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Tzschoppe T, Ohlinger J, Vordermark D, Bedir A, Medenwald D. Population based study on the progress in survival of primarily metastatic lung cancer patients in Germany. Sci Rep 2024; 14:16005. [PMID: 38992115 PMCID: PMC11239887 DOI: 10.1038/s41598-024-66307-3] [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: 03/24/2024] [Accepted: 07/01/2024] [Indexed: 07/13/2024] Open
Abstract
Lung cancer is known for its high mortality; many patients already present with metastases at the time of diagnosis. The aim of this study is to assess the impact of new treatment strategies on the survival of primarily metastatic lung cancer patients and to analyze the differences in outcomes between non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) patients. Population-based data, provided by the Robert-Koch Institute in Germany, was used and patients diagnosed between 2007 and 2018 were included in the study. We differentiated between NSCLC and SCLC patients and analyzed the survival over time for both sexes separately, using the Kaplan-Meier method. To evaluate survival advantages, we calculated multivariable hazard ratios. In total, 127,723 patients were considered for the study. We observed a moderate increase in survival over time. All patients showed an increased survival rate when undergoing chemotherapy. Minimal to no increase in survival was shown in NSCLC patients when receiving radiotherapy, whereas SCLC patients' survival time did benefit from it. NSCLC patients receiving immunotherapy showed an increase in survival as well. It can be concluded that advancements in radiotherapy, the application of chemotherapy, and the introduction of immunotherapies lead to an increased survival time of both NSCLC and SCLC primarily metastatic lung cancer patients.
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Affiliation(s)
- Therese Tzschoppe
- Department of Radiation Oncology, Health Services Research Group, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Julia Ohlinger
- Department of Radiation Oncology, Health Services Research Group, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Dirk Vordermark
- Department of Radiation Oncology, Health Services Research Group, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Ahmed Bedir
- Department of Radiation Oncology, Health Services Research Group, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Daniel Medenwald
- Department of Radiation Oncology, Health Services Research Group, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
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Sant M, Vener C, Lillini R, Rossi S, Bonfarnuzzo S, Marcos-Gragera R, Maynadié M, Innos K, Paapsi K, Visser O, Bernasconi A, Demuru E, Di Benedetto C, Mousavi SM, Blum M, Went P, Serraino D, Bennett D, Sánchez MJ, De Angelis R. Long-term survival for lymphoid neoplasms and national health expenditure (EUROCARE-6): a retrospective, population-based study. Lancet Oncol 2024; 25:731-743. [PMID: 38703784 DOI: 10.1016/s1470-2045(24)00141-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Management of lymphoid malignancies requires substantial health system resources. Total national health expenditure might influence population-based lymphoid malignancy survival. We studied the long-term survival of patients with 12 lymphoid malignancy types and examined whether different levels of national health expenditure might explain differences in lymphoid malignancy prognosis between European countries and regions. METHODS For this observational, retrospective, population-based study, we analysed the EUROCARE-6 dataset of patients aged 15 or older diagnosed between 2001 and 2013 with one of 12 lymphoid malignancies defined according to International Classification of Disease for Oncology (third edition) and WHO classification, and followed up to 2014 (Jan 1, 2001-Dec 31, 2014). Countries were classified according to their mean total national health expenditure quartile in 2001-13. For each lymphoid malignancy, 5-year and 10-year age-standardised relative survival (ASRS) was calculated using the period approach. Generalised linear models indicated the effects of age at diagnosis, gender, and total national health expenditure on the relative excess risk of death (RER). FINDINGS 82 cancer registries (61 regional and 21 national) from 27 European countries provided data eligible for 10-year survival estimates comprising 890 730 lymphoid malignancy cases diagnosed in 2001-13. Median follow-up time was 13 years (IQR 13-14). Of the 12 lymphoid malignancies, the 10-year ASRS in Europe was highest for hairy cell leukaemia (82·6% [95% CI 78·9-86·5) and Hodgkin lymphoma (79·3% [78·6-79·9]) and lowest for plasma cell neoplasms (29·5% [28·9-30·0]). RER increased with age at diagnosis, particularly from 55-64 years to 75 years or older, for all lymphoid malignancies. Women had higher ASRS than men for all lymphoid malignancies, except for precursor B, T, or natural killer cell, or not-otherwise specified lymphoblastic lymphoma or leukaemia. 10-year ASRS for each lymphoid malignancy was higher (and the RER lower) in countries in the highest national health expenditure quartile than in countries in the lowest quartile, with a decreasing pattern through quartiles for many lymphoid malignancies. 10-year ASRS for non-Hodgkin lymphoma, the most representative class for lymphoid malignancies based on the number of incident cases, was 59·3% (95% CI 58·7-60·0) in the first quartile, 57·6% (55·2-58·7) in the second quartile, 55·4% (54·3-56·5) in the third quartile, and 44·7% (43·6-45·8) in the fourth quartile; with reference to the European mean, the RER was 0·80 (95% CI 0·79-0·82) in the first, 0·91 (0·90-0·93) in the second, 0·94 (0·92-0·96) in the third, and 1·45 (1·42-1·48) in the fourth quartiles. INTERPRETATION Total national health expenditure is associated with geographical inequalities in lymphoid malignancy prognosis. Policy decisions on allocating economic resources and implementing evidence-based models of care are needed to reduce these differences. FUNDING Italian Ministry of Health, European Commission, Estonian Research Council.
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Affiliation(s)
- Milena Sant
- Analytical Epidemiology and Health Impact Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Vener
- Analytical Epidemiology and Health Impact Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Epidemiology and Prevention Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Roberto Lillini
- Analytical Epidemiology and Health Impact Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Rossi
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Simone Bonfarnuzzo
- Analytical Epidemiology and Health Impact Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rafael Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health Government of Catalonia, Catalan Institute of Oncology, Girona, Spain
| | - Marc Maynadié
- Registre des Hémopathies Malignes de Côte d'Or, University of Burgundy and Dijon University Hospital, Dijon, France
| | - Kaire Innos
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Keiu Paapsi
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Otto Visser
- Department of Registration, Netherlands Comprehensive Cancer Organization, Utrecht, Netherlands
| | - Alice Bernasconi
- Evaluative Epidemiology Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Demuru
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Corrado Di Benedetto
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | | | - Marcel Blum
- East Switzerland Cancer Registry and Cancer Registry Liechtenstein, St Gallen, Switzerland
| | - Philip Went
- Institut für Pathologie, Kantonsspital Graubünden, Chur, Switzerland
| | | | - Damien Bennett
- Northern Ireland Cancer Registry (NICR), Belfast, UK; Queens University Belfast (QUB), Centre for Public Health, Institute of Clinical Sciences, Royal Victoria Hospital, Belfast, UK
| | - Maria-Jose Sánchez
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain; Instituto de Investigación Biosanitaria ibs Granada, Granada, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Roberta De Angelis
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
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De Angelis R, Demuru E, Baili P, Troussard X, Katalinic A, Chirlaque Lopez MD, Innos K, Santaquilani M, Blum M, Ventura L, Paapsi K, Galasso R, Guevara M, Randi G, Bettio M, Botta L, Guzzinati S, Dal Maso L, Rossi S. Complete cancer prevalence in Europe in 2020 by disease duration and country (EUROCARE-6): a population-based study. Lancet Oncol 2024; 25:293-307. [PMID: 38307102 DOI: 10.1016/s1470-2045(23)00646-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/23/2023] [Accepted: 12/13/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Cancer survivors-people living with and beyond cancer-are a growing population with different health needs depending on prognosis and time since diagnosis. Despite being increasingly necessary, complete information on cancer prevalence is not systematically available in all European countries. We aimed to fill this gap by analysing population-based cancer registry data from the EUROCARE-6 study. METHODS In this population-based study, using incidence and follow-up data up to Jan 1, 2013, from 61 cancer registries, complete and limited-duration prevalence by cancer type, sex, and age were estimated for 29 European countries and the 27 countries in the EU (EU27; represented by 22 member states that contributed registry data) using the completeness index method. We focused on 32 malignant cancers defined according to the third edition of the International Classification of Diseases for Oncology, and only the first primary tumour was considered when estimating the prevalence. Prevalence measures are expressed in terms of absolute number of prevalent cases, crude prevalence proportion (reported as percentage or cases per 100 000 resident people), and age-standardised prevalence proportion based on the European Standard Population 2013. We made projections of cancer prevalence proportions up to Jan 1, 2020, using linear regression. FINDINGS In 2020, 23 711 thousand (95% CI 23 565-23 857) people (5·0% of the population) were estimated to be alive after a cancer diagnosis in Europe, and 22 347 thousand (95% CI 22 210-22 483) in EU27. Cancer survivors were more frequently female (12 818 thousand [95% CI 12 720-12 917]) than male (10 892 thousand [10 785-11 000]). The five leading tumours in female survivors were breast cancer, colorectal cancer, corpus uterine cancer, skin melanoma, and thyroid cancer (crude prevalence proportion from 2270 [95%CI 2248-2292] per 100 000 to 301 [297-305] per 100 000). Prostate cancer, colorectal cancer, urinary bladder cancer, skin melanoma, and kidney cancer were the most common tumours in male survivors (from 1714 [95% CI 1686-1741] per 100 000 to 255 [249-260] per 100 000). The differences in prevalence between countries were large (from 2 to 10 times depending on cancer type), in line with the demographic structure, incidence, and survival patterns. Between 2010 and 2020, the number of prevalent cases increased by 3·5% per year (41% overall), partly due to an ageing population. In 2020, 14 850 thousand (95% CI 14 681-15 018) people were estimated to be alive more than 5 years after diagnosis and 9099 thousand (8909-9288) people were estimated to be alive more than 10 years after diagnosis, representing an increasing proportion of the cancer survivor population. INTERPRETATION Our findings are useful at the country level in Europe to support evidence-based policies to improve the quality of life, care, and rehabilitation of patients with cancer throughout the disease pathway. Future work includes estimating time to cure by stage at diagnosis in prevalent cases. FUNDING European Commission.
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Affiliation(s)
- Roberta De Angelis
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Elena Demuru
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy.
| | - Paolo Baili
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS National Cancer Institute and Foundation, Milan, Italy
| | - Xavier Troussard
- Registre Régional des Hémopathies malignes de Basse-Normandie - Laboratory of Hematology, University Hospital, Caen, France
| | | | | | - Kaire Innos
- National Institute for Health Development - Tervise Arengu Instituut, Tallinn, Estonia
| | | | - Marcel Blum
- Eastern Switzerland Cancer Registry, St Gallen, Switzerland
| | - Leonardo Ventura
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica, Firenze, Italy
| | - Keiu Paapsi
- National Institute for Health Development - Tervise Arengu Instituut, Tallinn, Estonia
| | | | - Marcela Guevara
- Instituto de Salud Pública y Laboral de Navarra, Pamplona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain; Navarre Institute for Health Research, Pamplona, Spain
| | - Giorgia Randi
- European Commission, Joint Research Centre, Ispra, Italy
| | - Manola Bettio
- European Commission, Joint Research Centre, Ispra, Italy
| | - Laura Botta
- Evaluative Epidemiology Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - Silvia Rossi
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
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Dantony E, Uhry Z, Fauvernier M, Coureau G, Mounier M, Trétarre B, Molinié F, Roche L, Remontet L. Multidimensional penalized splines for survival models: illustration for net survival trend analyses. Int J Epidemiol 2024; 53:dyae033. [PMID: 38499394 DOI: 10.1093/ije/dyae033] [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: 06/08/2023] [Accepted: 02/13/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND In descriptive epidemiology, there are strong similarities between incidence and survival analyses. Because of the success of multidimensional penalized splines (MPSs) in incidence analysis, we propose in this pedagogical paper to show that MPSs are also very suitable for survival or net survival studies. METHODS The use of MPSs is illustrated in cancer epidemiology in the context of survival trends studies that require specific statistical modelling. We focus on two examples (cervical and colon cancers) using survival data from the French cancer registries (cases 1990-2015). The dynamic of the excess mortality hazard according to time since diagnosis was modelled using an MPS of time since diagnosis, age at diagnosis and year of diagnosis. Multidimensional splines bring the flexibility necessary to capture any trend patterns while penalization ensures selecting only the complexities necessary to describe the data. RESULTS For cervical cancer, the dynamic of the excess mortality hazard changed with the year of diagnosis in opposite ways according to age: this led to a net survival that improved in young women and worsened in older women. For colon cancer, regardless of age, excess mortality decreases with the year of diagnosis but this only concerns mortality at the start of follow-up. CONCLUSIONS MPSs make it possible to describe the dynamic of the mortality hazard and how this dynamic changes with the year of diagnosis, or more generally with any covariates of interest: this gives essential epidemiological insights for interpreting results. We use the R package survPen to do this type of analysis.
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Affiliation(s)
- Emmanuelle Dantony
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
- Equipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France
- Université de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Zoé Uhry
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
- Direction des Maladies Non Transmissibles et des Traumatismes, Santé Publique France, Saint-Maurice, France
| | - Mathieu Fauvernier
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
- Equipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France
- Université de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Gaëlle Coureau
- French Network of Cancer Registries (Francim), Toulouse, France
- Gironde General Cancer Registry, Univ Bordeaux, Bordeaux, France
- Service d'information Médicale, CHU de Bordeaux, Bordeaux, France
| | - Morgane Mounier
- French Network of Cancer Registries (Francim), Toulouse, France
- Registre des Hémopathies Malignes de la Côte-d'Or, CHU de Dijon Bourgogne, Dijon, France
- UMR INSERM 1231, Université Bourgogne Franche-Comté, Dijon, France
| | - Brigitte Trétarre
- French Network of Cancer Registries (Francim), Toulouse, France
- Hérault Cancer Registry, Montpellier, France
- CERPOP, UMR 1295, Université de Toulouse III, Toulouse, France
| | - Florence Molinié
- French Network of Cancer Registries (Francim), Toulouse, France
- CERPOP, UMR 1295, Université de Toulouse III, Toulouse, France
- Loire-Atlantique/Vendée Cancer Registry, SIRIC-ILIAD, Nantes, France
| | - Laurent Roche
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
- Equipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France
- Université de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Laurent Remontet
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
- Equipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France
- Université de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
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Zamudio-Sánchez A, Camarero-Gómez P, Rodríguez-Manjón E, Iglesias-Parra MR, Gómez-Salgado J, Romero A. Needs and Expectations of Long-Term Cancer Survivors: Multi-Centre Study Protocol. J Pers Med 2024; 14:64. [PMID: 38248765 PMCID: PMC10817242 DOI: 10.3390/jpm14010064] [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: 11/10/2023] [Revised: 12/11/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024] Open
Abstract
Cancer is a social issue as its outreach affects not only mortality (it is the second cause of death in our environment) but also the costs due to morbidity and the distress it causes, as well as the losses and consequences in personal, family, work, and even social areas. This study is trying to find out the health needs of long-term cancer survivors and their perceptions and expectations of the care they received during their survival stage. For this, a joint, cross-sectional descriptive study with a qualitative and quantitative approach has been designed. For the qualitative approach, we have used different focus groups representing different geographical areas of the Spanish territory. For the qualitative approach, we have used a validated questionnaire. This study will provide a better knowledge of the quality of life of these patients, as well as their level of unmet and even unexpressed needs, in order to develop effective strategies and interventions that allow for the implementation of adapted care plans that include such unexpressed needs. This study will also allow for the creation and development of assessment methods for health results from the patient's perspective and experience. These issues require a multidisciplinary, complex approach. These survivors may require not well-known health services, as the number of these patients has grown recently, and their survival time is also longer. This research explores a wider and more thorough perspective of long-term cancer survivors' needs, experiences, and expectations to be achieved.
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Affiliation(s)
- Antonio Zamudio-Sánchez
- Internal Medicine Clinical Management Unit, Hospital Regional Universitario of Malaga, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Malaga, 29010 Malaga, Spain; (A.Z.-S.)
| | - Pilar Camarero-Gómez
- Malaga Guadalhorce Health District, Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain
| | - Estefanía Rodríguez-Manjón
- Internal Medicine Clinical Management Unit, Hospital Regional Universitario of Malaga, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Malaga, 29010 Malaga, Spain; (A.Z.-S.)
| | - María Rosa Iglesias-Parra
- Department of Nursing and Podiatry, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Malaga, 29010 Malaga, Spain (A.R.)
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work, and Public Health, Faculty of Labour Sciences, University of Huelva, 21007 Huelva, Spain
- Safety and Health Posgrade Program, Espíritu Santo University, Samborondón 09-01-952, Ecuador
| | - Adolfo Romero
- Department of Nursing and Podiatry, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Malaga, 29010 Malaga, Spain (A.R.)
