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Corral J, Borras JM, Lievens Y. Utilisation of radiotherapy in lung cancer: A scoping narrative literature review with a focus on the introduction of evidence-based therapeutic approaches in Europe. Clin Transl Radiat Oncol 2024; 45:100717. [PMID: 38226026 PMCID: PMC10788411 DOI: 10.1016/j.ctro.2023.100717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/16/2023] [Indexed: 01/17/2024] Open
Abstract
Background and purpose The aim of this study was to review the published studies on the utilisation of radiotherapy in lung cancer (both small and non-small cell lung cancer, SCLC and NSCLC) patients in European countries with a population-based perspective. Material and methods A literature search since January 2000 until December 2022 was carried out. Only English-published papers were included, and only European data was considered. PRISMA guidelines were followed. A scoping narrative review was undertaken due to the hetereogeneity of the published papers. Results 38 papers were included in the analysis, with the majority from the Netherlands (52.6%) and the UK (18.4%). Large variability is observed in the reported radiotherapy utilisation, around 40% for NSCLC in general and between 26 and 42% in stage I NSCLC. Stereotactic body radiotherapy (SBRT) shows a wide range of utilisation across countries and over time, from 8 to 63%. Similary, in stage III lung cancer, chemoradiotherapy (CRT) utilisation varied considerably (11-70%). Eleven studies compared radiotherapy utilisation between older and younger age-groups, showing that younger patients receive more CRT, while the opposite applies for SBRT. An widespreadlack of data on relevant covariates such as comorbidty and health-services related variables is observed. Conclusion The actual utilisation of radiotherapy for lung cancer reported in patterns-of-care studies (POCs) is notably lower than the evidence-based optimal utilisation. Important variability is observed by country, time period, stage at diagnosis and age. A wider use of POCs should be promoted to improve our knowledge on the actual application of evidence-based treatment recommendations.
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Affiliation(s)
- Julieta Corral
- Catalonian Cancer Plan, Department of Health, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet, Barcelona, Spain
| | - Josep M. Borras
- Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet, Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, Spain
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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2
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Ayeni OA, Joffe M, Mapanga W, Chen WC, O'Neil DS, Phakathi B, Nietz S, Buccimazza I, Čačala S, Stopforth LW, Jacobson JS, Crew KD, Neugut AI, Ramiah D, Ruff P, Cubasch H, Chirwa T, McCormack V, Micklesfield LK, Norris SA. Multimorbidity and overall survival among women with breast cancer: results from the South African Breast Cancer and HIV Outcomes Study. Breast Cancer Res 2023; 25:7. [PMID: 36691057 PMCID: PMC9872426 DOI: 10.1186/s13058-023-01603-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 01/06/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Breast cancer survival in South Africa is low, but when diagnosed with breast cancer, many women in South Africa also have other chronic conditions. We investigated the impact of multimorbidity (≥ 2 other chronic conditions) on overall survival among women with breast cancer in South Africa. METHODS Between 1 July 2015 and 31 December 2019, we enrolled women newly diagnosed with breast cancer at six public hospitals participating in the South African Breast Cancer and HIV Outcomes (SABCHO) Study. We examined seven chronic conditions (obesity, hypertension, diabetes, HIV, cerebrovascular diseases (CVD), asthma/chronic obstructive pulmonary disease, and tuberculosis), and we compared socio-demographic, clinical, and treatment factors between patients with and without each condition, and with and without multimorbidity. We investigated the association of multimorbidity with overall survival using multivariable Cox proportional hazard models. RESULTS Of 3,261 women included in the analysis, 45% had multimorbidity; obesity (53%), hypertension (41%), HIV (22%), and diabetes (13%) were the most common individual conditions. Women with multimorbidity had poorer overall survival at 3 years than women without multimorbidity in both the full cohort (60.8% vs. 64.3%, p = 0.036) and stage groups: stages I-II, 80.7% vs. 86.3% (p = 0.005), and stage III, 53.0% vs. 59.4% (p = 0.024). In an adjusted model, women with diabetes (hazard ratio (HR) = 1.20, 95% confidence interval (CI) = 1.03-1.41), CVD (HR = 1.43, 95% CI = 1.17-1.76), HIV (HR = 1.21, 95% CI = 1.06-1.38), obesity + HIV (HR = 1.24 95% CI = 1.04-1.48), and multimorbidity (HR = 1.26, 95% CI = 1.13-1.40) had poorer overall survival than women without these conditions. CONCLUSIONS Irrespective of the stage, multimorbidity at breast cancer diagnosis was an important prognostic factor for survival in our SABCHO cohort. The high prevalence of multimorbidity in our cohort calls for more comprehensive care to improve outcomes for South African women with breast cancer.
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Affiliation(s)
- Oluwatosin A Ayeni
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- Department of Radiation Oncology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Maureen Joffe
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Witness Mapanga
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Wenlong Carl Chen
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Daniel S O'Neil
- Sylvester Comprehensive Cancer Center and Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Boitumelo Phakathi
- Department of Surgery, School of Clinical Medicine, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Sarah Nietz
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ines Buccimazza
- Department of Surgery, School of Clinical Medicine, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Sharon Čačala
- Department of Surgery, School of Clinical Medicine, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
- Department of Surgery, Ngwelezana Hospital, Empangeni and University of KwaZulu-Natal, Empangeni, KwaZulu-Natal, South Africa
| | - Laura W Stopforth
- Department of Surgery, School of Clinical Medicine, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
- Departments of Surgery and Radiation Oncology, Grey's Hospital, University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Judith S Jacobson
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Katherine D Crew
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Alfred I Neugut
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Duvern Ramiah
- Department of Radiation Oncology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Paul Ruff
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Herbert Cubasch
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tobias Chirwa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193, South Africa
| | - Valerie McCormack
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, (IARC/WHO), Lyon, France
| | - Lisa K Micklesfield
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Global Health Research Institute, School of Human Development and Health, University of Southampton, Southampton, UK
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3
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İmamoğlu Gİ, Oğuz A, Cimen S, Eren T, Karacin C, Colak D, Altşbaş M, Türker S, Yazılıta D. The impact of lymph node ratio on overall survival in patients with colorectal cancer. J Cancer Res Ther 2021; 17:1069-1074. [PMID: 34528566 DOI: 10.4103/jcrt.jcrt_11_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Lymph node metastasis is a predominant prognostic indicator in colorectal cancer. Number of lymph nodes removed surgically was demonstrated to correlate with staging accuracy and oncological outcomes. However, number of lymph nodes removed depends on uncontrolled variables. Therefore, a more reliable prognostic indicator is needed. Calculation of ratio of positive lymph nodes to total number of removed lymph nodes may be an appealing solution. Materials and Methods We retrospectively analyzed data of 156 Stage III colorectal cancer patients whom underwent surgery between 2008 and 2015. Patients' demographic characteristics, tumor grade, location, vascular-perineural invasion status, number of removed lymph nodes, and ratio of positive lymph nodes to number of removed lymph nodes were recorded. Spearman correlation analysis was used to determine the correlation coefficient while Kaplan-Meier method and Cox proportional hazard regression model were performed for the prediction of survival and multivariate analysis, respectively. Results Number of removed lymph nodes did not correlate with survival, but it was inversely correlated with number of positive lymph nodes. Multivariate analysis showed that ratio of removed positive lymph nodes to the total number of lymph nodes was a significant prognostic factor for survival for a ratio equal or above 0.31 was a poor prognostic indicator (108 months vs. 34 months, hazard ratio: 4.24 [95% confidence interval: 2.15-8.34]; P < 0.019). Tumor characteristics failed to demonstrate any prognostic value. Conclusions This study showed that positive lymph node ratio (PLNR) is an important prognostic factor for Stage III colorectal cancer. Although 0.31 can be taken as threshold for "PLNR," prospective trials including larger patient groups are needed to validate its role as a prognostic indicator.
