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Baltussen JC, Cárdenas-Reyes P, Chavarri-Guerra Y, Ramirez-Fontes A, Morales-Alfaro A, Portielje JEA, Ramos-Lopez WA, Rosado-Canto V, Soto-Perez-de-Celis E. Time toxicity among older patients with cancer treated with palliative systemic therapy. Support Care Cancer 2024; 32:621. [PMID: 39212749 DOI: 10.1007/s00520-024-08844-1] [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: 05/15/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE The time toxicity of anticancer therapy, defined as days spent with healthcare contact during treatment, represents a critical but understudied outcome. This study aims to quantify time toxicity among older patients with cancer receiving palliative systemic treatment. METHODS All patients aged ≥ 65 years with metastatic cancer receiving cytotoxic chemotherapy, immunotherapy, or targeted therapy at a single center in Mexico were selected from a prospective patient navigation cohort. Patients completed a baseline assessment, including the G8 screening and quality of life measures. Physical healthcare contact days within the first 6 months were extracted from medical records and divided by days alive during the same period. Beta regression models were used to identify predictors of time toxicity. RESULTS We identified 158 older patients (median age 71 years); 86% received cytotoxic chemotherapy. Seventy-three percent had an impaired G8 score and were considered vulnerable/frail. Six-month overall survival was 74%. Within the first 6 months, patients spent a mean of 21% (95% confidence interval (CI) 19-23%) of days with healthcare contact. Concurrent radiotherapy (odds ratio (OR) 1.55; 95%CI 1.21-1.97), cytotoxic chemotherapy versus targeted therapy (OR 1.64; 95%CI 1.13-2.37), and an impaired G8 (OR 1.27; 95%CI 1.01-1.60) were associated with increased time toxicity. CONCLUSION Older adults with metastatic cancer spend 1 in 5 days with healthcare contact during treatment, with a higher burden of time toxicity for patients receiving radiotherapy or cytotoxic chemotherapy and those with potential frailty. These findings underscore the importance of informing patients about their expected healthcare contact days within the context of a limited life expectancy.
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Affiliation(s)
- Joosje C Baltussen
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Secc 16, Tlalpan, 14080, Mexico City, Mexico
| | - Paula Cárdenas-Reyes
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Secc 16, Tlalpan, 14080, Mexico City, Mexico
| | - Yanin Chavarri-Guerra
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Andrea Ramirez-Fontes
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Secc 16, Tlalpan, 14080, Mexico City, Mexico
| | - Andrea Morales-Alfaro
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Secc 16, Tlalpan, 14080, Mexico City, Mexico
| | | | - Wendy A Ramos-Lopez
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Valentina Rosado-Canto
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Secc 16, Tlalpan, 14080, Mexico City, Mexico
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Secc 16, Tlalpan, 14080, Mexico City, Mexico.
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Hemminki K, Zitricky F, Försti A, Hemminki O, Liska V, Hemminki A. Survival improvements in esophageal and gastric cancers in the Nordic countries favor younger patients. Cancer Med 2024; 13:e7365. [PMID: 39096090 PMCID: PMC11297530 DOI: 10.1002/cam4.7365] [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: 01/24/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 08/04/2024] Open
Abstract
Esophageal cancer (EC) and gastric cancer (GC) are fatal cancers with a relatively late age of onset. Age is a negative risk factor for survival in many cancers and our aim was to analyze age-specific survival in EC and GC using the recently updated NORDCAN database. NORDCAN data originate from the Danish, Finnish, Norwegian, and Swedish nationwide cancer registries covering years 1972 through 2021 inviting for comparison of 50-year survival trends between the countries. Relative 1- and 5-year survival and 5/1-year conditional survival (i.e., survival in those who were alive in Year 1 to survive additional 4 years) were analyzed. Survival in EC showed large gains for patients below age 80 years, 5-year survival in Norwegian men reaching 30% and in women over 30% but for 80-89 year old survival remained at 10%. In contrast, hardly any gain was seen among the 80-89 year patients for 1-year survival and small gains in 5 year and 5/1-year survival. Survival gaps between age-groups increased over time. For GC there was also a clear age-related negative survival gradient but the survival gaps between the age groups did not widen over time; Norwegian male and female 5-year survival for 80-89 year old was about 20%. The age-specific survival difference in GC arose in Year 1 and did not essentially increase in 5-year survival. While there were differences in survival improvements between the countries, poor survival of the 80-89 year old patients was shared by all of them. To conclude, survival has improved steadily in younger GC and EC patients in most Nordic countries. While the 80-89 year old population accounts for nearly a quarter of all patients and their poor survival depressed overall survival, which can therefore be increased further by improving diagnostics, treatment and care of elderly EC and GC patients.
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Affiliation(s)
- Kari Hemminki
- Biomedical Center, Faculty of Medicine in PilsenCharles UniversityPilsenCzech Republic
- Division of Cancer EpidemiologyGerman Cancer Research Center (DKFZ)HeidelbergGermany
| | - Frantisek Zitricky
- Biomedical Center, Faculty of Medicine in PilsenCharles UniversityPilsenCzech Republic
| | - Asta Försti
- Hopp Children's Cancer Center (KiTZ)HeidelbergGermany
- Division of Pediatric NeurooncologyGerman Cancer Research Center (DKFZ), German Cancer Consortium (DKTK)HeidelbergGermany
| | - Otto Hemminki
- Department of UrologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
- Cancer Gene Therapy Group, Translational Immunology Research ProgramUniversity of HelsinkiHelsinkiFinland
| | - Vaclav Liska
- Biomedical Center, Faculty of Medicine in PilsenCharles UniversityPilsenCzech Republic
- Department of Surgery, University Hospital, Faculty of Medicine in PilsenCharles UniversityPilsenCzech Republic
| | - Akseli Hemminki
- Cancer Gene Therapy Group, Translational Immunology Research ProgramUniversity of HelsinkiHelsinkiFinland
- Comprehensive Cancer CenterHelsinki University HospitalHelsinkiFinland
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3
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Zitricky F, Hemminki K. A metric for comparison and visualization of age disparities in cancer survival. Cancer Epidemiol 2024; 91:102586. [PMID: 38762920 DOI: 10.1016/j.canep.2024.102586] [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: 02/08/2024] [Revised: 04/29/2024] [Accepted: 05/13/2024] [Indexed: 05/21/2024]
Abstract
AIMS Diagnostic age is an important determinant of cancer survival but the methods generally used to analyze age-group-specific survival are not developed for ready visualization of survival differences. We aim at developing a novel metric for comparing and visualizing age-group-specific survival data over different cancers, sexes, periods and countries. METHODS The metric describes the mean absolute deviation between age-groups. The metric can be used in two variations, one showing the mean variation and its 95% confidence intervals and the other highlighting individually each age-groups distinguishing positive or negative deviations. We demonstrate the applications with age-group- specific 5-year relative survival data from the NORDCAN database RESULTS: The mean absolute deviation between age-groups for Swedish colon cancer survival declined from about 5% in 1972-1981-1% in 1992-2001 and to 1.3% in 2012-2021. Patients diagnosed before age 50 years accounted for the largest positive deviation. For acute myeloid leukemia (AML) the mean deviation increased from 4% (female) to 17% and 23%. Patients diagnosed at age below 50 years showed the largest deviations. Comparing colon cancer mean deviations between the Nordic countries, a time-related decline was observed for all, those in Sweden ending at the lowest and in Finland the highest level. CONCLUSIONS We demonstrated the usefulness of the devised metric for summarizing age-specific survival data between cancers, sexes, periods and countries. The two variations of the metric allow a simple visual presentation of the survival experience as to deviation of the survival data, its 95%CIs and its highlighted individual age-group components.
