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Clèries R, Ameijide A, Buxó M, Vilardell M, Martínez JM, Font R, Marcos-Gragera R, Puigdemont M, Viñas G, Carulla M, Espinàs JA, Galceran J, Izquierdo Á, Borràs JM. Ten-Year Probabilities of Death Due to Cancer and Cardiovascular Disease among Breast Cancer Patients Diagnosed in North-Eastern Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:405. [PMID: 36612726 PMCID: PMC9819018 DOI: 10.3390/ijerph20010405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 06/17/2023]
Abstract
Mortality from cardiovascular disease (CVD), second tumours, and other causes is of clinical interest in the long-term follow-up of breast cancer (BC) patients. Using a cohort of BC patients (N = 6758) from the cancer registries of Girona and Tarragona (north-eastern Spain), we studied the 10-year probabilities of death due to BC, other cancers, and CVD according to stage at diagnosis and hormone receptor (HR) status. Among the non-BC causes of death (N = 720), CVD (N = 218) surpassed other cancers (N = 196). The BC cohort presented a significantly higher risk of death due to endometrial and ovarian cancers than the general population. In Stage I, HR- patients showed a 1.72-fold higher probability of all-cause death and a 6.11-fold higher probability of breast cancer death than HR+ patients. In Stages II-III, the probability of CVD death (range 3.11% to 3.86%) surpassed that of other cancers (range 0.54% to 3.11%). In Stage IV patients, the probability of death from any cancer drove the mortality risk. Promoting screening and preventive measures in BC patients are warranted, since long-term control should encompass early detection of second neoplasms, ruling out the possibility of late recurrence. In patients diagnosed in Stages II-III at an older age, surveillance for preventing late cardiotoxicity is crucial.
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Affiliation(s)
- Ramon Clèries
- Pla Director d’Oncología, Av Gran Vía 199-203, 08908 L’Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute, IDIBELL, Av. Gran Via de l’Hospitalet, 199-203-1a planta, 08908 L’Hospitalet de Llobregat, Barcelona, Spain
- Clinical Sciences Department, Universitat de Barcelona, 08907 Barcelona, Spain
| | - Alberto Ameijide
- Tarragona Cancer Registry, Epidemiology and Cancer Prevention Service, Hospital Universitari Sant Joan de Reus, IISPV, 43204 Reus, Spain
| | - Maria Buxó
- Girona Biomedical Research Institute, IDIBGI, C/Dr. Castany s/n, Edifici M2, Parc Hospitalari Martí i Julià, 17190 Salt, Spain
| | | | - José Miguel Martínez
- Statistics and Operational Research Department, Universitat Politècnica de Catalunya, EDIFICI H, Diagonal 647, 08028 Barcelona, Spain
- Public Health Research Group, University of Alicante, 03690 Alicante, Spain
| | - Rebeca Font
- Pla Director d’Oncología, Av Gran Vía 199-203, 08908 L’Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute, IDIBELL, Av. Gran Via de l’Hospitalet, 199-203-1a planta, 08908 L’Hospitalet de Llobregat, Barcelona, Spain
| | - Rafael Marcos-Gragera
- Girona Biomedical Research Institute, IDIBGI, C/Dr. Castany s/n, Edifici M2, Parc Hospitalari Martí i Julià, 17190 Salt, Spain
- Girona Cancer Registry, Epidemiology Unit, Pla Director d’Oncologia, Institut Català d’Oncología, Group for Descriptive Epidemiology, Genetics and Cancer Prevention, Girona-IDIBGI, 17005 Girona, Spain
- Medical School, Universitat de Girona (UdG), 17071 Girona, Spain
- Epidemiology and Public Health Research Network Centre (CIBERESP), 28029 Madrid, Spain
| | - Montse Puigdemont
- Girona Cancer Registry, Epidemiology Unit, Pla Director d’Oncologia, Institut Català d’Oncología, Group for Descriptive Epidemiology, Genetics and Cancer Prevention, Girona-IDIBGI, 17005 Girona, Spain
| | - Gemma Viñas
- Medical Oncology Service, Catalan Institute of Oncology, Hospital Universitari de Girona “Doctor Josep Trueta”, 17005 Girona, Spain
| | - Marià Carulla
- Tarragona Cancer Registry, Epidemiology and Cancer Prevention Service, Hospital Universitari Sant Joan de Reus, IISPV, 43204 Reus, Spain
| | - Josep Alfons Espinàs
- Pla Director d’Oncología, Av Gran Vía 199-203, 08908 L’Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute, IDIBELL, Av. Gran Via de l’Hospitalet, 199-203-1a planta, 08908 L’Hospitalet de Llobregat, Barcelona, Spain
| | - Jaume Galceran
- Tarragona Cancer Registry, Epidemiology and Cancer Prevention Service, Hospital Universitari Sant Joan de Reus, IISPV, 43204 Reus, Spain
