1
|
Nobes JH, Baxter MA, Mowat C. Emergency presentation of colorectal cancer in older adults: A retrospective cohort analysis. J Geriatr Oncol 2024; 15:101780. [PMID: 38678774 DOI: 10.1016/j.jgo.2024.101780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/22/2024] [Accepted: 04/24/2024] [Indexed: 05/01/2024]
Abstract
INTRODUCTION Adults aged 70 years and over account for almost 60% of colorectal cancer (CRC) diagnoses in the United Kingdom. Whilst emergency presentation of CRC is known to be associated with poorer outcomes across all ages, older adults are less likely to be treated with curative intent and have poorer overall survival (OS). We aimed to investigate whether presentation, management, or outcome differed in older (≥70 years) versus younger (<70 years) adults in our population. MATERIALS AND METHODS The electronic records of patients diagnosed with CRC within the period 2016 to 2019 in National Health Service (NHS) Tayside, Scotland were retrospectively analysed. Patients were grouped by age (<70 years and ≥70 years). Demographics were compared by Chi-squared or t-test, and Kaplan-Meier and Cox proportional hazard regression were used for survival analyses. RESULTS In total, 1245 patients were diagnosed with CRC (median age 71 years, range 20-98). Of these, 215 patients (17.3%) presented emergently and were included in the analysis. Older adults accounted for 65.1% (n = 140) of emergency presentations. Older adults were less likely to present with classical symptoms of CRC (80.0% vs 90.7%, p = 0.04) and more likely to present via the medical assessment unit (46.4% vs 30.7%, p = 0.03). Additionally, older adults were less likely to receive a histological diagnosis of CRC (71.4% vs 97.3%, p < 0.001) or have complete staging investigations performed (78.6% vs 96.0%, p < 0.001). Fewer older adults underwent surgical management (55.0% vs 86.7%, p < 0.001) and fewer were treated with chemotherapy (14.3% vs 69.3%, p < 0.001). Whilst older adults had poorer median OS than those aged <70 years (12.0 vs 34.4 months, p < 0.001), multivariate Cox proportional hazards regression demonstrated that higher stage (stage III hazard ratio [HR] 2.7, 95% confidence interval [CI] 1.6-4.7, stage IV HR 16.7, 95% CI 9.7-28.8, incomplete HR 8.2, 95% CI 4.6-14.7) and not receiving chemotherapy (HR 2.6, 95% CI 1.7-4.0) were associated with poorer survival, whereas age and sex were not. DISCUSSION Emergency presentation of colorectal cancer was more common in older adults. Older adults were more likely to present atypically, less likely to have completed staging, and had lower rates of intervention, which were associated with poorer survival outcome.
Collapse
Affiliation(s)
- Jennifer H Nobes
- Division of Population Health and Genomics, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK; Department of Blood Sciences, NHS Tayside, Dundee, UK.
| | - Mark A Baxter
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK; Tayside Cancer Centre, NHS Tayside, Dundee, UK
| | - Craig Mowat
- Division of Population Health and Genomics, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK; Department of Gastroenterology, NHS Tayside, Dundee, UK
| |
Collapse
|
2
|
Zarnescu EC, Zarnescu NO, Sanda N, Costea R. Risk Factors for Severe Postoperative Complications after Oncologic Right Colectomy: Unicenter Analysis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1598. [PMID: 36363555 PMCID: PMC9697206 DOI: 10.3390/medicina58111598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 08/30/2023]
Abstract
Background and Objectives: This study aimed to investigate the potential risk factors for severe postoperative complications after oncologic right colectomy. Materials and Methods: All consecutive patients with right colon cancer who underwent right colectomy in our department between 2016 and 2021 were retrospectively included in this study. The Clavien-Dindo grading system was used to evaluate postoperative complications. Univariate and multivariate logistic regression analyses were used to investigate risk factors for postoperative severe complications. Results: Of the 144 patients, there were 69 males and 75 females, with a median age of 69 (IQR 60-78). Postoperative morbidity and mortality rates were 41.7% (60 patients) and 11.1% (16 patients), respectively. The anastomotic leak rate was 5.3% (7 patients). Severe postoperative complications (Clavien-Dindo grades III-V) were present in 20 patients (13.9%). Univariate analysis showed the following as risk factors for postoperative severe complications: Charlson score, lack of mechanical bowel preparation, level of preoperative proteins, blood transfusions, and degree of urgency (elective/emergency right colectomy). In the logistic binary regression, the Charlson score (OR = 1.931, 95% CI = 1.077-3.463, p = 0.025) and preoperative protein level (OR = 0.049, 95% CI = 0.006-0.433, p = 0.007) were found to be independent risk factors for postoperative severe complications. Conclusions: Severe complications after oncologic right colectomy are associated with a low preoperative protein level and a higher Charlson comorbidity index.
Collapse
Affiliation(s)
- Eugenia Claudia Zarnescu
- Department of General Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Second Department of Surgery, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Narcis Octavian Zarnescu
- Department of General Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Second Department of Surgery, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Nicoleta Sanda
- Department of General Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Second Department of Surgery, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Radu Costea
- Department of General Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Second Department of Surgery, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| |
Collapse
|
3
|
Hultstrand C, Hörnsten C, Lilja M, Coe A, Fjällström P, Hajdarevic S. The association between sociodemographic factors and time to diagnosis for colorectal cancer in northern Sweden. Eur J Cancer Care (Engl) 2022; 31:e13687. [PMID: 35970596 PMCID: PMC9787547 DOI: 10.1111/ecc.13687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 06/29/2022] [Accepted: 08/02/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES This study examined whether sociodemographic factors, including distance to hospital, were associated with differences in the diagnostic interval and the treatment interval for colorectal cancer in northern Sweden. METHODS Data were retrieved from the Swedish cancer register on patients (n = 446) diagnosed in three northern regions during 2017-2018, then linked to data from Statistics Sweden and medical records. Also, Google maps was used to map the distance between patients' place of residence and nearest hospital. The different time intervals were analysed using Mann-Whitney U-test and Cox regression. RESULTS Differences in time to diagnosis were found between groups for income and distance to hospital, favouring those with higher income and shorter distance. The unadjusted regression analysis showed higher income to be associated with more rapid diagnosis (HR 1.004, CI 1.001-1.007). This association remained in the fully adjusted model for income (HR 1.004, CI 1.000-1.008), but not for distance. No differences between sociodemographic groups were found in the treatment interval. CONCLUSION Higher income and shorter distance to hospital were in the unadjusted models associated with shorter time to diagnosis for patients with CRC in northern Sweden. The association remained for income when adjusting for other variables even though the difference was small.