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Affiliation(s)
- Goksen İnanğ İmamoğlu
- Departments of Medical Oncology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Arzu Oğuz
- Department of Medical Oncology, Baskent University, Ankara, Turkey
| | - Sanem Cimen
- Departments of Medical Oncology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Tülay Eren
- Departments of Medical Oncology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Cengiz Karacin
- Department of Medical Oncology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Dilşen Colak
- Department of Medical Oncology, Baskent University, Ankara, Turkey
| | - Mustafa Altşbaş
- Department of Medical Oncology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Sema Türker
- Departments of Medical Oncology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Doğan Yazılıta
- Department of Medical Oncology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
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Limam M, Matthes KL, Pestoni G, Michalopoulou E, Held L, Dehler S, Korol D, Rohrmann S. Are there sex differences among colorectal cancer patients in treatment and survival? A Swiss cohort study. J Cancer Res Clin Oncol 2021; 147:1407-1419. [PMID: 33661394 PMCID: PMC8021518 DOI: 10.1007/s00432-021-03557-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/04/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) is among the three most common incident cancers and causes of cancer death in Switzerland for both men and women. To promote aspects of gender medicine, we examined differences in treatment decision and survival by sex in CRC patients diagnosed 2000 and 2001 in the canton of Zurich, Switzerland. METHODS Characteristics assessed of 1076 CRC patients were sex, tumor subsite, age at diagnosis, tumor stage, primary treatment option and comorbidity rated by the Charlson Comorbidity Index (CCI). Missing data for stage and comorbidities were completed using multivariate imputation by chained equations. We estimated the probability of receiving surgery versus another primary treatment using multivariable binomial logistic regression models. Univariable and multivariable Cox proportional hazards regression models were used for survival analysis. RESULTS Females were older at diagnosis and had less comorbidities than men. There was no difference with respect to treatment decisions between men and women. The probability of receiving a primary treatment other than surgery was nearly twice as high in patients with the highest comorbidity index, CCI 2+, compared with patients without comorbidities. This effect was significantly stronger in women than in men (p-interaction = 0.010). Survival decreased with higher CCI, tumor stage and age in all CRC patients. Sex had no impact on survival. CONCLUSION The probability of receiving any primary treatment and survival were independent of sex. However, female CRC patients with the highest CCI appeared more likely to receive other therapy than surgery compared to their male counterparts.
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Affiliation(s)
- Manuela Limam
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Cancer Registry Zurich, Zug, Schaffhausen and Schwyz, University Hospital Zurich, Zurich, Switzerland
| | - Katarina Luise Matthes
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Cancer Registry Zurich, Zug, Schaffhausen and Schwyz, University Hospital Zurich, Zurich, Switzerland
| | - Giulia Pestoni
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Cancer Registry Zurich, Zug, Schaffhausen and Schwyz, University Hospital Zurich, Zurich, Switzerland
| | | | - Leonhard Held
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Silvia Dehler
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Cancer Registry Zurich, Zug, Schaffhausen and Schwyz, University Hospital Zurich, Zurich, Switzerland
| | - Dimitri Korol
- Cancer Registry Zurich, Zug, Schaffhausen and Schwyz, University Hospital Zurich, Zurich, Switzerland
| | - Sabine Rohrmann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
- Cancer Registry Zurich, Zug, Schaffhausen and Schwyz, University Hospital Zurich, Zurich, Switzerland.
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5
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Hayes L, Adams J, McCallum I, Forrest L, Hidajat M, White M, Sharp L. Age-related and socioeconomic inequalities in timeliness of referral and start of treatment in colorectal cancer: a population-based analysis. J Epidemiol Community Health 2021; 75:1-9. [PMID: 33055178 DOI: 10.1136/jech-2020-214232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/11/2020] [Accepted: 06/20/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Poorer colorectal cancer survival in the UK than in similar countries may be partly due to delays in the care pathway. To address this, cancer waiting time targets were established. We investigated if socio-demographic inequalities exist in meeting cancer waiting times for colorectal cancer. METHODS We identified primary colorectal cancers (International Classification of Diseases, Tenth Revision C18-C20; n=35 142) diagnosed in the period 2001-2010 in the Northern and Yorkshire Cancer Registry area. Using multivariable logistic regression, we calculated likelihood of referral and treatment within target by age group and deprivation quintile. RESULTS 48% of the patients were referred to hospital within target (≤14 days from general practitioner (GP) referral to first hospital appointment); 52% started treatment within 31 days of diagnosis; and 44% started treatment within 62 days of GP referral. Individuals aged 60-69, 70-79 and 80+ years were significantly more likely to attend a first hospital appointment within 14 days than those aged <60 years (adjusted OR=1.23, 95% CI 1.12 to 1.34; adjusted OR=1.19, 95% CI 1.09 to 1.29; adjusted OR=1.30, 95% CI 1.18 to 1.42, respectively). Older age was significantly associated with lower likelihood of starting treatment within 31 days of diagnosis and 62 days of referral. Deprivation was not related to referral within target but was associated with lower likelihood of starting treatment within 31 days of diagnosis or 62 days of referral (most vs least: adjusted OR=0.82, 95% CI 0.74 to 0.91). CONCLUSIONS Older patients with colorectal cancer were less likely to experience referral delays but more likely to experience treatment delays. More deprived patients were more likely to experience treatment delays. Investigation of patient pathways, treatment decision-making and treatment planning would improve understanding of these inequalities.
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Affiliation(s)
- Louise Hayes
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Iain McCallum
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Lynne Forrest
- University of Edinburgh School of GeoSciences, Edinburgh, UK
| | - Mira Hidajat
- University of Bristol School of Social and Community Medicine, Bristol, UK
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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6
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A population perspective on the use of external beam radiotherapy in Catalonia, Spain. Clin Transl Oncol 2020; 22:2222-2229. [PMID: 32424700 DOI: 10.1007/s12094-020-02355-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/28/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To assess the use of external beam radiotherapy in Catalonia (Spain), overall and by health management area. METHODS We assessed radiotherapy treatments in a cohort of patients diagnosed with cancer from 2009 to 2011, using the population-based cancer registries in Girona and Tarragona. Participants had to have a minimum follow-up of 5 years from the time the cancer registry database was linked to the catalan health service database for financing radiation oncology. Outcomes included the proportion of patients receiving radiotherapy within 1 and 5 years of diagnosis. A log-binomial model was used to assess age-related trends in the use of radiotherapy by tumour site. Finally, we calculated the standardized utilization rate and 95% confidence intervals by health management area covered by the radiation oncology services, using indirect methods. RESULTS At 1 and 5 years from diagnosis, 21.4 and 24.4% of patients, respectively, had received external beam radiotherapy. Patients aged 40-64 years had the most indications for the treatment, and there was a negative correlation between the patients' age and the use of radiotherapy for most tumour sites (exceptions were cervical, thyroid, and uterine cancers). There were no statistically significant differences in the use of radiotherapy according to th health management area. CONCLUSIONS Population-based data show that external beam radiotherapy is underutilized in Catalonia. This situation requires a careful analysis to understand the causes, as well as an improvement of the available resources, oriented toward achieving realistic targets for the optimal use of external beam radiotherapy in our country.
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7
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Lievens Y, Borras JM, Grau C. Provision and use of radiotherapy in Europe. Mol Oncol 2020; 14:1461-1469. [PMID: 32293084 PMCID: PMC7332207 DOI: 10.1002/1878-0261.12690] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 01/07/2020] [Accepted: 04/09/2020] [Indexed: 12/30/2022] Open
Abstract
Radiation therapy is one of the core components of multidisciplinary cancer care. Although ~ 50% of all European cancer patients have an indication for radiotherapy at least once in the course of their disease, more than one out of four cancer patients in Europe do not receive the radiotherapy they need. There are multiple reasons for this underutilisation, with limited availability of the necessary resources – in terms of both trained personnel and equipment – being a major underlying cause of suboptimal access to radiotherapy. Moreover, large variations across European countries are observed, not only in available radiotherapy equipment and personnel per inhabitant or per cancer patient requiring radiotherapy, but also in workload. This variation is in part determined by the country's gross national income. Radiation therapy and technology are advancing quickly; hence, recommendations supporting resource planning and investment should reflect this dynamic environment and account for evolving treatment complexity and fractionation schedules. The forecasted increase in cancer incidence, the rapid introduction of innovative cancer treatments and the more active involvement of patients in the healthcare discussion are all factors that should be taken under consideration. In this continuously changing oncology landscape, reliable data on the actual provision and use of radiotherapy, the optimal evidence‐based demand and the future needs are crucial to inform cancer care planning and address and overcome the current inequalities in access to radiotherapy in Europe.
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Affiliation(s)
- Yolande Lievens
- Department of Radiation OncologyGhent University Hospital and Ghent UniversityBelgium
| | - Josep M. Borras
- Department of Clinical SciencesIDIBELLUniversity of BarcelonaSpain
| | - Cai Grau
- Department of Oncology and Danish Center for Particle TherapyAarhus University HospitalDenmark
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8
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Jayaraj R, Kumarasamy C, Sabarimurugan S, Madhav MR, Shetty SS, Baxi S. Conceptual interpretation of findings on systematic review and meta-analysis of altered-fractionation radiotherapy improves local control in the early-stage glottic carcinoma. Oral Oncol 2020; 101:104319. [DOI: 10.1016/j.oraloncology.2019.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 05/27/2019] [Accepted: 05/31/2019] [Indexed: 10/26/2022]
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9
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Yap ML, O'Connell DL, Goldsbury D, Weber M, Barton M. Factors Associated With Radiotherapy Utilisation In New South Wales, Australia: Results From The 45 and Up Study. Clin Oncol (R Coll Radiol) 2020; 32:282-291. [PMID: 32007353 DOI: 10.1016/j.clon.2020.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/03/2019] [Accepted: 12/09/2019] [Indexed: 12/28/2022]
Abstract
AIMS Actual radiotherapy utilisation rates tend to be lower than the estimated optimal rates. Little is known about the factors contributing to this difference. Our aim was to identify factors associated with radiotherapy receipt for a cohort of cancer patients in New South Wales (NSW), Australia. MATERIALS AND METHODS In total, 267 153 participants in the NSW 45 and Up Study completed a questionnaire during 2006-2009 providing detailed health and socio-demographic information and consented to record linkage with administrative health datasets. Single primary cancers diagnosed after study enrolment were identified through linkage with the NSW Cancer Registry to December 2013. Radiotherapy receipt was determined from claims to the Medicare Benefits Schedule and/or records in the NSW Admitted Patient Data Collection (2006 to June 2016). Competing risks regression was used to examine associations between health and socio-demographic characteristics and radiotherapy treatment. RESULTS Of 17 873 patients with an incident cancer, 5414 (30.3%) received radiotherapy during follow-up (median 5.3 years). Patients less likely to receive radiotherapy were aged <60 or 80+ years, female, had a Charlson co-morbidity index of 1+, needed help with daily tasks or lived ≥100 km from the nearest radiotherapy centre. CONCLUSION Distinct subgroups of patients are less likely to receive radiotherapy. Advocacy and/or policy changes are needed to improve access.
