clarke CA, Glaser SL. Rituximab use and survival after diffuse large B-cell or follicular lymphoma: a population-based study. Leuk Lymphoma 2012; 54:743-51. [DOI: 10.3109/10428194.2012.727415] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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18
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Smith EC, Ziogas A, Anton-Culver H. Association between insurance and socioeconomic status and risk of advanced stage Hodgkin lymphoma in adolescents and young adults. Cancer 2012; 118:6179-87. [PMID: 22736071 DOI: 10.1002/cncr.27684] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 01/06/2012] [Accepted: 02/01/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND Hodgkin lymphoma (HL) is one of the most common types of cancer among adolescents and young adults (AYAs) in the United States. Unfortunately, a greater percentage of AYAs are presenting with an advanced stage of disease at the time of diagnosis compared with their younger counterparts. METHODS The objective of the current study was to examine the association between possible barriers and characteristics (including gender, race, birthplace, marital status, socioeconomic status [SES], and insurance status) that may increase the risk of advanced stage HL at the time of diagnosis in a large cohort of AYA patients with HL from the California Cancer Registry (7343 incident cases of HL diagnosed from 1988-2006, between ages 15 years-40 years). RESULTS AYAs with advanced stage HL were more likely to be male, of Hispanic or black race/ethnicity, foreign born, single, of lower SES, and uninsured or to have only public health insurance (P < .05). Multivariate logistic regression analysis demonstrated that there was a significant increase in the odds of having advanced HL in males (odds ratio [OR], 1.57; 95% confidence interval [95% CI], 1.42-1.74 [P < .0001]), those with the lowest SES (OR, 1.47; 95% CI, 1.23-1.75 [P = .0003]), those without health insurance (OR, 1.76; 95% CI, 1.34-2.31 [P < .0001]), and those with public health insurance (OR, 1.45; 95% CI, 1.23-1.71 [P < .0001]). CONCLUSIONS A strong association was found between male gender, lower SES, and lack of health insurance and advanced stage HL at the time of diagnosis in AYAs (See editorial on pages 000-000, this issue.).
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Affiliation(s)
- Erlyn C Smith
- Department of Pediatric Hematology-Oncology, Children's Hospital of Orange County, Orange, California, USA
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19
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Frederiksen BL, Dalton SO, Osler M, Steding-Jessen M, de Nully Brown P. Socioeconomic position, treatment, and survival of non-Hodgkin lymphoma in Denmark--a nationwide study. Br J Cancer 2012; 106:988-95. [PMID: 22315055 PMCID: PMC3305955 DOI: 10.1038/bjc.2012.3] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Not all patients have benefited equally from the advances in non-Hodgkin lymphoma (NHL) survival. This study investigates several individual-level markers of socioeconomic position (SEP) in relation to NHL survival, and explores whether any social differences could be attributed to comorbidity, disease and prognostic factors, or the treatment given. Methods: This registry-based cohort study links clinical data on prognostic factors and treatment from the national Danish lymphoma database to individual socioeconomic information in Statistics Denmark including 6234 patients diagnosed with NHL in 2000–2008. Results: All-cause mortality was 40% higher in NHL patients with short vs higher education diagnosed in the period 2000–2004 (hazard ratio (HR)=1.40 (1.27–1.54)), and 63% higher in the period 2005–2008 (HR=1.63 (1.40–1.90)). Further, mortality was increased in unemployed and disability pensioners, those with low income, and singles. Clinical prognostic factors attenuated, but did not eliminate the association between education and mortality. Radiotherapy was less frequently given to those with a short education (odds ratio (OR)= 0.84 (0.77–0.92)), low income (OR=0.80 (0.70–0.91)), and less frequent to singles (OR=0.79 (0.64–0.96)). Patients living alone were less likely to receive all treatment modalities. Conclusion: Patients with low SEP have an elevated mortality rate after a NHL diagnosis, and more advanced disease at the time of diagnosis explained a part of this disparity. Thus, socioeconomic disparities in NHL survival might be reduced by improving early detection among patients of low SEP.
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Affiliation(s)
- B L Frederiksen
- Research Centre for Prevention and Health, Glostrup University Hospital, DK-2600 Glostrup, Denmark.