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Bedir A, Mehrotra S, Gnüchtel J, Vordermark D, Medenwald D. Treatment patterns in stage III non‑small‑cell lung cancer patients: a population‑based study using German cancer registry data. J Cancer Res Clin Oncol 2023; 149:15489-15497. [PMID: 37648808 PMCID: PMC10620268 DOI: 10.1007/s00432-023-05289-7] [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: 06/15/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE Lung cancer remains the leading cause of cancer-related mortality worldwide, mostly due to delayed diagnosis. The objective of this study is to examine the treatment patterns and overall survival (OS) outcomes in a cohort of patients diagnosed with stage III non-small cell lung cancer (NSCLC) over a period of 12 years in Germany. METHODS This retrospective study is based on German cancer registry data and included 14,606 stage III NSCLC patients diagnosed during 2007-2018. Three time-periods were defined according to the availability of advanced diagnostic and treatment strategies (2007-2010 low availability era (LAE), 2011-2014 transition era (TE), 2015-2018 modern era (ME)). Patients were categorized according to the treatment they received during those eras. Kaplan-Meier curves and multivariate Cox proportional hazards models were used to investigate the association between being diagnosed during a certain era and survival. The hazard ratio (HR) estimates were reported along with the 95% confidence interval (CI). RESULTS The median OS rose from 16 months in the LAE to 22 months in the ME. The HR for patients diagnosed and treated in the ME was estimated to be [0.78; 95% CI (0.74-0.83)] compared to those diagnosed and treated in LAE. The benefit was most evident for patients treated by radiotherapy and chemotherapy [HR 0.73 95% CI (0.66-0.82)]. CONCLUSION This study highlights the importance of diagnostic and treatment advances in improving outcomes for lung cancer patients. Further studies are needed to assess progress in survival rates with current immunotherapy integration.
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Affiliation(s)
- Ahmed Bedir
- Department of Radiation Oncology, Health Services Research Group, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Sneha Mehrotra
- Faculty of Life Sciences and Medicine, King's College London, Guy's Campus, London, SE1 1UL, UK
| | - Jessica Gnüchtel
- Department of Radiation Oncology, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
- Department of Traumatology, Elisabeth-Hospital Leipzig, Biedermannstraße 84, 04277, Leipzig, Germany
| | - Dirk Vordermark
- Department of Radiation Oncology, Health Services Research Group, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
- Department of Radiation Oncology, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Daniel Medenwald
- Department of Radiation Oncology, Health Services Research Group, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
- Department of Radiation Oncology, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
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7
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Botta L, Matsuda T, Charvat H, Chiang CJ, Lee WC, van Gestel AJ, Martin F, Geleijnse G, Cellamare M, Bonfarnuzzo S, Marcos-Gragera R, Guevara M, Mousavi M, Craig S, Rodrigues J, Rubió-Casadevall J, Licitra L, Cavalieri S, Resteghini C, Gatta G, Trama A. Head and neck cancers survival in Europe, Taiwan, and Japan: results from RARECAREnet Asia based on a privacy-preserving federated infrastructure. Front Oncol 2023; 13:1219111. [PMID: 37781187 PMCID: PMC10534949 DOI: 10.3389/fonc.2023.1219111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/17/2023] [Indexed: 10/03/2023] Open
Abstract
Background The head and neck cancers (HNCs) incidence differs between Europe and East Asia. Our objective was to determine whether survival of HNC also differs between European and Asian countries. Methods We used population-based cancer registry data to calculate 5-year relative survival (RS) for the oral cavity, hypopharynx, larynx, nasal cavity, and major salivary gland in Europe, Taiwan, and Japan. We modeled RS with a generalized linear model adjusting for time since diagnosis, sex, age, subsite, and histological grouping. Analyses were performed using federated learning, which enables analyses without sharing sensitive data. Findings Five-year RS for HNC varied between geographical areas. For each HNC site, Europe had a lower RS than both Japan and Taiwan. HNC subsites and histologies distribution and survival differed between the three areas. Differences between Europe and both Asian countries persisted even after adjustments for all HNC sites but nasal cavity and paranasal sinuses, when comparing Europe and Taiwan. Interpretation Survival differences can be attributed to different factors including different period of diagnosis, more advanced stage at diagnosis, or different availability/access of treatment. Cancer registries did not have stage and treatment information to further explore the reasons of the observed survival differences. Our analyses have confirmed federated learning as a feasible approach for data analyses that addresses the challenges of data sharing and urge for further collaborative studies including relevant prognostic factors.
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Affiliation(s)
- Laura Botta
- Evaluative Epidemiology Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tomohiro Matsuda
- Insititute of Cancer Control, National Cancer Center, Tokyo, Japan
| | - Hadrien Charvat
- Faculty of International Liberal Arts, Juntendo University, Tokyo, Japan
- Division of International Health Policy Research, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Chun-ju Chiang
- Taiwan Cancer Registry Center, and Institute of Epidemiology and Preventive Medicine, Taipei, Taiwan
| | - Wen-Chung Lee
- Taiwan Cancer Registry Center, and Institute of Epidemiology and Preventive Medicine, Taipei, Taiwan
| | - Anna Jacoba van Gestel
- IKNL, Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrech, Netherlands
| | - Frank Martin
- IKNL, Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrech, Netherlands
| | - Gijs Geleijnse
- IKNL, Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrech, Netherlands
| | - Matteo Cellamare
- IKNL, Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrech, Netherlands
| | - Simone Bonfarnuzzo
- Analytical Epidemiology and Health Impact Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rafael Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona Biomedical Research Institute (IdiBGi), Universitat de Girona, Girona, Spain
- Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Group of Descriptive and Analytical Epidemiology of Cancer, Josep Carreras Leukemia Research Institute, Girona, Spain
| | - Marcela Guevara
- Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Navarra Cancer Registry, Instituto de Salud Pública y Laboral de Navarra, Pamplona, Spain
- Epidemiology and Public Health Area, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Mohsen Mousavi
- East Switzerland Cancer Registry, St. Gallen, Switzerland
| | - Stephanie Craig
- Patrick G. Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast, United Kingdom
| | - Jessica Rodrigues
- Cancer Epidemiology Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC) & RISE@CI-IPOP (Health Research Network), Porto, Portugal
| | - Jordi Rubió-Casadevall
- Medical Oncology Department, Catalan Institute of Oncology, Girona, Spain
- OncoGirPro Group, Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Lisa Licitra
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Stefano Cavalieri
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Carlo Resteghini
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gemma Gatta
- Evaluative Epidemiology Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Annalisa Trama
- Evaluative Epidemiology Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Rudolph C, Engholm G, Pritzkuleit R, Storm HH, Katalinic A. Colorectal Cancer Survival in German-Danish Border Regions-A Registry-Based Cohort Study. Cancers (Basel) 2023; 15:4474. [PMID: 37760444 PMCID: PMC10526529 DOI: 10.3390/cancers15184474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
The aim of this study was (i) to update the reporting of colorectal cancer survival differences over time in the German-Danish border region (Schleswig-Holstein, Southern Denmark, and Zealand) and (ii) to assess the extent to which it can be explained by stage and primary treatment. Incident invasive colorectal cancer cases diagnosed from 2004 to 2016 with a follow-up of vital status through 31 December 2017 were extracted from cancer registries. Analyses were conducted by anatomical subsite and for four consecutive periods. Kaplan-Meier curves and log-rank tests were computed. Cox regression models using data from Schleswig-Holstein from 2004 to 2007 as the reference category were run while controlling for age, sex, stage, and treatment. The cox regression models showed decreasing hazard ratios of death for all three regions over time for both anatomical subsites. The improvement was stronger in the Danish regions, and adjustment for age, sex, stage, and treatment attenuated the results only slightly. In 2014-2016, colon cancer survival was similar across regions, while rectal cancer survival was significantly superior in the Danish regions. Regional survival differences can only partially be explained by differing stage distribution and treatment and may be linked additionally to healthcare system reforms and screening efforts.
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Affiliation(s)
- Christiane Rudolph
- Institute for Cancer Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Gerda Engholm
- Danish Cancer Society, Strandboulevarden 49, 2100 København, Denmark
| | - Ron Pritzkuleit
- Institute for Cancer Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Hans H. Storm
- Danish Cancer Society, Strandboulevarden 49, 2100 København, Denmark
| | - Alexander Katalinic
- Institute for Cancer Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
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9
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Zachou G, El-Khouly F, Dilley J. Evaluation of follow-up strategies for women with epithelial ovarian cancer following completion of primary treatment. Cochrane Database Syst Rev 2023; 8:CD006119. [PMID: 37650760 PMCID: PMC10471005 DOI: 10.1002/14651858.cd006119.pub4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND This is an update of a previous Cochrane Review, last updated in 2014. Ovarian cancer is the eighth most common cancer and seventh most common cause of death due to cancer in women worldwide. Traditionally, most women who have been treated for cancer undergo long-term follow-up in secondary care. However, it has been suggested that the use of routine review may not be effective in improving survival, or health-related quality of life (HRQOL), or relieving anxiety. In addition, traditional follow-up may not be cost-effective. OBJECTIVES To compare the potential effects of different strategies of follow-up in women with epithelial ovarian cancer, following completion of primary treatment. SEARCH METHODS For this update, we searched the Cochrane Gynaecological Cancer Group Trials Register, CENTRAL 2022, Issue 11, MEDLINE, and Embase from August 2013 to November 2022. We also searched review articles and contacted experts in the field. SELECTION CRITERIA All randomised controlled trials (RCTs) that evaluated follow-up strategies for women with epithelial ovarian cancer following completion of primary treatment. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methodology. Two review authors independently selected potentially relevant trials, extracted data, and assessed risk of bias. They compared results, and resolved disagreements by discussion. We assessed the certainty of evidence, using the GRADE approach, for the outcomes of interest: overall survival (OS), health-related quality of life (HRQOL), psychological effects, and cost analysis. MAIN RESULTS For this update, we included one new RCT, including 112 women with ovarian, fallopian tube, or peritoneal cancer, who had completed primary treatment by surgery, with or without chemotherapy. This study reported the effect of individualised, i.e. individually tailored, nurse-led follow-up versus conventional medical follow-up on HRQOL, psychological outcomes, and cost-analysis. Individualised follow-up improved HRQOL in one of the two scales, with a decrease in mean difference (MD) in the QLQ-C30 discomfort scale following 12 months of individualised treatment compared to 12 months of conventional treatment (MD -5.76 points, 95% confidence interval (CI) -10.92 to -0.60; 1 study, 112 participants; low-certainty evidence; minimal important difference 4 to 10 points). There may be little or no difference in the other HRQOL scale (QLQ-Ov28, MD -0.97 points, 95% CI -2.57 to 0.63; 1 study, 112 participants: low-certainty evidence); psychological outcome, measured with the hospital anxiety and depression scale (HADS; MD 0.10 point, 95% CI -0.81 to 1.02; 1 study, 112 participants: low-certainty evidence), or cost analysis (MD -GBP 695.00, 95% CI -1467.23 to 77.23; 1 study, 112 participants: moderate-certainty evidence). Our previous review included one RCT, with 529 women in a confirmed remission, with normal CA125 concentration and no radiological evidence of disease, after surgery and first-line chemotherapy for ovarian cancer. This study evaluated immediate treatment of ovarian cancer relapse following a rise of serum CA125 levels versus delaying treatment until symptoms developed for OS, and HRQOL. There was little or no difference in OS between the immediate and delayed arms after a median follow-up of 56.9 months (unadjusted hazard ratio (HR) 0.98, 95% CI 0.80 to 1.20; 1 study, 529 participants; moderate-certainty evidence). Time from randomisation to first deterioration in global health score or death was shorter in the immediate treatment group than in the delayed treatment group (HR 0.71, 95% CI 0.58 to 0.88). AUTHORS' CONCLUSIONS Limited evidence from one trial suggests that routine surveillance with CA125 in asymptomatic women and treatment at CA125-defined relapse does not seem to offer survival advantage when compared to treatment at symptomatic relapse. However, this study pre-dates the use of PARPi maintenance treatment and the increased use of secondary cytoreductive surgery, so the results may be limited in their applicability to current practice. Limited evidence from one trial suggests that individualised nurse-led follow-up may improve HRQOL in women with ovarian cancer following completion of primary treatment. Large RCTs are needed to compare different types of follow-up, looking at survival, HRQOL, psychological effects, and cost as outcomes.
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Affiliation(s)
- Georgia Zachou
- Gynaecological Oncology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Fatima El-Khouly
- Medical Oncology, Barking, Havering and Redbridge University Hospital NHS Trust, London, UK
| | - James Dilley
- Gynaecological Oncology, Royal London Hospital, Barts Health NHS Trust, London, UK
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Reddavid R, Sofia S, Puca L, Moro J, Ceraolo S, Jimenez-Rodriguez R, Degiuli M. Robotic Rectal Resection for Rectal Cancer in Elderly Patients: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:5331. [PMID: 37629373 PMCID: PMC10456068 DOI: 10.3390/jcm12165331] [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: 06/23/2023] [Revised: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Rectal cancer is estimated to increase due to an expanding aging population, thus affecting elderly patients more frequently. The optimal surgical treatment for this type of patient remains controversial because they are often excluded from or underrepresented in trials. This meta-analysis aimed to evaluate the feasibility and the safety of robotic surgery in elderly patients (>70 years old) undergoing curative treatment for rectal cancer. Studies comparing elderly (E) and young (Y) patients submitted to robotic rectal resection were searched on PubMed, Embase, and the Cochrane Library. Data regarding surgical oncologic quality, post-operative, and survival outcomes were extracted. Overall, 322 patients underwent robotic resection (81 in the E group and 241 in the Y group) for rectal cancer. No differences between the two groups were found regarding distal margins and the number of nodes yielded (12.70 in the E group vs. 14.02 in the Y group, p = 0.16). No differences were found in conversion rate, postoperative morbidity, mortality, and length of stay. Survival outcomes were only reported in one study. The results of this study suggest that elderly patients can be submitted to robotic resection for rectal cancer with the same oncologic surgical quality offered to young patients, without increasing postoperative mortality and morbidity.
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Affiliation(s)
- Rossella Reddavid
- University of Turin, Department of Oncology, Division of Surgical Oncology and Digestive Surgery, San Luigi University Hospital, 10043 Turin, Italy; (S.S.); (L.P.); (J.M.)
| | - Silvia Sofia
- University of Turin, Department of Oncology, Division of Surgical Oncology and Digestive Surgery, San Luigi University Hospital, 10043 Turin, Italy; (S.S.); (L.P.); (J.M.)
| | - Lucia Puca
- University of Turin, Department of Oncology, Division of Surgical Oncology and Digestive Surgery, San Luigi University Hospital, 10043 Turin, Italy; (S.S.); (L.P.); (J.M.)
| | - Jacopo Moro
- University of Turin, Department of Oncology, Division of Surgical Oncology and Digestive Surgery, San Luigi University Hospital, 10043 Turin, Italy; (S.S.); (L.P.); (J.M.)
| | - Simona Ceraolo
- Nursing Degree Program, Department of Clinical and Biological Sciences, University of Turin, 10124 Torino, Italy;
| | | | - Maurizio Degiuli
- University of Turin, Department of Oncology, Division of Surgical Oncology and Digestive Surgery, San Luigi University Hospital, 10043 Turin, Italy; (S.S.); (L.P.); (J.M.)
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11
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Chen JG, Chen HZ, Zhu J, Shen AG, Sun XY, Parkin DM. Cancer survival: left truncation and comparison of results from hospital-based cancer registry and population-based cancer registry. Front Oncol 2023; 13:1173828. [PMID: 37350938 PMCID: PMC10284078 DOI: 10.3389/fonc.2023.1173828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/16/2023] [Indexed: 06/24/2023] Open
Abstract
Background Cancer survival is an important indicator for evaluating cancer prognosis and cancer care outcomes. The incidence dates used in calculating survival differ between population-based registries and hospital-based registries. Studies examining the effects of the left truncation of incidence dates and delayed reporting on survival estimates are scarce in real-world applications. Methods Cancer cases hospitalized at Nantong Tumor Hospital during the years 2002-2017 were traced with their records registered in the Qidong Cancer Registry. Survival was calculated using the life table method for cancer patients with the first visit dates recorded in the hospital-based cancer registry (HBR) as the diagnosis date (OSH), those with the registered dates of population-based cancer (PBR) registered as the incidence date (OSP), and those with corrected dates when the delayed report dates were calibrated (OSC). Results Among 2,636 cases, 1,307 had incidence dates registered in PBR prior to the diagnosis dates of the first hospitalization registered in HBR, while 667 cases with incidence dates registered in PBR were later than the diagnosis dates registered in HBR. The 5-year OSH, OSP, and OSC were 36.1%, 37.4%, and 39.0%, respectively. The "lost" proportion of 5-year survival due to the left truncation for HBR data was estimated to be between 3.5% and 7.4%, and the "delayed-report" proportion of 5-year survival for PBR data was found to be 4.1%. Conclusion Left truncation of survival in HBR cases was demonstrated. The pseudo-left truncation in PBR should be reduced by controlling delayed reporting and maximizing completeness. Our study provides practical references and suggestions for evaluating the survival of cancer patients with HBR and PBR.
