Quality of online information for the general public on COVID-19

OBJECTIVES

To analyse the quality of information included in websites aimed at the public on COVID-19.

METHODS

Yahoo!, Google and Bing search engines were browsed using selected keywords on COVID-19. The first 100 websites from each search engine for each keyword were evaluated. Validated tools were used to assess readability [Flesch Reading Ease Score (FRES)], usability and reliability (LIDA tool) and quality (DISCERN instrument). Non-parametric tests were used for statistical analyses.

RESULTS

Eighty-four eligible sites were analysed. The median FRES score was 54.2 (range: 23.2-73.5). The median LIDA usability and reliability scores were 46 (range: 18-54) and 37(range:14-51), respectively. A low (<50 %) overall LIDA score was recorded for 30.9 % (n = 26) of the websites. The median DISCERN score was 49.5 (range: 21-77). The DISCERN score of ≤50 % was found in 45 (53.6 %) websites. The DISCERN score was significantly associated with LIDA usability and reliability scores (p < 0.001) and the FRES score (p = 0.024).

CONCLUSION

The majority of websites on COVID-19 for the public had moderate to low scores with regards to readability, usability, reliability and quality.

PRACTICE IMPLICATIONS

Prompt strategies should be implemented to standardize online health information on COVID-19 during this pandemic to ensure the general public has access to good quality reliable information.

The incidence and patterns of colorectal cancers in Sri Lanka from 2001 to 2010: Analysis of national cancer registry data

OBJECTIVES

The incidence of colorectal cancer (CRC) has been increasing in many Asian countries. This study aims to analyse trends in CRC incidence and histological patterns in Sri Lanka.

METHODS

All newly diagnosed patients with CRC in Sri Lanka during 2001-2010 included in the National Cancer Registry were analysed for trends in incidence using Joinpoint regression software.

RESULTS

A total of 7,694 CRC (male:female = 1.02:1, mean age = 58.7 years) were analysed. The incidence of CRC in Sri Lanka has increased from a WHO age-standardised rate of 2.9/100,000 in 2001 (95%-confidence interval [95%-CI]: 2.64-3.16) to 6.08/100,000 in 2010 (95%-CI: 5.71-6.44). This is an estimated annual percentage change (EAPC) of 8.9 (95%-CI: 7.5-10.4). The proportional increase in incidence was observed to be greater for females (2.8 to 5.6, EAPC: 9.4 (95%-CI: 7.7-11.2), p < .05) than males (3.02 to 6.62, EAPC: 8.5 (95%-CI: 6.9-10.2), p < .05).

CONCLUSIONS

Similar to other Asian countries, a significant increase in the incidence of CRC was observed in Sri Lanka. Rate of the increase may have been artificially inflated due to better case reporting and diagnostic scrutiny. Future studies focussing on trends in tumour stage and fatality will help shed light on changing patterns in the burden of CRC in Sri Lanka.

Translation and Validation of the Sinhala Version of the EORTC-QLQ-CR29 Questionnaire

Purpose:

To validate the Sinhalese version of the EORTC QLQ-CR29 quality of life questionnaire for colorectal cancer.

Method:

We translated and pilot-tested (n=10) the questionnaire in Sri Lanka. We then assessed the reliability, factor structure and construct validity according to the EORTC guidelines. The testing was done in two tertiary care hospitals in Sri Lanka.

Results:

Of 110 participants, 103 (93%) returned the questionnaire, and 15 out of 20 (75%) returned the repeat-test questionnaire within a period of two weeks. Out of the original four scales three had better reliability than the original scales: urinary frequency (Cronbach α - 0.82), blood and mucus in stools (α-0.85), defaecation problems (α-0.76). The body image scale showed low reliability (α – 0.33). However, when one of the 3 items in the scale was omitted, it showed sufficient reliability (α – 0.74). Factor analysis showed good reliability for overall assessment of the two item scale for stool frequency (α – 0.82) and six item scale for defaecation problems (α – 0.76). Correlations between the subscales of CR29 and C30 questionnaires were below 0.40, except for body image, which correlated moderately (r-0.44) with emotional functioning. This confirmed satisfactory overall construct validity

Conclusion:

The scales for urinary frequency, blood and mucus in stools and defaecation problems which were reliable and had good validity. Body image scale failed to show sufficient reliability with the three-item scale and we suggest omitting one of the items to improve the overall reliability of the questionnaire. Construct validity was comparable to published data.

