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Densmore R, Hajizadeh M, Hu M. Trends in socio-economic inequalities in bladder cancer incidence in Canada: 1992-2010. Canadian Journal of Public Health 2019; 110:722-731. [PMID: 31209789 DOI: 10.17269/s41997-019-00227-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 05/15/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Growing literature demonstrates widening socio-economic gradients in cancer incidence in different countries. However, few studies have measured the magnitude of socio-economic inequalities in the incidence of different types of cancers. This study aimed to evaluate socio-economic inequalities in bladder cancer incidence in Canada over time. METHODS Using data obtained from the Canadian Cancer Registry (CCR), the Canadian Census of Population (CCP), and the National Household Survey (NHS), we examined socio-economic inequalities of bladder cancer incidence among men and women in Canada from 1992 to 2010. Income- and education-related inequalities were measured using the concentration index (C) approach. We also analyzed the trends of income- and education-related inequalities over the study period. RESULTS There is an increasing trend in bladder cancer incidence in Canada. The estimated C suggested a higher incidence of bladder cancer among low socio-economic-status individuals. The results revealed that income-related inequality in bladder cancer incidence increased among the female population. Education-related inequality in the incidence of bladder cancer widened for both males and females in Canada. CONCLUSION The concentration of bladder cancer in Canada is growing among the socio-economically disadvantaged population. Further studies are required to help elucidate causal relationships between socio-economic status and bladder cancer incidence in Canada.
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Affiliation(s)
- Ryan Densmore
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Mohammad Hajizadeh
- School of Health Administration, Faculty of Health, Dalhousie University, Sir Charles Tupper Medical Building, 5850 College Street, 2nd Floor, Halifax, NS, B3H 4R2, Canada.
| | - Min Hu
- School of Health Administration, Faculty of Health, Dalhousie University, Sir Charles Tupper Medical Building, 5850 College Street, 2nd Floor, Halifax, NS, B3H 4R2, Canada
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152
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Ghimire B, Maroni R, Vulkan D, Shah Z, Gaynor E, Timoney M, Jones L, Arvanitis R, Ledson M, Lukehirst L, Rutherford P, Clarke F, Gardner K, Marcus MW, Hill S, Fidoe D, Mason S, Smith SG, Quaife SL, Fitzgerald K, Poirier V, Duffy SW, Field JK. Evaluation of a health service adopting proactive approach to reduce high risk of lung cancer: The Liverpool Healthy Lung Programme. Lung Cancer 2019; 134:66-71. [PMID: 31319997 DOI: 10.1016/j.lungcan.2019.05.026] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/21/2019] [Accepted: 05/26/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This Liverpool Healthy Lung Programme is a response to high rates of lung cancer and respiratory diseases locally and aims to diagnose lung cancer at an earlier stage by proactive approach to those at high risk of lung cancer. The objective of this study is to evaluate the programme in terms of its likely effect on mortality from lung cancer and its delivery to deprived populations. METHODS Persons aged 58-75 years, with a history of smoking or a diagnosis of chronic obstructive pulmonary disease (COPD)2 according to general practice records were invited for lung health check in a community health hub setting. A detailed risk assessment and spirometry were performed in eligible patients. Those with a 5% or greater five-year risk of lung cancer were referred for a low dose CT3 scan. RESULTS A total of 4 566 subjects attended the appointment for risk assessment and 3 591 (79%) consented to data sharing. More than 80% of the patients were in the most deprived quintile of the index of multiple deprivation. Of those attending, 63% underwent spirometry and 43% were recommended for a CT scan. A total of 25 cancers were diagnosed, of which 16 (64%) were stage I. Comparison with the national stage distribution implied that the programme was reducing lung cancer mortality by 22%. CONCLUSIONS Community based proactive approaches to early diagnosis of lung cancer in health deprived regions are likely to be effective in early detection of lung cancer.
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Affiliation(s)
- Bhagabati Ghimire
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, UK.
| | - Roberta Maroni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, UK
| | - Daniel Vulkan
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, UK
| | - Zoheb Shah
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, UK
| | - Edward Gaynor
- National Health Service (NHS) Liverpool Clinical Commissioning Group, UK
| | - Michelle Timoney
- National Health Service (NHS) Liverpool Clinical Commissioning Group, UK
| | - Lisa Jones
- National Health Service (NHS) Liverpool Clinical Commissioning Group, UK
| | - Rachel Arvanitis
- National Health Service (NHS) Liverpool Clinical Commissioning Group, UK
| | | | | | | | | | - Katy Gardner
- Macmillan General Practitioner, NHS Liverpool Clinical Commissioning Group, UK
| | - Michael W Marcus
- Roy Castle Lung Cancer Research Programme, University of Liverpool Cancer Research Centre, UK
| | - Sarah Hill
- Roy Castle Lung Cancer Research Programme, University of Liverpool Cancer Research Centre, UK
| | - Darcy Fidoe
- Roy Castle Lung Cancer Research Programme, University of Liverpool Cancer Research Centre, UK
| | - Sabrina Mason
- Roy Castle Lung Cancer Research Programme, University of Liverpool Cancer Research Centre, UK
| | - Samuel G Smith
- Leeds Institute of Health Sciences, University of Leeds, UK
| | - Samantha L Quaife
- Research Department of Behavioural Science and Health, University College London, UK
| | - Karen Fitzgerald
- Accelerate, Coordinate, Evaluate (ACE) team, Cancer Research, UK
| | | | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, UK
| | - John K Field
- Roy Castle Lung Cancer Research Programme, University of Liverpool Cancer Research Centre, UK
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153
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Ayala ALM, Anjos JCD, Cassol GA, Höfelmann DA. [Survival rate of 10 years among women with breast cancer: a historic cohort from 2000-2014]. CIENCIA & SAUDE COLETIVA 2019; 24:1537-1550. [PMID: 31066855 DOI: 10.1590/1413-81232018244.16722017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 07/25/2017] [Indexed: 11/21/2022] Open
Abstract
Breast cancer is a public health problem due to its high incidence, morbidity and mortality. The analysis of survival for this disease contributes to the description of behavior and prognostic factors. The scope of this article is to investigate survival for 10 years after diagnosis and the prognostic factors of women with breast cancer admitted to the Unified Health System Mastology Service in Joinville, State of Santa Catarina, between 2000 and 2014. A historical cohort study with data from the medical records and death certificates of 1,321 women, of whom 471 were considered eligible under the minimum follow-up criteria of 10 years (n = 288), and/or death before this period (n = 183). Survival analysis using the Kaplan-Meier model, the Log-Rank test and the Cox regression model was conducted. Overall survival at 10 years was 41% (CI 95%, 36.1%-45.0%). The risk of 10-year mortality stratified by tumor staging was higher among women with lymphatic invasion and staging II, and staging III, at 60 years or older. The findings suggest that the presence of lymphatic invasion, advanced age and intermediate/advanced staging of the disease can be considered indicators of a worse prognosis for breast cancer.
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154
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Zandbergen N, de Rooij BH, Vos MC, Pijnenborg JMA, Boll D, Kruitwagen RFPM, van de Poll-Franse LV, Ezendam NPM. Changes in health-related quality of life among gynecologic cancer survivors during the two years after initial treatment: a longitudinal analysis. Acta Oncol 2019; 58:790-800. [PMID: 30698069 DOI: 10.1080/0284186x.2018.1560498] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background: While many cancer survivors experience persistent impairments in health-related quality of life (HRQoL) for extended periods of time, others recover soon after treatment. The aim of this research is to assess changes in health-related quality of life in endometrial and ovarian cancer survivors during two years post initial treatment, and to assess clinical and sociodemographic characteristics associated with those changes. Methods: This prospective population-based cohort study includes longitudinal data of endometrial (N = 221) and ovarian (N = 174) cancer survivors diagnosed between 2011 and 2014. The EORTC QLQ-C30 functioning scales were used to assess HRQoL after initial treatment and after 6, 12 and 24 months. Clinical (stage, treatment and comorbidities) and sociodemographic (age, marital status and socio-economic status) characteristics were obtained from the Netherlands Cancer Registry and through self-administered questionnaires. Linear mixed models were used to assess changes in HRQoL over time and characteristics associated with these changes. Results: Among both endometrial and ovarian cancer patients, HRQoL improved within the first 6 months after initial treatment. Changes in HRQoL were mainly associated with clinical characteristics including comorbidities, treatment and tumor stage, and to a lesser extent with sociodemographic characteristics such as socioeconomic status. However, these associations varied per tumor type. Endometrial cancer survivors, who received radiotherapy and had no comorbidities, reported greater improvements in some HRQoL scales over time. Ovarian cancer patients who received chemotherapy and with advanced tumor stages reported poorer functioning during treatment. Most functioning domains (global health, physical and role functioning) recovered to levels of patients without chemotherapy or with early-stage disease after 12 months, but cognitive and social functioning remained impaired. Conclusion: Some subgroups of patients, including those with multiple comorbidities, with an advanced tumor stage and who received chemotherapy, may be in need of additional support as they are less likely to show improvements in HRQoL over time.
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Affiliation(s)
| | - Belle H. de Rooij
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - M. Caroline Vos
- Elisabeth-TweeSteden Hospital, Department of Obstetrics and Gynecology, Gynecologic Cancer Center South, Tilburg and Waalwijk, The Netherlands
| | - Johanna M. A. Pijnenborg
- Department of Obstetrics & Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dorry Boll
- Department of Gynecology, Catharina Hospital, Eindhoven, The Netherlands
| | - Roy F. P. M. Kruitwagen
- Department of Gynecology and GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lonneke V. van de Poll-Franse
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Nicole P. M. Ezendam
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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155
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Dalton SO, Olsen MH, Johansen C, Olsen JH, Andersen KK. Socioeconomic inequality in cancer survival - changes over time. A population-based study, Denmark, 1987-2013. Acta Oncol 2019; 58:737-744. [PMID: 30741062 DOI: 10.1080/0284186x.2019.1566772] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: Socioeconomic inequality in survival after cancer have been reported in several countries and also in Denmark. Changes in cancer diagnostics and treatment may have changed the gap in survival between affluent and deprived patients and we investigated if the differences in relative survival by income has changed in Danish cancer patients over the past 25 years. Methods: The 1- and 5-year relative survival by income quintile is computed by comparing survival among cancer patients diagnosed 1987-2009 to the survival of a cancer-free matched sample of the background population. The comparison is done within the 15 most common cancers and all cancers combined. The gap in relative survival due to socioeconomic inequality for the period 1987-1991 is compared the period 2005-2009. Results: The relative 5-year survival increased for all 15 cancer sites investigated in the study period. In general, low-income patients diagnosed in 1987-1991 had between 0% and 11% units lower 5-year relative survival compared with high-income patients; however, only four sites (breast, prostate, bladder and head & neck) were statistically different. In patients diagnosed 2005-2009, the gap in 5-year RS was ranging from 2% to 22% units and statistically significantly different for 9 out of 15 sites. The results for 1-year relative survival were similar to the 5-year survival gap. An estimated 22% of all deaths at five years after diagnosis could be avoided had patients in all income groups had same survival as the high-income group. Conclusion: In this nationwide population-based study, we observed that the large improvements in both short- and long-term cancer survival among patients diagnosed 1987-2009. The improvements have been most pronounced for high-income cancer patients, leading to stable or even increasing survival differences between richest and poorest patients. Improving survival among low-income patients would improve survival rates among Danish cancer patients overall and reduce differences in survival when compared to other Western European countries.
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Affiliation(s)
- Susanne Oksbjerg Dalton
- Danish Cancer Society Research Center, Survivorship, Copenhagen, Denmark
- Department of Oncology, Zealand University Hospital, Naestved, Denmark
| | - Maja Halgren Olsen
- Danish Cancer Society Research Center, Survivorship, Copenhagen, Denmark
| | - Christoffer Johansen
- Danish Cancer Society Research Center, Survivorship, Copenhagen, Denmark
- Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jørgen H. Olsen
- Danish Cancer Society Research Center, Survivorship, Copenhagen, Denmark
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156
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Syriopoulou E, Morris E, Finan PJ, Lambert PC, Rutherford MJ. Understanding the impact of socioeconomic differences in colorectal cancer survival: potential gain in life-years. Br J Cancer 2019; 120:1052-1058. [PMID: 31040385 PMCID: PMC6738073 DOI: 10.1038/s41416-019-0455-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/28/2019] [Accepted: 03/29/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Colorectal cancer prognosis varies substantially with socioeconomic status. We investigated differences in life expectancy between socioeconomic groups and estimated the potential gain in life-years if cancer-related survival differences could be eliminated. METHODS This population-based study included 470,000 individuals diagnosed with colon and rectal cancers between 1998 and 2013 in England. Using flexible parametric survival models, we obtained a range of life expectancy measures by deprivation status. The number of life-years that could be gained if differences in cancer-related survival between the least and most deprived groups were removed was also estimated. RESULTS We observed up to 10% points differences in 5-year relative survival between the least and most deprived. If these differences had been eliminated for colon and rectal cancers diagnosed in 2013 then almost 8231 and 7295 life-years would have been gained respectively. This results for instance in more than 1-year gain for each colon cancer male patient in the most deprived group on average. Cancer-related differences are more profound earlier on, as conditioning on 1-year survival the main reason for socioeconomic differences were factors other than cancer. CONCLUSION This study highlights the importance of policies to eliminate socioeconomic differences in cancer survival as in this way many life-years could be gained.
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Affiliation(s)
- Elisavet Syriopoulou
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, University Road, LE1 7RH, Leicester, UK.
| | - Eva Morris
- Cancer Epidemiology Group, Institute of Medical Research at St James's and Institute of Data Analytics, University of Leeds, Worsley Building, Leeds, LS2 9JT, UK
| | - Paul J Finan
- Cancer Epidemiology Group, Institute of Medical Research at St James's and Institute of Data Analytics, University of Leeds, Worsley Building, Leeds, LS2 9JT, UK
| | - Paul C Lambert
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, University Road, LE1 7RH, Leicester, UK
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Mark J Rutherford
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, University Road, LE1 7RH, Leicester, UK
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157
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Torá-Rocamora I, Grau J, Oliver-Vall-Llosera B, Bargalló X, Aldea M, Puigpinós-Riera R. [Influence of diagnostic pathway on clinical and non-conventional therapies use in women with breast cancer of the cohort DAMA]. GACETA SANITARIA 2019; 34:157-165. [PMID: 31000217 DOI: 10.1016/j.gaceta.2019.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 02/06/2019] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To describe and analyze the characteristics of breast cancer tumours according to the diagnostic pathway. We analyse the adverse effects of the treatments and the use of unconventional therapies in order to alleviate them. METHOD Descriptive design nested in a mixed cohort (Cohort DAMA). The dependent variable was the route to diagnosis of breast cancer. The independent variables were age, body mass index, social class, disposable family income, type of tumour, histological degree, tumour stage, recurrences, treatment, adverse effects derived from treatments and unconventional therapies. Bivariate descriptive analyses were performed and univariate and multivariate regression models were adjusted; and graphic representations of the unconventional therapies. RESULTS There are differences in the characteristics of the tumours, and the impact of the adverse effects derived from the treatments. The patients diagnosed by screening were older, from a high social class, had a higher percentage of tumours of grade I differentiation, initial stages, fewer recurrences and fewer adverse effects due to treatment, although this was not different in the screening group compared to the rest. There was also less use of unconventional therapies. CONCLUSIONS The results indicate that the implementation of screening programmes increases the possibility of detecting tumours in initial stages and with therapies with fewer adverse effects. As a result, there is less need to resort to unconventional therapies.
