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Tomlinson MM, Pugh F, Nail AN, Newton JD, Udoh K, Abraham S, Kavalukas S, Guinn B, Tamimi RM, Laden F, Iyer HS, States JC, Ruther M, Ellis CT, DuPré NC. Heavy-metal associated breast cancer and colorectal cancer hot spots and their demographic and socioeconomic characteristics. Cancer Causes Control 2024:10.1007/s10552-024-01894-0. [PMID: 38916703 DOI: 10.1007/s10552-024-01894-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/01/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE Cancer registries offer an avenue to identify cancer clusters across large populations and efficiently examine potential environmental harms affecting cancer. The role of known metal carcinogens (i.e., cadmium, arsenic, nickel, chromium(VI)) in breast and colorectal carcinogenesis is largely unknown. Historically marginalized communities are disproportionately exposed to metals, which could explain cancer disparities. We examined area-based metal exposures and odds of residing in breast and colorectal cancer hotspots utilizing state tumor registry data and described the characteristics of those living in heavy metal-associated cancer hotspots. METHODS Breast and colorectal cancer hotspots were mapped across Kentucky, and area-based ambient metal exposure to cadmium, arsenic, nickel, and chromium(VI) were extracted from the 2014 National Air Toxics Assessment for Kentucky census tracts. Among colorectal cancer (n = 56,598) and female breast cancer (n = 77,637) diagnoses in Kentucky, we used logistic regression models to estimate Odds Ratios (ORs) and 95% Confidence Intervals to examine the association between ambient metal concentrations and odds of residing in cancer hotspots, independent of individual-level and neighborhood risk factors. RESULTS Higher ambient metal exposures were associated with higher odds of residing in breast and colorectal cancer hotspots. Populations in breast and colorectal cancer hotspots were disproportionately Black and had markers of lower socioeconomic status. Furthermore, adjusting for age, race, tobacco and neighborhood factors did not significantly change cancer hotspot ORs for ambient metal exposures analyzed. CONCLUSION Ambient metal exposures contribute to higher cancer rates in certain geographic areas that are largely composed of marginalized populations. Individual-level assessments of metal exposures and cancer disparities are needed.
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Affiliation(s)
- Madeline M Tomlinson
- Department of Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville, 485 E Gray St, Louisville, KY, 40202, USA
| | - Felicia Pugh
- Department of Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville, 485 E Gray St, Louisville, KY, 40202, USA
- Louisville Metro Department of Public Health and Wellness, Center for Health Equity, Louisville, KY, USA
| | - Alexandra N Nail
- Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Johnnie D Newton
- Department of Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville, 485 E Gray St, Louisville, KY, 40202, USA
| | - Karen Udoh
- Department of Surgery, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Stephie Abraham
- Department of Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville, 485 E Gray St, Louisville, KY, 40202, USA
| | - Sandy Kavalukas
- Department of Surgery, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Brian Guinn
- Department of Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville, 485 E Gray St, Louisville, KY, 40202, USA
| | - Rulla M Tamimi
- Department of Population Health Sciences, Weill Cornell Medical, New York, NY, USA
| | - Francine Laden
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology and Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Hari S Iyer
- Section of Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - J Christopher States
- Department of Pharmacology and Toxicology, School of Medicine, University of Louisville, Louisville, KY, USA
- Center for Integrative Environmental Health Sciences, University of Louisville, Louisville, KY, USA
| | - Matthew Ruther
- Department of Urban and Public Affairs, College of Arts and Sciences, University of Louisville, Louisville, KY, USA
| | - C Tyler Ellis
- Department of Surgery, School of Medicine, University of Louisville, Louisville, KY, USA
- Center for Integrative Environmental Health Sciences, University of Louisville, Louisville, KY, USA
| | - Natalie C DuPré
- Department of Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville, 485 E Gray St, Louisville, KY, 40202, USA.
- Center for Integrative Environmental Health Sciences, University of Louisville, Louisville, KY, USA.
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Ross-Driscoll K, Ayuk-Arrey AT, Lynch R, McCullough LE, Roccaro G, Nephew L, Hundley J, Rubin RA, Patzer R. Disparities in Access to Liver Transplant Referral and Evaluation among Patients with Hepatocellular Carcinoma in Georgia. CANCER RESEARCH COMMUNICATIONS 2024; 4:1111-1119. [PMID: 38517133 PMCID: PMC11034460 DOI: 10.1158/2767-9764.crc-23-0541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/16/2024] [Accepted: 03/15/2024] [Indexed: 03/23/2024]
Abstract
Liver transplantation offers the best survival for patients with early-stage hepatocellular carcinoma (HCC). Prior studies have demonstrated disparities in transplant access; none have examined the early steps of the transplant process. We identified determinants of access to transplant referral and evaluation among patients with HCC with a single tumor either within Milan or meeting downstaging criteria in Georgia.Population-based cancer registry data from 2010 to 2019 were linked to liver transplant centers in Georgia. Primary cohort: adult patients with HCC with a single tumor ≤8 cm in diameter, no extrahepatic involvement, and no vascular involvement. Secondary cohort: primary cohort plus patients with multiple tumors confined to one lobe. We estimated time to transplant referral, evaluation initiation, and evaluation completion, accounting for the competing risk of death. In sensitivity analyses, we also accounted for non-transplant cancer treatment.Among 1,379 patients with early-stage HCC in Georgia, 26% were referred to liver transplant. Private insurance and younger age were associated with increased likelihood of referral, while requiring downstaging was associated with lower likelihood of referral. Patients living in census tracts with ≥20% of residents in poverty were less likely to initiate evaluation among those referred [cause-specific hazard ratio (csHR): 0.62, 95% confidence interval (CI): 0.42-0.94]. Medicaid patients were less likely to complete the evaluation once initiated (csHR: 0.53, 95% CI: 0.32-0.89).Different sociodemographic factors were associated with each stage of the transplant process among patients with early-stage HCC in Georgia, emphasizing unique barriers to access and the need for targeted interventions at each step. SIGNIFICANCE Among patients with early-stage HCC in Georgia, age and insurance type were associated with referral to liver transplant, race, and poverty with evaluation initiation, and insurance type with evaluation completion. Opportunities to improve transplant access include informing referring providers about insurance requirements, addressing barriers to evaluation initiation, and streamlining the evaluation process.
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Affiliation(s)
- Katherine Ross-Driscoll
- Division of Transplantation, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
- Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana
- Department of Epidemiology, Rollins School of Public Health, Atlanta, Georgia
| | | | - Raymond Lynch
- Division of Transplantation, Department of Surgery, Pennsylvania State University School of Medicine, Hershey, Pennsylvania
| | - Lauren E. McCullough
- Department of Epidemiology, Rollins School of Public Health, Atlanta, Georgia
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Giorgio Roccaro
- Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Lauren Nephew
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University, Indianapolis, Indiana
| | - Jonathan Hundley
- Piedmont Transplant Institute, Piedmont Healthcare, Atlanta, Georgia
| | - Raymond A. Rubin
- Piedmont Transplant Institute, Piedmont Healthcare, Atlanta, Georgia
| | - Rachel Patzer
- Division of Transplantation, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
- Regenstrief Institute, Indianapolis, Indiana
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Michalek IM, Martos C, Caetano Dos Santos FL, Giusti F, Degerlund H, Neamtiu L, Taraszkiewicz L, Van Eycken L, Visser O. Advancing data collection and analysis: 2023 revised European Network of Cancer Registries recommendations for standard dataset. Eur J Cancer 2024; 199:113557. [PMID: 38281372 DOI: 10.1016/j.ejca.2024.113557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/07/2024] [Accepted: 01/10/2024] [Indexed: 01/30/2024]
Affiliation(s)
- Irmina Maria Michalek
- Polish National Cancer Registry, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Carmen Martos
- European Commission, Joint Research Centre, Ispra, Italy
| | | | | | | | - Luciana Neamtiu
- Cluj Cancer Registry, Institute of Oncology "Prof.dr. Ion Chiricuta", Cluj-Napoca, Romania; University Babes Bolyai, Cluj-Napoca, Romania
| | | | | | - Otto Visser
- Department of Registration, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands.
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Movsisyan Vernon AS, Hoch JS, Fejerman L, Keegan TH. Cancer incidence among Armenians in California. Cancer Med 2024; 13:e7100. [PMID: 38491836 PMCID: PMC10943375 DOI: 10.1002/cam4.7100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/17/2024] [Accepted: 03/02/2024] [Indexed: 03/18/2024] Open
Abstract
INTRODUCTION California is home to the largest population of Armenians in the United States. The historical categorization of Armenians as 'White' or 'Some Other Race' in population databases has likely masked cancer incidence patterns in this population. This is the first study considering cancer incidence among Armenians in California. METHODS We used the Armenian Surname List and birthplace information in the California Cancer Registry to identify Armenians with cancer diagnosed during 1988-2019. We calculated proportional incidence ratios (PIR) among Armenians compared with non-Hispanic Whites (NHWs). As an exploratory analysis, we calculated incidence rate ratios (IRR) during 2006-2015 using Armenian population denominators from the American Community Survey (ACS). We selected PIR as our primary method given uncertainty regarding the use of ACS population estimates for rate calculations. RESULTS There were 27,212 cancer diagnoses among Armenians in California, 13,754 among males and 13,458 among females. Armenian males had notably higher proportions of stomach (PIR = 2.39), thyroid (PIR = 1.45), and tobacco-related cancers including bladder (PIR = 1.53), colorectal (PIR = 1.29), and lung (PIR = 1.16) cancers. Higher proportional incidence of cancers including stomach (PIR = 3.24), thyroid (PIR = 1.47), and colorectal (PIR = 1.29) were observed among Armenian females. Exploratory IRR analyses showed higher stomach (IRR = 1.78), bladder (IRR = 1.13), and colorectal (IRR = 1.12) cancers among Armenian males and higher stomach (IRR = 2.54) cancer among Armenian females. CONCLUSION We observed higher stomach, colorectal and thyroid cancer incidence among males and females, and tobacco-related cancers among males. Further research is needed to refine Armenian population estimates and understand and address risk factors associated with specific cancers among Armenians in California.
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Affiliation(s)
- Ani S. Movsisyan Vernon
- Department of Public Health SciencesUniversity of California DavisDavisCaliforniaUSA
- UC Davis Comprehensive Cancer CenterUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
| | - Jeffrey S. Hoch
- Department of Public Health SciencesUniversity of California DavisDavisCaliforniaUSA
- Center for Healthcare Policy and ResearchUniversity of CaliforniaDavisCaliforniaUSA
| | - Laura Fejerman
- Department of Public Health SciencesUniversity of California DavisDavisCaliforniaUSA
- UC Davis Comprehensive Cancer CenterUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
| | - Theresa H. Keegan
- Department of Public Health SciencesUniversity of California DavisDavisCaliforniaUSA
- UC Davis Comprehensive Cancer CenterUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
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Nahvijou A, Esmaeeli E, Kalaghchi B, Sheikhtaheri A, Zendehdel K. Using Electronic Health Record System to Establish a National Patient's Registry : Lessons learned from the Cancer Registry in Iran. Int J Med Inform 2023; 180:105245. [PMID: 37864948 DOI: 10.1016/j.ijmedinf.2023.105245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 10/05/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND In Iran, the Integrated Electronic Health Record system, called SEPAS, has been established to store all patient encounters of individuals referring to healthcare facilities. OBJECTIVE We aimed to develop a model for cleaning SEPAS and applying its data in other databases. METHODS We used cancer data from SEPAS as the sample. We developed a guideline to identify codes for cancer-related diagnoses and services in the database. Furthermore, we searched the SEPAS database based on ICD-10 and the diagnosis description in English and Farsi in an Excel sheet. We added codes and descriptions of pharmaceuticals and procedures to the list. We applied the above database and linked it to the patient records to identify cancer patients. A dashboard was designed based on this information for every cancer patient. RESULTS We selected 5,841 diagnostic codes and phrases, 9,300 cancer pharmaceutics codes, and 452 codes from cancer-specific items related to the diagnostic procedures and treatment methods. Linkage of this list to the patient list generated a database of about 197,164 cancer patients for linkage in the registry database. CONCLUSIONS Patient registries are one of the most important sources of information in healthcare systems. Data linkage between Electronic Health Record Systems (EHRs) and registries, despite its challenges, is profitable. EHRs can be used for case finding in any patient registry to reduce the time and cost of case finding.