| | - Ángel Izquierdo
- Girona Cancer Registry, Epidemiology Unit, Pla Director d’Oncologia, Institut Català d’Oncología, Group for Descriptive Epidemiology, Genetics and Cancer Prevention, Girona-IDIBGI, 17005 Girona, Spain
- Medical Oncology Service, Catalan Institute of Oncology, Hospital Universitari de Girona “Doctor Josep Trueta”, 17005 Girona, Spain
| | - Josep Maria Borràs
- Pla Director d’Oncología, Av Gran Vía 199-203, 08908 L’Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute, IDIBELL, Av. Gran Via de l’Hospitalet, 199-203-1a planta, 08908 L’Hospitalet de Llobregat, Barcelona, Spain
- Clinical Sciences Department, Universitat de Barcelona, 08907 Barcelona, Spain
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2
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Font R, Buxó M, Ameijide A, Martínez JM, Marcos-Gragera R, Carulla M, Puigdemont M, Vilardell M, Civit S, Viñas G, Espinàs JA, Galceran J, Izquierdo Á, Borràs JM, Clèries R. Using population-based data to evaluate the impact of adherence to endocrine therapy on survival in breast cancer through the web-application BreCanSurvPred. Sci Rep 2022; 12:8097. [PMID: 35577853 PMCID: PMC9110408 DOI: 10.1038/s41598-022-12228-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 04/22/2022] [Indexed: 11/26/2022] Open
Abstract
We show how the use and interpretation of population-based cancer survival indicators can help oncologists talk with breast cancer (BC) patients about the relationship between their prognosis and their adherence to endocrine therapy (ET). The study population comprised a population-based cohort of estrogen receptor positive BC patients (N = 1268) diagnosed in Girona and Tarragona (Northeastern Spain) and classified according to HER2 status (+ / −), stage at diagnosis (I/II/III) and five-year cumulative adherence rate (adherent > 80%; non-adherent ≤ 80%). Cox regression analysis was performed to identify significant prognostic factors for overall survival, whereas relative survival (RS) was used to estimate the crude probability of death due to BC (PBC). Stage and adherence to ET were the significant factors for predicting all-cause mortality. Compared to stage I, risk of death increased in stage II (hazard ratio [HR] 2.24, 95% confidence interval [CI]: 1.51–3.30) and stage III (HR 5.11, 95% CI 3.46–7.51), and it decreased with adherence to ET (HR 0.57, 95% CI 0.41–0.59). PBC differences were higher in non-adherent patients compared to adherent ones and increased across stages: stage I: 6.61% (95% CI 0.05–13.20); stage II: 9.77% (95% CI 0.59–19.01), and stage III: 22.31% (95% CI 6.34–38.45). The age-adjusted survival curves derived from this modeling were implemented in the web application BreCanSurvPred (https://pdocomputation.snpstats.net/BreCanSurvPred). Web applications like BreCanSurvPred can help oncologists discuss the consequences of non-adherence to prescribed ET with patients.
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Affiliation(s)
- Rebeca Font
- Pla Director d'Oncología, IDIBELL, Av. Gran Vía 199-203, 08908, Hospitalet de Llobregat, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, Av. Gran Via de L'Hospitalet, 199-203 - 1a planta, 08908, Hospitalet de Llobregat, Barcelona, Spain
| | - Maria Buxó
- Institut d'Investigació Biomèdica de Girona, IDIBGI, C/Dr.Castany S/N. Edifici M2. Parc Hospitalari Martí I Julià, 17190, Salt, Spain
| | - Alberto Ameijide
- Registre de Càncer de Tarragona, Servei d'Epidemiologia i Prevenció del Càncer, Hospital Universitari Sant Joan de Reus, IISPV, Reus, Spain
| | - José Miguel Martínez
- Department de Estadística I Investigació Operativa de La Universitat Politècnica de Catalunya. EDIFICI H, Diagonal 647, 08028, Barcelona, Spain.,Grupo de Investigación en Salud Pública, Universidad de Alicante, 03690, Alicante, Spain
| | - Rafael Marcos-Gragera
- Registre de Cáncer de Girona - Unitat d'Epidemiologia. Pla Director d'Oncologia. Institut Català d'Oncología. Grup d'Epidemiologia Descriptiva, Genètica I Prevenció del Càncer de Girona-IDIBGI, 17005, Girona, Spain.,Facultat de Medicina, Universitat de Girona (UdG), Girona, Spain.,Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Marià Carulla
- Registre de Càncer de Tarragona, Servei d'Epidemiologia i Prevenció del Càncer, Hospital Universitari Sant Joan de Reus, IISPV, Reus, Spain
| | - Montse Puigdemont
- Registre de Cáncer de Girona - Unitat d'Epidemiologia. Pla Director d'Oncologia. Institut Català d'Oncología. Grup d'Epidemiologia Descriptiva, Genètica I Prevenció del Càncer de Girona-IDIBGI, 17005, Girona, Spain