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Affiliation(s)
- Isabel Torá-Rocamora
- Servicio de Medicina Preventiva, Hospital Clínic de Barcelona, Barcelona, España.
| | - Jaume Grau
- Servicio de Medicina Preventiva, Hospital Clínic de Barcelona, Barcelona, España; Departament de Medicina, Facultat de Medicina y Ciències de la Salut, Universitat de Barcelona, Barcelona, España
| | | | - Xavier Bargalló
- Departament de Medicina, Facultat de Medicina y Ciències de la Salut, Universitat de Barcelona, Barcelona, España; Servicio de Radiología, Hospital Clínic de Barcelona, Barcelona, España
| | - Marta Aldea
- Servicio de Medicina Preventiva, Hospital Clínic de Barcelona, Barcelona, España; Departament de Medicina, Facultat de Medicina y Ciències de la Salut, Universitat de Barcelona, Barcelona, España
| | - Rosa Puigpinós-Riera
- Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut de Recerca Biomèdica Sant Pau, Barcelona, España
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158
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Erdmann F, Feychting M, Mogensen H, Schmiegelow K, Zeeb H. Social Inequalities Along the Childhood Cancer Continuum: An Overview of Evidence and a Conceptual Framework to Identify Underlying Mechanisms and Pathways. Front Public Health 2019; 7:84. [PMID: 31106186 PMCID: PMC6492628 DOI: 10.3389/fpubh.2019.00084] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 03/26/2019] [Indexed: 12/13/2022] Open
Abstract
Inequalities in health according to social conditions are regarded as unnecessary and unjust. There is a large body of evidence on inequalities in adult cancer, observable throughout the societies on a national level as well as on a global scale. Socioeconomic influences on health matter at all ages including childhood, for which childhood cancer is the leading cause of disease related death in high-income countries (HICs). Substantial differences in the reported incidence of childhood cancers have been observed globally by socioeconomic development of a population. This is reflected in the higher incidence rates reported for HICs, particularly for acute lymphoblastic leukemia, and for cancer in infants (below 1 year), compared to low- and middle-income countries (LMICs). Considerable inequalities between populations and degree of socioeconomic development are also noted for survival from childhood cancer, with substantially lower survival rates seen in most LMICs compared to HICs. With respect to inequalities by socioeconomic position (SEP) within countries, findings of an association between SEP and childhood cancer risk are diverse and limited to studies from HICs. On the contrary, observations on social inequalities in survival within countries are accumulating and indicate that survival inequalities do not only concern resource-poor countries but also high-income populations including European countries. In turn, a childhood cancer diagnosis in itself may have implications on the parents' socioeconomic situation as well as on the later socioeconomic life after having survived the disease. The underlying mechanisms and causal pathways of these empirically demonstrated social inequalities are poorly understood, although it is of significant public health relevance for any actions or strategies to reduce childhood cancer-related inequity. We propose a conceptual framework on potential underlying mechanism and pathways specifically addressing social inequalities in childhood cancer and after childhood cancer to (i) illustrate potential pathways by which social determinants may create health inequities at different points of the childhood cancer continuum; (ii) illustrate potential pathways by which a childhood cancer diagnosis may impact the socioeconomic situation of the concerned family or the later life of a childhood survivor; and (iii) point out how major determinants may relate to each other.
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Affiliation(s)
- Friederike Erdmann
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
- Department of Prevention and Evaluation, Leibniz - Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Mogensen
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz - Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
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159
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Li J, Cornacchi SD, Farrokhyar F, Johnston N, Forbes S, Reid S, Hodgson N, Lovrics S, Lucibello K, Lovrics P. Relation between socioeconomic variables and surgical, systemic and radiation treatment in a cohort of patients with breast cancer in an urban Canadian centre. Can J Surg 2019; 62:83-92. [PMID: 30697993 DOI: 10.1503/cjs.009217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background Studies have shown an association between socioeconomic status and breast cancer treatment. We examined the relation between socioeconomic status and the treatment of breast cancer (surgical, systemic and radiation) in a universal health care system. Methods Data from a single urban Canadian centre were collected for consecutive patients who received a diagnosis of breast cancer from January 2010 to December 2011. Variables included patient and disease factors, surgery type, systemic and radiation treatment, and breast reconstruction. Socioeconomic variables were obtained from 2006 Canadian census data. We used multivariable logistic regression to identify predictors of breast cancer treatment. Results A total of 721 patients were treated for breast cancer during the study period. Socioeconomic variables were not related to type of breast surgery for breast cancer. Age less than 50 years, having a first-degree relative with breast cancer and income status were predictors of breast reconstruction. Employment status was a consistent predictor of systemic and radiation treatment. Conclusion Employment consistently predicted systemic and radiation treatment, and age and income were predictors of breast reconstruction in a universal health care system. Further research is required to determine precisely how socioeconomic
factors affect care and to minimize possible disparities in delivery of health care services.
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Affiliation(s)
- Jennifer Li
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Li, Cornacchi, Farrokhyar, Forbes, Reid, Hodgson, Lucibello, Lovrics); the Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, Ont. (Forbes, Rid, Hodgson, Lovrics); the Department of Surgery, St. Joseph’s Healthcare, Hamilton, Ont. (Lovrics); and the Department of Medicine, McMaster University, Hamilton, Ont. (Johnston)
| | - Sylvie D. Cornacchi
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Li, Cornacchi, Farrokhyar, Forbes, Reid, Hodgson, Lucibello, Lovrics); the Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, Ont. (Forbes, Rid, Hodgson, Lovrics); the Department of Surgery, St. Joseph’s Healthcare, Hamilton, Ont. (Lovrics); and the Department of Medicine, McMaster University, Hamilton, Ont. (Johnston)
| | - Forough Farrokhyar
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Li, Cornacchi, Farrokhyar, Forbes, Reid, Hodgson, Lucibello, Lovrics); the Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, Ont. (Forbes, Rid, Hodgson, Lovrics); the Department of Surgery, St. Joseph’s Healthcare, Hamilton, Ont. (Lovrics); and the Department of Medicine, McMaster University, Hamilton, Ont. (Johnston)
| | - Neil Johnston
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Li, Cornacchi, Farrokhyar, Forbes, Reid, Hodgson, Lucibello, Lovrics); the Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, Ont. (Forbes, Rid, Hodgson, Lovrics); the Department of Surgery, St. Joseph’s Healthcare, Hamilton, Ont. (Lovrics); and the Department of Medicine, McMaster University, Hamilton, Ont. (Johnston)
| | - Shawn Forbes
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Li, Cornacchi, Farrokhyar, Forbes, Reid, Hodgson, Lucibello, Lovrics); the Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, Ont. (Forbes, Rid, Hodgson, Lovrics); the Department of Surgery, St. Joseph’s Healthcare, Hamilton, Ont. (Lovrics); and the Department of Medicine, McMaster University, Hamilton, Ont. (Johnston)
| | - Susan Reid
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Li, Cornacchi, Farrokhyar, Forbes, Reid, Hodgson, Lucibello, Lovrics); the Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, Ont. (Forbes, Rid, Hodgson, Lovrics); the Department of Surgery, St. Joseph’s Healthcare, Hamilton, Ont. (Lovrics); and the Department of Medicine, McMaster University, Hamilton, Ont. (Johnston)
| | - Nicole Hodgson
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Li, Cornacchi, Farrokhyar, Forbes, Reid, Hodgson, Lucibello, Lovrics); the Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, Ont. (Forbes, Rid, Hodgson, Lovrics); the Department of Surgery, St. Joseph’s Healthcare, Hamilton, Ont. (Lovrics); and the Department of Medicine, McMaster University, Hamilton, Ont. (Johnston)
| | - Sarah Lovrics
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Li, Cornacchi, Farrokhyar, Forbes, Reid, Hodgson, Lucibello, Lovrics); the Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, Ont. (Forbes, Rid, Hodgson, Lovrics); the Department of Surgery, St. Joseph’s Healthcare, Hamilton, Ont. (Lovrics); and the Department of Medicine, McMaster University, Hamilton, Ont. (Johnston)
| | - Kristen Lucibello
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Li, Cornacchi, Farrokhyar, Forbes, Reid, Hodgson, Lucibello, Lovrics); the Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, Ont. (Forbes, Rid, Hodgson, Lovrics); the Department of Surgery, St. Joseph’s Healthcare, Hamilton, Ont. (Lovrics); and the Department of Medicine, McMaster University, Hamilton, Ont. (Johnston)
| | - Peter Lovrics
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Li, Cornacchi, Farrokhyar, Forbes, Reid, Hodgson, Lucibello, Lovrics); the Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, Ont. (Forbes, Rid, Hodgson, Lovrics); the Department of Surgery, St. Joseph’s Healthcare, Hamilton, Ont. (Lovrics); and the Department of Medicine, McMaster University, Hamilton, Ont. (Johnston)
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160
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Yeoh ZY, Jaganathan M, Rajaram N, Rawat S, Tajudeen NA, Rahim N, Zainal NH, Maniam S, Suvelayutnan U, Yaacob R, Krishnapillai V, Kamal MZM, Teo SH, Wahab MYA. Feasibility of Patient Navigation to Improve Breast Cancer Care in Malaysia. J Glob Oncol 2019; 4:1-13. [PMID: 30398950 PMCID: PMC7010457 DOI: 10.1200/jgo.17.00229] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Late stage at presentation and poor adherence to treatment remain major contributors to poor survival in low- and middle-income countries (LMICs). Patient navigation (PN) programs in the United States have led to improvement in diagnostic or treatment timeliness, particularly for women in lower socioeconomic classes or minority groups. To date, studies of PN in Asia have been limited. We aimed to assess the feasibility of PN in a state-run hospital in an LMIC and to report the impact on diagnostic and treatment timeliness for patients in its first year of implementation. METHODS We established PN in a dedicated breast clinic of a Malaysian state-run hospital. We compared diagnostic and treatment timeliness between navigated patients (n = 135) and patients diagnosed in the prior year (n = 148), and described factors associated with timeliness. RESULTS Women with PN received timely mammography compared with patients in the prior year (96.4% v 74.4%; P < .001), biopsy (92.5% v 76.1%; P = .003), and communication of news (80.0% v 58.5%; P < .001). PN reduced treatment default rates (4.4% v 11.5%; P = .048). Among navigated patients, late stage at presentation was independently associated with having emotional and language barriers ( P = .01). Finally, the main reason reported for delay, default, or refusal of treatment was the preference for alternative therapy. CONCLUSION PN is feasible for addressing barriers to cancer care when integrated with a state-run breast clinic of an LMIC. Its implementation resulted in improved diagnostic timeliness and reduced treatment default. Wider adoption of PN could be a key element of cancer control in LMICs.