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Affiliation(s)
- M L Yap
- Collaboration for Cancer Outcomes, Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, UNSW Sydney, Liverpool, NSW, Australia; Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; School of Medicine, Western Sydney University, Campbelltown, NSW, Australia; Cancer Research Division, Cancer Council NSW, Kings Cross, NSW, Australia; Sydney Medical School - Public Health, University of Sydney, Sydney, NSW, Australia.
| | - D L O'Connell
- Cancer Research Division, Cancer Council NSW, Kings Cross, NSW, Australia; Sydney Medical School - Public Health, University of Sydney, Sydney, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - D Goldsbury
- Cancer Research Division, Cancer Council NSW, Kings Cross, NSW, Australia
| | - M Weber
- Cancer Research Division, Cancer Council NSW, Kings Cross, NSW, Australia; Sydney Medical School - Public Health, University of Sydney, Sydney, NSW, Australia
| | - M Barton
- Collaboration for Cancer Outcomes, Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, UNSW Sydney, Liverpool, NSW, Australia; Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia
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10
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Survival Benefit of Adjuvant Radiotherapy in Elderly Patients with WHO Grade III Meningioma. World Neurosurg 2019; 131:e303-e311. [DOI: 10.1016/j.wneu.2019.07.140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 02/07/2023]
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11
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Schreuder K, Middelburg JG, Aarts MJ, Merkus JWS, Poortmans PMP, Jobsen JJ, Siesling S, Struikmans H. An actualised population-based study on the use of radiotherapy in breast cancer patients in the Netherlands. Breast J 2019; 25:942-947. [PMID: 31165586 DOI: 10.1111/tbj.13376] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/25/2019] [Accepted: 01/25/2019] [Indexed: 11/29/2022]
Abstract
The utilization rate of RT increased from 64.4% in 2011 to 70.3% in 2015. After BCS and mastectomy, 97.3% and 26.1% of the patients received RT, respectively. For patients undergoing BCS and mastectomy, lower age and ER + tumours were associated with higher RT utilisation rates. After mastectomy, also larger tumour sizes, lymph node involvement, grade-2 and 3 tumours and diagnosis in more recent years were associated with higher RT use.
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Affiliation(s)
- Kay Schreuder
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.,Scientific Committee NABON Breast Cancer Audit (NBCA), The Netherlands
| | - Judith G Middelburg
- Department of Radiation Oncology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Mieke J Aarts
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Jos W S Merkus
- Department of Surgery, Haga Hospital, The Hague, The Netherlands
| | | | - Jan J Jobsen
- Department of Radiation Oncology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.,Scientific Committee NABON Breast Cancer Audit (NBCA), The Netherlands
| | - Henk Struikmans
- Scientific Committee NABON Breast Cancer Audit (NBCA), The Netherlands.,Department of Radiation Oncology, Leiden University Medical Centre, Leiden, The Netherlands
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van Maaren MC, Kneepkens RF, Verbaan J, Huijgens PC, Lemmens VEPP, Verhoeven RHA, Siesling S. A conditional model predicting the 10-year annual extra mortality risk compared to the general population: a large population-based study in Dutch breast cancer patients. PLoS One 2019; 14:e0210887. [PMID: 30677053 PMCID: PMC6345454 DOI: 10.1371/journal.pone.0210887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/03/2019] [Indexed: 11/28/2022] Open
Abstract
Objective Many cancer survivors are facing difficulties in getting a life insurance; raised premiums and declinatures are common. We generated a prediction model estimating the conditional extra mortality risk of breast cancer patients in the Netherlands. This model can be used by life insurers to accurately estimate the additional risk of an individual patient, conditional on the years survived. Methodology All women diagnosed with stage I-III breast cancer in 2005–2006, treated with surgery, were selected from the Netherlands Cancer Registry. For all stages separately, multivariable logistic regression was used to estimate annual mortality risks, conditional on the years survived, until 10 years after diagnosis, resulting in 30 models. The conditional extra mortality risk was calculated by subtracting mortality rates of the general Dutch population from the patient mortality rates, matched by age, gender and year. The final model was internally and externally validated, and tested by life insurers. Results We included 23,234 patients: 10,101 stage I, 9,868 stage II and 3,265 stage III. The final models included age, tumor stage, nodal stage, lateralization, location within the breast, grade, multifocality, hormonal receptor status, HER2 status, type of surgery, axillary lymph node dissection, radiotherapy, (neo)adjuvant systemic therapy and targeted therapy. All models showed good calibration and discrimination. Testing of the model by life insurers showed that insurability using the newly-developed model increased with 13%, ranging from 0%-24% among subgroups. Conclusion The final model provides accurate conditional extra mortality risks of breast cancer patients, which can be used by life insurers to make more reliable calculations. The model is expected to increase breast cancer patients’ insurability and transparency among life insurers.
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Affiliation(s)
- Marissa C. van Maaren
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands
- * E-mail:
| | | | - Joke Verbaan
- De Hoop Life Reinsurance, the Hague, the Netherlands
| | - Peter C. Huijgens
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Valery E. P. P. Lemmens
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
- Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Rob H. A. Verhoeven
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands
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Di Donato V, Page Z, Bracchi C, Tomao F, Musella A, Perniola G, Panici PB. The age-adjusted Charlson comorbidity index as a predictor of survival in surgically treated vulvar cancer patients. J Gynecol Oncol 2018; 30:e6. [PMID: 30479090 PMCID: PMC6304403 DOI: 10.3802/jgo.2019.30.e6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 12/13/2022] Open
Abstract
Objective To evaluate the impact of age-adjusted Charlson comorbidity index (ACCI) in predicting disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS) among surgically treated patients with vulvar carcinoma. The secondary aim is to evaluate its impact as a predictor of the pattern of recurrence. Methods We retrospectively evaluated data of patients that underwent surgical treatment for vulvar cancer from 1998 to 2016. ACCI at the time of primary surgery was evaluated and patients were classified as low (ACCI 0–1), intermediate (ACCI 2–3), and high risk (>3). DFS, OS and CSS were analyzed using the Kaplan-Meir and the Cox proportional hazard models. Logistic regression model was used to assess predictors of distant and local recurrence. Results Seventy-eight patients were included in the study. Twelve were classified as low, 36 as intermediate, and 30 as high risk according to their ACCI. Using multivariate analysis, ACCI class was an independent predictor of worse DFS (hazard ratio [HR]=3.04; 95% confidence interval [CI]=1.54–5.99; p<0.001), OS (HR=5.25; 95% CI=1.63–16.89; p=0.005) and CSS (HR=3.79; 95% CI=1.13–12.78; p=0.03). Positive nodal status (odds ratio=8.46; 95% CI=2.13–33.58; p=0.002) was the only parameter correlated with distant recurrence at logistic regression. Conclusion ACCI could be a useful tool in predicting prognosis in surgically treated vulvar cancer patients. Prospective multicenter trials assessing the role of ACCI in vulvar cancer patients are warranted.