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Affiliation(s)
- Azin Nahvijou
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Esmaeeli
- Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Bita Kalaghchi
- Radiation Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Sheikhtaheri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Kazem Zendehdel
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
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Kataoka A, Ota M, Taniguchi K, Komura K, Ito Y. Clinical Epidemiological Studies of Colorectal Cancer by Record Linkage of Cancer Registries and Biospecimen Data: A Systematic Review. Asian Pac J Cancer Prev 2023; 24:4017-4023. [PMID: 38156833 PMCID: PMC10909078 DOI: 10.31557/apjcp.2023.24.12.4017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND The incidence and prognosis of colorectal cancer are associated with lifestyle, family history, and genetic predisposition. Record linkage between cancer registries and biospecimen data would enable us to conduct clinical epidemiological studies on incidence or prognosis including genome information. In this study, we conducted a systematic review of clinical epidemiological studies of colorectal cancer using record linkage between cancer registries and biospecimen data and examined the possibilities for future use of this linkage. METHODS We searched PubMed and Google Scholar for articles regarding cancer registries and biospecimen data use published before December 2021. Selected articles were summarized by cancer registry use, biospecimen use, exposure, outcome, informed consent, and participant numbers by study design and type of cancer registry. RESULTS Of the 2,793 identified articles, 81 studies were included in this review. The most frequently used cancer registries and study design were site specific cancer registries and cohort studies. Most use of cancer registries was for patient selection in cohort studies and case selection in case-control studies. Most use of biospecimen data was for prognostic factors in cohort studies and risk factors in case-control studies. In site specific cancer registries for the examination of familial colorectal cancer, most use of biospecimen data is to examine genome mutation, expression, or deficiency. CONCLUSION We suggest that record linkage between cancer registries and biospecimen data would enable the accurate capture of outcomes and detailed genome-environmental factors, and to conduct clinical epidemiological studies according to specific research questions and tailored study designs.
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Affiliation(s)
- Aoi Kataoka
- Department of Medical Statistics, Research & Development Center, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan.
- Division of Molecular Epidemiology, Future Medical Science, Kobe University, Kobe City, Hyogo, Japan.
| | - Masato Ota
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan.
| | - Kohei Taniguchi
- Translational Research Program, Research & Development Center, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan.
| | - Kazumasa Komura
- Translational Research Program, Research & Development Center, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan.
- Department of Urology, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan.
| | - Yuri Ito
- Department of Medical Statistics, Research & Development Center, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan.
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Kurth L, Mazurek JM, Blackley DJ. Malignant mesothelioma among US Medicare beneficiaries: incidence, prevalence and therapy, 2016-2019. Occup Environ Med 2023; 80:86-92. [PMID: 36635096 PMCID: PMC10423587 DOI: 10.1136/oemed-2022-108706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/19/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Mesothelioma is a rare, aggressive cancer caused by exposure to asbestos fibres. Mesothelioma patients who receive trimodal therapy (chemotherapy, surgical resection and radiation) survive longer than those who receive two or fewer therapy modalities. This study analyses the 2016-2019 Medicare claims data to estimate the burden of malignant mesothelioma and describe therapy patterns (when available) among continuously enrolled fee-for-service (FFS; Medicare parts A and B) beneficiaries. METHODS We analysed claims and enrolment information from 42 529 117 FFS Medicare beneficiaries using three mesothelioma case definitions (broad, intermediate and narrow) with varying levels of diagnostic requirements. Results are presented as ranges of values for the three definitions. RESULTS Among FFS beneficiaries, 8213-19 036 beneficiaries with mesothelioma were identified depending on the case definition. The annual prevalence per 100 000 beneficiaries ranged from 8.8 in 2016 (narrow) to 31.3 in 2019 (broad) and annual incidence per 100 000 beneficiaries ranged from 4.5 in 2019 (narrow) to 12.6 in 2017 (broad). Depending on the mesothelioma case definition, 41.8%-81.5% had available therapy claim information indicating that 7.6%-11.3% received chemotherapy alone, 1.3%-1.5% received radiation alone, and 14.3%-27.0% underwent surgery only, with 4.6%-10.5% receiving all three therapy modalities. CONCLUSIONS Mesothelioma was a prevalent disease among FFS Medicare beneficiaries during 2016-2019, and a limited proportion of beneficiaries received all three therapy modalities. Medicare data build on findings from cancer registry data to enhance our understanding of the mesothelioma burden and therapy patterns.
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Affiliation(s)
- Laura Kurth
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Jacek M Mazurek
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - David J Blackley
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
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Bradley H, Caldeira S, Furtado A, Nicholl C. Trusted Data Spaces as a Viable and Sustainable Solution for Networks of Population-Based Patient Registries. JMIR Public Health Surveill 2023; 9:e34123. [PMID: 36637894 PMCID: PMC9883740 DOI: 10.2196/34123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 05/31/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022] Open
Abstract
Harmonization and integration of health data remain as the focus of many ongoing efforts toward the goal of optimizing health and health care policies. Population-based patient registries constitute a critical element of these endeavors. Although their main function is monitoring and surveillance of a particular disease within a given population, they are also an important data source for epidemiology. Comparing indicators across national boundaries brings an extra dimension to the use of registry data, especially in regions where supranational initiatives are or could be coordinated to leverage good practices; this is particularly relevant for the European Union. However, strict data protection laws can unintentionally hamper the efforts of data harmonization to ensure the removal of statistical bias in the individual data sets, thereby compromising the integrated value of registries' data. Consequently, there is the motivation for creating a new paradigm to ensure that registries can operate in an environment that is not unnecessarily restrictive and to allow accurate comparison of data to better ascertain the measures and practices that are most conducive to the public health of societies. The pan-European organizational model of cancer registries, owing to its long and successful establishment, was considered as a sound basis from which to proceed toward such a paradigm. However, it has certain drawbacks, particularly regarding governance, scalability, and resourcing, which are essential elements to consider for a generic patient registry model. These issues are addressed in a proposal of an adapted model that promises a valuable pan-European data resource for epidemiological research, while providing a closely regulated environment for the processing of pseudonymized patient summary data on a broader scale than has hitherto been possible.
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Affiliation(s)
| | | | - Artur Furtado
- European Commission, Directorate General for Health and Food Safety, Luxembourg, Luxembourg
| | - Ciaran Nicholl
- European Commission, Joint Research Centre, Ispra, Italy
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Ng D, Ross W, Traverso-Ortiz M, Rim SH, Wike JM, Moore AR. Rationale and Methodologic Approach for Assessing Ovarian Cancer Treatment and Gynecologic Oncologist Involvement in the Midwest Region of the United States. JOURNAL OF REGISTRY MANAGEMENT 2023; 50:85-91. [PMID: 37941740 PMCID: PMC10629802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Introduction A study was conducted to examine treatment patterns and outcomes among women with a primary ovarian cancer diagnosis in the Midwest region of the United States, an area that has relatively fewer gynecologic oncologists (GOs) and diverse geography with respect to urban and rural areas. In this paper, we examine the methodology of working with central cancer registries (CCRs) to collect additional data items, including those related to GO involvement and detailed treatment. Methods Westat recruited 3 state CCRs from the Midwest to participate in the study. Cases were randomly selected from 2010-2012 ovarian, fallopian tube, or primary peritoneal cancer diagnoses in participating registry databases that met the selection criteria. CCRs abstracted additional information for selected cases, including study-specific data items regarding surgery and chemotherapy, GO involvement, and recurrence, where applicable. Results Abstracts with study-specific data items were collected among a total of 1,003 incidence ovarian cancer cases, with 432 additional abstracts for those cases identified as having recurrence. Variables with the highest frequency of unknowns were mostly for patients who had chemotherapy. While data were available for whether the patient received chemotherapy, the specifics about that chemotherapy were not always available, with dosing and unit being unknown in 27% of cases. There were several challenges with initiating and completing this study associated with recruitment, the data collection timeline, and the collection of study-specific data items. Conclusion This paper outlines the methodologic approach and experience of collecting additional surgical and chemotherapy treatment variables and data on GO involvement in care from medical records. Experiences from this study provide critical lessons that can be applied to future data collection in this area. Ultimately, the accurate collection of these elements enables researchers to identify groups of women who are not receiving the benefit of optimal surgery or GO care and provides critical data on interventions for improved outcomes and survival in ovarian cancer patients.
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Affiliation(s)
- Diane Ng
- Westat, Inc, Rockville, Maryland
| | | | | | - Sun Hee Rim
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer M. Wike
- Centers for Disease Control and Prevention's National Program of Cancer Registries, Atlanta, Georgia (contractor)
| | - Angela R. Moore
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Miller KA, Li AA, Wojcik KY, Stal J, Cockburn MG, In GK, Freyer DR, Hamilton AS, Milam JE. Prevalence and correlates of skin examination among ethnically diverse young adult survivors of childhood cancer. Cancer Med 2022; 12:8557-8566. [PMID: 36495004 PMCID: PMC10134373 DOI: 10.1002/cam4.5520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/20/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Skin cancer is the most common secondary malignancy among young adult childhood cancer survivors (YA-CCS). Skin examination to detect skin cancer early (including melanoma as well as basal or squamous cell skin cancers), both physician-based (PSE) and self-skin exam (SSE), is recommended, particularly for radiotherapy-exposed YA-CCS who are at high risk of developing skin cancer. METHODS Awareness and prevalence of skin examination and demographic, clinical, and healthcare correlates were examined in a population-based sample of YA-CCS with diverse cancer types excluding melanoma. Descriptive frequencies and logistic regression models were conducted using sample weights to correct for non-response bias with PSE, SSE and adherence to both as outcomes. RESULTS The sample comprised 1064 participants with 53% Latino. Eight percent of participants were aware of the need for skin examination; 9% reported receipt of PSE within past 2 years; 35% reported regular SSE; and 6% were adherent to both. Among the radiotherapy-treated, 10% were aware of the need for skin examination, 10% reported recent PSE; 38% reported regular SSE; and 8% were adherent to both. Healthcare and clinical factors including healthcare self-efficacy, engagement in cancer-related follow-up care, greater treatment intensity and greater number of treatment-related late effects were positively associated with PSE and SSE. Latino YA-CCS were less likely to engage in PSE and SSE. CONCLUSION(S) Adherence to recommended screening for skin cancer was low in this at-risk population, notably for YA-CCS exposed to radiotherapy. The development of effective strategies to expand skin cancer screening is needed in this at-risk population.
