Delayed surgery is associated with worse lung cancer outcomes. Social determinants can influence health disparities. This study aimed to examine the potential racial disparity and the effects from ...social determinants on receipt of timely surgery among lung cancer patients in Louisiana, a southern state in the U.S. White and black stage I–IIIA non-small cell lung cancer patients diagnosed in Louisiana between 2004 and 2016, receiving surgical lobectomy or a more extensive surgery, were selected. Diagnosis-to-surgery interval >6 weeks were considered as delayed surgery. Social determinants included marital status, insurance, census tract level poverty, and census tract level urbanicity. Multivariable logistic regression and generalized multiple mediation analysis were conducted. A total of 3,616 white (78.9%) and black (21.1%) patients were identified. The median time interval from diagnosis to surgery was 27 days in whites and 42 days in blacks (
P
< 0.0001). About 28.7% of white and 48.4% of black patients received delayed surgery (
P
< 0.0001). Black patients had almost two-fold odds of receiving delayed surgery than white patients (adjusted odds ratio: 1.91; 95% confidence interval: 1.59–2.30). Social determinants explained about 26% of the racial disparity in receiving delayed surgery. Having social support, private insurance, and living in census tracts with lower poverty level were associated with improved access to timely surgery. The census tract level poverty level a stronger effect on delayed surgery in black patients than in white patients. Tailored interventions to improve the timely treatment in NSCLC patients, especially black patients, are needed in the future.
This study aimed to develop a prognostic model to predict the breast cancer-specific survival and overall survival for breast cancer patients in Asia and to demonstrate a significant difference in ...clinical outcomes between Asian and non-Asian patients.
We developed our prognostic models by applying a multivariate Cox proportional hazards model to Taiwan Cancer Registry (TCR) data. A data-splitting strategy was used for internal validation, and a multivariable fractional polynomial approach was adopted for prognostic continuous variables. Subjects who were Asian, black, or white in the US-based Surveillance, Epidemiology, and End Results (SEER) database were analyzed for external validation. Model discrimination and calibration were evaluated in both internal and external datasets.
In the internal validation, both training data and testing data calibrated well and generated good area under the ROC curves (AUC; 0.865 in training data and 0.846 in testing data). In the external validation, although the AUC values were larger than 0.85 in all populations, a lack of model calibration in non-Asian groups revealed that racial differences had a significant impact on the prediction of breast cancer mortality. For the calibration of breast cancer-specific mortality, P values < 0.001 at 1 year and 0.018 at 4 years in whites, and P values ≤ 0.001 at 1 and 2 years and 0.032 at 3 years in blacks, indicated that there were significant differences (P value < 0.05) between the predicted mortality and the observed mortality. Our model generally underestimated the mortality of the black population. In the white population, our model underestimated mortality at 1 year and overestimated it at 4 years. And in the Asian population, all P values > 0.05, indicating predicted mortality and actual mortality at 1 to 4 years were consistent.
We developed and validated a pioneering prognostic model that especially benefits breast cancer patients in Asia. This study can serve as an important reference for breast cancer prediction in the future.
Introduction
While timely assessment of long-term survival for patients with liver cancer is essential for the evaluation of early detection and screening programs of liver cancer, those data are ...extremely scarce in China. We aimed to timely and accurately assess long-term survival for liver cancer patients in eastern China.
Methods
Patients diagnosed with liver cancer during 2004–2018 from four cancer registries with high-quality data from Taizhou, eastern China, were included. The period analysis was used to calculate the 5-year relative survival (RS) for overall and the stratification by sex, age at diagnosis, and region. The projected 5-year RS of liver cancer patients during 2019–2023 was also assessed using a model-based period analysis.
Results
The overall 5-year RS for patients with liver cancer during 2014–2018 reached 32.4%, being 29.3% for men and 36.1% for women. The 5-year RS declined along with aging, decreasing from 38.2% for age <45 years to 18.8% for age >74 years, while the 5-year RS for urban area was higher compared to rural area (36.8% vs. 29.3%). The projected overall 5-year RS of liver cancer patients could reach 41.4% during the upcoming period 2019–2023.
Conclusions
We provided, for first time in China using the period analysis, the most up-to-date 5-year RS for patients with liver cancer from Taizhou, eastern China, and also found that the 5-year RS for liver cancer patients have improved greatly during 2004–2018, which has important implications for the timely evaluation of early detection and screening programs for patients with liver cancer in eastern China.
To assess the risk of prostate cancer (PCa) specific mortality (PCSM) compared to cardiovascular disease mortality (CVDM), or other-cause mortality (OCM) of men with nonmetastatic PCa according to ...PCa risk groups, primary treatment, and age.