| | | | - Sergi Civit
- Secció de Estadística del Departament de Genètica, Microbiología i Estadística de La Facultat de Biologia. Universitat de Barcelona, 08028, Barcelona, Spain
| | - Gema Viñas
- Servei d'Oncología Médica, Institut Català d'Oncología. Hospital Universitari de Girona Doctor Josep Trueta, 17005, Girona, Spain
| | - Josep A Espinàs
- Pla Director d'Oncología, IDIBELL, Av. Gran Vía 199-203, 08908, Hospitalet de Llobregat, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, Av. Gran Via de L'Hospitalet, 199-203 - 1a planta, 08908, Hospitalet de Llobregat, Barcelona, Spain
| | - Jaume Galceran
- Registre de Càncer de Tarragona, Servei d'Epidemiologia i Prevenció del Càncer, Hospital Universitari Sant Joan de Reus, IISPV, Reus, Spain
| | - Ángel Izquierdo
- Registre de Cáncer de Girona - Unitat d'Epidemiologia. Pla Director d'Oncologia. Institut Català d'Oncología. Grup d'Epidemiologia Descriptiva, Genètica I Prevenció del Càncer de Girona-IDIBGI, 17005, Girona, Spain.,Servei d'Oncología Médica, Institut Català d'Oncología. Hospital Universitari de Girona Doctor Josep Trueta, 17005, Girona, Spain
| | - Josep M Borràs
- Pla Director d'Oncología, IDIBELL, Av. Gran Vía 199-203, 08908, Hospitalet de Llobregat, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, Av. Gran Via de L'Hospitalet, 199-203 - 1a planta, 08908, Hospitalet de Llobregat, Barcelona, Spain.,Department de Ciències Clíniques de La Universitat de Barcelona, 08907, Barcelona, Spain
| | - Ramon Clèries
- Pla Director d'Oncología, IDIBELL, Av. Gran Vía 199-203, 08908, Hospitalet de Llobregat, Barcelona, Spain. .,Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, Av. Gran Via de L'Hospitalet, 199-203 - 1a planta, 08908, Hospitalet de Llobregat, Barcelona, Spain. .,Department de Ciències Clíniques de La Universitat de Barcelona, 08907, Barcelona, Spain.
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3
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Neven A, van Maaren MC, Schreuder K, Kranse R, Struikmans H, Poortmans PM, Bartelink H, Collette L, Liu L, Siesling S. Representativeness of trial participants: linking the EORTC boost-no boost trial to the Netherlands Cancer Registry. J Clin Epidemiol 2022; 148:54-64. [DOI: 10.1016/j.jclinepi.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/23/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
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4
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Clèries R, Buxó M, Vilardell M, Ameijide A, Martínez JM, Font R, Marcos-Gragera R, Puigdemont M, Viñas G, Carulla M, Espinàs JA, Galceran J, Izquierdo Á, Borràs JM. No Excess Mortality up to 10 Years in Early Stages of Breast Cancer in Women Adherent to Oral Endocrine Therapy: A Probabilistic Graphical Modeling Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063605. [PMID: 35329292 PMCID: PMC8950380 DOI: 10.3390/ijerph19063605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 02/04/2023]
Abstract
Breast cancer (BC) is globally the most frequent cancer in women. Adherence to endocrine therapy (ET) in hormone-receptor-positive BC patients is active and voluntary for the first five years after diagnosis. This study examines the impact of adherence to ET on 10-year excess mortality (EM) in patients diagnosed with Stages I to III BC (N = 2297). Since sample size is an issue for estimating age- and stage-specific survival indicators, we developed a method, ComSynSurData, for generating a large synthetic dataset (SynD) through probabilistic graphical modeling of the original cohort. We derived population-based survival indicators using a Bayesian relative survival model fitted to the SynD. Our modeling showed that hormone-receptor-positive BC patients diagnosed beyond 49 years of age at Stage I or beyond 59 years at Stage II do not have 10-year EM if they follow the prescribed ET regimen. This result calls for developing interventions to promote adherence to ET in patients with hormone receptor-positive BC and in turn improving cancer survival. The presented methodology here demonstrates the potential use of probabilistic graphical modeling for generating reliable synthetic datasets for validating population-based survival indicators when sample size is an issue.
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Affiliation(s)
- Ramon Clèries
- Hospitalet de Llobregat Avenue Gran Vía 199-203, 08908 Barcelona, Spain; (R.F.); (J.A.E.); (J.M.B.)
- Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, Avenue Gran Via de l’Hospitalet, 199-203-1a Planta, 08908 Barcelona, Spain
- Department de Ciències Clíniques, Universitat de Barcelona, 08907 Barcelona, Spain
- Correspondence: ; Tel.: +34-93-260-74-17
| | - Maria Buxó
- Institut d’Investigació Biomèdica de Girona (IDIBGI), C/Dr. Castany s/n, Edifici M2, Parc Hospitalari Martí i Julià, 17190 Girona, Spain; (M.B.); (R.M.-G.)
| | | | - Alberto Ameijide
- Registre de Càncer de Tarragona, Servei d’Epidemiologia i Prevenció del Càncer, Hospital Universitari Sant Joan de Reus (IISPV), 43204 Reus, Spain; (A.A.); (M.C.); (J.G.)
| | - José Miguel Martínez
- Department de Estadística i Investigació Operativa, Universitat Politècnica de Catalunya (EDIFICI H), Diagonal 647, 08028 Barcelona, Spain;
- Grupo de Investigación en Salud Pública, Universidad de Alicante, 03690 Alicante, Spain
| | - Rebeca Font
- Hospitalet de Llobregat Avenue Gran Vía 199-203, 08908 Barcelona, Spain; (R.F.); (J.A.E.); (J.M.B.)
- Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, Avenue Gran Via de l’Hospitalet, 199-203-1a Planta, 08908 Barcelona, Spain
| | - Rafael Marcos-Gragera
- Institut d’Investigació Biomèdica de Girona (IDIBGI), C/Dr. Castany s/n, Edifici M2, Parc Hospitalari Martí i Julià, 17190 Girona, Spain; (M.B.); (R.M.-G.)
- Registre de Cáncer de Girona-Unitat d’Epidemiologia, Institut Català d’Oncología, 17005 Girona, Spain; (M.P.); (Á.I.)
- Grup d’Epidemiologia Descriptiva, Genètica i Prevenció del Càncer de Girona-IDIBGI, 17005 Girona, Spain
- Facultat de Medicina, Universitat de Girona (UdG), 17071 Girona, Spain
- Centro de Investigación Biomédica en Red, Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Montse Puigdemont
- Registre de Cáncer de Girona-Unitat d’Epidemiologia, Institut Català d’Oncología, 17005 Girona, Spain; (M.P.); (Á.I.)
- Grup d’Epidemiologia Descriptiva, Genètica i Prevenció del Càncer de Girona-IDIBGI, 17005 Girona, Spain
| | - Gemma Viñas
- Servei d’Oncología Médica, Institut Català d’Oncología, Hospital Universitari de Girona “Doctor Josep Trueta”, 17005 Girona, Spain;
| | - Marià Carulla
- Registre de Càncer de Tarragona, Servei d’Epidemiologia i Prevenció del Càncer, Hospital Universitari Sant Joan de Reus (IISPV), 43204 Reus, Spain; (A.A.); (M.C.); (J.G.)
| | - Josep Alfons Espinàs
- Hospitalet de Llobregat Avenue Gran Vía 199-203, 08908 Barcelona, Spain; (R.F.); (J.A.E.); (J.M.B.)
- Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, Avenue Gran Via de l’Hospitalet, 199-203-1a Planta, 08908 Barcelona, Spain
| | - Jaume Galceran
- Registre de Càncer de Tarragona, Servei d’Epidemiologia i Prevenció del Càncer, Hospital Universitari Sant Joan de Reus (IISPV), 43204 Reus, Spain; (A.A.); (M.C.); (J.G.)
| | - Ángel Izquierdo
- Registre de Cáncer de Girona-Unitat d’Epidemiologia, Institut Català d’Oncología, 17005 Girona, Spain; (M.P.); (Á.I.)
- Grup d’Epidemiologia Descriptiva, Genètica i Prevenció del Càncer de Girona-IDIBGI, 17005 Girona, Spain
- Servei d’Oncología Médica, Institut Català d’Oncología, Hospital Universitari de Girona “Doctor Josep Trueta”, 17005 Girona, Spain;
| | - Josep Maria Borràs
- Hospitalet de Llobregat Avenue Gran Vía 199-203, 08908 Barcelona, Spain; (R.F.); (J.A.E.); (J.M.B.)
- Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, Avenue Gran Via de l’Hospitalet, 199-203-1a Planta, 08908 Barcelona, Spain
- Department de Ciències Clíniques, Universitat de Barcelona, 08907 Barcelona, Spain
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Fernández-Arce L, Robles-Rodríguez N, Fernández-Feito A, Llaneza-Folgueras A, Encinas-Muñiz AI, Lana A. Type 2 Diabetes and all-cause mortality among Spanish women with breast cancer. Cancer Causes Control 2021; 33:271-278. [PMID: 34853980 PMCID: PMC8776668 DOI: 10.1007/s10552-021-01526-x] [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: 06/23/2020] [Accepted: 11/18/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To explore the effect of type 2 diabetes mellitus (T2DM) on the risk of death among women with breast cancer (BC). METHODS A survival analysis was conducted among a cohort of women diagnosed with BC between 2006 and 2012 in Spain (n = 4,493). Biopsy or surgery confirmed BC cases were identified through the state population-based cancer registry with information on patients' characteristics and vital status. Physician-diagnosed T2DM was confirmed based on primary health care clinical history. Cox regression analyses were used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for all-cause death. Analyses were adjusted for age, hospital size, several clinical characteristics (including BC stage and histology, among others) and treatment modalities. RESULTS Among the 4,493 BC women, 388 (8.6%) had coexisting T2DM. Overall, 1,299 (28.9%) BC women died during the completion of the follow-up and 785 (17.5%) did so during the first five years after BC diagnosis, resulting in a five-year survival rate of 82.5%. The death rate was higher in women with T2DM (43.8% died during whole period and 26.0% during the first five years) when compared with women without T2DM (27.5% and 16.7%, respectively). Accordingly, all-cause mortality was higher in women with T2DM (aHR: 1.22; 95% CI 1.03-1.44), especially if T2DM was diagnosed before BC (aHR:1.24; 95% CI 1.03-1.50) and in women with BC diagnosed before 50 years (aHR: 2.38; 95% CI 1.04-5.48). CONCLUSIONS T2DM was associated with higher all-cause mortality among Spanish women with BC, particularly when the T2DM diagnosis was prior to the BC.
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Affiliation(s)
- L Fernández-Arce
- Community Health Center of La Ería, Health Care Service of Asturias, C/Alejandro Casona s/n, 33013, Oviedo, Spain.,Department of Medicine, School of Medicine and Health Sciences, University of Oviedo, Avda Julián Clavería s/n., 33006, Oviedo, Spain.,Institute of Sanitary Research of Asturias (ISPA), Avda de Roma s/n, 33011, Oviedo, Spain
| | - N Robles-Rodríguez
- Department of Medicine, School of Medicine and Health Sciences, University of Oviedo, Avda Julián Clavería s/n., 33006, Oviedo, Spain
| | - A Fernández-Feito
- Department of Medicine, School of Medicine and Health Sciences, University of Oviedo, Avda Julián Clavería s/n., 33006, Oviedo, Spain. .,Institute of Sanitary Research of Asturias (ISPA), Avda de Roma s/n, 33011, Oviedo, Spain.
| | - A Llaneza-Folgueras
- Breast Pathology Unit, Health Care Service of Asturias, Central University Hospital of Asturias, Avda de Roma s/n, 33011, Oviedo, Spain
| | - A I Encinas-Muñiz
- Anatomical Pathology Service, Health Care Service of Asturias, Central University Hospital of Asturias, Avda de Roma s/n, 33011, Oviedo, Spain
| | - A Lana
- Department of Medicine, School of Medicine and Health Sciences, University of Oviedo, Avda Julián Clavería s/n., 33006, Oviedo, Spain.,Institute of Sanitary Research of Asturias (ISPA), Avda de Roma s/n, 33011, Oviedo, Spain
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6
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Jansana A, Domingo L, Ibañez B, Prados A, Del Cura I, Padilla-Ruiz M, Sanz T, Poblador B, Tamayo I, Gimeno A, Alberquilla A, Abizanda M, Comas M, Lanzuela M, Burgui R, Holgado AD, Duarte-Salles T, Moreno C, Louro J, Baquedano J, Molina C, Del Carmen Martinez M, Gorricho J, Redondo M, Castells X, Sala M. Use of health services among long-term breast cancer survivors in Spain: longitudinal study based on real-world data. J Cancer Surviv 2021; 16:132-141. [PMID: 33759086 DOI: 10.1007/s11764-021-01011-z] [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: 11/30/2020] [Accepted: 02/17/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE This study aimed to evaluate health service utilization in Spain among long-term breast cancer survivors and to compare it with that among women with no history of breast cancer. METHODS Study based on the SURBCAN cohort includes a sample of long-term breast cancer survivors and a sample of women without breast cancer from 5 Spanish regions. Healthcare utilization was assessed through primary care, hospital visits, and tests during the follow-up period (2012 to 2016) by using electronic health records. Annual contact rates to healthcare services were calculated, and crude and multivariate count models were fitted to estimate the adjusted relative risk of healthcare services use. RESULTS Data were obtained from 19,328 women, including 6512 long-term breast cancer survivors. Healthcare use was higher among breast cancer survivors (20.9 vs 16.6; p < 0.0001) and decreased from >10 years of survival. Breast cancer survivors who underwent a mastectomy were more likely to have a primary care visit (RR = 3.10 95% CI 3.08-3.11). Five to ten years survivors were more likely to have hospital inpatient visits and imaging test compared to women without breast cancer (RRa = 1.35 95% CI 1.30-1.39 and RRa = 1.27 95% CI 1.25-1.29 respectively). CONCLUSION This study shows higher use of health services in long-term breast cancer survivors than in women without breast cancer regardless of survival time. IMPLICATIONS FOR CANCER SURVIVORS These results help to estimate the health resources needed for the growing group of breast cancer survivors and to identify risk factors that drive higher use of health services.
