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Arbour C, Lapierre A, Hjeij D, Bilodeau K. Do All Patients Benefit From the Soothing Properties of a Conversational Nursing Intervention to Reduce Symptom Burden During Outpatient Chemotherapy?: A Multimethod Secondary Analysis. Cancer Nurs 2024:00002820-990000000-00259. [PMID: 38865610 DOI: 10.1097/ncc.0000000000001376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
BACKGROUND Soothing conversation (SC) is particularly promising for symptom management during outpatient chemotherapy. However, we know little about the profile of patients who are most likely to benefit from this intervention. OBJECTIVE To gain a better understanding of the profile of patients most likely to benefit from SC to reduce symptom burden during outpatient chemotherapy. METHODS We performed a multimethod secondary analysis of 2 data sets: the first gathered during a quantitative pilot trial investigating the impact of SC on patients' symptom fluctuations during chemotherapy perfusion (n = 24); the second derived from qualitative interviews about nurses' experiences with SC in this context (n = 6). RESULTS Secondary quantitative analysis suggests that symptom control with SC is more effective in older patients, reporting lower education, widowed status, work incapacity, advanced cancer, and undergoing chemotherapy perfusion for less than 1 hour. According to nurses' interviews, SC could best benefit patients (1) prone to anxiety and fear, (2) with unalleviated pain, (3) who are unaccompanied during treatment, and contrary to what was shown with quantitative data, (4) undergoing longer perfusion duration. CONCLUSION Although this study provides valuable insights, much work remains to be done to fully understand the factors that predispose patients to respond positively to SC during outpatient chemotherapy. IMPLICATIONS FOR PRACTICE This study extends previous research on the effectiveness of SC for symptom management during outpatient chemotherapy by comparing nurses' experience with the intervention to patients' results. Results could be used to inform the assignment and delivery of supportive communication-based interventions during chemotherapy protocols.
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Affiliation(s)
- Caroline Arbour
- Author Affiliations: Hôpital du Sacré-Cœur de Montréal, CIUSSS du Nord-de-l'Île-de-Montréal (Drs Arbour and Lapierre and Mrs Hjeij); Faculty of Nursing, Université de Montréal (Drs Arbour, Lapierre, and Bilodeau); Hôpital Maisonneuve-Rosemont, CIUSSS de l'Est-de-l'Île-de-Montréal (Dr Bilodeau), Quebec, Canada
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Wang C, Zheng Y, Luo Z, Xie J, Chen X, Zhao L, Cao W, Xu Y, Wang F, Dong X, Tan F, Li N, He J. Socioeconomic characteristics, cancer mortality, and universal health coverage: A global analysis. MED 2024:S2666-6340(24)00172-7. [PMID: 38761802 DOI: 10.1016/j.medj.2024.04.002] [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: 12/11/2023] [Revised: 02/23/2024] [Accepted: 04/05/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Achieving universal health coverage (UHC) involves all individuals attaining accessible health interventions at an affordable cost. We examined current patterns and temporal trends of cancer mortality and UHC across sociodemographic index (SDI) settings, and quantified these association. METHODS We used data from the Global Burden of Disease Study 2019 and Our World in Data. The UHC effective coverage index was obtained to assess the potential population health gains delivered by health systems. The estimated annual percentage change (EAPC) with a 95% confidence interval (CI) was calculated to quantify the trend of cancer age-standardized mortality rate (ASMR). A generalized linear model was applied to estimate the association between ASMR and UHC. FINDINGS The high (EAPC = -0.9% [95% CI, -1.0%, -0.9%]) and high-middle (-0.9% [-1.0%, -0.8%]) SDI regions had the fastest decline in ASMR (per 100,000) for total cancers from 1990 to 2019. The overall UHC effective coverage index increased by 27.9% in the high-SDI quintile to 62.2% in the low-SDI quintile. A negative association was observed between ASMR for all-cancer (adjusted odds ratio [OR] = 0.87 [0.76, 0.99]), stomach (0.73 [0.56, 0.95]), breast (0.64 [0.52, 0.79]), cervical (0.42 [0.30, 0.60]), lip and oral cavity (0.55 [0.40, 0.75]), and nasopharynx (0.42 [0.26, 0.68]) cancers and high UHC level (the lowest as the reference). CONCLUSIONS Our findings strengthen the evidence base for achieving UHC to improve cancer outcomes. FUNDING This work is funded by the China National Natural Science Foundation and Chinese Academy of Medical Sciences Innovation Fund for Medical Science.