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Affiliation(s)
- Violante Di Donato
- Department of Gynecology Obstetrics Sciences and Urologic Sciences, Sapienza University of Rome, Rome, Italy
| | - Zoe Page
- Department of Gynecology Obstetrics Sciences and Urologic Sciences, Sapienza University of Rome, Rome, Italy
| | - Carlotta Bracchi
- Department of Gynecology Obstetrics Sciences and Urologic Sciences, Sapienza University of Rome, Rome, Italy.
| | - Federica Tomao
- Department of Gynecology Obstetrics Sciences and Urologic Sciences, Sapienza University of Rome, Rome, Italy
| | - Angela Musella
- Department of Gynecology Obstetrics Sciences and Urologic Sciences, Sapienza University of Rome, Rome, Italy
| | - Giorgia Perniola
- Department of Gynecology Obstetrics Sciences and Urologic Sciences, Sapienza University of Rome, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Gynecology Obstetrics Sciences and Urologic Sciences, Sapienza University of Rome, Rome, Italy
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Vernet R, Borras JM, Aliste L, Antonio M, Guarga A, Manchon-Walsh P. Influence of age on variation in patterns of care in patients with rectal cancer in Catalonia (Spain). Clin Transl Oncol 2018; 20:1538-1547. [DOI: 10.1007/s12094-018-1882-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 04/23/2018] [Indexed: 10/16/2022]
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Influence of comorbidity on chemotherapy use for early breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat 2017; 165:17-39. [DOI: 10.1007/s10549-017-4295-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 05/13/2017] [Indexed: 10/19/2022]
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Comber H, De Camargo Cancela M, Haase T, Johnson H, Sharp L, Pratschke J. Affluence and Private Health Insurance Influence Treatment and Survival in Non-Hodgkin's Lymphoma. PLoS One 2016; 11:e0168684. [PMID: 27992551 PMCID: PMC5167407 DOI: 10.1371/journal.pone.0168684] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 12/05/2016] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate inequalities in survival for non-Hodgkin's lymphoma (NHL), distinguishing between direct and indirect effects of patient, social and process-of-care factors. METHODS All cases of NHL diagnosed in Ireland in 2004-2008 were included. Variables describing patient, cancer, stage and process of care were included in a discrete-time model of survival using Structural Equation Modelling software. RESULTS Emergency admissions were more common in patients with co-morbid conditions or with more aggressive cancers, and less frequent for patients from more affluent areas. Aggressive morphology, female sex, emergency admission, increasing age, comorbidity, treatment in a high caseload hospital and late stage were associated with increased hazard of mortality. Private patients had a reduced hazard of mortality, mediated by systemic therapy, admission to high caseload hospitals and fewer emergency admissions. DISCUSSION The higher rate of emergency presentation, and consequent poorer survival, of uninsured patients, suggests they face barriers to early presentation. Social, educational and cultural factors may also discourage disadvantaged patients from consulting with early symptoms of NHL. Non-insured patients, who present later and have more emergency admissions would benefit from better access to diagnostic services. Older patients remain disadvantaged by sub-optimal treatment, treatment in non-specialist centres and emergency admission.
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Affiliation(s)
| | | | - Trutz Haase
- Social and Economic Consultant, Dublin, Ireland
| | - Howard Johnson
- Health & Wellbeing Directorate Health Intelligence Unit, Health Service Executive, Dublin, Ireland
| | - Linda Sharp
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jonathan Pratschke
- Department of Economics and Statistics, University of Salerno, Salerno, Italy
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Elliot A, Martling A, Glimelius B, Johansson H, Nilsson P. Impact of pre-treatment patient-related selection parameters on outcome in rectal cancer. Eur J Surg Oncol 2016; 42:1667-1673. [DOI: 10.1016/j.ejso.2016.05.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/02/2016] [Accepted: 05/19/2016] [Indexed: 01/10/2023] Open
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Adjuvant Treatment and Clinical Trials in Elderly Patients With Endometrial Cancer: A Time for Change? Int J Gynecol Cancer 2016; 26:282-9. [PMID: 26745698 DOI: 10.1097/igc.0000000000000605] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim of the study were to evaluate the gap between recommended and received adjuvant therapy in elderly patients with endometrial cancer (EC) and to determine the percent of women 70 years and older who would meet enrollment criteria for representative Gynecologic Oncology Group (GOG) trials. METHODS AND MATERIALS An institutional review board approved retrospective chart review of all EC cases from a tertiary care institution from 2005 to 2010 was performed. Clinical, surgical, and pathologic data were abstracted from electronic medical records. Gynecologic Oncology Group protocols 249, 209, and 229L were selected as representative national EC trials. Patients were evaluated for eligibility by each protocol's criteria. RESULTS Twenty-six percent (280/1064) of patients with EC were older than 70 years. More than 60% (181/280) of elderly patients with EC were recommended to undergo adjuvant therapy. By therapy type, 64% (48/75) of elderly patients who were recommended adjuvant radiation received it, 53% (49/92) of elderly patients who were recommended combination chemotherapy and radiation received it, and 29% (4/14) of elderly patients who were recommended chemotherapy received it. In evaluating enrollment criteria for GOG 249, 30% (40/134) of pathologically eligible patients would have been eliminated for medical clearance; for GOG 209, 31% (26/86) would have been eliminated, and for GOG 229L, 9% (4/45) would have been eliminated purely for medical reasons. CONCLUSIONS More adjuvant treatment is recommended in the elderly patients because of a higher incidence of advanced disease and aggressive histopathology. Approximately half of the elderly patients who were recommended treatment actually received it. In addition, clinical trial data are limited for elderly patients because approximately one third of the women aged 70 years and older who meet pathologic enrollment criteria for trials were excluded because of complex medical disease.
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Knowledge, Attitudes, and Practices Related to Preoperative Chemoradiotherapy in Rectal Cancer Patients. Gastroenterol Res Pract 2016; 2016:1081374. [PMID: 27761141 PMCID: PMC5059530 DOI: 10.1155/2016/1081374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 08/03/2016] [Accepted: 08/28/2016] [Indexed: 11/18/2022] Open
Abstract
Background. The aim of this study is to assess the knowledge, attitudes, and practices related to pre-CRT in patients of stage II/III rectal cancer. Materials and Methods. Questionnaires regarding the knowledge, attitudes, and practices of pre-CRT were mailed to 145 rectal cancer patients in II/III stage between January 2012 and December 2014, and 111 agreed to participate and returned completed questionnaires to the researcher. Logistic regression model was used to compare sociodemographic characteristics, knowledge, and attitude with practice, respectively. Results. A total of 145 patients were approached for interview, of which 111 responded and 48.6% (54) had undergone pre-CRT. Only 31.5% of the participants knew that CRT is a treatment of rectal cancer and 39.6% were aware of the importance of CRT. However, the vast majority of participants (68.5%) expressed a positive attitude toward rectal cancer. Multivariate logistic regression analysis revealed that knowledge level (p = 0.006) and attitudes (p = 0.001) influence the actual practice significantly. Furthermore, age, gender, and income were potential predictors of practice (all p < 0.05). Conclusion. This study shows that, despite the fact that participants had suboptimal level of knowledge on rectal cancer, their attitude is favorable to pre-CRT. Strengthening the professional health knowledge and realizing the importance of attitudes may deepen patients' understanding of preoperative therapy.
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Current impact of age and comorbidity assessment on prostate cancer treatment choice and over/undertreatment risk. World J Urol 2016; 35:587-593. [DOI: 10.1007/s00345-016-1900-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/14/2016] [Indexed: 10/21/2022] Open
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Magestro LM, Gieger TL. Detection of synchronous primary tumours and previously undetected metastases in 736 dogs with neoplasia undergoing CT scans for diagnostic, staging and/or radiation treatment planning purposes. Vet Comp Oncol 2016; 15:576-581. [PMID: 27135757 DOI: 10.1111/vco.12201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 11/02/2015] [Accepted: 11/02/2015] [Indexed: 11/28/2022]
Abstract
The purpose of our study was to describe synchronous primary tumours and previously undetected metastases in 736 dogs with confirmed neoplasia in which computed tomography (CT) scans were performed for diagnostic, staging and/or radiation treatment planning purposes. All CTs were reviewed by a radiologist. Tumour-associated CT abnormalities were detected in 38/736 (5%), including confirmed or suspected synchronous primary neoplasms (n = 24), metastases of the primary tumour (n = 9) or both (n = 3). In lymph nodes (LN) that were considered abnormal on CT scan and were aspirated, 23% contained metastasis, and 6% of 'normal' appearing LN that were aspirated contained metastasis. Thorough evaluation of CTs and routine aspiration of regional LN are critical because results affect recommendations to perform additional staging tests and treatment for the primary and secondary tumour(s).
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Affiliation(s)
- L M Magestro
- Department of Clinical Sciences (College of Veterinary Medicine) and Comparative Medicine Institute, North Carolina, State University, Raleigh, NC, 27607, USA
| | - T L Gieger
- Department of Clinical Sciences (College of Veterinary Medicine) and Comparative Medicine Institute, North Carolina, State University, Raleigh, NC, 27607, USA
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22
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[Radiation therapy for elderly patients]. Cancer Radiother 2015; 19:391-6. [PMID: 26344439 DOI: 10.1016/j.canrad.2015.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 05/22/2015] [Accepted: 05/29/2015] [Indexed: 11/21/2022]
Abstract
Cancer is a disease that predominantly occurs in older patients who represent a quarter of the population in western countries. Numerous types of cancer are observed in elderly people. Radiotherapy is one of the most powerful treatments against cancer. Most of published studies have demonstrated feasibility of radiotherapy in curative or palliative intent whatever cancer types are considered. Complete geriatric assessment and a multidisciplinary approach are the key points. The purpose of this review is to highlight sights of radiation oncology specifically related to aging. Particular emphasis is placed on logistic and technical aspects of radiation, as dose, irradiated volume, fractionation and the potential usefulness of new technologies.