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Affiliation(s)
- Frantisek Zitricky
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen 323 00, Czech Republic
| | - Kari Hemminki
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen 323 00, Czech Republic; Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, Heidelberg D-69120, Germany.
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4
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Pilleron S, Bastiaannet E. Epidemiology of Cancer in Older Adults: A Systematic Review. Curr Oncol Rep 2024:10.1007/s11912-024-01567-w. [PMID: 38963522 DOI: 10.1007/s11912-024-01567-w] [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] [Accepted: 06/03/2024] [Indexed: 07/05/2024]
Abstract
PURPOSE OF REVIEW What are the prevalence, incidence and mortality rates of cancer among individuals aged 60 or older on a national, regional, and global scale? What factors affect differences in cancer survival between older and younger adults? RECENT FINDINGS The epidemiological literature on cancer in older adults, particularly in low- and middle-income countries (LMICs) and that focusing on the oldest adults, is expanding. These studies consistently show increasing global cancer incidence rates in older populations. Recent research also highlights a widening survival gap between middle-aged and older adults, with the stage at diagnosis being the primary driver. More research is needed to describe the cancer burden in older adults, especially focusing on the oldest population and LMICs, to better understand global healthcare challenges. Additionally, further exploring patient-related, clinical, and tumour-related factors which drive age-related survival differences could improve cancer outcomes in older adults.
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Affiliation(s)
- Sophie Pilleron
- Ageing, Cancer, and Disparities Research Unit, Department of Precision Health, Luxembourg Institute of Health, 1 A-B, Rue Thomas Edison, 1445, Strassen, Luxembourg.
| | - Esther Bastiaannet
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001, Zurich, Switzerland
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Johansson ALV, Kønig SM, Larønningen S, Engholm G, Kroman N, Seppä K, Malila N, Steig BÁ, Gudmundsdóttir EM, Ólafsdóttir EJ, Lundberg FE, Andersson TML, Lambert PC, Lambe M, Pettersson D, Aagnes B, Friis S, Storm H. Have the recent advancements in cancer therapy and survival benefitted patients of all age groups across the Nordic countries? NORDCAN survival analyses 2002-2021. Acta Oncol 2024; 63:179-191. [PMID: 38597666 PMCID: PMC11332520 DOI: 10.2340/1651-226x.2024.35094] [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: 01/02/2024] [Accepted: 03/08/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Since the early 2000s, overall and site-specific cancer survival have improved substantially in the Nordic countries. We evaluated whether the improvements have been similar across countries, major cancer types, and age groups. MATERIAL AND METHODS Using population-based data from the five Nordic cancer registries recorded in the NORDCAN database, we included a cohort of 1,525,854 men and 1,378,470 women diagnosed with cancer (except non-melanoma skin cancer) during 2002-2021, and followed for death until 2021. We estimated 5-year relative survival (RS) in 5-year calendar periods, and percentage points (pp) differences in 5-year RS from 2002-2006 until 2017-2021. Separate analyses were performed for eight cancer sites (i.e. colorectum, pancreas, lung, breast, cervix uteri, kidney, prostate, and melanoma of skin). RESULTS Five-year RS improved across nearly all cancer sites in all countries (except Iceland), with absolute differences across age groups ranging from 1 to 21 pp (all cancer sites), 2 to 20 pp (colorectum), -1 to 36 pp (pancreas), 2 to 28 pp (lung), 0 to 9 pp (breast), -11 to 26 pp (cervix uteri), 2 to 44 pp (kidney), -2 to 23 pp (prostate) and -3 to 30 pp (skin melanoma). The oldest patients (80-89 years) exhibited lower survival across all countries and sites, although with varying improvements over time. INTERPRETATION Nordic cancer patients have generally experienced substantial improvements in cancer survival during the last two decades, including major cancer sites and age groups. Although survival has improved over time, older patients remain at a lower cancer survival compared to younger patients.