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Affiliation(s)
- Chenran Wang
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yadi Zheng
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zilin Luo
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiaxin Xie
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaolu Chen
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liang Zhao
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Cao
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongjie Xu
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Wang
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuesi Dong
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengwei Tan
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Ni Li
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Epidemiology and Biostatistics, Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China.
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Aggarwal A, Choudhury A, Fearnhead N, Kearns P, Kirby A, Lawler M, Quinlan S, Palmieri C, Roques T, Simcock R, Walter FM, Price P, Sullivan R. The future of cancer care in the UK-time for a radical and sustainable National Cancer Plan. Lancet Oncol 2024; 25:e6-e17. [PMID: 37977167 DOI: 10.1016/s1470-2045(23)00511-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 11/19/2023]
Abstract
Cancer affects one in two people in the UK and the incidence is set to increase. The UK National Health Service is facing major workforce deficits and cancer services have struggled to recover after the COVID-19 pandemic, with waiting times for cancer care becoming the worst on record. There are severe and widening disparities across the country and survival rates remain unacceptably poor for many cancers. This is at a time when cancer care has become increasingly complex, specialised, and expensive. The current crisis has deep historic roots, and to be reversed, the scale of the challenge must be acknowledged and a fundamental reset is required. The loss of a dedicated National Cancer Control Plan in England and Wales, poor operationalisation of plans elsewhere in the UK, and the closure of the National Cancer Research Institute have all added to a sense of strategic misdirection. The UK finds itself at a crossroads, where the political decisions of governments, the cancer community, and research funders will determine whether we can, together, achieve equitable, affordable, and high-quality cancer care for patients that is commensurate with our wealth, and position our outcomes among the best in the world. In this Policy Review, we describe the challenges and opportunities that are needed to develop radical, yet sustainable plans, which are comprehensive, evidence-based, integrated, patient-outcome focused, and deliver value for money.
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Affiliation(s)
- Ajay Aggarwal
- Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ananya Choudhury
- Department of Clinical Oncology and Division of Cancer Sciences, The Christie NHS Foundation Trust, Manchester, UK
| | - Nicola Fearnhead
- Department of Colorectal Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Pam Kearns
- Institute of Cancer and Genomic Sciences NIHR Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Anna Kirby
- Department of Radiotherapy, Royal Marsden Hospital, London, UK
| | - Mark Lawler
- Patrick G Johnston Centre for Cancer Research, Queens University Belfast Belfast, UK
| | | | - Carlo Palmieri
- The Clatterbridge Cancer Centre NHS Foundation Trust, & Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Tom Roques
- Royal College of Radiologists & Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Richard Simcock
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Fiona M Walter
- Wolfson Institute of Population Health, Faculty of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Pat Price
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Richard Sullivan
- Institute of Cancer Policy, Centre for Cancer, Society & Public Health, King's College London, London, UK
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Huang CY, Chen CC. The COVID-19 pandemic has impeded cytopathology practices and hindered cancer screening and management. Cytopathology 2023; 34:406-416. [PMID: 37332230 DOI: 10.1111/cyt.13259] [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: 01/15/2023] [Revised: 04/24/2023] [Accepted: 05/23/2023] [Indexed: 06/20/2023]
Abstract
The COVID-19 pandemic has had a global impact on the environment and economy and has affected hospital administration and patient behaviour. Since human-to-human coronavirus transmission occurs via droplets and physical contact, health care professionals are particularly vulnerable to contracting COVID-19. Many cytopathology laboratories updated their workflow, established new standard biosafety protocols, and built digital pathology or telescope platforms to mitigate these risks and deal with the shortage of health care personnel. The COVID-19 pandemic also disrupted medical education-all indoor training events, including conferences, multidisciplinary tumour boards, seminars, and microscope inspections were postponed. As a result, many laboratories now use new web-based applications and platforms to maintain educational programs and multidisciplinary tumour boards. To comply with government directives, health care facilities postponed non-emergency surgeries, reduced the number of routine medical examinations, restricted visitor numbers, and scaled back cancer screening activities, resulting in a sharp decline in cytopathology diagnoses, cancer screening specimens, and molecular testing for cancer. Subsequent misses or delays in the diagnosis and treatment of cancer were not uncommon. This review aims to provide comprehensive summaries of the consequences of the COVID-19 pandemic for cytopathology, particularly in terms of cancer diagnosis, workload, human resources, and molecular testing.