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Petera J, Dušek L, Sirák I, Soumarova R, Jarkovsky J. Cancer in the elderly in the Czech Republic. Eur J Cancer Care (Engl) 2015; 24:163-78. [DOI: 10.1111/ecc.12287] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2014] [Indexed: 12/26/2022]
Affiliation(s)
- J. Petera
- Department of Oncology and Radiotherapy; University Hospital and Medical Faculty; Hradec Kralove Czech Republic
| | - L. Dušek
- Institute of Biostatistics and Analyses; Masaryk University; Brno Czech Republic
| | - I. Sirák
- Department of Oncology and Radiotherapy; University Hospital; Hradec Kralove Czech Republic
| | - R. Soumarova
- Department of Radiotherapy and Oncology; Mendel Cancer Centre; Nový Jičín Czech Republic
| | - J. Jarkovsky
- Institute of Biostatistics and Analyses; Masaryk University; Brno Czech Republic
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Comorbidities and Their Management: Potential Impact on Breast Cancer Outcomes. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 862:155-75. [DOI: 10.1007/978-3-319-16366-6_11] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Kaufmann A, Schmidt H, Ostheimer C, Ullrich J, Landenberger M, Vordermark D. Quality of life in very elderly radiotherapy patients: a prospective pilot study using the EORTC QLQ-ELD14 module. Support Care Cancer 2014; 23:1883-92. [PMID: 25475738 DOI: 10.1007/s00520-014-2546-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 11/30/2014] [Indexed: 12/26/2022]
Abstract
PURPOSE In very elderly cancer patients, health-related quality of life (HRQOL) is a particularly important issue but has rarely been studied due to a lack of specific instruments and of reference data. We performed a prospective analysis of HRQOL in patients ≥80 years undergoing radiotherapy with the newly validated elderly-specific HRQOL module EORTC QLQ-ELD14. METHODS We prospectively assessed HRQOL in n = 50 radiotherapy patients ≥80 years (32% lung, 20% gastrointestinal, 8% each of breast, head and neck, gynecologic cancer) at the start (t1), end (t2), and 6 months after (t3) radiotherapy, using EORTC QLQ-C30 and EORTC QLQ-ELD14. Overall survival was determined in the whole cohort and subgroups. RESULTS Median overall survival from the start of radiotherapy was 15 months; 1-year and 2-year overall survival rates were 57.1 and 31.0%, respectively. Eastern Cooperative Oncology Group (ECOG) performance status <2, Charlson comorbidity index ≤6, curative treatment intention, local tumor stage Union Internationale Contre le Cancer (UICC I, II), and total dose >45 Gy were associated with prolonged survival. No significant changes in any HRQOL domain were observed during the course of treatment (t1 to t2). Six months after radiotherapy (t3), a significant and clinically relevant deterioration of HRQOL was seen in EORTC QLQ-C30 for physical function and role function and in EORTC QLQ-ELD14 for future worries, burden of illness, and family support. CONCLUSIONS In radiotherapy patients ≥80 years, HRQOL was maintained until the end of radiotherapy but deteriorated in general and elderly-specific areas thereafter, suggesting a need to develop specific supportive interventions for this age group.
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Affiliation(s)
- Anne Kaufmann
- Department of Radiation Oncology, Martin Luther University Halle-Wittenberg, Dryanderstr. 4, 06110, Halle/Saale, Germany
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Elliot A, Martling A, Glimelius B, Nordenvall C, Johansson H, Nilsson P. Preoperative treatment selection in rectal cancer: A population-based cohort study. Eur J Surg Oncol 2014; 40:1782-8. [DOI: 10.1016/j.ejso.2014.08.481] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 08/31/2014] [Indexed: 01/16/2023] Open
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Ommundsen N, Wyller TB, Nesbakken A, Jordhøy MS, Bakka A, Skovlund E, Rostoft S. Frailty is an independent predictor of survival in older patients with colorectal cancer. Oncologist 2014; 19:1268-75. [PMID: 25355846 DOI: 10.1634/theoncologist.2014-0237] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is prevalent in the older population. Geriatric assessment (GA) has previously been found to predict treatment tolerance and postoperative complications in older cancer patients. The aim of this study was to explore whether GA also predicts 1-year and 5-year survival after CRC surgery in older patients and to compare the predictive power of GA with that of established prognostic factors such as TNM classification of malignant tumors (TNM) stage and age. MATERIALS AND METHODS A cohort of 178 CRC patients aged 70 and older were followed prospectively. All patients went through elective surgery, and GA was performed presurgery. The GA resulted in patients being divided into two groups: frail or nonfrail. All patients were followed for 5 years or until death. Data were analyzed by Kaplan-Meier plots and the Cox proportional hazards model. RESULTS Seventy-six patients (43%) were frail, and one hundred and two (57%) were nonfrail. Twenty-three patients (13%) died during the first year after surgery. One-year survival was 80% in the frail group and 92% in the nonfrail group. Five-year survival was significantly lower in frail (24%) than nonfrail patients (66%), and this difference was apparent both within the stratums of TNM stages 0-II and TNM stage III. In multivariable analysis adjusting for TNM stage, age, and sex, frailty was an independent prognostic factor for survival. CONCLUSION A GA-based frailty assessment predicts 1-year and 5-year survival in older patients after surgery for CRC. In localized and regional disease, the impact of frailty upon 5-year survival is comparable with that of TNM stage.
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Affiliation(s)
- Nina Ommundsen
- Institute of Clinical Medicine and Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Norway; Departments of Geriatric Medicine and Gastrointestinal Surgery and Regional Centre for Excellence in Palliative Care, South-East Norway, Oslo University Hospital, Oslo, Norway; Departments of Geriatric and General Internal Medicine and Digestive Surgery, Akershus University Hospital, Lørenskog, Norway; Cancer Unit, Innlandet Hospital Trust, Hamar, Norway; K.G. Jebsen Colorectal Cancer Research Centre, Oslo, Norway
| | - Torgeir B Wyller
- Institute of Clinical Medicine and Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Norway; Departments of Geriatric Medicine and Gastrointestinal Surgery and Regional Centre for Excellence in Palliative Care, South-East Norway, Oslo University Hospital, Oslo, Norway; Departments of Geriatric and General Internal Medicine and Digestive Surgery, Akershus University Hospital, Lørenskog, Norway; Cancer Unit, Innlandet Hospital Trust, Hamar, Norway; K.G. Jebsen Colorectal Cancer Research Centre, Oslo, Norway
| | - Arild Nesbakken
- Institute of Clinical Medicine and Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Norway; Departments of Geriatric Medicine and Gastrointestinal Surgery and Regional Centre for Excellence in Palliative Care, South-East Norway, Oslo University Hospital, Oslo, Norway; Departments of Geriatric and General Internal Medicine and Digestive Surgery, Akershus University Hospital, Lørenskog, Norway; Cancer Unit, Innlandet Hospital Trust, Hamar, Norway; K.G. Jebsen Colorectal Cancer Research Centre, Oslo, Norway
| | - Marit S Jordhøy
- Institute of Clinical Medicine and Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Norway; Departments of Geriatric Medicine and Gastrointestinal Surgery and Regional Centre for Excellence in Palliative Care, South-East Norway, Oslo University Hospital, Oslo, Norway; Departments of Geriatric and General Internal Medicine and Digestive Surgery, Akershus University Hospital, Lørenskog, Norway; Cancer Unit, Innlandet Hospital Trust, Hamar, Norway; K.G. Jebsen Colorectal Cancer Research Centre, Oslo, Norway
| | - Arne Bakka
- Institute of Clinical Medicine and Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Norway; Departments of Geriatric Medicine and Gastrointestinal Surgery and Regional Centre for Excellence in Palliative Care, South-East Norway, Oslo University Hospital, Oslo, Norway; Departments of Geriatric and General Internal Medicine and Digestive Surgery, Akershus University Hospital, Lørenskog, Norway; Cancer Unit, Innlandet Hospital Trust, Hamar, Norway; K.G. Jebsen Colorectal Cancer Research Centre, Oslo, Norway
| | - Eva Skovlund
- Institute of Clinical Medicine and Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Norway; Departments of Geriatric Medicine and Gastrointestinal Surgery and Regional Centre for Excellence in Palliative Care, South-East Norway, Oslo University Hospital, Oslo, Norway; Departments of Geriatric and General Internal Medicine and Digestive Surgery, Akershus University Hospital, Lørenskog, Norway; Cancer Unit, Innlandet Hospital Trust, Hamar, Norway; K.G. Jebsen Colorectal Cancer Research Centre, Oslo, Norway
| | - Siri Rostoft