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Affiliation(s)
- Kimberly A. Miller
- Department of Population and Public Health Sciences Keck School of Medicine of the University of Southern California Los Angeles California USA
- Department of Dermatology Keck School of Medicine of the University of Southern California Los Angeles California USA
| | - Angela A. Li
- Department of Population and Public Health Sciences Keck School of Medicine of the University of Southern California Los Angeles California USA
| | - Katherine Y. Wojcik
- Department of Population and Public Health Sciences Keck School of Medicine of the University of Southern California Los Angeles California USA
| | - Julia Stal
- Department of Population and Public Health Sciences Keck School of Medicine of the University of Southern California Los Angeles California USA
| | - Myles G. Cockburn
- Department of Population and Public Health Sciences Keck School of Medicine of the University of Southern California Los Angeles California USA
- Department of Dermatology Keck School of Medicine of the University of Southern California Los Angeles California USA
- Spatial Sciences Institute, Dana and David Dornsife College of Letters, Arts and Sciences University of Southern California Los Angeles California USA
| | - Gino K. In
- Department of Dermatology Keck School of Medicine of the University of Southern California Los Angeles California USA
- Department of Medicine Keck School of Medicine of the University of Southern California Los Angeles California USA
- USC Norris Comprehensive Cancer Center Los Angeles California USA
| | - David R. Freyer
- Department of Population and Public Health Sciences Keck School of Medicine of the University of Southern California Los Angeles California USA
- USC Norris Comprehensive Cancer Center Los Angeles California USA
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles Los Angeles California USA
- Department of Pediatrics Keck School of Medicine of the University of Southern California Los Angeles California USA
| | - Ann S. Hamilton
- Department of Population and Public Health Sciences Keck School of Medicine of the University of Southern California Los Angeles California USA
| | - Joel E. Milam
- Department of Epidemiology and Biostatistics, Program in Public Health, Chao Family Comprehensive Cancer Center University of California Irvine California USA
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Florensa D, Mateo-Fornes J, Lopez Sorribes S, Torres Tuca A, Solsona F, Godoy P. Exploring Cancer Incidence, Risk Factors and Mortality in the Lleida Region: An Interactive open-source R Shiny Application for cancer data analysis. (Preprint). JMIR Cancer 2022; 9:e44695. [PMID: 37079353 PMCID: PMC10160936 DOI: 10.2196/44695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/13/2023] [Accepted: 03/07/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND The cancer incidence rate is essential to public health surveillance. The analysis of this information allows authorities to know the cancer situation in their regions, especially to determine cancer patterns, monitor cancer trends, and help prioritize the allocation of health resource. OBJECTIVE This study aimed to present the design and implementation of an R Shiny application to assist cancer registries conduct rapid descriptive and predictive analytics in a user-friendly, intuitive, portable, and scalable way. Moreover, we wanted to describe the design and implementation road map to inspire other population registries to exploit their data sets and develop similar tools and models. METHODS The first step was to consolidate the data into the population registry cancer database. These data were cross validated by ASEDAT software, checked later, and reviewed by experts. Next, we developed an online tool to visualize the data and generate reports to assist decision-making under the R Shiny framework. Currently, the application can generate descriptive analytics using population variables, such as age, sex, and cancer type; cancer incidence in region-level geographical heat maps; line plots to visualize temporal trends; and typical risk factor plots. The application also showed descriptive plots about cancer mortality in the Lleida region. This web platform was built as a microservices cloud platform. The web back end consists of an application programming interface and a database, which NodeJS and MongoDB have implemented. All these parts were encapsulated and deployed by Docker and Docker Compose. RESULTS The results provide a successful case study in which the tool was applied to the cancer registry of the Lleida region. The study illustrates how researchers and cancer registries can use the application to analyze cancer databases. Furthermore, the results highlight the analytics related to risk factors, second tumors, and cancer mortality. The application shows the incidence and evolution of each cancer during a specific period for gender, age groups, and cancer location, among other functionalities. The risk factors view permitted us to detect that approximately 60% of cancer patients were diagnosed with excess weight at diagnosis. Regarding mortality, the application showed that lung cancer registered the highest number of deaths for both genders. Breast cancer was the lethal cancer in women. Finally, a customization guide was included as a result of this implementation to deploy the architecture presented. CONCLUSIONS This paper aimed to document a successful methodology for exploiting the data in population cancer registries and propose guidelines for other similar records to develop similar tools. We intend to inspire other entities to build an application that can help decision-making and make data more accessible and transparent for the community of users.
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Affiliation(s)
- Didac Florensa
- Department of Computer Engineering, University of Lleida, Lleida, Spain
- Population-based Cancer Registry, Santa Maria University Hospital, Lleida, Spain
- Field Epidemiology Unit, Lleida Biomedical Research Institute, Lleida, Spain
| | | | | | - Anna Torres Tuca
- Department of Computer Engineering, University of Lleida, Lleida, Spain
| | - Francesc Solsona
- Department of Computer Engineering, University of Lleida, Lleida, Spain
| | - Pere Godoy
- Population-based Cancer Registry, Santa Maria University Hospital, Lleida, Spain
- Field Epidemiology Unit, Lleida Biomedical Research Institute, Lleida, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Health Institute Carlos III, Madrid, Spain
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12
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Ihenacho U, Hamilton AS, Mack WJ, Wu AH, Unger JB, Pathak DR, Hirko KA, Houang RT, Press MF, Schwartz KL, Marcus LR, Velie EM. Lifetime personal cigarette smoking and risk of young-onset breast cancer by subtype among non-Hispanic Black and White women in the Young Women's Health History Study. Breast Cancer Res Treat 2022; 195:353-366. [PMID: 35925453 PMCID: PMC10424682 DOI: 10.1007/s10549-022-06675-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/05/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To evaluate the association between lifetime personal cigarette smoking and young-onset breast cancer (YOBC; diagnosed <50 years of age) risk overall and by breast cancer (BC) subtype, and whether risk varies by race or socioeconomic position (SEP). METHODS Data are from the Young Women's Health History Study (YWHHS), a population-based case-control study of non-Hispanic Black (NHB) and White (NHW) women, ages 20-49 years (n = 1812 cases, n = 1381 controls) in the Los Angeles County and Metropolitan Detroit Surveillance, Epidemiology, and End Results (SEER) registry areas, 2010-2015. Lifetime personal cigarette smoking characteristics and YOBC risk by subtype were examined using sample-weighted, multivariable-adjusted polytomous logistic regression. RESULTS YOBC risk associated with ever versus never smoking differed by subtype (Pheterogeneity = 0.01) with risk significantly increased for Luminal A (adjusted odds ratio [aOR] 1.34; 95% confidence interval [CI] 1.06-1.68) and HER2-type (aOR 1.97; 95% CI 1.23-3.16), and no association with Luminal B or Triple Negative subtypes. Additionally, ≥30 years since smoking initiation (versus never) was statistically significantly associated with an increased risk of Luminal A (aOR 1.55; 95% CI 1.07-2.26) and HER2-type YOBC (aOR 2.77; 95% CI 1.32-5.79), but not other subtypes. In addition, among parous women, smoking initiated before first full-term pregnancy (versus never) was significantly associated with an increased risk of Luminal A YOBC (aOR 1.45; 95% CI 1.11-1.89). We observed little evidence for interactions by race and SEP. CONCLUSION Findings confirm prior reports of a positive association between cigarette smoking and Luminal A YOBC and identify a novel association between smoking and HER2-type YOBC.
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Affiliation(s)
- Ugonna Ihenacho
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Ann S. Hamilton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Wendy J. Mack
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Anna H. Wu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Jennifer B. Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Dorothy R. Pathak
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan, United States
| | - Kelly A. Hirko
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan, United States
| | - Richard T. Houang
- Center for the Study of Curriculum, College of Education, Michigan State University, East Lansing, Michigan, United States
| | - Michael F. Press
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Kendra L. Schwartz
- Department of Family Medicine and Public Health Sciences, School of Medicine, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, United States
- Wayne State University, Detroit, Michigan, United States
| | - Lydia R. Marcus
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, United States
| | - Ellen M. Velie
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, United States
- Departments of Medicine and Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
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13
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Preussler JM, Meyer CL, Sees Coles JA, Yoo D, Mau LW, Garrett ND, Auletta JJ. Enhancing Administrative Claims Data: Feasibility, Validation and Application of Linking Medicare Claims Data and National Marrow Donor Program Search Data. JCO Clin Cancer Inform 2022; 6:e2200069. [PMID: 36228178 PMCID: PMC9848571 DOI: 10.1200/cci.22.00069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/22/2022] [Accepted: 08/26/2022] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Administrative claims data provide real-world service utilization of acute myeloid leukemia (AML) treatment, but lacks insight into treatment delays or barriers. The National Marrow Donor Program (NMDP)/Be The Match Search (Search) data contains information on donor search, but lacks information on treatment received if allogeneic hematopoietic cell transplant (HCT) is not performed. We hypothesized that linking these two data sets would create a rich resource to define factors associated with receiving HCT that could not be evaluated with either data set alone. METHODS A subset of 2010-2016 Medicare administrative claims data was linked with Search data. A total of 5,351 patients with AML age 65-74 years (HCT = 607, no HCT = 4,744) were identified using Medicare. These patients were then linked to 93,800 records with a donor search between 2009 and 2016. Patient date of birth, sex, disease, ZIP code, transplant center/hospital, and diagnosis date were used for matching. Exploratory analysis was conducted to identify predictors associated with receiving HCT for patients with AML who received a search. RESULTS The data sets were successfully linked, showing high sensitivity and specificity. The final cohort included 5,085 patients with AML (HCT = 533, no HCT = 4,552). Of 97 patients who received HCT without a matched search, more than 85% received a related donor HCT. Of those not receiving HCT, 609 had a matched NMDP search and 3,943 did not have a matched NMDP search. Multivariate analysis showed time to search, age, diagnosis year, race/ethnicity, and neighborhood education status associated with receiving HCT. CONCLUSION Methods herein demonstrate the feasibility of linking Search and Medicare data. Similar methods may be applied to answer critical questions regarding barriers to HCT, thereby identifying areas to improve access to care.
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Affiliation(s)
- Jaime M. Preussler
- National Marrow Donor Program/Be The Match, Minneapolis, MN
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | - Christa L. Meyer
- National Marrow Donor Program/Be The Match, Minneapolis, MN
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | - Jennifer A. Sees Coles
- National Marrow Donor Program/Be The Match, Minneapolis, MN
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | - Dana Yoo
- National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Lih-Wen Mau
- National Marrow Donor Program/Be The Match, Minneapolis, MN
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | | | - Jeffery J. Auletta
- National Marrow Donor Program/Be The Match, Minneapolis, MN
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN
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14
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Lima FCDSD, Souza BDSND, Oliveira JFP, Galvão ND, Souza PCFD. Cervical cancer specific survival in Grande Cuiabá, Mato Grosso State, Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2022; 25:e220017. [PMID: 35766774 DOI: 10.1590/1980-549720220017.supl.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 04/07/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To estimate specific five-year survival in women diagnosed with cervical cancer living in the municipalities of Cuiabá and Várzea Grande, in the state of Mato Grosso, Brazil. METHODS This is a retrospective cohort study with information from the Cuiabá Population-based Cancer Registry and the Mortality Information System. To estimate the probability of specific survival in five years, the Kaplan-Meier estimator and the log-rank test were used aiming at verifying if there were statistical differences in the lifetime per groups. To verify the proportionality of the failure rates, the Schoenfeld residual test was used according to the statistical significance level of 0.05. RESULTS Specific five-year survival and median time were 90.0% and 50.3 months, respectively, for cervical cancer. When analyzing by age, the highest specific survival was among women aged 20 to 49 years (91.7%) and median time was 53.3 months. For the histological type, the highest specific survival was among women with adenocarcinoma (92.3%) and the mean survival time was 53.5 months. CONCLUSION This study showed that specific survival after five years of diagnosis remained about 90% in patients with cervical cancer. Patients aged 20 to 49 years had higher specific survival and there was statistically significant difference only between age groups.
