Impact of socioeconomic status on cancer incidence and stage at diagnosis: selected findings from the surveillance, epidemiology, and end results: National Longitudinal Mortality Study

Enhancing Cancer Patient Navigation: Lessons from an Evaluation of Navigation Services in Alberta, Canada

Cancer patient navigation has emerged as a patient-centric intervention enabling equitable cancer care, by mitigating barriers patients encounter throughout their cancer journey. Cancer Care Alberta (CCA) implemented a professional navigation model over a decade ago and commissioned a program evaluation in response to evolving operational demands. The objectives were (1) to better understand the current state of CCA's cancer patient navigation program; (2) to explore the need for other specialized streams; and (3) to provide key recommendations to strengthen and grow the program. A mixed methods approach, including a survey, administrative data, and semi-structured interviews, captured patient-, staff-, and system-level insights. Findings revealed difficulties in identifying complex patients needing navigation, along with inconsistencies regarding intake practices, program awareness, referral pathways, standardized workflows, and a lack of programmatic supports, which contributed to variability in service delivery. A need for enhanced palliative navigation support also emerged. Approximately 25% of surveyed patients reported being unable to access perceived needed support before their first oncology consultation. These findings underscore the importance of early, targeted navigation for equity-deserving populations. Recommendations include harmonizing program structure, refining navigator roles, expanding navigation streams, standardizing processes, and enhancing equity-focused competencies. These findings offer a roadmap with which to improve person-centered cancer care.

Sociodemographic disparities in incidence rates of advanced and low-risk prostate cancer as a proxy for diagnostic activity

BACKGROUND

Inequity in prostate cancer detection can be assessed by relating the diagnostic intensity to the incidence rate of advanced disease in different population groups, according to factors such as socioeconomic status or ethnicity.

METHODS

We used nationwide Swedish register data from Prostate Cancer data Base Sweden 5.0 and Statistics Sweden, which enabled us to estimate incidence rates of low-risk prostate cancer (a proxy for diagnostic activity) and advanced disease (locally advanced and/or metastatic) across population groups according to household income, country of birth, and neighborhood-level characteristics.

RESULTS

We found a gradient in the age-standardized incidence of low-risk prostate cancer across income groups, from 60 per 100,000/year in men with high to 34 per 100,000/year in men with low household income: adjusted incidence rate ratio (IRR) 0.65 (95% confidence interval [CI] 0.59-0.71). The gradient in the incidence of advanced disease had the opposite direction, from 44 to 60 per 100,000/year, IRR 1.43 (95% CI 1.31-1.56). Immigrants from a non-Nordic country (nearly 40% from Asia) had lower incidence rates of both low-risk (IRR 0.47, 95% CI 0.42-0.53) and advanced disease (IRR 0.65, 95% CI 0.58-0.73) than men born in a Nordic country. Neighborhood-level analysis considering economic standard, share of immigrants, and degree of urbanization did not clearly differentiate the incidence of advanced disease.

INTERPRETATION

Our results suggest that measures to facilitate early detection of prostate cancer should be targeted to men with a low income. A low diagnostic activity for prostate cancer among immigrants from countries with low background risk may not imply unjustified social disparity.

Racial, Ethnic, and Socioeconomic Trends in Microtia and Anotia Care

This study aims to investigate the effects of ethnic, racial, and socioeconomic differences on outcomes for patients undergoing surgical management for microtia or anotia in the United States. Using the Pediatric Health Information System (PHIS) database, 2928 patients presenting for primary microtia or anotia reconstruction between 2017 and 2023 were analyzed. The majority of patients were non-White (55.2%, 1617/2928), with a significant proportion identifying as Hispanic/Latino (48.5%, 1421/2928). Non-White patients were more likely to present at a later age for surgery (10.8 versus 9.4 y; P=0.036), reside in urban areas (90.4% versus 82.2%, P<0.01), and live in households with incomes below the national median (71.7% versus 69.1%; P=0.13). Similarly, Hispanic/Latino patients presented at an older age (10.7 versus 9.0 y; P<0.01), were more frequently located in urban areas (90.6% versus 82.6%; P<0.01), and more likely to live in households with incomes below the national median (79.2% versus 61.8%; P<0.01). In the United States, the majority of patients presenting for primary reconstruction of microtia or anotia are non-White and Hispanic/Latino. This suggests an increased prevalence in these populations. Non-White and Hispanic/Latino patients are more likely to live in households with incomes below the national median and are more likely to present at a later age for primary reconstructive procedures. Multidisciplinary care teams should prioritize the development and implementation of targeted outreach programs to improve timely access to care for at-risk populations.

Incidence of solid cancers among residents near nuclear facilities: a systematic review and meta-analysis

BACKGROUND

Concerns about the potential health effects of radiation exposure in communities living near nuclear facilities persist, prompting ongoing studies across various countries. However, research on solid cancers in these communities remains limited. This systematic review and meta-analysis aimed to comprehensively investigate the incidence of various solid cancers among residents near nuclear facilities, providing up-to-date scientific evidence on potential health effects in the context of energy security and net-zero emission targets.

METHODS

A comprehensive search of the databases PubMed, Excerpta Medica Database, and Web of Science was conducted. Data were extracted from 13 studies on breast, bladder, thyroid, CNS, and respiratory cancers, with the meta-analysis focusing on cancer types supported by at least five quantitative estimates to account for study heterogeneity. Study quality was assessed using the Office of Health Assessment and Translation tool. Pooled standardized incidence ratios (SIRs) were calculated using random-effects models, and publication bias was evaluated using funnel plots and Egger's test.

RESULTS

The meta-analyses included the following number of cases for each selected cancer type: breast, n = 20,701; bladder, n = 5,398; thyroid, n = 9,907; CNS, n = 3,634; and respiratory system, n = 18,033. Pooled SIRs for all cancer subtypes were statistically insignificant and ranged from 0.99 to 1.04, with substantial heterogeneity among studies (I2 range: 64%-96%). Little evidence of publication bias was revealed upon visual inspection of the funnel plots and performing Egger's test.

CONCLUSIONS

Current scientific evidence regarding the incidence of solid cancers in populations living near nuclear facilities is insufficient to draw definitive conclusions. Nonetheless, the wide range of heterogeneity among studies highlights the need for further research with refined study designs, particularly with regard to radiation exposure and individual-level confounding factors, to provide more robust evidence on the public health implications for residents near nuclear facilities.

Factors and Considerations in No-Treatment Decisions in Patients With Key Hematological Malignancies: A Nationwide, Population-Based Study in the Netherlands

Comprehensive insights are lacking into why patients with hematological malignancies (HMs) receive no cancer-directed treatment. We evaluated socio-demographic and cancer-related characteristics, decision-making rationales, and overall survival in patients with three common HMs-diffuse large B-cell lymphoma (DLBCL), symptomatic multiple myeloma (MM), and acute myeloid leukemia (AML)-who do not receive cancer-directed treatment, using the nationwide Netherlands Cancer Registry. A total of 26 945 patients diagnosed with DLBCL (47%), symptomatic MM (29%), or AML (25%) between 2014 and 2021 were included. About 16% of the patients did not receive cancer-directed treatment, ranging from 26% in AML to 15% in DLBCL and 10% in MM. The primary reason for not receiving cancer-directed treatment in all three HMs was related to physical condition. The second main reason was patient/family choice in DLBCL and MM, whereas in AML it was rapid disease progression. In female patients, patient/family choice was a more prevalent reason for not receiving cancer-directed treatment than in male patients. Patients with a lower socio-economic position more often did not receive cancer-directed treatment. Median OS varied by reason for not receiving cancer-directed treatment, with the shortest OS in patients experiencing rapid disease progression or death before treatment initiation (0·4 to 0·6 months).

Personalized Lifestyle Interventions for Prevention and Treatment of Obesity-Related Cancers: A Call to Action

The increasing global burden of cancer necessitates innovative approaches to prevention and treatment. Lifestyle factors such as diet, physical activity, and smoking significantly contribute to cancer. At the same time, current guidelines are based on a one-size-fits-all approach, which limits their effectiveness across diverse populations. Obesity is a well-documented risk factor for cancer, directly affecting 13 types of cancer. The complex interplay of genetic, metabolic, hormonal, and environmental factors in obesity's etiology highlights the need for more tailored approaches to obesity-related cancers. This perspective article advocates for a shift toward an integrative, personalized approach that considers a variety of intrinsic and extrinsic factors associated with the etiology of obesity-related cancers. Lifestyle-based cancer prevention strategies should be tailored to an individual's biological profile, demographic background, behaviors, and environmental exposures. Following a diagnosis, a comprehensive treatment approach should consider how these genetic, physiological, lifestyle, and environmental factors interact in the onset and progression of the disease while also taking cancer type and stage into account. This approach paves the way for more precise and effective strategies in tackling cancer. Fulfilling collaboration across research, healthcare, and policy sectors is essential to achieve these goals.

Association between socio-demographic factors and reasons for medical care in Mexican adults

Background

The occurrence and distribution of diseases result from the interaction between biological, environmental, economic, and social factors. Although Mexico has made significant progress in the health sector, there are several problems associated with the social determinants of health, which are linked to social factors such as gender, age, income, and schooling, among others. Therefore, the purpose of this study was to evaluate the relationship between socio-demographic factors with the main reasons for medical care among patients seen at a public healthcare institution in Mexico City.

Materials and Methods

A cross-sectional analytical study in which the clinical records of 1,018 adult patients who attended any of the services provided by a public healthcare institution in Mexico City between August and December 2023 were examined.