- Institute of Clinical Medicine and Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Norway; Departments of Geriatric Medicine and Gastrointestinal Surgery and Regional Centre for Excellence in Palliative Care, South-East Norway, Oslo University Hospital, Oslo, Norway; Departments of Geriatric and General Internal Medicine and Digestive Surgery, Akershus University Hospital, Lørenskog, Norway; Cancer Unit, Innlandet Hospital Trust, Hamar, Norway; K.G. Jebsen Colorectal Cancer Research Centre, Oslo, Norway
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Al-Shamsi HO, Al Farsi A, Ellis PM. Stage III Non–Small-Cell Lung Cancer: Establishing a Benchmark for the Proportion of Patients Suitable for Radical Treatment. Clin Lung Cancer 2014; 15:274-80. [DOI: 10.1016/j.cllc.2014.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/11/2014] [Accepted: 02/11/2014] [Indexed: 10/25/2022]
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Chargari C, Moriceau G, Auberdiac P, Guy JB, Assouline A, Tinquaut F, Falk AT, Eddekkaoui H, Bourmaud A, Coscas Y, Annede P, Rivoirard R, Mery B, Trone JC, Otmezguine Y, Pacaut C, Bauduceau O, Vedrine L, Merrouche Y, Magne N. Feasibility of radiation therapy in patients 90years of age and older: A French multicentre analysis. Eur J Cancer 2014; 50:1490-7. [DOI: 10.1016/j.ejca.2014.02.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 02/11/2014] [Accepted: 02/13/2014] [Indexed: 10/25/2022]
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Efficacy and safety of sunitinib in elderly patients with metastatic renal cell carcinoma. Br J Cancer 2014; 110:1125-32. [PMID: 24434434 PMCID: PMC3950861 DOI: 10.1038/bjc.2013.832] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 12/16/2013] [Accepted: 12/17/2013] [Indexed: 12/13/2022] Open
Abstract
Background: We retrospectively analyzed sunitinib outcome as a function of age in metastatic renal cell carcinoma (mRCC) patients. Methods: Data were pooled from 1059 patients in six trials. Kaplan–Meier estimates of progression-free survival (PFS) and overall survival (OS) were compared by log-rank test between patients aged <70 (n=857; 81%) and ⩾70 (n=202; 19%) years. Results: In first-line patients, median PFS was comparable in younger and older patients, 9.9 vs 11.0 months, respectively (HR, 0.89; 95% CI: 0.73–1.09; P=0.2629), as was median OS, 23.6 vs 25.6 months (HR, 0.93; 95% CI: 0.74–1.18; P=0.5442). Similarly, in cytokine-refractory patients, median PFS was 8.1 vs 8.4 months (HR, 0.79; 95% CI: 0.49–1.28; P=0.3350), while median OS was 20.2 vs 15.8 months (HR, 1.14; 95% CI: 0.73–1.79; P=0.5657). Some treatment-emergent adverse events were significantly less common in younger vs older patients, including fatigue (60% vs 69%), cough (20% vs 29%), peripheral edema (17% vs 27%), anemia (18% vs 25%), decreased appetite (13% vs 29%), and thrombocytopenia (16% vs 25% all P<0.05). Hand–foot syndrome was more common in younger patients (32% vs 24%). Conclusions: Advanced age should not be a deterrent to sunitinib therapy and elderly patients may achieve additional clinical benefit.
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Deleuran T, Thomsen RW, Nørgaard M, Jacobsen JB, Rasmussen TR, Søgaard M. Comorbidity and survival of Danish lung cancer patients from 2000-2011: a population-based cohort study. Clin Epidemiol 2013; 5:31-8. [PMID: 24227921 PMCID: PMC3820474 DOI: 10.2147/clep.s47473] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objective To examine lung cancer survival and the impact of comorbidity in the Central Denmark Region from 2000 to 2011. Methods We performed a population-based cohort study of lung cancer patients diagnosed during four 3-year calendar periods (2000–2002, 2003–2005, 2006–2008, and 2009–2011) in the Central Denmark Region. The Danish National Registry of Patients was used to identify 9,369 incident lung cancer patients, and to obtain data on their Charlson comorbidity index score, categorized as no (score = 0), medium (score = 1–2), or high (score ≥3) level comorbidity. We calculated 1- and 5-year survival in different calendar time periods overall, and by age, sex, and level of comorbidity, and used Cox regression to compute mortality rate ratios (MRR) for each level of comorbidity versus no comorbidity in different calendar time periods. Results Overall 1-year survival increased from 31% in 2000–2002 to 37% in 2009–2011, while the 5-year survival increased from 10% in 2000–2002 to predicted 13% in 2009–2011 with the largest improvement observed for women and patients less than 80 years. The adjusted 1-year MRR in patients with high comorbidity compared with those without comorbidity was 1.23 (95% confidence interval [CI]: 1.05–1.46) in 2000–2002 and 1.35 (95% CI: 1.17–1.56) in 2009–2011. The corresponding adjusted 5-year MRRs were 1.21 (95% CI: 1.04–1.40) in 2000–2002 and 1.26 (95% CI: 1.11–1.42) in 2009–2011. Conclusion Lung cancer patients’ survival increased from 2000 to 2011 in the Central Denmark Region, most prominently for women under 80 years and patients with no, or medium level of comorbidity. Their prognosis remained nonetheless dismal with overall 5-year survival of 13%, and comorbidity remained a negative prognostic factor.
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Affiliation(s)
- Thomas Deleuran
- Department of Clinical Epidemiology, Aarhus, Denmark ; Department of Medicine V, Hepatology and Gastroenterology, Aarhus, Denmark
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Bigio Marcello A, Gieger TL, Jiménez DA, Granger LA. Detection of comorbidities and synchronous primary tumours via thoracic radiography and abdominal ultrasonography and their influence on treatment outcome in dogs with soft tissue sarcomas, primary brain tumours and intranasal tumours. Vet Comp Oncol 2013; 13:433-42. [PMID: 23968175 DOI: 10.1111/vco.12063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 07/23/2013] [Accepted: 07/24/2013] [Indexed: 11/30/2022]
Abstract
Canine soft tissue sarcomas (STS), primary brain tumours and intranasal tumours are commonly treated with radiotherapy (RT). Given the low metastatic potential of these tumours, recommendations regarding imaging tests as staging are variable among institutions. The purpose of our study was to describe thoracic radiographic and abdominal ultrasonographic findings in dogs with these neoplasms and to investigate association of abnormal findings with alterations in recommended treatment. Medical records from 101 dogs, each having thoracic radiographs and abdominal ultrasound performed as part of their staging, were reviewed. In 98 of 101 (97%), imaging abnormalities were detected, 27% of which were further investigated with fine needle aspiration cytology or biopsy. Nine percent of the detected abnormalities were considered serious comorbidities that altered treatment recommendations, including 3 (3%) which were confirmed as synchronous primary neoplasms. These findings may influence recommendations regarding the decision to perform thoracic radiographs and abdominal ultrasound prior to initiation of RT.
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Affiliation(s)
- A Bigio Marcello
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
| | - T L Gieger
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
| | - D A Jiménez
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - L Abbigail Granger
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
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Walker AJ, Card TR, West J, Crooks C, Grainge MJ. Incidence of venous thromboembolism in patients with cancer - a cohort study using linked United Kingdom databases. Eur J Cancer 2013; 49:1404-13. [PMID: 23146958 DOI: 10.1016/j.ejca.2012.10.021] [Citation(s) in RCA: 335] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 10/18/2012] [Accepted: 10/18/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND Accurate population-based data are needed on the incidence of venous thromboembolism (VTE) in patients with different cancers in order to inform guidelines on which hospitalised and ambulatory cancer patients should receive VTE prophylaxis. METHODS We conducted a cohort study using data from the Clinical Practice Research Datalink, linked to Hospital Episode Statistics, Cancer Registry data and Office for National Statistics cause of death data. We determined the incidence rates (cases per 1000 person-years) of VTE separately for 24 cancer sites. To determine relative risk, incidence rates were compared to frequency-matched controls (by age) with no record of cancer. FINDINGS We identified 83,203 cancer patients and 577,207 controls. New cases of VTE were diagnosed in 3352 cancer patients, and 6353 controls. The absolute rate of VTE in all cancers was 13.9 per 1000 person-years (95% confidence interval [CI] 13.4-14.4), corresponding to an age, sex and calendar year adjusted hazard-ratio of 4.7 (CI 4.5-4.9) between cancer patients and the general population. Rates varied greatly by cancer site (range; 98 (CI 80-119) in pancreatic cancer to 3.1 (CI 1.5-6.5) in thyroid cancer), age (range; 16.9 for patients over 80 years to 4.9 for those under 30 years) and time from diagnosis (range; 75 in the first three months to 8.4, >1 year after diagnosis). INTERPRETATION VTE is strongly linked to cancer, but the annual rate varies greatly by cancer site, proximity to diagnosis and age. Prophylaxis guidelines should take account of cancer site and such intervention should also be targeted towards the three months following diagnosis.