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20
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Frederiksen BL, Brown PDN, Dalton SO, Steding-Jessen M, Osler M. Socioeconomic inequalities in prognostic markers of non-Hodgkin lymphoma: analysis of a national clinical database. Eur J Cancer 2010; 47:910-7. [PMID: 21145729 DOI: 10.1016/j.ejca.2010.11.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 11/10/2010] [Accepted: 11/12/2010] [Indexed: 11/18/2022]
Abstract
The survival of non-Hodgkin lymphoma patients strongly depends on a range of prognostic factors. This registry-based clinical cohort study investigates the relation between socioeconomic position and prognostic markers in 6234 persons included in a national clinical database in 2000-2008, Denmark. Several measures of individual socioeconomic position were achieved from Statistics Denmark. The risk of being diagnosed with advanced disease, as expressed by the six prognostic markers (Ann Arbor stage III or IV, more than one extranodal lesion, elevated serum lactate dehydrogenase (LDH), performance status of two or more, presence of B symptoms and International Prognostic Index (IPI) of two or more), increased with decreasing level of education, in patients living alone, and in men. For instance, a significant decrease in the odds of being diagnosed with elevated LDH (p=0.02), high performance status (p=0.004), high IPI score (p=0.004) and B symptoms (p=0.02) was seen with higher level of education, whereas high stage of disease was significantly less likely in the higher educated (odds ratio [OR]=0.85 (0.74-0.99)). The difference in risk seemed not to be mediated by differences in histological subgroups reflecting aggressiveness of disease among the social groups. One of the most likely mechanisms of the social difference is longer delay in those with low socioeconomic position. The findings of social inequality in prognostic markers in non-Hodgkin lymphoma (NHL) patients could already be implemented in the clinical practice if general practitioners (GP's) and physicians on hospitals paid special attention to patients with low educational level and unspecific symptoms.
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21
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Clinical, molecular, and environmental risk factors for hodgkin lymphoma. Adv Hematol 2010; 2011:736261. [PMID: 21127715 PMCID: PMC2994062 DOI: 10.1155/2011/736261] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 10/11/2010] [Indexed: 12/14/2022] Open
Abstract
Epidemiological studies suggest unique occurrence patterns of Hodgkin lymphoma (HL) worldwide. In most Western countries there is a clear bimodal age distribution with an early peak in young adults followed by a second peak in older adults, particularly among males. In the Middle East and Asia, HL is more common in early childhood. There also are marked racial differences in the presentations of HL and HL subtypes, and particular single nucleotide polymorphisms (SNPs) have been identified as etiological factors suggesting that gene-gene and gene-environment interactions are involved. Personal health choices such as exercise and smoking may modify an individual's chances of developing HL. Numerous studies highlight the impact that exposure to Epstein-Barr virus and other environmental factors have on HL risk. Understanding the relative importance of each of these findings and their links to HL development and survival will help clinical researchers expand curative therapies and create preventative strategies for HL.
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22
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Socioeconomic Impacts on Survival Differ by Race/Ethnicity among Adolescents and Young Adults with Non-Hodgkin's Lymphoma. J Cancer Epidemiol 2010; 2010:824691. [PMID: 20652048 PMCID: PMC2905919 DOI: 10.1155/2010/824691] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 04/15/2010] [Indexed: 11/29/2022] Open
Abstract
Shorter survival has been associated with low socioeconomic status (SES) among elderly non-Hodgkin's lymphoma (NHL) patients; however it remains unknown whether the same relationship holds for younger patients. We explored the California Cancer Registry (CCR), to investigate this relationship in adolescent and young adult (AYA) NHL patients diagnosed from 1996 to 2005. A case-only survival analysis was conducted to examine demographic and clinical variables hypothesized to be related to survival. Included in the final analysis were 3,489 incident NHL cases. In the multivariate analyses, all-cause mortality (ACM) was higher in individuals who had later stage at diagnosis (P < .05) or did not receive first-course chemotherapy (P < .05). There was also a significant gradient decrease in survival, with higher ACM at each decreasing quintile of SES (P < .001). Overall results were similar for lymphoma-specific mortality. In the race/ethnicity stratified analyses, only non-Hispanic Whites (NHWs) had a significant SES-ACM trend (P < .001). Reduced overall and lymphoma-specific survival was associated with lower SES in AYAs with NHL, although a significant trend was only observed for NHWs.
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23
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Han X, Zheng T, Foss F, Holford TR, Ma S, Zhao P, Dai M, Kim C, Zhang Y, Bai Y, Zhang Y. Vegetable and fruit intake and non-Hodgkin lymphoma survival in Connecticut women. Leuk Lymphoma 2010; 51:1047-54. [PMID: 20350273 PMCID: PMC3110752 DOI: 10.3109/10428191003690364] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We investigated whether an increased intake of vegetables and fruits favors NHL survival. A cohort of 568 female cases of incident NHL diagnosed during 1996-2000 in Connecticut was followed up for a median of 7.7 years. Adjusted hazard ratios (HRs) were estimated by Cox proportional hazard models. Our results show that a pre-diagnostic high intake of vegetables appeared to favor overall survival (HR = 0.74, 95% CI 0.57-0.98) among patients with NHL who survived longer than 6 months. In particular, pre-diagnostic high intakes of green leafy vegetables and citrus fruits were associated with 29% (95% CI 0.51-0.98) and 27% (95% CI 0.54-0.99) reduced risk of death, respectively. When different types of vegetables and fruits were investigated separately, their impacts were found to vary in NHL subtypes. Our study suggests that increasing vegetable and citrus fruit consumption could be a useful strategy to improve survival in NHL patients.