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Affiliation(s)
| | | | | | - Noemi Dreyer Galvão
- Universidade Federal de Mato Grosso, Public Health Institute, Graduate Program - Cuiabá (MT), Brazil.,Secretaria de Estado de Saúde do Mato Grosso - Cuiabá (MT), Brazil
| | - Paulo Cesar Fernandes de Souza
- Universidade Federal de Mato Grosso, Public Health Institute, Graduate Program - Cuiabá (MT), Brazil.,Secretaria de Estado de Saúde do Mato Grosso - Cuiabá (MT), Brazil
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15
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Rose J, Dong W, Kim U, Hnath J, Statler A, Saroufim P, Song S, Ascha M, Menegay H, Tian Y, Beno M, Koroukian SM. An informatics infrastructure to catalyze cancer control research and practice. Cancer Causes Control 2022; 33:899-911. [PMID: 35380304 PMCID: PMC10865999 DOI: 10.1007/s10552-022-01571-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE A disconnect often exists between those with the expertise to manage and analyze complex, multi-source data sets, and the clinical, social services, advocacy, and public health professionals who can pose the most relevant questions and best apply the answers. We describe development and implementation of a cancer informatics infrastructure aimed at broadening the usability of community cancer data to inform cancer control research and practice; and we share lessons learned. METHODS We built a multi-level database known as The Ohio Cancer Assessment and Surveillance Engine (OH-CASE) to link data from Ohio's cancer registry with community data from the U.S. Census and other sources. Space-and place-based characteristics were assigned to individuals according to residential address. Stakeholder input informed development of an interface for generating queries based on geographic, demographic, and disease inputs and for outputting results aggregated at the state, county, municipality, or zip code levels. RESULTS OH-CASE contains data on 791,786 cancer cases diagnosed from 1/1/2006 to 12/31/2018 across 88 Ohio counties containing 1215 municipalities and 1197 zip codes. Stakeholder feedback from cancer center community outreach teams, advocacy organizations, public health, and researchers suggests a broad range of uses of such multi-level data resources accessible via a user interface. CONCLUSION OH-CASE represents a prototype of a transportable model for curating and synthesizing data to understand cancer burden across communities. Beyond supporting collaborative research, this infrastructure can serve the clinical, social services, public health, and advocacy communities by enabling targeting of outreach, funding, and interventions to narrow cancer disparities.
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Affiliation(s)
- Johnie Rose
- Case Western Reserve University Center for Community Health Integration, 11000 Cedar Ave., Ste. 402, Cleveland, OH, 44106-7136, USA.
- Case Comprehensive Cancer Center, Cleveland, OH, USA.
| | - Weichuan Dong
- Case Comprehensive Cancer Center, Cleveland, OH, USA
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Uriel Kim
- Case Western Reserve University Center for Community Health Integration, 11000 Cedar Ave., Ste. 402, Cleveland, OH, 44106-7136, USA
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Joseph Hnath
- Case Western Reserve University Center for Community Health Integration, 11000 Cedar Ave., Ste. 402, Cleveland, OH, 44106-7136, USA
| | - Abby Statler
- Case Comprehensive Cancer Center, Cleveland, OH, USA
- Taussig Cancer Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Paola Saroufim
- Cleveland Institute for Computational Biology, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sunah Song
- Cleveland Institute for Computational Biology, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Mustafa Ascha
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
- Cleveland Institute for Computational Biology, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Harry Menegay
- Cleveland Institute for Computational Biology, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Ye Tian
- Cleveland Institute for Computational Biology, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Mark Beno
- Cleveland Institute for Computational Biology, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Siran M Koroukian
- Case Comprehensive Cancer Center, Cleveland, OH, USA
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
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16
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Roberson ML, Nichols HB, Wheeler SB, Reeder-Hayes KE, Olshan AF, Baggett CD, Robinson WR. Validity of breast cancer surgery treatment information in a state-based cancer registry. Cancer Causes Control 2022; 33:261-269. [PMID: 34783925 PMCID: PMC8593629 DOI: 10.1007/s10552-021-01520-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/09/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Surgery is an important part of early stage breast cancer treatment that affects overall survival. Many studies of surgical treatment of breast cancer rely on data sources that condition on continuous insurance coverage or treatment at specified facilities and thus under-sample populations especially affected by cancer care inequities including the uninsured and rural populations. Statewide cancer registries contain data on first course of cancer treatment for all patients diagnosed with cancer but the accuracy of these data are uncertain. METHODS Patients diagnosed with stage I-III breast cancer between 2003 and 2016 were identified using the North Carolina Central Cancer Registry and linked to Medicaid, Medicare, and private insurance claims. We calculated the sensitivity, specificity, positive predictive value, negative predictive value, and Kappa statistics for receipt of surgery and type of surgery (breast conserving surgery or mastectomy) using the insurance claims as the presumed gold standard. Analyses were stratified by race, insurance type, and rurality. RESULTS Of 26,819 patients who met eligibility criteria, 23,125 were identified as having surgery in both the claims and registry for a sensitivity of 97.9% (95% CI 97.8%, 98.1%). There was also strong agreement for surgery type between the cancer registry and the insurance claims (Kappa: 0.91). Registry treatment data validity was lower for Medicaid insured patients than for Medicare and commercially insured patients. CONCLUSIONS Cancer registry treatment data reliably identified receipt and type of breast cancer surgery. Cancer registries are an important source of data for understanding cancer care in underrepresented populations.
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Affiliation(s)
- Mya L Roberson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Health Policy, Vanderbilt University School of Medicine, 2525 West End Ave, suite 1200, Nashville, TN, 37203, USA.
| | - Hazel B Nichols
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephanie B Wheeler
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katherine E Reeder-Hayes
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Oncology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Andrew F Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christopher D Baggett
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Whitney R Robinson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
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17
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Lima FCDSD, Souza BDSND, Oliveira JFP, Galvão ND, Souza PCFD. Sobrevida específica do câncer do colo do útero na Grande Cuiabá, Mato Grosso, Brasil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2022. [DOI: 10.1590/1980-549720220017.supl.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO: Objetivo: Estimar a sobrevida específica em cinco anos de mulheres diagnosticadas com câncer do colo do útero que residem nos municípios de Cuiabá e Várzea Grande, Mato Grosso. Métodos: Estudo de coorte retrospectiva com informações provenientes do Registro de Câncer de Base Populacional de Cuiabá e do Sistema de Informação sobre Mortalidade. Para estimar a probabilidade de sobrevivência específica em cinco anos, foram utilizados o estimador de Kaplan-Meier e o teste de log-rank. Para verificar a proporcionalidade das taxas de falhas, usou-se o teste de resíduos de Schoenfeld, conforme o nível de significância estatística de 0,05. Resultados: A sobrevida específica em cinco anos e o tempo mediano de sobrevida foram de 90% e 50,3 meses, respectivamente, para o câncer do colo do útero. Quando se analisa por idade, a maior sobrevida específica foi entre as mulheres de 20 a 49 anos (91,7%) e o tempo mediano de sobrevida foi de 53,3 meses. Para o tipo histológico, a maior sobrevida específica foi entre as mulheres com adenocarcinoma (92,3%) e o tempo mediano de sobrevida foi de 53,5 meses. Conclusão: Este estudo mostrou que a sobrevida específica após cinco anos do diagnóstico se manteve em torno de 90% em pacientes com câncer de colo do útero. As pacientes entre 20 e 49 anos tiveram maiores sobrevidas específicas e houve diferença estatisticamente significativa somente entre as faixas etárias.
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Affiliation(s)
| | | | | | - Noemi Dreyer Galvão
- Universidade Federal de Mato Grosso, Brazil; Secretaria de Estado de Saúde do Mato Grosso, Brazil
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18
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Bandini M, Ahmed M, Basile G, Watkin N, Master V, Zhu Y, Prakash G, Rodriguez A, Ssebakumba MK, Leni R, Cirulli GO, Ayres B, Compitello R, Pederzoli F, Joshi PM, Kulkarni SB, Montorsi F, Sonpavde G, Necchi A, Spiess PE. A global approach to improving penile cancer care. Nat Rev Urol 2022; 19:231-239. [PMID: 34937881 PMCID: PMC8693593 DOI: 10.1038/s41585-021-00557-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 02/06/2023]
Abstract
Rare tumours such as penile carcinoma have been largely neglected by the urology scientific community in favour of more common - and, therefore, more easily fundable - diseases. Nevertheless, penile cancer represents a rising burden for health-care systems around the world, because a lack of widespread expertise, ineffective centralization of care and absence of research funds have hampered our ability to improve the global care of these patients. Moreover, a dichotomy has arisen in the field of penile cancer, further impeding care: the countries that are mainly supporting research on this topic through the development of epidemiological studies and design of clinical trials are not the countries that have the highest prevalence of the disease. This situation means that randomized controlled trials in developed countries often do not meet the minimum accrual and are intended to close before reaching their end points, whereas trials are almost completely absent in those areas with the highest disease prevalence and probability of successful recruitment, such as Africa, South America and South Asia. The scientific and organizational inaction that arises owing to this mismatch translates into a burdensome cost for our patients. A global effort to gather experts and pull together scientific data from around the world may be the best way to boost clinical research, to change clinical practice and, ultimately, to improve care for patients and their families.
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Affiliation(s)
- Marco Bandini
- Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.
| | - Mohamed Ahmed
- grid.66875.3a0000 0004 0459 167XDepartment of Urology, Mayo Clinic, Rochester, MN USA
| | - Giuseppe Basile
- grid.15496.3f0000 0001 0439 0892Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Nicholas Watkin
- grid.451349.eSt George’s University Hospitals, NHS Foundation Trust, London, UK
| | - Viraj Master
- grid.189967.80000 0001 0941 6502Emory University School of Medicine, Department of Urology, Atlanta, GA USA
| | - Yao Zhu
- grid.452404.30000 0004 1808 0942Fudan University Shanghai Cancer Center, Shanghai, China
| | - Gagan Prakash
- grid.450257.10000 0004 1775 9822Department of Urosurgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Alejandro Rodriguez
- grid.416016.40000 0004 0456 3003Urology Associates of Rochester, Rochester General Hospital, Rochester, NY USA
| | | | - Riccardo Leni
- grid.15496.3f0000 0001 0439 0892Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Ottone Cirulli
- grid.15496.3f0000 0001 0439 0892Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Ben Ayres
- grid.451349.eSt George’s University Hospitals, NHS Foundation Trust, London, UK
| | - Rachel Compitello
- grid.468198.a0000 0000 9891 5233Moffitt Cancer Center and Research Institute, Tampa, FL USA
| | - Filippo Pederzoli
- grid.15496.3f0000 0001 0439 0892Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Pankaj M. Joshi
- grid.512719.9Kulkarni Reconstructive Urology Center, Pune, India
| | | | - Francesco Montorsi
- grid.15496.3f0000 0001 0439 0892Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Guru Sonpavde
- grid.38142.3c000000041936754XDana Farber Cancer Institute, Harvard Medical School, Boston, MA USA
| | - Andrea Necchi
- grid.15496.3f0000 0001 0439 0892Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Philippe E. Spiess
- grid.468198.a0000 0000 9891 5233Moffitt Cancer Center and Research Institute, Tampa, FL USA
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Fadhil I, Alkhalawi E, Nasr R, Fouad H, Basu P, Camacho R, Alsaadoon H. National cancer control plans across the Eastern Mediterranean region: challenges and opportunities to scale-up. Lancet Oncol 2021; 22:e517-e529. [PMID: 34735820 DOI: 10.1016/s1470-2045(21)00410-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 12/15/2022]
Abstract
National cancer control planning is crucial for countries in the WHO Eastern Mediterranean region. This region is challenged with an increase in cancer incidence leading to substantial disease burden, premature deaths, and increasing health-care costs in most countries. Huge inequity in cancer control planning and implementation exists between and within the countries. Over half of the countries (12 [55%] of 22) have standalone comprehensive National Cancer Control Plans and six (27%) have non-communicable disease plans that include cancer. The implementation of cancer plans has common challenges related to weak governance structure, few coordination mechanisms within countries, and inadequate human and financial resources. In most countries, the plan is not costed. Yet, the majority of countries (20 [91%]) reported having fully or partially funded plans. Additionally, political instability and conflicts affecting over half of the countries in the Eastern Mediterranean region have enormously affected cancer planning and implementation, both among the affected countries and those that host large numbers of refugees. In this Policy Review, we used the WHO regional framework for action on cancer to systematically analyse the status of cancer control planning and implementation across the six domains of cancer control, from prevention to palliation. We highlight the gaps, and the opportunities for bridging these gaps, to achieve scale-up on implementation of cancer control programmes in the Eastern Mediterranean region.