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Affiliation(s)
- Alex J Walker
- Division of Epidemiology and Public Health, School of Community Health Sciences, University of Nottingham, Clinical Sciences Building 2, City Hospital, Nottingham NG5 1PB, UK.
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Rodrigues G, Sanatani M. Age and comorbidity considerations related to radiotherapy and chemotherapy administration. Semin Radiat Oncol 2013; 22:277-83. [PMID: 22985810 DOI: 10.1016/j.semradonc.2012.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Oncological treatment decision-making is a highly complex enterprise integrating multiple patient, tumor, treatment, and professional factors with the available medical evidence. This management complexity can be exacerbated by the interplay of patient age and comorbid non-cancer conditions that can affect patient quality of life, treatment tolerance, and survival outcomes. Given the expected increase in median age (and associated comorbidity burden) of Western populations over the next few decades, the use of evidence-based therapies that appropriately balance treatment intensity and tolerability to achieve the desired goal of treatment (radical, adjuvant, salvage, or palliative) will be increasingly important to health care systems, providers, and patients. In this review, we highlight the evidence related to age and comorbidity, as it relates to radiotherapy and chemotherapy decision making. We will address evidence as it relates to age and comorbidity considerations separately and also the interplay between the factors. Clinical considerations to adapt radiation and/or chemotherapy treatment to deal with comorbidity challenges will be discussed. Knowledge gaps, future research, and clinical recommendation in this increasingly important field are highlighted as well.
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Affiliation(s)
- George Rodrigues
- Department of Radiation Oncology, London Health Sciences Centre, London, ON, Canada.
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Colorectal Cancer in the Elderly: How Do We Tailor Treatment with Chemotherapy and Radiotherapy Most Appropriately? CURRENT COLORECTAL CANCER REPORTS 2013. [DOI: 10.1007/s11888-013-0163-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Aarts MJ, Koldewijn EL, Poortmans PM, Coebergh JWW, Louwman M. The Impact of Socioeconomic Status on Prostate Cancer Treatment and Survival in the Southern Netherlands. Urology 2013; 81:593-9. [DOI: 10.1016/j.urology.2012.11.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 10/22/2012] [Accepted: 11/05/2012] [Indexed: 11/29/2022]
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Wo JY, Hong TS, Kachnic LA. Impact of Age and Comorbidities on the Treatment of Gastrointestinal Malignancies. Semin Radiat Oncol 2012; 22:311-20. [DOI: 10.1016/j.semradonc.2012.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Wang SL, Li YX, Zhang BN, Li J, Fan JH, Pang Y, Zhang P, Zheng S, Zhang B, Yang HJ, Xie XM, Tang ZH, Li H, Li JY, He JJ, Qiao YL. Epidemiologic study of compliance to postmastectomy radiation therapy guidelines in breast cancer patients in China between 1999 and 2008. Pract Radiat Oncol 2012; 3:209-215. [PMID: 24674366 DOI: 10.1016/j.prro.2012.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 05/16/2012] [Accepted: 05/21/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate compliance with postmastectomy radiation therapy (PMRT) guidelines in breast cancer patients in China over a 10-year period. METHODS AND MATERIALS A hospital-based, nationwide, multicenter retrospective epidemiologic study of primary breast cancer in women was conducted. Seven first-class, upper-level hospitals from different geographic regions of China were selected. One month was randomly selected to represent each year from 1999-2008 in every hospital. All inpatient cases within the selected months were reviewed and demographic, clinical, and pathologic characteristics and treatment patterns were collected. Patients enrolled in this study had to meet the following inclusion criteria: (1) treated with mastectomy and axillary dissection; (2) information regarding whether or not they received postmastectomy radiation therapy was available; and (3) information about staging was available. Patients were divided into 3 groups based on National Comprehensive Cancer Network guidelines. Utilization of PMRT in each group was analyzed and compared between different years and different hospitals. RESULTS A total of 2310 patients were analyzed. There were 643 (27.8%) patients in the PMRT recommended group, 557 (24.1%) patients in the controversial group, and 1110 (48.1%) patients in the nonrecommended group. PMRT was used in 48.8% of patients in the recommended group, 15.6% in the controversial group, and 5.7% in the nonrecommended group. There was a trend toward increasing use of radiation therapy in the recommended and controversial groups from 1999-2008. The use of PMRT in the nonrecommended group remained relatively stable from 1999-2008. Fewer positive nodes and nonreceipt of chemotherapy or hormone therapy were associated with underuse of PMRT in the recommended group. In the controversial group, a higher ratio of positive nodes was associated with use of PMRT. CONCLUSIONS There is an apparent underuse of PMRT in the PMRT recommended group. Efforts should be made to improve the compliance to PMRT guidelines.
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Affiliation(s)
- Shu-Lian Wang
- Department of Radiation Oncology, Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ye-Xiong Li
- Department of Radiation Oncology, Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
| | - Bao-Ning Zhang
- Department of Breast Surgery, Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jing Li
- Department of Cancer Epidemiology, Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jin-Hu Fan
- Department of Cancer Epidemiology, Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yi Pang
- Department of Cancer Epidemiology, Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Pin Zhang
- Department of Medical Oncology, Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Shan Zheng
- Department of Pathology, Cancer Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Bin Zhang
- Department of Breast Surgery, Liaoning Cancer Hospital, Shenyang, China
| | - Hong-Jian Yang
- Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, China
| | - Xiao-Ming Xie
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Zhong-Hua Tang
- Department of Breast-thyroid Surgery, Xiangya Sencod Hospital, Central South University, Changsha, China
| | - Hui Li
- Department of Breast Surgery, the Second People's Hospital of Sichuan Province, Chengdu, China
| | - Jia-Yuan Li
- Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Jian-Jun He
- Department of Oncosurgery, the First Affiliated Hospital of Medical College, Xi'an JiaoTong University, Xi'an, China
| | - You-Lin Qiao
- Department of Cancer Epidemiology, Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Mapping Use of Radiotherapy for Patients with Non-small Cell Lung Cancer in the Netherlands between 1997 and 2008. Clin Oncol (R Coll Radiol) 2012; 24:e46-53. [DOI: 10.1016/j.clon.2011.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 05/23/2011] [Accepted: 05/24/2011] [Indexed: 11/19/2022]
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OLDEN T, SCHOLS J, HAMERS J, VAN DE SCHANS S, COEBERGH J, JANSSEN-HEIJNEN M. Predicting the need for end-of-life care for elderly cancer patients: findings from a Dutch regional cancer registry database. Eur J Cancer Care (Engl) 2011; 21:477-84. [DOI: 10.1111/j.1365-2354.2011.01319.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Use of primary radiotherapy for rectal cancer in the Netherlands between 1997 and 2008: a population-based study. Clin Oncol (R Coll Radiol) 2011; 24:e1-8. [PMID: 21968247 DOI: 10.1016/j.clon.2011.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 06/23/2011] [Accepted: 08/10/2011] [Indexed: 01/27/2023]
Abstract
AIMS To describe variation in the utilisation rates of primary radiotherapy for patients with rectal cancer in the Netherlands, focusing on time trends and age effects. MATERIALS AND METHODS Data on primary non-metastatic rectal cancer were derived from the population-based cancer registries of four comprehensive cancer centres (regions) in the Netherlands (1997-2008, n=13,055). RESULTS An increase in the utilisation rate was noted for the four regions, from 37-46% in 1997 to 66-76% in 2008, for both genders. This increase was found predominately for preoperative radiotherapy (from 13-31% to 58-67%) and (unsurprisingly) was most pronounced for stage T2-3 patients (from 9-27% to 68-80%). The probability of receiving radiotherapy decreased with age: the odds of receiving preoperative radiotherapy was reduced in patients aged 65 years and older, as well as the odds of receiving postoperative radiotherapy in those aged 75 years and older, which remained significant after adjustment for stage, gender and region. Regional differences persisted in multivariable analyses, i.e. the odds of receiving preoperative radiotherapy was reduced in two regions: odds ratio: 0.4 (95% confidence interval: 0.4-0.5) and 0.7 (0.6-0.8). The odds of receiving postoperative radiotherapy was significantly increased in these regions [odds ratio: 2.6 (2.2-3.2) and 1.6 (1.3-1.9), respectively] and reduced in another [odds ratio 0.8 (0.6-0.96)]. CONCLUSIONS The utilisation rate of radiotherapy for rectal cancer increased significantly over time, particularly for preoperative radiotherapy and was most pronounced for T2-3 patients. Due to national multidisciplinary treatment guidelines, regional differences became limited in recent years after adjustment for age and stage of the disease. A low utilisation rate of radiotherapy was seen in women and elderly patients.