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Affiliation(s)
- Jian-Guo Chen
- Department of Epidemiology, Nantong Tumor Hospital, Affiliated Tumor Hospital of Nantong University, Nantong, China
- Department of Epidemiology, Qidong Liver Cancer Institute, Qidong People’s Hospital, Affiliated Qidong Hospital of Nantong University, Qidong, China
| | - Hai-Zhen Chen
- Department of Epidemiology, Nantong Tumor Hospital, Affiliated Tumor Hospital of Nantong University, Nantong, China
| | - Jian Zhu
- Department of Epidemiology, Qidong Liver Cancer Institute, Qidong People’s Hospital, Affiliated Qidong Hospital of Nantong University, Qidong, China
| | - Ai-Guo Shen
- Department of Epidemiology, Nantong Tumor Hospital, Affiliated Tumor Hospital of Nantong University, Nantong, China
| | - Xiang-Yang Sun
- Department of Epidemiology, Nantong Tumor Hospital, Affiliated Tumor Hospital of Nantong University, Nantong, China
| | - Donald Maxwell Parkin
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
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12
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Tralongo P, Cappuccio F, Gori S, Donato V, Beretta G, Elia A, Romano F, Iacono M, Tralongo AC, Bordonaro S, Di Mari A, Giuliano SR, Buccafusca G, Careri MC, Santoro A. Clinicians' and Patients' Perceptions and Use of the Word "Cured" in Cancer Care: An Italian Survey. Curr Oncol 2023; 30:1332-1353. [PMID: 36826064 PMCID: PMC9955737 DOI: 10.3390/curroncol30020103] [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: 12/12/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The words "hope" and "cure" were used in a greater number of articles and sentences in narrative and editorial papers than in primary research. Despite concomitant improvements in cancer outcomes, the related reluctance to use these terms in more scientifically oriented original reports may reflect a bias worthy of future exploration. This study aims to survey a group of physicians and cancer patients regarding their perception and use of the word cure. MATERIALS AND METHOD An anonymous online and print survey was conducted to explore Italian clinicians' (the sample includes medical oncologists, radiotherapists, and oncological surgeons) and cancer patients' approach to the perception and use of the word "cure" in cancer care. The participants received an email informing them of the study's purpose and were invited to participate in the survey via a linked form. A portion, two-thirds, of questionnaires were also administered to patients in the traditional paper form. RESULTS The survey was completed by 224 clinicians (54 oncologists, 78 radiotherapists, and 92 cancer surgeons) and 249 patients. The results indicate a favourable attitude for patients in favour of a new language ("cured" vs. "complete remission") of the disease experience. CONCLUSIONS The use of the word cured is substantially accepted and equally shared by doctors and patients. Its use can facilitate the elimination of metaphoric implications and toxic cancer-related connotations registered in all cultures that discourage patients from viewing cancer as a disease with varied outcomes, including cure.
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Affiliation(s)
- Paolo Tralongo
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
- Correspondence:
| | - Francesco Cappuccio
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | - Stefania Gori
- Medical Oncology Unit, IRCCS Sacro Cuore Don Calabria, Negrar di Valpolicella, 37024 Verona, Italy
| | - Vittorio Donato
- Radiotherapy Unit, San Camillo Forlanini Hospital, 00152 Rome, Italy
| | - Giordano Beretta
- Medical Oncology Unit, Santo Spirito Hospital, 65124 Pescara, Italy
| | - Ausilia Elia
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | - Fabrizio Romano
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | - Margherita Iacono
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | | | - Sebastiano Bordonaro
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | - Annamaria Di Mari
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | | | - Gabriella Buccafusca
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | - Maria Carmela Careri
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital and Humanitas Cancer Center, 20089 Milan, Italy
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13
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Delage de Luget C, Blanc J, Chantalat E, Auquier P, Carcopino X. [Database's development for prospective national collection of clinical data on cervical cancer: A Delphi survey identifying consensual variables]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:615-619. [PMID: 35667561 DOI: 10.1016/j.gofs.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/24/2022] [Accepted: 05/20/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Cervical cancer (CC) is associated with poor prognosis and therapeutic morbidity in young women. The impact of European recommendations for treatments and follow-up of these patients must be assessed. There is no real-time CCU tracking basis. Main objective of our study was to identify the items of the clinical and therapeutic data necessary for the constitution of a national, dynamic and prospective clinical database allowing to characterize treatments and follow-up of patients with CC in France. METHODS An exhaustive bibliographic research was lead with the help of the ESGO recommendations. A list of qualitative and quantitative variables characterizing CC was established. These variables were assessed by a panel of national experts from the Francogyn group, using the Delphi survey. The rate of agreement was calculated for each variable. RESULTS 345 variables divided into 6 sections were identified and submitted to 26 experts. 17 experts responded to the three rounds of the Delphi method. A total of 273 items were validated. The majority of experts (90 %) also gave a favorable opinion on the addition of a quality of life section in the database. CONCLUSION This is the first study identifying 273 items chosen by consensus. The items are collected in a future national gynecological database "Epigyn".
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Affiliation(s)
- Claire Delage de Luget
- Department of Obstetrics and Gynecology, Nord Hospital, APHM, chemin des Bourrely, 13015 Marseille, France.
| | - Julie Blanc
- Department of Obstetrics and Gynecology, Nord Hospital, APHM, chemin des Bourrely, 13015 Marseille, France; EA 3279, Public Health, Chronic Diseases and Quality of Life, Research Unit, Aix-Marseille University, 13284 Marseille, France.
| | - Elodie Chantalat
- Department of Gynecological Surgery, CHU Rangueil, Toulouse, France.
| | - Pascal Auquier
- Department of Public Health, CHU Timone, Aix-Marseille University, 264, rue St-Pierre, Marseille, France.
| | - Xavier Carcopino
- Department of Obstetrics and Gynecology, Nord Hospital, APHM, chemin des Bourrely, 13015 Marseille, France; Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR, Marseille, France
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De Bari B, Lefevre L, Henriques J, Gatta R, Falcoz A, Mathieu P, Borg C, Dinapoli N, Boulahdour H, Boldrini L, Valentini V, Vernerey D. Could 18-FDG PET-CT Radiomic Features Predict the Locoregional Progression-Free Survival in Inoperable or Unresectable Oesophageal Cancer? Cancers (Basel) 2022; 14:cancers14164043. [PMID: 36011035 PMCID: PMC9406583 DOI: 10.3390/cancers14164043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/28/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background: We evaluated the value of pre-treatment positron-emission tomography−computed tomography (PET-CT)-based radiomic features in predicting the locoregional progression-free survival (LR-PFS) of patients with inoperable or unresectable oesophageal cancer. Material and Methods: Forty-six patients were included and 230 radiomic parameters were extracted. After a principal component analysis (PCA), we identified the more robust radiomic parameters, and we used them to develop a heatmap. Finally, we correlated these radiomic features with LR-PFS. Results: The median follow-up time was 17 months. The two-year LR-PFS and PFS rates were 35.9% (95% CI: 18.9−53.3) and 21.6% (95%CI: 10.0−36.2), respectively. After the correlation analysis, we identified 55 radiomic parameters that were included in the heatmap. According to the results of the hierarchical clustering, we identified two groups of patients presenting statistically different median LR-PFSs (22.8 months vs. 9.9 months; HR = 2.64; 95% CI 0.97−7.15; p = 0.0573). We also identified two radiomic features (“F_rlm_rl_entr_per” and “F_rlm_2_5D_rl_entr”) significantly associated with LR-PFS. Patients expressing a “F_rlm_2_5D_rl_entr” of <3.3 had a better median LR- PFS (29.4 months vs. 8.2 months; p = 0.0343). Patients presenting a “F_rlm_rl_entr_per” of <4.7 had a better median LR-PFS (50.4 months vs. 9.9 months; p = 0.0132). Conclusion: We identified two radiomic signatures associated with a lower risk of locoregional relapse after CRT.
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Affiliation(s)
- Berardino De Bari
- Radiation Oncology Department, Neuchâtel Hospital Network, CH-2300 La Chaux-de-Fonds, Switzerland
- Radiation Oncology Department, University Hospital of Besançon, F-25000 Besancon, France
- Correspondence: ; Tel.: +41-32-967-21-46
| | - Loriane Lefevre
- Radiation Oncology Department, University Hospital of Besançon, F-25000 Besancon, France
- Radiation Oncology Department, Centre Eugène Marquis, F-35042 Rennes, France
| | - Julie Henriques
- INSERM, Établissement Français du Sang Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Bourgogne Franche-Comté University, F-25000 Besancon, France
- Methodology and Quality of Life Unit in Oncology, University Hospital of Besançon, F-25000 Besancon, France
| | - Roberto Gatta
- Dipartimento di Scienze Cliniche e Sperimentali, Università degli Studi di Brescia, I-25123 Brescia, Italy
| | - Antoine Falcoz
- INSERM, Établissement Français du Sang Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Bourgogne Franche-Comté University, F-25000 Besancon, France
- Methodology and Quality of Life Unit in Oncology, University Hospital of Besançon, F-25000 Besancon, France
| | - Pierre Mathieu
- Department of Digestive Surgery and Liver Transplantation, University Hospital of Besançon, F-25000 Besancon, France
| | - Christophe Borg
- INSERM, Établissement Français du Sang Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Bourgogne Franche-Comté University, F-25000 Besancon, France
- Department of Medical Oncology, University Hospital of Besançon, F-25000 Besancon, France
| | - Nicola Dinapoli
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, I-00100 Rome, Italy
| | - Hatem Boulahdour
- EA 4662-“Nanomedicine Lab, Imagery and Therapeutics”, Nuclear Medicine Department, University Hospital of Besançon, F-25000 Besancon, France
| | - Luca Boldrini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, I-00100 Rome, Italy
| | - Vincenzo Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, I-00100 Rome, Italy
| | - Dewi Vernerey
- INSERM, Établissement Français du Sang Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Bourgogne Franche-Comté University, F-25000 Besancon, France
- Methodology and Quality of Life Unit in Oncology, University Hospital of Besançon, F-25000 Besancon, France
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15
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Vener C, Rossi S, Minicozzi P, Marcos-Gragera R, Poirel HA, Maynadié M, Troussard X, Pravettoni G, De Angelis R, Sant M. Clear Improvement in Real-World Chronic Myeloid Leukemia Survival: A Comparison With Randomized Controlled Trials. Front Oncol 2022; 12:892684. [PMID: 35912208 PMCID: PMC9333088 DOI: 10.3389/fonc.2022.892684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/19/2022] [Indexed: 12/04/2022] Open
Abstract
Tyrosine kinase inhibitors (TKIs) have been improving the prognosis of patients with chronic myeloid leukemia (CML), but there are still large differences in survival among European countries. This raises questions on the added value of results from population-based studies, which use real-world data, compared to results of randomized controlled trials (RCTs) involving patients with CML. There are also questions about the extent of the findings on RCTs effectiveness for patients in the general population. We compare survival data extracted from our previous systematic review and meta-analysis of CML RCTs with the latest updated population-based survival data of EUROCARE-6, the widest collaborative study on cancer survival in Europe. The EUROCARE-6 CML survival estimated in patients (15–64 years) diagnosed in 2000–2006 vs. 2007–2013 revealed that the prognostic improvement highlighted by RCTs was confirmed in real-world settings, too. The study shows, evaluating for the first time all European regions, that the optimal outcome figures obtained in controlled settings for CML are also achievable (and indeed achieved) in real-world settings with prompt introduction of TKIs in daily clinical practice. However, some differences still persist, particularly in Eastern European countries, where overall survival values are lower than elsewhere, probably due to a delayed introduction of TKIs. Our results suggest an insufficient adoption of adequate protocols in daily clinical practice in those countries where CML survival values remain lower in real life than the values obtained in RCTs. New high-resolution population-based studies may help to identify failures in the clinical pathways followed there.
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Affiliation(s)
- Claudia Vener
- Analytical Epidemiology and Health Impact Unit, Department of Research, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Silvia Rossi
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Department of Research, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy.,Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rafael Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona Biomedical Research Institute (IdiBGi), Universitat de Girona, Girona, Spain.,Biomedical Network Research Centers of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Group of Descriptive and Analytical Epidemiology of Cancer, Josep Carreras Leukemia Research Institute, Girona, Spain
| | | | - Marc Maynadié
- Côte d'Or Hematological Malignancies Registry, Dijon, France
| | - Xavier Troussard
- Basse Normandie Cancer Registry, Centre Hospitalier Universitaire (CHU) de Caen, Normandie, Caen, France
| | | | - Roberta De Angelis
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Milena Sant
- Analytical Epidemiology and Health Impact Unit, Department of Research, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
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16
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Popescu ER, Geantă M, Brand A. Mapping of clinical research on artificial intelligence in the treatment of cancer and the challenges and opportunities underpinning its integration in the European Union health sector. Eur J Public Health 2022; 32:443-449. [PMID: 35238918 PMCID: PMC9159319 DOI: 10.1093/eurpub/ckac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Although current efforts are made to diminish the incidence and burden of disease, cancer is still widely identified late at stage. This study aims to conduct a systematic review mapping the existent and emerging clinical research on artificial intelligence (AI) in the treatment of cancer and to underpin its integration challenges and opportunities in the European Union (EU) health sector. METHODS A systematic literature review (SLR) evaluating global clinical trials (CTs; published between 2010 and 2020 or forthcoming) was concluded. Additionally, a horizon scanning (HS) exercise focusing on emerging trends (published between 2017 and 2020) was conducted. RESULTS Forty-four CTs were identified and analyzed. Selected CTs were divided into three research areas: (i) potential of AI combined with imaging techniques, (ii) AI's applicability in robotic surgery interventions and (iii) AI's potential in clinical decision making. Twenty-one studies presented an interventional nature, nine papers were observational and 14 articles did not explicitly mention the type of study performed. The papers presented an increased heterogeneity in sample size, type of tumour, type of study and reporting of results. In addition, a shift in research is observed and only a small fraction of studies were completed in the EU. These findings could be further linked to the current socio-economic, political, scientific, technological and environmental state of the EU in regard to AI innovation. CONCLUSION To overcome the challenges threatening the EU's integration of such technology in the healthcare field, new strategies taking into account the EU's socio-economic and political environment are deemed necessary.
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Affiliation(s)
| | - Marius Geantă
- Center for Innovation in Medicine, Bucharest, Romania
- KOL Medical Media, Bucharest, Romania
- United Nations University—Maastricht Economic and Social Research Institute on Innovation and Technology, Maastricht, The Netherlands
| | - Angela Brand
- United Nations University—Maastricht Economic and Social Research Institute on Innovation and Technology, Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Public Health Genomics, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, India
- Dr. TMA Pai Endowment Chair in Public Health Genomics, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, India
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17
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Barrenho E, Halmai R, Miraldo M, Tzintzun I, Raïs Ali S, Toulemon L, Dupont JCK, Rochaix L. Inequities in cancer drug development in terms of unmet medical need. Soc Sci Med 2022; 302:114953. [PMID: 35489114 DOI: 10.1016/j.socscimed.2022.114953] [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: 02/04/2021] [Revised: 02/28/2022] [Accepted: 03/26/2022] [Indexed: 10/18/2022]
Abstract
This study measures inequality and inequity in the distribution of clinical trials on cancer drug development between 1996 and 2016, comparing the number of clinical trials with cancer need, proxied by prevalence, incidence, or survival rates for both rare and non-rare cancers. We leverage a unique global database of clinical trials activity and costs between 1996 and 2016, constructed for 227 different cancer types to measure for rare and non-rare cancers: i) inequalities and inequity of clinical trial activity, considering all trials as well as split by R&D stage; ii) inequalities and inequity in R&D investment proxied by trial enrollment and duration; iii) evolution of inequity over time. Inequalities are measured with concentration curves and indices and inequities measured with the health inequity index. We find four important results. First, we show pro-low need inequity across cancer types for both rare and non-rare cancers, for all need proxies. Second, we show inequity differs across R&D stages and between rare and non-rare cancers. The distribution of clinical trials for non-rare cancers disproportionately favors low-need non-rare cancers from earlier to later stages of R&D, whilst for rare cancers this only occurs in Phase 2 trials. Third, inequity analyses in R&D investment show that only trial enrollment for rare cancers and trial duration for non-rare cancers are disproportionately concentrated among low-need cancers. Finally, while pro-low need inequity has persisted between 1996 and 2016 for non-rare cancers, it has faded for rare cancers post-EU orphan drugs' legislation.