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Affiliation(s)
- Anna L V Johansson
- Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Simon M Kønig
- Danish Cancer Institute, Danish Cancer Society, Copenhagen, Denmark
| | - Siri Larønningen
- Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
| | - Gerda Engholm
- Danish Cancer Institute, Danish Cancer Society, Copenhagen, Denmark
| | - Niels Kroman
- Department Breast Surgery, Copenhagen University Hospital (Herlev/Gentofte), Copenhagen, Denmark
| | - Karri Seppä
- Finnish Cancer Registry, Helsinki, Finland; Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Nea Malila
- Finnish Cancer Registry, Helsinki, Finland
| | - Bjarni Á Steig
- National Hospital of the Faroe Islands, Tórshavn, Faroe Islands
| | | | | | - Frida E Lundberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Therese M-L Andersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul C Lambert
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Biostatistics Research Group, Department of Health Sciences, University of Leicester, UK
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Regional Cancer Center Mid-Sweden, Uppsala, Sweden
| | - David Pettersson
- Swedish Cancer Registry, National Board of Health and Welfare, Stockholm, Sweden
| | - Bjarte Aagnes
- Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway
| | - Søren Friis
- Danish Cancer Institute, Danish Cancer Society, Copenhagen, Denmark
| | - Hans Storm
- Danish Cancer Society, Copenhagen, Denmark
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6
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Wang W, Shen T, Wang J. Analysis of the impact of radiotherapy and surgical treatment regimens based on the SEER database on the survival outcomes of rectal cancer patients over 70 years. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2024; 21:4463-4484. [PMID: 38549336 DOI: 10.3934/mbe.2024197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
OBJECTIVE This study evaluates the impact of different combinations of treatment regimens, such as additional radiation, chemotherapy, and surgical treatments, on the survival of elderly rectal cancer patients ≥ 70 years of age to support physicians' clinical decision-making. METHODS Data from a sample of elderly rectal cancer patients aged ≥ 70 years diagnosed from 2005-2015 from the US surveillance, epidemiology, and end results (SEER) database were retrospectively analyzed. The best cut-off point was selected using the x-tile software for the three continuity indices: age, tumor size, and number of regional lymph nodes. All patients were categorized into either the neoadjuvant radiotherapy and surgery group (R_S group), the surgical treatment group (S group), or the surgery and adjuvant radiotherapy group (S_R group). The propensity score allocation was used to match each included study subject in a 1:1 ratio, and the restricted mean survival time method (RMST) was used to predict the mean survival of rectal cancer patients within 5 and 10 years. The prognostic risk factors for rectal cancer patients were determined using univariate and multivariate Cox regression analyses, and nomograms were constructed. A subgroup stratification analysis of patients with different treatment combination regimens was performed using the Kaplan-Meier method, and log-rank tests were used for between-group comparisons. The model's predictive accuracy was assessed by receiver operating characteristic (ROC) curves, correction curves, and a clinical decision curve analysis (DCA). RESULTS A total of 7556 cases of sample data from 2005 to 2015 were included, which were categorized into 6639 patients (87.86%) in the S group, 408 patients (5.4%) in the R_S group, and 509 patients (6.74%) in the S_R group, according to the relevant order of radiotherapy and surgery. After propensity score matching (PSM), the primary clinical characteristics of the groups were balanced and comparable. The difference in the mean survival time before and after PSM was not statistically significant in both R_S and S groups (P value > 0.05), and the difference in the mean survival time after PSM was statistically substantial in S_R and S groups (P value < 0.05). In the multifactorial Cox analysis, the M1 stage and Nodes ≥ 9 were independent risk factors. An age between 70-75 was an independent protective factor for patients with rectal cancer in the R_S and S groups. The Marital_status, T4 stage, N2 stage, M1 stage, and Nodes ≥ 9 were independent risk factors for patients with rectal cancer in the S_R and S groups, and an age between 70-81 was an independent protective factor. The ROC curve area, the model C index, and the survival calibration curve suggested good agreement between the actual and predicted values of the model. The DCA for 3-year, 5-year, and 10-year survival periods indicated that the model had some potential for application. CONCLUSIONS The results of the study showed no significant difference in the overall survival (OS) between elderly patients who received neoadjuvant radiotherapy and surgery and those who received surgery alone; elderly patients who received surgery and adjuvant radiotherapy had some survival benefits compared with those who received surgery alone, though the benefit of adjuvant radiotherapy was not significant. Therefore, radiotherapy for rectal cancer patients older than 70 years old should be based on individual differences in condition, and a precise treatment plan should be developed.
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Affiliation(s)
- Wei Wang
- The First Affiliated Hospital, Anhui University of Chinese Medicine, Hefei, China
| | - Tongping Shen
- School of Information Engineering, Anhui University of Chinese Medicine, Hefei, China
- Graduate School, Angeles University Foundation, Angeles, Philippines
| | - Jiaming Wang
- School of Information Engineering, Anhui University of Chinese Medicine, Hefei, China
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Yang M, Narasimhan VM, Zhan FB. High polygenic risk score is a risk factor associated with colorectal cancer based on data from the UK Biobank. PLoS One 2023; 18:e0295155. [PMID: 38032963 PMCID: PMC10688735 DOI: 10.1371/journal.pone.0295155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/15/2023] [Indexed: 12/02/2023] Open
Abstract
Colorectal cancer (CRC) is a common cancer among both men and women and is one of the leading causes of cancer death worldwide. It is important to identify risk factors that may be used to help reduce morbidity and mortality of the disease. We used a case-control study design to explore the association between CRC, polygenic risk scores (PRS), and other factors. We extracted data about 2,585 CRC cases and 9,362 controls from the UK Biobank, calculated the PRS for these cases and controls based on 140 single nucleotide polymorphisms, and performed logistic regression analyses for the 11,947 cases and controls, for an older group (ages 50+), and for a younger group (younger than 50). Five significant risk factors were identified when all 11,947 cases and controls were considered. These factors were, in descending order of the values of the adjusted odds ratios (aOR), high PRS (aOR: 2.70, CI: 2.27-3.19), male sex (aOR: 1.52, CI: 1.39-1.66), unemployment (aOR: 1.47, CI: 1.17-1.85), family history of CRC (aOR: 1.44, CI: 1.28-1.62), and age (aOR: 1.01, CI: 1.01-1.02). These five risk factors also remained significant in the older group. For the younger group, only high PRS (aOR: 2.87, CI: 1.65-5.00) and family history of CRC (aOR: 1.73, CI: 1.12-2.67) were significant risk factors. These findings indicate that genetic risk for the disease is a significant risk factor for CRC even after adjusting for family history. Additional studies are needed to examine this association using larger samples and different population groups.