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Affiliation(s)
- Ibtihal Fadhil
- The Eastern Mediterranean NCD Alliance, Kuwait City, Kuwait.
| | - Eman Alkhalawi
- Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Rihab Nasr
- Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, Cancer Prevention and Control Program, Naef K Basile Cancer Institute, American University of Beirut, Beirut, Lebanon
| | - Heba Fouad
- NCD Surveillance Unit, WHO, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Partha Basu
- Early Detection, Prevention, and Infections Branch, International Agency for Research on Cancer, WHO, Lyon, France
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20
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Semeere A, Byakwaga H, Laker-Oketta M, Freeman E, Busakhala N, Wenger M, Kasozi C, Ssemakadde M, Bwana M, Kanyesigye M, Kadama-Makanga P, Rotich E, Kisuya J, Sang E, Maurer T, Wools-Kaloustian K, Kambugu A, Martin J. Feasibility of Rapid Case Ascertainment for Cancer in East Africa: An Investigation of Community-Representative Kaposi Sarcoma in the Era of Antiretroviral Therapy. Cancer Epidemiol 2021; 74:101997. [PMID: 34385076 PMCID: PMC8480528 DOI: 10.1016/j.canep.2021.101997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/12/2021] [Accepted: 07/17/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Rapid case ascertainment (RCA) refers to the expeditious and detailed examination of patients with a potentially rapidly fatal disease shortly after diagnosis. RCA is frequently performed in resource-rich settings to facilitate cancer research. Despite its utility, RCA is rarely implemented in resource-limited settings and has not been performed for malignancies. One cancer and context that would benefit from RCA in a resource-limited setting is HIV-related Kaposi sarcoma (KS) in sub-Saharan Africa. METHODS To determine the feasibility of RCA for KS, we searched for all potential newly diagnosed KS among HIV-infected adults attending three community-based facilities in Uganda and Kenya. Searching involved querying of electronic medical records, pathology record review, and notification by clinicians. Upon identification, a team verified eligibility and attempted to locate patients to perform RCA, which included epidemiologic, clinical and laboratory measurements. RESULTS We identified 593 patients with suspected new KS. Of the 593, 171 were ineligible, mainly because biopsy failed to confirm KS (65%) or KS was not new (30%). Among the 422 remaining, RCA was performed within 1 month for 56% of patients and within 3 months for 65% (95% confidence interval: 59 to 70%). Reasons for not performing RCA included intervening death (47%), inability to contact (44%), refusal/unsuitable to consent (8.3%), and patient re-location (0.7%). CONCLUSIONS We found that RCA - an important tool for cancer research in resource-rich settings - is feasible for the investigation of community-representative KS in East Africa. Feasibility of RCA for KS suggests feasibility for other cancers in Africa.
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Affiliation(s)
- Aggrey Semeere
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Helen Byakwaga
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Miriam Laker-Oketta
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Naftali Busakhala
- Moi University, Eldoret, Kenya; Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Megan Wenger
- University of California, San Francisco, CA, United States
| | | | | | | | | | - Philippa Kadama-Makanga
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Elyne Rotich
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Job Kisuya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Edwin Sang
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Toby Maurer
- Indiana University, Indianapolis, IN, United States
| | | | - Andrew Kambugu
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jeffrey Martin
- University of California, San Francisco, CA, United States
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21
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Freeman EE, Semeere A, McMahon DE, Byakwaga H, Laker-Oketta M, Regan S, Wenger M, Kasozi C, Ssemakadde M, Bwana M, Kanyesigye M, Kadama-Makanga P, Rotich E, Kisuya J, Wools-Kaloustian K, Bassett IV, Busakhala N, Martin J. Beyond T Staging in the "Treat-All" Era: Severity and Heterogeneity of Kaposi Sarcoma in East Africa. J Acquir Immune Defic Syndr 2021; 87:1119-1127. [PMID: 33871409 PMCID: PMC8263487 DOI: 10.1097/qai.0000000000002699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/11/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Although many patients with Kaposi sarcoma (KS) in sub-Saharan Africa are diagnosed with AIDS Clinical Trials Group (ACTG) T1 disease, T1 staging insufficiently captures clinical heterogeneity of advanced KS. Using a representative community-based sample, we detailed disease severity at diagnosis to inform KS staging and treatment in sub-Saharan Africa. METHODS We performed rapid case ascertainment on people living with HIV, aged 18 years or older, newly diagnosed with KS from 2016 to 2019 at 3 clinic sites in Kenya and Uganda to ascertain disease stage as close as possible to diagnosis. We reported KS severity using ACTG and WHO staging criteria and detailed measurements that are not captured in the current staging systems. RESULTS We performed rapid case ascertainment within 1 month for 241 adults newly diagnosed with KS out of 389 adult patients with suspected KS. The study was 68% men with median age 35 years and median CD4 count 239. Most of the patients had advanced disease, with 82% qualifying as ACTG T1 and 64% as WHO severe/symptomatic KS. The most common ACTG T1 qualifiers were edema (79%), tumor-associated ulceration (24%), extensive oral KS (9%), pulmonary KS (7%), and gastrointestinal KS (4%). There was marked heterogeneity within T1 KS, with 25% of patients having 2 T1 qualifying symptoms and 3% having 3 or more. CONCLUSION Most of the patients newly diagnosed with KS had advanced stage disease, even in the current antiretroviral therapy "treat-all" era. We observed great clinical heterogeneity among advanced stage patients, leading to questions about whether all patients with advanced KS require the same treatment strategy.
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Affiliation(s)
- Esther E Freeman
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Aggrey Semeere
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Devon E McMahon
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Helen Byakwaga
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | - Susan Regan
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | | | | | | | | | | | - Elyne Rotich
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Job Kisuya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Ingrid V Bassett
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Naftali Busakhala
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi University, Eldoret, Kenya
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22
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Kerlavage AR, Kirchhoff AC, Guidry Auvil JM, Sharpless NE, Davis KL, Reilly K, Reaman G, Penberthy L, Deapen D, Hwang A, Durbin EB, Gallotto SL, Aplenc R, Volchenboum SL, Heath AP, Aronow BJ, Zhang J, Vaske O, Alonzo TA, Nathan PC, Poynter JN, Armstrong G, Hahn EE, Wernli KJ, Greene C, DiGiovanna J, Resnick AC, Shalley ER, Nadaf S, Kibbe WA. Cancer Informatics for Cancer Centers: Scientific Drivers for Informatics, Data Science, and Care in Pediatric, Adolescent, and Young Adult Cancer. JCO Clin Cancer Inform 2021; 5:881-896. [PMID: 34428097 PMCID: PMC8763339 DOI: 10.1200/cci.21.00040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/11/2021] [Accepted: 06/10/2021] [Indexed: 11/29/2022] Open
Abstract
Cancer Informatics for Cancer Centers (CI4CC) is a grassroots, nonprofit 501c3 organization intended to provide a focused national forum for engagement of senior cancer informatics leaders, primarily aimed at academic cancer centers anywhere in the world but with a special emphasis on the 70 National Cancer Institute-funded cancer centers. This consortium has regularly held topic-focused biannual face-to-face symposiums. These meetings are a place to review cancer informatics and data science priorities and initiatives, providing a forum for discussion of the strategic and pragmatic issues that we faced at our respective institutions and cancer centers. Here, we provide meeting highlights from the latest CI4CC Symposium, which was delayed from its original April 2020 schedule because of the COVID-19 pandemic and held virtually over three days (September 24, October 1, and October 8) in the fall of 2020. In addition to the content presented, we found that holding this event virtually once a week for 6 hours was a great way to keep the kind of deep engagement that a face-to-face meeting engenders. This is the second such publication of CI4CC Symposium highlights, the first covering the meeting that took place in Napa, California, from October 14-16, 2019. We conclude with some thoughts about using data science to learn from every child with cancer, focusing on emerging activities of the National Cancer Institute's Childhood Cancer Data Initiative.
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Affiliation(s)
- Anthony R Kerlavage
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Rockville, MD
| | - Anne C Kirchhoff
- Huntsman Cancer Institute and University of Utah, School of Medicine, Salt Lake City, UT
| | - Jaime M Guidry Auvil
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Rockville, MD
| | | | - Kara L Davis
- Maternal and Child Health Research Institute, Stanford School of Medicine, Stanford, CA
| | - Karlyne Reilly
- Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Gregory Reaman
- Center for Drug Evaluation and Research, Food and Drug Administration, Bethesda, MD
| | - Lynne Penberthy
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Dennis Deapen
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Amie Hwang
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Eric B Durbin
- University of Kentucky, Markey Cancer Center, Lexington, KY
| | | | | | | | | | | | | | - Olena Vaske
- University of California, Santa Cruz, Santa Cruz, CA
| | - Todd A Alonzo
- University of Southern California, Keck School of Medicine, Los Angeles, CA
| | | | - Jenny N Poynter
- University of Minnesota, Masonic Cancer Center, Minneapolis, MN
| | | | - Erin E Hahn
- Kaiser Permanente Southern California, Los Angeles, CA
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
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23
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Pinheiro PS, Medina HN, Koru-Sengul T, Qiao B, Schymura M, Kobetz EN, Schlumbrecht MP. Endometrial Cancer Type 2 Incidence and Survival Disparities Within Subsets of the US Black Population. Front Oncol 2021; 11:699577. [PMID: 34354948 PMCID: PMC8329656 DOI: 10.3389/fonc.2021.699577] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/05/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction Endometrial cancer type 2 (EC2) carries a worse prognosis compared to EC type 1. EC2 disproportionately affects Black women among whom incidence is higher and survival is poorer compared to Whites. Here we assessed EC2 incidence and survival patterns among US Black ethnic groups: US-born Blacks (UBB), Caribbean-born Blacks (CBB), and Black Hispanics (BH). Methods We analyzed population-based data (n=24,387) for the entire states of Florida and New York (2005–2016). Hysterectomy-corrected EC2 incidence rates were computed by racial-ethnic group, and survival disparities were examined using Cox regression adjusting for tumor characteristics, poverty level, and insurance status. Results EC2 incidence rates were highest among UBB (24.4 per 100,000), followed by CBB (18.2), Whites (11.1), and Hispanics of all races (10.1). Compared to Whites, the age-adjusted cause-specific survival was worse for non-Hispanic Blacks (aHR: 1.61; 95%CI 1.52–1.71) and Hispanics of all races (aHR:1.09; 95% CI:1.01–1.18). In relation to Whites, survival was worse for non-Hispanic Blacks: UBB (aHR:1.62; 95%CI 1.52–1.74) and CBB (aHR:1.59; 95% CI:1.44–1.76) than for BH (aHR:1.30; 95% CI:1.05–1.61). Surgical resection was associated with a lower risk of death, while carcinosarcoma subtype and advanced stage at diagnosis were associated with a greater risk. Conclusions Although higher EC2 incidence and lower survival are observed among all African-descent groups, there are significant intra-racial differences among UBB, CBB, and BH. This heterogeneity in EC2 patterns among Black populations suggests an interplay between genetic and socioenvironmental factors.