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Affiliation(s)
- Zi-Yi Yeoh
- Zi-Yi Yeoh, Maheswari Jaganathan, Nadia Rajaram, Sakthi Maniam, and Soo-Hwang Teo, Cancer Research Malaysia; Sudha Rawat, Nurul Ain Tajudeen, Norlia Rahim, Nur Hidayati Zainal, Ushananthiny Suvelayutnan, Rahani Yaacob, Vijayalakshmi Krishnapillai, Meor Zamari Meor Kamal, and Mohamed Yusof Abdul Wahab, Hospital Tengku Ampuan Rahimah, Selangor; and Soo-Hwang Teo, University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
| | - Maheswari Jaganathan
- Zi-Yi Yeoh, Maheswari Jaganathan, Nadia Rajaram, Sakthi Maniam, and Soo-Hwang Teo, Cancer Research Malaysia; Sudha Rawat, Nurul Ain Tajudeen, Norlia Rahim, Nur Hidayati Zainal, Ushananthiny Suvelayutnan, Rahani Yaacob, Vijayalakshmi Krishnapillai, Meor Zamari Meor Kamal, and Mohamed Yusof Abdul Wahab, Hospital Tengku Ampuan Rahimah, Selangor; and Soo-Hwang Teo, University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
| | - Nadia Rajaram
- Zi-Yi Yeoh, Maheswari Jaganathan, Nadia Rajaram, Sakthi Maniam, and Soo-Hwang Teo, Cancer Research Malaysia; Sudha Rawat, Nurul Ain Tajudeen, Norlia Rahim, Nur Hidayati Zainal, Ushananthiny Suvelayutnan, Rahani Yaacob, Vijayalakshmi Krishnapillai, Meor Zamari Meor Kamal, and Mohamed Yusof Abdul Wahab, Hospital Tengku Ampuan Rahimah, Selangor; and Soo-Hwang Teo, University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
| | - Sudha Rawat
- Zi-Yi Yeoh, Maheswari Jaganathan, Nadia Rajaram, Sakthi Maniam, and Soo-Hwang Teo, Cancer Research Malaysia; Sudha Rawat, Nurul Ain Tajudeen, Norlia Rahim, Nur Hidayati Zainal, Ushananthiny Suvelayutnan, Rahani Yaacob, Vijayalakshmi Krishnapillai, Meor Zamari Meor Kamal, and Mohamed Yusof Abdul Wahab, Hospital Tengku Ampuan Rahimah, Selangor; and Soo-Hwang Teo, University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
| | - Nurul Ain Tajudeen
- Zi-Yi Yeoh, Maheswari Jaganathan, Nadia Rajaram, Sakthi Maniam, and Soo-Hwang Teo, Cancer Research Malaysia; Sudha Rawat, Nurul Ain Tajudeen, Norlia Rahim, Nur Hidayati Zainal, Ushananthiny Suvelayutnan, Rahani Yaacob, Vijayalakshmi Krishnapillai, Meor Zamari Meor Kamal, and Mohamed Yusof Abdul Wahab, Hospital Tengku Ampuan Rahimah, Selangor; and Soo-Hwang Teo, University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
| | - Norlia Rahim
- Zi-Yi Yeoh, Maheswari Jaganathan, Nadia Rajaram, Sakthi Maniam, and Soo-Hwang Teo, Cancer Research Malaysia; Sudha Rawat, Nurul Ain Tajudeen, Norlia Rahim, Nur Hidayati Zainal, Ushananthiny Suvelayutnan, Rahani Yaacob, Vijayalakshmi Krishnapillai, Meor Zamari Meor Kamal, and Mohamed Yusof Abdul Wahab, Hospital Tengku Ampuan Rahimah, Selangor; and Soo-Hwang Teo, University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
| | - Nur Hidayati Zainal
- Zi-Yi Yeoh, Maheswari Jaganathan, Nadia Rajaram, Sakthi Maniam, and Soo-Hwang Teo, Cancer Research Malaysia; Sudha Rawat, Nurul Ain Tajudeen, Norlia Rahim, Nur Hidayati Zainal, Ushananthiny Suvelayutnan, Rahani Yaacob, Vijayalakshmi Krishnapillai, Meor Zamari Meor Kamal, and Mohamed Yusof Abdul Wahab, Hospital Tengku Ampuan Rahimah, Selangor; and Soo-Hwang Teo, University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
| | - Sakthi Maniam
- Zi-Yi Yeoh, Maheswari Jaganathan, Nadia Rajaram, Sakthi Maniam, and Soo-Hwang Teo, Cancer Research Malaysia; Sudha Rawat, Nurul Ain Tajudeen, Norlia Rahim, Nur Hidayati Zainal, Ushananthiny Suvelayutnan, Rahani Yaacob, Vijayalakshmi Krishnapillai, Meor Zamari Meor Kamal, and Mohamed Yusof Abdul Wahab, Hospital Tengku Ampuan Rahimah, Selangor; and Soo-Hwang Teo, University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
| | - Ushananthiny Suvelayutnan
- Zi-Yi Yeoh, Maheswari Jaganathan, Nadia Rajaram, Sakthi Maniam, and Soo-Hwang Teo, Cancer Research Malaysia; Sudha Rawat, Nurul Ain Tajudeen, Norlia Rahim, Nur Hidayati Zainal, Ushananthiny Suvelayutnan, Rahani Yaacob, Vijayalakshmi Krishnapillai, Meor Zamari Meor Kamal, and Mohamed Yusof Abdul Wahab, Hospital Tengku Ampuan Rahimah, Selangor; and Soo-Hwang Teo, University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
| | - Rahani Yaacob
- Zi-Yi Yeoh, Maheswari Jaganathan, Nadia Rajaram, Sakthi Maniam, and Soo-Hwang Teo, Cancer Research Malaysia; Sudha Rawat, Nurul Ain Tajudeen, Norlia Rahim, Nur Hidayati Zainal, Ushananthiny Suvelayutnan, Rahani Yaacob, Vijayalakshmi Krishnapillai, Meor Zamari Meor Kamal, and Mohamed Yusof Abdul Wahab, Hospital Tengku Ampuan Rahimah, Selangor; and Soo-Hwang Teo, University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
| | - Vijayalakshmi Krishnapillai
- Zi-Yi Yeoh, Maheswari Jaganathan, Nadia Rajaram, Sakthi Maniam, and Soo-Hwang Teo, Cancer Research Malaysia; Sudha Rawat, Nurul Ain Tajudeen, Norlia Rahim, Nur Hidayati Zainal, Ushananthiny Suvelayutnan, Rahani Yaacob, Vijayalakshmi Krishnapillai, Meor Zamari Meor Kamal, and Mohamed Yusof Abdul Wahab, Hospital Tengku Ampuan Rahimah, Selangor; and Soo-Hwang Teo, University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
| | - Meor Zamari Meor Kamal
- Zi-Yi Yeoh, Maheswari Jaganathan, Nadia Rajaram, Sakthi Maniam, and Soo-Hwang Teo, Cancer Research Malaysia; Sudha Rawat, Nurul Ain Tajudeen, Norlia Rahim, Nur Hidayati Zainal, Ushananthiny Suvelayutnan, Rahani Yaacob, Vijayalakshmi Krishnapillai, Meor Zamari Meor Kamal, and Mohamed Yusof Abdul Wahab, Hospital Tengku Ampuan Rahimah, Selangor; and Soo-Hwang Teo, University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
| | - Soo-Hwang Teo
- Zi-Yi Yeoh, Maheswari Jaganathan, Nadia Rajaram, Sakthi Maniam, and Soo-Hwang Teo, Cancer Research Malaysia; Sudha Rawat, Nurul Ain Tajudeen, Norlia Rahim, Nur Hidayati Zainal, Ushananthiny Suvelayutnan, Rahani Yaacob, Vijayalakshmi Krishnapillai, Meor Zamari Meor Kamal, and Mohamed Yusof Abdul Wahab, Hospital Tengku Ampuan Rahimah, Selangor; and Soo-Hwang Teo, University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
| | - Mohamed Yusof Abdul Wahab
- Zi-Yi Yeoh, Maheswari Jaganathan, Nadia Rajaram, Sakthi Maniam, and Soo-Hwang Teo, Cancer Research Malaysia; Sudha Rawat, Nurul Ain Tajudeen, Norlia Rahim, Nur Hidayati Zainal, Ushananthiny Suvelayutnan, Rahani Yaacob, Vijayalakshmi Krishnapillai, Meor Zamari Meor Kamal, and Mohamed Yusof Abdul Wahab, Hospital Tengku Ampuan Rahimah, Selangor; and Soo-Hwang Teo, University Malaya Cancer Research Institute, Kuala Lumpur, Malaysia
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Tron L, Belot A, Fauvernier M, Remontet L, Bossard N, Launay L, Bryere J, Monnereau A, Dejardin O, Launoy G. Socioeconomic environment and disparities in cancer survival for 19 solid tumor sites: An analysis of the French Network of Cancer Registries (FRANCIM) data. Int J Cancer 2019; 144:1262-1274. [PMID: 30367459 DOI: 10.1002/ijc.31951] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/14/2018] [Accepted: 10/18/2018] [Indexed: 01/02/2023]
Abstract
Social inequalities are concerning along the cancer continuum. In France, social gradient in health is particularly marked but little is known about social gradient in cancer survival. We aimed to investigate the influence of socioeconomic environment on cancer survival, for all cancers reported in the French Network of Cancer Registries. We analyzed 189,657 solid tumors diagnosed between 2006 and 2009, recorded in 18 registries. The European Deprivation Index (EDI), an ecological index measuring relative poverty in small geographic areas, assessed social environment. The EDI was categorized into quintiles of the national distribution. One- and five-year age-standardized net survival (ASNS) were estimated for each solid tumor site and deprivation quintile, among men and among women. We found that 5-year ASNS was lower among patients living in the most deprived areas compared to those living in the least deprived ones for 14/16 cancers among men and 16/18 cancers among women. The extent of cancer survival disparities according to deprivation varied substantially across the cancer sites. The reduction in ASNS between the least and the most deprived quintile reached 34% for liver cancer among men and 59% for bile duct cancer among women. For pancreas, stomach and esophagus cancer (among men), and ovary and stomach cancer (among women), deprivation gaps were larger at 1-year than 5-year survival. In conclusion, survival was worse in the most deprived areas for almost all cancers. Our results from population-based cancer registries data highlight the need for implementing actions to reduce social inequalities in cancer survival in France.
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Affiliation(s)
- Laure Tron
- University Hospital of Caen, Caen cedex, France; 'ANTICIPE' U1086 INSERM-UCN, Team labeled 'Ligue Contre le Cancer', Centre François Baclesse, Caen, France
| | - Aurélien Belot
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mathieu Fauvernier
- Service de Biostatistique et de Bioinformatique, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Université Lyon 1, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Laurent Remontet
- Service de Biostatistique et de Bioinformatique, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Université Lyon 1, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Nadine Bossard
- Service de Biostatistique et de Bioinformatique, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Université Lyon 1, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Ludivine Launay
- 'ANTICIPE' U1086 INSERM-UCN, Team labeled 'Ligue Contre le Cancer', Centre François Baclesse, Caen, France
| | - Joséphine Bryere
- 'ANTICIPE' U1086 INSERM-UCN, Team labeled 'Ligue Contre le Cancer', Centre François Baclesse, Caen, France
| | - Alain Monnereau
- Registre des hémopathies malignes de la Gironde, Institut Bergonié, Bordeaux, France
- French Network of Cancer Registries, Toulouse, France
| | - Olivier Dejardin
- University Hospital of Caen, Caen cedex, France; 'ANTICIPE' U1086 INSERM-UCN, Team labeled 'Ligue Contre le Cancer', Centre François Baclesse, Caen, France
| | - Guy Launoy
- University Hospital of Caen, Caen cedex, France; 'ANTICIPE' U1086 INSERM-UCN, Team labeled 'Ligue Contre le Cancer', Centre François Baclesse, Caen, France
- French Network of Cancer Registries, Toulouse, France
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162
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Lehto US, Ojanen M, Väkevä A, Dyba T, Aromaa A, Kellokumpu-Lehtinen P. Early quality-of-life and psychological predictors of disease-free time and survival in localized prostate cancer. Qual Life Res 2019; 28:677-686. [PMID: 30511254 PMCID: PMC6394517 DOI: 10.1007/s11136-018-2069-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE The constructs evaluated in investigating association between psychosocial factors and cancer survival has varied between studies, and factors related to quality of life (QOL) have shown contradictory results. We investigated the effect of socioeconomic and early QOL and psychological factors on disease-free time and survival in localized prostate cancer. METHODS A consecutive sample of patients with localized prostate cancer (T1-3, N0, M0) treated with external beam radiotherapy completed validated questionnaires on coping with cancer (the Ways of Coping Questionnaire WOC-CA), anger expression (the Anger Expression Scale), life events (the Life Experience Survey), and various aspects of QOL (the Rotterdam Symptom Checklist, the Depression Scale DEPS, the EORTC QLQ-C30, the LENT-SOMA outcome measure) approximately 4.5 months after diagnosis. Cox regression analyses were used to determine the predictors of the disease-free and overall survival times measured from the date of diagnosis to the date of a PSA-relapse and date of death. RESULTS After controlling for biological prognostic factors, age, and adjuvant hormonal therapies, moderate and high socioeconomic status and an increased level of pain predicted longer survival, whereas an increased level of prostate-area symptoms and fatigue and, especially, reports of no/few physical symptoms were predictors of a shorter survival time. A longer PSA-relapse-free time was predicted by Cognitive Avoidance/Denial coping, whereas problems in social functioning, hopelessness, and an excellent self-reported QOL predicted a shorter PSA-relapse-free time. CONCLUSIONS Higher socioeconomic status was prognostic for longer survival, as previously reported. Patients with a seemingly good QOL (few physical complaints, excellent self-reported QOL) had poorer prognoses. This association may due to the survival decreasing effect of emotional non-expression; patients with high emotional non-expression may over-report their wellbeing in simple measures, and thus actually be in need of extra attention and care.
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Affiliation(s)
- Ulla-Sisko Lehto
- Medical School, Oncology, University of Tampere, 33014, Tampere, Finland.
- Public Health Evaluation and Projection, National Institute for Health and Welfare THL, Mannerheimintie 166, P.O. Box 30, 00271, Helsinki, Finland.
- Department of Oncology, Tampere University Hospital, PL 2000, 33521, Tampere, Finland.
| | - Markku Ojanen
- Department of Psychology, University of Tampere, 33014, Tampere, Finland
| | - Anna Väkevä
- Medical School, Oncology, University of Tampere, 33014, Tampere, Finland
- Department of Oncology, Tampere University Hospital, PL 2000, 33521, Tampere, Finland
| | - Tadeusz Dyba
- Finnish Cancer Registry, Pieni Roobertinkatu 9, 00130, Helsinki, Finland
- Joint Research Centre (JRC), European Commission, Building 58A/006, Via Enrico Fermi 2749, TP 581, 21027, Ispra, Italy
| | - Arpo Aromaa
- Public Health Evaluation and Projection, National Institute for Health and Welfare THL, Mannerheimintie 166, P.O. Box 30, 00271, Helsinki, Finland
| | - Pirkko Kellokumpu-Lehtinen
- Medical School, Oncology, University of Tampere, 33014, Tampere, Finland
- Department of Oncology, Tampere University Hospital, PL 2000, 33521, Tampere, Finland
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163
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Li G, Tian ML, Bing YT, Tao LY, Wang HY, Jiang B, Yuan CH, Xiu DR. Clinicopathological features and prognosis factors for survival in elderly patients with pancreatic neuroendocrine tumor: A STROBE-compliant article. Medicine (Baltimore) 2019; 98:e14576. [PMID: 30882623 PMCID: PMC6426577 DOI: 10.1097/md.0000000000014576] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
To investigate the features and prognosis of the elderly patients with pancreatic neuroendocrine tumor (pNET).The patients diagnosed with pNETs between 2004 and 2014 were identified from the Surveillance Epidemiology and End Results database. The ethical approval was waived because the present study was analysis of the data from Surveillance Epidemiology and End Results database.A total of 4608 patients with "one primary only" histologically pNETs were confirmed and 653 were older than 75 years. Cancer-specific survival (CSS) and overall survival (OS) were examined. The elderly patients (≥75 years) have disadvantage in CSS and OS compared with younger cohort. Multivariate logistic regression revealed that the elderly patients have increased poorly differentiated composition, and decreased proportion of Black patients, receipt of surgery, married status, and number of removed lymph node. Multivariate Cox regression analysis demonstrated worse differentiation. Patients of T3-4 and M1 stage were associated with poor CSS, while patients of being female, tumor locating at pancreatic body/tail, receipt of surgery, and being married were associated with better CSS in the elderly patients. Meanwhile, patients with higher histological grade and M1 stage have poor OS, while patients with the characteristics of female, being married, tumor location at pancreatic body/tail and tumor surgery have better OS. Distant metastatic elderly patients underwent primary site surgery had better CSS and OS than the patients without surgery.The elderly patients have increased possibility of poorly differentiated tumor, and decreased proportion of Black patients, surgery of primary site, number of removed lymph node and married status. Worse differentiation and tumor metastasis were independent risk factors for both CSS and OS, while primary tumor located in body/tail of pancreas, female patients, surgery of tumor primary site, and being married were protective factors.
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164
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Palazzo LL, Sheehan DF, Tramontano AC, Kong CY. Disparities and Trends in Genetic Testing and Erlotinib Treatment among Metastatic Non-Small Cell Lung Cancer Patients. Cancer Epidemiol Biomarkers Prev 2019; 28:926-934. [PMID: 30787053 DOI: 10.1158/1055-9965.epi-18-0917] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/13/2018] [Accepted: 02/14/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Despite reports of socioeconomic disparities in rates of genetic testing and targeted therapy treatment for metastatic non-small cell lung cancer (NSCLC), little is known about whether such disparities are changing over time. METHODS We performed a retrospective analysis to identify disparities and trends in genetic testing and treatment with erlotinib. Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we identified 9,900 patients with stage IV NSCLC diagnosed in 2007 to 2011 at age 65 or older. We performed logistic regression analyses to identify patient factors associated with odds of receiving a genetic test and erlotinib treatment, and to assess trends in these differences with respect to diagnosis year. RESULTS Patients were more likely to receive genetic testing if they were under age 75 at diagnosis [odds ratio (OR), 1.55] independent of comorbidity level, and this age-based gap showed a decrease over time (OR, 0.93). For untested patients, erlotinib treatment was associated with race (OR, 0.58, black vs. white; OR, 2.45, Asian vs. white), and was more likely among female patients (OR, 1.45); for tested patients, erlotinib treatment was less likely among low-income patients (OR, 0.32). Most of these associations persisted or increased in magnitude. CONCLUSIONS Race and sex are associated with rates of erlotinib treatment for patients who did not receive genetic testing, and low-income status is associated with treatment rates for those who did receive testing. The racial disparity remained stable over time, while the income-based disparity grew larger. IMPACT Attention to reducing disparities is needed as precision cancer treatments continue to be developed.
