Introduction The number of adults entering the age groups at greatest risk for being diagnosed with cancer is increasing. Projecting cancer incidence can help the cancer control community plan and ...evaluate prevention strategies aimed at reducing the growing number of cancer cases. Methods We used data from the Surveillance, Epidemiology, and End Results Program and the US Census Bureau to estimate average, annual, age-standardized cancer incidence rates and case counts (for all sites combined and top 22 invasive cancers) in the US for 2015 and to project cancer rates and counts to 2050. We used age, period, and cohort models to inform projections. Results Between 2015 and 2050, we predict the overall age-standardized incidence rate (proxy for population risk for being diagnosed with cancer) to stabilize in women (1%) and decrease in men (−9%). Cancers with the largest change in risk include a 34% reduction for lung and bronchus and a 32% increase for corpus uterine (32%). Because of the growth and aging of the US population, we predict that the annual number of cancer cases will increase 49%, from 1,534,500 in 2015 to 2,286,300 in 2050, with the largest percentage increase among adults aged ≥75 years. Cancers with the largest projected absolute increase include female breast, colon and rectum, and prostate. Discussion By 2050, we predict the total number of incident cases to increase by almost 50% as a result of the growth and aging of the US population. A greater emphasis on cancer risk reduction is needed to counter these trends.
Esophageal adenocarcinoma rates may be increasing, whereas, squamous cell carcinoma rates appear to be decreasing in the United States. Previous population‐based research on esophageal cancer has ...only covered up to 68% of the country. Additional, updated research on a larger percentage of the country is needed to describe racial, ethnic and regional trends in histologic subtypes of esophageal cancer. Invasive esophageal cancer cases diagnosed between 1998 and 2003 (n = 65,926), collected by the National Program of Cancer Registries or the Surveillance, Epidemiology, and End Results program, were included. These data cover 83% of the US population. Esophageal squamous cell carcinoma incidence fell by 3.6%/year, whereas esophageal adenocarcinoma increased by 2.1%/year. Squamous cell carcinoma rates decreased among both sexes in most racial or ethnic groups, whereas adenocarcinoma rates increased primarily among white or non‐Hispanic men. Except for white or non‐Hispanic men, squamous cell carcinoma rates were similar to, or greater than, adenocarcinoma rates for men and women of all other races and ethnicities. The largest decrease in squamous cell carcinoma rates occurred in the West census region, which also exhibited no increase in adenocarcinoma rates. The rate of regional and distant‐staged adenocarcinomas increased, while rates for local‐staged adenocarcinoma remained stable. This is the first article to characterize esophageal cancer trends using data covering the majority of the US. Substantial racial, ethnic and regional variation in esophageal cancer is present in the US. Our work may inform interventions related to tobacco and alcohol use, and overweight/obesity prevention, and provide avenues for further research. Published 2008 Wiley‐Liss, Inc.
BACKGROUND
The lifetime risk of developing leukemia in the United States is 1.5%. There are challenges in the estimation of population‐based survival using registry data because treatments and ...prognosis vary greatly by subtype. The objective of the current study was to determine leukemia survival estimates in the United States from 1995 to 2009 according to subtype, sex, geographical area, and race.
METHODS
Five‐year net survival was estimated using data for 370,994 patients from 43 registries in 37 states and in 6 metropolitan areas, covering approximately 81% of the adult (15‐99 years) US population. Leukemia was categorized according to principal subtype (chronic lymphocytic leukemia, acute myeloid leukemia, and acute lymphocytic leukemia), and subcategorized in accordance with the HAEMACARE protocol. We analyzed age‐standardized 5‐year net survival by calendar period (1995‐1999, 2000‐2004, and 2005‐2009), leukemia subtype, sex, race, and US state.
RESULTS
The age‐standardized 5‐year net survival estimates increased from 45.0% for patients diagnosed during 1995‐1999 to 49.0% for those diagnosed during 2000‐2004 and 52.0% for those diagnosed during 2005‐2009. For patients diagnosed during 2005‐2009, 5‐year survival was 18.2% (95% confidence interval 95% CI, 17.8%‐18.6%) for acute myeloid leukemia, 44.0% (95% CI, 43.2%‐44.8%) for acute lymphocytic leukemia, and 77.3% (95% CI, 76.9%‐77.7%) for chronic lymphocytic leukemia. For nearly all leukemia subtypes, survival declined in successive age groups above 45 to 54 years. Men were found to have slightly lower survival than women; however, this discrepancy was noted to have fallen in successive calendar periods. Net survival was substantially higher in white than black patients in all calendar periods. There were large differences in survival noted between states and metropolitan areas.
CONCLUSIONS
Survival from leukemia in US adults improved during 1995‐2009. Some geographical differences in survival may be related to access to care. We found disparities in survival by sex and between black and white patients.
While survival from leukemia in adults in the United States has improved during 1995‐2009, disparities are found in survival by sex and between black and white patients.
