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Ricciardiello L, Ferrari C, Cameletti M, Gaianill F, Buttitta F, Bazzoli F, Luigi de'Angelis G, Malesci A, Laghi L. Impact of SARS-CoV-2 Pandemic on Colorectal Cancer Screening Delay: Effect on Stage Shift and Increased Mortality. Clin Gastroenterol Hepatol 2021; 19:1410-1417.e9. [PMID: 32898707 PMCID: PMC7474804 DOI: 10.1016/j.cgh.2020.09.008] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The SARS-CoV-2 pandemic had a sudden, dramatic impact on healthcare. In Italy, since the beginning of the pandemic, colorectal cancer (CRC) screening programs have been forcefully suspended. We aimed to evaluate whether screening procedure delays can affect the outcomes of CRC screening. METHODS We built a procedural model considering delays in the time to colonoscopy and estimating the effect on mortality due to up-stage migration of patients. The number of expected CRC cases was computed by using the data of the Italian screened population. Estimates of the effects of delay to colonoscopy on CRC stage, and of stage on mortality were assessed by a meta-analytic approach. RESULTS With a delay of 0-3 months, 74% of CRC is expected to be stage I-II, while with a delay of 4-6 months there would be a 2%-increase for stage I-II and a concomitant decrease for stage III-IV (P = .068). Compared to baseline (0-3 months), moderate (7-12 months) and long (> 12 months) delays would lead to a significant increase in advanced CRC (from 26% to 29% and 33%, respectively; P = .008 and P < .001, respectively). We estimated a significant increase in the total number of deaths (+12.0%) when moving from a 0-3-months to a >12-month delay (P = .005), and a significant change in mortality distribution by stage when comparing the baseline with the >12-months (P < .001). CONCLUSIONS Screening delays beyond 4-6 months would significantly increase advanced CRC cases, and also mortality if lasting beyond 12 months. Our data highlight the need to reorganize efforts against high-impact diseases such as CRC, considering possible future waves of SARS-CoV-2 or other pandemics.
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Affiliation(s)
- Luigi Ricciardiello
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy.
| | - Clarissa Ferrari
- Unit of Statistics, IRCCS Istituto Centro San Giovanni di Dio, Fatebenefratelli, Brescia, Italy
| | - Michela Cameletti
- Department of Management, Economics and Quantitative Methods, University of Bergamo, Bergamo, Italy
| | - Federica Gaianill
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, Parma, Italy
| | - Francesco Buttitta
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Franco Bazzoli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Gian Luigi de'Angelis
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Gastroenterology and Endoscopy Unit, University Hospital of Parma, Parma, Italy
| | - Alberto Malesci
- Department of Gastroenterology, Humanitas Research Institute and Humanitas University, Rozzano, Italy
| | - Luigi Laghi
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Laboratory of Molecular Gastroenterology, Humanitas Clinical and Research Centre, Rozzano, Italy.
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Heins MJ, de Jong JD, Spronk I, Ho VKY, Brink M, Korevaar JC. Adherence to cancer treatment guidelines: influence of general and cancer-specific guideline characteristics. Eur J Public Health 2018; 27:616-620. [PMID: 28013246 DOI: 10.1093/eurpub/ckw234] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Guideline adherence remains a challenge in clinical practice, despite guidelines' ascribed potential to improve patient outcomes. We studied the level of adherence to recommendations from Dutch national cancer treatment guidelines, and the influence of general and cancer-specific guideline characteristics on adherence. Methods Based on data from a national cancer registry, adherence was evaluated for 15 treatment recommendations for breast, colorectal, prostate and lung cancer, and melanoma. Recommendations were selected by representatives of the medical specialist associations responsible for developing and implementing the guidelines. We used multivariable multilevel analysis to calculate mean adherence and variation between individual hospitals. Results Mean adherence to the different treatment recommendations ranged from 40 to 99%. Adherence differed only slightly between older and newer guidelines and between recommendations with low, moderate or high levels of evidence (range 79-84% and 77-91%, respectively), while adherence differed more between recommendations for different cancer types (range 54-99%), different treatment modalities (adherence ranged from 40 to 92%) or recommendations that advised against or recommended in favour of particular treatment (adherence ranged from 75 to 98%). Conclusion We found significant variation in adherence between different cancer treatment guidelines. While some guideline characteristics that seem to explain this variation may be considered difficult to modify, the potential for variance across cancer types and treatment modalities suggests that adherence could be further improved. At the same time, these results warrant tailored strategies for the improvement of adherence to clinical practice guidelines.