P6187Multicentre diagnostic performance of on-site workstation CT derived fractional flow reserve

Background

On-site workstation based computed tomography derived fractional flow reserve (CT-FFR) is an emerging method to assess vessel specific ischaemia in coronary artery disease (CAD). Global data on its diagnostic performance when compared with CT coronary angiography (CTA) is limited.

Purpose

To evaluate the on-site multicentre diagnostic performance of reduced-order CT-FFR at detecting vessel specific ischaemia.

Method

This is a retrospective pooled analysis of 141 patients (204 vessels) with suspected CAD enrolled from 3 global centres who underwent CTA, onsite CT-FFR and invasive FFR. On-site CT-FFR was performed using a reduced order model on a standard desktop computer with dedicated software. The per vessel diagnostic performance of CT-FFR (≤0.8) for vessel specific ischemia (FFR≤0.8) was compared with CTA (≥50% stenosis).

Results

Mean age was 65.8±9.9, 70.7% were male. FFR significant stenosis was present in 34.3% (70/204) of vessels. Pearson correlation of CT-FFR for invasive FFR was 0.52, P<0.001. Bland Altman analysis demonstrated a mean difference of 0.06±0.15 (95% limits of agreement −0.22 to 0.35). Per vessel diagnostic accuracy, sensitivity and specificity of CT-FFR and CTA were 79.9% vs 53.5%; 78.6% vs 85.7%; 80.6% vs 35.9% respectively. Diagnostic performance as assessed by area under the receiver operator curve (AUC) for CT FFR was superior to CTA (0.82 [95% CI 0.76–0.88] vs 0.61 [0.55–0.67]; P<0.001).

Conclusion

On-site workstation CT-FFR demonstrated high per vessel diagnostic performance and was superior when compared with CTA in assessment of vessel specific ischaemia as assessed by invasive FFR in a multicentre setting.

Outcomes in different ethnic groups of New Zealand patients with screen-detected vs. non-screen-detected breast cancer

Objective

To compare characteristics and survival of New Zealand European, Māori, and Pacific women with screen-detected vs. non-screen-detected breast cancer.

Methods

Women aged 45–69 diagnosed with invasive breast cancer between January 2005 and May 2013 were identified from the Waikato and Auckland Breast Cancer Registries. Patient demographics and tumour characteristics were described by detection mode and ethnicity. Kaplan–Meier method was used to estimate the five-year breast cancer-specific survival of women with stage I–III breast cancer by ethnicity and detection mode.

Results

Women with screen-detected cancers were older, had smaller tumours, fewer stage IV (0.8% vs. 7.6%), fewer high grade (16.8% vs. 39.0%), and fewer lymph node positive diseases (26.3% vs. 51.5%) than women with non-screen-detected cancers. There were more Luminal A (70.0% vs. 54.0%), fewer human epidermal growth factor receptor 2 positive non-Luminal (4.4% vs. 8.8%), and fewer triple negative cases (7.0% vs. 13.8%) in screen-detected than non-screen-detected cancers. If not screen detected, 22.7% of breast cancers in Pacific women were stage IV compared with 2.4% if screen detected. If not screen detected, the five-year breast cancer-specific survival was 91.1% for New Zealand European women, 84.2% for Māori women, and 80.2% for Pacific women (p-value <0.001). For screen-detected breast cancer, survival between different ethnic groups was similar.

Conclusions

Breast cancers detected through screening are diagnosed at an earlier stage and have a greater proportion of subtypes, with better outcome. Variations in survival for Māori and Pacific women are only found in women with non-screen-detected breast cancer.

The impact of different tumour subtypes on management and survival of New Zealand women with Stage I-III breast cancer

AIMS

This study aims to describe the prevalence and characteristics of the different ER/PR/HER2 subtypes in New Zealand women with breast cancer, and to explore their treatment and outcomes.

METHODS

This study included women diagnosed with Stage I-III breast cancer between January 2006 and May 2013, recorded in the combined Waikato and Auckland Breast Cancer Registers, and with complete data on their ER, PR and HER2 status. Five ER/PR/HER2 phenotypes were classified. Kaplan-Meier method and Cox proportional hazards model were used to examine the survival differences among these subtypes.