Results

The odds of seeking medical care for neoplastic diseases were lower in men, among patients with their own home, with balanced economic status and surplus, but higher in people aged 40 years and older, in those with fewer intra-household and public services in their homes.

Conclusions

Strategies for prevention, management, and control of chronic and infectious diseases need to consider social inequalities, addressing the determinants of health to generate a significant impact on the health of the population.

Effects of Socioeconomic Deprivation on UTUC Staging, Mortality, and Recurrence

OBJECTIVE

To determine whether the area deprivation index (ADI), a surrogate for socioeconomic status (SES) associated with patient residence, affected UTUC staging, recurrence rates, and mortality.

METHODS

Patients undergoing radical nephroureterectomy or ureterectomy for UTUC at a single institution between February 2010 and August 2021 were classified by ADI. A 50th percentile cut-off of ADI classified patients as "advantaged" or "disadvantaged. Tumor characteristics, staging, and use of neoadjuvant chemotherapy were compared between groups. Recurrence-free (RFS) and overall survival (OS) were compared among groups using Mantel-Cox log-rank testing.

RESULTS

In this cohort, 215 patients had advantaged SES, and 217 had disadvantaged SES. Neoadjuvant chemotherapy was utilized more frequently among advantaged versus disadvantaged patients (20% vs 13%, P=.035), though this difference was not significant when comparing the most advantaged and least advantaged quartiles (18% vs 14%, P=.45). No significant difference was observed in positive resection margins between groups (11% vs 13%, P=.53). Tumor characteristics, including median tumor size (P=.15), pathologic tumor stage (P=.81), and pathologic lymph node stage (P=.28), were also similar. There were no differences in median RFS or OS between SES groups.

CONCLUSION

This regional data, considering previous studies suggesting worse outcomes with increased urothelial carcinoma incidence and mortality in those with a lower socioeconomic status, may reflect efforts to improve healthcare access and adhere to evidence-based management patterns.

Disparities in disease presentation among patients with papillary thyroid cancer: A retrospective cohort study

PURPOSE

Prior research suggests that racial and ethnic minorities present with advanced papillary thyroid cancer (PTC), traditionally defined using surgical pathology. However, marginalized populations are more likely to experience delays in surgical treatment, raising concerns that surgical staging may misrepresent the extent of disease at initial presentation. This study investigates disparities in disease presentation using cytology from Fine Needle Aspiration (FNA), which is performed at first evaluation and precedes surgery, in an institutional cohort of PTC patients.

METHODS

A single-site retrospective review of 405 patients with PTC from 2018 to 2019 evaluated the association between sociodemographic variables and the likelihood of presenting with cytologically-confirmed malignancy using FNA. Patients with malignant cytology (Bethesda VI) were compared to those with unconfirmed malignancy (Bethesda III-V). To validate the clinical significance of the Bethesda VI classification, we conducted an additional analysis examining whether these patients presented with more advanced disease.

RESULTS

Patients classified as Bethesda VI on FNA were younger and more likely to present with advanced disease features, compared to Bethesda III-V patients. On multivariable analysis, patients in the lowest income group were significantly more likely to present with Bethesda VI compared to those in the highest income group.

CONCLUSION

Differences in initial presentation were observed in our institutional cohort of PTC patients. Lower median household income was independently associated with presenting with Bethesda VI, even after adjusting for race/ethnicity. This analysis highlights the clinical relevance of considering factors beyond race and ethnicity alone to better tailor early detection efforts and strategic resource allocation, thereby addressing disparities more effectively.

Education level and risk of breast cancer by tumor subtype in the EPIC cohort

Breast cancer (BC) is a heterogeneous disease with subtypes based on receptor status (estrogen receptor [ER], progesterone receptor [PR], and human epidermal growth factor receptor 2 [HER2]), influencing prognosis and treatment. A higher socioeconomic position (SEP) is associated with an increased BC risk, but its relation to BC subtypes is less clear. This study analyzed 311,631 women from the EPIC cohort, focusing on the incidence of in situ and invasive BC (overall and by receptor status and subtype). Educational attainment was used as a proxy for SEP, and hazard ratios (HRs) were calculated using Cox regression models. Mediation analyses were performed to evaluate the extent to which selected risk factors explained the educational gradient. Over 14 years, 14,432 BC cases were identified, including 12,863 invasive cases. Lower education was associated with a reduced risk of both in situ and invasive BCs. The HRs for primary versus tertiary education were 0.61 (95% CI 0.49-0.73) for in situ and 0.81 (95% CI 0.75-0.87) for invasive BC overall, with similar reductions across ER-positive, PR-positive, HER2-positive, Luminal A, BH-, and BH+. No significant association was found between education and ER-negative, and HER2-enriched BCs. Reproductive and lifestyle factors explained 20-40% of the educational differences in BC risk. While many of the risk factors through which education impacts the development of subtype-specific BC were identified, others remain to be fully elucidated. Differences in screening attendance could partially explain the higher ER-positive BC risk among highly educated; this study further contributes to the understanding of the complex nature of BC in terms of its social gradient and aetiology.

A Geospatial Analysis of the Association between Access to Tanning Bed Facilities and Melanoma in the United States New England Region

Substantial geographic disparities in melanoma incidence and access to tanning bed facilities exist. In this spatial ecological study, we evaluate the relationship between access to tanning bed facilities and melanoma incidence. New England county-level melanoma incidence rates (2014-2018), tanning bed facilities location, demographic data, socioeconomic data, and geographic data were obtained from the National Cancer Institute State Cancer Profiles, Data Axle, American Community Survey, and United States Geological Survey. Spatial regression models were utilized to determine the association between melanoma incidence and access to tanning beds, adjusting for confounding factors. Adjusted spatial regression identified that for every 1-minute increase in average travel time to tanning facilities within 30 minutes travel time threshold, the melanoma incidence rate decreased by 3.46% in the same county and by 1.92% across New England. We found a negative association between average travel time to tanning facilities and county-level melanoma incidence rate, suggesting that policy aimed at decreasing access to indoor tanning facilities has the potential to reduce melanoma rates. High-risk clusters, with respect to county-level melanoma rate, were also identified. Targeting of interventions and resources to high-risk clusters may reduce geographic melanoma rates disparities.

Socioeconomic disparities: a more important risk factor for advanced-stage oral cancer in Florida than smoking?

PURPOSE

To explore the associations between sociodemographic factors with advanced-stage oral cavity cancer (OCC) presentation among Floridians.

METHODS

Demographic and cancer data on OCC patients (n = 7,826) diagnosed between 2010 and 2017 were retrieved from the Florida Cancer Data System (FCDS). Census tract median income and percentage of population with a bachelor's degree or higher were used to infer income and education. Pearson's chi-square tests of independence were used to compare sociodemographic factors between racial/ethnic groups and staging groups. Multinomial logistic regression analyzed predictors of advanced disease. Incidence and percent late-stage diagnosis versus income were mapped using ArcGIS Pro.

RESULTS

Among 5,252 cases analyzed: 5.7% were Black, 82.4% White Non-Hispanic, 61.5% male, 63.3% publicly insured, 6.5% uninsured, 58.7% current or former smokers, and 73.0% urban residents. Black patients were more likely to present with advanced disease, be single/unmarried, uninsured, and less likely to be former smokers. Male sex, Black race, non-married status, no insurance, Medicaid, VA/military insurance, and lower educational status were associated with increased risk of regional vs. early disease in multivariable analysis (MVA) (p < 0.05). These factors, in addition to Medicare, were associated with distant disease in MVA. Geospatial mapping revealed higher rates of regional and distant disease presentation in the Tampa Bay and Orlando areas.

CONCLUSION

Black race, male sex, non-married status, lower education, Medicaid, VA/Military insurance and no insurance were associated with advanced OCC in Florida. Smoking status was not associated with advanced disease presentation after adjusting for sociodemographic variables.

Socio-economic position, area-level deprivation and gradients in cancer incidence: England and Wales, 1971-2016

BACKGROUND

Social gradients for cancer mortality and survival have been reported but are less clear for cancer incidence where social factors external to health care systems are likely to be of more etiologic importance.

METHODS

We examined social gradients in cancer incidence using data from the Office for National Statistics Longitudinal Study (ONS-LS), which selects an approximately 1.1% representative sample of the population of England and Wales. Data were analyzed for each successive ten-year census period from 1971-2011 with outcome data to 2016, the latest date available. Socioeconomic position of individuals was assessed using the National Statistics Socio-economic classification (NS-SEC). Areal level deprivation was measured using deciles of the Townsend Index. Cancer outcomes from the National Cancer Intelligence Network linked to the ONS-LS were examined for all cancers, and more common individual cancer sites. We used logistic regression to generate odds ratios to estimate the risk of a first incident cancer within each follow-up period.

RESULTS

The 1971 ONS-LS census sample population initially comprised 257,803 individuals updated each census; and by 2016 137,755 incident cancer cases. Social gradients in cancer incidence were present for individual cancer sites of lung, stomach, and cervix for both individual and areal measures of socioeconomic standing with the least advantaged having higher incidence rates. Reverse gradients were present for prostate and breast cancers. The relationship of SES to increased cancer incidence for these common cancers is consistent with prior literature, but the striking gradients in these relationships reveal the strong association of SES factors with increasing social disadvantage for these cancers.

CONCLUSION

The findings demonstrate the importance of socioeconomic position in the incidence of some common cancers prior to diagnosis and treatment and reinforces the need for further research to address the contribution of upstream social determinants in the etiology of cancer.