This retrospective population-based cohort study identified 1,908 nonmetastatic PCa patients in the cancer registry Zurich and Zug, diagnosed between 2000 and 2009 living in the City of Zurich. Multiple imputation methods were applied to handle missing PCa information. Fine and Gray competing risk regression analysis was used to estimate subdistribution hazard ratios for the outcomes PCSM, CVDM, or OCM
Ten years after diagnosis the cumulative probability of PCSM and CVDM was 16.4% and 10.0%, respectively. We observed an increased adjusted risk of PCSM in men treated with androgen deprivation therapy (ADT) compared to surgery, but could not observe an association between ADT and CVDM. The probability of PCSM was significantly higher for patients on active surveillance or watchful waiting, compared to surgery. Age and PCa risk categories were positively associated with risk of PCSM, whereas there was no evidence for an association with CVDM or OCM based on risk groups.
Overall, men with PCa were more likely to die from non-PCa related outcomes. Nevertheless, the analyses showed a high proportion of PCSM among men on ADT, older men and men with a high-risk tumor. However, further research is needed to understand comprehensively the benefits of the respective treatments.
•Men were more likely to die from non-prostate cancer related outcomes.•We did not observe an association between androgen deprivation therapy and cardiovascular disease mortality after adjustment for age and risk groups.•The analyses showed a high proportion of prostate cancer specific mortality among men on androgen deprivation therapy, older men and men with a high-risk tumor.
An investigation of trends of incidence and net survival (NS) for endometrial cancer in Sweden.
Morphologically verified endometrial carcinoma diagnosed 1960 to 2014 were collected from the ...nation-wide Swedish Cancer Registry. Endometrial cancer patients were assessed with regards to time trends for incidence and 54,825 cases remained for survival analyses. Cases diagnosed 1995 to 2014 were categorized according to detailed morphology and from 2005 to 2014 FIGO stage was also categorized.
There was a trend of increasing incidence of endometrial carcinoma for women above 55 years of age. NS was improved at 5- and 10-year follow-up. The 5-year net survival in 2010-2014 was 86%. The most prominent improvement in NS was found in the elderly women above 75 years of age.
This study observed increased incidence of endometrial cancer in Sweden from 1960 to 2014. The progress in diagnostics and treatment, seem to have improved the net survival, especially in elderly women.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background
Cancer stage is a determinant of survival of childhood central nervous system (CNS) cancers and could help the interpretation of survival variability among countries. Consensus guidelines ...to stage childhood malignancies in population cancer registries (“Toronto Childhood Cancer Stage Guidelines”) have been recently proposed with the goal of data comparability. Indeed, stage is not systematically recorded in all registries and, when it is, different classification systems are used.
We applied the Toronto Childhood Cancer Stage Guidelines to CNS cancer cases of three population‐based cancer registries with the aim of evaluating the feasibility of staging this type of cancer and the critical points in the classification of CNS tumors.
Procedures
The Toronto Childhood Cancer Stage Guidelines were applied to 175 CNS patients, diagnosed from January 1, 2002 to December 31, 2014 in three cancer registries in Italy, and the percentage of cases that could be staged was assessed.
Results
One hundred eight of 126 (86%) medulloblastomas and other embryonal CNS cancers and 22 of 49 (45%) ependymomas were staged. Using these guidelines, survival of children with localized tumors could be discriminated from that of children with metastatic disease.
Conclusions
The use of the Toronto Childhood Cancer Stage Guidelines is feasible for staging medulloblastoma in Italian population‐based cancer registries, whereas it is more difficult for ependymomas. In Italy, cerebrospinal fluid examination, one of the decisive tests to stage CNS tumors, is not routinely performed as a first‐line diagnosis procedure in ependymoma pediatric patients.
A similar exercise by a larger number of cancer registries in different countries could suggest improvements in the childhood cancer staging system.
Abstract
Introduction
Cancer continues to grow in number. Knowing the epidemiology helps in prevention and treatment. Existing hospital-based cancer registries (HBCRs) provide little data of private ...sector including patients for medical tourism.
Objectives
The aim of this study was to describe the distribution of cancer at a tertiary center in the private sector in North India for all cancer patients.
Materials and Methods
Cases were ascertained from the Oncology Outpatient Department of Max Super Specialty Hospital, Saket, between January 1, 2013, and December 31, 2017, and from pathology database since July 2015. They were abstracted into National Cancer Registry Program (NCRP) core pro forma. We conducted a descriptive analysis of distribution by age, gender, nationality, site, stage, and treatment.
Results
Among the 15,850 confirmed cases, 8,034 (51%) were males. Nearly 1.8% of patients were pediatric (<15 years) and 30.1% geriatric (>65 years). A high proportion of patients (13%) came from outside India and 27% from outside Delhi-National Capital Region. The most common cancers in males were prostate (10.9%), lung (10%), and mouth (7.6%). Stomach was the most common site of cancer in international male patients. Four of the top ten cancers in males were of the gastrointestinal tract (esophagus, stomach, colon, and rectum). The most common cancers in females were breast (37.4%), ovary (7.1%), and corpus uteri (5.6%). Tobacco-related cancers accounted for 36.9% of cancers in males and 11.3% in females. The composite stage in males was IV in 54%, followed by stage III (21%), stage II (15%), and stage I (10%). In females, stage IV was 33%, stage III was 23%, stage II was 28%, and stage I was 16%. As registry included outpatient record visits and pathology records, not all registered patients received treatment at Max Super Specialty Hospital. Overall, 49.8% of male patients and 49.7% of female patients received treatment at Max Super Specialty Hospital. Data quality metrics matched other national HBCRs.