Collapse
Affiliation(s)
- Cecilia Hultstrand
- Department of NursingUmeå UniversityUmeåSweden,Department of Public Health and Clinical Medicine, Family MedicineUmeå UniversityUmeåSweden
| | | | - Mikael Lilja
- Department of Public Health and Clinical Medicine, Unit of Research, Education, and DevelopmentÖstersund Hospital, Umeå UniversityUmeåSweden
| | | | | | - Senada Hajdarevic
- Department of NursingUmeå UniversityUmeåSweden,Department of Public Health and Clinical Medicine, Family MedicineUmeå UniversityUmeåSweden
| |
Collapse
|
4
|
Guan Z, Webber C, Flemming JA, Mavor ME, Whitehead M, Chen BE, Groome PA. Real-world colorectal cancer diagnostic pathways in Ontario, Canada: A population-based study. Eur J Cancer Care (Engl) 2022; 31:e13603. [PMID: 35502982 DOI: 10.1111/ecc.13603] [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: 06/03/2021] [Revised: 01/21/2022] [Accepted: 04/18/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study aimed to identify colorectal cancer (CRC) diagnostic pathways and describe patients in those pathway groups. METHODS This was a cross-sectional study of CRC patients in Ontario, Canada, diagnosed 2009-2012 that used linked administrative data at ICES. We used cluster analysis on 11 pathway variables characterising patient presentation, symptoms, procedures and referrals. We assessed associations between patient- and disease-related characteristics and diagnostic pathway group. We further characterised the pathways by diagnostic interval and number of related physician visits. RESULTS Six diagnostic pathways were identified, with three adhering to provincial diagnostic guidelines: screening (N = 4494), colonoscopy (N = 10,066) and imaging plus colonoscopy (N = 3427). Non-adherent pathways were imaging alone (N = 2238), imaging and emergency presentation (N = 2849) and no pre-diagnostic workup (N = 887). Patients in adherent pathways were younger, had fewer comorbidities, lived in less deprived areas and had earlier stage disease. The median diagnostic interval length varied across pathways from 12 to 126 days, correlating with the number of CRC-related visits. CONCLUSIONS This study demonstrated substantial variations in real-world CRC diagnostic pathways and 25% were diagnosed through non-adherent pathways. Those patients were older, had more comorbid disease and had higher stage cancer. Further research needs to identify and describe the reasons for divergent diagnostic processes.
Collapse
Affiliation(s)
- Zhen Guan
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Colleen Webber
- Bruyère Research Institute, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jennifer A Flemming
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada.,Department of Medicine, Queen's University, Kingston, Ontario, Canada.,ICES Queen's, Kingston, Ontario, Canada
| | - Meaghan E Mavor
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | | | - Bingshu E Chen
- Canadian Cancer Trials Group (CCTG), Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Patti A Groome
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada.,ICES Queen's, Kingston, Ontario, Canada
| |
Collapse
|
5
|
Nejadghaderi SA, Roshani S, Mohammadi E, Yoosefi M, Rezaei N, Esfahani Z, Azadnajafabad S, Ahmadi N, Shahin S, Kazemi A, Namazi Shabestari A, Khosravi A, Mokdad AH, Larijani B, Farzadfar F. The global, regional, and national burden and quality of care index (QCI) of colorectal cancer; a global burden of disease systematic analysis 1990-2019. PLoS One 2022; 17:e0263403. [PMID: 35446852 PMCID: PMC9022854 DOI: 10.1371/journal.pone.0263403] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 01/18/2022] [Indexed: 12/27/2022] Open
Abstract
Background Colorectal cancer (CRC) is among the five most incident and lethal cancers in world and its burden varies between countries and sexes. We aimed to present a comprehensive measure called the quality of care index (QCI) to evaluate the inequity and healthcare quality of care regarding CRC by sex and location. Methods Data on the burden of CRC were extracted from the Global Burden of Disease study 2019. It was transformed to four ratios, including mortality-to-incidence, disability-adjusted life years (DALYs)-to-prevalence, prevalence-to-incidence, and years of life lost (YLLs)-to-years lived with disability (YLDs). Principal component analysis was implemented on the four ratios and the most influential component was considered as QCI with a score ranging from zero to 100, for which higher scores represented better quality of care. Gender Disparity Ratio (GDR) was calculated by dividing QCI for females by males. Results The global incidence and death numbers of CRC were 2,166,168 (95% uncertainty interval: 1,996,298–2,342,842) and 1,085,797 (1,002,795–1,149,679) in 2019, respectively. Globally, QCI and GDR values were 77.6 and 1.0 respectively in 2019. There was a positive association between the level of quality of care and socio-demographic index (SDI) quintiles. Region of the Americas and African Region had the highest and lowest QCI values, respectively (84.4 vs. 23.6). The QCI values started decreasing beyond the age of 75 in 2019 worldwide. Conclusion There is heterogeneity in QCI between SDI quintiles. More attention should be paid to people aged more than 75 years old because of the lower quality of care in this group.