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Affiliation(s)
- Paulo S Pinheiro
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL, United States.,Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, United States
| | - Heidy N Medina
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, United States
| | - Tulay Koru-Sengul
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL, United States.,Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, United States
| | - Baozhen Qiao
- New York State Cancer Registry, New York State Department of Health, Albany, NY, United States
| | - Maria Schymura
- New York State Cancer Registry, New York State Department of Health, Albany, NY, United States
| | - Erin N Kobetz
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL, United States.,Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, United States.,Department of Medicine, University of Miami School of Medicine, Miami, FL, United States
| | - Matthew P Schlumbrecht
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL, United States.,Department of Obstetrics & Gynecology, University of Miami School of Medicine, Miami, FL, United States
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24
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Hoopes M, Voss R, Angier H, Marino M, Schmidt T, DeVoe JE, Soule J, Huguet N. Assessing Cancer History Accuracy in Primary Care Electronic Health Records Through Cancer Registry Linkage. J Natl Cancer Inst 2021; 113:924-932. [PMID: 33377908 PMCID: PMC8246795 DOI: 10.1093/jnci/djaa210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/23/2020] [Accepted: 12/14/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Many cancer survivors receive primary care in community health centers (CHCs). Cancer history is an important factor to consider in the provision of primary care, yet little is known about the completeness or accuracy of cancer history data contained in CHC electronic health records (EHRs). METHODS We probabilistically linked EHR data from more than1.5 million adult CHC patients to state cancer registries in California, Oregon, and Washington and estimated measures of agreement (eg, kappa, sensitivity, specificity). We compared demographic and clinical characteristics of cancer patients as estimated by each data source, evaluating distributional differences with absolute standardized mean differences. RESULTS A total 74 707 cancer patients were identified between the 2 sources (EHR only, n = 22 730; registry only, n = 23 616; both, n = 28 361). Nearly one-half of cancer patients identified in registries were missing cancer documentation in the EHR. Overall agreement of cancer ascertainment in the EHR vs cancer registries (gold standard) was moderate (kappa = 0.535). Cancer site-specific agreement ranged from substantial (eg, prostate and female breast; kappa > 0.60) to fair (melanoma and cervix; kappa < 0.40). Comparing population characteristics of cancer patients as ascertained from each data source, groups were similar for sex, age, and federal poverty level, but EHR-recorded cases showed greater medical complexity than those ascertained from cancer registries. CONCLUSIONS Agreement between EHR and cancer registry data was moderate and varied by cancer site. These findings suggest the need for strategies to improve capture of cancer history information in CHC EHRs to ensure adequate delivery of care and optimal health outcomes for cancer survivors.
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Affiliation(s)
| | | | - Heather Angier
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Miguel Marino
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | | | - Jennifer E DeVoe
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Jeffrey Soule
- Oregon State Cancer Registry, Oregon Health Authority, Portland, OR, USA
| | - Nathalie Huguet
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
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25
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Wormeli P, Mazreku J, Pine J, Damesyn M. Next Generation of Central Cancer Registries. JCO Clin Cancer Inform 2021; 5:288-294. [PMID: 33760641 DOI: 10.1200/cci.20.00177] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
For central cancer registries to become a more significant public health resource, they must evolve to capture more timely, accurate, and extensive data. Key stakeholders have called for a faster time to deliver work products, data extensions such as social determinants of health, and more relevant information for cancer control programs at the local level. The proposed model consists of near real-time reporting stages to replace the current time and labor-intensive efforts to populate a complete cancer case abstract on the basis of the 12- and 24-month data submission timelines. The first stage collects a cancer diagnosis minimum data set sufficient to describe population incidence and prevalence, which is then followed by a second stage capturing subsequent case updates and treatment data. A third stage procures targeted information in response to identified research projects' needs. The model also provides for further supplemental reports as may be defined to gather additional data. All stages leverage electronic health records' widespread development and the many emerging standards for data content, including national policies related to healthcare and technical standards for interoperability, such as the Fast Healthcare Interoperability Resources specifications to automate and accelerate reporting to central cancer registries. The emergence of application programming interfaces that allow for more interoperability among systems would be leveraged, leading to more efficient information sharing. Adopting this model will expedite cancer data availability to improve cancer control while supporting data integrity and flexibility in data items. It presents a long-term and feasible solution that addresses the extensive burden and unsustainable manual data collection requirements placed on Certified Tumor Registrars at disease reporting entities nationally.
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Affiliation(s)
| | - Jenna Mazreku
- California Department of Public Health, Sacramento, CA
| | - Jeremy Pine
- California Department of Public Health, Sacramento, CA
| | - Mark Damesyn
- California Department of Public Health, Sacramento, CA
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26
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Howards PP, Mink PJ, Kim KH, Woodard JJ, Mertens AC. Comparison of Young Adult Female Cancer Survivors Recruited from a Population-Based Cancer Registry to Eligible Survivors. Cancer Epidemiol Biomarkers Prev 2021; 30:727-735. [PMID: 33531434 DOI: 10.1158/1055-9965.epi-20-1409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/18/2020] [Accepted: 01/19/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Population-based cancer registries provide a resource to recruit young adult cancer survivors who may not be easily identified otherwise. METHODS We compared demographic and cancer-related characteristics of participants in a cohort of female young adult cancer survivors to those of eligible survivors in the Georgia Cancer Registry, a population-based registry in the United States. We examined associations between survivor characteristics and nonparticipation using logistic regression and associations between survivor characteristics and different types of nonparticipation (refusal, unable to contact, or unresolved vs. interviewed) using polytomous regression. RESULTS The Georgia Cancer Registry was able to contact 60% of eligible women (3,061/5,137). Of those, 78% agreed to study contact (n = 2,378), and of those, 56% were interviewed (n = 1,342). Participation was similar across age at contact and at diagnosis but varied across cancer type from 17% for cervical cancer to 32% for breast cancer. White women were slightly more likely to be interviewed (28%) than African American women (23%), which was mostly attributable to greater difficulty in contacting African American women (odds ratio 1.7, 95% confidence interval: 1.5-2.1). CONCLUSIONS The greatest challenge to recruiting women was contacting them, which differed across some but not all demographic and cancer-related characteristics. When successfully contacted, most survivors agreed to participate. IMPACT Population-based cancer registries can serve as an invaluable resource to recruit representative samples of young adult cancer survivors, who are otherwise difficult to identify.
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Affiliation(s)
- Penelope P Howards
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
| | - Pamela J Mink
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Health Economics Program, Minnesota Department of Health, Saint Paul, Minnesota
| | - Konny H Kim
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jill J Woodard
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ann C Mertens
- Emory University, School of Medicine, Department of Pediatrics, Atlanta, Georgia
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27
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Townsend JS, Jones MC, Jones MN, Waits AW, Konrad K, McCoy NM. A Case Study of Early-Onset Colorectal Cancer: Using Electronic Health Records to Support Public Health Surveillance on an Emerging Cancer Control Topic. JOURNAL OF REGISTRY MANAGEMENT 2021; 48:4-11. [PMID: 34170890 PMCID: PMC9231638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Electronic health records (EHRs) are increasingly being used to support public health surveillance, including in cancer, where many population-based registries can now accept electronic case reporting. Using EHRs to supplement cancer registry data provides the opportunity to examine in more detail emerging issues in cancer control, such as the increasing incidence rates of early onset colorectal cancer (CRC). The purpose of this study was to evaluate the feasibility of a public health organization partnering with a health system to examine risk factors for early-onset CRC in a community cancer setting, and to further understand challenges with using EHRs to address emerging topics in cancer control. We conducted a mixed-methods evaluation using key informant interviews with public health practitioners, researchers, and registry staff to generate insights on how using EHRs and partnering with health systems can improve chronic disease surveillance and cancer control. A data quality assessment of variables representing risk factors for CRC and other clinical characteristics was conducted on all CRC patients diagnosed in 2016 at the participating cancer center. The quantitative assessment of the EHR data revealed that, while most chronic health conditions were well documented, around 25% of CRC patients were missing information on body mass index, alcohol, and tobacco use. Key informants offered ideas and ways to overcome challenges with using EHR data to support chronic disease surveillance. Their recommendations included the following activities: engaging EHR vendors in the development of standards, taking leadership roles on workgroups to address emerging technological issues, participating in pilot studies and task forces, and negotiating with EHR vendors so that clinical decision support tools built to support public health initiatives are freely available to all users of those EHRs. Although using EHR data to support public health efforts is not without its challenges, it soon could be an important part of chronic disease surveillance and cancer control.
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Affiliation(s)
- Julie S. Townsend
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Amy W. Waits
- Northside Hospital Cancer Institute, Atlanta, Georgia
| | | | - Natasha M. McCoy
- National Association of Chronic Disease Directors, Decatur, Georgia
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28
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Gallicchio L, Elena JW, Fagan S, Carter M, Hamilton AS, Hastert TA, Hunter LL, Li J, Lynch CF, Milam J, Millar MM, Modjeski D, Paddock LE, Reed AR, Moses LB, Stroup AM, Sweeney C, Trapido EJ, West MM, Wu XC, Helzlsouer KJ. Utilizing SEER Cancer Registries for Population-Based Cancer Survivor Epidemiologic Studies: A Feasibility Study. Cancer Epidemiol Biomarkers Prev 2020; 29:1699-1709. [PMID: 32651214 PMCID: PMC7484198 DOI: 10.1158/1055-9965.epi-20-0153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/24/2020] [Accepted: 06/09/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND While the primary role of central cancer registries in the United States is to provide vital information needed for cancer surveillance and control, these registries can also be leveraged for population-based epidemiologic studies of cancer survivors. This study was undertaken to assess the feasibility of using the NCI's Surveillance, Epidemiology, and End Results (SEER) Program registries to rapidly identify, recruit, and enroll individuals for survivor research studies and to assess their willingness to engage in a variety of research activities. METHODS In 2016 and 2017, six SEER registries recruited both recently diagnosed and longer-term survivors with early age-onset multiple myeloma or colorectal, breast, prostate, or ovarian cancer. Potential participants were asked to complete a survey, providing data on demographics, health, and their willingness to participate in various aspects of research studies. RESULTS Response rates across the registries ranged from 24.9% to 46.9%, with sample sizes of 115 to 239 enrolled by each registry over a 12- to 18-month period. Among the 992 total respondents, 90% answered that they would be willing to fill out a survey for a future research study, 91% reported that they would donate a biospecimen of some type, and approximately 82% reported that they would consent to have their medical records accessed for research. CONCLUSIONS This study demonstrated the feasibility of leveraging SEER registries to recruit a geographically and racially diverse group of cancer survivors. IMPACT Central cancer registries are a source of high-quality data that can be utilized to conduct population-based cancer survivor studies.