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Affiliation(s)
- Lauren L Palazzo
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts
| | - Deirdre F Sheehan
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts
| | - Angela C Tramontano
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts
| | - Chung Yin Kong
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts. .,Harvard Medical School, Boston, Massachusetts
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165
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Yedjou CG, Mbemi AT, Noubissi F, Tchounwou SS, Tsabang N, Payton M, Miele L, Tchounwou PB. Prostate Cancer Disparity, Chemoprevention, and Treatment by Specific Medicinal Plants. Nutrients 2019; 11:E336. [PMID: 30720759 PMCID: PMC6412894 DOI: 10.3390/nu11020336] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/02/2019] [Accepted: 01/29/2019] [Indexed: 12/16/2022] Open
Abstract
Prostate cancer (PC) is one of the most common cancers in men. The global burden of this disease is rising. Its incidence and mortality rates are higher in African American (AA) men compared to white men and other ethnic groups. The treatment decisions for PC are based exclusively on histological architecture, prostate-specific antigen (PSA) levels, and local disease state. Despite advances in screening for and early detection of PC, a large percentage of men continue to be diagnosed with metastatic disease including about 20% of men affected with a high mortality rate within the African American population. As such, this population group may benefit from edible natural products that are safe with a low cost. Hence, the central goal of this article is to highlight PC disparity associated with nutritional factors and highlight chemo-preventive agents from medicinal plants that are more likely to reduce PC. To reach this central goal, we searched the PubMed Central database and the Google Scholar website for relevant papers. Our search results revealed that there are significant improvements in PC statistics among white men and other ethnic groups. However, its mortality rate remains significantly high among AA men. In addition, there are limited studies that have addressed the benefits of medicinal plants as chemo-preventive agents for PC treatment, especially among AA men. This review paper addresses this knowledge gap by discussing PC disparity associated with nutritional factors and highlighting the biomedical significance of three medicinal plants (curcumin, garlic, and Vernonia amygdalina) that show a great potential to prevent/treat PC, as well as to reduce its incidence/prevalence and mortality, improve survival rate, and reduce PC-related health disparity.
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Affiliation(s)
- Clement G Yedjou
- Natural Chemotherapeutics Research Laboratory, NIH/NIMHD RCMI-Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, 1400 Lynch Street, Jackson, MS 39217, USA.
| | - Ariane T Mbemi
- Natural Chemotherapeutics Research Laboratory, NIH/NIMHD RCMI-Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, 1400 Lynch Street, Jackson, MS 39217, USA.
| | - Felicite Noubissi
- Department of Biology, College of Science, Engineering and Technology, Jackson State University, 1400 Lynch Street, Jackson, MS 39217, USA.
| | - Solange S Tchounwou
- Department of Biology, University of Mississippi, 214 Shoemaker Hall, P.O. Box 1848, MS 38677, USA.
| | - Nole Tsabang
- Department of Animal Biology, Higher Institute of Environmental Sciences, Yaounde P.O.Box 16317, Cameroon.
| | - Marinelle Payton
- Center of Excellence in Minority Health and Health Disparities, School of Public Health, Jackson State University, Jackson Medical Mall-Thad Cochran Center, 350 West Woodrow Wilson Avenue, Jackson, MS 39213, USA.
| | - Lucio Miele
- Department of Genetics, LSU Health Sciences Center, School of Medicine, 533 Bolivar Street, Room 657, New Orleans, LA 70112, USA.
| | - Paul B Tchounwou
- Department of Biology, College of Science, Engineering and Technology, Jackson State University, 1400 Lynch Street, Jackson, MS 39217, USA.
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166
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Siegel DA, Li J, Ding H, Singh SD, King JB, Pollack LA. Racial and ethnic differences in survival of pediatric patients with brain and central nervous system cancer in the United States. Pediatr Blood Cancer 2019; 66:e27501. [PMID: 30350913 PMCID: PMC6314020 DOI: 10.1002/pbc.27501] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/30/2018] [Accepted: 09/15/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Brain and central nervous system (CNS) cancer is the leading cause of cancer death among children and adolescents in the United States. Data from earlier studies suggested racial and ethnic differences in survival among pediatric patients with brain tumor. This study examined racial/ethnic difference in survival using national data and considered the effects of demographic and clinical factors. METHODS Using National Program of Cancer Registries data, 1-, 3-, and 5-year relative survival (cancer survival in the absence of other causes of death) was calculated for patients with brain and CNS cancer aged < 20 years diagnosed during 2001-2008 and followed up through 2013. Racial and ethnic differences in survival were measured by sex, age, economic status, stage, anatomic location, and histology. Adjusted racial and ethnic difference in 5-year cancer specific survival was estimated using multivariable Cox regression analysis. RESULTS Using data from 11 302 patients, 5-year relative survival was 77.6% for non-Hispanic white patients, 69.8% for non-Hispanic black patients, and 72.9% for Hispanic patients. Differences in relative survival by race/ethnicity existed within all demographic groups. Based on multivariable analysis, non-Hispanic black patients had a higher risk of death at 5 years after diagnosis compared to non-Hispanic white patients (adjusted hazard ratio = 1.2, 95% confidence interval, 1.1-1.4). CONCLUSIONS Pediatric brain and CNS cancer survival differed by race/ethnicity, with non-Hispanic black patients having a higher risk of death than non-Hispanic white patients. Future investigation of access to care, social and economic barriers, and host genetic factors might identify reasons for disparities in survival.
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Affiliation(s)
- David A. Siegel
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia,Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jun Li
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Helen Ding
- DB Consulting Group, Inc., Atlanta, Georgia
| | - Simple D. Singh
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jessica B. King
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lori A. Pollack
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Ingarfield K, McMahon AD, Douglas CM, Savage SA, MacKenzie K, Conway DI. Inequality in the Survival of Patients With Head and Neck Cancer in Scotland. Front Oncol 2019; 8:673. [PMID: 30723696 PMCID: PMC6349751 DOI: 10.3389/fonc.2018.00673] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 12/20/2018] [Indexed: 12/03/2022] Open
Abstract
Background: Socioeconomic inequalities impact on the survival of head and neck cancer (HNC) patients, but there is limited understanding of the explanations of the inequality, particularly in long-term survival. Methods: Patients were recruited from the Scottish Audit of Head and Neck Cancer between 1999 and 2001 and were linked to mortality data as at 30th September 2013. Socioeconomic status was determined using the area-based Carstairs 2001 index. Overall and disease-specific survival were calculated using the Kaplan-Meier method with 95% confidence intervals (CI's) at 1-, 5-, and 12-years. Net survival at 1-, 5-, and 12-years was also computed with 95% CIs. Cox proportional hazard models with 95% CIs were used to determine the explanations for the inequality in survival by all-cause mortality and disease-specific mortality with 95% CIs. Results: Most patients were from the most deprived group, and were more likely to smoke, drink, have cancer of a higher stage and have a lower WHO Performance Status. A clear gradient across Carstairs fifths for unadjusted overall and disease-specific survival was observed at 1-, 5-, and 12-years for patients with HNC. Following the adjustment for multiple patient, tumor and treatment factors, the inequality in survival for patients with HNC had attenuated and was no longer statistically significant at 1-, 5-, and 12-years. Conclusion: A clear gradient across Carstairs fifths for unadjusted overall, disease-specific and net survival was observed at 1-, 5-, and 12-years for HNC patients in Scotland from 1999 to 2001. This study concludes that explanations for the inequality in the survival of patients with HNC are not straightforward, and that many factors including various patient, tumor and treatment factors play a part in the inequality in the survival of patients with HNC.
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Affiliation(s)
- Kate Ingarfield
- University of Glasgow Dental School, University of Glasgow, Glasgow, United Kingdom
| | - Alex Douglas McMahon
- University of Glasgow Dental School, University of Glasgow, Glasgow, United Kingdom
| | - Catriona M. Douglas
- Department of Otolaryngology – Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Shirley-Anne Savage
- Emergency Care and Medicine Directorate, Victoria Hospital, Kirkcaldy, United Kingdom
| | - Kenneth MacKenzie
- Department of Otolaryngology – Head and Neck Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - David I. Conway
- University of Glasgow Dental School, University of Glasgow, Glasgow, United Kingdom
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168
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The association of socioeconomic status with quality of life in cancer patients over a 6-month period using individual growth models. Support Care Cancer 2019; 27:3347-3355. [PMID: 30627920 DOI: 10.1007/s00520-018-4634-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 12/27/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE Studies examining longitudinal associations between socioeconomic factors and quality of life (QoL) in cancer patients are rare. This study investigates changes in QoL over a 6-month period. METHODS Four hundred forty-two cancer patients (mean age 64, SD = 11, 70% male) completed standardized questionnaires at the beginning (t1) and end (t2) of their hospital stay and 3 (t3) and 6 months (t4) thereafter. QoL was assessed with the EORTC QLQ-C30 core questionnaire. Mixed effect models were employed to analyze individual changes in QoL in relation to socioeconomic status (education, income, job status) over the four timepoints. Age, sex, cohabitation, disease and treatment factors, and comorbidity were included as covariates in the models. RESULTS Income was a predictive factor for QoL. Patients with a low income had 8.8 percentage points (PP) lower physical, 4.9 PP lower emotional, and 11.4 PP lower role functioning. They also had 6.6 PP lower global QoL. Lower social functioning (6.2 PP) was found in patients with higher education or university degrees compared with those who were less educated or had not undergone an apprenticeship. Income also influenced trajectories of role functioning. There was no evidence that primary or secondary education and job type were related to QoL. CONCLUSIONS The fact that income is negatively associated with many aspects of quality of life should be considered during and after treatment with a focus on patients with special needs.
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169
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Olsson A, Bouaoun L, Auvinen A, Feychting M, Johansen C, Mathiesen T, Melin B, Lahkola A, Larjavaara S, Villegier AS, Byrnes G, Deltour I, Schüz J. Survival of glioma patients in relation to mobile phone use in Denmark, Finland and Sweden. J Neurooncol 2019; 141:139-149. [PMID: 30421160 DOI: 10.1007/s11060-018-03019-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/28/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE Gliomas are the most common cancer of the brain, with a poor prognosis in particular for glioblastoma. In 2014, a study suggested reduced survival in relation to latency of mobile phone use among glioblastoma patients. A joint epidemiological/experimental project to study effects of RF-EMF on tumor development and progression was established. The current analysis relates to the epidemiological part and addresses whether pre-diagnostic mobile phone use was associated with survival among glioma patients. METHODS Glioma cases (n = 806) previously enrolled in a collaborative population-based case-control study in Denmark, Finland and Sweden were followed up for survival. Vital status, date of death, date of emigration, or date last known to be alive was obtained based on registry linkages with a unique personal ID in each country. Cox regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) stratified by country. Covariates investigated were sex, age, education, histology, treatment, anatomic location and marital status. RESULTS No indication of reduced survival among glioblastoma patients was observed for various measures of mobile phone use (ever regular use, time since start of regular use, cumulative call time overall or in the last 12 months) relative to no or non-regular use. All significant associations suggested better survival for mobile phone users. Results were similar for high-grade and low-grade gliomas. CONCLUSIONS We found no evidence of reduced survival among glioma patients in relation to previous mobile phone use.
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Affiliation(s)
- Ann Olsson
- Section of Environment and Radiation, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon CEDEX 08, France.
| | - Liacine Bouaoun
- Section of Environment and Radiation, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon CEDEX 08, France
| | - Anssi Auvinen
- Faculty of Social Sciences, Health Sciences, University of Tampere, Tampere, Finland
| | - Maria Feychting
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Christoffer Johansen
- Oncology Clinic, 5073 Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Survivorship Unit, The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Tiit Mathiesen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Beatrice Melin
- Department of Radiation Sciences, Oncology, Umeå University Hospital, Umeå, Sweden
| | - Anna Lahkola
- Radiation and Nuclear Safety Authority (STUK), Helsinki, Finland
| | | | | | - Graham Byrnes
- Section of Environment and Radiation, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon CEDEX 08, France
| | - Isabelle Deltour
- Section of Environment and Radiation, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon CEDEX 08, France
| | - Joachim Schüz
- Section of Environment and Radiation, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372, Lyon CEDEX 08, France
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170
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Christopher O, Charles N. Cancer mortality in the Niger Delta Region of Nigeria: A case study of the University of Port Harcourt Teaching Hospital. Niger Med J 2019. [PMID: 31844357 PMCID: PMC6900904 DOI: 10.4103/nmj.nmj_15_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aim: The aim of this study is to determine the pattern of cancer mortality (CM) seen in the University of Port Harcourt Teaching Hospital (UPTH) which is a cancer reference center in the Niger Delta Region. Methodology: This is a 6-year retrospective study of cancer-related deaths in UPTH using patients' admission registers in all the wards and emergency units. Furthermore, the death certificates of cases were reviewed. Results: Three hundred and sixteen cases of cancer-related deaths occurred, involving 174 females and 142 males, in a female-to-male sex ratio of 1.2:1. All age groups were affected, with age group 40–49 years accounting for the majority (20.6%). CM was seen in all the systems, except the central nervous system. Cancers of the gastrointestinal tract and its accessory organs (liver and gall bladder) caused most mortality (27.9%), in a female-to-male ratio of 0.8:1. The single most involved organ in CM is the female breast (20.6%), distantly followed by mortality due to prostate cancers and hematolymphoid cancers which accounted for 9.2% each. Colorectal cancers accounted for 7.3% of cancer deaths and ranked 4th. Cancers of both cervix and stomach each accounted for 5.7% of mortality. The major histologic diagnoses were carcinomas (adenocarcinoma; 36.7%, invasive ductal carcinoma; 20.3%, squamous cell carcinomas; 8.2% and hepatocellular carcinomas; 4.4%). Leukemias and lymphomas accounted for 9.2% of cases, whereas sarcomas accounted for 5.1% of cases. Conclusion: Infection-related and noninfection-related cancers cause most mortality in UPTH. The 5th decade was the most commonly affected, while female breast was the single most involved organ. Breast, prostate and hematolymphoid malignancies are common causes of CM with death from breast occurring earliest. Majority of the deceased were educated, working-class urban dwellers. More advocacies on public acceptance of cancer screening and cancer preventive lifestyles as well as governments' improvement on workforce training and treatment infrastructure will improve the current CM profile in Port Harcourt.