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Affiliation(s)
- Anna Jansana
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003, Barcelona, Spain.,European Higher Education Area Doctoral Program in Methodology of Biomedical Research and Public Health in Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autónoma de Barcelona (UAB), Bellaterra, Barcelona, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain
| | - Laia Domingo
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain
| | - Berta Ibañez
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Navarrabiomed-Complejo Hospitalario de Navarra-Universidad Pública de Navarra, IdiSNA, Irunlarrea, s/n, 31008, Pamplona, Spain
| | - Alexandra Prados
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,IIS Aragon, Miguel Servet University Hospital, EpiChron Research Group, Aragon Health Sciences Institute (IACS), Zaragoza, Spain
| | - Isabel Del Cura
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Madrid Health Service, Primary Care Research Unit, Calle San Martín de Porres, 6-5ª planta, 28035, Madrid, Spain.,Department of Preventive Medicine and Public Health, University Rey Juan Carlos, Avenida de Atenas, 28922, Alcorcón, Madrid, Spain
| | - Maria Padilla-Ruiz
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Research Unit, Costa del Sol Hospital, University of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Marbella, Spain
| | - Teresa Sanz
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Madrid Health Service, Primary Care Research Unit, Calle San Martín de Porres, 6-5ª planta, 28035, Madrid, Spain
| | - Beatriz Poblador
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,IIS Aragon, Miguel Servet University Hospital, EpiChron Research Group, Aragon Health Sciences Institute (IACS), Zaragoza, Spain
| | - Ibai Tamayo
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Navarrabiomed-Complejo Hospitalario de Navarra-Universidad Pública de Navarra, IdiSNA, Irunlarrea, s/n, 31008, Pamplona, Spain
| | - Antonio Gimeno
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Navarrabiomed-Complejo Hospitalario de Navarra-Universidad Pública de Navarra, IdiSNA, Irunlarrea, s/n, 31008, Pamplona, Spain
| | - Angel Alberquilla
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Madrid Health Service, Primary Care Research Unit, Calle San Martín de Porres, 6-5ª planta, 28035, Madrid, Spain
| | - Mercè Abizanda
- Department of Organization and Communication, Parc Sanitari Pere Virgili, Barcelona, Spain
| | - Mercè Comas
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain
| | - Manuela Lanzuela
- Radiotherapy Department, Miguel Servet University Hospital, Saragossa, Spain
| | - Rossana Burgui
- Instituto de Salud Pública y Laboral de Navarra (ISPLN), IdiSNA, Pamplona, Spain
| | - Antonio Diaz Holgado
- Madrid Health Service, Technical Direction of Sanitary Information System, Calle San Martín de Porres, 6- 5ª planta, 28035, Madrid, Spain
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Conchi Moreno
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Instituto de Salud Pública y Laboral de Navarra (ISPLN), IdiSNA, Pamplona, Spain
| | - Javier Louro
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain
| | - Javier Baquedano
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Servicio Navarro de Salud-Osasunbidea, Gerencia de Atención Primaria, Pamplona, Spain
| | - Cristobal Molina
- Research Unit, Costa del Sol Hospital, University of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Marbella, Spain
| | - Maria Del Carmen Martinez
- Research Unit, Costa del Sol Hospital, University of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Marbella, Spain
| | - Javier Gorricho
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Servicio de Evaluación y Difusión de resultados en Salud, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - Maximino Redondo
- Research Unit, Costa del Sol Hospital, University of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Marbella, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Autonomous University of Barcelona (UAB), 08193, Bellaterra, Barcelona, Spain
| | - Maria Sala
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003, Barcelona, Spain. .,Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.