Age-Related Variations in Clinical, Histological, and Genetic Characteristics in Multiple and Familial Melanomas: A Study of 333 Patients

Background/Objectives: Melanoma is an aggressive cutaneous malignancy with a rising incidence. While most cases are sporadic, 5-10% are hereditary, especially in patients with multiple or familial melanomas. The aim of this study is to explore the epidemiological, clinical, histological, and genetic features of this class of patients to identify risk factors for better management and surveillance. Methods: Between 2021 and 2024, patients with multiple melanomas or a familial history of melanoma were recruited. Collected data included demographic, clinic-pathologic features, and genetic analyses. Results: Patients >60 years had a higher prevalence of multiple melanomas (>50%, p = 0.0002), while familial melanoma was more common in those <40 years (54.3%). UV exposure increased with age, while sunscreen use decreased (p = 0.0004). Younger patients showed the highest nevi counts (mean: 139.6) and density (p < 0.0001). Dermatologists more frequently detected subsequent melanomas in older patients (>60 years) (p = 0.001). Genetic testing and melanoma subtypes showed no significant age-related differences. Conclusions: melanoma can develop at any age, and early detection through regular screening is crucial. Older patients (>60 years) have a higher prevalence of multiple melanomas, influenced by UV exposure and genetics. Indeed, in our cohort, a history of sun exposure, sunburns, and tanning bed use emerged as key risk factors, particularly among older individuals. Genetic testing showed a 4.3% rate of pathogenic/likely pathogenic variants, mainly in CDKN2A. Family history and nevus burden are significant risk factors, highlighting the need for targeted surveillance in high-risk populations.

Prediction model establishment of prognosis factors for acute myeloid leukemia based on the SEER database

Acute myeloid leukemia (AML) with t (9;11) (p22; q23) presents as a varied hematological malignancy. The t (9;11) (p22; q23) translocation is the most common among 11q23/KMT2A rearrangements in AML. This research aimed to develop a nomogram for precise prediction of overall survival (OS) and cancer-specific survival (CSS) in AML with the t (9;11) (p22; q23) translocation. We utilized the Surveillance, Epidemiology, and End Results (SEER) database to identify patients diagnosed with t (9;11) (p22; q23) AML from 2000 to 2021. Prognostic factors for this AML subtype were determined using least absolute shrinkage and selection operator (LASSO) regression, which guided the creation of prognostic nomograms. To evaluate the model's discrimination, accuracy, and effectiveness, we employed the concordance index (C-index), calibration charts, receiver operating characteristic curves (ROC), area under the curve (AUC), and decision-curve analysis (DCA). The research was meticulously planned, executed, and documented in full adherence to the TRIPOD guidelines. The nomogram was developed using key variables including age, race, first primary tumor, and chemotherapy. The concordance indices (C-indices) were 0.704 for OS and for 0.686 for CSS. Patients were classified into high-risk and low-risk groups based on nomogram scores, with significant differences in OS and CSS between these groups (P < 0.001). This study developed innovative nomograms that combine clinical and treatment factors to predict 1-, 3-, and 5-year survival rates for patients with t (9;11) (p22; q23) AML.

Perceived Economic Strain, Subjective Social Status, and Colorectal Cancer Screening Utilization in U.S. Men-A Cross-Sectional Analysis

Although socioeconomic status (SES) is fundamentally related to underutilization of colorectal cancer (CRC) screening, the role of perceived economic strain and subjective social status with CRC screening is understudied. The aim of this study was to investigate whether greater perceived economic strain or lower subjective social status would decrease the odds of CRC screening uptake and being up-to-date with guideline-recommended CRC screening. We also explored interactions with household income and educational attainment. Cross-sectional survey-based data from men aged 45-75 years living in the United States (N = 499) were collected in February 2022. Study outcomes were ever completing a stool- or exam-based CRC screening test and being up-to-date with CRC screening. Perceived economic strain and subjective social status were the predictors. We conducted logistic regression models to estimate odds ratios (OR) and 95% confidence intervals (CI). Greater perceptions of economic strain decreased odds of being up-to-date with CRC screening. Household income modified the association between perceived economic strain and completing a stool-based test; the association was stronger for men from lower-income households. In unadjusted models, higher subjective social status increased odds of completing an exam-based test and being up-to-date with CRC screening. Our findings suggest that experiencing economic strain may interfere with men's CRC screening decisions and may capture additional information about barriers to CRC screening utilization beyond those captured by income or education.

The intersection of melanoma survival and social determinants of health in the United States: A systematic review

Background

Despite recent improvements in melanoma survival rates, persistent inequalities pose barriers to care for some patients.

Objective

To assess the influence of social determinants of health (SDoH) on melanoma treatment outcomes.

Methods

A systematic review (Prospective Register of Systematic Reviews CRD42022346854) of manuscripts that examined the association between SDoH and melanoma treatment-related outcomes in the United States was conducted using 5 databases.

Results

The analysis encompassed data from 12 retrospective manuscripts. The SDoH domains most frequently investigated were health care access and quality (n = 6 manuscripts, 50%) and economic stability (n = 7, 58.3%). Other domains included social and community context (n = 5, 41.7%) and education access (n = 3, 25%). These findings revealed significant correlations between poor melanoma survival and low levels of economic stability, limited education, government health insurance, and being uninsured and unmarried.

Limitations

Many SDoH were not analyzed at the patient level. SDoH are vast categories, but manuscripts usually analyze one aspect of a particular category.

Conclusions

These results highlight the need for physicians to recognize the substantial impact of SDoH on melanoma outcomes and to adopt more comprehensive strategies focused on patient-centered care. Integrating social support mechanisms into clinical practice emerges as a key mechanism to promote equitable and effective interventions.

Nomogram models predicting prognosis for patients with t(8;21) acute myeloid leukemia: a SEER-based study

BACKGROUND

Acute myeloid leukemia (AML) with t(8;21) manifests as a diverse hematological malignancy. Although it was categorized into a favorable subtype, 30-40% of patients experience relapse. The objective of this research was to devise a nomogram for the accurate anticipation of both overall survival (OS) and cancer-specific survival (CSS) in t(8;21) AML.

METHODS

From the Surveillance, Epidemiology, and End Results (SEER) database, individuals diagnosed with t(8;21) AML from 2000 to 2018 were selected. Prognostic factors for t(8;21) AML were identified using Cox regression analysis and Akaike Information Criterion (AIC), forming the basis for constructing prognostic nomograms.

RESULTS

Key variables, including first primary tumor, age group, race, and chemotherapy, were identified and integrated into the nomogram. The C-index values for the nomograms predicting OS and CSS were 0.753 (validation: 0.765) and 0.764 (validation: 0.757), respectively. Ultimately, based on nomogram scores, patients were stratified into high-risk and low-risk groups, revealing significant disparities in both OS and CSS between these groups (P < 0.001).

CONCLUSION

This study innovatively crafted nomograms, incorporating clinical and therapeutic variables, to forecast the 1-, 3-, and 5-year survival rates for individuals with t(8;21) AML.

Digital tools to support informed decision making among screening invitees in a vulnerable position for population-based cancer screening: A scoping review

BACKGROUND

Individuals in a vulnerable position are generally less inclined to participate in population-based cancer screening. Digital tools, such as educational videos, narratives or decision aids, show promise in reaching and informing these invitees by tailoring information needs based on their preferences. This review aims to provide an overview of design features and reported outcomes of digital tools intended to support informed decision making among screening invitees in a vulnerable position.

METHODS

The review was conducted according to the Preferred Reporting Items for Scoping Reviews guidelines. We searched PubMed, Scopus/MEDLINE and Web of Science and included studies when the effectiveness of the digital tool was assessed and focussed on reaching and/or informing screening invitees in a vulnerable position for breast, cervical or colorectal cancer screening. For each included study, the study population, type of digital tool, the development process, reported design features and reported effects were extracted.

FINDINGS

We found 448 articles, and finally 13 were included in this review after reading full text. Study designs included randomised controlled trials (n = 5), pre-post-test design (n = 7) and experimental design (n = 1). Six different types of digital tools were identified: decision aids (n = 6), educational programs (n = 3), narrative video (n = 1), text-messaging intervention (n = 1), animation video (n = 1), and iPad program (n = 1). A population specific design was applied in 12/13 interventions, such as avoiding jargon and using a voice over function. Reported outcomes measures regarding reaching and informing the target population were: knowledge, attitude, screening intention, self-efficacy, susceptibility, feeling informed, values clarity, and screening uptake. All digital tools reported a significant improvement on at least one of the reported outcome measures.

PRINCIPAL CONCLUSIONS

The use of digital tools seems to contribute to reach or inform screening invitees in a vulnerable position for cancer screening. However, insufficient evidence was found regarding the development process of the tools and their effects on outcome measures related to reaching and informing the screening invitees in a vulnerable position. Future research may look in to combining multiple digital tools and animated visual information in combination with spoken text to improve reaching and informing screening invitees in a vulnerable position.

The Context of Poverty and Cancer: Denying Human Potential

Poverty is a carcinogen and a leading cause of cancer disparities and overall mortality in the United States. Poverty is often viewed as an individual failure for "being poor," but in fact, poverty is structurally driven, intergenerational, and place-based that socially deprives and denies human potential. Disparities in timely cancer prevention, diagnosis, treatment, survivorship, and survival disproportionally impact people living in poverty and especially in persistent poverty areas, an extreme form of place-based poverty that affects communities over multiple generations. There has been some progress made to address place-based conditions that exacerbate poverty, such as the NCI's initiative on persistent poverty. However, gross inequality and cancer disparities continue to exist and persist. The time is now to accelerate the development of research-informed strategies and solutions with communities along with multisectoral collaborations with education, housing, occupation/workforce, foster care, criminal justice, transportation, and data collection systems. This commentary discusses the structural, place-based, and generational context of poverty, illustrates how entrenched inequities shape poor cancer outcomes, and describes opportunities for future research.