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171
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Westfal ML, Chang DC, Kelleher CM. A population-based analysis of pediatric breast cancer. J Pediatr Surg 2019; 54:140-144. [PMID: 30352693 DOI: 10.1016/j.jpedsurg.2018.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 10/01/2018] [Indexed: 01/27/2023]
Abstract
PURPOSE The purpose of this study was to evaluate trends in demographics and outcomes of pediatric breast cancer in a United States population-based cohort. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was utilized to identify all pediatric patients with malignant breast tumors between 1973 and 2014. Analysis was performed using Stata Statistical Software version 13.1. Associations between categorical variables were made using X2 test. Log-rank test was used for univariate survival analysis. Kaplan-Meier analysis investigated five-year survival rates across several variables. Adjusted analysis was performed using a Cox Proportional-Hazards regression. RESULTS 134 patients with breast malignancies were identified. Carcinoma was the most prevalent histology (48.5%), followed by fibroepithelial tumors (FETs) (35.1%), and sarcoma (14.2%). FETs were twice as common in black compared to nonblack patients (56.3% vs. 29.0%, p < 0.01). Analyzing histology by stage revealed that 100% of FETs were early stage disease (p < 0.0001). 46.7% of the tumors tested were ER/PR negative, more than twice as many compared to the published adult estimate of 20.0%. Unadjusted survival analysis revealed worse survival for patients with adenocarcinoma/sarcomas, advanced stage, and high grade disease, without a survival difference between races. CONCLUSION Breast cancer remains a rare malignancy among pediatric patients. Although black patients were found to have more noncarcinomatous tumors with less advanced disease, this did not confer a survival advantage. TYPE OF STUDY Retrospective cohort study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Maggie L Westfal
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - David C Chang
- Department of Surgery, Massachusetts General Hospital, Boston, MA
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172
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Suresh T, Sharma J, Goel S, Kovac E, Gao Q, Gartrell B. Patient Characteristics at Prostate Cancer Diagnosis in Different Races at an Academic Center Serving a Diverse Population. Clin Genitourin Cancer 2018; 17:139-144. [PMID: 30655076 DOI: 10.1016/j.clgc.2018.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/30/2018] [Accepted: 12/01/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND In the United States, the prostate cancer (PCa) incidence and death rate has been greater in non-Hispanic black (NHB) men than in non-Hispanic white (NHW) men and slightly lower in Hispanic men than in NHW men. We compared the sociodemographic and baseline prognostic factors at the diagnosis of PCa in different races/ethnicities at a large, academic center serving an ethnically diverse population. METHODS The Montefiore Medical Center Cancer Registry was used to generate a comprehensive list of all patients with PCa diagnosed from 2004 to 2014. The clinical Looking Glass (a proprietary searchable database of patient information) and individual patient medical record review were used to obtain data, including age at diagnosis, socioeconomic status (SES), clinical Gleason score, clinical stage, and prostate-specific antigen level at diagnosis. The patients were classified by self-identified race/ethnicity as Hispanic, NHB, NHW, or other. The χ2 test was used for categorical variables, and analysis of variance or the Kruskal-Wallis test was used for continuous variables. RESULTS We identified 2352 patients with newly diagnosed PCa during the study period, including 778 Hispanic, 1046 NHB, 486 NHW, and 42 other. The NHW men were significantly older at diagnosis (Hispanic, 63.2 years; NHB, 63.4 years; NHW, 67 years; other, 63.0 years; P < .0001). The mean SES for the Hispanic and NHB men was significantly lower (SES below average: Hispanic, 92.8%; NHB, 91.3%; NHW, 56.6%; other, 75%; P < .0001). The Gleason score at diagnosis differed among these race groups (Gleason score ≤6 PCa: Hispanic, 42.8%; NHB, 39.1%; NHW, 52.2%; other, 50%; Gleason score 8-10: Hispanic, 15.8%; NHB, 17.6%; NHW, 14.3%; other, 16.7%; P = .0005). The proportion of men with metastatic disease at diagnosis also differed significantly among the groups (Hispanic, 7.5%; NHB, 9.0%; NHW, 4.3%; other, 9.5%; P = .0139). Using pairwise comparisons, the odds ratio for a higher Gleason score at presentation between NHB and NHW was 1.592 (P < .001) and was 1.378 for Hispanic versus NHW (P = .0200). The pairwise comparison for metastatic disease at diagnosis showed an odds ratio of 2.186 for NHB versus NHW (P = .0087). After adjusting for SES, the odds ratio for a higher Gleason score comparing NHB and NHW was 1.55 (P = .001). Although the odds of metastatic disease were greater in Hispanic men than in NHW men (odds ratio, 1.784), the differences were not statistically significant (P = .1197). CONCLUSIONS At our center, the clinical features of men from different racial groups differed significantly at the time of newly diagnosed PCa. Differences included age at diagnosis, SES, Gleason score, and proportion with metastatic disease. Our pairwise comparisons between different ethnic groups suggested that PCa in Hispanic men might be more similar to that in NHB than to that in NHW patients and are generally more aggressive at diagnosis.
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Affiliation(s)
- Tejas Suresh
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
| | - Janaki Sharma
- Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Sanjay Goel
- Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Evan Kovac
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Qi Gao
- Department of Epidemiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Benjamin Gartrell
- Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
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Hughes AE, Tiro JA, Balasubramanian BA, Skinner CS, Pruitt SL. Social Disadvantage, Healthcare Utilization, and Colorectal Cancer Screening: Leveraging Longitudinal Patient Address and Health Records Data. Cancer Epidemiol Biomarkers Prev 2018; 27:1424-1432. [PMID: 30135072 PMCID: PMC6279539 DOI: 10.1158/1055-9965.epi-18-0446] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/11/2018] [Accepted: 08/17/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Social disadvantage predicts colorectal cancer outcomes across the cancer care continuum for many populations and places. For medically underserved populations, social disadvantage is likely intersectional-affecting individuals at multiple levels and through membership in multiple disadvantaged groups. However, most measures of social disadvantage are cross-sectional and limited to race, ethnicity, and income. Linkages between electronic health records (EHR) and external datasets offer rich, multilevel measures that may be more informative. METHODS We identified urban safety-net patients eligible and due for colorectal cancer screening from the Parkland-UT Southwestern PROSPR cohort. We assessed one-time screening receipt (via colonoscopy or fecal immunochemical test) in the 18 months following cohort entry via the EHR. We linked EHR data to housing and Census data to generate measures of social disadvantage at the parcel- and block-group level. We evaluated the association of these measures with screening using multilevel logistic regression models controlling for sociodemographics, comorbidity, and healthcare utilization. RESULTS Among 32,965 patients, 45.1% received screening. In adjusted models, residential mobility, residence type, and neighborhood majority race were associated with colorectal cancer screening. Nearly all measures of patient-level social disadvantage and healthcare utilization were significant. CONCLUSIONS Address-based linkage of EHRs to external datasets may have the potential to expand meaningful measurement of multilevel social disadvantage. Researchers should strive to use granular, specific data in investigations of social disadvantage. IMPACT Generating multilevel measures of social disadvantage through address-based linkages efficiently uses existing EHR data for applied, population-level research.
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Affiliation(s)
- Amy E Hughes
- Department of Clinical Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Jasmin A Tiro
- Department of Clinical Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | - Bijal A Balasubramanian
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
- Department of Epidemiology, Human Genetics, and Environmental Sciences UTHealth in Dallas, Dallas, Texas
| | - Celette Sugg Skinner
- Department of Clinical Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | - Sandi L Pruitt
- Department of Clinical Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
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Kalin B, Pijnappel EN, van Gelder M, Visser O, van de Loosdrecht AA, Ossenkoppele GJ, Cornelissen JJ, Dinmohamed AG, Jongen-Lavrencic M. Intensive treatment and trial participation in elderly acute myeloid leukemia patients: A population-based analysis in The Netherlands. Cancer Epidemiol 2018; 57:90-96. [DOI: 10.1016/j.canep.2018.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/28/2018] [Accepted: 09/29/2018] [Indexed: 12/22/2022]
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175
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Ramirez O, Aristizabal P, Zaidi A, Gagnepain-Lacheteau A, Ribeiro RC, Bravo LE. Childhood cancer survival disparities in a universalized health system in Cali, Colombia. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2018. [DOI: 10.1016/j.phoj.2019.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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176
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Pou SA, Diaz MDP, Velazquez GA. Socio-Environmental Patterns Associated with Cancer Mortality: A Study Based on a Quality of Life Approach. Asian Pac J Cancer Prev 2018; 19:3045-3052. [PMID: 30485939 PMCID: PMC6318418 DOI: 10.31557/apjcp.2018.19.11.3045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: With 18.6% of total deaths due to malignant tumors in 2016, cancer is the second leading death cause
in Argentina. While there is a broad consensus on common risk factors at the individual cancer level, those operating
at a contextual level have been poorly studied in developing countries. The objective of our study was to identify
socio-environmental patterns in Argentina (2010), emphasizing quality of life, and to explore their associations with the
spatial distribution of cancer mortality in the country. Methods: The study was conducted in 525 geographical divisions
nested into 24 provinces. Sex-specific crude and age-standardized mortality rates (ASMR) for cancer (2009-2011 period)
were calculated. Empirically derived socio-environmental patterns were identified through principal-component factor
analysis on a selected set of variables: an urban scale and 29 indicators of a quality of life index in Argentina for 2010.
Two-level Poisson regression models were used to estimate associations between the ASMR and the continuous factor
scores for socio-environmental patterns as covariates. A random intercept was included to account for spatial variability
in the ASMR distribution using Stata software. Results: Four socio-environmental patterns were identified, termed
“Contexts with urban-related resources or cultural capital”, “Socioeconomically prosperous contexts”, “Environments
with anthropic exposures” and “Plains region” (cumulative explained variance=57%). High mortality rates were found
in counties characterized by socioeconomically prosperous contexts (RR=1.025 in women; 1.088 in men) and plain
landscapes (RR=1.057 and 1.117, respectively). Counties featuring urban or cultural resources demonstrated increased
mortality in women (RR=1.015, 95%CI=1.005-1.025), whereas rising rates associated with environments having
anthropic exposures (RR=1.008, 95%CI=1.001-1.016) were observed only for men. Conclusion: This study identified
four characteristic socio-environmental patterns in Argentina which incorporate features of quality of life, accounting
to some extent for the differential burden of cancer mortality in this country.
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Affiliation(s)
- Sonia Alejandra Pou
- Institute of Health Sciences Research (INICSA), Faculty of Medical Sciences, National Scientific and Technical Research Council (CONICET), University of Córdoba, Tandil, Argentina.,Biostatistics Unit, School of Nutrition, Faculty of Medical Sciences, University of Córdoba, Tandil, Argentina.
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177
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Finke I, Behrens G, Weisser L, Brenner H, Jansen L. Socioeconomic Differences and Lung Cancer Survival-Systematic Review and Meta-Analysis. Front Oncol 2018; 8:536. [PMID: 30542641 PMCID: PMC6277796 DOI: 10.3389/fonc.2018.00536] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 10/31/2018] [Indexed: 12/14/2022] Open
Abstract
Background: The impact of socioeconomic differences on cancer survival has been investigated for several cancer types showing lower cancer survival in patients from lower socioeconomic groups. However, little is known about the relation between the strength of association and the level of adjustment and level of aggregation of the socioeconomic status measure. Here, we conduct the first systematic review and meta-analysis on the association of individual and area-based measures of socioeconomic status with lung cancer survival. Methods: In accordance with PRISMA guidelines, we searched for studies on socioeconomic differences in lung cancer survival in four electronic databases. A study was included if it reported a measure of survival in relation to education, income, occupation, or composite measures (indices). If possible, meta-analyses were conducted for studies reporting on individual and area-based socioeconomic measures. Results: We included 94 studies in the review, of which 23 measured socioeconomic status on an individual level and 71 on an area-based level. Seventeen studies were eligible to be included in the meta-analyses. The meta-analyses revealed a poorer prognosis for patients with low individual income (pooled hazard ratio: 1.13, 95 % confidence interval: 1.08–1.19, reference: high income), but not for individual education. Group comparisons for hazard ratios of area-based studies indicated a poorer prognosis for lower socioeconomic groups, irrespective of the socioeconomic measure. In most studies, reported 1-, 3-, and 5-year survival rates across socioeconomic status groups showed decreasing rates with decreasing socioeconomic status for both individual and area-based measures. We cannot confirm a consistent relationship between level of aggregation and effect size, however, comparability across studies was hampered by heterogeneous reporting of socioeconomic status and survival measures. Only eight studies considered smoking status in the analysis. Conclusions: Our findings suggest a weak positive association between individual income and lung cancer survival. Studies reporting on socioeconomic differences in lung cancer survival should consider including smoking status of the patients in their analysis and to stratify by relevant prognostic factors to further explore the reasons for socioeconomic differences. A common definition for socioeconomic status measures is desirable to further enhance comparisons between nations and across different levels of aggregation.
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Affiliation(s)
- Isabelle Finke
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Gundula Behrens
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Linda Weisser
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
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178
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The appearance of breast cancer metastases on dry bone: Implications for forensic anthropology. J Forensic Leg Med 2018; 61:5-12. [PMID: 30388503 DOI: 10.1016/j.jflm.2018.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/02/2018] [Accepted: 10/22/2018] [Indexed: 02/06/2023]
Abstract
Breast carcinoma is a major cause of morbidity and mortality in women. The study of bone pathologies presents considerable potential in anthropology, paleopathology, forensic science and medicine. In this paper, we present and discuss metastatic lesions found in the skeletons of known individuals from the CAL Milano Cemetery Skeletal Collection, clinically diagnosed with breast cancer during life. Fourteen skeletons from a contemporary and identified collection were macroscopically studied and metastases were identified by comparison with clinical literature. As a result, bone metastases were observed in 43% of the study sample. They were located most commonly on the ribs (28.1%), pelvic girdle (19.8%), vertebrae (15.6%), skull (15.6%), scapulae (10.2%) as well as proximal segment of the femora (8.4%) and humeri (2.4%) respectively, favoring sites of high vascularization. The majority of the lesions were osteolytic, although osteoblastic and mixed metastases did occur. Osteolytic metastases appear as coalescent porosity or round to oval perforating lesions on bones with denticulated margins and pitted surrounding bone, whereas osteoblastic metastases thickened the existing trabecula (spongiosclerosis). Mixed metastases were perforating lytic lesions exposing the osteoblastic activity in the underlying trabecular bone. These results, consistent with the data from the literature, strengthen the diagnostic criteria for metastases and illustrate the aspect of bone metastases in breast carcinoma.