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Affiliation(s)
- Xuesong Han
- School of Public Health, Yale University, New Haven, CT, USA
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24
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Association of Human Development Index with rates and outcomes of hematopoietic stem cell transplantation for patients with acute leukemia. Blood 2010; 116:122-8. [PMID: 20395416 DOI: 10.1182/blood-2010-01-266478] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Human Development Index (HDI) is used by the United Nations Organization to measure socioeconomic achievements of countries. We evaluated the association of HDI with rates and outcomes of hematopoietic stem cell transplantation (HSCT) for patients with acute leukemia. For the analysis of HSCT rates, all adults with acute leukemia (n = 16 403) treated in 30 European countries, between 2001 and 2005, were included. Association of HDI with the outcome was analyzed for 2015 patients with acute myeloid leukemia treated with myeloablative allotransplantation. Countries were classified according to HDI quintiles. Highly significant correlation was found for HDI and the total number of HSCT per population (R = 0.78; P < .001), as well as separately for sibling HSCT (R = 0.84; P < .001), unrelated HSCT (R = 0.66; P < .001), and autologous HSCT (R = 0.43; P = .02). The probabilities of leukemia-free survival for 5 consecutive groups of countries with increasing HDI were: 56%, 59%, 63%, 58%, and 68% (P = .01). In a multivariate analysis, transplantations performed in countries belonging to the upper HDI category were associated with higher leukemia-free survival compared with the remaining ones (HR = 1.36, P = .008), which resulted mainly from reduced risk of relapse (HR = 0.72, P = .04). We conclude that, in Europe, the HDI is associated with both rates and results of HSCT for acute leukemia.
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Keegan THM, Clarke CA, Chang ET, Shema SJ, Glaser SL. Disparities in survival after Hodgkin lymphoma: a population-based study. Cancer Causes Control 2009; 20:1881-92. [PMID: 19557531 PMCID: PMC2888633 DOI: 10.1007/s10552-009-9382-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Accepted: 06/08/2009] [Indexed: 10/20/2022]
Abstract
Survival after Hodgkin lymphoma (HL) is generally favorable, but may vary by patient demographic characteristics. The authors examined HL survival according to race/ethnicity and neighborhood socioeconomic status (SES), determined from residential census-block group at diagnosis. For 12,492 classical HL patients ≥ 15 years diagnosed in California during 1988-2006 and followed through 2007, we determined risk of overall and HL-specific death using Cox proportional hazards regression; analyses were stratified by age and Ann Arbor stage. Irrespective of disease stage, patients with lower neighborhood SES had worse overall and HL-specific survival than patients with higher SES. Patients with the lowest quintile of neighborhood SES had a 64% (patients aged 15-44 years) and 36% (≥ 45 years) increased risk of HL-death compared to patients with the highest quintile of SES; SES results were similar for overall survival. Even after adjustment for neighborhood SES, blacks and Hispanics had increased risks of HL-death 74% and 43% (15-44 years) and 40% and 17% (≥ 45 years), respectively, higher than white patients. The racial/ethnic differences in survival were evident for all stages of disease. These data provide evidence for substantial, and probably remediable, racial/ethnic and neighborhood SES disparities in HL outcomes.
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Affiliation(s)
- Theresa H M Keegan
- Northern California Cancer Center, 2201 Walnut Ave, Suite 300, Fremont, CA 94536, USA.
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26
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Wang R, Gross CP, Halene S, Ma X. Neighborhood socioeconomic status influences the survival of elderly patients with myelodysplastic syndromes in the United States. Cancer Causes Control 2009; 20:1369-76. [PMID: 19455395 PMCID: PMC2921772 DOI: 10.1007/s10552-009-9362-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Accepted: 04/30/2009] [Indexed: 02/02/2023]
Abstract
The potential role of socioeconomic status (SES) in the survival of patients with myelodysplastic syndromes (MDS) has not been evaluated. We conducted the first study to assess the prognostic role of neighborhood SES among a cohort of 2,118 patients (age >/= 66 years) who were diagnosed with incident MDS in the United States during 2001-2002. Principal component analysis was used to develop a summary SES score by combining multiple measures of neighborhood SES. The score was then used to classify the census tract each patient resided in into a category of high, medium, or low SES. Hazard ratios (HRs) were estimated using multivariate Cox proportional hazard models. After adjusting for age, gender, comorbidities, and histological subtypes, compared with MDS patients lived in high-SES census tracts, those resided in medium (HR = 1.14, 95% CI: 1.01-1.30) and low (HR = 1.17, 95% CI: 1.02-1.34) SES census tracts had significantly increased the risks of death. The impact of SES on survival was more apparent for patients with refractory anemia with ringed sideroblasts-patients residing in medium (HR = 1.85, 95% CI: 1.17-2.91) and low (HR = 2.06, 95% CI: 1.27-3.37) census tracts had a nearly two-fold increased the risk of mortality, compared with those living in high-SES census tracts. In conclusion, this population-based study suggests that neighborhood SES status is a significant and independent determinant of survival among elderly patients with MDS in the United States.