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Affiliation(s)
- Eliana Barrenho
- Department of Economics and Public Policy, Business School, Imperial College London, UK; Organisation for Economic Co-operation and Development (OECD), France.
| | - Réka Halmai
- Hospinnomics (PSE-Ecole d'Economie de Paris, Assistance Publique des Hôpitaux de Paris-AP-HP), France.
| | - Marisa Miraldo
- Department of Economics and Public Policy, Business School, Imperial College London, UK; Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, UK.
| | - Iván Tzintzun
- Hospinnomics (PSE-Ecole d'Economie de Paris, Assistance Publique des Hôpitaux de Paris-AP-HP), France.
| | - Setti Raïs Ali
- Hospinnomics (PSE-Ecole d'Economie de Paris, Assistance Publique des Hôpitaux de Paris-AP-HP), France.
| | - Léa Toulemon
- Hospinnomics (PSE-Ecole d'Economie de Paris, Assistance Publique des Hôpitaux de Paris-AP-HP), France; Institut des Politiques Publiques, PSE-Ecole d'Economie de Paris, France.
| | - Jean-Claude K Dupont
- Hospinnomics (PSE-Ecole d'Economie de Paris, Assistance Publique des Hôpitaux de Paris-AP-HP), France; Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Inserm, Laboratoire ETREs, F-75006, Paris, France.
| | - Lise Rochaix
- Hospinnomics (PSE-Ecole d'Economie de Paris, Assistance Publique des Hôpitaux de Paris-AP-HP), France; Université Paris 1 Panthéon-Sorbonne, Paris-Jourdan Sciences économiques (UMR 8545), Paris, France.
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Caetano dos Santos FL, Wojciechowska U, Michalek IM, Didkowska J. Progress in cancer survival across last two decades: A nationwide study of over 1.2 million Polish patients diagnosed with the most common cancers. Cancer Epidemiol 2022; 78:102147. [DOI: 10.1016/j.canep.2022.102147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/10/2022] [Accepted: 03/12/2022] [Indexed: 11/02/2022]
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Guevara M, Molinuevo A, Salmerón D, Marcos-Gragera R, Carulla M, Chirlaque MD, Rodríguez Camblor M, Alemán A, Rojas D, Vizcaíno Batllés A, Chico M, Jiménez Chillarón R, López de Munain A, de Castro V, Sánchez MJ, Ramalle-Gómara E, Franch P, Galceran J, Ardanaz E. Cancer Survival in Adults in Spain: A Population-Based Study of the Spanish Network of Cancer Registries (REDECAN). Cancers (Basel) 2022; 14:cancers14102441. [PMID: 35626046 PMCID: PMC9139549 DOI: 10.3390/cancers14102441] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary We studied cancer survival and its trends in adult patients in Spain. We included more than 600,000 patients with primary cancer diagnosed during 2002–2013 and followed them up to 2015. The study provides cancer survival estimates up to five years after diagnosis by sex and age for 29 cancer groups. We found survival improvements for most cancer groups from 2002–2007 to 2008–2013, although with differences by age, being greater for patients younger than 75 years than for older patients. The persistent poor prognosis for some cancers emphasizes the need to reinforce actions along the cancer continuum, from primary prevention to early diagnosis, optimal treatment, and supportive care. Further examination of possible sociodemographic inequalities is warranted. Abstract The assessment of cancer survival at the population level is essential for monitoring progress in cancer control. We aimed to assess cancer survival and its trends in adults in Spain. Individual records of 601,250 adults with primary cancer diagnosed during 2002–2013 and followed up to 2015 were included from 13 population-based cancer registries. We estimated net survival up to five years after diagnosis and analyzed absolute changes between 2002–2007 and 2008–2013. Estimates were age-standardized. Analyses were performed for 29 cancer groups, by age and sex. Overall, age-standardized five-year net survival was higher in women (61.7%, 95% CI 61.4–62.1%) than in men (55.3%, 95% CI 55.0–55.6%), and ranged by cancer from 7.2% (pancreas) to 89.6% (prostate) in men, and from 10.0% (pancreas) to 93.1% (thyroid) in women in the last period. Survival declined with age, showing different patterns by cancer. Between both periods, age-standardized five-year net survival increased overall by 3.3% (95% CI 3.0–3.7%) in men and 2.5% (95% CI 2.0–3.0%) in women, and for most cancer groups. Improvements were greater in patients younger than 75 years than in older patients. Chronic myeloid leukemia and myeloma showed the largest increases. Among the most common malignancies, the greatest absolute increases in survival were observed for colon (5.0%, 95% CI 4.0–6.0%) and rectal cancers (4.5%, 95% CI 3.2–5.9%). Survival improved even for some cancers with poor prognosis (pancreas, esophagus, lung, liver, and brain cancer). Further investigation of possible sociodemographic inequalities is warranted. This study contributes to the evaluation of cancer control and health services’ effectiveness.
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Affiliation(s)
- Marcela Guevara
- Navarra Public Health Institute, 31003 Pamplona, Spain;
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (D.S.); (R.M.-G.); (M.-D.C.); (M.-J.S.)
- Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain
- Correspondence:
| | - Amaia Molinuevo
- Biodonostia Health Research Institute, 20014 San Sebastian, Spain;
| | - Diego Salmerón
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (D.S.); (R.M.-G.); (M.-D.C.); (M.-J.S.)
- Departamento de Ciencias Sociosanitarias, IMIB-Arrixaca, Universidad de Murcia, 30100 Murcia, Spain
| | - Rafael Marcos-Gragera
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (D.S.); (R.M.-G.); (M.-D.C.); (M.-J.S.)
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Catalan Institute of Oncology, Department of Health, Government of Catalonia, 17007 Girona, Spain
- Descriptive Epidemiology, Genetics and Cancer Prevention Research Group, Girona Biomedical Research Institute (IdiBGi), 17190 Girona, Spain
- Faculty of Medicine, University of Girona, 17071 Girona, Spain
- Josep Carreras Leukemia Research Institute, 17003 Girona, Spain
| | - Marià Carulla
- Tarragona Cancer Registry, Cancer Epidemiology and Prevention Service, Hospital Universitari Sant Joan de Reus, CatSalut, 43204 Reus, Spain; (M.C.); (J.G.)
- Pere Virgili Health Research Institute (IISPV), 43204 Reus, Spain
- Faculty of Medicine and Health Sciences, Rovira i Virgili University, 43204 Reus, Spain
| | - María-Dolores Chirlaque
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (D.S.); (R.M.-G.); (M.-D.C.); (M.-J.S.)
- Departamento de Ciencias Sociosanitarias, IMIB-Arrixaca, Universidad de Murcia, 30100 Murcia, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, 30008 Murcia, Spain
| | | | - Araceli Alemán
- Canary Islands Cancer Registry, Public Health Directorate, Canary Health Service, 35003 Las Palmas de Gran Canaria, Spain; (A.A.); (D.R.)
| | - Dolores Rojas
- Canary Islands Cancer Registry, Public Health Directorate, Canary Health Service, 35003 Las Palmas de Gran Canaria, Spain; (A.A.); (D.R.)
| | - Ana Vizcaíno Batllés
- Castellón Cancer Registry, Public Health Directorate, General Health Department, Generalitat Valenciana, 46020 Valencia, Spain;
| | - Matilde Chico
- Ciudad Real Cancer Registry, Health and Social Welfare Authority, Castile-La Mancha, 13071 Ciudad Real, Spain;
| | - Rosario Jiménez Chillarón
- Cuenca Cancer Registry, Health and Social Welfare Authority, Castile-La Mancha, 16071 Cuenca, Spain;
| | - Arantza López de Munain
- Basque Country Cancer Registry, Health Department, 01010 Vitoria, Spain; (A.L.d.M.); (V.d.C.)
| | - Visitación de Castro
- Basque Country Cancer Registry, Health Department, 01010 Vitoria, Spain; (A.L.d.M.); (V.d.C.)
| | - Maria-José Sánchez
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (D.S.); (R.M.-G.); (M.-D.C.); (M.-J.S.)
- Escuela Andaluza de Salud Pública (EASP), 18011 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
- Department of Preventive Medicine and Public Health, University of Granada, 18071 Granada, Spain
| | - Enrique Ramalle-Gómara
- Department of Epidemiology and Prevention, La Rioja Regional Health Authority, 26071 Logroño, Spain;
| | - Paula Franch
- Balearic Islands Health Research Institute (IdISBa), Illes Balears, 07120 Palma, Spain;
- Mallorca Cancer Registry, Balearic Islands Public Health Department, 07010 Palma, Spain
| | - Jaume Galceran
- Tarragona Cancer Registry, Cancer Epidemiology and Prevention Service, Hospital Universitari Sant Joan de Reus, CatSalut, 43204 Reus, Spain; (M.C.); (J.G.)
- Pere Virgili Health Research Institute (IISPV), 43204 Reus, Spain
- Faculty of Medicine and Health Sciences, Rovira i Virgili University, 43204 Reus, Spain
| | - Eva Ardanaz
- Navarra Public Health Institute, 31003 Pamplona, Spain;
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (D.S.); (R.M.-G.); (M.-D.C.); (M.-J.S.)
- Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain
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Bedir A, Abera SF, Vordermark D, Medenwald D. Socioeconomic disparities in endometrial cancer survival in Germany: a survival analysis using population-based cancer registry data. J Cancer Res Clin Oncol 2022; 148:1087-1095. [PMID: 35064816 PMCID: PMC9015991 DOI: 10.1007/s00432-021-03908-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/27/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Area-based socioeconomic deprivation has been established as an important indicator of health and a potential predictor of survival. In this study, we aimed to measure the effect of socioeconomic inequality on endometrial cancer survival. METHODS Population-based data on patients diagnosed with endometrial cancer between 2004 and 2014 were obtained from the German Centre for Cancer Registry Data. Socioeconomic inequality was defined by the German Index of Socioeconomic Deprivation. We investigated the association of deprivation and overall survival through Kaplan-Meier curves and Cox proportional regression models. RESULTS A total of 21,602 women, with a mean age of 67.8 years, were included in our analysis. The observed 5-year overall survival time for endometrial cancer patients living in the most affluent districts (first quintile) was 78.6%. The overall survival rate decreased as the level of deprivation increased (77.2%, 73.9%, 76.1%, 74.7%, for patients in the second, third, fourth, and fifth quintile (most deprived patients), respectively). Cox regression models showed stage I patients living in the most deprived districts to have a higher hazard of overall mortality when compared to the cases living in the most affluent districts [Hazard ratio: 1.20; 95% Confidence interval (0.99-1.47)] after adjusting for age, tumor characteristics, and treatment. CONCLUSION Our results indicate differences in endometrial cancer survival according to socioeconomic deprivation among stage I patients. Considering data limitations, future studies with access to individual-level patient information should be conducted to examine the underlying causes for the observed disparity in cancer survival.
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Affiliation(s)
- Ahmed Bedir
- Health Services Research Group, Department of Radiation Oncology, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Semaw Ferede Abera
- Health Services Research Group, Department of Radiation Oncology, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Dirk Vordermark
- Health Services Research Group, Department of Radiation Oncology, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
- Department of Radiation Oncology, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Daniel Medenwald
- Health Services Research Group, Department of Radiation Oncology, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
- Department of Radiation Oncology, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
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Dynamic Bayesian networks for prediction of health status and treatment effect in patients with chronic lymphocytic leukemia. Sci Rep 2022; 12:1811. [PMID: 35110619 PMCID: PMC8810890 DOI: 10.1038/s41598-022-05813-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 01/13/2022] [Indexed: 11/21/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) is the most common blood cancer in adults. The course of CLL and patients' response to treatment are varied. This variability makes it difficult to select the most appropriate treatment regimen and predict the progression of the disease. This work was aimed at developing and validating dynamic Bayesian networks (DBNs) to predict changes of the health status of patients with CLL and progression of the disease over time. Two DBNs were developed and implemented i.e. Health Status Network (HSN) and Treatment Effect Network (TEN). Based on the literature data and expert knowledge we identified relationships linking the most important factors influencing the health status and treatment effects in patients with CLL. The developed networks, and in particular TEN, were able to predict probability of survival in patients with CLL, which was in line with the survival data collected in large medical registries. The networks can be used to personalize the predictions, taking into account a priori knowledge concerning a particular patient with CLL. The proposed approach can serve as a basis for the development of artificial intelligence systems that facilitate the choice of treatment that maximizes the chances of survival in patients with CLL.
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Forjaz G, Howlader N, Scoppa S, Johnson CJ, Mariotto AB. Impact of including second and later cancers in cause-specific survival estimates using population-based registry data. Cancer 2022; 128:547-557. [PMID: 34623641 PMCID: PMC8776580 DOI: 10.1002/cncr.33940] [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: 06/14/2021] [Revised: 08/15/2021] [Accepted: 09/07/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Second or later primary cancers account for approximately 20% of incident cases in the United States. Currently, cause-specific survival (CSS) analyses exclude these cancers because the cause of death (COD) classification algorithm was available only for first cancers. The authors added rules for later cancers to the Surveillance, Epidemiology, and End Results cause-specific death classification algorithm and evaluated CSS to include individuals with prior tumors. METHODS The authors constructed 2 cohorts: 1) the first ever primary cohort, including patients whose first cancer was diagnosed during 2000 through 2016) and 2) the earliest matching primary cohort, including patients with any cancer who matched the selection criteria irrespective of whether it was the first or a later cancer diagnosed during 2000 through 2016. The cohorts' CSS estimates were compared using follow-up through December 31, 2017. The new rules were used in the second cohort for patients whose first cancers during 2000 through 2016 were their second or later cancers. RESULTS Overall, there were no statistically significant differences in CSS estimates between the 2 cohorts. Estimates were similar by age, stage, race, and time since diagnosis, except for patients with leukemia and those aged 65 to 74 years (3.4 percentage point absolute difference). CONCLUSIONS The absolute difference in CSS estimates for the first cancer ever cohort versus earliest of any cancers cohort in the study period was small for most cancer types. As the number of newly diagnosed patients with prior cancers increases, the algorithm will make CSS more inclusive and enable estimating survival for a group of patients with cancer for whom life tables are not available or life tables are available but do not capture other-cause mortality appropriately.
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Affiliation(s)
- Gonçalo Forjaz
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA,Azores Cancer Registry, Azores Oncological Centre, Portugal,Corresponding author: Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Room 4E568, Rockville, MD 20850, USA. (G. Forjaz)
| | - Nadia Howlader
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Steve Scoppa
- Information Management Services, Inc., Calverton, MD, USA
| | | | - Angela B. Mariotto
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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Aseafan M, Devol E, AlAhwal M, Souissi R, Sindi R, AlEid H, Bazarbashi S. Population-based survival for cancer patients in Saudi Arabia for the years 2005-2009. Sci Rep 2022; 12:235. [PMID: 34997176 PMCID: PMC8742104 DOI: 10.1038/s41598-021-04374-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 12/21/2021] [Indexed: 02/08/2023] Open
Abstract
The Saudi Cancer Registry reported in 2007 the 5-year observed survival for the most common cancer sites for the years 1994-2004. In this report we looked at the cancer survival in the period 2005-2009 and evaluated the trend over the 15 years period from 1994 to 2009. Cases of the top 14 cancer sites reported by the population based Saudi Cancer Registry from 1 January 2005 to December 31, 2009, were submitted for survival analysis. The vital status of those patients was collected. Analysis of survival for the above period was compared with the prior reported 2 periods (1994-1999, 2000-2004). In addition, analysis was done according to age, sex, disease stage and the province. Data of 25,969 patients of the commonest cancer sites were submitted. Of those 14,146 patients (54%) had complete demographic data available and vital status was reported. Thyroid cancer had the highest 5- year observed survival of 94% (95% confidence interval (CI) 93-95%)), followed by Breast (72%, 95% CI 71-74%). In hematological malignancies, Hodgkin's Lymphoma had the highest 5-year survival of 86% (95% CI 84-88%). Survival rates has improved in most of the cancers sites for the studied periods except for lung, uterine and Hodgkin's lymphoma which plateaued. Our study confirms a steady improvement in the 5-year observed survival over time for the majority of cancers. Our survival data were comparable to western countries. This data should be used by policy makers to improve on cancer care in the kingdom.
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Affiliation(s)
- Mohamed Aseafan
- Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, 11211, Saudi Arabia
| | - Edward Devol
- Department of Biostatistics, Epidemiology and Scientific Computing, King Faisal Specialist Hospital and Research Center, Riyadh, 11211, Saudi Arabia
| | - Mahmoud AlAhwal
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Riad Souissi
- Research Department, Elm Company, Riyadh, Saudi Arabia
| | - Reham Sindi
- Department of Biostatistics, Epidemiology and Scientific Computing, King Faisal Specialist Hospital and Research Center, Riyadh, 11211, Saudi Arabia
| | - Haya AlEid
- Department of Therapeutic Services, Ministry of Health, Riyadh, Saudi Arabia
| | - Shouki Bazarbashi
- Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, 11211, Saudi Arabia.