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Affiliation(s)
- Cheng-Yi Huang
- Department of Pathology, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Chien-Chin Chen
- Department of Pathology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
- Department of Cosmetic Science, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
- Department of Biotechnology and Bioindustry Sciences, National Cheng Kung University, Tainan, Taiwan
- Ph.D. Program in Translational Medicine, Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
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Björkman A, Gisslén M, Gullberg M, Ludvigsson J. The Swedish COVID-19 approach: a scientific dialogue on mitigation policies. Front Public Health 2023; 11:1206732. [PMID: 37546333 PMCID: PMC10399217 DOI: 10.3389/fpubh.2023.1206732] [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: 04/16/2023] [Accepted: 06/26/2023] [Indexed: 08/08/2023] Open
Abstract
During the COVID-19 pandemic, Sweden was among the few countries that did not enforce strict lockdown measures but instead relied more on voluntary and sustainable mitigation recommendations. While supported by the majority of Swedes, this approach faced rapid and continuous criticism. Unfortunately, the respectful debate centered around scientific evidence often gave way to mudslinging. However, the available data on excess all-cause mortality rates indicate that Sweden experienced fewer deaths per population unit during the pandemic (2020-2022) than most high-income countries and was comparable to neighboring Nordic countries through the pandemic. An open, objective scientific dialogue is essential for learning and preparing for future outbreaks.
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Affiliation(s)
- Anders Björkman
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Gisslén
- Department of Infectious Diseases, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Gullberg
- Department of Molecular Biology, University of Umeå, Umeå, Sweden
| | - Johnny Ludvigsson
- Division of Pediatrics, Department of Biomedical and Clinical Sciences, Crown Princess Victoria Children's Hospital, Linköping University, Linköping, Sweden
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Hu M, Jiang C, Meng R, Luo Y, Wang Y, Huang M, Li F, Ma H. Effect of air pollution on the prevalence of breast and cervical cancer in China: a panel data regression analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:82031-82044. [PMID: 37318726 DOI: 10.1007/s11356-023-28068-w] [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: 03/20/2023] [Accepted: 05/30/2023] [Indexed: 06/16/2023]
Abstract
The association between the prevalence of breast and cervical cancer in Chinese women and air pollution is obscure. The study aims to analyze the correlation between air pollution and the prevalence of breast and cervical cancer, and whether the gross domestic product (GDP) has a modifying effect on the impact of air pollution on the prevalence of breast and cervical cancer. Extracting panel data from 31 provinces and cities between 2006 and 2020, we evaluated the association between breast and cervical cancer prevalence and pollutant emissions from 2006 to 2015 with two-way fixed-effect models. We also analyzed the interaction between GDP and pollutant emissions and further check the robustness of the moderating effect results using group regression from 2016 to 2020. Cluster robust standard errors were used to correct for the heteroskedasticity and autocorrelation. The coefficients of models show that the coefficients of logarithmic soot and dust emissions are estimated to be significantly positive, and the coefficients of their square terms are significantly negative. The robust results suggest that the relationship between soot and dust emissions and breast or cervical cancer prevalence is non-linear, from 2006 to 2015. In the analysis of particulate matter (PM) data in 2016-2020, the PM-GDP interaction term was also significantly negative, indicating that GDP growth weakened the effect of PM on the prevalence of breast cancer and cervical cancer. In provinces with higher GDP, the indirect effect of PM emissions concerning breast cancer is -0.396 while in provinces with lower GDP, it is about -0.215. The corresponding coefficient concerning cervical cancer is about -0.209 in provinces with higher GDP but not significant in provinces with lower GDP. Our results suggest that there is an inverted U-shaped relationship between the prevalence of breast cancer and cervical cancer and air pollutants from 2006 to 2015. GDP growth has a significant negative moderating effect on the impact of air pollutants on the prevalence of breast cancer and cervical cancer. PM emissions have a higher effect on the prevalence of breast and cervical cancer in provinces with higher GDP and a lower impact in provinces with lower GDP.