Collapse
Affiliation(s)
- Seyed Aria Nejadghaderi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Roshani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mohammadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Moein Yoosefi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Esfahani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Naser Ahmadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sarvenaz Shahin
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ameneh Kazemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Namazi Shabestari
- Department of Geriatric Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ali H. Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States of America
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- * E-mail: ,
| |
Collapse
|
6
|
Foucan AS, Grosclaude P, Bousser V, Bauvin E, Smith D, Andre-Fardeau C, Daubisse-Marliac L, Mathoulin-Pelissier S, Amadeo B, Coureau G. Management of colon cancer patients: A comprehensive analysis of the absence of multidisciplinary team meetings in two French departments. Clin Res Hepatol Gastroenterol 2021; 45:101413. [PMID: 32359832 DOI: 10.1016/j.clinre.2020.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/28/2020] [Accepted: 02/26/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The care management of colorectal cancers has evolved, particularly since the implementation of multidisciplinary team meetings (MDTm). The aim of this study was to identify factors associated with the non-presentation of colon cancer patients in MDTm (no-MDTm) and to assess the association between no-MDTm and the diagnostic and therapeutic care management, in two areas in France, in 2010. METHODS Patients over 18 years diagnosed for invasive colon cancer in Gironde and Tarn during 2010 were included from the cancer registries of these two departments. We used five indicators to evaluate the care management of colon cancer patients (about diagnosis, treatment and selection of patients for chemotherapy). RESULTS No-MDTm patients were more likely to die early after diagnosis (OR=2.94, 95% CI=[1.52-5.66]). Elderly patients and those living in more disadvantaged areas were less often presented in MDTm (OR≥85years=2.10, 95% CI=[1.06-4.18]; OREDIQ4-Q5=1.96, 95% CI=[1.23-3.14]). After adjusting for patient-related variables (age, comorbidities, deprivation) and tumor (stage at diagnosis), we found that thoracic CT scan was less often performed among no-MDTm patients (OR=0.40, 95% CI=[0.24-0.65]). There was no association between the absence of MDTm and the therapeutic care management indicators. CONCLUSION In conclusion, therapeutic care management was not associated with the absence of MDTm but with patient and tumor characteristics, including age, comorbidities and level of deprivation, that influence the non-presentation in MDTm.
Collapse
Affiliation(s)
- Anne-Sophie Foucan
- Gironde General Cancer Registry, 33000 Bordeaux, France; Inserm Bordeaux Population Health, Research Center U1219, Epicene Team, university of Bordeaux, 33000 Bordeaux, France.
| | - Pascale Grosclaude
- Claudius Regaud Institute, Regional Cancer Center, IUCT-O, Tarn Cancer Registry, 31059 Toulouse, France; LEASP, Inserm U1027, university of Toulouse III, 31000 Toulouse, France
| | | | - Eric Bauvin
- LEASP, Inserm U1027, university of Toulouse III, 31000 Toulouse, France; Occitanie Regional Cancer network (Onco-Occitanie), 31059 Toulouse, France
| | - Denis Smith
- University hospital of Haut-Lévêque, 33000 Bordeaux, France
| | | | - Laetitia Daubisse-Marliac
- Claudius Regaud Institute, Regional Cancer Center, IUCT-O, Tarn Cancer Registry, 31059 Toulouse, France; LEASP, Inserm U1027, university of Toulouse III, 31000 Toulouse, France
| | - Simone Mathoulin-Pelissier
- Inserm Bordeaux Population Health, Research Center U1219, Epicene Team, university of Bordeaux, 33000 Bordeaux, France; Inserm CIC1401, Clinical and Epidemiological Research Unit, Bergonie Institute, Comprehensive Cancer Center, 33000 Bordeaux, France
| | - Brice Amadeo
- Gironde General Cancer Registry, 33000 Bordeaux, France; Inserm Bordeaux Population Health, Research Center U1219, Epicene Team, university of Bordeaux, 33000 Bordeaux, France
| | - Gaëlle Coureau
- Gironde General Cancer Registry, 33000 Bordeaux, France; Inserm Bordeaux Population Health, Research Center U1219, Epicene Team, university of Bordeaux, 33000 Bordeaux, France; Medical Information Service, Public Health Department, university Bordeaux hospital, 33000 Bordeaux, France
| |
Collapse
|
7
|
Golding H, Webber CE, Groome PA. Factors contributing to time to diagnosis in symptomatic colorectal cancer: A scoping review. Eur J Cancer Care (Engl) 2020; 30:e13397. [PMID: 33377574 DOI: 10.1111/ecc.13397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/11/2020] [Accepted: 10/14/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Colorectal cancer (CRC) is the third most common cancer worldwide (Ferlay et al., 2015, International Journal of Cancer, 136, E359), and delayed diagnosis is associated with mortality (Tørring et al., 2011, British Journal of Cancer, 104, 934; Tørring et al., 2012, Journal of Clinical Epidemiology, 65, 669). The purpose of this review was to determine the factors associated with time to diagnosis in symptomatic CRC using scoping review methods. METHODS We performed database and citation searches to identify studies which examine the length of any interval from symptom presentation to diagnosis. Study selection was conducted by two independent reviewers. Factors contributing to time to diagnosis were extracted from selected articles and mapped onto a conceptual framework consisting of four levels: patient and disease factors, provider factors, organisation/setting factors and sectors of influence. RESULTS From the 31 studies included in this review, we identified 138 unique factors, 17 of which were investigated by at least three studies and 11 of which had consistent results. Patient and disease factors were most commonly studied. Patient perception that their symptoms were benign, a non-urgent referral, female sex and rectal tumour location were each associated with a longer time to diagnosis. CONCLUSION Thus far, the literature has focused on patient or disease-related factors, while other levels of influence have been relatively understudied.