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Rudolph CES, Engholm G, Pritzkuleit R, Storm HH, Katalinic A. Survival of breast cancer patients in German-Danish border regions - A registry-based cohort study. Cancer Epidemiol 2021; 74:102001. [PMID: 34450451 DOI: 10.1016/j.canep.2021.102001] [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: 02/23/2021] [Revised: 06/14/2021] [Accepted: 08/01/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIM Denmark reports slightly lower breast cancer survival before 2010 than its neighbouring country Germany. Previous research is limited by lacking stage and treatment information. This study aims to investigate differences in breast cancer survival between the bordering regions Schleswig-Holstein (Germany), Southern Denmark and Zealand (Denmark) using registry data including stage and treatment information. METHOD Invasive female breast cancer cases diagnosed during 2004-2013 with follow up through 31st December 2014 were extracted from cancer registries. Cases notified by death certificates only and those aged 90+ years were excluded. Kaplan-Meier curves and log-rank tests were computed. Cox regression analysis was conducted with adjustment for year of diagnosis, age, stage, and treatment. RESULTS The analytical sample included 42,966 cases. Kaplan-Meier curves and log-rank tests show significant survival differences between the regions. The Cox regression model adjusted for year of diagnosis and age shows significantly worse overall survival of breast cancer patients in both Danish regions compared to Schleswig-Holstein with hazard ratios (HR) of 1.09 (95 % CI: 1.04; 1.15) for patients from Southern Denmark (SD) and 1.25 (95 % CI: 1.18; 1.32) for residents of Zealand (ZL). This effect diminished after adjustment for stage and treatment (HR: 1.05 (SD), 1.09 (ZL) 95 % CI: 0.99; 1.10 (SD), 1.03; 1.15 (ZL)). CONCLUSION Survival differences can be explained by differing stage distribution and treatment administration, which formerly were more favourable in Schleswig-Holstein. The survival gap will probably close due to Denmark's national screening program and increased use of adjuvant cancer therapy.
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Affiliation(s)
- Christiane E S Rudolph
- Institute for Cancer Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
| | - Gerda Engholm
- Danish Cancer Society, Strandboulevarden 49, 2100, København, Denmark
| | - Ron Pritzkuleit
- Institute for Cancer Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Hans H Storm
- Danish Cancer Society, Strandboulevarden 49, 2100, København, Denmark
| | - Alexander Katalinic
- Institute for Cancer Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
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Coleridge SL, Bryant A, Kehoe S, Morrison J. Neoadjuvant chemotherapy before surgery versus surgery followed by chemotherapy for initial treatment in advanced ovarian epithelial cancer. Cochrane Database Syst Rev 2021; 7:CD005343. [PMID: 34328210 PMCID: PMC8406953 DOI: 10.1002/14651858.cd005343.pub6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Epithelial ovarian cancer presents at an advanced stage in the majority of women. These women require a combination of surgery and chemotherapy for optimal treatment. Conventional treatment has been to perform surgery first and then give chemotherapy. However, there may be advantages to using chemotherapy before surgery. OBJECTIVES To assess whether there is an advantage to treating women with advanced epithelial ovarian cancer with chemotherapy before debulking surgery (neoadjuvant chemotherapy (NACT)) compared with conventional treatment where chemotherapy follows debulking surgery (primary debulking surgery (PDS)). SEARCH METHODS We searched the following databases up to 9 October 2020: the Cochrane Central Register of Controlled Trials (CENTRAL), Embase via Ovid, MEDLINE (Silver Platter/Ovid), PDQ and MetaRegister. We also checked the reference lists of relevant papers that were identified to search for further studies. The main investigators of relevant trials were contacted for further information. SELECTION CRITERIA Randomised controlled trials (RCTs) of women with advanced epithelial ovarian cancer (Federation of International Gynaecologists and Obstetricians (FIGO) stage III/IV) who were randomly allocated to treatment groups that compared platinum-based chemotherapy before cytoreductive surgery with platinum-based chemotherapy following cytoreductive surgery. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias in each included trial. We extracted data of overall (OS) and progression-free survival (PFS), adverse events, surgically-related mortality and morbidity and quality of life outcomes. We used GRADE methods to determine the certainty of evidence. MAIN RESULTS We identified 2227 titles and abstracts through our searches, of which five RCTs of varying quality and size met the inclusion criteria. These studies assessed a total of 1774 women with stage IIIc/IV ovarian cancer randomised to NACT followed by interval debulking surgery (IDS) or PDS followed by chemotherapy. We pooled results of the four studies where data were available and found little or no difference with regard to overall survival (OS) (Hazard Ratio (HR) 0.96, 95% CI 0.86 to 1.08; participants = 1692; studies = 4; high-certainty evidence) or progression-free survival in four trials where we were able to pool data (Hazard Ratio 0.98, 95% CI 0.88 to 1.08; participants = 1692; studies = 4; moderate-certainty evidence). Adverse events, surgical morbidity and quality of life (QoL) outcomes were variably and incompletely reported across studies. There are probably clinically meaningful differences in favour of NACT compared to PDS with regard to overall postoperative serious adverse effects (SAE grade 3+): 6% in NACT group, versus 29% in PDS group, (risk ratio (RR) 0.22, 95% CI 0.13 to 0.38; participants = 435; studies = 2; heterogeneity index (I2) = 0%; moderate-certainty evidence). NACT probably results in a large reduction in the need for stoma formation: 5.9% in NACT group, versus 20.4% in PDS group, (RR 0.29, 95% CI 0.12 to 0.74; participants = 632; studies = 2; I2 = 70%; moderate-certainty evidence), and probably reduces the risk of needing bowel resection at the time of surgery: 13.0% in NACT group versus 26.6% in PDS group (RR 0.49, 95% CI 0.30 to 0.79; participants = 1565; studies = 4; I2 = 79%; moderate-certainty evidence). NACT reduces postoperative mortality: 0.6% in NACT group, versus 3.6% in PDS group, (RR 0.16, 95% CI 0.06 to 0.46; participants = 1623; studies = 5; I2 = 0%; high-certainty evidence). QoL on the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) scale produced inconsistent and imprecise results in three studies (MD -0.29, 95% CI -2.77 to 2.20; participants = 524; studies = 3; I2 = 81%; very low-certainty evidence) but the evidence is very uncertain and should be interpreted with caution. AUTHORS' CONCLUSIONS The available high to moderate-certainty evidence suggests there is little or no difference in primary survival outcomes between PDS and NACT. NACT probably reduces the risk of serious adverse events, especially those around the time of surgery, and reduces the risk of postoperative mortality and the need for stoma formation. These data will inform women and clinicians (involving specialist gynaecological multidisciplinary teams) and allow treatment to be tailored to the person, taking into account surgical resectability, age, histology, stage and performance status. Data from an unpublished study and ongoing studies are awaited.
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Affiliation(s)
- Sarah L Coleridge
- Department of Obstetrics and Gynaecology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Andrew Bryant
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Sean Kehoe
- Institute of Cancer and Genomics, University of Birmingham, Birmingham, UK
| | - Jo Morrison
- Department of Gynaecological Oncology, Musgrove Park Hospital, Taunton, UK
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The effect of a gastric second primary cancer on the survival of patients with a previous cancer history. Eur J Cancer Prev 2021; 29:215-221. [PMID: 31651567 DOI: 10.1097/cej.0000000000000540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Second primary cancers (SPCs) are an increasing concern among cancer survivors. In Northern Portugal, gastric cancer incidence is high, and alone corresponds to one in 10 SPCs diagnosed. Therefore, this study aims to estimate the contribution of gastric SPCs to the mortality of patients with a previous cancer. A population-based cohort of nongastric first primary cancer (FPC) patients from the North Region Cancer Registry of Portugal, diagnosed between 2000 and 2006, was followed for a gastric SPC until the end of 2012, and for death by any cause until the end of 2017. Patients with a gastric SPC (85 synchronous and 215 metachronous, diagnosed within one and >1 year after the FPC, respectively) were matched (1:3, by sex, five-year age group, year and site of FPC diagnosis) to those who did not develop a gastric SPC and were alive when the corresponding SPC was diagnosed. Significantly higher hazards for mortality [hazard ratio (95% confidence interval)] were observed among patients diagnosed with a synchronous [3.74 (2.69-5.21) in males and 3.36 (2.02-5.58) in females] or metachronous [6.93 (5.41-8.87) in males and 5.93 (4.04-8.72) in females] gastric SPC. The differences in the 10-year cumulative mortality between gastric SPC patients and those with no SPC were approximately 30% for synchronous and over 40% for metachronous gastric SPCs, corresponding to a 1.5- to 2-fold higher relative risk, respectively. In conclusion, cancer patients with a gastric SPC have a nearly two-fold higher risk of death over 10 years than those with a corresponding FPC only.
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Lawler M, Oliver K, Gijssels S, Aapro M, Abolina A, Albreht T, Erdem S, Geissler J, Jassem J, Karjalainen S, La Vecchia C, Lievens Y, Meunier F, Morrissey M, Naredi P, Oberst S, Poortmans P, Price R, Sullivan R, Velikova G, Vrdoljak E, Wilking N, Yared W, Selby P. The European Code of Cancer Practice. J Cancer Policy 2021; 28:100282. [DOI: 10.1016/j.jcpo.2021.100282] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/19/2021] [Accepted: 03/31/2021] [Indexed: 12/11/2022]
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Bogos K, Kiss Z, Tamási L, Ostoros G, Müller V, Urbán L, Bittner N, Sárosi V, Vastag A, Polányi Z, Nagy-Erdei Z, Daniel A, Vokó Z, Nagy B, Horváth K, Rokszin G, Abonyi-Tóth Z, Barcza Z, Gálffy G, Moldvay J. Improvement in Lung Cancer Survival: 6-Year Trends of Overall Survival at Hungarian Patients Diagnosed in 2011-2016. Pathol Oncol Res 2021; 27:603937. [PMID: 34257563 PMCID: PMC8262181 DOI: 10.3389/pore.2021.603937] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/24/2021] [Indexed: 12/25/2022]
Abstract
Objective: Lung cancer is one of the most common cancers worldwide and its survival is still poor. The objective of our study was to estimate long-term survival of Hungarian lung cancer patients at first time based on a nationwide review of the National Health Insurance Fund database. Methods: Our retrospective, longitudinal study included patients aged ≥20 years who were diagnosed with lung cancer (ICD-10 C34) between January 1, 2011 and December 31, 2016. Survival rates were evaluated by year of diagnosis, patient gender and age, and morphology of lung cancer. Results: 41,854 newly diagnosed lung cancer patients were recorded. Mean age at diagnosis varied between 64.7 and 65.9 years during study period. One- and 5-year overall survival rates for the total population were 42.2 and 17.9%, respectively. Survival was statistically associated with gender, age and type of lung cancer. Female patients (n = 16,362) had 23% better survival (HR: 0.77, 95% confidence interval (CI): 0.75–0.79; p < 0.001) than males (n = 25,492). The highest survival rates were found in the 20–49 age cohort (5Y = 31.3%) and if the cancer type was adenocarcinoma (5Y = 20.5%). We measured 5.3% improvement (9.2% adjusted) in lung cancer survival comparing the period 2015–2016 to 2011–2012 (HR: 0.95 95% CI: 0.92–0.97; p = 0.003), the highest at females <60 year (0.86 (adjusted HR was 0.79), interaction analysis was significant for age and histology types. Conclusion: Our study provided long-term Lung cancer survival data in Hungary for the first time. We found a 5.3% improvement in 5-year survival in 4 years. Women and young patients had better survival. Survival rates were comparable to–and at the higher end of–rates registered in other East-Central European countries (7.7%–15.7%).
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Affiliation(s)
- Krisztina Bogos
- National Korányi Institute of Pulmonology, Budapest, Hungary
| | | | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Gyula Ostoros
- National Korányi Institute of Pulmonology, Budapest, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - László Urbán
- Matrahaza Healthcare Center and University Teaching Hospital, Matrahaza, Hungary
| | - Nóra Bittner
- Pulmonology Clinic University of Debrecen, Debrecen, Hungary
| | | | | | | | | | | | | | | | | | | | - Zsolt Abonyi-Tóth
- RxTarget Ltd. Szolnok, Budapest, Hungary.,University of Veterinary Medicine Budapest, Budapest, Hungary
| | | | | | - Judit Moldvay
- Ist Department of Pulmonology, National Korányi Institute of Pulmonology, Semmelweis University, Budapest, Hungary.,2nd Department of Pathology, MTA-SE NAP, Brain Metastasis Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
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29
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Dal Maso L, Panato C, Tavilla A, Guzzinati S, Serraino D, Mallone S, Botta L, Boussari O, Capocaccia R, Colonna M, Crocetti E, Dumas A, Dyba T, Franceschi S, Gatta G, Gigli A, Giusti F, Jooste V, Minicozzi P, Neamtiu L, Romain G, Zorzi M, De Angelis R, Francisci S. Cancer cure for 32 cancer types: results from the EUROCARE-5 study. Int J Epidemiol 2021; 49:1517-1525. [PMID: 32984907 DOI: 10.1093/ije/dyaa128] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Few studies have estimated the probability of being cured for cancer patients. This study aims to estimate population-based indicators of cancer cure in Europe by type, sex, age and period. METHODS 7.2 million cancer patients (42 population-based cancer registries in 17 European countries) diagnosed at ages 15-74 years in 1990-2007 with follow-up to 2008 were selected from the EUROCARE-5 dataset. Mixture-cure models were used to estimate: (i) life expectancy of fatal cases (LEF); (ii) cure fraction (CF) as proportion of patients with same death rates as the general population; (iii) time to cure (TTC) as time to reach 5-year conditional relative survival (CRS) >95%. RESULTS LEF ranged from 10 years for chronic lymphocytic leukaemia patients to <6 months for those with liver, pancreas, brain, gallbladder and lung cancers. It was 7.7 years for patients with prostate cancer at age 65-74 years and >5 years for women with breast cancer. The CF was 94% for testis, 87% for thyroid cancer in women and 70% in men, 86% for skin melanoma in women and 76% in men, 66% for breast, 63% for prostate and <10% for liver, lung and pancreatic cancers. TTC was <5 years for testis and thyroid cancer patients diagnosed below age 55 years, and <10 years for stomach, colorectal, corpus uteri and melanoma patients of all ages. For breast and prostate cancers, a small excess (CRS < 95%) remained for at least 15 years. CONCLUSIONS Estimates from this analysis should help to reduce unneeded medicalization and costs. They represent an opportunity to improve patients' quality of life.
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Affiliation(s)
- Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Chiara Panato
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Andrea Tavilla
- National Center for Prevention and Health Promotion, Italian National Institute of Health (ISS), Rome, Italy
| | | | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Sandra Mallone
- National Center for Prevention and Health Promotion, Italian National Institute of Health (ISS), Rome, Italy
| | - Laura Botta
- Evaluative Epidemiology Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Olayidé Boussari
- Registre Bourguignon des Cancers Digestifs, INSERM UMR 1231, CHU de Dijon, Université de Bourgogne, Dijon, France
| | | | | | - Emanuele Crocetti
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, ItalyAzienda Usl della Romagna, Forlì, Italy
| | - Agnes Dumas
- National Institute for Health and Medical Research (INSERM), Paris, France
| | - Tadek Dyba
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Silvia Franceschi
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Gemma Gatta
- Evaluative Epidemiology Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Anna Gigli
- Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
| | | | - Valerie Jooste
- Registre Bourguignon des Cancers Digestifs, INSERM UMR 1231, CHU de Dijon, Université de Bourgogne, Dijon, France
| | - Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Luciana Neamtiu
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Gaëlle Romain
- Registre Bourguignon des Cancers Digestifs, INSERM UMR 1231, CHU de Dijon, Université de Bourgogne, Dijon, France
| | - Manuel Zorzi
- Veneto Tumour Registry, Azienda Zero, Padua, Italy
| | - Roberta De Angelis
- Department of Oncology and Molecular Medicine, Italian National Institute of Health (ISS), Rome, Italy
| | - Silvia Francisci
- National Center for Prevention and Health Promotion, Italian National Institute of Health (ISS), Rome, Italy
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Evaluation of the impact of the COVID-19 lockdown on the quality of life of patients monitored for cancer who practice an adapted physical activity: rugby for health. J Cancer Res Clin Oncol 2021; 148:425-439. [PMID: 33821320 PMCID: PMC8021215 DOI: 10.1007/s00432-021-03621-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/29/2021] [Indexed: 11/19/2022]
Abstract
Purpose The benefits of regular physical exercise on the tolerability of cancer treatments, quality of life and survival rates post-diagnosis have been demonstrated but all supervised physical activities have been interrupted due to the global health crisis and the need for lockdown to halt the spread of SARS-CoV-2. To reintroduce activities post-lockdown, we wanted to assess the impact of the COVID-19 lockdown on the quality of life and the psychological status of patients who practice an adapted physical activity such as rugby for health. Methods The evaluation was conducted in two phases: an initial self-questionnaire comprised of 42 questions sent to all participants to assess the impact of lockdown and a second assessment phase in the presence of the participants. We assessed anthropometric data, functional fitness parameters, quality of life and the psychosocial status of the subjects. The data were compared to pre-lockdown data as part of a standardised follow-up procedure for patients enrolled in the programme. Results 105/120 (87.5%) individuals responded to the rapid post-lockdown survey analysis. In 20% of the cases, the patients reported anxiety, pain, a decline in fitness and a significant impact on the tolerability of cancer treatments. Twenty-seven patients agreed to participate in the individual analysis. Following lockdown, there was a significant decrease in the intensity of physical activity (p = 8.223e–05). No post-lockdown changes were noted in the assessments that focus on the quality of life and the level of psychological distress. Conversely, there was a significant correlation between the total of high energy expended during lockdown and the quality of life (p = 0.03; rho = 0.2248) and the level of psychological distress post-lockdown (p = 0.05; rho = − 0.3772). Conclusion Lockdown and reduced physical activity, particularly leisure activities, did not impact the overall health of the patients. However, there was a significant correlation with the level of physical activity since the higher the level of physical activity, the better the quality of life and the lower the level of psychological distress. Supplementary Information The online version contains supplementary material available at 10.1007/s00432-021-03621-7.