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Affiliation(s)
- Mei Yang
- Department of Geography and Environmental Studies, Texas State University, San Marcos, Texas, United States of America
| | - Vagheesh M. Narasimhan
- Department of Integrative Biology, The University of Texas at Austin, Austin, Texas, United States of America
- Department of Statistics and Data Science, The University of Texas at Austin, Austin, Texas, United States of America
| | - F. Benjamin Zhan
- Department of Geography and Environmental Studies, Texas State University, San Marcos, Texas, United States of America
- Department of Population Health, University of Texas Dell Medical School, Austin, Texas, United States of America
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Jain B, Bajaj SS, Patel TA, Vapiwala N, Lam MB, Mahal BA, Muralidhar V, Amen TB, Nguyen PL, Sanford NN, Dee EC. Colon Cancer Disparities in Stage at Presentation and Time to Surgery for Asian Americans, Native Hawaiians, and Pacific Islanders: A Study with Disaggregated Ethnic Groups. Ann Surg Oncol 2023; 30:5495-5505. [PMID: 37017832 PMCID: PMC10075171 DOI: 10.1245/s10434-023-13339-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 02/19/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Vast differences in barriers to care exist among Asian American, Native Hawaiian, and Pacific Islander (AANHPI) groups and may manifest as disparities in stage at presentation and access to treatment. Thus, we characterized AANHPI patients with stage 0-IV colon cancer and examined differences in (1) stage at presentation and (2) time to surgery relative to white patients. PATIENTS AND METHODS We assessed all patients in the National Cancer Database (NCDB) with stage 0-IV colon cancer from 2004 to 2016 who identified as white, Chinese, Japanese, Filipino, Native Hawaiian, Korean, Vietnamese, Laotian, Hmong, Kampuchean, Thai, Asian Indian or Pakistani, and Pacific Islander. Multivariable ordinal logistic regression defined adjusted odds ratios (AORs), with 95% confidence intervals (CI), of (1) patients presenting with advanced stage colon cancer and (2) patients with stage 0-III colon cancer receiving surgery at ≥ 60 days versus 30-59 days versus < 30 days postdiagnosis, adjusting for sociodemographic/clinical factors. RESULTS Among 694,876 patients, Japanese [AOR 1.08 (95% CI 1.01-1.15), p < 0.05], Filipino [AOR 1.17 (95% CI 1.09-1.25), p < 0.001], Korean [AOR 1.09 (95% CI 1.01-1.18), p < 0.05], Laotian [AOR 1.51 (95% CI 1.17-1.95), p < 0.01], Kampuchean [AOR 1.33 (95% CI 1.04-1.70), p < 0.01], Thai [AOR 1.60 (95% CI 1.22-2.10), p = 0.001], and Pacific Islander [AOR 1.41 (95% CI 1.20-1.67), p < 0.001] patients were more likely to present with more advanced colon cancer compared with white patients. Chinese [AOR 1.27 (95% CI 1.17-1.38), p < 0.001], Japanese [AOR 1.23 (95% CI 1.10-1.37], p < 0.001], Filipino [AOR 1.36 (95% CI 1.22-1.52), p < 0.001], Korean [AOR 1.16 (95% CI 1.02-1.32), p < 0.05], and Vietnamese [AOR 1.55 (95% CI 1.36-1.77), p < 0.001] patients were more likely to experience greater time to surgery than white patients. Disparities persisted when comparing among AANHPI subgroups. CONCLUSIONS Our findings reveal key disparities in stage at presentation and time to surgery by race/ethnicity among AANHPI subgroups. Heterogeneity upon disaggregation underscores the importance of examining and addressing access barriers and clinical disparities.
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Affiliation(s)
- Bhav Jain
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Tej A Patel
- University of Pennsylvania, Philadelphia, PA, USA
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Miranda B Lam
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Brandon A Mahal
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Vinayak Muralidhar
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Kaiser Permanente Northwest, Portland, OR, USA
| | - Troy B Amen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Nina N Sanford
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA.
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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9
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Withrow DR, Nicholson BD, Morris EJA, Wong ML, Pilleron S. Age-related differences in cancer relative survival in the United States: A SEER-18 analysis. Int J Cancer 2023; 152:2283-2291. [PMID: 36752633 DOI: 10.1002/ijc.34463] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/09/2023]
Abstract
Cancer survival has improved since the 1990s, but to different extents across age groups, with a disadvantage for older adults. We aimed to quantify age-related differences in relative survival (RS-1-year and 1-year conditioning on surviving 1 year) for 10 common cancer types by stage at diagnosis. We used data from 18 United States Surveillance Epidemiology and End Results cancer registries and included cancers diagnosed in 2012 to 2016 followed until December 31, 2017. We estimated absolute differences in RS between the 50 to 64 age group and the 75 to 84 age group. The smallest differences were observed for prostate and breast cancers (1.8%-points [95% confidence interval (CI): 1.5-2.1] and 1.9%-points [95% CI: 1.5-2.3], respectively). The largest was for ovarian cancer (27%-points, 95% CI: 24-29). For other cancers, differences ranged between 7 (95% CI: 5-9, esophagus) and 18%-points (95% CI: 17-19, pancreas). Except for pancreatic cancer, cancer type and stage combinations with very high (>95%) or very low (<40%) 1-year RS tended to have smaller age-related differences in survival than those with mid-range prognoses. Age-related differences in 1-year survival conditioning on having survived 1-year were small for most cancer and stage combinations. The broad variation in survival differences by age across cancer types and stages, especially in the first year, age-related differences in survival are likely influenced by amenability to treatment. Future work to measure the extent of age-related differences that are avoidable, and identify how to narrow the survival gap, may have most benefit by prioritizing cancers with relatively large age-related differences in survival (eg, stomach, esophagus, liver and pancreas).
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Affiliation(s)
- Diana R Withrow
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Eva J A Morris
- Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK
| | - Melisa L Wong
- MAS Divisions of Hematology/Oncology and Geriatrics, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, USA
| | - Sophie Pilleron
- Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK
- Ageing, Cancer, and Disparities Research Unit, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
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Pilleron S, Withrow DR, Nicholson BD, Morris EJA. Age-related differences in colon and rectal cancer survival by stage, histology, and tumour site: An analysis of United States SEER-18 data. Cancer Epidemiol 2023; 84:102363. [PMID: 37060832 DOI: 10.1016/j.canep.2023.102363] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/27/2023] [Accepted: 04/02/2023] [Indexed: 04/17/2023]
Abstract
Age-related differences in colon and rectal cancer survival have been observed, even after accounting for differences in background mortality. To determine how stage, tumour site, and histology contribute to these differences, we extracted age-specific one-year relative survival ratio (RS) stratified by these factors. We used colon and rectal cancer cases diagnosed between 2012 and 2016 from 18 United States Surveillance Epidemiology and End Results cancer registries. For colon cancer, 1-year RS ranged from 87.8 % [95 % Confidence Interval: 87.5-88.2] in the 50-64-year-olds to 62.3 % [61.3-63.3] in 85-99-year-olds and for rectal cancer ranged from 92.3 % [91.8-92.7] to 65.0 % [62.3-67.5]. With respect to stage, absolute differences in RS between 50-64-year-olds and 75-84-year-olds increased with increasing stage (from 6 [5-7] %-points in localised disease to 27 [25-29] %-points in distant disease) and were the highest for cancers of unknown stage (> 28 %-points). Age-related differences in survival were smallest for persons with tumours in the right-sided colon (8 [7-9] %-points) and largest for tumours of the colon without tumour site further specified (25 [21-29] %-points). With respect to histology, differences ranged from 7.4 % to 10.6 %-points for cancers with one of the three primary histologies (adenocarcinoma, mucinous adenocarcinoma, signet ring cell carcinoma) and were several-fold higher (42 %-points) for those with unknown/other histology (< 6 % of cases). Because age-related differences in survival were observed for all histologies and tumour sites, RS differences are unlikely to be driven by differences in the distribution of these factors by age. Differences in stage distribution by age are likely to contribute toward age-related differences in survival. Within stage groups, age differences in survival could be explained by frailty and/or therapy. Future studies incorporating data on treatment and geriatric conditions including frailty and comorbidity would support further understanding of the age gap in colon and rectal cancer survival.