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Affiliation(s)
- Marianne J Heins
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Judith D de Jong
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Inge Spronk
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Vincent K Y Ho
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Mirian Brink
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Joke C Korevaar
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
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Panato C, Abusamaan K, Bidoli E, Hamdi-Cherif M, Pierannunzio D, Ferretti S, Daher M, Elissawi F, Serraino D. Survival after the diagnosis of breast or colorectal cancer in the GAZA Strip from 2005 to 2014. BMC Cancer 2018; 18:632. [PMID: 29866055 PMCID: PMC5987449 DOI: 10.1186/s12885-018-4552-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 05/24/2018] [Indexed: 02/03/2023] Open
Abstract
Background Within a dramatic socio-political context, cancer represents a growing health burden in the Gaza Strip. We investigated the survival experience of people diagnosed with breast (BC) or colorectal (CRC) cancer from 2005 to 2014. Methods Data included 1360 BC cases (median age 55.1 years) and 722 CRC cases (median age: 59.5 years; 52.5% men) recorded by the Gaza Cancer Registry according to a standard protocol. Clinical information was available for cases diagnosed in 2005–2006 only. Survival probabilities were estimated by Kaplan-Meyer method, while hazard ratios (HRs) and 95% confidence intervals (CI), adjusted for age and sex, were computed to assess factors associated with the risk of death. Results Five-year survival was 65.1% for women with BC and 50.2% for patients with CRC. Advanced age (> 65 years), stage, and grade increased the death risk. Full access to therapies was associated with a reduced risk of death as compared with patients who had limited access (HR = 0.26, 95% CI:0.13–0.51 for BC; and HR = 0.11, 95% CI:0.04–0.31 for CRC). Conclusion(s) The 5-year survival after BC or CRC in the Gaza Strip was in line with estimates from surrounding Arab countries, but it was much lower than in developed Mediterranean countries (e.g., in Italy or in Jewish people in Israel).
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Affiliation(s)
- Chiara Panato
- Cancer Epidemiology Unit, IRCCS Centro di Riferimento Oncologico, Aviano, Italy
| | - Khaled Abusamaan
- Ministry of Health, PHC, Training and Education Department, Gaza, Palestine
| | - Ettore Bidoli
- Cancer Epidemiology Unit, IRCCS Centro di Riferimento Oncologico, Aviano, Italy
| | | | - Daniela Pierannunzio
- Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Stefano Ferretti
- Dipartment Morfologia, Chirurgia e Medicina Sperimentale, Università di Ferrara - Registro Tumori Area Vasta Emilia Centrale, Azienda USL Ferrara, - Servizio Prevenzione collettiva e Sanità pubblica, Ferrara, Regione Emilia-Romagna, Italy
| | - Mahmoud Daher
- WHO Office. Occupied Palestinian Territory, UNDP Building, Elnasr Street, Gaza, Palestine
| | - Fouad Elissawi
- Ministry of Health, Primary Health Care directorate, Gaza, Palestine
| | - Diego Serraino
- Cancer Epidemiology Unit, IRCCS Centro di Riferimento Oncologico, Aviano, Italy. .,Friuli Venezia Giulia Cancer Registry, IRCCS Centro di Riferimento Oncologico, Aviano, Italy.