Collapse
Affiliation(s)
- Haley Golding
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Colleen E Webber
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada
| | - Patti A Groome
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.,Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, ON, Canada
| |
Collapse
|
8
|
Darbà J, Marsà A. Evaluation of productivity losses due to premature mortality from colorectal cancer. PLoS One 2020; 15:e0244375. [PMID: 33362274 PMCID: PMC7757866 DOI: 10.1371/journal.pone.0244375] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 12/08/2020] [Indexed: 12/30/2022] Open
Abstract
Cancer is responsible annually for around 27% of all deaths in Spain, 15% of which are caused by colorectal cancer. This malignancy has increased its incidence considerably over the past years, which surely impacts global productivity losses. The evaluation of lost productivity due to premature mortality provides valuable information that guides healthcare policies into the establishment of prevention and screening programs. The purpose of this study was to assess the productivity losses from premature deaths due to colorectal cancer over a ten year period (2008–2017). The costs derived from premature mortality due to this highly prevalent cancer were estimated using data on mortality, age- and sex-specific reference salaries and unemployment rates in Spain via the human capital approach. Between 2008 and 2017, 15,103 persons died per year from colorectal cancer, representing almost 15% of all cancer-related deaths. Annually, 25,333 years of potential productive life were estimated to be lost on average, 14,992 in males and 10,341 in females. Productivity losses summed €510.8 million in in 2017, and the cancers of the colon and rectum accounted for 9.6% of cancer-related productivity losses in 2017 in Spain. Colorectal cancer has an important weight in terms of productivity losses within the Spanish population, consequently, prevention and early detection programmes should be promoted and implemented to achieve significant reductions in mortality and productivity losses.
Collapse
Affiliation(s)
- Josep Darbà
- Department of Economics, Universitat de Barcelona, Barcelona, Spain
- * E-mail:
| | - Alicia Marsà
- Department of Health Economics, BCN Health Economics & Outcomes Research S.L., Barcelona, Spain
| |
Collapse
|
9
|
Darbà J, Marsà A. Results after 10 years of colorectal cancer screenings in Spain: Hospital incidence and in-hospital mortality (2011-2016). PLoS One 2020; 15:e0228795. [PMID: 32040530 PMCID: PMC7010253 DOI: 10.1371/journal.pone.0228795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 01/22/2020] [Indexed: 01/20/2023] Open
Abstract
Background Colorectal cancer incidence in Spain increased considerably between the early nineties and 2010. To reverse this tendency, screenings were progressively implemented starting the year 2001, targeting the population aged 50 to 69 years. Objectives This study aimed to update colorectal cancer incidence and mortality trends in Spain and provide a detailed analysis of disease management and risk factors involved in in-hospital mortality. Methods To this aim, anonymised primary and specialised care admission records from 2011 to 2016 were extracted from a Spanish claims database representative of all Spanish regions. Results Primary care files from 37,317 patients and specialised care files from 192,048 patients were obtained, in which males represented the 56.17% and 60.70% of patients respectively. In-hospital mortality rate was 10.07% and remained stable during the study period, similarly to colorectal cancer incidence within the hospitalised population, which was 106 per 10,000 patients. Patients deceased during the hospitalisation presented an increased presence of metastatic tumours. Mean length of hospital stay decreased significantly over the study period from 13.43 days to 11.67 days (p<0.001), similarly to patients’ 30-day readmission rate, which registered a decrease from the 15.29% to 13.58% (p<0.001). In consequence, the direct medical cost measured per patient, of €10,992, decreased over time. The implementation of colorectal cancer screening programmes caused a significant decrease in the number of new diagnoses in patients aged 75 to 79 years that may be attributable to the implementation of colorectal cancer screening programmes; however, in-hospital mortality was not reduced. Metastatic tumours and other conditions as anaemia are associated with higher in-hospital mortality rates.
Collapse
Affiliation(s)
- Josep Darbà
- Department of Economics, Universitat de Barcelona, Barcelona, Spain
- * E-mail:
| | - Alicia Marsà
- Department of Health Economics, BCN Health Economics & Outcomes Research S.L, Barcelona, Spain
| |
Collapse
|
10
|
Nee J, Chippendale RZ, Feuerstein JD. Screening for Colon Cancer in Older Adults: Risks, Benefits, and When to Stop. Mayo Clin Proc 2020; 95:184-196. [PMID: 31902414 DOI: 10.1016/j.mayocp.2019.02.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 02/08/2019] [Accepted: 02/19/2019] [Indexed: 12/26/2022]
Abstract
Colorectal cancer (CRC) is the fourth leading cause of cancer and second leading cause of mortality from cancer in the United States. As the population ages, decisions regarding the initiation and cessation of screening and surveillance for CRC are of increasing importance. In elderly patients, the risks of CRC and the presenting signs and symptoms are similar to those in younger patients. Screening and ongoing surveillance should be considered in patients who have a life expectancy of 10 years or more. Life expectancy estimates can be calculated using online calculators. If screening is deemed appropriate, the choice of which test to use first is unclear. Currently, there are a number of modalities available to screen for CRC, including both invasive modalities (eg, colonoscopy, sigmoidoscopy, capsule colonoscopy, and computed tomographic colonography) and noninvasive modalities (fecal immunochemical test, stool DNA testing, and blood testing). Colonoscopy and other invasive testing options are considered safe, but the risks of complications of the bowel preparation, the procedure, and sedation medications are all increased in older patients. In contrast, noninvasive testing provides a safe initial test; however, it is important to consider the increased false-positive rates in the elderly, and a positive test result will usually necessitate colonoscopy to establish the diagnosis. Ongoing screening and surveillance should be a shared decision-making process with the patient based on multiple factors including the patient's morbidity and mortality risk from CRC and his or her underlying comorbidities, the patient's functional status, and the patient's preferences for screening. Ultimately, the decision to initiate or discontinue screening for CRC in older patients should be done based on a case-by-case individualized discussion.