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Affiliation(s)
- Sophie Pilleron
- Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK; Ageing, Cancer, and Disparities Research Unit, Department of Precision Health, Luxembourg Institute of Health, 1A-B, rue Thomas Edison, 1445 Strassen, Luxembourg
| | - Diana R Withrow
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Eva J A Morris
- Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK
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11
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Pilleron S, Maringe C, Morris EJA, Leyrat C. Immortal-time bias in older vs younger age groups: a simulation study with application to a population-based cohort of patients with colon cancer. Br J Cancer 2023; 128:1521-1528. [PMID: 36759725 PMCID: PMC10070415 DOI: 10.1038/s41416-023-02187-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 01/18/2023] [Accepted: 01/26/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND In observational studies, the risk of immortal-time bias (ITB) increases with the likelihood of early death, itself increasing with age. We investigated how age impacts the magnitude of ITB when estimating the effect of surgery on 1-year overall survival (OS) in patients with Stage IV colon cancer aged 50-74 and 75-84 in England. METHODS Using simulations, we compared estimates from a time-fixed exposure model to three statistical methods addressing ITB: time-varying exposure, delayed entry and landmark methods. We then estimated the effect of surgery on OS using a population-based cohort of patients from the CORECT-R resource and conducted the analysis using the emulated target trial framework. RESULTS In simulations, the magnitude of ITB was larger among older patients when their probability of early death increased or treatment was delayed. The bias was corrected using the methods addressing ITB. When applied to CORECT-R data, these methods yielded a smaller effect of surgery than the time-fixed exposure approach but effects were similar in both age groups. CONCLUSION ITB must be addressed in all longitudinal studies, particularly, when investigating the effect of exposure on an outcome in different groups of people (e.g., age groups) with different distributions of exposure and outcomes.
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Affiliation(s)
- Sophie Pilleron
- Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford, OX3 7LF, UK.
- Ageing, Cancer, and Disparities Research Unit, Department of Precision Health, Luxembourg Institute of Health, 1A-B, rue Thomas Edison, 1445, Strassen, Luxembourg.
| | - Camille Maringe
- Inequalities in Cancer Outcomes Network, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Eva J A Morris
- Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford, OX3 7LF, UK
| | - Clémence Leyrat
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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12
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Tichanek F, Försti A, Liska V, Hemminki A, Hemminki K. Survival in Colon, Rectal and Small Intestinal Cancers in the Nordic Countries through a Half Century. Cancers (Basel) 2023; 15:cancers15030991. [PMID: 36765946 PMCID: PMC9913304 DOI: 10.3390/cancers15030991] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
Background: Survival studies in intestinal cancers have generally shown favorable development, but few studies have been able to pinpoint the timing of the changes in survival over an extended period. Here, we compared the relative survival rates for colon, rectal and small intestinal cancers from Denmark (DK), Finland (FI), Norway (NO) and Sweden (SE). Design: Relative 1-, 5- and 5/1-year conditional survival data were obtained from the NORDCAN database for the years 1971-2020. Results: The 50-year survival patterns were country-specific. For colon and rectal cancers, the slopes of survival curves bended upwards for DK, were almost linear for NO and bended downwards for FI and SE; 5-year survival was the highest in DK. Survival in small intestinal cancer was initially below colon and rectal cancers but in FI and NO it caught up toward the end of the follow-up. Conclusions: Relative survival in intestinal cancers has developed well in the Nordic countries, and DK is an example of a country which in 20 years was able to achieve excellent survival rates in colon and rectal cancers. In the other countries, the increase in survival curves for colon and rectal cancer has slowed down, which may be a challenge posed by metastatic cancers.
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Affiliation(s)
- Filip Tichanek
- Biomedical Center, Faculty of Medicine, Charles University Pilsen, 30605 Pilsen, Czech Republic
- Institute of Pathological Physiology, Faculty of Medicine in Pilsen, Charles University, 32300 Pilsen, Czech Republic
| | - Asta Försti
- Hopp Children’s Cancer Center (KiTZ), 69120 Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), 69210 Heidelberg, Germany
| | - Vaclav Liska
- Biomedical Center, Faculty of Medicine, Charles University Pilsen, 30605 Pilsen, Czech Republic
- Department of Surgery, School of Medicine in Pilsen, University Hospital, 30605 Pilsen, Czech Republic
| | - Akseli Hemminki
- Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, 00290 Helsinki, Finland
- Comprehensive Cancer Center, Helsinki University Hospital, 00290 Helsinki, Finland
| | - Kari Hemminki
- Biomedical Center, Faculty of Medicine, Charles University Pilsen, 30605 Pilsen, Czech Republic
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, 69120 Heidelberg, Germany
- Correspondence:
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13
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Kennedy SP, Treacy O, Allott EH, Eustace AJ, Lynam-Lennon N, Buckley N, Robson T. Precision Medicine and Novel Therapeutic Strategies in Detection and Treatment of Cancer: Highlights from the 58th IACR Annual Conference. Cancers (Basel) 2022; 14:6213. [PMID: 36551698 PMCID: PMC9777219 DOI: 10.3390/cancers14246213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Innovation in both detection and treatment of cancer is necessary for the constant improvement in therapeutic strategies, especially in patients with novel or resistant variants of cancer. Cancer mortality rates have declined by almost 30% since 1991, however, depending on the cancer type, acquired resistance can occur to varying degrees. To combat this, researchers are looking towards advancing our understanding of cancer biology, in order to inform early detection, and guide novel therapeutic approaches. Through combination of these approaches, it is believed that a more complete and thorough intervention on cancer can be achieved. Here, we will discuss the advances and approaches in both detection and treatment of cancer, presented at the 58th Irish Association for Cancer Research (IACR) annual conference.