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179
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Treatment strategies and survival outcomes in older women with breast cancer: A comparative study between the FOCUS cohort and Nottingham cohort. J Geriatr Oncol 2018; 9:635-641. [DOI: 10.1016/j.jgo.2018.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/14/2018] [Accepted: 05/04/2018] [Indexed: 11/18/2022]
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180
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Mehta AJ, Stock S, Gray SW, Nerenz DR, Ayanian JZ, Keating NL. Factors contributing to disparities in mortality among patients with non-small-cell lung cancer. Cancer Med 2018; 7:5832-5842. [PMID: 30264921 PMCID: PMC6246958 DOI: 10.1002/cam4.1796] [Citation(s) in RCA: 9] [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: 11/26/2017] [Revised: 08/02/2018] [Accepted: 08/28/2018] [Indexed: 12/31/2022] Open
Abstract
Historically, non-small-cell lung cancer (NSCLC) patients who are non-white, have low incomes, low educational attainment, and non-private insurance have worse survival. We assessed whether differences in survival were attributable to sociodemographic factors, clinical characteristics at diagnosis, or treatments received. We surveyed a multiregional cohort of patients diagnosed with NSCLC from 2003 to 2005 and followed through 2012. We used Cox proportional hazard analyses to estimate the risk of death associated with race/ethnicity, annual income, educational attainment, and insurance status, unadjusted and sequentially adjusting for sociodemographic factors, clinical characteristics, and receipt of surgery, chemotherapy, and radiotherapy. Of 3250 patients, 64% were white, 16% black, 7% Hispanic, and 7% Asian; 36% of patients had incomes <$20 000/y; 23% had not completed high school; and 74% had non-private insurance. In unadjusted analyses, black race, Hispanic ethnicity, income <$60 000/y, not attending college, and not having private insurance were all associated with an increased risk of mortality. Black-white differences were not statistically significant after adjustment for sociodemographic factors, although patients with patients without a high school diploma and patients with incomes <$40 000/y continued to have an increased risk of mortality. Differences by educational attainment were not statistically significant after adjustment for clinical characteristics. Differences by income were not statistically significant after adjustment for clinical characteristics and treatments. Clinical characteristics and treatments received primarily contributed to mortality disparities by race/ethnicity and socioeconomic status in patients with NSCLC. Additional efforts are needed to assure timely diagnosis and use of effective treatment to lessen these disparities.
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Affiliation(s)
- Anish J. Mehta
- Department of MedicineBrigham and Women's HospitalBostonMassachusetts
| | - Shannon Stock
- Department of Mathematics and Computer ScienceCollege of the Holy CrossWorcesterMassachusetts
| | - Stacy W. Gray
- Department of Population SciencesCity of Hope Cancer CenterDuarteCalifornia
| | - David R. Nerenz
- Center for Health Policy and Health Services ResearchHenry Ford Health SystemDetroitMichigan
| | - John Z. Ayanian
- Institute for Healthcare Policy and InnovationUniversity of MichiganAnn ArborMichigan
| | - Nancy L. Keating
- Department of MedicineBrigham and Women's HospitalBostonMassachusetts
- Department of Health Care PolicyHarvard Medical SchoolBostonMassachusetts
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181
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Mai TTX, Lee YY, Suh M, Choi E, Lee EY, Ki M, Cho H, Park B, Jun JK, Kim Y, Oh JK, Choi KS. Socioeconomic Inequalities in Colorectal Cancer Screening in Korea, 2005-2015: After the Introduction of the National Cancer Screening Program. Yonsei Med J 2018; 59:1034-1040. [PMID: 30328317 PMCID: PMC6192887 DOI: 10.3349/ymj.2018.59.9.1034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 08/02/2018] [Accepted: 09/03/2018] [Indexed: 12/01/2022] Open
Abstract
PURPOSE This study aimed to investigate inequalities in colorectal cancer (CRC) screening rates in Korea and trends therein using the slope index of inequality (SII) and relative index of inequality (RII) across income and education groups. MATERIALS AND METHODS Data from the Korean National Cancer Screening Survey, an annually conducted, nationwide cross-sectional survey, were utilized. A total of 17174 men and women aged 50 to 74 years were included for analysis. Prior experience with CRC screening was defined as having either a fecal occult blood test within the past year or a lifetime colonoscopy. CRC screening rates and annual percentage changes (APCs) were evaluated. Then, SII and RII were calculated to assess inequality in CRC screening for each survey year. RESULTS CRC screening rates increased from 23.4% in 2005 to 50.9% in 2015 (APC, 7.8%; 95% CI, 6.0 to 9.6). Upward trends in CRC screening rates were observed for all age, education, and household income groups. Education inequalities were noted in 2009, 2014, and overall pooled estimates in both indices. Income inequalities were inconsistent among survey years, and overall estimates did not reach statistical significance. CONCLUSION Education inequalities in CRC screening among men and women aged 50 to 74 years were observed in Korea. No apparent pattern, however, was found for income inequalities. Further studies are needed to thoroughly outline socio-economic inequalities in CRC screening.
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Affiliation(s)
- Tran Thi Xuan Mai
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Yoon Young Lee
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Eunji Choi
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Eun Young Lee
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Moran Ki
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Hyunsoon Cho
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Boyoung Park
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Yeol Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Jin Kyoung Oh
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.
| | - Kui Son Choi
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.
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182
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Hallet J, Coburn NG, Singh S, Beyfuss K, Koujanian S, Liu N, Law CHL. Access to care and outcomes for neuroendocrine tumours: does socioeconomic status matter? ACTA ACUST UNITED AC 2018; 25:e356-e364. [PMID: 30464685 DOI: 10.3747/co.35.3930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Neuroendocrine tumours (nets) are a poorly understood malignancy lacking standardized care. Differences in socioeconomic status (ses) might worsen the effect of non-standardized care. We examined the effect of ses on net peri-diagnostic care patterns and outcomes. Methods In this population-based cohort study, net cases identified from a provincial cancer registry (1994-2009) were divided into low (1st and 2nd income quintiles) and high (3rd, 4th, and 5th quintiles) ses groups. We compared peri-diagnostic health care utilization (-2 years to +6 months), metastatic recurrence, and overall survival (os) between the groups. Results Of 4966 net patients, 38.3% had a low ses. Neither the primary net sites (p = 0.15), nor the metastatic presentation (p = 0.31) differed. Patients with low ses had a higher mean number of physician visits (20.1 ± 19.9 vs. 18.1 ± 16.5, p = 0.001) and imaging studies (56 ± 50 vs. 52 ± 44, p = 0.009) leading to the net diagnosis. Rates of primary tumour resection (p = 0.14), hepatectomy (p = 0.45), systemic therapy (p = 0.38), and liver embolization (p = 0.13) did not differ with ses. In the low-ses group, metastatic recurrence was more likely (41.1% vs. 37.6%, p = 0.01) during a median follow-up of 61.7 months, and the 10-year os was inferior (47.1% vs. 52.2%, p < 0.01). Low ses was associated with worse os (hazard ratio: 1.16; 95% confidence interval: 1.06 to 1.26) after adjustment for age, sex, comorbidity burden, primary net site, and rural living. Conclusions Low ses was associated with more physician visits and imaging before a net diagnosis, but not with more advanced stage at presentation nor with an effect on the pattern of therapy. Long-term outcomes were inferior in the low-ses group. These data can help to inform the design of health care delivery for nets.
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Affiliation(s)
- J Hallet
- Susan Leslie Clinic for Neuroendocrine Tumours, Odette Cancer Centre at Sunnybrook Health Sciences Centre, University of Toronto, ON.,Department of Surgery, University of Toronto, ON.,Institute for Clinical Evaluative Sciences, University of Toronto, ON.,Sunnybrook Research Institute, University of Toronto, ON
| | - N G Coburn
- Department of Surgery, University of Toronto, ON.,Institute for Clinical Evaluative Sciences, University of Toronto, ON.,Sunnybrook Research Institute, University of Toronto, ON
| | - S Singh
- Susan Leslie Clinic for Neuroendocrine Tumours, Odette Cancer Centre at Sunnybrook Health Sciences Centre, University of Toronto, ON.,Institute for Clinical Evaluative Sciences, University of Toronto, ON.,Sunnybrook Research Institute, University of Toronto, ON.,Department of Medicine, University of Toronto, ON
| | - K Beyfuss
- Sunnybrook Research Institute, University of Toronto, ON
| | - S Koujanian
- Sunnybrook Research Institute, University of Toronto, ON
| | - N Liu
- Institute for Clinical Evaluative Sciences, University of Toronto, ON
| | - C H L Law
- Susan Leslie Clinic for Neuroendocrine Tumours, Odette Cancer Centre at Sunnybrook Health Sciences Centre, University of Toronto, ON.,Department of Surgery, University of Toronto, ON.,Sunnybrook Research Institute, University of Toronto, ON
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183
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Patient, tumor, and healthcare factors associated with regional variability in lung cancer survival: a Spanish high-resolution population-based study. Clin Transl Oncol 2018; 21:621-629. [PMID: 30341474 DOI: 10.1007/s12094-018-1962-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/08/2018] [Indexed: 01/21/2023]
Abstract
PURPOSE The third most frequently diagnosed cancer in Europe in 2018 was lung cancer; it is also the leading cause of cancer death in Europe. We studied patient and tumor characteristics, and patterns of healthcare provision explaining regional variability in lung cancer survival in southern Spain. METHODS A population-based cohort study included all 1196 incident first invasive primary lung cancer (C33-C34 according to ICD-10) cases diagnosed between 2010 and 2011 with follow-up until April 2015. Data were drawn from local population-based cancer registries and patients' hospital medical records from all public and private hospitals from two regions in southern Spain. RESULTS There was evidence of regional differences in lung cancer late diagnosis (58% stage IV in Granada vs. 65% in Huelva, p value < 0.001). Among patients with stage I, only 67% received surgery compared with 0.6% of patients with stage IV. Patients treated with a combination of radiotherapy, chemotherapy, and surgery had a 2-year mortality risk reduction of 94% compared with patients who did not receive any treatment (excess mortality risk 0.06; 95% CI 0.02-0.16). Geographical differences in survival were observed between the two regions: 35% vs. 26% at 1-year since diagnosis. CONCLUSIONS The observed geographic differences in survival between regions are due in part to the late cancer diagnosis which determines the use of less effective therapeutic options. Results from our study justify the need for promoting lung cancer early detection strategies and the harmonization of the best practice in lung cancer management and treatment.
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184
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Sharp L, Westman B, Olofsson A, Leppänen A, Henriksson R. Access to supportive care during and after cancer treatment and the impact of socioeconomic factors. Acta Oncol 2018; 57:1303-1310. [PMID: 29947281 DOI: 10.1080/0284186x.2018.1484157] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Sweden's national cancer strategy points out several areas of cancer care that need improvements. Among them the need for supportive care resources to be accessible through the entire cancer trajectory and the reduction of socioeconomic inequalities. The aim of this study was to compare the patient-reported access to supportive care in the Stockholm-Gotland region between patients diagnosed in 2014 and 2016. The aim was also to describe how socioeconomic and other demographic factors impact access to supportive care. MATERIAL AND METHODS All patients with gynaecological, head and neck, haematological and upper gastrointestinal cancers diagnosed in the Stockholm-Gotland regions were identified through the Swedish Cancer Registries. Data were collected via a questionnaire on demographic, socioeconomic factors and patients' perception (n = 1872) of access to supportive care. Data were summarized using descriptive statistics and logistic regression was used for relevant variables. RESULTS Access to some supportive care resources, such as contact nurses (CNs) and individual written care plans (IWCPs) had significantly improved from 2014 to 2016. The proportion of patients that had received information about patient advocacy groups (PAGs) had also improved but remained on a relatively low level (29 and 35%, respectively). The proportion of patients being refereed to palliative care (PC) did not change between 2014 and 2016. In total, 10% of the patients reported to having received information on second medical opinion (SMO). Patients that had undergone multimodality cancer treatment were more likely to report access to supportive care, and those with lower education levels were more likely to have access to CNs and IWCPs. CONCLUSION Access to some of the supportive care resources have shown improvements in the Stockholm-Gotland region but further efforts are required, especially regarding access to PC, information about PAGs and SMOs.
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Affiliation(s)
- Lena Sharp
- Regional Cancer Centre, Stockholm-Gotland, Stockholm, Sweden
- Department of Learning Informatics Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Bodil Westman
- Regional Cancer Centre, Stockholm-Gotland, Stockholm, Sweden
| | - Anna Olofsson
- Regional Cancer Centre, Stockholm-Gotland, Stockholm, Sweden
| | - Arja Leppänen
- Regional Cancer Centre, Stockholm-Gotland, Stockholm, Sweden
| | - Roger Henriksson
- Regional Cancer Centre, Stockholm-Gotland, Stockholm, Sweden
- Department Radiation Sciences & Oncology, Umeå University, Umeå, Sweden
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185
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Nogueira MC, Guerra MR, Cintra JRD, Corrêa CSL, Fayer VA, Bustamante-Teixeira MT. Disparidade racial na sobrevivência em 10 anos para o câncer de mama: uma análise de mediação usando abordagem de respostas potenciais. CAD SAUDE PUBLICA 2018; 34:e00211717. [DOI: 10.1590/0102-311x00211717] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 05/02/2018] [Indexed: 01/23/2023] Open
Abstract
Os objetivos foram investigar a associação entre raça/cor e a sobrevivência em 10 anos de mulheres com câncer de mama e o papel do estadiamento como mediador. Coorte hospitalar com 481 mulheres com câncer invasivo de mama, diagnosticadas entre 2003 e 2005. Foram feitas comparações entre mulheres brancas e negras quanto às características sociodemográficas e ao estadiamento, usando o teste qui-quadrado, e à sobrevivência em 10 anos, usando os métodos de Kaplan-Meier e regressão de Cox. Foram estimados para a variável raça/cor efeitos diretos e indiretos, mediados pelo estadiamento, com ajuste para a condição social da área de residência e idade, utilizando o modelo de respostas potenciais (contrafactual) e regressão múltipla de Cox. As mulheres negras residiam em setores censitários de menor renda, eram usuárias do setor público em maior proporção e foram diagnosticadas com estadiamentos mais avançados. A sobrevivência específica em 10 anos foi de 64,3% (IC95%: 60,0; 68,9), com diferença significativa entre brancas (69,5%; IC95%: 64,8; 74,6) e negras (44%; IC95%: 35,2; 55,1). Nos modelos múltiplos, ajustados para renda e idade, as negras tiveram pior prognóstico (HR = 2,09; IC95%: 1,76; 2,51), e a proporção mediada pelo estadiamento foi de 40% (IC95%: 37; 42). Há disparidade racial na sobrevivência do câncer de mama em 10 anos, mediada principalmente pelo estadiamento mais avançado da doença nas mulheres negras. Isso aponta para a necessidade de ampliar a cobertura e a qualidade do programa de rastreamento dessa doença e facilitar o acesso ao diagnóstico e tratamento precoces, com vistas à redução da iniquidade racial.