Medicaid expansion in California and breast cancer incidence across neighborhoods with varying social vulnerabilities

PURPOSE

To investigate changes in breast cancer incidence rates associated with Medicaid expansion in California.

METHODS

We extracted yearly census tract-level population counts and cases of breast cancer diagnosed among women aged between 20 and 64 years in California during years 2010-2017. Census tracts were classified into low, medium and high groups according to their social vulnerability index (SVI). Using a difference-in-difference (DID) approach with Poisson regression models, we estimated the incidence rate, incidence rate ratio (IRR) during the pre- (2010-2013) and post-expansion periods (2014-2017), and the relative IRR (DID estimates) across three groups of neighborhoods.

RESULTS

Prior to the Medicaid expansion, the overall incidence rate was 93.61, 122.03, and 151.12 cases per 100,000 persons among tracts with high, medium, and low-SVI, respectively; and was 96.49, 122.07, and 151.66 cases per 100,000 persons during the post-expansion period, respectively. The IRR between high and low vulnerability neighborhoods was 0.62 and 0.64 in the pre- and post-expansion period, respectively, and the relative IRR was 1.03 (95% CI 1.00 to 1.06, p = 0.026). In addition, significant DID estimate was only found for localized breast cancer (relative IRR = 1.05; 95% CI, 1.01 to 1.09, p = 0.049) between high and low-SVI neighborhoods, not for regional and distant cancer stage.

CONCLUSIONS

The Medicaid expansion had differential impact on breast cancer incidence across neighborhoods in California, with the most pronounced increase found for localized cancer stage in high-SVI neighborhoods. Significant pre-post change was only found for localized breast cancer between high and low-SVI neighborhoods.

Recovery From COVID-19-Related Disruptions in Cancer Detection

Importance

The COVID-19 pandemic impacted the timely diagnosis of cancer, which persisted as the second leading cause of death in the US throughout the pandemic.

Objective

To evaluate the disruption and potential recovery in cancer detection during the first (2020) and second (2021) years of the COVID-19 pandemic.

Design, Setting, and Participants

This cross-sectional study involved an epidemiologic analysis of nationally representative, population-based cancer incidence data from the Surveillance, Epidemiology, and End Results (SEER) Program. Included patients were diagnosed with incident cancer from January 1, 2000, through December 31, 2021. The analysis was conducted in May 2024 using the April 2024 SEER data release, which includes incidence data through December 31, 2021.

Exposures

Diagnosis of cancer during the first 2 years of the COVID-19 pandemic (2020, 2021).

Main Outcomes and Measures

Difference between the expected and observed cancer incidence in 2020 compared with 2021, with additional analyses by demographic subgroups (sex, race and ethnicity, and age group) and community (county-level) characteristics.

Results

The analysis included 15 831 912 patients diagnosed with invasive cancer between 2000 and 2021, including 759 810 patients in 2020 and 825 645 in 2021. The median age was 65 years (IQR, 56-75 years), and 51.0% were male. The percentage difference between the expected and observed cancer incidence was -8.6% (95% CI, -9.1% to -8.1%) in 2020, with no significant difference in 2021 (-0.2%; 95% CI, -0.7% to 0.4%). These translated to a cumulative (2020-2021) deficit in observed vs expected cases of -127 931 (95% CI, -139 206 to -116 655). Subgroup analyses revealed that incidence rates remained substantially depressed from expected rates into 2021 for patients living in the most rural counties (-4.9%; 95% CI, -6.7% to -3.1%). The cancer sites with the largest cumulative deficit in observed vs expected cases included lung and bronchus (-24 940 cases; 95% CI, -28 936 to -20 944 cases), prostate (-14 104 cases; 95% CI, -27 472 to -736 cases), and melanoma (-10 274 cases; 95% CI, -12 825 to -7724 cases).

Conclusions and Relevance

This cross-sectional study of nationally representative registry data found that cancer incidence recovered meaningfully in 2021 following substantial disruptions in 2020. However, incidence rates need to recover further to address the substantial number of patients with undiagnosed cancer during the pandemic.

Exploring the Multifactorial Landscape of Penile Cancer: A Comprehensive Analysis of Risk Factors

Penile cancer, while rare, is a critical public health issue due to its profound impact on patients and the complexities of its management. The disease's multifactorial etiology includes risk factors such as HPV infection, poor hygiene, smoking, genetic predispositions, and socioeconomic determinants. This article provides a comprehensive review and analysis of these diverse risk factors, aiming to enhance understanding of the disease's underlying causes. By elucidating these factors, the article seeks to inform and improve prevention strategies, early detection methods, and therapeutic interventions. A nuanced grasp of the multifactorial nature of penile cancer can enable healthcare professionals to develop more effective approaches to reducing incidence rates and improving patient outcomes.

The impact of multiple deprivation on the management of vestibular schwannomas

PURPOSE

While some factors have been well-shown to affect the decision-making in treating patients with vestibular schwannomas (VS), little is known on the role of deprivation. Our objective was to assess the effect of socioeconomic background on the management of patients with VS.

METHODS

This retrospective cohort study included 460 patients with sporadic VS from West of Scotland. The postcode-based, multifactorial Scottish Index of Multiple Deprivation (SIMD) was used to assess the socioeconomic background of each patient. We performed a multivariate analysis including tumour size, growth and patient age with management modality (observation, stereotactic radiotherapy, microsurgery) being the main outcome measure and outcome (need for additional treatment) an additional measure.

RESULTS

We found no significant difference in the demographics, tumour characteristics and primary treatment choice between patients with different SIMD scores. In addition, there was no statistically significant difference in the growth occurrence rates following first-line treatment (p = 0.964) and in the second-line treatment choice (p = 0.460).

CONCLUSIONS

Multiple deprivation does not affect decision making in patients with VS in the examined cohort. This is probably linked to the centralisation and uniformity of the service and might not necessarily be applicable to other health services without centralisation.

Demographic and Prognostic Factors of the Columnar Cell Variant of Papillary Thyroid Carcinoma: A National Cancer Database Study

Objective The columnar cell variant of papillary thyroid carcinoma (PTC-CC) is a rare, malignant tumor of the thyroid gland. This study uses the National Cancer Database (NCDB) to analyze demographic and prognostic factors affecting the overall survival rates of PTC-CC. Methods From 2004 to 2020, 7,079 patients diagnosed with columnar cell papillary thyroid carcinoma were identified in the NCDB. Patient demographics were reviewed based on categories listed in the NCDB participant user file data dictionary. Kaplan-Meier curves, log-rank tests, and multivariable Cox hazard regression models were used to analyze the significance of demographic and prognostic factors on overall survival rates of PTC-CC. Results Multivariate analysis demonstrated each five-year increment in age was associated with a 30% increase in mortality (hazard ratio (HR) = 1.30, 95% confidence interval (CI): 1.25-1.36, P < 0.001). Charlson-Deyo scores displayed similar incremental increases, such that patients with a score ≥ 3 had a 154% increase in mortality risk relative to a score of 0 (HR = 2.54; 95% CI: 1.75-3.68, P < 0.001). Black individuals had a 70% increase in mortality compared to White individuals (HR = 1.70, 95% CI: 1.25-2.30, P < 0.001), while all Other races had the highest 10-year survival rate of 92.7%. Females had a significant 37% decrease in mortality compared to males (HR = 0.63, 95% CI: 0.54-0.73, P < 0.001). Patients in the lowest income quartiles were found to have a significant increase in mortality compared to the highest income group (HR = 0.54; 95% CI: 0.41-0.71, P < 0.001). Survival rates were negatively correlated with NCDB Analytic Staging increases. Conclusion In general, age, sex, race, education, income, comorbidities, and cancer staging were found to be predictive factors of overall survival rates of PTC-CC. However, insurance status and education levels did not result in significant differences.

Factors influencing delayed cancer health seeking in Meghalaya, Northeast India: A qualitative study

Background & objectives India accounts for about seven per cent of the global cancer burden with the highest cancer incidence reported from the North-Eastern Region (NER), including Meghalaya. Despite this, there is paucity of published studies on health seeking behaviour for cancer in the NER. To address this gap, this study used a qualitative approach to document patient, caregiver and provider perspectives to understand the factors influencing healthcare seeking for cancers in Meghalaya. Methods In-depth interviews were undertaken with 37 individuals diagnosed with one of the top five cancers in Meghalaya, namely, oesophageal, breast, oral, cervical and lung cancer. They were identified from the State referral cancer hospital. Twelve caregivers and five healthcare providers were also interviewed. All interviews were conducted in the local language using semi-structured interview guides. Transcripts were translated to English, coded, categorized and analyzed using thematic framework content analysis approach. Results A key factor influencing delayed cancer treatment in Meghalaya included misconceptions regarding the causes of cancer and cultural concepts such as bih and skai (Khasi language), i.e. notions of a figurative 'poison' or ill intent that makes one susceptible to illness. A general reluctance to discuss cancer diagnoses, perceived stigma, apprehension of treatment methods influenced their decision. Other factors included negligence and misinterpretation of early symptoms of cancer, self-management, preference for traditional medicines, financial constraints and health system-related factors. Interpretation & conclusions This study underscores the importance of addressing barriers to cancer diagnosis and treatment in indigenous populations in northeast India, advocating for culturally appropriate messaging, capacity building for healthcare workers, integration of traditional healers, and community involvement to enhance early healthcare seeking and improve outcomes.