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Affiliation(s)
- Meiyu Hu
- Department of Public Health, Hangzhou Normal University, Yuhangtang Road, Yuhang District, 311121, Hangzhou, Zhejiang Province, China
| | - Chen Jiang
- Department of Public Health, Hangzhou Normal University, Yuhangtang Road, Yuhang District, 311121, Hangzhou, Zhejiang Province, China
| | - Runtang Meng
- Department of Public Health, Hangzhou Normal University, Yuhangtang Road, Yuhang District, 311121, Hangzhou, Zhejiang Province, China
| | - Yingxian Luo
- Department of Public Health, Hangzhou Normal University, Yuhangtang Road, Yuhang District, 311121, Hangzhou, Zhejiang Province, China
| | - Yaxin Wang
- Department of Public Health, Hangzhou Normal University, Yuhangtang Road, Yuhang District, 311121, Hangzhou, Zhejiang Province, China
| | - Mengyi Huang
- Department of Public Health, Hangzhou Normal University, Yuhangtang Road, Yuhang District, 311121, Hangzhou, Zhejiang Province, China
| | - Fudong Li
- Department of Public Health Surveillance & Advisory, Zhejiang Provincial Center for Disease Control and Prevention, Xincheng Road, Binjiang District, 310051, Hangzhou, Zhejiang, China
| | - Haiyan Ma
- Department of Public Health, Hangzhou Normal University, Yuhangtang Road, Yuhang District, 311121, Hangzhou, Zhejiang Province, China.
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Xu WF, Yang P, Wei ZW, Liu JS, Yan RL, Chen Q, Tong RX, Xu SY, Gao WQ, Zhang W, Chang ZZ, Wang PL, Fang HJ, Zheng YY, Wang T, Liu NN, Yao C, Liu YL, Xia W, Zhao W, Wang ZJ. Correlation between the Human Development Index and the Incidence and Mortality of Non-Hodgkin Lymphoma. Curr Med Sci 2023; 43:255-260. [PMID: 36943542 DOI: 10.1007/s11596-022-2682-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 11/11/2022] [Indexed: 03/23/2023]
Abstract
OBJECTIVE This study was to examine the relationship between socioeconomic status and the incidence and mortality of non-Hodgkin lymphoma (NHL). METHODS We compared the age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and the ASMR to ASIR ratio (MIR) at national and regional levels and studied the correlation between the MIR and the human development index (HDI) in 2012 and 2018. RESULTS The highest ASIR was in North America in 2012 and in Australia in 2018, and the lowest ASIR was in Central and South Asia in both 2012 and 2018. The highest ASMR was in North Africa in both 2012 and 2018, and the lowest ASMR was in Eastern Asia and South-Central Asia in 2012 and in South-Central Asia in 2018. The lowest MIR was in Australia in both 2012 and 2018, and the highest MIR was in Western Africa in both 2012 and 2018. HDI was strongly negatively correlated with MIR (r: -0.8810, P<0.0001, 2012; r: -0.8895, P<0.0001, 2018). Compared to the 2012 data, the MIR in the intermediate HDI countries significantly deceased and the HDI in low and high HDI countries significantly increased in 2018. CONCLUSION The MIR is negatively correlated with HDI. Increasing the HDI in low and intermediate HDI countries may reduce the MIR and increase the survival of patients with NHL.