Treatment by a gynecologic oncologist is an important part of ovarian cancer care; however, implementation strategies are needed to increase care by these specialists. We partnered with National ...Comprehensive Cancer Control Programs in Iowa, Michigan, and Rhode Island in a demonstration project to deepen the evidence base for promising strategies that would facilitate care for ovarian cancer by gynecologic oncologists.
Five main implementation strategies (increase knowledge/awareness; improve models of care; improve payment structures; increase insurance coverage; enhance workforce) were identified in the literature and used to develop initiatives. Specific activities were chosen by state programs according to feasibility and needs.
Activities included: (1) qualitative interviews with patients to determine barriers to receipt of specialized care; (2) development of patient/provider educational materials; (3) creation of patient/provider checklists to facilitate appropriate referrals; (4) expansion of a toll-free patient navigation hotline for ovarian cancer patients; (5) training of the health care workforce. The programs developed resources (educational handouts, toolkits, 2 webinars, 2 podcasts); trained 167 medical and nursing students during 8 Survivors Teaching Students
workshops; and conducted 3 provider education sessions reaching 362 providers in 45 states. Evaluations showed increases in providers' knowledge, awareness, abilities, and intentions to refer ovarian cancer patients to a gynecologic oncologist.
The state program resources we discussed are available for other cancer control programs interested in initiating or expanding activities to improve access/referrals to gynecologic oncologists for ovarian cancer care. They serve as a valuable repository for public health professionals seeking to implement similar interventions.
Up to one-third of women with ovarian cancer in the United States do not receive surgical care from a gynecologic oncologist specialist despite guideline recommendations. We aim to investigate the ...impact of rurality on receiving surgical care from a specialist, referral to a specialist, and specialist surgery after referral, and the consequences of specialist care.
We utilized a retrospective cohort created through an extension of standard cancer surveillance in three Midwestern states. Multivariable adjusted logistic regression was utilized to assess gynecologic oncologist treatment of women 18–89 years old, who were diagnosed with primary, histologically confirmed, malignant ovarian cancer in 2010–2012 in Kansas, Missouri and Iowa by rurality.
Rural women were significantly less likely to receive surgical care from a gynecologic oncologist specialist (adjusted odds ratio (OR) 0.37, 95% confidence interval (CI) 0.24–0.58) and referral to a specialist (OR 0.37, 95% CI 0.23–0.59) compared to urban women. There was no significant difference in specialist surgery after a referral (OR 0.56, 95% CI 0.26–1.20). Rural women treated surgically by a gynecologic oncologist versus non-specialist were more likely to receive cytoreduction and more complete tumor removal to ≤1 cm.
There is a large rural-urban difference in receipt of ovarian cancer surgery from a gynecologic oncologist specialist (versus a non-specialist). Disparities in referral rates contribute to the rural-urban difference. Further research will help define the causes of referral disparities, as well as promising strategies to address them.
•Rural ovarian cancer patients are 63% less likely to receive a referral to a gynecologic oncologist for surgery•Rural ovarian cancer patients are significantly less likely to receive surgery from a gynecologic oncologist•After a surgical referral, rural ovarian cancer patients are just as likely to receive surgery from a specialist•Specialist-provided surgery increases receipt of cytoreduction and complete tumor removal for rural ovarian cancer patients•Rural women (versus urban) who receive surgery from a gynecologic oncologist travel farther to surgical care
BACKGROUND
Ovarian cancer is the fifth leading cause of cancer death among women in the United States. This study reports ovarian cancer survival by state, race, and stage at diagnosis using data ...from the CONCORD‐2 study, the largest and most geographically comprehensive, population‐based survival study to date.
METHODS
Data from women diagnosed with ovarian cancer between 2001 and 2009 from 37 states, covering 80% of the US population, were used in all analyses. Survival was estimated up to 5 years and was age standardized and adjusted for background mortality (net survival) using state‐specific and race‐specific life tables.
RESULTS
Among the 172,849 ovarian cancers diagnosed between 2001 and 2009, more than one‐half were diagnosed at distant stage. Five‐year net survival was 39.6% between 2001 and 2003 and 41% between 2004 and 2009. Black women had consistently worse survival compared with white women (29.6% from 2001‐2003 and 31.1% from 2004‐2009), despite similar stage distributions. Stage‐specific survival for all races combined between 2004 and 2009 was 86.4% for localized stage, 60.9% for regional stage, and 27.4% for distant stage.
CONCLUSIONS
The current data demonstrate a large and persistent disparity in ovarian cancer survival among black women compared with white women in most states. Clinical and public health efforts that ensure all women who are diagnosed with ovarian cancer receive appropriate, guidelines‐based treatment may help to decrease these disparities. Future research that focuses on the development of new methods or modalities to detect ovarian cancer at early stages, when survival is relatively high, will likely improve overall US ovarian cancer survival. Cancer 2017;123:5138‐59. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.
Population‐based ovarian cancer survival in the United States is moderate (at approximately 40%) between 2001 and 2009; however, large and persistent racial disparities are observed. Black women have lower survival than white women in most states.
Our goal was to describe current childhood cancer incidence in the United States and identify demographic and geographic variation among children and adolescents with cancer.