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Affiliation(s)
- Sean P. Kennedy
- School of Biological, Health and Sports Sciences, Technological University Dublin, D07 ADY7 Dublin, Ireland
| | - Oliver Treacy
- Discipline of Pharmacology and Therapeutics, College of Medicine, Nursing and Health Sciences, University of Galway, H91 TK33 Galway, Ireland
| | - Emma H. Allott
- Patrick G. Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast BT9 7AE, UK
- Department of Histopathology and Morbid Anatomy, Trinity Translational Medicine Institute, Trinity College Dublin, D08 HD53 Dublin, Ireland
| | - Alex J. Eustace
- National Institute for Cellular Biotechnology, Dublin City University, D09 NR58 Dublin, Ireland
| | - Niamh Lynam-Lennon
- Department of Surgery, Trinity St James’s Cancer Institute, Trinity Translational Medicine Institute, St James’s Hospital, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Niamh Buckley
- School of Pharmacy, Queen’s University Belfast, 97 Lisburn Road, Belfast BT9 7AE, UK
| | - Tracy Robson
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons Ireland, D02 YN77 Dublin, Ireland
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14
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Jung KU, Kim HO, Kim H. Epidemiology, Risk Factors, and Prevention of Colorectal Cancer-An English Version. J Anus Rectum Colon 2022; 6:231-238. [DOI: 10.23922/jarc.2022-050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/07/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kyung Uk Jung
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
| | - Hyung Ook Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
| | - Hungdai Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
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15
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Stannard R, Lambert PC, Andersson TML, Rutherford MJ. Obtaining long-term stage-specific relative survival estimates in the presence of incomplete historical stage information. Br J Cancer 2022; 127:1061-1068. [PMID: 35715629 PMCID: PMC9470741 DOI: 10.1038/s41416-022-01866-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 05/13/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Completeness of recording for cancer stage at diagnosis is often historically poor in cancer registries, making it challenging to provide long-term stage-specific survival estimates. Stage-specific survival differences are driven by differences in short-term prognosis, meaning estimated survival metrics using period analysis are unlikely to be sensitive to imputed historical stage data. METHODS We used data from the Surveillance, Epidemiology, and End Results (SEER) Program for lung, colon and breast cancer. To represent missing data patterns in less complete registry data, we artificially inflated the proportion of missing stage information conditional on stage at diagnosis and calendar year of diagnosis. Period analysis was applied and missing stage at diagnosis information was imputed under four different conditions to emulate extreme imputed stage distributions. RESULTS We fit a flexible parametric model for each cancer stage on the excess hazard scale and the differences in stage-specific marginal relative survival were assessed. Estimates were also obtained from non-parametric approaches for validation. There was little difference between the 10-year stage-specific marginal relative survival estimates, regardless of the assumed historical stage distribution. CONCLUSIONS When conducting a period analysis, multiple imputation can be used to obtain stage-specific long-term estimates of relative survival, even when the historical stage information is largely incomplete.
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Affiliation(s)
- Rachael Stannard
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK.
| | - Paul C Lambert
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Therese M-L Andersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mark J Rutherford
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
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16
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Park IJ. Direction of diagnosis and treatment improvement in colorectal cancer. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2022. [DOI: 10.5124/jkma.2022.65.9.540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background: Cancer is a major public health problem and the leading cause of death in Korea since 2000. Colorectal cancer is the third leading cause of cancer-related death. Therefore, early detection through screening, surgical techniques improvement, anticancer drugs, adjuvant treatment, and medical resources advancement is important to reduce colorectal cancer-related mortality.Current Concepts: In Korea, the 5-year relative survival rate of patients with colorectal cancer is approximately mid-70%, which is superior to other developed countries, such as the United States, United Kingdom, and Japan, with 60% to 68% because of the well performed screening program and technical improvement. Efforts are underway to conduct active endoscopic treatment for early colorectal cancer and identify cases requiring surgery. Minimally invasive surgery has evolved beyond conventional applications into disease-specific methods, and the robotic system has an important role for evolvement. Performing metastatic colorectal cancer efforts is necessary to improve the survival rate through active surgical treatment and gene therapy.Discussion and Conclusion: Eventually, the role of the patient’s genetic information in diagnosing and treating colorectal cancer is expected to increase. In some cases, diagnosing colorectal cancer using a non-invasive method is already realized. Active surgical treatment based on personal characteristics contributes in improving the treatment outcomes for difficult-to-treat metastatic colorectal cancer. After the period of overall colorectal cancer treatment results improvement, we will undertake the precision treatment era.
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17
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Jung KU, Kim HO, Kim H. Epidemiology, risk factors, and prevention of colorectal cancer. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2022. [DOI: 10.5124/jkma.2022.65.9.549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Colorectal cancer remains the fourth most common malignancy in Korea, and has been ranked as the third leading cause of cancer deaths in 2020. This study aims to describe the epidemiologic status of colorectal cancer in Korea, and provide basic data for effective primary and secondary prevention methods by summarizing risk factors and screening tools.Current Concepts: Although colorectal cancer incidence and mortality have decreased in recent years in Korea, it still poses a significant public health burden. From the early 1990s until the mid-2000s, the 5-year relative survival of patients with colorectal cancer in Korea continuously increased. This can be attributed to the successful introduction of the government-led screening program; development of improved surgical techniques, anticancer drugs, and adjuvant treatment; and advances medical resources and infrastructure along with economic growth. However, since the late 2000s, the improvement in survival has stagnated. The coronavirus disease 2019 outbreak has reduced hospital visits and screenings, which is assumed to cause delays in diagnosis, leading to a worse prognosis in the patients. To overcome these obstacles, it is essential to explore modifiable environmental risk factors and appropriate screening test methods in Korea.Discussion and Conclusion: Primary prevention through risk factor modification and secondary prevention using suitable screening programs can reduce the incidence and mortality rates of colorectal cancer.