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Affiliation(s)
- Wen-Fu Xu
- Department of Pediatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Auhui Medical University, Hefei, 230011, China
| | - Ping Yang
- Quality Control Department, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Auhui Medical University, Hefei, 230011, China
| | - Zhi-Wen Wei
- Department of Pediatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Auhui Medical University, Hefei, 230011, China
| | - Jin-Sheng Liu
- Department of Pediatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Auhui Medical University, Hefei, 230011, China
| | - Ren-Lin Yan
- Department of Pediatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Auhui Medical University, Hefei, 230011, China
| | - Qian Chen
- Department of Pediatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Auhui Medical University, Hefei, 230011, China
| | - Ren-Xiang Tong
- Department of Pediatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Auhui Medical University, Hefei, 230011, China
| | - Shuang-Yun Xu
- Department of Pediatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Auhui Medical University, Hefei, 230011, China
| | - Wan-Qing Gao
- Department of Pediatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Auhui Medical University, Hefei, 230011, China
| | - Wen Zhang
- Department of Pediatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Auhui Medical University, Hefei, 230011, China
| | - Zhen-Zhen Chang
- Department of Pediatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Auhui Medical University, Hefei, 230011, China
| | - Pei-Lin Wang
- Department of Pediatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Auhui Medical University, Hefei, 230011, China
| | - Hong-Juan Fang
- Department of Pediatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Auhui Medical University, Hefei, 230011, China
| | - Yun-Yun Zheng
- Department of Pediatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Auhui Medical University, Hefei, 230011, China
| | - Tao Wang
- Department of Pediatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Auhui Medical University, Hefei, 230011, China
| | - Na-Na Liu
- Department of Pediatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Auhui Medical University, Hefei, 230011, China
| | - Chao Yao
- Department of Pediatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Auhui Medical University, Hefei, 230011, China
| | - Yan-Li Liu
- Department of Pediatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Auhui Medical University, Hefei, 230011, China
| | - Wei Xia
- Department of Pediatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Auhui Medical University, Hefei, 230011, China
| | - Wei Zhao
- Department of Pediatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Auhui Medical University, Hefei, 230011, China
| | - Zhu-Jun Wang
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Sullivan R, Aggarwal A. Proposal to scrap England's long term plan for cancer. BMJ 2023; 380:326. [PMID: 36792136 DOI: 10.1136/bmj.p326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- Richard Sullivan
- Institute of Cancer Policy, Global Oncology Group, King's College London, UK
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Mahase E. Cancer: NHS plan is "no longer fit for purpose," researcher warns. BMJ 2022; 379:o2694. [PMID: 36351686 DOI: 10.1136/bmj.o2694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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da Silva RGD, Araujo CAS. Initiatives to reduce the waiting time to initiate oncological treatment: a scoping literature review. Rev Panam Salud Publica 2022; 46:e170. [PMID: 36382252 PMCID: PMC9642818 DOI: 10.26633/rpsp.2022.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/06/2022] [Indexed: 11/09/2022] Open
Abstract
Objective. To identify the managerial actions proposed and employed to reduce the waiting time to initiate oncological treatments in the public health system and its application in Latin America. Method. We searched seven databases in December 2020. Search terms were conceptualized into three groups: waiting time, cancer, and terms related to public sector. The eligibility criteria included theoretical or empirical academic articles written in English, Spanish, or Portuguese, that focused on managerial solutions to face oncological healthcare queues' dilemma. Results. The search returned 1 255 articles, and 20 were selected and analysed in this review. Results show that most of the proposals are related to the process and people dimensions. The actions related to the process dimension were mainly associated with programming new treatment pathways and integrating cancer systems. People's dimension initiatives referred mostly to task forces and groups of specialists. Some initiatives were related to implementing technological solutions and the technology dimension, mainly concerning radiotherapy devices' acquisition. Conclusion. Few studies focus on analysing actions to minimize waiting time to initiate oncological treatments. The prevalence of conceptual and illustrative case studies indicates the lack of research maturity on this theme. Future studies should focus on setting the field's theoretical foundations, considering the existing paradigms, or developing new ones. There is a need for empirical studies applying a multidisciplinary approach to face the oncological treatment waiting time challenge and proposing new and innovative initiatives.