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Efremov L, Abera SF, Bedir A, Vordermark D, Medenwald D. Patterns of glioblastoma treatment and survival over a 16-years period: pooled data from the German Cancer Registries. J Cancer Res Clin Oncol 2021; 147:3381-3390. [PMID: 33743072 PMCID: PMC8484256 DOI: 10.1007/s00432-021-03596-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 03/11/2021] [Indexed: 11/24/2022]
Abstract
Introduction Glioblastoma multiforme (GBM) is a primary malignant brain tumour characterized by a very low long-term survival. The aim of this study was to analyse the distribution of treatment modalities and their effect on survival for GBM cases diagnosed in Germany between 1999 and 2014. Methods Cases were pooled from the German Cancer Registries with International Classification of Diseases for Oncology, third edition (ICD-O-3) codes for GBM or giant-cell GBM. Three periods, first (January 1999–December 2005), second (January 2006–December 2010) and a third period (January 2011–December 2014) were defined. Kaplan–Meier plots with long-rank test compared median overall survival (OS) between groups. Survival differences were assessed with Cox proportional-hazards models adjusted for available confounders. Results In total, 40,138 adult GBM cases were analysed, with a mean age at diagnosis 64.0 ± 12.4 years. GBM was more common in men (57.3%). The median OS was 10.0 (95% CI 9.0–10.0) months. There was an increase in 2-year survival, from 16.6% in the first to 19.3% in the third period. When stratified by age group, period and treatment modalities, there was an improved median OS after 2005 due to treatment advancements. Younger age, female sex, surgical resection, use of radiotherapy and chemotherapy, were independent factors associated with better survival. Conclusion The inclusion of temozolomide chemotherapy has considerably improved median OS in the older age groups but had a lesser effect in the younger age group of cases. The analysis showed survival improvements for each treatment option over time. Supplementary Information The online version contains supplementary material available at 10.1007/s00432-021-03596-5.
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Affiliation(s)
- Ljupcho Efremov
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany.,Department of Radiation Oncology, Martin-Luther-University, Halle (Saale), Germany
| | - Semaw Ferede Abera
- Department of Radiation Oncology, Martin-Luther-University, Halle (Saale), Germany
| | - Ahmed Bedir
- Department of Radiation Oncology, Martin-Luther-University, Halle (Saale), Germany
| | - Dirk Vordermark
- Department of Radiation Oncology, Martin-Luther-University, Halle (Saale), Germany
| | - Daniel Medenwald
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany. .,Department of Radiation Oncology, Martin-Luther-University, Halle (Saale), Germany.
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Bedir A, Abera SF, Efremov L, Hassan L, Vordermark D, Medenwald D. Socioeconomic disparities in head and neck cancer survival in Germany: a causal mediation analysis using population-based cancer registry data. J Cancer Res Clin Oncol 2021; 147:1325-1334. [PMID: 33569714 PMCID: PMC8021523 DOI: 10.1007/s00432-021-03537-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/15/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE Despite recent improvements in cancer treatment in Germany, a marked difference in cancer survival based on socioeconomic factors persists. We aim to quantify the effect of socioeconomic inequality on head and neck cancer (HNC) survival. METHODS Information on 20,821 HNC patients diagnosed in 2009-2013 was routinely collected by German population-based cancer registries. Socioeconomic inequality was defined by the German Index of Socioeconomic Deprivation. The Cox proportional regression and relative survival analysis measured the survival disparity according to level of socioeconomic deprivation with respective confidence intervals (CI). A causal mediation analysis was conducted to quantify the effect of socioeconomic deprivation mediated through medical care, stage at diagnosis, and treatment on HNC survival. RESULTS The most socioeconomically deprived patients were found to have the highest hazard of dying when compared to the most affluent (Hazard Ratio: 1.25, 95% CI 1.17-1.34). The most deprived patients also had the worst 5-year age-adjusted relative survival (50.8%, 95% CI 48.5-53.0). Our mediation analysis showed that most of the effect of deprivation on survival was mediated through differential stage at diagnosis during the first 6 months after HNC diagnosis. As follow-up time increased, medical care, stage at diagnosis, and treatment played no role in mediating the effect of deprivation on survival. CONCLUSION This study confirms the survival disparity between affluent and deprived HNC patients in Germany. Considering data limitations, our results suggest that, within six months after HNC diagnosis, the elimination of differences in stage at diagnosis could reduce survival inequalities.
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Affiliation(s)
- Ahmed Bedir
- Department of Radiation Oncology, Health Services Research Group, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Semaw Ferede Abera
- Department of Radiation Oncology, Health Services Research Group, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Ljupcho Efremov
- Department of Radiation Oncology, Health Services Research Group, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
- Institute of Medical Epidemiology, Biometry, and Informatics, Martin Luther University Halle-Wittenberg, Magdeburger Strasse 8, 06112, Halle (Saale), Germany
| | - Lamiaa Hassan
- Institute of Medical Epidemiology, Biometry, and Informatics, Martin Luther University Halle-Wittenberg, Magdeburger Strasse 8, 06112, Halle (Saale), Germany
| | - Dirk Vordermark
- Department of Radiation Oncology, Health Services Research Group, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
- Department of Radiation Oncology, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany
| | - Daniel Medenwald
- Department of Radiation Oncology, Health Services Research Group, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
- Department of Radiation Oncology, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.
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Coleridge SL, Bryant A, Kehoe S, Morrison J. Chemotherapy versus surgery for initial treatment in advanced ovarian epithelial cancer. Cochrane Database Syst Rev 2021; 2:CD005343. [PMID: 33543776 PMCID: PMC8094177 DOI: 10.1002/14651858.cd005343.pub5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Epithelial ovarian cancer presents at an advanced stage in the majority of women. These women require surgery and chemotherapy for optimal treatment. Conventional treatment has been to perform surgery first and then give chemotherapy. However, there may be advantages to using chemotherapy before surgery. OBJECTIVES To assess whether there is an advantage to treating women with advanced epithelial ovarian cancer with chemotherapy before debulking surgery (neoadjuvant chemotherapy (NACT)) compared with conventional treatment where chemotherapy follows debulking surgery (primary debulking surgery (PDS)). SEARCH METHODS We searched the following databases on 11 February 2019: CENTRAL, Embase via Ovid, MEDLINE (Silver Platter/Ovid), PDQ and MetaRegister. We also checked the reference lists of relevant papers that were identified to search for further studies. The main investigators of relevant trials were contacted for further information. SELECTION CRITERIA Randomised controlled trials (RCTs) of women with advanced epithelial ovarian cancer (Federation of International Gynaecologists and Obstetricians (FIGO) stage III/IV) who were randomly allocated to treatment groups that compared platinum-based chemotherapy before cytoreductive surgery with platinum-based chemotherapy following cytoreductive surgery. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias in each included trial. MAIN RESULTS We found 1952 potential titles, with a most recent search date of February 2019, of which five RCTs of varying quality and size met the inclusion criteria. These studies assessed a total of 1713 women with stage IIIc/IV ovarian cancer randomised to NACT followed by interval debulking surgery (IDS) or PDS followed by chemotherapy. We pooled results of the three studies where data were available and found little or no difference with regard to overall survival (OS) (1521 women; Hazard Ratio (HR) 0.95, 95% CI 0.84 to 1.07; I2 = 0%; moderate-certainty evidence) or progression-free survival in four trials where we were able to pool data (1631 women; HR 0.97, 95% CI 0.87 to 1.07; I2 = 0%; moderate-certainty evidence). Adverse events, surgical morbidity and quality of life (QoL) outcomes were poorly and incompletely reported across studies. There may be clinically meaningful differences in favour of NACT compared to PDS with regard to serious adverse effects (SAE grade 3+). These data suggest that NACT may reduce the risk of need for blood transfusion (risk ratio (RR) 0.80; 95% CI 0.64 to 0.99; four studies,1085 women; low-certainty evidence), venous thromboembolism (RR 0.28; 95% CI 0.09 to 0.90; four studies, 1490 women; low-certainty evidence), infection (RR 0.30; 95% CI 0.16 to 0.56; four studies, 1490 women; moderate-certainty evidence), compared to PDS. NACT probably reduces the need for stoma formation (RR 0.43, 95% CI 0.26 to 0.72; two studies, 581 women; moderate-certainty evidence) and bowel resection (RR 0.49, 95% CI 0.26 to 0.92; three studies, 1213 women; moderate-certainty evidence), as well as reducing postoperative mortality (RR 0.18; 95% CI 0.06 to 0.54:five studies, 1571 women; moderate-certainty evidence). QoL on the EORTC QLQ-C30 scale produced inconsistent and imprecise results in two studies (MD -1.34, 95% CI -2.36 to -0.32; participants = 307; very low-certainty evidence) and use of the QLQC-30 and QLQC-Ov28 in another study (MD 7.60, 95% CI 1.89 to 13.31; participants = 217; very low-certainty evidence) meant that little could be inferred. AUTHORS' CONCLUSIONS The available moderate-certainty evidence suggests there is little or no difference in primary survival outcomes between PDS and NACT. NACT may reduce the risk of serious adverse events, especially those around the time of surgery, and the need for bowel resection and stoma formation. These data will inform women and clinicians and allow treatment to be tailored to the person, taking into account surgical resectability, age, histology, stage and performance status. Data from an unpublished study and ongoing studies are awaited.
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Affiliation(s)
- Sarah L Coleridge
- Obstetrics and Gynaecology, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Andrew Bryant
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Sean Kehoe
- Institute of Cancer and Genomics, University of Birmingham, Birmingham, UK
| | - Jo Morrison
- Department of Gynaecological Oncology, Musgrove Park Hospital, Taunton, UK
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Tasoulas J, Divaris K, Theocharis S, Farquhar D, Shen C, Hackman T, Amelio AL. Impact of Tumor Site and Adjuvant Radiotherapy on Survival of Patients with Adenoid Cystic Carcinoma: A SEER Database Analysis. Cancers (Basel) 2021; 13:cancers13040589. [PMID: 33546179 PMCID: PMC7913220 DOI: 10.3390/cancers13040589] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/21/2021] [Accepted: 01/29/2021] [Indexed: 11/16/2022] Open
Abstract
Adenoid cystic carcinoma (ACC) is a rare salivary gland tumor, displaying aggressive behavior with frequent recurrence and metastasis. Little information exists regarding the impact of clinicopathological parameters and adjuvant radiotherapy (aRT) on ACC disease specific (DSS) and overall survival (OS). We extracted demographic, treatment, and survival information of 1439 patients with major or minor intraoral salivary gland ACC from the Surveillance, Epidemiology, and End Results (SEER) database. The associations between tumor characteristics and aRT with OS and DSS were estimated using hazard ratios (HR) and 95% confidence intervals (CI). Submandibular gland ACCs had the worst prognosis (adjusted DSS HR = 1.48; 95% CI = 0.99-2.20, compared to parotid), and this difference was more pronounced among patients with advanced-stage tumors (adjusted DSS HR = 1.93; 95% CI = 1.13-3.30). aRT was associated with increased overall survival only among stage III submandibular ACC patients (HR = 0.64; 95% CI = 0.42-0.98) and had no benefit in any other group. In conclusion, submandibular gland ACC carries a worse prognosis than other gland subsites and may benefit from aRT. The different outcomes between submandibular gland and other major or minor gland ACCs warrant further mechanistic investigation.
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Affiliation(s)
- Jason Tasoulas
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (J.T.); (S.T.)
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7455, USA
| | - Kimon Divaris
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7455, USA
| | - Stamatios Theocharis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (J.T.); (S.T.)
| | - Douglas Farquhar
- Department of Otolaryngology/Head and Neck Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (D.F.); (T.H.)
| | - Colette Shen
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Trevor Hackman
- Department of Otolaryngology/Head and Neck Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (D.F.); (T.H.)
| | - Antonio L. Amelio
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7455, USA
- Department of Cell Biology and Physiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Cancer Cell Biology Program, Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Correspondence: ; Tel.: +1-919-537-3309; Fax: +1-919-966-3633
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Virgili G, Parravano M, Gatta G, Capocaccia R, Mazzini C, Mallone S, Botta L. Incidence and Survival of Patients With Conjunctival Melanoma in Europe. JAMA Ophthalmol 2021; 138:601-608. [PMID: 32215588 DOI: 10.1001/jamaophthalmol.2020.0531] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Conjunctival melanoma (CM) is a rare ocular tumor. Estimates of incidence and survival of patients with CM are important to researchers and policy makers. Objective To estimate incidence and survival of patients with CM in Europe. Design, Setting, and Participants This population-based cohort study used data from 41 European cancer registries adhering to the RARECAREnet project. All individuals diagnosed as having malignant CM from January 1995 to December 2007 coded according to the International Classification of Diseases for Oncology, Third Edition codes C69.0 (conjunctiva) and 8720-8780 (melanoma) were included. Analysis began March 2019. Main Outcomes and Measures Trend estimates for incidence and for 5-year relative survival (the ratio of the measured survival of patients to the expected survival in the general population for the same country, age, sex, and calendar year). Crude, age-standardized, and bayesian incidence rates were calculated. Five-year relative survival was calculated by the Ederer II method with the cohort and period approach. Results A total of 724 patients 15 years or older (512 [70.7%] were 55 years or older; 366 [50.6%] were female) were analyzed with an overall crude incidence of CM (per 1 000 000 person/y) of 0.46 (95% CI, 0.42-0.49). Crude incidence was similar in men and women (0.48; 95% CI, 0.44-0.54 and 0.46; 95% CI, 0.41-0.51, respectively) and increased with age. Age-standardized incidence increased over time only in men and was the highest in Norway and the Netherlands (more than 0.70). Only 1 case in 14 years was estimated to occur in Iceland vs about 20 cases per year in large countries such as France and Germany. Percentage of 5-year survival (83.5 overall; 95% CI, 78.6-87.3) was not different between adult and elderly patients but showed large geographical disparities across European regions (range, 66-89) and improved markedly in male patients (from 76 in 1995-1998 to 86 in 2003-2007, with a difference of 10.2 [95% CI, 1.3-19.2]; P < .05) becoming similar to that of women in the last period. Conclusions and Relevance Although these data are only available through 2007 and based on registries not uniformly covering the European population, the study provides the first Europe-wide estimates of the incidence and relative survival of patients with CM using population-based data. Geographical differences in survival indicate room for outcome improvement in Southern, Northern, and Eastern European countries.