RESULTS

Of the 6,875 eligible women, 4,274 (62.2%) were classified as Luminal A, 836 (12.2%) as Luminal B HER2-, 605 (8.8%) as Luminal B HER2+, 401 (5.8%) as HER2+ non-Luminal and 759 (11.0%) as Triple Negative. Māori and Pacific women were less likely to have Triple Negative disease, while Pacific women were more likely to be HER2+ non-Luminal. The five-year breast cancer-specific survival was worst for HER2+ non-Luminal (80.1%) and Triple Negative (81.9%), followed by Luminal B HER2- (89.3%) and Luminal B HER2+ (91.6%), and was the best for Luminal A (96.8%). The adjusted breast cancer-specific mortality hazard ratio for Triple Negative and HER2+ non-Luminal compared to Luminal A was 4.91 (95% CI: 3.86-6.26) and 3.94 (95% CI: 2.94-5.30), respectively.

CONCLUSIONS

The pattern of phenotype in women with Stage I-III breast cancer is similar to the overseas cohorts. Most New Zealand women with Luminal A breast cancer have a very good prognosis, but the less common subtypes have relatively poor outcomes.

Ethnic disparities in breast cancer survival in New Zealand: which factors contribute?

Background

New Zealand has major ethnic disparities in breast cancer survival with Māori (indigenous people) and Pacific women (immigrants or descended from immigrants from Pacific Islands) faring much worse than other ethnic groups. This paper identified underlying factors and assessed their relative contribution to this risk differential.

Methods

This study involved all women who were diagnosed with primary invasive breast cancer in two health regions, covering about 40% of the national population, between January 2000 and June 2014. Māori and Pacific patients were compared with other ethnic groups in terms of demographics, mode of diagnosis, disease factors and treatment factors. Cox regression modelling was performed with stepwise adjustments, and hazards of excess mortality from breast cancer for Māori and Pacific patients were assessed.

Results

Of the 13,657 patients who were included in this analysis, 1281 (9.4%) were Māori, and 897 (6.6%) were Pacific women. Compared to other ethnic groups, they were younger, more likely to reside in deprived neighbourhoods and to have co-morbidities, and less likely to be diagnosed through screening and with early stage cancer, to be treated in a private care facility, to receive timely cancer treatment, and to receive breast conserving surgery. They had a higher risk of excess mortality from breast cancer (age and year of diagnosis adjusted hazard ratio: 1.76; 95% CI: 1.51–2.04 for Māori and 1.97; 95% CI: 1.67–2.32 for Pacific women), of which 75% and 99% respectively were explained by baseline differences. The most important contributor was late stage at diagnosis. Other contributors included neighbourhood deprivation, mode of diagnosis, type of health care facility where primary cancer treatment was undertaken and type of loco-regional therapy.

Conclusions

Late diagnosis, deprivation and differential access to and quality of cancer care services were the key contributors to ethnic disparities in breast cancer survival in New Zealand. Our findings underscore the need for a greater equity focus along the breast cancer care pathway, with an emphasis on improving access to early diagnosis for Māori and Pacific women.

Electronic supplementary material

The online version of this article (10.1186/s12885-017-3797-0) contains supplementary material, which is available to authorized users.

Abstract P4-21-28: Trastuzumab improves outcomes of New Zealand women with HER2+ stage I-III breast cancer

Introduction

HER2 status has been routinely ascertained for stage I-III breast cancer since late 2005. Trastuzumab was first funded in New Zealand for use in HER2+ breast cancer in July 2007. This observational study aims to compare the difference in outcome between women with HER2+ stage I-III breast cancer who received trastuzumab as adjuvant therapy versus those who did not. Differences in presentation, treatment and outcomes between Māori and NZ European were studied.

Methods

The combined Waikato and Auckland Breast Cancer Registries have clinical details of 12377 women diagnosed with breast cancer between June 2000 and May 2013. 9506 women with breast cancer were tested for HER2 receptor status. Proportion of women with HER2+ (FISH amplified or IHC 3+), stage I-III breast cancer were examined by age, ethnicity and stage. Differences in use of trastuzumab for women with stage I-III breast cancer with a tumour size equal or larger than 1 cm and aged less than 75 years were assessed by ethnicity and year of diagnosis. Patients who had inflammatory breast cancer or developed metastatic disease or local recurrence within 3 months after diagnosis were excluded. Kaplan-Meier method and Cox proportional hazards model were used to examine the breast cancer-specific survival between women treated with trastuzumab and chemotherapy and those treated with chemotherapy without trastuzumab.