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18
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Barrera Ferro D, Bayer S, Brailsford S, Smith H. Improving intervention design to promote cervical cancer screening among hard-to-reach women: assessing beliefs and predicting individual attendance probabilities in Bogotá, Colombia. BMC Womens Health 2022; 22:212. [PMID: 35672816 PMCID: PMC9172610 DOI: 10.1186/s12905-022-01800-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 05/05/2022] [Indexed: 11/30/2022] Open
Abstract
Background Despite being a preventable disease, cervical cancer continues to be a public health concern, affecting mainly lower and middle-income countries. Therefore, in Bogotá a home-visit based program was instituted to increase screening uptake. However, around 40% of the visited women fail to attend their Pap smear test appointments. Using this program as a case study, this paper presents a methodology that combines machine learning methods, using routinely collected administrative data, with Champion’s Health Belief Model to assess women’s beliefs about cervical cancer screening. The aim is to improve the cost-effectiveness of behavioural interventions aiming to increase attendance for screening. The results presented here relate specifically to the case study, but the methodology is generic and can be applied in all low-income settings.
Methods This is a cross-sectional study using two different datasets from the same population and a sequential modelling approach. To assess beliefs, we used a 37-item questionnaire to measure the constructs of the CHBM towards cervical cancer screening. Data were collected through a face-to-face survey (N = 1699). We examined instrument reliability using Cronbach’s coefficient and performed a principal component analysis to assess construct validity. Then, Kruskal–Wallis and Dunn tests were conducted to analyse differences on the HBM scores, among patients with different poverty levels. Next, we used data retrieved from administrative health records (N = 23,370) to fit a LASSO regression model to predict individual no-show probabilities. Finally, we used the results of the CHBM in the LASSO model to improve its accuracy. Results Nine components were identified accounting for 57.7% of the variability of our data. Lower income patients were found to have a lower Health motivation score (p-value < 0.001), a higher Severity score (p-value < 0.001) and a higher Barriers score (p-value < 0.001). Additionally, patients between 25 and 30 years old and with higher poverty levels are less likely to attend their appointments (O.R 0.93 (CI: 0.83–0.98) and 0.74 (CI: 0.66–0.85), respectively). We also found a relationship between the CHBM scores and the patient attendance probability. Average AUROC score for our prediction model is 0.9.
Conclusion In the case of Bogotá, our results highlight the need to develop education campaigns to address misconceptions about the disease mortality and treatment (aiming at decreasing perceived severity), particularly among younger patients living in extreme poverty. Additionally, it is important to conduct an economic evaluation of screening options to strengthen the cervical cancer screening program (to reduce perceived barriers). More widely, our prediction approach has the potential to improve the cost-effectiveness of behavioural interventions to increase attendance for screening in developing countries where funding is limited.
Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01800-3.
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Affiliation(s)
- David Barrera Ferro
- Southampton Business School, University of Southampton, Southampton, UK. .,Departamento de Ingeniería Industrial, Pontificia Universidad Javeriana, Bogotá, Colombia.
| | - Steffen Bayer
- Southampton Business School, University of Southampton, Southampton, UK
| | - Sally Brailsford
- Southampton Business School, University of Southampton, Southampton, UK
| | - Honora Smith
- Mathematical Sciences, University of Southampton, Southampton, UK
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19
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Andersson TML, Myklebust TÅ, Rutherford MJ, Møller B, Arnold M, Soerjomataram I, Bray F, Parkin DM, Lambert PC. Five ways to improve international comparisons of cancer survival: lessons learned from ICBP SURVMARK-2. Br J Cancer 2022; 126:1224-1228. [PMID: 35058590 PMCID: PMC9023566 DOI: 10.1038/s41416-022-01701-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 12/09/2021] [Accepted: 01/06/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Comparisons of population-based cancer survival between countries are important to benchmark the overall effectiveness of cancer management. The International Cancer Benchmarking Partnership (ICBP) Survmark-2 study aims to compare survival in seven high-income countries across eight cancer sites and explore reasons for the observed differences. A critical aspect in ensuring comparability in the reported survival estimates are similarities in practice across cancer registries. While ICBP Survmark-2 has shown these differences are unlikely to explain the observed differences in cancer-specific survival between countries, it is important to keep in mind potential biases linked to registry practice and understand their likely impact. METHODS Based on experiences gained within ICBP Survmark-2, we have developed a set of recommendations that seek to optimally harmonise cancer registry datasets to improve future benchmarking exercises. RESULTS Our recommendations stem from considering the impact on cancer survival estimates in five key areas: (1) the completeness of the registry and the availability of registration sources; (2) the inclusion of death certification as a source of identifying cases; (3) the specification of the date of incidence; (4) the approach to handling multiple primary tumours and (5) the quality of linkage of cases to the deaths register. CONCLUSION These recommendations seek to improve comparability whilst maintaining the opportunity to understand and act upon international variations in outcomes among cancer patients.