Risk and predictors of penile cancer in US Veterans with HIV

OBJECTIVES

People with HIV (PWH) may have an increased burden of penile cancer. We aimed to evaluate the risk of penile cancer in PWH compared with that of the general population.

DESIGN

We conducted a nationwide retrospective matched cohort study of penile cancer incidence among veterans with HIV (VWH) compared with veterans without HIV.

METHODS

We compared penile cancer incidence rates in 44 173 VWH to those of veterans without HIV ( N  = 159 443; 4 : 1 matched in age). We used Cox regression models to estimate hazard ratios and 95% confidence intervals (CIs) for associations with HIV infection and for penile cancer risk factors.

RESULTS

HIV positivity was associated with an increased risk of penile cancer, with adjusted hazard ratios of 2.63 (95% CI 1.64-4.23) when adjusting for age, race/ethnicity, baseline BMI, smoking and alcohol use, economic means test, and history of condyloma. The risk increased to hazard ratio = 4.25 (95% CI 2.75-6.57) when adjusting for all factors except history of condyloma. Risk factors for penile cancer in VWH included lower nadir CD4 + count, less than 50% of follow-up time with undetectable HIV viral load, and history of condyloma.

CONCLUSION

VWH - particularly those with low CD4 + counts, detectable HIV viral loads, or history of condyloma - are at increased risk of penile cancer, suggesting the penile cancer prevention activities are needed in this population.

Epidemiology of HPV-associated cancers past, present and future: towards prevention and elimination

Cervical cancer is the first cancer deemed amenable to elimination through prevention, and thus lessons from the epidemiology and prevention of this cancer type can provide information on strategies to manage other cancers. Infection with the human papillomavirus (HPV) causes virtually all cervical cancers, and an important proportion of oropharyngeal, anal and genital cancers. Whereas 20th century prevention efforts were dominated by cytology-based screening, the present and future of HPV-associated cancer prevention relies mostly on HPV vaccination and molecular screening tests. In this Review, we provide an overview of the epidemiology of HPV-associated cancers, their disease burden, how past and contemporary preventive interventions have shaped their incidence and mortality, and the potential for elimination. We particularly focus on the cofactors that could have the greatest effect on prevention efforts, such as parity and human immunodeficiency virus infection, as well as on social determinants of health. Given that the incidence of and mortality from HPV-associated cancers remain strongly associated with the socioeconomic status of individuals and the human development index of countries, elimination efforts are unlikely to succeed unless prevention efforts focus on health equity, with a commitment to both primary and secondary prevention.

Anogenital HPV-Related Cancers in Women: Investigating Trends and Sociodemographic Risk Factors

The incidences of anogenital HPV-related cancers in women are on the rise; this is especially true for anal cancer. Medical societies are now beginning to recommend anal cancer screening in certain high-risk populations, including high-risk women with a history of genital dysplasia. The aim of this study is to investigate national anogenital HPV cancer trends as well as the role of demographics, deprivation, and ethnicity on anogenital cancer incidence in England, in an attempt to better understand this cohort of women which is increasingly affected by anogenital HPV-related disease. Demographic data from the Clinical Outcomes and Services Dataset (COSD) were extracted for all patients diagnosed with anal, cervical, vulval and vaginal cancer in England between 2014 and 2020. Outcomes included age, ethnicity, deprivation status and staging. An age over 55 years, non-white ethnicity and high deprivation are significant risk factors for late cancer staging, as per logistic regression. In 2019, the incidences of anal and vulval cancer in white women aged 55-74 years surpassed that of cervical cancer. More needs to be done to educate women on HPV-related disease and their lifetime risk of these conditions.

Socioeconomic Status, Length of Stay, and Postoperative Complications in Oral Cavity Squamous Cell Carcinoma

Background: Despite universal healthcare in Canada, low socioeconomic status (SES) has been associated with worse survival in oral cavity squamous cell carcinoma (OCSCC) patients. However, the relationship between SES and outcomes during the acute postoperative period is poorly defined. Hamilton, Ontario, presents a unique population with widely varying SES within the same geography. The objective of this study was to examine the relationship between SES, length of hospital stay (LOHS), and postoperative complications in OCSCC. Methods: Newly diagnosed OCSCC patients receiving primary surgical treatment from 2010 to 2014 were identified within a prospectively collected database. Inclusion criteria included age >18 years old, pathological diagnosis of oral cavity cancer, and primary surgical treatment with curative intent. Patients were excluded if they were undergoing palliative treatment or had previous head and neck surgery/radiotherapy. Postal codes were used to identify neighborhood-level socioeconomic variables via 2011 Canada Census data. Income quartiles were defined from groups of neighboring municipalities based on Canada Census definitions. Demographic, social, pathological, staging, and treatment data were collected through chart review. Results: One hundred and seventy-four patients were included in the final analysis. OCSCC patients with lower SES were more likely to be younger (P = .041), male (P = .040), have significant tobacco and alcohol use (P = .001), higher Charlson Comorbidity Index (CCI; P = .014), lower levels of education (P = .001), and have lower employment levels (P = .001). Lower SES patients had higher clinical tumor (P = .006) and clinical nodal (P = .004) staging and were more likely to receive adjuvant therapy (P = .001) and G-tubes (P = .001). Multivariable regression analysis showed that low SES was a statistically significant predictor of postoperative complications [β 2.50 (95% confidence interval (CI) 0.200, 3.17); P = .014] and LOHS [β 2.03 (95% CI 1.06, 2.99); P = .0001]. Tobacco and alcohol use, clinical tumor, and nodal stage, CCI, and planned adjuvant therapy were also statistically significant predictors of postoperative complications and LOHS (P < .05). Conclusion: Patients with lower SES have more advanced OCSCC disease with increased comorbidities that owes itself to more acute postoperative complications and LOHS within this study population. Patients with low SES should be identified as patients that require more support during their cancer treatment.

Socioeconomic disadvantage and long-term survival duration in out-of-hospital cardiac arrest patients: A population-based cohort study

Background

Socioeconomic status (SES) is a well-established determinant of cardiovascular health. However, the relationship between SES and clinical outcomes in long-term out-of-hospital cardiac arrest (OHCA) is less well-understood. The Singapore Housing Index (SHI) is a validated building-level SES indicator. We investigated whether SES as measured by SHI is associated with long-term OHCA survival in Singapore.

Methods

We conducted an open cohort study with linked data from the Singapore Pan-Asian Resuscitation Outcomes Study (PAROS), and the Singapore Registry of Births and Deaths (SRBD) from 2010 to 2020. We fitted generalized structural equation models, calculating hazard ratios (HRs) using a Weibull model. We constructed Kaplan-Meier survival curves and calculated the predicted marginal probability for each SHI category.

Results

We included 659 cases. In both univariable and multivariable analyses, SHI did not have a significant association with survival. Indirect pathways of SHI mediated through covariates such as Emergency Medical Services (EMS) response time (HR of low-medium, high-medium and high SHI when compared to low SHI: 0.98 (0.88-1.10), 1.01 (0.93-1.11), 1.02 (0.93-1.12) respectively), and age of arrest (HR of low-medium, high-medium and high SHI when compared to low SHI: 1.02 (0.75-1.38), 1.08 (0.84-1.38), 1.18 (0.91-1.54) respectively) had no significant association with OHCA survival. There was no clear trend in the predicted marginal probability of survival among the different SHI categories.

Conclusions

We did not find a significant association between SES and OHCA survival outcomes in residential areas in Singapore. Among other reasons, this could be due to affordable healthcare across different socioeconomic classes.

Internal Responsiveness of EQ-5D-5L and EORTC QLQ-C30 in Dutch Breast Cancer Patients during the First Year Post-Surgery: A Longitudinal Cohort Study

The EuroQoL 5-Dimension 5-Level questionnaire (EQ-5D-5L) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30) are commonly used Patient-Reported Outcome Measures (PROMs) for breast cancer. This study assesses and compares the internal responsiveness of the EQ-5D-5L and EORTC QLQ-C30 in Dutch breast cancer patients during the first year post-surgery. Women diagnosed with breast cancer who completed the EQ-5D-5L and EORTC QLQ-C30 pre-operatively (T0), 6 months (T6), and 12 months post-surgery (T12) were included. Mean differences of the EQ-5D-5L and EORTC QLQ-C30 between baseline and 6 months (delta 1) and between baseline and 12 months post-surgery (delta 2) were calculated and compared against the respective minimal clinically important differences (MCIDs) of 0.08 and 5. Internal responsiveness was assessed using effect sizes (ES) and standardized response means (SRM) for both deltas. In total, 333 breast cancer patients were included. Delta 1 and delta 2 for the EQ-5D-5L index and most scales of the EORTC QLQ-C30 were below the MCID. The internal responsiveness for both PROMs was small (ES and SRM < 0.5), with greater internal responsiveness for delta 1 compared to delta 2. The EQ-5D-5L index showed greater internal responsiveness than the EORTC QLQ-C30 Global Quality of Life scale and summary score. These findings are valuable for the interpretation of both PROMs in Dutch breast cancer research and clinical care.