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7
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Viral P, Pavithran K, Beena K, Shaji A, Vijaykumar DK. Ten-year survival outcome of breast cancer patients in India. J Carcinog 2021; 20:1. [PMID: 34211337 PMCID: PMC8202444 DOI: 10.4103/jcar.jcar_26_20] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/06/2021] [Accepted: 01/09/2021] [Indexed: 12/09/2022] Open
Abstract
INTRODUCTION: Breast cancer is the most frequently diagnosed cancer among women in India; however, there are no studies addressing long-term survival (10 years and above). This study sought to evaluate long-term oncological outcome among women with breast cancer treated with a curative intent. MATERIALS AND METHODS: This is a retrospective cohort analysis of 1301 breast cancer patients of all stages who had received primary treatment with curative intent from 2004 to 2010 at a single cancer institution of India. RESULTS: A total of 1301 breast cancer patients were available for final analysis. The median age was 51 years (range, 21–86 years). 70.25% of the patients had early breast cancer (EBC), 21.9% had locally advanced breast cancer, and 7.85% of the patients with de novo metastatic disease also underwent surgery. 56.5% of the patients had hormone-sensitive tumors, human epidermal growth factor receptor 2 over expression was seen in 17%, and triple-negative tumors accounted for 26.2% of the patients. The 5- and 10-year overall survival (OS) of the entire cohort was 79% and 66%, and the 5- and 10-year breast cancer-specific survival (BCSS) was 79% and 70%, respectively. OS and BCSS were 51% and 58%, respectively, at 15-year follow-up after primary cancer treatment. On multivariate analysis, the factors associated with prolonged survival were age ≤50 years, EBC, and treatment during the later period (2008–2010). CONCLUSION: Difference between OS and BCSS was found to have an increasing trend during 10–15-year follow-up, the difference being 4% at 10 years and 7% at 15 years. Age ≤50 years, early-stage disease at presentation, and primary cancer treatment in later years (2008–2010) were favorable predictors for 10-year survival.
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Affiliation(s)
- Patel Viral
- Department of Gynecological Oncology, Amrita Institute of Medical Science, Kochi, Kerala, India
| | - K Pavithran
- Department of Medical Oncology, Amrita Institute of Medical Science, Kochi, Kerala, India
| | - K Beena
- Department of Radiation Oncology, Amrita Institute of Medical Science, Kochi, Kerala, India
| | - Ajil Shaji
- Department of Cancer Registry, Amrita Institute of Medical Science, Kochi, Kerala, India
| | - D K Vijaykumar
- Amrita Centre for Breast Diseases, Amrita Institute of Medical Science, Kochi, Kerala, India
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8
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Vilardell M, Buxó M, Clèries R, Martínez JM, Garcia G, Ameijide A, Font R, Civit S, Marcos-Gragera R, Vilardell ML, Carulla M, Espinàs JA, Galceran J, Izquierdo A, Borràs JM. Missing data imputation and synthetic data simulation through modeling graphical probabilistic dependencies between variables (ModGraProDep): An application to breast cancer survival. Artif Intell Med 2020; 107:101875. [DOI: 10.1016/j.artmed.2020.101875] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/12/2020] [Accepted: 05/02/2020] [Indexed: 12/29/2022]
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9
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Ameijide A, Clèries R, Carulla M, Buxó M, Marcos-Gragera R, Martínez JM, Vilardell ML, Vilardell M, Espinàs JA, Borràs JM, Izquierdo Á, Galceran J. Cause-specific mortality after a breast cancer diagnosis: a cohort study of 10,195 women in Girona and Tarragona. Clin Transl Oncol 2019; 21:1014-1025. [PMID: 30607790 DOI: 10.1007/s12094-018-02015-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/10/2018] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Evidence suggests an excess of long-term mortality due to cardiovascular diseases, second tumours and other causes in patients diagnosed with invasive breast cancer (BC). Our aim was to assess this risk of death in a cohort of patients diagnosed with BC in Girona and Tarragona, northeastern Spain. MATERIALS AND METHODS Using data from the cancer registries in these areas, a population-based cohort study was carried out including all the women diagnosed with BC during 1985-2004 and followed up until December 31st 2014 (N = 10,195). The standardised mortality ratios (SMRs) were calculated for causes other than BC in the cohort at 10 years (periods 1985-1994/1995-2004) and 20 years (period 1985-1994). The impact of competing causes of death in the long-term survival was evaluated through competing risk analysis. RESULTS The SMRs at 10 and 20 years for all-cause mortality, except BC, were 1.21 and 1.22. The main causes of mortality showing statistically significant SMR at 10 years were other tumours (colon, lung, corpus uteri, ovary, and haematological), diabetes mellitus, diseases of the nervous system, cardiovascular diseases (after BC, the second competing cause of death among patients diagnosed > 69 years) and diseases of the kidney. Globally, the 10-year SMR was higher in the first period. After 20 years of follow-up (1985-1994 cohort), there were 48.5 excess deaths per 10,000 patient-years for causes other than BC. CONCLUSIONS Women who did not die from BC at 10 or 20 years after the BC diagnosis had 20% higher risk of dying from other causes than women without BC. This excess risk must be clinically considered during 20 years after the BC diagnosis.