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Affiliation(s)
- Therese M-L Andersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Tor Åge Myklebust
- Cancer Registry of Norway, Oslo, Norway
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Mark J Rutherford
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
- Cancer Surveillance Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | | | - Melina Arnold
- Cancer Surveillance Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Isabelle Soerjomataram
- Cancer Surveillance Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - D Maxwell Parkin
- School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
- INCTR Challenge Fund, Prama House, Oxford, UK
| | - Paul C Lambert
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
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20
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The survival gap between young and older patients after surgical resection for colorectal cancer remains largely based on early mortality: A EURECCA comparison of four European countries. J Geriatr Oncol 2022; 13:803-812. [DOI: 10.1016/j.jgo.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 03/21/2022] [Accepted: 04/15/2022] [Indexed: 11/18/2022]
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21
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Kim DS, Ahn HS, Kim HJ. Statin use and incidence and mortality of breast and gynecology cancer: A cohort study using the National Health Insurance claims database. Int J Cancer 2021; 150:1156-1165. [PMID: 34751444 DOI: 10.1002/ijc.33869] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/03/2021] [Accepted: 10/15/2021] [Indexed: 11/06/2022]
Abstract
Previous studies have reported inconsistent findings concerning the impact of statin use on cancer prevention. This study examined the association between statin use and cancer incidence and mortality related to breast and gynecologic cancers in South Korea. A population-based cohort study was conducted using the National Health Insurance claims database. Women aged 45-70 years old who had taken statins for at least 6 months were compared to statin non-users of the same age from January 2005 to June 2013. The primary outcomes were cancer incidence and mortality related to breast cancer, total gynecologic cancers, cervix uteri cancer, and ovarian cancer. Cox proportional hazards regression was conducted to calculate the adjusted hazard ratios (aHRs) and 95% confidence intervals (95% CIs). Out of 587 705 women, there were 3591 cases of breast cancer, 2239 cases of gynecologic cancers, and 565 breast and total gynecologic cancer deaths during 7.6 person-years. The aHRs for the association between the risk of each cancer and statin use were 0.88 (95% CI 0.79-0.97) for breast cancer and 0.83 (95% CI 0.67-0.99) for cervix uteri cancer. Statin use was associated with decreased breast cancer mortality (HR = 0.65, 95% CI 0.43-0.99) and total gynecologic cancer mortality (HR = 0.70, 95% CI 0.50-0.98). A dose-response relationship was only found for all-cancer mortality. Statin use for at least 6 months was significantly associated with a lower risk of breast and cervix uteri cancer incidence, and with lower mortality of breast and gynecologic cancers. Further research on these associations will be needed. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Dong-Sook Kim
- Department of Research, Health Insurance Review & Assessment Service, Wonju, Republic of Korea
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
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22
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Nilssen Y, Eriksen MT, Guren MG, Møller B. Factors associated with emergency-onset diagnosis, time to treatment and type of treatment in colorectal cancer patients in Norway. BMC Cancer 2021; 21:757. [PMID: 34187404 PMCID: PMC8244161 DOI: 10.1186/s12885-021-08415-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/25/2021] [Indexed: 12/15/2022] Open
Abstract
Background International differences in survival among colorectal cancer (CRC) patients may partly be explained by differences in emergency presentations (EP), waiting times and access to treatment. Methods CRC patients registered in 2015–2016 at the Cancer Registry of Norway were linked with the Norwegian Patient Registry and Statistics Norway. Multivariable logistic regressions analysed the odds of an EP and access to surgery, radiotherapy and systemic anticancer treatment (SACT). Multivariable quantile regression analysed time from diagnosis to treatment. Results Of 8216 CRC patients 29.2% had an EP before diagnosis, of which 81.4% were admitted to hospital with a malignancy-related condition. Higher age, more advanced stage, more comorbidities and colon cancer were associated with increased odds of an EP (p < 0.001). One-year mortality was 87% higher among EP patients (HR=1.87, 95%CI:1.75–2.02). Being married or high income was associated with 30% reduced odds of an EP (p < 0.001). Older age was significantly associated with increased waiting time to treatment (p < 0.001). Region of residence was significantly associated with waiting time and access to treatment (p < 0.001). Male (OR = 1.30, 95%CI:1.03,1.64) or married (OR = 1.39, 95%CI:1.09,1.77) colon cancer patients had an increased odds of SACT. High income rectal cancer patients had an increased odds (OR = 1.48, 95%CI:1.03,2.13) of surgery. Conclusion Patients who were older, with advanced disease or more comorbidities were more likely to have an emergency-onset diagnosis and less likely to receive treatment. Income was not associated with waiting time or access to treatment among CRC patients, but was associated with the likelihood of surgery among rectal cancer patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08415-1.
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Affiliation(s)
- Yngvar Nilssen
- Department of Registration, Cancer Registry of Norway, Postboks 5313 Majorstuen, 0304, Oslo, Norway.
| | - Morten Tandberg Eriksen
- Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Bjørn Møller
- Department of Registration, Cancer Registry of Norway, Postboks 5313 Majorstuen, 0304, Oslo, Norway
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Pilleron S, Gower H, Janssen-Heijnen M, Signal VC, Gurney JK, Morris EJ, Cunningham R, Sarfati D. Patterns of age disparities in colon and lung cancer survival: a systematic narrative literature review. BMJ Open 2021; 11:e044239. [PMID: 33692182 PMCID: PMC7949400 DOI: 10.1136/bmjopen-2020-044239] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To identify patterns of age disparities in cancer survival, using colon and lung cancer as exemplars. DESIGN Systematic review of the literature. DATA SOURCES We searched Embase, MEDLINE, Scopus and Web of Science through 18 December 2020. ELIGIBILITY CRITERIA We retained all original articles published in English including patients with colon or lung cancer. Eligible studies were required to be population-based, report survival across several age groups (of which at least one was over the age of 65) and at least one other characteristic (eg, sex, treatment). DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed the quality of included studies against selected evaluation domains from the QUIPS tool, and items concerning statistical reporting. We evaluated age disparities using the absolute difference in survival or mortality rates between the middle-aged group and the oldest age group, or by describing survival curves. RESULTS Out of 3047 references, we retained 59 studies (20 for colon, 34 for lung and 5 for both sites). Regardless of the cancer site, the included studies were highly heterogeneous and often of poor quality. The magnitude of age disparities in survival varied greatly by sex, ethnicity, socioeconomic status, stage at diagnosis, cancer site, and morphology, the number of nodes examined and treatment strategy. Although results were inconsistent for most characteristics, we consistently observed greater age disparities for women with lung cancer compared with men. Also, age disparities increased with more advanced stages for colon cancer and decreased with more advanced stages for lung cancer. CONCLUSIONS Although age is one of the most important prognostic factors in cancer survival, age disparities in colon and lung cancer survival have so far been understudied in population-based research. Further studies are needed to better understand age disparities in colon and lung cancer survival. PROSPERO REGISTRATION NUMBER CRD42020151402.
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Affiliation(s)
- Sophie Pilleron
- Department of Public Health, School of Medicine, University of Otago, Wellington, New Zealand
| | - Helen Gower
- Department of Surgery and Anaesthesia, Surgical Cancer Research Group, University of Otago, Wellington, New Zealand
| | - Maryska Janssen-Heijnen
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands
- Department of Epidemiology, Maastricht University Medical Centre+, GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Virginia Claire Signal
- Department of Public Health, School of Medicine, University of Otago, Wellington, New Zealand
| | - Jason K Gurney
- Department of Public Health, School of Medicine, University of Otago, Wellington, New Zealand
| | - Eva Ja Morris
- Nuffield Department of Population Health, University of Oxford, Big Data Institute, Oxford, UK
| | - Ruth Cunningham
- Department of Public Health, School of Medicine, University of Otago, Wellington, New Zealand
| | - Diana Sarfati
- New Zealand Cancer Control Agency, Wellington, New Zealand
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