Results

1454 patients with early invasive breast cancer were HER2+. The proportion of cases with HER2+, stage I-III breast cancer increased with stage (stage I-III: 11.5%-26.9%), but decreased with age (&lt;40 years to 80+ years: 28.8%-9.7%). Māori women were more likely to have HER2+ cancers than NZ European (17.8% versus 14.9%; p=0.02). Among the eligible patients, 605 women received trastuzumab and chemotherapy within 12 months for stage I-III breast cancer, and 275 had chemotherapy without trastuzumab. A small proportion (10.2%, 34/333) of women diagnosed in 2000-2005 received trastuzumab as part of a clinical trial. The proportion of women who received trastuzumab increased to 60.3% in 2006-2009 and to 87.1% in 2010-2013. 46.2% of Māori women were treated with trastuzumab compared to 55.9% of NZ European (p=0.040). The cancer-specific survival estimated with Kaplan-Meier method is shown in Table 1. Women treated with chemotherapy without trastuzumab were 2.7 times (95% CI: 1.9-3.9) more likely to die of breast cancer compared to those treated with trastuzumab and chemotherapy, after adjustment for stage, tumour size and hormone therapy.

Table 1. Breast cancer-specific survival between women with HER2+ stage I-III breast cancer who received trastuzumab as adjuvant therapy versus those who did notTreatmentNumber of patientsMedian follow-up time (months)5-year survival10-year survivalTrastuzumab+chemotherapy6055389.6%84.3%Chemotherapy without trastuzumab27510775.6%69.1%

Conclusions

Trastuzumab improved the breast cancer-specific survival of women with HER2+ stage I-III breast cancer. Māori women were more likely to have HER2+ cancer and less likely to be treated with trastuzumab. Rates of treatment with trastuzumab and the adjusted survival between Māori women and NZ European women were not significantly different.

Citation Format: Lawrenson R, Lao C, Harvey V, Campbell I, Brown C, Seneviratne S, Edwards M, Scott N, Elwood M, Sarfati D, Kuper-Hommel M. Trastuzumab improves outcomes of New Zealand women with HER2+ stage I-III breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-21-28.

A cohort study of ethnic differences in use of adjuvant chemotherapy and radiation therapy for breast cancer in New Zealand

Background

Ethnic and socioeconomic inequities in use of breast cancer adjuvant therapy are well documented in many countries including the USA, and are known to contribute to lower breast cancer survival among minority ethnic and socioeconomically deprived women. We investigated ethnic and socioeconomic inequities in use of adjuvant radiotherapy and chemotherapy in a cohort of women with invasive breast cancer in New Zealand.

Methods

All women with newly diagnosed invasive breast cancer during 1999-2012 were identified from the Waikato Breast Cancer Register. Rates of chemotherapy use and radiotherapy use were assessed in women who were deemed to be eligible for chemotherapy (n = 1212) and radiotherapy (n = 1708) based on guidelines. Factors associated with use of chemotherapy and radiation therapy were analysed in univariate and multivariate regression models, adjusting for covariates.

Results

Overall, rates of chemotherapy and radiotherapy use were 69% (n = 836) and 87.3% (n = 1491), respectively. In the multivariate model, significantly lower rates of radiotherapy use were associated with Māori compared with NZ European (Odds Ratio [OR] = 0.63, 0.40-0.98), presence of comorbidity (OR = 0.49, 0.34-0.72), distance from hospital of over 100km (OR = 0.47, 0.23-0.96), mastectomy compared with breast conserving surgery (OR = 0.32, 0.17-0.56) and non-screen compared with screen detection (OR = 0.53, 0.35-0.79). No significant associations were observed between chemotherapy use and ethnic or socio-demographic factors.

Conclusions

Improving access for radiotherapy, especially for women who are at a higher risk of not receiving optimum cancer therapy due to ethnicity, geography or socioeconomic status need to be recognized as a priority to reduce inequities in breast cancer care in New Zealand.