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Affiliation(s)
- A Ameijide
- Registre de Càncer de Tarragona, Fundació per a la investigació i la prevenció del Càncer (FUNCA), IISPV, Reus, Spain
| | - R Clèries
- Pla Director d'Oncologia, IDIBELL, Hospitalet de Llobregat, Spain.
- Department de Ciències Clíniques, Universitat de Barcelona, Barcelona, Spain.
| | - M Carulla
- Registre de Càncer de Tarragona, Fundació per a la investigació i la prevenció del Càncer (FUNCA), IISPV, Reus, Spain
| | - M Buxó
- Institut d'Investigació Biomèdica de Girona, IDIBGI, Parc Hospitalari Martí i Julià, Salt, Spain
| | - R Marcos-Gragera
- Registre de Càncer de Girona-Unitat d'Epidemiologia, Pla Director d'Oncologia, Institut Català d'Oncologia, Grup d'Epidemiologia Descriptiva, Genètica i Prevenció del Càncer de Girona-IDIBGI, Girona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Carlos III Institute of Health, Av/Monforte de Lemos, 5, 28029, Madrid, Spain
| | - J M Martínez
- Departamento de Investigación y Análisis de Prestaciones, MC MUTUAL, Barcelona, Spain
- Departament d'Estadística i Investigació Operativa, Universitat Politècnica de Catalunya, Barcelona, Spain
- Public Health Research Group, University of Alicante, Alicante, Spain
| | - M L Vilardell
- Registre de Càncer de Girona-Unitat d'Epidemiologia, Pla Director d'Oncologia, Institut Català d'Oncologia, Grup d'Epidemiologia Descriptiva, Genètica i Prevenció del Càncer de Girona-IDIBGI, Girona, Spain
| | - M Vilardell
- Secció d'Estadística del Departament de Genètica, Microbiología i Estadística de la Facultat de Biología, Universitat de Barcelona, Barcelona, Spain
| | - J A Espinàs
- Pla Director d'Oncologia, IDIBELL, Hospitalet de Llobregat, Spain
| | - J M Borràs
- Pla Director d'Oncologia, IDIBELL, Hospitalet de Llobregat, Spain
- Department de Ciències Clíniques, Universitat de Barcelona, Barcelona, Spain
| | - Á Izquierdo
- Registre de Càncer de Girona-Unitat d'Epidemiologia, Pla Director d'Oncologia, Institut Català d'Oncologia, Grup d'Epidemiologia Descriptiva, Genètica i Prevenció del Càncer de Girona-IDIBGI, Girona, Spain
- Departament d'Oncologia Médica, Institut Català d'Oncologia, Hospital Universitari Doctor Josep Trueta, Girona, Spain
| | - J Galceran
- Registre de Càncer de Tarragona, Fundació per a la investigació i la prevenció del Càncer (FUNCA), IISPV, Reus, Spain
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10
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[Excess mortality among breast cancer patients in early stages in Tarragona and Gerona (Spain)]. GACETA SANITARIA 2018; 34:356-362. [PMID: 30573319 DOI: 10.1016/j.gaceta.2018.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/12/2018] [Accepted: 09/20/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To analyze the population-based survival of breast cancer (CM) diagnosed in early stages estimating the time trends of excess mortality (EM) in the long term in annual and five-year time intervals, and to determine, if possible, a proportion of patients who can be considered cured. METHOD We included women diagnosed with BC under the age of 60 years in stages I and II in Girona and Tarragona (N = 2453). The observed (OS) and relative survival (RS) were calculated up to 20 years of follow-up. RS was also estimated at annual (RSI) and in five-year intervals (RS5) to graphically assess the EM. The results are presented by age groups (≤49 and 50-59), stage (I/II) and diagnostic period (1985-1994 and 1995-2004). RESULTS In stage I, OS and RS were higher during 1995-2004 compared to 1985-1994: 3.5% at 15 years of follow-up and 4.5% at 20-years of follow-up. In 1995-2004, the OS surpassed 80% in stage I patients whereas in stage II it remained below 70%. During 1995-2004, the long-term EM did not level off towards 0 (RSI <1) independently of age group, stage and period of diagnosis. After 15 years of follow-up, the 5-year EM oscillated between 1 and 5% in stage I (RS5 ≥0.95) and between 5 and 10% in stage II. CONCLUSIONS In our cohort, after 15 years of follow-up, it was detected that the annual EM did not disappear and the five-year EM remained between 1 and 10%. Therefore, it was not possible to determine a cure rate of BC during the study period.
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