Does improved nurse staffing impact patient outcomes in cancer? Association between chronic diseases and mortality among older adult patients with lung cancer in Korea

BACKGROUND

Evidence regarding the impact of nurse staffing on the health outcomes of older adult patients with cancer is scarce. Therefore, this study aimed to evaluate the impact of nurse staffing on long-term and short-term mortality in elderly lung cancer patients.

METHODS

This study analyzed data from 5,832 patients with lung cancer in Korea from 2008 to 2018. Nursing grade was considered to assess the effect of nursing staff on mortality in older adult patients with lung cancer. The Cox proportional hazards model was used to evaluate the effect of the initial treatment hospital's nursing grade on one- and five-year mortality. Additionally, economic status and treatment type of patients were analyzed.

RESULTS

Approximately 31% of older adult patients with lung cancer died within one year post-diagnosis. Patients in hospitals with superior nursing grades (lower nurse-to-bed ratios) exhibited lower mortality rates. Hospitals with nursing grades 2 and 3 exhibited approximately 1.242-1.289 times higher mortality than grade 1 hospitals. Further, the lower the nursing grade (higher nurse-to-bed ratio), the higher the five-year mortality rate.

CONCLUSION

Both short- and long-term mortality rates for older adult patients with lung cancer increased at inferior nursing grades. Treatment in hospitals having inferior nursing grades, upon initial hospitalization, may yield better outcomes. This study provides valuable insight into the quality of adequate staffing to improve the quality of care for elderly cancer patients.

Essential data variables for a minimum dataset for head and neck cancer trials and clinical research: HNCIG consensus recommendations and database

The Head and Neck Cancer International Group (HNCIG) has undertaken an international modified Delphi process to reach consensus on the essential data variables to be included in a minimum database for HNC research. Endorsed by 19 research organisations representing 34 countries, these recommendations provide the framework to facilitate and harmonise data collection and sharing for HNC research. These variables have also been incorporated into a ready to use downloadable HNCIG minimum database, available from the HNCIG website.

Assessment of Social Vulnerabilities of Care and Prognosis in Adult Ocular Melanomas in the US

BACKGROUND

Prior works have studied the impact of social determinants on various cancers but there is limited analysis on eye-orbit cancers. Current literature tends to focus on socioeconomic status and race, with sparse analysis of interdisciplinary contributions. We examined social determinants as measured by the Centers for Disease Control and Prevention (CDC) Social Vulnerability Index (SVI), quantifying eye and orbit melanoma disparities across the United States.

METHODS

A retrospective review of 15,157 patients diagnosed with eye-orbit cancers in the Surveillance, Epidemiology, and End Results (SEER) database from 1975 to 2017 was performed, extracting 6139 ocular melanomas. SVI scores were abstracted and matched to SEER patient data, with scores generated by weighted averages per population density of county's census tracts. Primary outcome was months survived, while secondary outcomes were advanced staging, high grading, and primary surgery receipt.

RESULTS

With increased total SVI score, indicating more vulnerability, we observed significant decreases of 23.1% in months survival for melanoma histology (p < 0.001) and 19.6-39.7% by primary site. Increasing total SVI showed increased odds of higher grading (odds ratio [OR] 1.20, 95% confidence interval [CI] 1.02-1.43) and decreased odds of surgical intervention (OR 0.94, 95% CI 0.92-0.96). Of the four themes, higher magnitude contributions were observed with socioeconomic status (26.0%) and housing transportation (14.4%), while lesser magnitude contributions were observed with minority language status (13.5%) and household composition (9.0%).

CONCLUSIONS

Increasing social vulnerability, as measured by the CDC SVI and its subscores, displayed significant detrimental trends in prognostic and treatment factors for adult eye-orbit melanoma. Subscores quantified which social determinants contributed most to disparities. This lays groundwork for providers to target the highest-impact social determinant for non-clinical factors in patient care.

Analyzing Global Cancer Control: Progress of National Cancer Control Programs through Composite Indicators and Regression Modeling

Aim

Cancer is a significant public health concern, and National Cancer Control Programs (NCCPs) are crucial for reducing its burden. However, assessing the progress of NCCPs is challenging due to the complexity of cancer control outcomes and the various factors that influence them. Composite indicators can provide a comprehensive and accurate assessment of NCCP progress.

Materials and Methods

The dataset was compiled for 144 countries and comprised eight composite indices and two high-level comparative indicators (mortality-to-cancer incidence ratio [MIR] and 5-year cancer prevalence-to-incidence ratio [PCIR]) representing NCCP outcomes. Two large databases and six annual composite index reports were consulted. Linear regression analysis and Pearson correlation coefficients were used to establish a relationship between indicators and NCCP outcomes. A multiple regression machine learning model was generated to further improve the accuracy of NCCP outcome prediction.

Results

High-income countries had the highest cancer incidence, whereas low-income countries had the highest MIR. Linear regression analysis indicated a negative trend between all composite indicators and MIR, whereas a positive trend was observed with PCIR. The Human Development Index and the Legatum Prosperity Index had the highest adjusted R 2 values for MIR (0.74 and 0.73) and PCIR (0.86 and 0.81), respectively. Multiple linear regression modeling was performed, and the results indicated a low mean squared error score (-0.02) and a high R 2 score (0.86), suggesting that the model accurately predicts NCCP outcomes.

Conclusions

Overall, composite indicators can be an effective tool for evaluating NCCP, and the results of this study can aid in the development and keeping track of NCCP progress for better cancer control.

Disparities in Stage at Presentation Among Hispanic and Latinx Patients With Non-Small-Cell Lung Cancer in the United States

PURPOSE

Hispanic and Latinx people in the United States are the fastest-growing ethnic group. However, previous studies in non-small-cell lung cancer (NSCLC) often analyze these diverse communities in aggregate. We aimed to identify differences in NSCLC stage at diagnosis in the US population, focusing on disaggregated Hispanic/Latinx individuals.

METHODS

Data from the National Cancer Database from 2004 to 2018 identified patients with primary NSCLC. Individuals were disaggregated by racial and ethnic subgroup and Hispanic country of origin. Ordinal logistic regression adjusting for age, facility type, income, educational attainment, comorbidity index, insurance, and year of diagnosis was used to create adjusted odds ratios (aORs), with higher odds representing diagnosis at later-stage NSCLC.

RESULTS

Of 1,565,159 patients with NSCLC, 46,616 were Hispanic/Latinx (3.0%). When analyzed in the setting of race and ethnicity, Hispanic patients were more likely to be diagnosed with metastatic disease compared with non-Hispanic White (NHW) patients: 47.0% for Hispanic Black, 46.0% Hispanic White, and 44.3% of Hispanic other patients versus 39.1% of non-Hispanic White patients (P < .001 for all). By country of origin, 51.4% of Mexican, 41.7% of Puerto Rican, 44.6% of Cuban, 50.8% of South or Central American, 48.4% of Dominican, and 45.6% of other Hispanic patients were diagnosed with metastatic disease, compared with 39.1% of NHWs. Conversely, 20.2% of Mexican, 26.9% of Puerto Rican, 24.2% of Cuban, 22.5% of South or Central American, 23.7% of Dominican, and 24.5% of other Hispanic patients were diagnosed with stage I disease, compared with 30.0% of NHWs. All Hispanic groups were more likely to present with later-stage NSCLC than NHW patients (greatest odds for Mexican patients, aOR, 1.44; P < .001).

CONCLUSION

Hispanic/Latinx patients with non-small-cell lung cancer were more likely to be diagnosed with advanced disease compared with NHWs. Disparities persisted upon disaggregation by both race and country of origin, with over half of Mexican patients with metastatic disease at diagnosis. Disparities among Hispanic/Latinx groups by race and by country of origin highlight the shortcomings of treating these groups as a monolith and underscore the need for disaggregated research and targeted interventions.

Human papillomavirus-associated anal squamous cell carcinoma: sociodemographic, geographic, and county-level economic trends in incidence rates-United States, 2001-2019

BACKGROUND

Incidence of anal squamous cell carcinoma is increasing, but vaccination against human papillomavirus (HPV) and removal of precancerous anal lesions could prevent new cases. The overall HPV-associated cancer incidence is reported to be higher in rural populations and in counties with lower economic status. We assessed these differences specifically for HPV-associated anal squamous cell carcinoma and described the geographic, county-level economic, and sociodemographic variations in incidence rates and trends.

METHODS

We analyzed data from the US Cancer Statistics to assess age-standardized incidence rates of HPV-associated squamous cell carcinomas among adults aged 18 years and older from 2001 to 2019. We calculated rate ratios and 95% confidence intervals to examine differences in incidence rates. We also quantified changes in incidence rates over time using joinpoint regression.

RESULTS

From 2001 to 2019, 72 421 new cases of HPV-associated anal squamous cell carcinoma were diagnosed among women (2.8 per 100 000) and 37 147 among men (1.7 per 100 000). Age-standardized incidence rates were higher in the South compared with other census regions and in counties ranked in the bottom 25% and 25%-75% economically than in the top 25%. The overall incidence rate increased in women but remained stable in men during 2009-2019. Incidence rates increased in adults aged 50 years and older but decreased among those aged 40-44 years from 2001 to 2019 in women and from 2007 to 2019 in men.

CONCLUSIONS

There were inequities in HPV-associated anal squamous cell carcinoma incidence by geographic and county-level economic characteristics. Failure to improve vaccine and treatment equity may widen existing disparities.

Investigating inequalities in cancer staging and survival for adults with intellectual or developmental disabilities and cancer: A population-based study in Manitoba, Canada

BACKGROUND

Cancer is a leading cause of death among adults living with intellectual or developmental disabilities (IDD). However, few epidemiological studies exist worldwide quantifying inequalities in cancer stage at diagnosis and survival for people with IDD relative to those without IDD.