Collapse
Affiliation(s)
- Judy Nee
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Ryan Z Chippendale
- Division of Geriatrics, Department of Medicine, Boston Medical Center, Boston MA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| |
Collapse
|
11
|
Kulaylat AS, Schaefer EW, Messaris E, Hollenbeak CS. Truven Health Analytics MarketScan Databases for Clinical Research in Colon and Rectal Surgery. Clin Colon Rectal Surg 2019; 32:54-60. [PMID: 30647546 DOI: 10.1055/s-0038-1673354] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The MarketScan databases are a family of administrative claims databases that contain data on inpatient and outpatient claims, outpatient prescription claims, clinical utilization records, and healthcare expenditures. The three main databases available for use are each composed of a convenience sample for one of the following patient populations: (1) patients with employer-based health insurance from contributing employers, (2) Medicare beneficiaries who possess supplemental insurance paid by their employers, and (3) patients with Medicaid in one of eleven participating states. Eleven supplemental databases are available, which are utilized to overcome the limited clinical data available in the core MarketScan databases. There are several limitations to this database, primarily related to the fact that individuals or their family members within two of the core databases mandatorily possess some form of employer-based health insurance, which prevents the dataset from being nationally representative. Nonetheless, this database provides detailed and rigorously maintained claims data to identify healthcare utilization patterns among this cohort of patients.
Collapse
Affiliation(s)
- Audrey S Kulaylat
- Department of Surgery, Division of Colon and Rectal Surgery, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Eric W Schaefer
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | | | - Christopher S Hollenbeak
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| |
Collapse
|
12
|
Chen FW, Sundaram V, Chew TA, Ladabaum U. Advanced-Stage Colorectal Cancer in Persons Younger Than 50 Years Not Associated With Longer Duration of Symptoms or Time to Diagnosis. Clin Gastroenterol Hepatol 2017; 15:728-737.e3. [PMID: 27856366 PMCID: PMC5401776 DOI: 10.1016/j.cgh.2016.10.038] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 10/23/2016] [Accepted: 10/31/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The incidence of colorectal cancer (CRC) is increasing in the United States among adults younger than the age of 50 years. Studies of young-onset CRC have focused on outcomes and treatment patterns. We examined patient presentation, provider evaluation, and time to diagnosis, which can affect stage and prognosis. METHODS In a retrospective study, we collected data from patients with a diagnosis of colorectal adenocarcinoma, confirmed by pathologists, seen at the Stanford Cancer Institute from January 1, 2008, through December 31, 2014. We compared symptoms, clinical features, time to diagnosis, and cancer stage in patients with young-onset CRC (diagnosed at an age younger than 50 years; n = 253) with patients diagnosed with CRC at an age of 50 years or older (n = 232). RESULTS A higher proportion of patients with young-onset CRC were diagnosed with advanced-stage tumors (72%) compared with older patients (63%) (P = .03). Larger proportions of patients with young-onset CRC also had a family history of CRC (25% vs 17% in older patients; P = .03), confirmed or probable hereditary cancer syndromes (7% vs 1% in older patients; P < .01), and left-sided disease (distal colon cancer in 41% vs 34% in older patients; P = .01; and rectal cancer in 40% vs 35% in older patients; P = .29). Patients with young-onset CRC had a significantly longer median time to diagnosis (128 vs 79 days for older patients; P < .05), symptom duration (60 vs 30 days for older patients; P < .01), and time of evaluation (31 vs 22 days; P < .05). In multivariable analyses, time to diagnosis was 1.4-fold longer for younger than for older patients (P < .01). Among younger patients, those with stage III or IV CRC had shorter durations of symptoms and evaluations than those with stage I or II CRC. CONCLUSIONS In a retrospective analysis of patients with CRC, we found that greater proportions of patients younger than 50 years were diagnosed with advanced-stage tumors than older patients; this difference could not be explained simply by delays from symptom onset to diagnosis. Although tumor biology may be an important determinant of stage at diagnosis, clinicians should be aware of CRC alarm symptoms, family history, and genetic syndromes, to speed evaluation and diagnosis of younger patients and potentially improve outcomes. It remains to be determined whether subgroups of persons at risk for young-onset CRC who benefit from early screening can be identified.
Collapse
Affiliation(s)
- Frank W. Chen
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Vandana Sundaram
- Quantitative Sciences Unit, Stanford University School of Medicine, Palo Alto, CA
| | - Thomas A. Chew
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Uri Ladabaum
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California.
| |
Collapse
|
13
|
Sarakarn P, Suwanrungruang K, Vatanasapt P, Wiangnon S, Promthet S, Jenwitheesuk K, Koonmee S, Tipsunthonsak N, Chen SLS, Yen AMF, Chen THH. Joinpoint Analysis Trends in the Incidence of Colorectal Cancer in Khon Kaen, Thailand (1989 – 2012). Asian Pac J Cancer Prev 2017; 18:1039-1043. [PMID: 28547938 PMCID: PMC5494213 DOI: 10.22034/apjcp.2017.18.4.1039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective: This study focused on recent changes in the incidence of colorectal cancer (CRC) in Khon Kaen,
Thailand. Methods: Data for CRC over the period 1989 to 2012 from the population-based cancer registry of Khon
Kaen province were employed. Age-standardized incidence rates (ASR) were calculated and classified into 4 age-groups
for comparison. Joinpoint regression analysis was used to detect changes in trends among each line segment and an
overall line was generated, whether increasing or decreasing, with annual percent change (APC) and average annual
percent change (AAPC). Results: There were 3,364 CRC cases included in the analysis, 72.2% histological confirmed
and 53.5% in men. Trends of ASRs generally demonstrated gradual increase over the period 1989 to 2012. For those
aged under 45 or 50 years there was slight overall increase, with a somewhat zigzag pattern. From joinpoint analysis,
the trends of all aged groups were found to be increasing among both men and women: aged 45 years and older group
AAPC=3.40, 2.30 and 3.90, respectively); aged 50 years and older group AAPC=2.90, 2.20 and 3.40; aged under 45
years AAPC=6.30, 6.00 and 6.90; and aged under 50 years (AAPC=5.70, 3.20 and 5.70. Conclusions: ASRs for CRC
have been gradually increasing in the northeast region of Thailand. Future studies should consider the subsite distribution.