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Affiliation(s)
- Lisa Gallicchio
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland.
| | - Joanne W Elena
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Sarah Fagan
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Marjorie Carter
- Utah Cancer Registry, University of Utah, Salt Lake City, Utah
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Theresa A Hastert
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Lisa L Hunter
- Iowa Cancer Registry, University of Iowa College of Public Health, Iowa City, Iowa
| | - Jie Li
- New Jersey State Cancer Registry, State of New Jersey, Department of Health, Trenton, New Jersey
| | - Charles F Lynch
- Iowa Cancer Registry, University of Iowa College of Public Health, Iowa City, Iowa
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
- Cancer Epidemiology and Population Science Program, Holden Comprehensive Cancer Center, Iowa City, Iowa
| | - Joel Milam
- Department of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Morgan M Millar
- Utah Cancer Registry, University of Utah, Salt Lake City, Utah
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Denise Modjeski
- Department of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Lisa E Paddock
- New Jersey State Cancer Registry, State of New Jersey, Department of Health, Trenton, New Jersey
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Amanda R Reed
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Lisa B Moses
- Louisiana Tumor Registry, Louisiana State University School of Public Health, New Orleans, Louisiana
| | - Antoinette M Stroup
- New Jersey State Cancer Registry, State of New Jersey, Department of Health, Trenton, New Jersey
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Carol Sweeney
- Utah Cancer Registry, University of Utah, Salt Lake City, Utah
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Edward J Trapido
- Louisiana Tumor Registry, Louisiana State University School of Public Health, New Orleans, Louisiana
- Department of Epidemiology, Louisiana State University Health Sciences Center School of Public Health, New Orleans, Louisiana
| | - Michele M West
- Iowa Cancer Registry, University of Iowa College of Public Health, Iowa City, Iowa
- Cancer Epidemiology and Population Science Program, Holden Comprehensive Cancer Center, Iowa City, Iowa
| | - Xiao-Cheng Wu
- Louisiana Tumor Registry, Louisiana State University School of Public Health, New Orleans, Louisiana
| | - Kathy J Helzlsouer
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
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Use of public datasets in the examination of multimorbidity: Opportunities and challenges. Mech Ageing Dev 2020; 190:111310. [PMID: 32622995 DOI: 10.1016/j.mad.2020.111310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/01/2020] [Indexed: 01/27/2023]
Abstract
The interrogation of established, large-scale datasets presents great opportunities in health data science for the linkage and mining of potentially disparate resources to create new knowledge in a fast and cost-efficient manner. The number of datasets that can be queried in the field of multimorbidity is vast, ranging from national administrative and audit datasets, large clinical, technical and biological cohorts, through to more bespoke data collections made available by individual organisations and laboratories. However, with these opportunities also come technical and regulatory challenges that require an informed approach. In this review, we outline the potential benefits of using previously collected data as a vehicle for research activity. We illustrate the added value of combining potentially disparate datasets to find answers to novel questions in the field. We focus on the legal, governance and logistical considerations required to hold and analyse data acquired from disparate sources and outline some of the solutions to these challenges. We discuss the infrastructure resources required and the essential considerations in data curation and informatics management, and briefly discuss some of the analysis approaches currently used.
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Gupta S, Aitken J, Bartels U, Bhakta N, Bucurenci M, Brierley JD, De Camargo B, Chokunonga E, Clymer J, Coza D, Fraser C, Fuentes-Alabi S, Gatta G, Gross T, Jakab Z, Kohler B, Kutluk T, Moreno F, Nakata K, Nur S, Parkin DM, Penberthy L, Pole J, Poynter JN, Pritchard-Jones K, Ramirez O, Renner L, Steliarova-Foucher E, Sullivan M, Swaminathan R, Van Eycken L, Vora T, Frazier AL. Development of paediatric non-stage prognosticator guidelines for population-based cancer registries and updates to the 2014 Toronto Paediatric Cancer Stage Guidelines. Lancet Oncol 2020; 21:e444-e451. [PMID: 32888473 DOI: 10.1016/s1470-2045(20)30320-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 12/24/2022]
Abstract
Population-based cancer registries (PBCRs) generate measures of cancer incidence and survival that are essential for cancer surveillance, research, and cancer control strategies. In 2014, the Toronto Paediatric Cancer Stage Guidelines were developed to standardise how PBCRs collect data on the stage at diagnosis for childhood cancer cases. These guidelines have been implemented in multiple jurisdictions worldwide to facilitate international comparative studies of incidence and outcome. Robust stratification by risk also requires data on key non-stage prognosticators (NSPs). Key experts and stakeholders used a modified Delphi approach to establish principles guiding paediatric cancer NSP data collection. With the use of these principles, recommendations were made on which NSPs should be collected for the major malignancies in children. The 2014 Toronto Stage Guidelines were also reviewed and updated where necessary. Wide adoption of the resultant Paediatric NSP Guidelines and updated Toronto Stage Guidelines will enhance the harmonisation and use of childhood cancer data provided by PBCRs.
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Affiliation(s)
- Sumit Gupta
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.
| | | | - Ute Bartels
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Nickhill Bhakta
- Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - James D Brierley
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON, Canada
| | - Beatriz De Camargo
- Research Centre, National Cancer Institute National Cancer Institute, Rio de Janeiro, Brazil
| | | | - Jessica Clymer
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Dana Coza
- Romanian National Child Cancer Registry, Constanta, Romania
| | - Chris Fraser
- Department of Oncology, Children's Health Queensland Hospital, South Brisbane, QLD, Australia
| | | | | | - Thomas Gross
- National Cancer Institute, National Institute of Health, Bethesda, MD, USA
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer Registry, Semmelweis University, Budapest, Hungary
| | - Betsy Kohler
- North American Association of Central Cancer Registries, Springfield, IL, USA
| | - Tezer Kutluk
- Department of Paediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, Ankara, Turkey
| | | | - Kayo Nakata
- Cancer Control Centre, Osaka International Cancer Institute, Osaka, Japan
| | - Sari Nur
- Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Jawa Barat, Indonesia
| | - D M Parkin
- Nuffield Department of Population Health, University of Oxford, Oxford, UK; Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Lynne Penberthy
- National Cancer Institute, National Institute of Health, Bethesda, MD, USA
| | - Jason Pole
- Pediatric Group of Ontario, Toronto, ON, Canada
| | - Jenny N Poynter
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | | | - Oscar Ramirez
- Centro Médico Imbanaco, Cali, Valle del Cauca, Colombia
| | - Lorna Renner
- University of Ghana School of Medicine, Accra, Ghana
| | - Eva Steliarova-Foucher
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Michael Sullivan
- Faculty of Medicine, University of Melbourne, Parkville, VIC, Australia
| | | | | | - Tushar Vora
- Tata Memorial Centre, Mumbai, Maharashtra, India
| | - A L Frazier
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
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Znaor A, Fouad H, Majnoni d'Intignano F, Hammerich A, Slama S, Pourghazian N, Eser S, Piñeros Petersen M, Bray F. Use of cancer data for cancer control in the Eastern Mediterranean Region: Results of a survey among population-based cancer registries. Int J Cancer 2020; 148:593-600. [PMID: 32683692 DOI: 10.1002/ijc.33223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/04/2020] [Accepted: 07/02/2020] [Indexed: 12/20/2022]
Abstract
Data from population-based cancer registries (PBCR) are critical for planning, monitoring and evaluation of cancer control programs, but are frequently underutilized by key stakeholders. As part of the ongoing partnership of the International Agency for Research on Cancer (IARC) and the WHO Eastern Mediterranean Regional Office (EMRO) in cancer surveillance, we designed a cancer registry survey to assess the level of involvement of PBCR in national cancer control planning across the region. A questionnaire on registry characteristics, their contribution to cancer control and perceived barriers, was sent to 14 countries with operational PBCR. We obtained replies from Bahrain, Egypt, Iraq, Iran, Jordan, Kuwait, Lebanon, Morocco, Oman, Qatar, Saudi Arabia, Tunisia and the United Arab Emirates. We found a high participation of PBCR in cancer control planning (all registries involved, 46% routinely) and the evaluation of screening (92% registries involved, 46% routinely), but a much lower level of participation in palliative care and rehabilitation activities. Specified barriers included poor governance, a lack of awareness by policy makers, insufficient resources and a limited availability of data electronically, including mortality data. Appropriate planning to ensure the sustainability of PBCR (including the employment of permanent staff), increasing training, building research capacity and ensuring an efficient provision of high-quality data to policymakers, were among the proposed solutions. The results of our study reinforce the need for further tailoring of activities in support of cancer registration and enhanced networking among stakeholders, toward improving quality and use of cancer registry data for cancer control in the EMR.
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Affiliation(s)
- Ariana Znaor
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Heba Fouad
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | | | - Asmus Hammerich
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Slim Slama
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | | | - Sultan Eser
- Balıkesir University, Faculty of Medicine, Balikesir, Turkey
| | | | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
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Baclic O, Tunis M, Young K, Doan C, Swerdfeger H, Schonfeld J. Challenges and opportunities for public health made possible by advances in natural language processing. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2020; 46:161-168. [PMID: 32673380 PMCID: PMC7343054 DOI: 10.14745/ccdr.v46i06a02] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Natural language processing (NLP) is a subfield of artificial intelligence devoted to understanding and generation of language. The recent advances in NLP technologies are enabling rapid analysis of vast amounts of text, thereby creating opportunities for health research and evidence-informed decision making. The analysis and data extraction from scientific literature, technical reports, health records, social media, surveys, registries and other documents can support core public health functions including the enhancement of existing surveillance systems (e.g. through faster identification of diseases and risk factors/at-risk populations), disease prevention strategies (e.g. through more efficient evaluation of the safety and effectiveness of interventions) and health promotion efforts (e.g. by providing the ability to obtain expert-level answers to any health related question). NLP is emerging as an important tool that can assist public health authorities in decreasing the burden of health inequality/inequity in the population. The purpose of this paper is to provide some notable examples of both the potential applications and challenges of NLP use in public health.
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Affiliation(s)
- Oliver Baclic
- Centre for Immunization and Respiratory Infectious Disease, Public Health Agency of Canada, Ottawa, ON
| | - Matthew Tunis
- Centre for Immunization and Respiratory Infectious Disease, Public Health Agency of Canada, Ottawa, ON
| | - Kelsey Young
- Centre for Immunization and Respiratory Infectious Disease, Public Health Agency of Canada, Ottawa, ON
| | - Coraline Doan
- Data, Partnerships and Innovation Hub, Public Health Agency of Canada, Ottawa, ON
| | - Howard Swerdfeger
- Data, Partnerships and Innovation Hub, Public Health Agency of Canada, Ottawa, ON
| | - Justin Schonfeld
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
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White‐Gilbertson S, Lu P, Jones CM, Chiodini S, Hurley D, Das A, Delaney JR, Norris JS, Voelkel‐Johnson C. Tamoxifen is a candidate first-in-class inhibitor of acid ceramidase that reduces amitotic division in polyploid giant cancer cells-Unrecognized players in tumorigenesis. Cancer Med 2020; 9:3142-3152. [PMID: 32135040 PMCID: PMC7196070 DOI: 10.1002/cam4.2960] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 12/18/2022] Open
Abstract
Polyploid giant cancer cells (PGCC) represent a poorly understood, small subpopulation of tumor cells that are increasingly being recognized for their critical role in therapy resistance, metastasis, and cancer recurrence. PGCC have the potential to generate progeny through primitive or cleavage-like division, which allows them to evade antimitotic insults. We recently demonstrated that the sphingolipid enzyme acid ceramidase (ASAH1) is required for this process. Since specific ASAH1 inhibitors are not clinically available, we investigated whether tamoxifen, which interferes with ASAH1 function via off-target effects, has a potential clinical benefit independent of estrogen signaling. Our results show that tamoxifen inhibits generation of PGCC offspring in prostate cancer, glioblastoma, and melanoma cells. Analysis of two state-level cancer registries revealed that tamoxifen improves survival outcomes for second, nonbreast cancers that develop in women with early stage breast cancer. Our results suggest that tamoxifen may have a clinical benefit in a variety of cancers that is independent of estrogen signaling and could be due to its inhibition of acid ceramidase. Thus the distinct application of tamoxifen as potentially a first-in-class therapeutic that inhibits the generation of PGCC offspring should be considered in future clinical trials.