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Struikmans H, Aarts MJ, Jobsen JJ, Koning CC, Merkus JW, Lybeert ML, Immerzeel J, Poortmans PM, Veerbeek L, Louwman MW, Coebergh JWW. An increased utilisation rate and better compliance to guidelines for primary radiotherapy for breast cancer from 1997 till 2008: A population-based study in The Netherlands. Radiother Oncol 2011; 100:320-5. [DOI: 10.1016/j.radonc.2011.05.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Revised: 04/18/2011] [Accepted: 05/03/2011] [Indexed: 10/18/2022]
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Boll D, Verhoeven R, van der Aa M, Lybeert M, Coebergh J, Janssen-Heijnen M. Adherence to national guidelines for treatment and outcome of endometrial cancer stage I in relation to co-morbidity in southern Netherlands 1995–2008. Eur J Cancer 2011; 47:1504-10. [DOI: 10.1016/j.ejca.2011.03.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 03/16/2011] [Accepted: 03/21/2011] [Indexed: 11/26/2022]
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A population-based study on the utilisation rate of primary radiotherapy for prostate cancer in 4 regions in the Netherlands, 1997–2008. Radiother Oncol 2011; 99:207-13. [DOI: 10.1016/j.radonc.2011.05.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Revised: 04/18/2011] [Accepted: 05/03/2011] [Indexed: 11/21/2022]
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Quipourt V, Jooste V, Cottet V, Faivre J, Bouvier AM. Comorbidities alone do not explain the undertreatment of colorectal cancer in older adults: a French population-based study. J Am Geriatr Soc 2011; 59:694-8. [PMID: 21438864 DOI: 10.1111/j.1532-5415.2011.03334.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate the influence of comorbidities on treatment modalities of colorectal cancer according to the age of patients and French recommendations. DESIGN Population-based study SETTING French Digestive Cancer Registry, Burgundy. PARTICIPANTS Two thousand nine hundred twenty-one incident colorectal cancers diagnosed between 2004 and 2007. MEASUREMENTS The independent influence of comorbidities (recorded according to the Charlson index) on treatment was analyzed using multivariate logistic regressions controlling for age, sex, and their interaction. RESULTS The association between comorbidities and resection for cure was significant only in patients younger than 75 (P interaction=.008). For Stage III colon cancer, 40.4% of the patients aged 75 and older had adjuvant chemotherapy, versus 90.5% of those younger than 75 (P<.001). The association between comorbidities and adjuvant chemotherapy for Stage III colon cancer was significant only in patients younger than 75 (P interaction=.004). Patients aged 75 and older were less likely to receive chemotherapy, even when they had few or no comorbidities. Overall, 29.3% of patients aged 75 and older with advanced colorectal cancer had palliative chemotherapy, versus 77.1% of those younger than 75 (P<.001). Whatever the age, palliative chemotherapy was less frequent for a Charlson comorbidity index of 2 or greater (P interaction=.16). Radiotherapy was administered in 59.0% of patients aged 75 and older with rectal cancer, versus 85.3% of those younger than 75 (P<.001). Whatever the age, patients with a Charlson score of 2 or greater were less likely to receive radiotherapy for rectal cancer than were patients without comorbidities (P interaction=.86). CONCLUSION Further studies are warranted to identify more precisely the reasons for lower treatment rates for colorectal cancer in the older population.
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Affiliation(s)
- Valérie Quipourt
- Digestive Cancer Registry, Université de Bourgogne, Dijon, France
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Quaglia A, Lillini R, Casella C, Giachero G, Izzotti A, Vercelli M. The combined effect of age and socio-economic status on breast cancer survival. Crit Rev Oncol Hematol 2011; 77:210-20. [DOI: 10.1016/j.critrevonc.2010.02.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 01/31/2010] [Accepted: 02/16/2010] [Indexed: 01/19/2023] Open
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Socioeconomic inequalities in the use of radiotherapy for rectal cancer: A nationwide study. Eur J Cancer 2011; 47:347-53. [DOI: 10.1016/j.ejca.2010.03.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 03/14/2010] [Accepted: 03/17/2010] [Indexed: 01/16/2023]
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Hemminki K, Santi I, Weires M, Thomsen H, Sundquist J, Bermejo JL. Tumor location and patient characteristics of colon and rectal adenocarcinomas in relation to survival and TNM classes. BMC Cancer 2010; 10:688. [PMID: 21176147 PMCID: PMC3022888 DOI: 10.1186/1471-2407-10-688] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 12/21/2010] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Old age at diagnosis is associated with poor survival in colorectal cancer (CRC) for unknown reasons. Recent data show that colonoscopy is efficient in preventing left-sided cancers only. We examine the association of Tumor Node Metastasis (TNM) classes with diagnostic age and patient characteristics. METHODS The Swedish Family-Cancer Database has data on TNM classes on 6,105 CRC adenocarcinoma patients. Ordinal logistic regression analysis was performed to model tumor characteristics according to age at diagnosis, tumor localization, gender, socioeconomic status, medical region and family history. The results were compared to results from survival analysis. RESULTS The only parameters systematically associated with TNM classes were age and tumor localization. Young age at diagnosis was a risk factor for aggressive CRC, according to stage, N and M with odds ratios (ORs) ranging from 1.80 to 1.93 for diagnosis before age 50 years compared to diagnosis at 80+ years. All tumor characteristics, particularly T, were worse for colon compared to rectal tumors. Right-sided tumors showed worse characteristics for all classifiers but M. The survival analysis on patients diagnosed since 2000 showed a hazard ratio of 0.55 for diagnosis before age 50 years compared to diagnosis at over 80 years and a modestly better prognosis for left-sided compared to right-sided tumors. CONCLUSIONS The results showed systematically more aggressive tumors in young compared to old patients. The poorer survival of old patients in colon cancer was not related to the available tumor characteristics. However, these partially agreed with the limited colonoscopic success with right-sided tumors.
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Affiliation(s)
- Kari Hemminki
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120 Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Irene Santi
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120 Heidelberg, Germany
| | - Marianne Weires
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120 Heidelberg, Germany
| | - Hauke Thomsen
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120 Heidelberg, Germany
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, California, USA
| | - Justo Lorenzo Bermejo
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120 Heidelberg, Germany
- Institute of Medical Biometry and Informatics (IMBI), University Hospital Heidelberg, Germany
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Janssen-Heijnen ML, Szerencsi K, van de Schans SA, Maas HA, Widdershoven JW, Coebergh JWW. Cancer patients with cardiovascular disease have survival rates comparable to cancer patients within the age-cohort of 10 years older without cardiovascular morbidity. Crit Rev Oncol Hematol 2010; 76:196-207. [DOI: 10.1016/j.critrevonc.2009.11.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 11/19/2009] [Accepted: 11/26/2009] [Indexed: 11/26/2022] Open
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Wouters MWJM, Siesling S, Jansen-Landheer ML, Elferink MAG, Belderbos J, Coebergh JW, Schramel FMNH. Variation in treatment and outcome in patients with non-small cell lung cancer by region, hospital type and volume in the Netherlands. Eur J Surg Oncol 2010; 36 Suppl 1:S83-92. [PMID: 20598845 DOI: 10.1016/j.ejso.2010.06.020] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 06/08/2010] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Care processes for patients with NSCLC can vary by provider, which may lead to unwanted variation in outcomes. Therefore, in modern health care an increased focus on guideline development and implementation is seen. It is expected that more guideline adherence leads to a higher number of patients receiving optimal treatment for their cancer which could improve overall survival. OBJECTIVE The aim of this study was to evaluate variations in treatment patterns and outcomes of patients with NSCLC treated in different (types of) hospitals and regions in the Netherlands. Especially, variation in the percentage of patients receiving the optimal treatment for the stage of their disease, according to the Dutch national guideline of 2004, was analyzed. METHODS All patients with a histological confirmed primary NSCLC diagnosed in the period 2001-2006 in all Dutch hospitals (N = 97) were selected from the population-based Netherlands Cancer Registry. Hospitals were divided in groups based on their region (N = 9), annual volume of NSCLC patients, teaching status and presence of radiotherapy facilities. Stage-specific differences in optimal treatment rates between (groups of) hospitals and regions were evaluated. RESULTS In the study period 43 544 patients were diagnosed with NSCLC. The resection rates for stage I/II NSCLC patients increased during the study period, but resection rates varied by region and were higher in teaching hospitals for thoracic surgeons (OR 1.5; 95%CI 1.2-1.9, p = 0.001) and in hospitals with a diagnostic volume of more than 50/year (OR 1.3; 95%CI 1.1-1.5, p = 0.001). Also the use of chemoradiation in stage III patients increased, though marked differences between hospitals in the use of chemoradiation for stage III patients were revealed. Differences in optimal treatment rates between hospitals led to differences in survival. CONCLUSION Treatment patterns and outcome of NSCLC patients in the Netherlands varied by region and the hospital their cancer was diagnosed in. Though resection rates were higher in hospitals training thoracic surgeons, variation between individual hospitals was much more distinct. Hospital characteristics like a high diagnostic volume, teaching status or availability of radiotherapy facilities proved no guarantee for optimal treatment rates.
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Affiliation(s)
- M W J M Wouters
- Department of Thoracic Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
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