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186
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Coetzee WC, Apffelstaedt JP, Zeeman T, Du Plessis M. Disparities in Breast Cancer: Private Patients Have Better Outcomes Than Public Patients. World J Surg 2018; 42:727-735. [PMID: 28819769 DOI: 10.1007/s00268-017-4187-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Different outcomes in breast cancer have been reported for low and high socio-economic groups. We present data quantifying disparities between South African public and private patients. METHODS Records of 240 consecutive patients treated in 2008 in a public versus 97 patients in a private health facility were reviewed for demographic and oncologic data. RESULTS The average of patients was 56.2 versus 51.9 years (p = 0.032). Stage at presentation was 0 in 0.83 versus 25.8%, I in 4.5 versus 15.5%, II in 41.3 versus 37.1%, III in 37.1 versus 18.6% and IV in 16.3 versus 3.1% public versus private patients. Seventy-three percent of patients were symptomatic versus 57.7%. Of patients with stage 0-III disease, 17.9 versus 20% had simple tumour excision and 7.5 versus 14%, oncoplastic tumour excision. The mastectomy rate was similar (52 vs. 60%), but immediate reconstruction was performed in 10 versus 63%. Public patients were less likely to have radiotherapy. The pathology was similar, 27.2 versus 20, 54 versus 52, 87 versus 61% of patients with stage I, II and III disease, respectively, had chemotherapy. Hormonal therapy for premenopausal patients in private was a LHRH agonist in 9.3%, ovarian ablation/BSO in 11.7% of public patients; biologicals were given in 7.2 versus 0% of patients. Overall survival for public versus private was 66 versus 80% (p < 0.001) months. Better per stage survival of private patients 100 versus 100, 72.7 versus 93.3, 84.8 versus 88.9, 57.3 versus 77.8 and 33 versus 33% for stages 0, I, II, III and IV, did not reach statistical significance. CONCLUSION The greatest impact on outcome was stage at presentation, but more aggressive therapy for each stage resulted in a trend to better outcome for private patients.
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Affiliation(s)
- W C Coetzee
- Department of General Surgery, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
| | - J P Apffelstaedt
- Department of General Surgery, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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187
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Zhou H, Xian W, Zhang Y, Chen G, Zhao S, Chen X, Zhang Z, Shen J, Hong S, Huang Y, Zhang L. Trends in incidence and associated risk factors of suicide mortality in patients with non-small cell lung cancer. Cancer Med 2018; 7:4146-4155. [PMID: 29971970 PMCID: PMC6089196 DOI: 10.1002/cam4.1656] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 06/09/2018] [Accepted: 06/11/2018] [Indexed: 12/31/2022] Open
Abstract
Lung cancer patients have an increased risk for committing suicide. But no comprehensive study about the suicide issues among non-small-cell lung cancer (NSCLC) patients has been published. We aimed to estimate the trend of suicide rate and identify the high-risk group of NSCLC patients. Patients diagnosed with primary NSCLC were identified from Surveillance, Epidemiology, and End Results (SEER) database (1973-2013). Suicide mortality rate (SMR) were calculated. Multivariable logistic regression was employed to find out independent risk factors for suicide. Among 495 889 NSCLC patients, 694 (0.14%) of them died from suicide. The suicide mortality rates have significantly decreased (before 1993: 0.21%, 1994-2003: 0.16%, after 2004: 0.09%, P < .001). Male (OR 6.22, 95% CI: 4.96-7.98, P < .001), white (OR 3.89, 95% CI: 2.66-5.97, P < .001), being unmarried (OR 1.43, 95% CI: 1.22-1.67, P < .001), the elderly (60-74 vs <60: OR 1.24, 95% CI: 1.03-1.50, P = .024, >75 vs <60: OR 1.31, 95% CI: 1.05-1.63, P = .018) were independently associated with higher risk of suicide mortality. Surgery (OR: 1.44, 95% CI: 1.19-1.73, P < .001) was also relative with higher risk of suicide. Our study observed significant decrease in suicide mortality among NSCLC patients in US over past decades. Older age, male sex, unmarried status, and surgery were risk factors of committing suicide. Clinicians should be aware of these high-risk groups.
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Affiliation(s)
- Huaqiang Zhou
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaGuangzhouChina
- Collaborative Innovation Center for Cancer MedicineGuangzhouChina
- Zhongshan School of MedicineSun Yat‐sen UniversityGuangzhouChina
| | - Wei Xian
- Zhongshan School of MedicineSun Yat‐sen UniversityGuangzhouChina
| | - Yaxiong Zhang
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaGuangzhouChina
- Collaborative Innovation Center for Cancer MedicineGuangzhouChina
| | - Gang Chen
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaGuangzhouChina
- Collaborative Innovation Center for Cancer MedicineGuangzhouChina
| | - Shen Zhao
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaGuangzhouChina
- Collaborative Innovation Center for Cancer MedicineGuangzhouChina
| | - Xi Chen
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaGuangzhouChina
- Collaborative Innovation Center for Cancer MedicineGuangzhouChina
| | - Zhonghan Zhang
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaGuangzhouChina
- Collaborative Innovation Center for Cancer MedicineGuangzhouChina
| | - Jiayi Shen
- Zhongshan School of MedicineSun Yat‐sen UniversityGuangzhouChina
| | - Shaodong Hong
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaGuangzhouChina
- Collaborative Innovation Center for Cancer MedicineGuangzhouChina
| | - Yan Huang
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaGuangzhouChina
- Collaborative Innovation Center for Cancer MedicineGuangzhouChina
| | - Li Zhang
- Department of Medical OncologySun Yat‐sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaGuangzhouChina
- Collaborative Innovation Center for Cancer MedicineGuangzhouChina
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188
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Jacobs J, Peterson KL, Allender S, Alston LV, Nichols M. Regional variation in cardiovascular mortality in Australia 2009–2012: the impact of remoteness and socioeconomic status. Aust N Z J Public Health 2018; 42:467-473. [DOI: 10.1111/1753-6405.12807] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 01/01/2018] [Accepted: 05/01/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Jane Jacobs
- Global Obesity Centre, Centre for Population Health ResearchDeakin University Victoria
| | - Karen Louise Peterson
- Wardliparingga Aboriginal Research UnitSouth Australian Health and Medical Research Institute Adelaide South Australia
| | - Steven Allender
- Global Obesity Centre, Centre for Population Health ResearchDeakin University Victoria
| | - Laura Veronica Alston
- Global Obesity Centre, Centre for Population Health ResearchDeakin University Victoria
| | - Melanie Nichols
- Global Obesity Centre, Centre for Population Health ResearchDeakin University Victoria
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189
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Relecom A, Arzel B, Perneger T. Effect of an organised screening program on socioeconomic inequalities in mammography practice, knowledge and attitudes. Int J Equity Health 2018; 17:95. [PMID: 29970090 PMCID: PMC6031106 DOI: 10.1186/s12939-018-0811-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 06/25/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Breast cancer stands as the leading cause of cancer related mortality in women worldwide. Mammography screening has the potential to improve prognosis by reducing stage at diagnosis. Socioeconomic inequalities in mammography cancer screening have been widely reported. The influence of organised programs on socioeconomic disparities regarding mammography screening is to date unclear. We aimed to investigate the impact of an organised regional screening program on socioeconomic inequalities in terms of the uptake, knowledge and attitudes towards mammography screening. METHODS Data were obtained from two cross-sectional surveys of women 50 to 69 years old conducted in 1998 and 2012, before and after the implementation of an organised breast cancer screening program in Geneva, Switzerland. Socioeconomic status was measured by monthly household income and education level. Logistic and linear regression multivariable models were used to investigate the evolution of socioeconomic gradients between 1998 and 2012 in terms of uptake, knowledge and attitudes towards mammography screening. RESULTS In 1998, before the implementation of an organised screening program, 44% of women from the lowest education category reported mammography practice conforming to recommendations versus 63% of the more educated participants. This socioeconomic gradient was no longer present in 2012 where reported mammography practice at guideline-recommended frequency were 83 and 82% in the lowest and highest education level categories respectively (change in education gradient over time, p = 0.018). The difference in mammography practice in agreement with recommendations between the lowest and the highest income category went from 27 percentage points in 1998 to 14 percentage points in 2012 (change in income gradient over time, p = 0.10). The socioeconomic gradient in negative attitudes towards mammography screening persisted in 2012 but was reduced compared to 1998. We did not observe a reduction in the socioeconomic disparities in knowledge regarding mammography screening over this period. CONCLUSIONS This study suggests that mammography screening programs may lessen socioeconomic inequities in mammography practice. Such programs should feature adapted communication tools to reach women of lower socioeconomic status to attempt to further reduce socioeconomic gradients in mammography screening.
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Affiliation(s)
- A. Relecom
- Division of Clinical Epidemiology, Geneva University Hospitals, rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Oncology Unit, Geneva University Hospitals, rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
| | - B. Arzel
- Geneva Foundation for Breast Cancer Screening, Boulevard de la Cluse 43, 1205 Geneva, Switzerland
| | - T. Perneger
- Division of Clinical Epidemiology, Geneva University Hospitals, rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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190
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Tomic K, Ventimiglia E, Robinson D, Häggström C, Lambe M, Stattin P. Socioeconomic status and diagnosis, treatment, and mortality in men with prostate cancer. Nationwide population-based study. Int J Cancer 2018; 142:2478-2484. [PMID: 29363113 PMCID: PMC5947133 DOI: 10.1002/ijc.31272] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 12/05/2017] [Accepted: 01/10/2018] [Indexed: 11/17/2022]
Abstract
Patients with high socioeconomic status (SES) have better cancer outcomes than patients with low SES. This has also been shown in Sweden, a country with tax-financed health care aiming to provide care on equal terms to all residents. The association between income and educational level and diagnostics and treatment as outlined in national guidelines and prostate cancer (Pca) and all-cause mortality was assessed in 74,643 men by use of data in the National Prostate Cancer Register of Sweden and a number of other health care registers and demographic databases. In multivariable logistic regression analysis, men with high income had higher probability of Pca detected in a health-check-up, top versus bottom income quartile, odds ratio (OR) 1.60 (95% CI 1.45-1.77) and lower probability of waiting more than 3 months for prostatectomy, OR 0.77 (0.69-0.86). Men with the highest incomes also had higher probability of curative treatment for intermediate and high-risk cancer, OR 1.77 (1.61-1.95) and lower risk of positive margins, (incomplete resection) at prostatectomy, OR 0.80 (0.71-0.90). Similar, but weaker associations were observed for educational level. At 6 years of follow-up, Pca mortality was modestly lower for men with high income, which was statistically significant for localized high-risk and metastatic Pca in men with no comorbidities. All-cause mortality was less than half in top versus bottom quartile of income (12% vs. 30%, p < 0.001) among men above age 65. Our findings underscore the importance of adherence to guidelines to ensure optimal and equal care for all patients diagnosed with cancer.
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Affiliation(s)
- Katarina Tomic
- Department of Surgical and Perioperative Sciences, Urology and AndrologyUmeå UniversityUmeåSweden
| | - Eugenio Ventimiglia
- Division of Experimental Oncology/Unit of UrologyURI; IRCCS Ospedale San RaffaeleMilanItaly
| | | | - Christel Häggström
- Department of Surgical SciencesUppsala University HospitalUppsalaSweden
- Department of Biobank ResearchUmeå UniversityUmeåSweden
| | - Mats Lambe
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Regional Cancer Centre Uppsala ÖrebroUppsala University HospitalUppsalaSweden
| | - Pär Stattin
- Department of Surgical SciencesUppsala University HospitalUppsalaSweden
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191
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Klapheke A, Yap SA, Pan K, Cress RD. Sociodemographic disparities in chemotherapy treatment and impact on survival among patients with metastatic bladder cancer. Urol Oncol 2018; 36:308.e19-308.e25. [PMID: 29628318 PMCID: PMC5960436 DOI: 10.1016/j.urolonc.2018.03.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 03/06/2018] [Accepted: 03/12/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate how socioeconomic status and other demographic factors are associated with the receipt of chemotherapy and subsequent survival in patients diagnosed with metastatic bladder cancer. METHODS Using data from the California Cancer Registry, we identified 3,667 patients diagnosed with metastatic urothelial carcinoma of the urinary bladder between 1988 and 2014. The characteristics of patients who did and did not receive chemotherapy as part of the first course of treatment were compared using chi-square tests. Logistic regression was used to identify predictors of chemotherapy treatment. Fine and Gray competing-risks regression and Cox proportional hazards regression were used to estimate bladder cancer-specific and all-cause mortality, respectively. RESULTS Less than half (46.3%) of patients received chemotherapy. Patients from the lowest socioeconomic quintile were half as likely to have chemotherapy as those from highest quintile (odds ratio = 0.5, 95% CI: 0.4, 0.7). Unmarried patients were significantly less likely to receive treatment (odds ratio = 0.6, 95% CI: 0.5, 0.7). Not receiving chemotherapy was associated with greater mortality from bladder cancer (subdistribution hazard ratio = 1.4, 95% CI: 1.3, 1.5) and from all causes (hazard ratio = 2.0, 95% CI: 1.8, 2.1). CONCLUSIONS We found clear disparities in chemotherapy treatment and survival with respect to socioeconomic and marital status. Future studies should explore the possible reasons why patients with low socioeconomic status and who are unmarried are less likely to have chemotherapy.
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Affiliation(s)
- Amy Klapheke
- Public Health Institute, Cancer Registry of Greater California, Sacramento, CA; Department of Public Health Sciences, University of California Davis, Davis, CA.
| | - Stanley A Yap
- Department of Urology, University of California Davis, Sacramento, CA; University of California Davis Comprehensive Cancer Center, Sacramento, CA
| | | | - Rosemary D Cress
- Public Health Institute, Cancer Registry of Greater California, Sacramento, CA; Department of Public Health Sciences, University of California Davis, Davis, CA
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Vallance AE, van der Meulen J, Kuryba A, Braun M, Jayne DG, Hill J, Cameron IC, Walker K. Socioeconomic differences in selection for liver resection in metastatic colorectal cancer and the impact on survival. Eur J Surg Oncol 2018; 44:1588-1594. [PMID: 29895508 DOI: 10.1016/j.ejso.2018.05.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 05/02/2018] [Accepted: 05/17/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Socioeconomic inequalities in colorectal cancer (CRC) survival are well recognised. The aim of this study was to describe the impact of socioeconomic deprivation on survival in patients with synchronous CRC liver-limited metastases, and to investigate if any survival inequalities are explained by differences in liver resection rates. METHODS Patients in the National Bowel Cancer Audit diagnosed with CRC between 2010 and 2016 in the English National Health Service were included. Linked Hospital Episode Statistics data were used to identify the presence of liver metastases and whether a liver resection had been performed. Multivariable random-effects logistic regression was used to estimate the odds ratio (OR) of liver resection by Index of Multiple Deprivation (IMD) quintile. Cox-proportional hazards model was used to compare 3-year survival. RESULTS 13,656 patients were included, of whom 2213 (16.2%) underwent liver resection. Patients in the least deprived IMD quintile were more likely to undergo liver resection than those in the most deprived quintile (adjusted OR 1.42, 95% confidence interval (CI) 1.18-1.70). Patients in the least deprived quintile had better 3-year survival (least deprived vs. most deprived quintile, 22.3% vs. 17.4%; adjusted hazard ratio (HR) 1.20, 1.11-1.30). Adjusting for liver resection attenuated, but did not remove, this effect. There was no difference in survival between IMD quintile when restricted to patients who underwent liver resection (adjusted HR 0.97, 0.76-1.23). CONCLUSIONS Deprived CRC patients with synchronous liver-limited metastases have worse survival than more affluent patients. Lower rates of liver resection in more deprived patients is a contributory factor.