Conclusion
We highlight the differences from other NCRP HBCRs, with prostate cancer being the top cancer in males and gastrointestinal cancers forming major proportion among all. Socioeconomic status of our patients, referral bias, and international medical tourism could be responsible.
Introduction: Lung cancer is one of the leading causes of cancer-related deaths worldwide, including in Saudi Arabia. In the past few decades, the incidence and mortality has increased considerably ...among the Saudi population. The incidence of lung cancer has increased more than 3% in less than two decades. The current study focuses on analyzing the frequency of diagnosed lung cancer cases, age-standardized incidence rate (ASIR), and crude incidence rate (CIR) classified by year of diagnosis, age group, and different administrative regions of Saudi Arabia, based on the Saudi cancer registry (SCR) for the period of 10 years from 2006–2016. Methodology: The present study is a cohort study that focuses on the epidemiological analysis of lung cancer cases. The statistical analysis was performed by t-test, sex ratio, Kruskal–Wallis, and descriptive statistics through SPSS version 20.0. Results: A total of 4530 lung cancer cases were reported from January 2006 to December 2016. Among males, the ASIR range was reported as 1.2 to 12.3 per 100,000 cases in different regions of Saudi Arabia. Moreover, among females, the ASIR range was reported from 0.2 to 3.1 per 100,000 cases in different regions of Saudi Arabia. Additionally, the overall age-standardized incidence sex ratio was 3.2 per 100,000 cases. The incidence of lung cancer increased with age as 23% was reported in the age group of more than 75 years. Conclusions: The study concludes a rise in crude incidence rates and ASIR for lung cancer among Saudi population. Among males, the Eastern region had the highest overall ASIR followed by Tabuk region, and, among females, the highest overall ASIR was reported in the Eastern region followed by Riyadh and the Northern region.
Summary
Background Cancers occurring following solid organ transplantation are a rapidly growing public health concern. Defining the extent of the problem has been limited by surveillance systems ...with incomplete registration of cases and the paucity of reliable national incidence data.
Objectives To determine the incidence of all cancers following renal transplantation and to make a detailed examination of trends and patterns associated with postrenal transplant skin cancers.
Methods Integration of data from the national renal transplant database and the national cancer registry in Ireland enabled accurate determination of the number of renal transplant recipients (RTRs) with skin cancers and other malignancies in the time period 1 January 1994 to 31 December 2001.
Results We demonstrated a biphasic increase in skin cancer incidence following renal transplantation, determined by the age at transplantation. There was a steady increase in risk for older RTRs (age 50+ years) from year 2 post‐transplant, whereas the increased risk in younger RTRs (age < 50 years) occurred later but much more significantly, reaching 200 times the risk for an age‐matched nontransplanted population by year 6 post‐transplant. The number of nonmelanoma skin cancers (NMSCs) registered in RTRs accounted for 1% of all NMSCs registered nationally over the study period. The standardized incidence rates for invasive NMSC (33‐fold increase) and in situ carcinoma of the skin (65‐fold increase) were significantly increased (P < 0·05). The risk for invasive squamous cell carcinoma (SCC) was increased 82‐fold compared with the nontransplanted population. Male RTRs were at particular risk of invasive SCC at sun‐exposed sites such as the scalp and the external ear. Risk of malignant melanoma and Kaposi sarcoma were also increased relative to the nontransplanted population.
Conclusions This comprehensive national study illustrates how rates of skin cancer in Irish RTRs have influenced the national incidence of skin cancer. The high incidence of SCC, basal cell carcinoma and Bowen's disease in the early post‐transplant period for older patients and the cumulative risk in younger patients with increased duration of transplantation highlight the importance of implementing early and continued cancer surveillance regimens post‐transplant.
The COVID-19 pandemic has continued since January 2020 and affected cancer diagnosis and treatment. The aim of this study was to examine the impact of the pandemic on cancer patients in Nagano ...Prefecture, using data from the 2018-2020 hospital-based cancer registry (HBCR). The numbers and stage of cancer diagnosis in the HBCR from January 2018 to December 2020 in Nagano Prefecture were analyzed in this study. A total of 14,034 cancer patients in 2020 were registered. The number declined for the first time since HBCR system started in Nagano prefecture, and the rate of decline was 6.4％ (958 cases) compared with 2019. The decrease in number was remarkablc in colon, gastric and cervical carcinoma. The decrease in early detection cases targeted for open blood treatment in cancer treatment was also remarkable in gastric carcinoma and colon carcinoma, and among them, the decrease was remarkable in endoscopic surgery cases compared with the national data. We should continue this monitoring during the COVID-19 pandemic. Hospital-based cancer registries can be powerful tools for evaluating the epidemiology of cancer in Nagano Prefecture.
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