Collapse
Affiliation(s)
- Pongdech Sarakarn
- Institute of Epidemiology and Prevention Medicine, College of Public Health, National Taiwan University, Taiwan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Leiva A, Esteva M, Llobera J, Macià F, Pita-Fernández S, González-Luján L, Sánchez-Calavera MA, Ramos M. Time to diagnosis and stage of symptomatic colorectal cancer determined by three different sources of information: A population based retrospective study. Cancer Epidemiol 2017; 47:48-55. [PMID: 28126583 DOI: 10.1016/j.canep.2016.10.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 09/29/2016] [Accepted: 10/31/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Survival rates from colorectal cancer (CRC) are highly variable in Europe. This variability could potentially be explained by differences in healthcare system delays in diagnosis. However, even when such delays are reduced, the relationship of the diagnostic interval (time from presentation with symptoms to diagnosis) with outcome is uncertain. METHODS A total of 795 patients with CRC from 5 regions of Spain were retrospectively examined in this population-based multicenter study. Consecutive incident cases of CRC were identified from pathology services. The total diagnostic interval (TDI) was defined as the time from the first presentation with symptoms to diagnosis based on 3 different sources of information: (i) patient-recorded data (PR-TDI) by interview, (ii) hospital-recorded data (HR-TDI), and (iii) general practitioner-recorded data (GPR-TDI). Concordance correlation coefficients (CCCs) were used to estimate the agreement of 3 different TDIs. The TDIs of patients with different stages of CRC were also compared using the Kruskal-Wallis test. RESULTS The median TDI was 131days based on patient interview data, 91days based on HR data, and 111days based on GPR data. Overall, the agreement of these TDIs was poor (CCCPRvsHR=0.399, CCCPRvsGPR=0.518, CCCHRvsGPR=0.383). Univariate analysis indicated that the TDI was greater in those with less advanced CRC for all 3 methods of calculation, but this association was only statistically significant for the HR-TDI (p=0.021). CONCLUSION There is no evidence that patients with more advanced CRC have longer TDIs. In fact, we found an inverse relationship between the TDI and CRC stage, an example of the "waiting time paradox". This association may likely be due to the presence of unmeasured confounders as the stage when symptoms appear or the tumour aggressiveness.
Collapse
Affiliation(s)
- Alfonso Leiva
- Primary Care Research Unit of Mallorca, Baleares Health Services-IbSalut, 07005 Palma, España, Instituto de Investigación Sanitaria de Palma, 07010 Palma, Spain.
| | - Magdalena Esteva
- Primary Care Research Unit of Mallorca, Baleares Health Services-IbSalut, 07005 Palma, España, Instituto de Investigación Sanitaria de Palma, 07010 Palma, Spain.
| | - Joan Llobera
- Primary Care Research Unit of Mallorca, Baleares Health Services-IbSalut, 07005 Palma, España, Instituto de Investigación Sanitaria de Palma, 07010 Palma, Spain.
| | - Francesc Macià
- Evaluation and Clinical Epidemiology Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.
| | - Salvador Pita-Fernández
- Clinical Epidemiology and Biostatistics Unit, A Coruña University, Complexo Hospitalario Universitario A Coruña, Xubias de Arriba, 84, Hotel de los pacientes 7ª planta, 15006, A Coruña, Spain.
| | - Luis González-Luján
- Serreria II Primary Care Centre, Valencia Institute of Health, C/Pedro de Valencia 28, 46022, Valencia, Spain.
| | | | - María Ramos
- Department of Public Health, Balearic Department of Health, C/Jesus n 33, 07001, Instituto de Investigación Sanitaria de Palma, 07010 Palma, Spain, Spain.
| |
Collapse
|
15
|
Maffei S, Colantoni A, Kaleci S, Benatti P, Tesini E, de Leon MP. Clinical features of colorectal cancer patients in advanced age: a population-based approach. Intern Emerg Med 2016; 11:191-7. [PMID: 26482259 DOI: 10.1007/s11739-015-1286-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 07/24/2015] [Indexed: 12/27/2022]
Abstract
In the immediate future, the number of geriatric patients will continue to rise; consequently we should expect an increase of colorectal cancer, a disease of the elderly population. Through the data of a Cancer Registry, we examined (a) the effect of ageing on the main features of colorectal cancer; (b) changes in management, especially for individuals older than 80 years; and (c) changes in prognosis and survival in subgroups of patients with different age. The Registry provided information on colorectal cancer up to 2010 (27 years). A total of 5293 patients were registered; these were divided into three groups: A (0-64 years), B (65-79) and C (80 or more). Three periods of observation were chosen: 1 (1984-1992), 2 (1993-2001) and 3 (2001-2010). Group A included 1571 patients (29 %), Group B 2539 (48 %) and Group C 1183 (22.3 %). The fraction of old individuals increased during the 27 years of the investigation. In these patients, tumours were predominantly localized to the right colon (42.6 %). The rate of surgery and ratio between curative and palliative approaches were similar among the three groups (p < 0.38). There was disparity (p < 0.002) in the administration of chemotherapy (5.8 % of the elderly vs 34.4 % in remaining patients). Survival increased over time in all three groups. In the elderly, average 5-year survival was 31 % in period 1 and 55 % in period 3. These data show that in Western countries, the standard of care for colorectal cancer diagnosed in geriatric patients has improved over the last 30 years.