METHODS

A population-based, retrospective cohort study was conducted using provincial health and social administrative data in Manitoba, Canada. Adults (≥18 years) with a cancer diagnosis between 2004 and 2017 were included. Lifetime IDD was identified before the cancer diagnosis using an established algorithm. Modified Poisson regression with robust error variance was used to estimate the association between IDD status and metastatic cancer at diagnosis. Multivariable Cox proportional hazards analyses were used to the effect of IDD on overall survival following the cancer diagnosis.

RESULTS

The staging and prognosis cohorts included 62,886 (n = 473 with IDD) and 74,143 (n = 592 with IDD) cancer patients, respectively. People living with IDD were significantly more likely to be diagnosed with metastatic cancer and die following their cancer diagnosis compared to those without IDD (RR=1.20; 95 % CI 1.05-1.38; HR= 1.53; 95 % CI 1.38-1.71). Significant heterogeneity by sex was identified for cancer survival (p = 0.005).

DISCUSSION

People with IDD had more advanced cancer stage at diagnosis and worse survival relative to those without IDD. Identifying and developing strategies to address the factors responsible that contribute to these disparities is required for improving patient-centred cancer care for adults with IDD.

Estimating uninsured and underinsured women eligible for Minnesota's Breast Cancer Screening Program

Since its inception in 1991, the mission of the National Breast and Cervical Cancer Early Detection Program's (NBCCEDP) mission is to improve access to mammography. This program has demonstrated evidence showing that it has improved breast cancer screening rates for women who are uninsured and underinsured. However, the literature has shown that NBCCEDP screenings are decreasing, and only reach a portion of eligible women. Reliable estimates at the sub-county level are needed to identify and reach eligible women. Our work builds upon previous estimates by integrating uninsured and insurance status into spatially adaptive filters. We use spatially adaptive filters to create small area estimates of standardized incidence ratios describing the utilization rate of NBCCEDP services in Minnesota. We integrate the American Community Survey (2010-2014) insurance status data to account for the percentage that an individual is uninsured. We test five models that integrate insurance status by age, sex, and race/ethnicity. Our composite model, which adjusts for age, sex, and race/ethnicity insurance statuses, reduces 95% of the estimation error. We estimate that there approximately 49,913.7 women eligible to receive services for Minnesota. We also create small geography (i.e., county and sub-county) estimates for Minnesota. The integration of the insurance data improved our utilization estimate. The development of these methods will allow state programs to more efficiently use their resources and understand their reach.

Social determinants as predictors of resection and long-term mortality in Black patients with non-small cell lung cancer

BACKGROUND

Minorities diminished returns theory posits that socioeconomic attainment conveys fewer health benefits for Black than White individuals. The current study evaluates the effects of social constructs on resection rates and survival for non-small cell lung cancer (NSCLC).

METHODS

Patients with potentially resectable NSCLC stage IA to IIIA were identified using the 2004 to 2017 National Cancer Database. Patients were stratified into quartiles based on population-level education and income. Logistic regression was used to predict risk-adjusted resection rates. Mortality was assessed with Cox proportional hazard modeling.

RESULTS

Of the 416,025 patients identified, 213,643 (51.4%) underwent resection. Among White patients, the lowest income (adjusted odds ratio 0.76, 95% confidence interval 0.74-0.78, P < .01) and education quartiles (adjusted odds ratio 0.82, 95% confidence interval 0.79-0.84, P < .01) were associated with decreased odds of resection. The lowest education quartile among Black patients was not associated with lower resection rates. The lowest income quartile (adjusted odds ratio 0.67, 95% CI 0.61-0.74, P < .01) was associated with reduced resection. White patients in the lowest education and income quartiles experienced increased hazard of 5-year mortality (adjusted hazard ratio 1.13, 95% CI 1.11-1.15, P < .01 and adjusted hazard ratio 1.08, 95% CI 1.06-1.11, P < .01 respectively). In Black patients, there were no significant differences in 5-year survival between Black patients in the highest education and income quartiles and those in the lowest quartiles.

CONCLUSION

Among Black patients with NSCLC, educational attainment is not associated with increased resection rates. In addition, higher education and income were not associated with improved 5-year survival. The diminished gains experienced by Black patients, compared to Whites patients, illustrate the presence of pervasive race-specific mechanisms in observed inequalities in cancer outcomes.

Socioeconomic inequalities in cervical cancer mortality in Canada, 1990 and 2019: a trend analysis

OBJECTIVE

It is increasingly recognized that those of lower socioeconomic status (SES) are disproportionately affected by cancer mortality. The association between cervical cancer mortality and SES have been reported; however, it remains poorly understood in the Canadian population. Thus, this study investigates trends in income and education inequalities in cervical cancer mortality in Canada over the last three decades.

STUDY DESIGN

Trend analysis.

METHODS

A dataset constructed at the census division level (n = 280), comprising the Canadian Vital Statistics Death Database, the Canadian Census of Population, and the National Household Survey was used to measure cervical cancer mortality in Canada. Income and education inequalities in cervical cancer mortality were measured using age-standardized Concentration index (C).

RESULTS

Crude cervical cancer mortality rates decreased significantly during the study period. Age-standardized C values were negative for the majority of years for income and education inequalities, reaching significance in some years. Trend analyses indicated an increasing concentration of cervical cancer mortality amongst those with lower education levels.

CONCLUSION

Despite recent decreases in cervical cancer mortality rates, socioeconomic inequalities in cervical cancer mortality in Canada are persistent. Notably, those of lower income and education levels are disproportionately affected, underscoring an opportunity to improve clinical outcomes by addressing these inequalities.

Disparities in Cancer Incidence across Income Levels in South Korea

BACKGROUND

Recent nationwide studies of disparities in cancer incidence by income are scarce in Korea. This study investigated such disparities in cancer incidence and the stage at cancer diagnosis across income groups in Korea.

METHODS

This study utilized data from a national cancer database, specifically focusing on cases recorded in the year 2018. Income levels were categorized into quintiles according to the insurance premium paid in addition to the Medicaid benefit. The slope index of inequality (SII) and relative index of inequality (RII) were used to measure absolute and relative differences in cancer incidence by income. A multivariable logistic regression was performed to estimate the risk of a distant stage at cancer diagnosis.

RESULTS

The total number of cases of incident cancer was 223,371 (men: 116,320, women: 107,051) with shares of the total of 29.5% (5Q), 20.4% (4Q), 16.0% (3Q), 13.5% (2Q), 15.6% (1Q), and 5% (Medicaid). The most common cancer type was thyroid cancer, followed by gastric and colorectal cancers. The age-standardized incidence rate for all cancers was lowest in the highest income group, but the SII was not statistically significant (SII: -35.7), and the RII was -0.07. Colorectal and cervical cancers had lower incidence rates for higher income groups, while thyroid and prostate cancers had higher incidence rates for higher income groups. The odds ratio for a distant stage at diagnosis for all cancers increased for lower income groups relative to 5Q.

CONCLUSIONS

Disparities in cancer incidence in a Korean population differed by cancer type, and lower income was a significant predictor of a distant stage at diagnosis for cancers overall. These results emphasize the need for further study of the underlying causes of disparities in cancer incidence and the stage at diagnosis, as well as the need for interventions to mitigate these disparities.

Racial and ethnic and socioeconomic disparities in childhood cancer incidence trends in the United States, 2000-2019

BACKGROUND

Population-based surveillance of pediatric cancer incidence trends is critical to determine high-risk populations, drive hypothesis generation, and uncover etiologic heterogeneity. We provide a comprehensive update to the current understanding of pediatric cancer incidence trends by sex, race and ethnicity, and socioeconomic status (SES).

METHODS

The Surveillance, Epidemiology, and End Results 22 data (2000-2019) was used to summarize age-adjusted incidence rates for children and adolescents aged 0-19 years at diagnosis. The annual percentage change (APC) and 95% confidence interval (CI) were estimated to evaluate incidence trends by sex, race and ethnicity, and SES overall and for cancer subtypes. Tests of statistical significance were 2-sided.

RESULTS

Substantial variation was observed overall and for several histologic types in race and ethnicity- and SES-specific rates. Overall, we observed a statistically significant increase in incidence rates (APC = 0.8%, 95% CI = 0.6% to 1.1%). All race and ethnic groups saw an increase in incidence rates, with the largest occurring among non-Hispanic American Indian and Alaska Native children and adolescents (APC = 1.7%, 95% CI = 0.5% to 2.8%) and the smallest increase occurring among non-Hispanic White children and adolescents (APC = 0.7%, 95% CI = 0.5% to 1.0%). The lowest SES quintiles saw statistically significant increasing trends, while the highest quintile remained relatively stable (quintile 1 [Q1] APC = 1.6%, 95% CI = 0.6% to 2.6%; quintile 5 [Q5] APC = 0.3%, 95% CI = -0.1% to 0.7%).

CONCLUSIONS

Childhood cancer incidence is increasing overall and among every race and ethnic group. Variation by race and ethnicity and SES may enable hypothesis generation on drivers of disparities observed.

Trends in gastric cancer mortality 2005-2020 in Peru and its geographical areas: A joinpoint regression analysis

BACKGROUND

Gastric cancer (GC) is the leading cause of cancer death in Peru. However, information regarding trends in mortality rates in Peru and its geographical areas in the last few decades is lacking. Our objective was to describe GC mortality rates in Peru between 2005 and 2020.