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Affiliation(s)
- Gianni Virgili
- AOU Careggi, Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Firenze, Florence, Italy
| | | | - Gemma Gatta
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Cinzia Mazzini
- AOU Careggi, Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Firenze, Florence, Italy
| | | | - Laura Botta
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Stiller CA, Botta L, Sánchez Perez MJ, Chirlaque López MD, Marcos-Gragera R, Scuderi T, Huws DW, Trama A. Kaposi sarcoma incidence, survival and trends: Data from the information network on rare cancers in Europe (RARECAREnet). Cancer Epidemiol 2020; 70:101877. [PMID: 33385768 DOI: 10.1016/j.canep.2020.101877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/25/2020] [Accepted: 12/07/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study provides updated information on Kaposi sarcoma (KS) in Europe during 1995-2007 from the RARECARENet project. METHODS Data comes from 59 population-based cancer registries in 22 countries. KS was defined as ICD-O-3 morphology code 9140 combined with any topography code. Crude and age-adjusted incidence rates and relative survival for years of diagnosis 2000-2007 and with trends during 1995-2007 were calculated overall, by age and by country. RESULTS The crude annual incidence rate was 0.28 per 100,000 and age-adjusted incidence was 0.23 per 100,000; incidence increased with age, from 0.18/100,000 at age 0-44 to 0.25/100,000 at age 45-64 and 0.69/100,000 at age 65 and over. Age-adjusted incidence in males was more than four times that in females. Portugal, which had the highest incidence of AIDS in Europe, had by far the highest incidence of KS at age 0-44, 1.44/100,000, more than four times the rate in any other country. Incidence among males in Europe aged 0-44 fell significantly between 1995-1998 and 1999-2002, followed by a significant increase in 2003-2007. Younger patients, with predominantly AIDS-related KS, formerly had a worse prognosis, but since 1999-2001 5-year relative survival increased for patients aged under 65, and by 2005-2007 was 83-86 % for all three age groups 0-44, 45-64, and 65 and over. CONCLUSION Survival and quality of life for the increasing number of people in Europe affected by KS should improve further following the development of evidence-based guidelines for its management. Population-based cancer registries will continue to play a vital role in monitoring the burden of KS and improvements in its outcome.
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Affiliation(s)
- Charles A Stiller
- National Cancer Registration and Analysis Service, Public Health England, UK.
| | - Laura Botta
- Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Maria José Sánchez Perez
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.
| | | | - Rafael Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry, Cancer Plan, Department of Health, Generalitat de Catalunya, Catalan Institute of Oncology, Girona, Spain; Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain; University of Girona (UdG), Girona, Spain; Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
| | - Tiziana Scuderi
- UOS Registro Tumori Trapani-Agrigento, Dipartimento di Prevenzione, Asp Trapani, Trapani, Italy.
| | - Dyfed Wyn Huws
- Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales, Cardiff, Wales, UK; Honorary Research Fellow, Swansea University, Swansea, Wales, UK.
| | - Annalisa Trama
- Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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Medenwald D, Langer S, Gottschick C, Vordermark D. Effect of Radiotherapy in Addition to Surgery in Early Stage Endometrial Cancer: A Population-Based Study. Cancers (Basel) 2020; 12:E3814. [PMID: 33348738 PMCID: PMC7766752 DOI: 10.3390/cancers12123814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/09/2020] [Accepted: 12/16/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The role of radiotherapy in the management of early (FIGO I) endometrial cancer is controversial with limited availability of prospective data from randomized trials. METHODS German Epidemiologic Cancer Registries provided by the Robert Koch Institute. We considered FIGO I cases with recorded operative treatment (n = 12,718, 2000-2017). We computed hazard ratios (HR) from relative survival models in relation to the mortality of the general population with 95% confidence intervals (CI). Multivariate models were adjusted for age, stage (IA vs. IB), grading, and chemotherapy. Radiotherapy included external radiotherapy and brachytherapy. RESULTS Cases with a favorable risk profile (FIGO IA, G1/G2) had a slightly lower survival rate, relative to the general population (FIGO IA: 0.9, G1: 0.91). The proportion of FIGO IA cases was lower in the radiotherapy group (52.6%) vs. cases without radiotherapy (78.6%). Additional treatment with radiotherapy was beneficial in FIGO IB (HR = 0.74) and all histopathological grades, but not FIGO IA cases (HR = 0.93) cases. Compared to IA tumors, IB cases had a HR of 1.51 (95% CI: 1.34-1.7). CONCLUSIONS Radiotherapy in addition to surgery is beneficial for patients in a FIGO IB stage. Further studies need to address the impact of new techniques and risk assessment.
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Affiliation(s)
- Daniel Medenwald
- Department of Radiation Oncology, Martin Luther University Halle-Wittenberg, 06120 Halle, Germany; (S.L.); (C.G.); (D.V.)
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Piatek S, Panek G, Lewandowski Z, Bidzinski M, Piatek D, Kosinski P, Wielgos M. Rising serum CA-125 levels within the normal range is strongly associated recurrence risk and survival of ovarian cancer. J Ovarian Res 2020; 13:102. [PMID: 32878632 PMCID: PMC7469284 DOI: 10.1186/s13048-020-00681-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 07/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In clinical practice alterations in CA-125 concentration within normal range in patients with ovarian cancer after first-line treatment are common. Even minor increase in CA-125 concentration is associated with patients' anxiety and difficult interpretation and counselling for clinicians. The aim of this study was to evaluate the significance of CA-125 fluctuations within reference level in patients who suffered from ovarian cancer with complete response after first-line treatment. RESULTS 168 patients with epithelial ovarian cancer, who achieved complete remission after first line treatment were enrolled in the study. CA-125 concentration assessment was carried out during follow up visits. The recurrence of the disease was diagnosed on the first appearance of symptoms: clinical, radiological or histopathological/cytological. PFS and 5-year survival rate was calculated with Kaplan-Meier plots. Statistical analysis was performed with SAS / STAT® 9.4 / 14.4, SAS Institute Inc., Cary, NC, USA, 2017. Median concentration of CA-125 after first-line therapy was 10 U/ml. Increasing CA-125 concentration by > 5 U/ml, 3 and 6 months after the treatment was associated with higher risk of relapse (HR = 7.6, p < 0.0001 and HR = 5.29, p < 0.0001 respectively). 5-year survival rate was significantly lower in patients with increased CA-125 by 5 U/ml, 3 and 6 months after therapy (56.79% vs 0 and 50.62% vs 15.55%). CONCLUSIONS Increased concentration of CA-125 by > 5 U/ml within normal range, 3 and 6 months after treatment was unfavorable prognostic factor in ovarian cancer patients with complete response to primary therapy.
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Affiliation(s)
- Szymon Piatek
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, 1/3 Starynkiewicza Square, 02-015, Warsaw, Poland. .,Department of Gynecological Oncology, The Maria Sklodowska-Curie Institute - Oncology Center in Warsaw, 5 Roentgena Street, 02-781, Warsaw, Poland.
| | - Grzegorz Panek
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, 1/3 Starynkiewicza Square, 02-015, Warsaw, Poland
| | - Zbigniew Lewandowski
- Department of Epidemiology and Biostatistics, Medical University of Warsaw, 3 Oczki Street, 02-00, Warsaw, Poland
| | - Mariusz Bidzinski
- Department of Gynecological Oncology, The Maria Sklodowska-Curie Institute - Oncology Center in Warsaw, 5 Roentgena Street, 02-781, Warsaw, Poland
| | - Dominika Piatek
- 1st Department of Radiology, Medical University of Warsaw, 5 Chałubińskiego Street, 02-004, Warsaw, Poland
| | - Przemyslaw Kosinski
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, 1/3 Starynkiewicza Square, 02-015, Warsaw, Poland
| | - Miroslaw Wielgos
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, 1/3 Starynkiewicza Square, 02-015, Warsaw, Poland
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Santucci C, Carioli G, Bertuccio P, Malvezzi M, Pastorino U, Boffetta P, Negri E, Bosetti C, La Vecchia C. Progress in cancer mortality, incidence, and survival: a global overview. Eur J Cancer Prev 2020; 29:367-381. [PMID: 32740162 DOI: 10.1097/cej.0000000000000594] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cancer mortality has declined over the last three decades in most high-income countries reflecting improvements in cancer prevention, diagnosis, and management. However, there are persisting and substantial differences in mortality, incidence, and survival worldwide. In order to provide an up-to-date overview of trends in mortality, incidence, and survival, we retrieved data from high-quality, population-based cancer registries for all cancers and 10 selected cancer sites in six high-income countries and the European Union. We computed age-standardized (world standard population) mortality and incidence rates, and applied joinpoint regression models. Mortality from all cancers and most common cancer sites has declined over the last 25 years, except for the pancreas and lung (in women). The patterns for incidence are less consistent between countries, except for a steady decrease in stomach cancer in both sexes and lung cancer in men. Survival for all cancers and the selected cancer sites increased in all countries, even if there is still a substantial variability. Although overall cancer death rates continue to decline, incidence rates have been levelling off among men and have been moderately increasing among women. These trends reflect changes in cancer risk factors, screening test use, diagnostic practices, and treatment advances. Many cancers can be prevented or treated effectively if they are diagnosed early. Population-based cancer incidence and mortality data can be used to focus efforts to decrease the cancer burden and regularly monitor progress towards cancer control goals.
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Affiliation(s)
| | - Greta Carioli
- Department of Clinical Sciences and Community Health
| | - Paola Bertuccio
- Department of Biomedical and Clinical Sciences 'L. Sacco', Università degli Studi di Milano
| | | | - Ugo Pastorino
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Paolo Boffetta
- Tisch Cancer Center, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Medical and Surgical Sciences, University of Bologna, Bologna
| | - Eva Negri
- Department of Biomedical and Clinical Sciences 'L. Sacco', Università degli Studi di Milano
| | - Cristina Bosetti
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Grundmann N, Meisinger C, Trepel M, Müller-Nordhorn J, Schenkirsch G, Linseisen J. Trends in cancer incidence and survival in the Augsburg study region-results from the Augsburg cancer registry. BMJ Open 2020; 10:e036176. [PMID: 32868355 PMCID: PMC7462243 DOI: 10.1136/bmjopen-2019-036176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Knowledge about time trends of cancer incidence and cancer survival in a defined region is an essential prerequisite for the planning of regional healthcare infrastructure. The aim of the study was to provide population-based analyses of all common tumour sites to assess the cancer burden in the Augsburg study region. SETTING Total population of the study region of Augsburg (668 522 residents), Southern Germany. PARTICIPANTS The data obtained from the Cancer Registry Augsburg comprised 37 487 incident cases of malignant tumours (19 313 men and 18 174 women) diagnosed between 2005 and 2016 in the Augsburg region's resident population. PRIMARY AND SECONDARY OUTCOME MEASURES We calculated sex-specific, age-standardised incidence rates and annual percent change to assess time trends. In men and in women, 3-year and 5-year relative survival was calculated and results were compared with the latest German estimates. Survival trends were presented for the most common cancers only. RESULTS Decreasing age-standardised incidence rates were observed for prostate cancer and for colorectal cancer in men. For oropharyngeal cancer, rates declined in men, but significantly increased in women. Incidence for female breast cancer remained stable. Five-year relative survival ranged between 6.4% (95% CI: 4.1% to 10.1%) for pancreatic cancer and 97.7% (95% CI: 96.0% to 99.4%) for prostate cancer in men and between 10.2% (95% CI: 7.1% to 14.6%) for pancreatic cancer and 96.6% (95% CI: 93.6% to 99.6%) for malignant melanoma in women. Trends in 3-year survival of the five most common tumour sites in men showed a significant increase for lung and oropharyngeal cancer. In women, continuously rising survival trends were observed for breast cancer. CONCLUSIONS Survival of cancer patients in the Augsburg study region was largely concordant with the situation in Germany as a whole, while incidence showed slight deviations in some cancer sites. Regional evaluations on cancer survival are a valuable instrument for identifying deficits and determining advances in oncological health management.
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Affiliation(s)
- Nina Grundmann
- Chair of Epidemiology, Ludwig-Maximilians-Universität München at UNIKA-T, Augsburg, Germany
- IRG Clinical Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Christa Meisinger
- Chair of Epidemiology, Ludwig-Maximilians-Universität München at UNIKA-T, Augsburg, Germany
- IRG Clinical Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Martin Trepel
- Department of Internal Medicine II, University Medical Center of Augsburg, Augsburg, Germany
- Interdisciplinary Cancer Center, University Medical Center of Augsburg, Augsburg, Germany
| | | | - Gerhard Schenkirsch
- Interdisciplinary Cancer Center, University Medical Center of Augsburg, Augsburg, Germany
| | - Jakob Linseisen
- Chair of Epidemiology, Ludwig-Maximilians-Universität München at UNIKA-T, Augsburg, Germany
- IRG Clinical Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
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Forsea AM. Melanoma Epidemiology and Early Detection in Europe: Diversity and Disparities. Dermatol Pract Concept 2020; 10:e2020033. [PMID: 32642304 PMCID: PMC7319793 DOI: 10.5826/dpc.1003a33] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2019] [Indexed: 12/24/2022] Open
Abstract
Melanoma claims annually more than 20,000 lives in Europe and is an important public health burden through its continuously increasing incidence and with its high mortality, costs, and complexity of care in advanced stages. Epidemiological surveillance is indispensable for the research into its causes, new prognostic markers, and innovative therapies, as well as for the building of efficient cancer control plans. However, important differences in the sources and availability of accurate epidemiological data exist among European countries and regions, contributing to a heterogeneous picture with 20-fold differences in the reported national melanoma incidence rates, divergent mortality trends, and solid disparities in survival across the Continent. Countries in the eastern half of Europe report the lowest incidence rates, but high case fatality, persisting and increasing mortality, a higher proportion of thicker tumors and late diagnosis, and lower survival rates. They are the least well equipped with quality cancer registration and reporting, and they lag behind in efficient cancer control plans implementation. This review highlights the main differences in melanoma epidemiology across Europe, together with an insight into their underlying causes in the areas of melanoma registration, early diagnosis, and prevention. These differences should be acknowledged and understood by physicians, researchers, and all stakeholders involved in improving melanoma care and outcomes, as no one-size-fits-all solution can tackle the melanoma problem in Europe. Instead, there is a need for nuanced strategies, adapted to the heterogeneous national and regional contexts, that would build on European diversity to eliminate the outcome disparities.
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Affiliation(s)
- Ana-Maria Forsea
- Oncologic Dermatology Department, Elias University Hospital; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Bracun V, Aboumsallem JP, van der Meer P, de Boer RA. Cardiac Biomarkers in Patients with Cancer: Considerations, Clinical Implications, and Future Avenues. Curr Oncol Rep 2020; 22:67. [PMID: 32514994 PMCID: PMC7280346 DOI: 10.1007/s11912-020-00930-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF THE REVIEW As the number of cancer survivors increases due to early screening and modern (antineoplastic) treatments, cancer treatment associated cardiotoxicity (CTAC) is becoming an increasing health burden that affects survival and quality of life among cancer survivors. Thus, clinicians need to identify adverse events early, in an effort to take suitable measures before the occurrence of permanent or irreversible cardiac dysfunction. RECENT FINDINGS Cardiac troponin (cTn) and B-type natriuretic peptide (BNP) have been proven to detect subclinical cardiotoxicity during antineoplastic treatment. As such, these cardio-specific biomarkers could predict which patients are at risk of developing CTAC even before the start of therapy. Nevertheless, there are inconsistent data from published studies, and the recommendations regarding the use of these biomarkers and their validity are mostly based on expert consensus opinion. In this review, we summarize available literature that evaluates biomarkers of CTAC, and we encourage strategies that integrate circulating biomarkers and cardiac imaging in identifying cancer patients that are at high risk.
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Affiliation(s)
- Valentina Bracun
- Department of Cardiology, University Medical Center Groningen, University of Groningen, AB31, PO Box 30.001, 9700 RB Groningen, the Netherlands
| | - Joseph Pierre Aboumsallem
- Department of Cardiology, University Medical Center Groningen, University of Groningen, AB31, PO Box 30.001, 9700 RB Groningen, the Netherlands
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, AB31, PO Box 30.001, 9700 RB Groningen, the Netherlands
| | - Rudolf A. de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, AB31, PO Box 30.001, 9700 RB Groningen, the Netherlands
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Minicozzi P, Vicentini M, Innos K, Castro C, Guevara M, Stracci F, Carmona-Garcia M, Rodriguez-Barranco M, Vanschoenbeek K, Rapiti E, Katalinic A, Marcos-Gragera R, Van Eycken L, Sánchez MJ, Bielska-Lasota M, Rossi PG, Sant M. Comorbidities, timing of treatments, and chemotherapy use influence outcomes in stage III colon cancer: A population-based European study. Eur J Surg Oncol 2020; 46:1151-1159. [PMID: 32147427 DOI: 10.1016/j.ejso.2020.02.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/21/2020] [Accepted: 02/18/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION For stage III colon cancer (CC), surgery followed by chemotherapy is the main curative approach, although optimum times between diagnosis and surgery, and surgery and chemotherapy, have not been established. MATERIALS AND METHODS We analysed a population-based sample of 1912 stage III CC cases diagnosed in eight European countries in 2009-2013 aiming to estimate: (i) odds of receiving postoperative chemotherapy, overall and within eight weeks of surgery; (ii) risks of death/relapse, according to treatment, Charlson Comorbidity Index, time from diagnosis to surgery for emergency and elective cases, and time from surgery to chemotherapy; and (iii) time-trends in chemotherapy use. RESULTS Overall, 97% of cases received surgery and 65% postoperative chemotherapy, with 71% of these receiving chemotherapy within eight weeks of surgery. Risks of death and relapse were higher for cases starting chemotherapy with delay, but better than for cases not given chemotherapy. Fewer patients with high comorbidities received chemotherapy than those with low (P < 0.001). Chemotherapy timing did not vary (P = 0.250) between high and low comorbidity cases. Electively-operated cases with low comorbidities received surgery more promptly than high comorbidity cases. Risks of death and relapse were lower for elective cases given surgery after four weeks than cases given surgery within a week. High comorbidities were always independently associated with poorer outcomes. Chemotherapy use increased over time. CONCLUSIONS Our data indicate that promptly-administered postoperative chemotherapy maximizes its benefit, and that careful assessment of comorbidities is important before treatment. The survival benefit associated with slightly delayed elective surgery deserves further investigation.