Collapse
Affiliation(s)
- Stefania Maffei
- Medicina 1, Dipartimento di Medicina Diagnostica, Clinica e Sanità Pubblica, Università di Modena e Reggio Emilia, Policlinico, Via del Pozzo n.71, 41100, Modena, Italy
| | - Alessandra Colantoni
- Medicina 1, Dipartimento di Medicina Diagnostica, Clinica e Sanità Pubblica, Università di Modena e Reggio Emilia, Policlinico, Via del Pozzo n.71, 41100, Modena, Italy
| | - Shaniko Kaleci
- Unità di Statistica in Medicina, Dipartimento di Medicina Diagnostica, Clinica e Sanità Pubblica, Università di Modena e Reggio Emilia, Modena, Italy
| | - Piero Benatti
- Medicina 1, Dipartimento di Medicina Diagnostica, Clinica e Sanità Pubblica, Università di Modena e Reggio Emilia, Policlinico, Via del Pozzo n.71, 41100, Modena, Italy
| | - Ester Tesini
- Medicina 1, Dipartimento di Medicina Diagnostica, Clinica e Sanità Pubblica, Università di Modena e Reggio Emilia, Policlinico, Via del Pozzo n.71, 41100, Modena, Italy
| | - Maurizio Ponz de Leon
- Medicina 1, Dipartimento di Medicina Diagnostica, Clinica e Sanità Pubblica, Università di Modena e Reggio Emilia, Policlinico, Via del Pozzo n.71, 41100, Modena, Italy.
| |
Collapse
|
16
|
Colorectal cancer survival by stage of cases diagnosed in Mallorca, Spain, between 2006 and 2011 and factors associated with survival. Cancer Epidemiol 2016; 41:63-70. [PMID: 26828896 DOI: 10.1016/j.canep.2016.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 12/23/2015] [Accepted: 01/02/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To establish cause-specific survival by stage of colorectal cancer up to 8 years from diagnosis, and to identify factors which explain and predict the likelihood of survival. METHODOLOGY Retrospective follow-up study of people diagnosed with invasive colorectal cancer during 2006-2011, identified through the Mallorca Cancer Registry. DCO and lymphomas were excluded. Sex, age, diagnostic method, site, histology, T, N, M, and stage, date of diagnosis, date of follow-up or death, and cause of death were collected. End point of follow-up was 31st December 2013. Multiple imputation (MI) method was performed to obtain stage when unknown. Actuarial and Kaplan-Meier methods were used for survival analysis. Extended Cox models were built to identify factors that explain and predict survival. RESULTS 2889 cases were identified, 41.7% in women and 58.3% in men, with a mean age of 70.5 years. Unknown stage represented 15.3% of cases. After MI, 15% were in stage I, 26.7% were in II, 32.7% in III, and 25.6% in IV. Survival was 56% at the end of the 5th year. Survival by stage changed significantly after MI and was estimated to 83% at stage I, 73% at II, 62% at III, and 16% at IV. Extended Cox model showed that survival worsened with age, mucinous histology, and stage. Risk of dying was 17.0 times higher in stage IV compared to stage I, 3.7 times in stage III, and 1.6 times in stage II. CONCLUSIONS More than half of colorectal cancer patients will survive 5 years after diagnosis, but only if diagnosed in stages I-III.
Collapse
|
17
|
Ramos M, Franch P, Zaforteza M, Artero J, Durán M. Completeness of T, N, M and stage grouping for all cancers in the Mallorca Cancer Registry. BMC Cancer 2015; 15:847. [PMID: 26537005 PMCID: PMC4632343 DOI: 10.1186/s12885-015-1849-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 10/26/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND TNM staging of cancer is used to establish the treatment and prognosis for cancer patients, and also allows the assessment of screening programmes and hospital performance. Collection of staging data is becoming a cornerstone for cancer registries. The objective of the study was to assess the completeness of T, N, M and stage grouping registration for all cancers in the Mallorca Cancer Registry in 2006-2008 and to explore differences in T, N, M and stage grouping completeness by site, gender, age and type of hospital. METHODS All invasive cancer cases during the period 2006-2008 were selected. DCO, as well as children's cancers, CNS, unknown primary tumours and some haematological cases were excluded. T, N, M and stage grouping were collected separately and followed UICC (International Union Against Cancer) 7th edition guidelines. For T and N, we registered whether they were pathological or clinical. RESULTS Ten thousand two hundred fifty-seven cases were registered. After exclusions, the study was performed with 9283 cases; 39.4 % of whom were women and 60.6 % were men. T was obtained in 48.6 % cases, N in 36.5 %, M in 40 % and stage in 37.9 %. T and N were pathological in 71 % of cases. Stage completeness exceeded 50 % in lung, colon, ovary and oesophagus, although T also exceeded 50 % at other sites, including rectum, larynx, colon, breast, bladder and melanoma. No differences were found in TNM or stage completeness by gender. Completeness was lower in younger and older patients, and in cases diagnosed in private clinics. CONCLUSIONS T, N, M and stage grouping data collection in population-based cancer registries is feasible and desirable.