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Affiliation(s)
- Shai White‐Gilbertson
- Department of Microbiology & ImmunologyMedical University of South CarolinaCharlestonSCUSA
| | - Ping Lu
- Department of Microbiology & ImmunologyMedical University of South CarolinaCharlestonSCUSA
| | - Christian M. Jones
- Department of Biochemistry and Molecular BiologyMedical University of South CarolinaCharlestonSCUSA
| | | | - Deborah Hurley
- South Carolina Central Cancer RegistrySCDHECColumbiaSCUSA
| | - Arabinda Das
- Department of NeuroscienceMedical University of South CarolinaCharlestonSCUSA
| | - Joe R. Delaney
- Department of Biochemistry and Molecular BiologyMedical University of South CarolinaCharlestonSCUSA
| | - James S. Norris
- Department of Microbiology & ImmunologyMedical University of South CarolinaCharlestonSCUSA
| | - Christina Voelkel‐Johnson
- Department of Microbiology & ImmunologyMedical University of South CarolinaCharlestonSCUSA
- Department of Biochemistry and Molecular BiologyMedical University of South CarolinaCharlestonSCUSA
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Durbin EB, Christian WJ, Hands I, Koptyra MP, Jong JC, Badgett TC. Informatics Methods and Infrastructure Needed to Study Factors Associated with High Incidence of Pediatric Brain and Central Nervous System Tumors in Kentucky. JOURNAL OF REGISTRY MANAGEMENT 2020; 47:127-134. [PMID: 34128919 PMCID: PMC8276276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Pediatric brain and central nervous system tumors (PBCNSTs) are the most common solid tumors and are the leading cause of disease-related death in US children. PBCNST incidence rates in Kentucky are significantly higher than in the United States as a whole, and are even higher among Kentucky's Appalachian children. To understand and eventually eliminate such disparities, population-based research is needed to gain a thorough understanding of the epidemiology and etiology of the disease. This multi-institutional population-based retrospective cohort study is designed to identify factors associated with the high incidence of PBCNST in Kentucky, leveraging the infrastructure provided by the Kentucky Cancer Registry, its Virtual Tissue Repository (VTR), and the National Institutes of Health Gabriella Miller Kids First Data Resource Center (DRC). Spatiotemporal scan statistics have been used to explore geographic patterns of risk measured by standardized incidence ratios (SIRs) with 95% confidence intervals. The VTR is being used to collect biospecimens for the population-based cohort of PBCNST tissues that are being sequenced by Center for Data Driven Discovery in Biomedicine (D3b) at the Children's Hospital of Philadelphia (CHOP) with support from the Kids First DRC. After adjusting for demographic factors, we assess their potential relationship to environmental factors. We have identified regions in north-central and eastern Appalachian Kentucky where children experienced a significant increased risk of developing PBCNST from 1995-2017 (SIR, 1.48; 95% CI, 1.34-1.62). The VTR has been successful in the collection of a population-based cohort of 215 PBCNST specimens. Timely establishment of legal agreements for data sharing and tissue acquisition proved to be challenging which has been somewhat mitigated by the adoption of national agreement templates. Coronavirus disease 2019 (COVID-19) severely limited the generation of sequencing results due to laboratory shutdowns. However, tissue specimens processed before the shutdown indicated that punches were inferior to scrolls for generating enough quality material for DNA and RNA extraction. Informatics infrastructures that were developed have demonstrated the feasibility of our approach to generate and retrieve molecular results. Our study shows that population-based studies using historical tissue specimens are feasible and practical, but require significant investments in technical infrastructures.
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Millar MM, Elena JW, Gallicchio L, Edwards SL, Carter ME, Herget KA, Sweeney C. The feasibility of web surveys for obtaining patient-reported outcomes from cancer survivors: a randomized experiment comparing survey modes and brochure enclosures. BMC Med Res Methodol 2019; 19:208. [PMID: 31730474 PMCID: PMC6858678 DOI: 10.1186/s12874-019-0859-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/23/2019] [Indexed: 11/30/2022] Open
Abstract
Background Central cancer registries are often used to survey population-based samples of cancer survivors. These surveys are typically administered via paper or telephone. In most populations, web surveys obtain much lower response rates than paper surveys. This study assessed the feasibility of web surveys for collecting patient-reported outcomes via a central cancer registry. Methods Potential participants were sampled from Utah Cancer Registry records. Sample members were randomly assigned to receive a web or paper survey, and then randomized to either receive or not receive an informative brochure describing the cancer registry. We calculated adjusted risk ratios with 95% confidence intervals to compare response likelihood and the demographic profile of respondents across study arms. Results The web survey response rate (43.2%) was lower than the paper survey (50.4%), but this difference was not statistically significant (adjusted risk ratio = 0.88, 95% confidence interval = 0.72, 1.07). The brochure also did not significantly influence the proportion responding (adjusted risk ratio = 1.03, 95% confidence interval = 0.85, 1.25). There were few differences in the demographic profiles of respondents across the survey modes. Older age increased likelihood of response to a paper questionnaire but not a web questionnaire. Conclusions Web surveys of cancer survivors are feasible without significantly influencing response rates, but providing a paper response option may be advisable particularly when surveying older individuals. Further examination of the varying effects of brochure enclosures across different survey modes is warranted.
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Affiliation(s)
- Morgan M Millar
- Department of Internal Medicine, 295 Chipeta Way University of Utah, Salt Lake City, UT, 84132, USA. .,Utah Cancer Registry, University of Utah, 250 E 200 S, Suite 1375, Salt Lake City, UT, 84111, USA.
| | - Joanne W Elena
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rockville, MD, 20852, USA
| | - Lisa Gallicchio
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rockville, MD, 20852, USA
| | - Sandra L Edwards
- Utah Cancer Registry, University of Utah, 250 E 200 S, Suite 1375, Salt Lake City, UT, 84111, USA
| | - Marjorie E Carter
- Utah Cancer Registry, University of Utah, 250 E 200 S, Suite 1375, Salt Lake City, UT, 84111, USA
| | - Kimberly A Herget
- Utah Cancer Registry, University of Utah, 250 E 200 S, Suite 1375, Salt Lake City, UT, 84111, USA
| | - Carol Sweeney
- Department of Internal Medicine, 295 Chipeta Way University of Utah, Salt Lake City, UT, 84132, USA.,Utah Cancer Registry, University of Utah, 250 E 200 S, Suite 1375, Salt Lake City, UT, 84111, USA.,Huntsman Cancer Institute, University of Utah, 2000 Cir of Hope Dr. Salt, Lake City, UT, 84112, USA
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Millar MM, Elena JW, Gallicchio L, Edwards SL, Carter ME, Herget KA, Sweeney C. The feasibility of web surveys for obtaining patient-reported outcomes from cancer survivors: a randomized experiment comparing survey modes and brochure enclosures. BMC Med Res Methodol 2019. [PMID: 31730474 DOI: 10.1186/s12874-019-0859-9:10.1186/s12874-019-0859-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Central cancer registries are often used to survey population-based samples of cancer survivors. These surveys are typically administered via paper or telephone. In most populations, web surveys obtain much lower response rates than paper surveys. This study assessed the feasibility of web surveys for collecting patient-reported outcomes via a central cancer registry. METHODS Potential participants were sampled from Utah Cancer Registry records. Sample members were randomly assigned to receive a web or paper survey, and then randomized to either receive or not receive an informative brochure describing the cancer registry. We calculated adjusted risk ratios with 95% confidence intervals to compare response likelihood and the demographic profile of respondents across study arms. RESULTS The web survey response rate (43.2%) was lower than the paper survey (50.4%), but this difference was not statistically significant (adjusted risk ratio = 0.88, 95% confidence interval = 0.72, 1.07). The brochure also did not significantly influence the proportion responding (adjusted risk ratio = 1.03, 95% confidence interval = 0.85, 1.25). There were few differences in the demographic profiles of respondents across the survey modes. Older age increased likelihood of response to a paper questionnaire but not a web questionnaire. CONCLUSIONS Web surveys of cancer survivors are feasible without significantly influencing response rates, but providing a paper response option may be advisable particularly when surveying older individuals. Further examination of the varying effects of brochure enclosures across different survey modes is warranted.
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Affiliation(s)
- Morgan M Millar
- Department of Internal Medicine, 295 Chipeta Way University of Utah, Salt Lake City, UT, 84132, USA. .,Utah Cancer Registry, University of Utah, 250 E 200 S, Suite 1375, Salt Lake City, UT, 84111, USA.
| | - Joanne W Elena
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rockville, MD, 20852, USA
| | - Lisa Gallicchio
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rockville, MD, 20852, USA
| | - Sandra L Edwards
- Utah Cancer Registry, University of Utah, 250 E 200 S, Suite 1375, Salt Lake City, UT, 84111, USA
| | - Marjorie E Carter
- Utah Cancer Registry, University of Utah, 250 E 200 S, Suite 1375, Salt Lake City, UT, 84111, USA
| | - Kimberly A Herget
- Utah Cancer Registry, University of Utah, 250 E 200 S, Suite 1375, Salt Lake City, UT, 84111, USA
| | - Carol Sweeney
- Department of Internal Medicine, 295 Chipeta Way University of Utah, Salt Lake City, UT, 84132, USA.,Utah Cancer Registry, University of Utah, 250 E 200 S, Suite 1375, Salt Lake City, UT, 84111, USA.,Huntsman Cancer Institute, University of Utah, 2000 Cir of Hope Dr. Salt, Lake City, UT, 84112, USA
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da Silva MJS, O'Dwyer G, Osorio-de-Castro CGS. Cancer care in Brazil: structure and geographical distribution. BMC Cancer 2019; 19:987. [PMID: 31647005 PMCID: PMC6806503 DOI: 10.1186/s12885-019-6190-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 09/23/2019] [Indexed: 12/24/2022] Open
Abstract
Background The organisation and systematisation of health actions and services are essential to ensure patient safety and the effectiveness and efficiency of cancer care. The objective of this study was to analyse the structure of cancer care envisaged in Brazilian norms, describe the types of accreditations of cancer services and their geographic distribution, and determine the planning and evaluation parameters used to qualify the health units that provide cancer care in Brazil. Methods This observational study identified the current organisation of cancer care and other health services that are accredited by Brazil’s national health system (SUS) for cancer treatment as of February 2017. The following information was collected from the current norms and the National Registry of Health Establishments: geographic location, type of accreditation, type of care, and hospital classification according to annual data of the number of cancer surgeries. The adequacy of the number of licensed units relative to population size was assessed. The analysis considered the facilitative or restrictive nature of policies based on the available rules and resources. Results The analysis of the norms indicated that these documents serve as structuring rules and resources for developing and implementing cancer care policies in Brazil. A total of 299 high-complexity oncology services were identified in facilities located in 173 (3.1%) municipalities. In some states, there were no authorised services in radiotherapy, paediatric oncology and/or haematology-oncology. There was a significant deficit in accredited oncology services. Conclusions The parameters that have been used to assess the need for accredited cancer services in Brazil are widely questioned because the best basis of calculation is the incidence of cancer or disease burden rather than population size. The results indicate that the availability of cancer services is insufficient and the organisation of the cancer care network needs to be improved in Brazil.
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Affiliation(s)
- Mario Jorge Sobreira da Silva
- National Cancer Institute, Rua Marquês de Pombal, 125 - 3° andar - Centro, Rio de Janeiro, RJ, Zip code: 20230-240, Brazil.
| | - Gisele O'Dwyer
- Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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