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Affiliation(s)
- Rong Wang
- Department of Epidemiology and Public Health, Yale University School of Medicine, 60 College St, Box 208034, New Haven, CT 06520-8034, USA
| | - Cary P. Gross
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Stephanie Halene
- Section of Hematology, Yale University School of Medicine, New Haven, CT, USA
| | - Xiaomei Ma
- Department of Epidemiology and Public Health, Yale University School of Medicine, 60 College St, Box 208034, New Haven, CT 06520-8034, USA
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Thygesen LC, Nielsen OJ, Johansen C. Trends in adult leukemia incidence and survival in Denmark, 1943-2003. Cancer Causes Control 2009; 20:1671-80. [PMID: 19672681 DOI: 10.1007/s10552-009-9417-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Accepted: 07/31/2009] [Indexed: 02/08/2023]
Abstract
The etiology of leukemia is largely unknown. Ecological data indicating trends in incidence and survival can provide information about changes in risk factors, can reflect underlying changes in diagnostic classification, and can measure therapeutic advances. From the records of the Danish Cancer Registry with registration starting from 1943, we calculated age-specific, period-specific, and age-standardized (world standard) incidence rates of chronic lymphoid leukemia (CLL), acute lymphoid leukemia (ALL), chronic myeloid leukemia (CML), and acute myeloid leukemia (AML) for persons above the age of 18. Kaplan-Meier survival curves and median survival times were calculated. Between 1943 and 2003, there were 26,036 cases of leukemia reported. The age-specific incidence rates of CLL, CML, and AML were higher for older men and women, while the incidence rates of ALL by age were more homogeneous. The age-standardized incidence rates during the study period increased for CLL and AML, increased less strongly for ALL, and decreased for CML in both men and women, although the incidence rates for women were almost always lower. Patients with CLL had the longest survival time in all age groups. The median survival time increased for all leukemia subtypes throughout the period of study most pronounced for CLL since 1950 and CML since 1990.
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Affiliation(s)
- Lau Caspar Thygesen
- Institute of Cancer Epidemiology, Danish Cancer Society, Strandboulevarden 49, 2100, Copenhagen, Denmark.
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Menvielle G, Kunst A. Social inequalities in cancer incidence and cancer survival: Lessons from Danish studies. Eur J Cancer 2008; 44:1933-7. [DOI: 10.1016/j.ejca.2008.06.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Accepted: 06/20/2008] [Indexed: 11/25/2022]
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Dalton SO, Schüz J, Engholm G, Johansen C, Kjaer SK, Steding-Jessen M, Storm HH, Olsen JH. Social inequality in incidence of and survival from cancer in a population-based study in Denmark, 1994-2003: Summary of findings. Eur J Cancer 2008; 44:2074-85. [PMID: 18674895 DOI: 10.1016/j.ejca.2008.06.018] [Citation(s) in RCA: 167] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Revised: 06/10/2008] [Accepted: 06/16/2008] [Indexed: 11/25/2022]
Abstract
The purpose of this nationwide, population register-based study was to describe variations in cancer incidence and survival by social position in a social welfare state, Denmark, on the basis of a range of socioeconomic, demographic and health-related indicators. Our study population comprised all 3.22 million Danish residents born in 1925-1973 and aged >or=30 years, who were followed up for cancer incidence in 1994-2003 and for survival in 1994-2006, yielding 147,973 cancers. The incidence increased with lower education and income, especially for tobacco- and other lifestyle-related cancers, although for cancers of the breast and prostate and malignant melanoma the association was inverse. Conversely there was a general increase in incidence among early retirement pensioners, persons living in rented housing and those living in the smallest dwellings. Also incidence rates were generally higher in persons living alone compared to those living with a partner and in the capital area compared to the rural areas. Social inequality in the prognosis of most cancers was observed, despite the equal access to health care in Denmark, with poorer relative survival related to fewer advantages, regardless of how they were measured, often most pronounced in the first year after diagnosis. Also living alone and having somatic or psychiatric comorbidity negatively impacted the relative survival after most cancers. Our study shows that inequalities in cancer incidence and survival must be addressed in all aspects of public health, with interventions both to reduce incidence and to prolong survival.
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Affiliation(s)
- Susanne Oksbjerg Dalton
- Institute of Cancer Epidemiology, Danish Cancer Society, Strandboulevarden 49, DK-2100 Copenhagen Ø, Denmark.
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