Collapse
Affiliation(s)
- M Ramos
- Mallorca Cancer Registry, Public Health Department, Hospital Psiquiàtric 40, 07110, Palma, Balearic Islands, Spain.
| | - P Franch
- Mallorca Cancer Registry, Public Health Department, Hospital Psiquiàtric 40, 07110, Palma, Balearic Islands, Spain.
| | - M Zaforteza
- Mallorca Cancer Registry, Public Health Department, Hospital Psiquiàtric 40, 07110, Palma, Balearic Islands, Spain. .,Hospital Son Espases Tumour Registry, Balearic Islands Health Service, Palma, Spain.
| | - J Artero
- Hospital Manacor Tumour Registry, Balearic Islands Health Service, Manacor, Spain.
| | - M Durán
- Mallorca Cancer Registry, Public Health Department, Hospital Psiquiàtric 40, 07110, Palma, Balearic Islands, Spain.
| |
Collapse
|
18
|
Paganini Piazzolla L, Medeiros de Almeida R, Nóbrega dos Santos A, Gonçalves de Oliveira P, Freitas da Silva E, Batista de Sousa J. Does aging influence clinical presentation and pathological staging in colorectal cancer? Eur Geriatr Med 2015. [DOI: 10.1016/j.eurger.2015.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
19
|
Bayar B, Yılmaz KB, Akıncı M, Şahin A, Kulaçoğlu H. An evaluation of treatment results of emergency versus elective surgery in colorectal cancer patients. ULUSAL CERRAHI DERGISI 2015; 32:11-7. [PMID: 26985154 DOI: 10.5152/ucd.2015.2969] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 02/16/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Colorectal cancer is still one of the most common causes of cancer related deaths in the world despite improvements in diagnosis and treatment modalities, and application of community-based screening methods. Symptoms of colorectal cancer are non-specific and usually manifest following local progression. A number of patients with advanced stage colorectal cancer present to emergency departments with obstruction as the first sign of disease without any previous symptoms. This presentation is an indication for emergency surgery that has a high rate of morbidity and mortality. In this study, we aimed to determine the factors associated with early diagnosis and survival by comparing postoperative results of colorectal cancer patients who underwent surgery under emergency or elective situation. MATERIAL AND METHODS Files of colorectal patients treated between 2009-2013 were retrospectively analyzed. Data on patient age, gender, operation type, intraoperative results, length of hospital stay, co-morbidities, postoperative complications and pathological results were evaluated and compared. RESULTS There was no statistical difference between groups in terms of age, gender, and pathology results (p>0.05). The difference between groups in terms of postoperative length of hospital stay, presence of co-morbid diseases, pathological stage, and postoperative complications was statistically significant (p<0.05). Length of hospital stay, advanced stage on admission, complications such as surgical site infection, evisceration, and anastomosis leakage rates were higher in patients in the emergency surgery group. CONCLUSION Risk groups should be determined in order to diagnose colorectal cancer patients at an early stage while they are still asymptomatic, and this information should be incorporated into effective screening programs. This approach will be beneficial to treatment outcomes, complication rates, length of hospital stay, and survival and treatment results.
Collapse
Affiliation(s)
- Bahattin Bayar
- Clinic of General Surgery, Muş State Hospital, Muş, Turkey
| | - Kerim Bora Yılmaz
- Clinic of General Surgery, Ankara Dışkapı Training and Research Hospital, Ankara, Turkey
| | - Melih Akıncı
- Clinic of General Surgery, Ankara Dışkapı Training and Research Hospital, Ankara, Turkey
| | - Alpaslan Şahin
- Clinic of General Surgery, Konya Training and Research Hospital, Konya, Turkey
| | - Hakan Kulaçoğlu
- Clinic of General Surgery, Ankara Dışkapı Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
20
|
Malietzis G, Mughal A, Currie AC, Anyamene N, Kennedy RH, Athanasiou T, Jenkins JT. Factors Implicated for Delay of Adjuvant Chemotherapy in Colorectal Cancer: A Meta-analysis of Observational Studies. Ann Surg Oncol 2015; 22:3793-802. [PMID: 25777086 DOI: 10.1245/s10434-015-4479-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND The survival benefit of administering adjuvant chemotherapy (AC) in colorectal cancer is well established, as is the impact of its timing. Although various factors have been associated with treatment delay, their implications remain controversial. We determined clinicopathological factors associated with delay in transition to AC via systematic review and meta-analysis. METHODS Studies assessing factors for delay in initiating AC were identified from MEDLINE, EMBASE, and Cochrane Databases. Studies were included only if relevant clinicopathological factors were adequately described and appropriate comparative groups were balanced. For each study, the odds ratio (OR) and 95 % confidence interval (CI) were estimated, regarding response to early versus delayed AC initiation. RESULTS We identified 15 eligible studies involving 67,537 patients. Twelve studies were multicentre studies and three were single-center cohort studies. Meta-analysis demonstrated age >75 years [4 studies, OR = 1.44 (95 % CI 1.32-1.58)], marital status-single [3 studies, OR = 1.32 (95 % CI 1.20-1.44)], low socioeconomic status (SES) [7 studies, OR = 1.67 (95 % CI 1.32-2.12)], worse comorbidity status [5 studies, OR = 1.47 (95 % CI 1.14-1.90)], low tumour grade [7 studies, OR = 1.06 (95 % CI 1.02-1.11)], prolonged length of stay [3 studies, OR 2.37 (95 % CI 2.10-2.68)], and readmission [3 studies, OR = 3.23 (95 % CI 1.66-6.26)] were significant predictors of delayed initiation of AC. Laparoscopy compared to an open surgical approach was a significant predictor of earlier AC initiation [5 studies, OR = 0.70 (95 % CI 0.51-0.97)]. CONCLUSIONS Laparoscopy is associated with earlier initiation of AC, encouraging its increased adoption. Social isolation and low SES merit consideration of approaches that counter the lack of social support and deprivation to improve cancer outcomes.
Collapse
Affiliation(s)
- George Malietzis
- Department of Surgery, St Marks Hospital, Harrow, Middlesex, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - Aamer Mughal
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Andrew C Currie
- Department of Surgery, St Marks Hospital, Harrow, Middlesex, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - Nicola Anyamene
- Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, Middlesex, UK
| | - Robin H Kennedy
- Department of Surgery, St Marks Hospital, Harrow, Middlesex, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | | | - John T Jenkins
- Department of Surgery, St Marks Hospital, Harrow, Middlesex, UK. .,Department of Surgery and Cancer, Imperial College, London, UK.
| |
Collapse
|