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Affiliation(s)
- A E Vallance
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.
| | - J van der Meulen
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - A Kuryba
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - M Braun
- Christie NHS Foundation Trust, Manchester, UK
| | - D G Jayne
- The John Goligher Colorectal Surgery Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - J Hill
- Department of General Surgery, Manchester Royal Infirmary, Manchester, UK
| | - I C Cameron
- Department of Hepatobiliary and Pancreatic Surgery, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - K Walker
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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193
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Smits S, McCutchan G, Wood F, Edwards A, Lewis I, Robling M, Paranjothy S, Carter B, Townson J, Brain K. Development of a Behavior Change Intervention to Encourage Timely Cancer Symptom Presentation Among People Living in Deprived Communities Using the Behavior Change Wheel. Ann Behav Med 2018; 52:474-488. [PMID: 27826697 PMCID: PMC6367899 DOI: 10.1007/s12160-016-9849-x] [Citation(s) in RCA: 27] [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: 12/22/2022] Open
Abstract
Background Targeted public awareness interventions are needed to improve earlier cancer diagnosis and reduce socioeconomic inequalities in cancer outcomes. The health check (intervention) is a touchscreen questionnaire delivered by trained lay advisors that aims to raise awareness of cancer symptoms and risk factors and encourage timely help seeking. Purpose This study aimed to apply the Behavior Change Wheel to intervention refinement by identifying barriers and facilitators to timely symptom presentation among people living in socioeconomically deprived communities. Methods Primary data (six focus groups with health professionals, community partners and public) and secondary data (systematic review of barriers and facilitators to cancer symptom presentation) were mapped iteratively to the Behavior Change Wheel. Results Barriers and facilitators were identified from the systematic review and focus groups comprising 14 members of the public aged over 40, 14 community partners, and 14 healthcare professionals. Barriers included poor symptom knowledge and lack of motivation to engage in preventive or proactive behaviors. Facilitators included cues/prompts to action, general practitioner preparedness to listen, and social networks. The following behavior change techniques were selected to address identified barriers and facilitators: information about health consequences, prompts/cues, credible sources, restricting physical and social environment, social support, goal setting, and action planning. Conclusions The Behavior ChangeWheel triangulated findings from primary and secondary data sources. An intervention combining education and enablement could encourage timely symptom presentation to primary care among people living in socioeconomically deprived communities. Social encouragement and support is needed to increase symptom knowledge, challenge negative cancer beliefs, and prompt decisions to engage with the healthcare system.
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Affiliation(s)
- Stephanie Smits
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Grace McCutchan
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Fiona Wood
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | | | - Michael Robling
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Shantini Paranjothy
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Ben Carter
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Julia Townson
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Kate Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK
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Belot A, Remontet L, Rachet B, Dejardin O, Charvat H, Bara S, Guizard AV, Roche L, Launoy G, Bossard N. Describing the association between socioeconomic inequalities and cancer survival: methodological guidelines and illustration with population-based data. Clin Epidemiol 2018; 10:561-573. [PMID: 29844706 PMCID: PMC5961638 DOI: 10.2147/clep.s150848] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Describing the relationship between socioeconomic inequalities and cancer survival is important but methodologically challenging. We propose guidelines for addressing these challenges and illustrate their implementation on French population-based data. METHODS We analyzed 17 cancers. Socioeconomic deprivation was measured by an ecological measure, the European Deprivation Index (EDI). The Excess Mortality Hazard (EMH), ie, the mortality hazard among cancer patients after accounting for other causes of death, was modeled using a flexible parametric model, allowing for nonlinear and/or time-dependent association between the EDI and the EMH. The model included a cluster-specific random effect to deal with the hierarchical structure of the data. RESULTS We reported the conventional age-standardized net survival (ASNS) and described the changes of the EMH over the time since diagnosis at different levels of deprivation. We illustrated nonlinear and/or time-dependent associations between the EDI and the EMH by plotting the excess hazard ratio according to EDI values at different times after diagnosis. The median excess hazard ratio quantified the general contextual effect. Lip-oral cavity-pharynx cancer in men showed the widest deprivation gap, with 5-year ASNS at 41% and 29% for deprivation quintiles 1 and 5, respectively, and we found a nonlinear association between the EDI and the EMH. The EDI accounted for a substantial part of the general contextual effect on the EMH. The association between the EDI and the EMH was time dependent in stomach and pancreas cancers in men and in cervix cancer. CONCLUSION The methodological guidelines proved efficient in describing the way socioeconomic inequalities influence cancer survival. Their use would allow comparisons between different health care systems.
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Affiliation(s)
- Aurélien Belot
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Non-Communicable Diseases and Trauma Direction, The French Public Health Agency, Saint-Maurice, France
- Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France
| | - Laurent Remontet
- Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France
- UMR 5558, Biometry and Evolutionary Biology Laboratory, Biostatistics Health Group, CNRS, University Lyon 1, Lyon, France
| | - Bernard Rachet
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Olivier Dejardin
- National Institute of Health and Medical Research U1086 ANTICIPE, Caen, France
- Calvados Digestive Cancer Registry, Centre Hospitalier Universitaire, Caen, France
| | - Hadrien Charvat
- Prevention Division, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Simona Bara
- Manche General Cancer Registry, Centre Hospitalier Public du Cotentin, Cherbourg-en-Cotentin, France
| | - Anne-Valérie Guizard
- National Institute of Health and Medical Research U1086 ANTICIPE, Caen, France
- Calvados General Cancer Registry, Centre François Baclesse, Caen, France
| | - Laurent Roche
- Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France
- UMR 5558, Biometry and Evolutionary Biology Laboratory, Biostatistics Health Group, CNRS, University Lyon 1, Lyon, France
| | - Guy Launoy
- National Institute of Health and Medical Research U1086 ANTICIPE, Caen, France
- Calvados Digestive Cancer Registry, Centre Hospitalier Universitaire, Caen, France
| | - Nadine Bossard
- Department of Biostatistics and Bioinformatics, Hospices Civils de Lyon, Lyon, France
- UMR 5558, Biometry and Evolutionary Biology Laboratory, Biostatistics Health Group, CNRS, University Lyon 1, Lyon, France
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Benmarhnia T, Delpla I, Schwarz L, Rodriguez MJ, Levallois P. Heterogeneity in the Relationship between Disinfection By-Products in Drinking Water and Cancer: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15050979. [PMID: 29757939 PMCID: PMC5982018 DOI: 10.3390/ijerph15050979] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/07/2018] [Accepted: 05/09/2018] [Indexed: 12/02/2022]
Abstract
The epidemiological evidence demonstrating the effect of disinfection by-products (DBPs) from drinking water on colon and rectal cancers is well documented. However, no systematic assessment has been conducted to assess the potential effect measure modification (EMM) in the relationship between DBPs and cancer. The objective of this paper is to conduct a systematic literature review to determine the extent to which EMM has been assessed in the relationship between DBPs in drinking water in past epidemiological studies. Selected articles (n = 19) were reviewed, and effect estimates and covariates that could have been used in an EMM assessment were gathered. Approximately half of the studies assess EMM (n = 10), but the majority of studies only estimate it relative to sex subgroups (n = 6 for bladder cancer and n = 2 both for rectal and colon cancers). Although EMM is rarely assessed, several variables that could have a potential modification effect are routinely collected in these studies, such as socioeconomic status or age. The role of environmental exposures through drinking water can play an important role and contribute to cancer disparities. We encourage a systematic use of subgroup analysis to understand which populations or territories are more vulnerable to the health impacts of DBPs.
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Affiliation(s)
- Tarik Benmarhnia
- Department of Family Medicine and Public Health & Scripps Institution of Oceanography, University of California, San Diego, CA 92093, USA.
| | - Ianis Delpla
- École Supérieure D'aménagement du Territoire et de Développement Régional (ESAD), Université Laval, 1624 Pavillon Savard, Québec, QC G1K-7P4, Canada.
| | - Lara Schwarz
- Department of Family Medicine and Public Health & Scripps Institution of Oceanography, University of California, San Diego, CA 92093, USA.
| | - Manuel J Rodriguez
- École Supérieure D'aménagement du Territoire et de Développement Régional (ESAD), Université Laval, 1624 Pavillon Savard, Québec, QC G1K-7P4, Canada.
| | - Patrick Levallois
- Direction de la Santé Environnementale et de la Toxicologie, Institut National de Santé Publique du Québec, Québec, QC G1V 5B3, Canada.
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du Centre Hospitalier Universitaire (CHU) de Québec, Québec, QC G1V 2M2, Canada.
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197
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Nymo LS, Aabakken L, Lassen K. Priority and prejudice: does low socioeconomic status bias waiting time for endoscopy? A blinded, randomized survey. Scand J Gastroenterol 2018; 53:621-625. [PMID: 29141477 DOI: 10.1080/00365521.2017.1402207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION An unwanted socioeconomic health gap is observed in Western countries with easily accessible, government-financed health care systems. Survival rates from several malignancies differ between socioeconomic clusters and the disparities remain after adjusting for major co-morbidities and health related behavior. The possibility of biased conduct among health care workers has been proposed as a contributing factor, but evidence is sparse. METHODS A blinded, randomized online questionnaire survey was conducted among specialists in gastroenterology in Norway. Each respondent was asked to give priority for colonoscopy to three different referrals. By randomized sequence, half the referrals contained a discreet piece of information indicating low socioeconomic status (SES). The SES information given was focused on known low-status clusters in Norway, namely the morbidly obese and receivers of disability pensions. RESULTS There were 107 respondents giving a response rate of 67%. A lower priority was consistently given to the referrals containing information on low SES, but the difference only reached statistical significance (p = .018) for one of the referrals. CONCLUSION Information on low SES may influence how referrals for endoscopy are prioritized.
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Affiliation(s)
- Linn Såve Nymo
- a Department of Gastrointestinal Surgery , University Hospital of Northern Norway , Tromsoe , Norway
| | - Lars Aabakken
- b Division of Surgery, Inflammation medicine and Transplantation, Gastrointestinal endoscopy department , Oslo University Hospital , Rikshospitalet , Norway
| | - Kristoffer Lassen
- c Department of Gastrointestinal and Hepatopancreatobiliary Surgery , Oslo University Hospital , Rikshospitalet , Norway
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Friis K, Larsen FB, Nielsen CV, Momsen AMH, Stapelfeldt CM. Social inequality in cancer survivors' health behaviours-A Danish population-based study. Eur J Cancer Care (Engl) 2018; 27:e12840. [PMID: 29668067 DOI: 10.1111/ecc.12840] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2018] [Indexed: 11/30/2022]
Abstract
The aim of this study was to compare health behaviours (smoking, alcohol consumption, physical activity and diet), to explore social inequality in these behaviours among cancer survivors and individuals with no history of cancer, respectively, and to study the impact of time since diagnosis on cancer survivors' health behaviours. Data from the Danish National Health Survey from 2013 were linked with data from the Danish Cancer Registry to identify all cancer diagnoses among the respondents during the period 1945-2012. In total, 11,166 cancer survivors and 151,117 individuals with no history of cancer were included. Cancer survivors smoked less and had a more sedentary lifestyle than individuals with no history of cancer. In relation to alcohol and dietary habits, no differences were found between the groups. Wide variations in health behaviours were seen across cancer sites, and in particular lung, bladder and oral cancer survivors had poor health behaviours. We found a clear social gradient in cancer survivors' health behaviours which reveals the need for greater focus on socially differentiated initiatives within prevention and patient education for cancer survivors. Our study revealed rather blurred results in relation to identifying the optimal timing for health-related behavioural interventions in cancer survivors.
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Affiliation(s)
- K Friis
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - F B Larsen
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - C V Nielsen
- DEFACTUM, Central Denmark Region, Aarhus, Denmark.,Department of Public Health, Section of Clinical Social Medicine and Rehabilitation, Aarhus, Denmark
| | - A-M H Momsen
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
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Vercelli M, Lillini R, Quaglia A, Capocaccia R, Vercelli M, Lillini L, Quaglia A, Capocaccia R, De Angelis R, Gatta G, Tagliabue G, Pannozzo F, Ramazzotti V, Fusco M, Cilia S, De Felice E, Vattiato R, Senatore R, Zucchetto A, Buzzoni C, Tognazzo S, Bellù F, Piffer S, Cusimano R, Zarcone M, Cirilli C, Stracci F, Ferretti S, Cesaraccio R, Rosso S, Giacomin A, Cuccaro F, Michiara M. Italian Regional Health System Structure and Expected Cancer Survival. TUMORI JOURNAL 2018. [DOI: 10.1177/1636.17892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marina Vercelli
- Liguria Region Cancer Registry, Descriptive Epidemiology Unit, IRCCS Azienda Ospedaliera Universitaria San Martino – IST Istituto Nazionale per la Ricerca sul Cancro, Genoa
- Department of Health Sciences, University of Genoa, Genoa
| | - Roberto Lillini
- Liguria Region Cancer Registry, Descriptive Epidemiology Unit, IRCCS Azienda Ospedaliera Universitaria San Martino – IST Istituto Nazionale per la Ricerca sul Cancro, Genoa
- National Center of Epidemiology, Surveillance and Promotion of Health, National Institute of Health, Rome
- “Vita & Salute” San Raffaele University, Milan, Italy
| | - Alberto Quaglia
- Liguria Region Cancer Registry, Descriptive Epidemiology Unit, IRCCS Azienda Ospedaliera Universitaria San Martino – IST Istituto Nazionale per la Ricerca sul Cancro, Genoa
| | - Riccardo Capocaccia
- Liguria Region Cancer Registry, Descriptive Epidemiology Unit, IRCCS Azienda Ospedaliera Universitaria San Martino – IST Istituto Nazionale per la Ricerca sul Cancro, Genoa
- National Center of Epidemiology, Surveillance and Promotion of Health, National Institute of Health, Rome
| | - M Vercelli
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS
| | - L Lillini
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS
| | - A Quaglia
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS
| | - R Capocaccia
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS
| | - R De Angelis
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS
| | - G Gatta
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS
| | - G Tagliabue
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS
| | - F Pannozzo
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS
| | - V Ramazzotti
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS
| | - M Fusco
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS
| | - S Cilia
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS
| | - E De Felice
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS
| | - R Vattiato
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS
| | - R Senatore
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS
| | - A Zucchetto
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS
| | - C Buzzoni
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS
| | - S Tognazzo
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS
| | - F Bellù
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS
| | - S Piffer
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS
| | - R Cusimano
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS
| | - M Zarcone
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS
| | - C Cirilli
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS
| | - F Stracci
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS
| | - S Ferretti
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS
| | - R Cesaraccio
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS
| | - S Rosso
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS
| | - A Giacomin
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS
| | - F Cuccaro
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS
| | - M Michiara
- Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS
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Chien LH, Tseng TJ, Tsai FY, Wang JH, Hsiung CA, Liu TW, Chang IS. Patterns of age-specific socioeconomic inequalities in net survival for common cancers in Taiwan, a country with universal health coverage. Cancer Epidemiol 2018; 53:42-48. [DOI: 10.1016/j.canep.2018.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 12/04/2017] [Accepted: 01/10/2018] [Indexed: 01/26/2023]
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