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Affiliation(s)
- Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Massimo Vicentini
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Kaire Innos
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Clara Castro
- Cancer Epidemiology Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal; EpiUnit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Marcela Guevara
- Navarra Public Health Institute, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Fabrizio Stracci
- Department of Experimental Medicine, Section of Public Health, University of Perugia, Perugia, Italy; Umbria Cancer Registry, Perugia, Italy
| | - MaCarmen Carmona-Garcia
- Medical Oncology Department, Catalan Institute of Oncology, Universitary Hospital Dr Josep Trueta, Girona, Spain; Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Miguel Rodriguez-Barranco
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Andalusian School of Public Health (EASP), Granada, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain
| | | | - Elisabetta Rapiti
- Geneva Cancer Registry, Global Health Institute, University of Geneva, Switzerland
| | | | - Rafael Marcos-Gragera
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain; School of Medicine, University of Girona (UdG), Girona, Spain; Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health Government of Catalonia, Catalan Institute of Oncology, Girona, Spain
| | | | - Maria José Sánchez
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Andalusian School of Public Health (EASP), Granada, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain; Universidad de Granada (UGR), Granada, Spain
| | | | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Milena Sant
- Analytical Epidemiology and Health Impact Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Lesion detection on a combined “All-in-One” window compared to conventional window settings in thoracic oncology chest CT examinations. Diagn Interv Imaging 2020; 101:25-33. [DOI: 10.1016/j.diii.2019.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 07/21/2019] [Accepted: 07/24/2019] [Indexed: 01/11/2023]
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Bielska-Lasota M, Rossi S, Krzyżak M, Haelens A, Domenic A, De Angelis R, Maciejczyk A, Rodríguez-Barranco M, Zadnik V, Minicozzi P. Reasons for low cervical cancer survival in new accession European Union countries: a EUROCARE-5 study. Arch Gynecol Obstet 2019; 301:591-602. [PMID: 31853712 DOI: 10.1007/s00404-019-05412-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 12/07/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE With better access to early diagnosis and appropriate treatment, cervical cancer (CC) burden decreased in several European countries. In Eastern European (EE) countries, which accessed European Union in 2004, CC survival was worse than in the rest of Europe. The present study investigates CC survival differences across five European regions, considering stage at diagnosis (local, regional and metastatic), morphology (mainly squamous versus glandular tumours) and patients' age. METHODS We analysed 101,714 CC women diagnosed in 2000-2007 and followed-up to December 2008. Age-standardised 5-year relative survival (RS) and the excess risks of cancer death in the 5 years after diagnosis were computed. RESULTS EE women were older and less commonly diagnosed with glandular tumours. Proportions of local stage cancers were similar across Europe, while morphology- and stage-specific RS (especially for non-metastatic disease) were lower in Eastern Europe. Adjusting for age and morphology, excess risk of local stage CC death for EE patients remained higher than that for other European women. CONCLUSION Stage, age and morphology alone do not explain worse survival in Eastern Europe: less effective care may play a role, probably partly due to fewer or inadequate resources being allocated to health care in this area, compared to the rest of Europe.
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Affiliation(s)
- Magdalena Bielska-Lasota
- Department of Health Promotion and Chronic Diseases Prevention, National Institute of Public Health - National Institute of Hygiene, Warsaw, Poland
| | - Silvia Rossi
- Department of Oncology and Molecular Medicine, Istituto Superiore Di Sanità, Rome, Italy
| | - Michalina Krzyżak
- Department of Hygiene, Epidemiology and Ergonomics, Medical University of Bialystok, Bialystok, Poland
| | - Annemie Haelens
- Research Department, Belgian Cancer Registry, Brussels, Belgium
| | | | - Roberta De Angelis
- Department of Oncology and Molecular Medicine, Istituto Superiore Di Sanità, Rome, Italy
| | | | - Miguel Rodríguez-Barranco
- Andalusian School of Public Health, Instituto de Investigación Biosanitaria de Granada (Ibs.Granada), Granada, Spain.,Centro de Investigación Biomédica en Red de Epidemiologia Y Salud Pública (CIBERESP), Madrid, Spain
| | - Vesna Zadnik
- Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Research Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy. .,Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
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Coleridge SL, Bryant A, Lyons TJ, Goodall RJ, Kehoe S, Morrison J. Chemotherapy versus surgery for initial treatment in advanced ovarian epithelial cancer. Cochrane Database Syst Rev 2019; 2019:CD005343. [PMID: 31684686 PMCID: PMC6822157 DOI: 10.1002/14651858.cd005343.pub4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Epithelial ovarian cancer presents at an advanced stage in the majority of women. These women require surgery and chemotherapy for optimal treatment. Conventional treatment has been to perform surgery first and then give chemotherapy. However, there may be advantages to using chemotherapy before surgery. OBJECTIVES To assess whether there is an advantage to treating women with advanced epithelial ovarian cancer with chemotherapy before debulking surgery (neoadjuvant chemotherapy (NACT)) compared with conventional treatment where chemotherapy follows debulking surgery (primary debulking surgery (PDS)). SEARCH METHODS We searched the following databases on 11 February 2019: CENTRAL, Embase via Ovid, MEDLINE (Silver Platter/Ovid), PDQ and MetaRegister. We also checked the reference lists of relevant papers that were identified to search for further studies. The main investigators of relevant trials were contacted for further information. SELECTION CRITERIA Randomised controlled trials (RCTs) of women with advanced epithelial ovarian cancer (Federation of International Gynaecologists and Obstetricians (FIGO) stage III/IV) who were randomly allocated to treatment groups that compared platinum-based chemotherapy before cytoreductive surgery with platinum-based chemotherapy following cytoreductive surgery. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias in each included trial. MAIN RESULTS We found 1952 potential titles, with a most recent search date of February 2019, of which five RCTs of varying quality and size met the inclusion criteria. These studies assessed a total of 1713 women with stage IIIc/IV ovarian cancer randomised to NACT followed by interval debulking surgery (IDS) or PDS followed by chemotherapy. We pooled results of the three studies where data were available and found little or no difference with regard to overall survival (OS) (1521 women; hazard ratio (HR) 1.06; 95% confidence interval (CI) 0.94 to 1.19, I2 = 0%; moderate-certainty evidence) or progression-free survival in four trials where we were able to pool data (1631 women; HR 1.02; 95% CI 0.92 to 1.13, I2 = 0%; moderate-certainty evidence). Adverse events, surgical morbidity and quality of life (QoL) outcomes were poorly and incompletely reported across studies. There may be clinically meaningful differences in favour of NACT compared to PDS with regard to serious adverse effects (SAE grade 3+). These data suggest that NACT may reduce the risk of need for blood transfusion (risk ratio (RR) 0.80; 95% CI 0.64 to 0.99; four studies,1085 women; low-certainty evidence), venous thromboembolism (RR 0.28; 95% CI 0.09 to 0.90; four studies, 1490 women; low-certainty evidence), infection (RR 0.30; 95% CI 0.16 to 0.56; four studies, 1490 women; moderate-certainty evidence), compared to PDS. NACT probably reduces the need for stoma formation (RR 0.43, 95% CI 0.26 to 0.72; two studies, 581 women; moderate-certainty evidence) and bowel resection (RR 0.49, 95% CI 0.26 to 0.92; three studies, 1213 women; moderate-certainty evidence), as well as reducing postoperative mortality (RR 0.18; 95% CI 0.06 to 0.54:five studies, 1571 women; moderate-certainty evidence). QoL on the EORTC QLQ-C30 scale produced inconsistent and imprecise results in two studies (MD -1.34, 95% CI -2.36 to -0.32; participants = 307; very low-certainty evidence) and use of the QLQC-30 and QLQC-Ov28 in another study (MD 7.60, 95% CI 1.89 to 13.31; participants = 217; very low-certainty evidence) meant that little could be inferred. AUTHORS' CONCLUSIONS The available moderate-certainty evidence suggests there is little or no difference in primary survival outcomes between PDS and NACT. NACT may reduce the risk of serious adverse events, especially those around the time of surgery, and the need for bowel resection and stoma formation. These data will inform women and clinicians and allow treatment to be tailored to the person, taking into account surgical resectability, age, histology, stage and performance status. Data from an unpublished study and ongoing studies are awaited.
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Affiliation(s)
- Sarah L Coleridge
- Taunton and Somerset NHS Foundation TrustObstetrics and GynaecologyMusgrove Park HospitalTauntonUKTA1 5DA
| | - Andrew Bryant
- Newcastle UniversityInstitute of Health & SocietyMedical School New BuildRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Thomas J Lyons
- University of BristolSchool of Medical Sciences38 Kings Parade AvenueBristolUKBS8 2RB
| | - Richard J Goodall
- Imperial College LondonDepartment of Surgery and CancerKensingtonLondonUKSW7 2AZ
| | - Sean Kehoe
- University of BirminghamInstitute of Cancer and GenomicsBirminghamUKB15 2TT
| | - Jo Morrison
- Musgrove Park HospitalDepartment of Gynaecological OncologyTaunton and Somerset NHS Foundation TrustTauntonSomersetUKTA1 5DA
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A Scoring Index of Prioritization Factors Between Patients: An Iberian Comparison. Health Care Manag (Frederick) 2019; 38:267-275. [PMID: 31261196 DOI: 10.1097/hcm.0000000000000274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study intends to develop a Prioritization Scoring Index of Iberian Peninsula comprising Portuguese and Spanish citizens, to weigh the importance assigned to rationing criteria used to prioritize patients. Data were collected through an online survey from 2 samples of 355 Portuguese and 564 Spanish members of the general public. Respondents faced 12 hypothetical rationing scenarios and should reveal their level of agreement with each one according to a Likert scale. The statements comprise 3 allocative considerations: egalitarianism, efficiency, and equity. Findings suggest that Portuguese and Spanish respondents gave greater importance to the treatments outcomes, to the severity of the illness, and to younger patients. Furthermore, Iberian respondents assigned 57% of the weighting to equity considerations, 40% to efficiency considerations, and approximately only 3% to egalitarianism. Spaniards weighted more than Portuguese both equity and efficiency considerations while weighted less the egalitarian principle. Iberian Peninsula respondents require resource allocation decisions in health to be informed by considerations of equity as well as efficiency. As the first was most valued, it seems plausible that Portuguese and Spanish respondents are willing to sacrifice some efficiency to achieve a more equitable distribution of health.
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Wang Y, Chiang CJ, Lee WC. Age-standardized expected years of life lost: quantification of cancer severity. BMC Public Health 2019; 19:486. [PMID: 31046731 PMCID: PMC6498471 DOI: 10.1186/s12889-019-6843-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 04/16/2019] [Indexed: 01/04/2023] Open
Abstract
Background The critical implications of the expected years of life lost (EYLL) index of cancer for health policy assessments have been largely overlooked. We advocate to standardize life lost indices. Methods Using the Taiwan Cancer Registry database as an example, we calculated the EYLL and the age-standardized EYLL to facilitate comparisons among cancer types (a total of 903,935 patients from the database). The International Cancer Survival Standard was used for calculating age-standardized EYLL. Results Pancreatic cancer is the most severe cancer in Taiwan, with the greatest age-standardized EYLL for the men (15.6 years) and women (18.0 years) as well as for the men and women combined (16.6 years). Negative correlations were observed between unstandardized EYLL of cancer and mean age at diagnosis. Conclusions The unstandardized EYLL represents an overall assessment of disease burden, whereas the age-standardized EYLL is a suitable measure of disease severity. We suggest that both measures be incorporated into routine annual reports of cancer statistics alongside the usual incidence and mortality rates and their age-standardized counterparts. Electronic supplementary material The online version of this article (10.1186/s12889-019-6843-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yueh Wang
- Taiwan Cancer Registry, Rm 506, No. 17, Xuzhou Rd., Taipei, 100, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chun-Ju Chiang
- Taiwan Cancer Registry, Rm 506, No. 17, Xuzhou Rd., Taipei, 100, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Wen-Chung Lee
- Taiwan Cancer Registry, Rm 506, No. 17, Xuzhou Rd., Taipei, 100, Taiwan. .,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan. .,Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan.
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Rawla P, Sunkara T, Gaduputi V. Epidemiology of Pancreatic Cancer: Global Trends, Etiology and Risk Factors. World J Oncol 2019; 10:10-27. [PMID: 30834048 PMCID: PMC6396775 DOI: 10.14740/wjon1166] [Citation(s) in RCA: 1326] [Impact Index Per Article: 265.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 11/14/2018] [Indexed: 12/24/2022] Open
Abstract
Pancreatic cancer is the seventh leading cause of cancer-related deaths worldwide. However, its toll is higher in more developed countries. Reasons for vast differences in mortality rates of pancreatic cancer are not completely clear yet, but it may be due to lack of appropriate diagnosis, treatment and cataloging of cancer cases. Because patients seldom exhibit symptoms until an advanced stage of the disease, pancreatic cancer remains one of the most lethal malignant neoplasms that caused 432,242 new deaths in 2018 (GLOBOCAN 2018 estimates). Globally, 458,918 new cases of pancreatic cancer have been reported in 2018, and 355,317 new cases are estimated to occur until 2040. Despite advancements in the detection and management of pancreatic cancer, the 5-year survival rate still stands at 9% only. To date, the causes of pancreatic carcinoma are still insufficiently known, although certain risk factors have been identified, such as tobacco smoking, diabetes mellitus, obesity, dietary factors, alcohol abuse, age, ethnicity, family history and genetic factors, Helicobacter pylori infection, non-O blood group and chronic pancreatitis. In general population, screening of large groups is not considered useful to detect the disease at its early stage, although newer techniques and the screening of tightly targeted groups (especially of those with family history), are being evaluated. Primary prevention is considered of utmost importance. Up-to-date statistics on pancreatic cancer occurrence and outcome along with a better understanding of the etiology and identifying the causative risk factors are essential for the primary prevention of this disease.
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Affiliation(s)
- Prashanth Rawla
- Department of Internal Medicine, SOVAH Health, Martinsville, VA 24112, USA
| | - Tagore Sunkara
- Department of Gastroenterology and Hepatology, Mercy Medical Center, Des Moines, IA 50314, USA
| | - Vinaya Gaduputi
- Division of Gastroenterology, SBH Health System, Bronx, NY, USA
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Abstract
Aim The aim of the study was to determine the relationship between single nucleotide polymorphisms (SNPs) of DNA repair genes and modulation of the risk of breast cancer. The following SNPs were analysed: XRCC1-Arg399Gln (rs25487), hMSH2-Gly322Asp (rs4987188), XRCC2-Arg188His (rs3218536), XPD- Lys751Gln (rs13181), RAD51--4719A/T (rs2619679) and RAD51--4601A/G (rs5030789). Material and Methods The study included n = 600 patients: 300 with breast cancer and 300 healthy controls. The HRM (High-Resolution Melter) technique was applied for polymorphism analysis. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each genotype and allele. Results Statistically significant correlations were identified between four single nucleotide polymorphisms and the breast cancer risk: XRCC1-Arg399Gln, hMSH2-Gly322Asp, XPD- Lys751Gln and RAD51--4719A/T. Allele XRCC1-Gln (OR 6.37; 95% CI 4.86-8.35, p < .0001), hMSH2-Asp (OR 4.41; 95% CI 3.43-5.67, p < .0001), XPD -Gln (OR 2.56; 95% CI 2.02-3.25, p < .0001) and RAD51-T genes (OR 1.44; 95% CI 1.15-1.80, p = 0.002) strongly correlated with breast carcinoma. No relationship was observed between the studied polymorphisms and the cancer progression grade according to Scarf-Bloom-Richardson classification. Conclusions The results implies that polymorphisms of DNA repair genes may be associated with breast cancer occurrence.
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