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Impact of Dose Reductions, Delays Between Chemotherapy Cycles, and/or Shorter Courses of Adjuvant Chemotherapy in Stage II and III Colorectal Cancer Patients: a Single-Center Retrospective Study. J Gastrointest Cancer 2016; 46:343-9. [PMID: 26143067 DOI: 10.1007/s12029-015-9746-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Most stage II or III colorectal cancer patients are receiving nowadays a 4 to 6-month course of adjuvant chemotherapy. However, delays between cycles, reductions in the doses of chemotherapy drugs, or even permanent omissions of chemotherapy cycles might take place due to side effects or patient's preference. We examined the impact of these treatment modifications on recurrence-free survival (RFS) and overall survival (OS). METHODS We retrospectively collected data from colorectal cancer patients who had received adjuvant chemotherapy in our Department. Patients were categorized in five groups based on whether they had or not delays between chemotherapy cycles, dose reductions, and permanent omissions of chemotherapy cycles. Three-year RFS and OS of the five different groups were compared using the log-rank test and the Sidak approach. RESULTS Five hundred and eight patients received treatment. Twenty seven percent of the patients had the full course of chemotherapy; the others had delays, dose reductions, or early termination of the treatment. No statistically significant differences were observed in 3-year RFS and OS between the five groups. A trend for worse RFS was noticed with early termination of treatment. A similar trend was also noticed for OS but only for stage II patients. CONCLUSION In colorectal cancer patients, receiving adjuvant chemotherapy, delays between chemotherapy cycles, dose reductions of chemotherapy drugs, or even early termination of the treatment course do not seem to have a negative impact in 3-year RFS and OS; however, due to the trend of worse RFS in patients receiving shorter courses of chemotherapy, further studies are needed.
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Plummer JM, Leake PA, Ferron-Boothe D, Roberts PO, Mitchell DI, McFarlane ME. Colorectal cancer survival in Jamaica. Ann Med Surg (Lond) 2016; 6:26-9. [PMID: 26870324 PMCID: PMC4739148 DOI: 10.1016/j.amsu.2016.01.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 12/30/2015] [Accepted: 01/16/2016] [Indexed: 02/07/2023] Open
Abstract
Objective To determine the intermediate and long-term survival of patients diagnosed with colorectal cancer (CRC) and to determine factors that affect survival. Method Patients were identified from a prospectively maintained colonoscopy database. All patients who underwent colonoscopy during the period January 2008 to December 2012 and had histologically confirmed invasive carcinoma were included. These patients were contacted at the end of 2013 to determine their survival status. In addition to demographics, variables analyzed included presenting complaint and tumor site and stage at presentation. Results Of 1757 patients being subjected to colonoscopy, 118 had endoscopic and histologic documentation of invasive CRC. Of these the survival status of 102 was determined as of December 2013 and they formed the basis of our study. The mean age of the group was 62 years with approximately 20% of the group being age 50 years or younger. Females (54%) slightly outnumbered males. Anemia or overt rectal bleeding was a dominant indication (44%) and 65% of the tumours were left sided. There were 58 (57%) deaths and the median overall survival time was two years post diagnosis. Log rank tests for equality of survivorship looking at age, gender, tumor site and presentation revealed that only presenting complaint was a predictor of survivorship (p < 0.001). Patients presenting with bleeding or anemia have the best survival. Conclusions Long-term survival from colorectal cancer remains poor with only about 33% of patients being alive five years after their diagnosis. This manuscript documents the poor intermediate and long-term survival from colorectal cancer in Jamaica. Mean survival was 24 months and only 33% of patients were alive five years after their diagnosis. Patients presenting with anemia or bleeding had a better outcome.
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Affiliation(s)
- Joseph M Plummer
- Department of Surgery, Radiology, Anaesthesia and Intensive Care, University of the West Indies, Kingston, Jamaica
| | - Pierre-Anthony Leake
- Department of Surgery, Radiology, Anaesthesia and Intensive Care, University of the West Indies, Kingston, Jamaica
| | - Doreen Ferron-Boothe
- Department of Surgery, Radiology, Anaesthesia and Intensive Care, University of the West Indies, Kingston, Jamaica
| | - Patrick O Roberts
- Department of Surgery, Radiology, Anaesthesia and Intensive Care, University of the West Indies, Kingston, Jamaica
| | - Derek I Mitchell
- Department of Surgery, Radiology, Anaesthesia and Intensive Care, University of the West Indies, Kingston, Jamaica
| | - Michael E McFarlane
- Department of Surgery, Radiology, Anaesthesia and Intensive Care, University of the West Indies, Kingston, Jamaica
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