We examined data from 39 ...National Program of Cancer Registries and 5 Surveillance, Epidemiology, and End Results statewide registries (representing >90% of the US population) to identify cancers diagnosed among persons aged 0 to 19 from 2001-2003. Diagnosed cancers were grouped by the third version of the International Childhood Cancer Classification. Analyses were stratified according to gender, age, race, ethnicity, and US census region. A multivariable negative binomial regression model was used to evaluate demographic and geographic differences in incidence for all cancers combined.
We identified 36446 cases of childhood cancer with an age-adjusted incidence rate of 165.92 per million. Stratified analyses showed that, for all cancers combined, boys had a significantly higher rate than girls; children (aged 0-14 years) had a significantly lower rate than adolescents (aged 15-19 years); and white children had the highest incidence rate among all races. Young people living in the Northeast had the highest incidence rate among all US census regions, which may be partially attributed to significantly higher incidence rates for central nervous system neoplasms and lymphomas in this region compared with other US census regions. Negative binomial regression analysis demonstrated that the childhood cancer-incidence rate varied significantly according to gender, age, race, ethnicity, and geography.
This study is the first to demonstrate substantial regional differences in the incidence of childhood cancer. It also shows that incidence varies according to gender, age, race, and ethnicity. Our research findings are useful for prioritizing future childhood cancer research needs.
Objective
People with cancer are increasingly more likely to visit an emergency department for acute care than the general population. They often have long wait times and more exposure to infection ...and receive treatment from staff less experienced with cancer‐related problems. Our objective was to examine emergency department (ED) visits among people with cancer to understand how often and why they seek care.
Methods
We conducted a retrospective study of ED visits using the National Syndromic Surveillance Program BioSense Platform. Cancer reported during an ED visit was identified using International Classification of Diseases, Tenth Revision codes for any cancer type, including bladder, breast, cervical, colorectal, kidney, liver, lung, ovary, pancreas, prostate, or uterine cancers. Symptoms prompting the visit were identified for people with cancer who visited EDs in the United States from June 2017 to May 2018 in ≈4500 facilities, including 3000 EDs in 46 states and the District of Columbia (66% of all ED visits during a 1‐year period).
Results
Of 97 million ED visits examined, 710,297 (0.8%) were among people with cancer. Percentages were higher among women (50.1%) than men (49.5%) and among adults aged ≥65 years (53.6%) than among those ≤64 years (45.7%). The most common presenting symptoms were pain (19.1%); gastrointestinal (13.8%), respiratory (11.5%), and neurologic (5.3%) complaints; fever (4.9%); injury (4.1%); and bleeding (2.4%). Symptom prevalence differed significantly by cancer type.
Conclusions
The Centers for Medicare & Medicaid Services encourages efforts to reduce acute care visits among people with cancer. We characterized almost 70% of ED visits among this population.
We aim to evaluate the impact gynecologic oncologists have on ovarian cancer adjuvant chemotherapy care from their role as surgeons recommending adjuvant chemotherapy care and their role as adjuvant ...chemotherapy providers while considering rural-urban differences.
Multivariable adjusted logistic regressions and Cox proportional hazards models were developed using a population-based, retrospective cohort of stage II-IV and unknown stage ovarian cancer patients diagnosed in Iowa, Kansas, and Missouri in 2010–2012 whose medical records were abstracted in 2017–2018.
Gynecologic oncologist surgeons (versus other type of surgeon) were associated with increased odds of adjuvant chemotherapy initiation (adjusted odds ratio (OR) 2.18; 95% confidence interval (CI) 1.10–4.33) and having a gynecologic oncologist adjuvant chemotherapy provider (OR 10.0; 95% CI 4.58–21.8). Independent of type of surgeon, rural patients were less likely to have a gynecologic oncologist chemotherapy provider (OR 0.52; 95% CI 0.30–0.91). Gynecologic oncologist adjuvant chemotherapy providers (versus other providers) were associated with decreased surgery-to-chemotherapy time (rural: 6 days; urban: 8 days) and increased distance to chemotherapy (rural: 22 miles; urban: 11 miles). Rural women (versus urban) traveled 38 miles farther when their chemotherapy provider was a gynecologic oncologist and 27 miles farther when it was not.
Gynecologic oncologist surgeons may impact adjuvant chemotherapy initiation. Gynecologic oncologists serving as adjuvant chemotherapy providers were associated with some care benefits, such as reduced time from surgery-to-chemotherapy, and some care barriers, such as travel distance. The barriers and benefits of having a gynecologic oncologist involved in adjuvant chemotherapy care, including rural-urban differences, warrant further research in other populations.
•Gynecologic oncologist surgeons were associated with increased odds of initiating adjuvant chemotherapy.•Gynecologic oncologist surgeons were associated with greater odds of a gynecologic oncologist chemotherapy provider.•Gynecologic oncologist adjuvant chemotherapy providers were associated with decreased time from surgery-to-chemotherapy.•Rural and urban women traveled farther to receive chemotherapy care with gynecologic oncologist.•Rural women (versus urban) had a gynecologic oncologist involved in their adjuvant chemotherapy less and traveled farther.
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