METHODS

Age standardized mortality rates (ASMR) were calculated per 100,000 person-years using the world SEGI standard population. Joinpoint regression analysis was performed to examine mortality trends. The analysis of the last 5 years was performed for Peru and its geographical areas.

RESULTS

GC mortality rates in 2005 and in 2020 were 13.81 and 10.52, respectively, for men and 11.81 and 8.06, respectively, for women. Between 2016 and 2020, Huanuco and Huancavelica reported the highest mortality rates (≥20 deaths per 100,000). In men, Peru and the highlands region reported significant decreases in GC mortality rates in both sexes for some periods. Coastal region significant decreased by 2.6 % in all periods for women. In both sexes, six provinces reported significant decreases in GC mortality rates.

CONCLUSION

Although GC mortality rates in Peru have declined over the past 16 years. They are still one of the highest in the Latin American and Caribbean region. It is important that the Peruvian State seek to reduce the mortality of this disease through prevention efforts, timely detection and treatment in all patients.

Survival of cervical cancer patients at Moi teaching and Referral Hospital, Eldoret in western Kenya

BACKGROUND

Cervical cancer is a major health burden and the second most common cancer after breast cancer among women in Kenya. Worldwide cervical cancer constitutes 3.1% of all cancer cases. Mortality rates are greatest among the low-income countries because of lack of awareness, screening and early-detection programs and adequate treatment facilities. The main aim was to estimate survival and determine survival predictors of women with cervical cancer and limited resources in western Kenya.

METHODS

Retrospective charts review of women diagnosed with cervical cancer and follow-up for two years from the date of the histologic diagnosis. The outcome of interest was death or survival at two years. Kaplan Meier estimates of survival, log-rank test and Cox proportional hazards regression were used in the survival analysis.

RESULTS

One hundred and sixty-two (162) participants were included in the review. The median duration was 0.8 (interquartile range (IQR) 0.3, 1.6) years. The mean age at diagnosis was 50.6 years (SD12.5). The mean parity was 5.9 (SD 2.6). Fifty percent (50%) did not have health insurance. Twenty six percent (26%) used hormonal contraceptives, 25.9% were HIV positive and 70% of them were on anti-retroviral treatment. The participants were followed up for 152.6 person years. Of the 162 women in the study, 70 (43.2%) died giving an overall incidence rate (IR) of 45.9 deaths per 100 person years of follow up. The hazard ratios were better for the patients who survived (0.44 vs 0.88, p-value < 0.001), those who had medical insurance (0.70 vs 0.48, p-value = 0.007) and those with early stage at diagnosis (0.88 vs 0.39, p-value < 0.001). Participants who were diagnosed at late stage of the disease according to the International Federation of Gynecology and Obstetrics staging for cervical cancer (FIGO stage 2B-4B) had more than eight times increased hazard of death compared to those who were diagnosed at early stage (1-2A): Hazard Ratio: 8.01 (95% CI 3.65, 17.57). Similarly, those who underwent surgical management had 84% reduced hazard of mortality compared to those who were referred for other modes of care: HR: 0.16 (95% CI: 0.07, 0.38).

CONCLUSION

Majority of the participants were diagnosed late after presenting with symptoms. The 1 and 2-year survival probability after diagnosis of cervical cancer was 57% AND 45% respectively. It is imperative that women present early since surgery gives better prognosis or better still screening of all women prioritized.

Global inequalities in availability of systemic therapies for cancer care and strategies to address them

Many Low and middle-income countries face challenges in delivering chemotherapy services due to limitations in infrastructure, inadequate healthcare facilities, and a shortage of trained medical professionals. High-income countries often have well-developed healthcare systems and advanced technology.

Geographic Variation in Late-Stage Cervical Cancer Diagnosis

Importance

There are stark disparities in cervical cancer burden in the United States, notably by race and ethnicity and geography. Late-stage diagnosis is an indicator of inadequate access to and utilization of screening.

Objective

To identify geospatial clusters of late-stage cervical cancer at time of diagnosis in Texas.

Design, Setting, and Participants

This population-based cross-sectional study used incident cervical cancer data from the Texas Cancer Registry from 2014 to 2018 of female patients aged 18 years or older. Late-stage cervical cancer cases were geocoded at the census tract level (n = 5265) using their residential coordinates (latitude and longitude) at the time of diagnosis. Statistical analysis was performed from April to September 2023.

Exposures

Census tract of residence at diagnosis.

Main Outcome and Measures

Late-stage cervical cancer diagnosis (ie, cases classified by the National Cancer Institute Surveillance, Epidemiology and End Results summary stages 2 to 4 [regional spread] or 7 [distant metastasis]). A Poisson probability-based model of the SaTScan purely spatial scan statistics was applied at the census tract-level to identify geographic clusters of higher (hot spots) or lower (cold spots) proportions than expected of late-stage cervical cancer diagnosis and adjusted for age.

Results

Among a total of 6484 female patients with incident cervical cancer cases (mean [SD] age, 48.7 [14.7] years), 2300 (35.5%) were Hispanic, 798 (12.3%) were non-Hispanic Black, 3090 (47.6%) were non-Hispanic White, and 296 (4.6%) were other race or ethnicity. Of the 6484 patients, 2892 with late-stage diagnosis (mean [SD] age, 51.8 [14.4] years were analyzed. Among patients with late-stage diagnosis, 1069 (37.0%) were Hispanic, 417 (14.4%) were non-Hispanic Black, 1307 (45.2%) were non-Hispanic White, and 99 (3.4%) were other race or ethnicity. SaTScan spatial analysis identified 7 statistically significant clusters of late-stage cervical cancer diagnosis in Texas, of which 4 were hot spots and 3 were cold spots. Hot spots included 1128 census tracts, predominantly in the South Texas Plains, Gulf Coast, and Prairies and Lakes (North Texas) regions. Of the 2892 patients with late-stage cervical cancer, 880 (30.4%) were observed within hot spots. Census tract-level comparison of characteristics of clusters suggested that hot spots differed significantly from cold spots and the rest of Texas by proportions of racial and ethnic groups, non-US born persons, and socioeconomic status.

Conclusions and Relevance

In this cross-sectional study examining geospatial clusters of late-stage cervical cancer diagnosis, place-based disparities were found in late-stage cervical cancer diagnosis in Texas. These findings suggest that these communities may benefit from aggressive cervical cancer interventions.

Individual-level home values and cancer mortality in a statewide registry

BACKGROUND

Prior work assessing disparities in cancer outcomes has relied on regional socioeconomic metrics. These metrics average data across many individuals, resulting in a loss of granularity and confounding with other regional factors.

METHODS

Using patients' addresses at the time of diagnosis from the Ohio Cancer Incidence Surveillance System, we retrieved individual home price estimates from an online real estate marketplace. This individual-level estimate was compared with the Area Deprivation Index (ADI) at the census block group level. Multivariable Cox proportional hazards models were used to determine the relationship between home price estimates and all-cause and cancer-specific mortality.

RESULTS

A total of 667 277 patients in Ohio Cancer Incidence Surveillance System were linked to individual home prices across 16 cancers. Increasing home prices, adjusted for age, stage at diagnosis, and ADI, were associated with a decrease in the hazard of all-cause and cancer-specific mortality (hazard ratio [HR] = 0.92, 95% confidence interval [CI] = 0.92 to 0.93, and HR = 0.95, 95% CI = 0.94 to 0.95, respectively). Following a cancer diagnosis, individuals with home prices 2 standard deviations above the mean had an estimated 10-year survival probability (7.8%, 95% CI = 7.2% to 8.3%) higher than those with home prices 2 standard deviations below the mean. The association between home price and mortality was substantially more prominent for patients living in less deprived census block groups (Pinteraction < .001) than for those living in more deprived census block groups.

CONCLUSION

Higher individual home prices were associated with improved all-cause and cancer-specific mortality, even after accounting for regional measures of deprivation.

What factors are associated with the prognosis of primary testicular diffuse large B-cell lymphoma? A study based on the SEER database

PURPOSE

Primary testicular diffuse large B-cell lymphoma (PT-DLBCL) is a relatively rare urological tumor with a high degree of malignancy and a poor prognosis. This study aimed to investigate the prognostic risk factors for survival of patients with PT-DLBCL, and then to construct a predictive model and verify its reliability.

METHODS

First, we selected subjects from the SEER database (2000-2018) and analyzed the survival of PT-DLBCL patients by Kaplan-Meier test. Then, we analyzed prognostic factors by Cox regression. Finally, the data from the training cohort were used to construct a prediction model and represented with a nomogram. We evaluated the nomogram using the consistency index (C-index), decision curve analysis (DCA), and the area under the subject operating characteristic curve (ROC). In addition, calibration curves were plotted to assess the agreement between the column plot model and the actual model.

RESULTS

We identified five independent risk factors for patient prognosis affecting OS and CSS in patients with PT-DLBCL by univariate and multivariate analysis, including age, transversality, Ann Arbor staging, chemotherapy, and radiotherapy. According to the above factors, we constructed prognostic nomograms, and found that age contributed the most to the survival of patients with PT-DLBCL. The C-indexes for the nomogram of OS and CSS in the training cohort were 0.758 (0.716-0.799) and 0.763 (0.714-0.812), and in the validation cohort were OS and CSS 0.756 (0.697-0.815) and 0.748 (0.679-0.817).

CONCLUSION

We produced the first nomogram of PT-DLBCL, and it can be used to evaluate the CSS and OS of patients to determine the prognosis of patients.