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Dorn F, Lange B, Braml M, Gstrein D, Nyirenda JLZ, Vanella P, Winter J, Fuest C, Krause G. The challenge of estimating the direct and indirect effects of COVID-19 interventions - Toward an integrated economic and epidemiological approach. ECONOMICS AND HUMAN BIOLOGY 2022; 49:101198. [PMID: 36630757 PMCID: PMC9642024 DOI: 10.1016/j.ehb.2022.101198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 10/26/2022] [Accepted: 11/06/2022] [Indexed: 05/06/2023]
Abstract
Decisions on public health measures to contain a pandemic are often based on parameters such as expected disease burden and additional mortality due to the pandemic. Both pandemics and non-pharmaceutical interventions to fight pandemics, however, produce economic, social, and medical costs. The costs are, for example, caused by changes in access to healthcare, social distancing, and restrictions on economic activity. These factors indirectly influence health outcomes in the short- and long-term perspective. In a narrative review based on targeted literature searches, we develop a comprehensive perspective on the concepts available as well as the challenges of estimating the overall disease burden and the direct and indirect effects of COVID-19 interventions from both epidemiological and economic perspectives, particularly during the early part of a pandemic. We review the literature and discuss relevant components that need to be included when estimating the direct and indirect effects of the COVID-19 pandemic. The review presents data sources and different forms of death counts, and discusses empirical findings on direct and indirect effects of the pandemic and interventions on disease burden as well as the distribution of health risks.
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Affiliation(s)
- Florian Dorn
- ifo Institute - Leibniz Institute for Economic Research, Munich, Germany; Department of Economics, University of Munich (LMU), Germany; CESifo Munich, Germany.
| | - Berit Lange
- Epidemiology Department, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany; Hannover Medical School (MHH), Germany; German Center for Infection Research (DZIF), Braunschweig, Germany
| | - Martin Braml
- ifo Institute - Leibniz Institute for Economic Research, Munich, Germany; World Trade Organization, Economic Research and Statistics Division, Geneva, Switzerland
| | - David Gstrein
- ifo Institute - Leibniz Institute for Economic Research, Munich, Germany; Department of Economics, University of Munich (LMU), Germany
| | - John L Z Nyirenda
- Epidemiology Department, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany; University Hospital Freiburg, University of Freiburg, Germany
| | - Patrizio Vanella
- Epidemiology Department, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany; Hannover Medical School (MHH), Germany; Department of Health Reporting & Biometrics, aQua-Institut, Göttingen, Germany
| | - Joachim Winter
- Department of Economics, University of Munich (LMU), Germany; CESifo Munich, Germany
| | - Clemens Fuest
- ifo Institute - Leibniz Institute for Economic Research, Munich, Germany; Department of Economics, University of Munich (LMU), Germany; CESifo Munich, Germany
| | - Gérard Krause
- Epidemiology Department, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany; Hannover Medical School (MHH), Germany; German Center for Infection Research (DZIF), Braunschweig, Germany
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12
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Lin FPY, Salih OS, Scott N, Jameson MB, Epstein RJ. Development and Validation of a Machine Learning Approach Leveraging Real-World Clinical Narratives as a Predictor of Survival in Advanced Cancer. JCO Clin Cancer Inform 2022; 6:e2200064. [DOI: 10.1200/cci.22.00064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Predicting short-term mortality in patients with advanced cancer remains challenging. Whether digitalized clinical text can be used to build models to enhance survival prediction in this population is unclear. MATERIALS AND METHODS We conducted a single-centered retrospective cohort study in patients with advanced solid tumors. Clinical correspondence authored by oncologists at the first patient encounter was extracted from the electronic medical records. Machine learning (ML) models were trained using narratives from the derivation cohort, before being tested on a temporal validation cohort at the same site. Performance was benchmarked against Eastern Cooperative Oncology Group performance status (PS), comparing ML models alone (comparison 1) or in combination with PS (comparison 2), assessed by areas under receiver operating characteristic curves (AUCs) for predicting vital status at 11 time points from 2 to 52 weeks. RESULTS ML models were built on the derivation cohort (4,791 patients from 2001 to April 2017) and tested on the validation cohort of 726 patients (May 2017-June 2019). In 441 patients (61%) where clinical narratives were available and PS was documented, ML models outperformed the predictivity of PS (mean AUC improvement, 0.039, P < .001, comparison 1). Inclusion of both clinical text and PS in ML models resulted in further improvement in prediction accuracy over PS with a mean AUC improvement of 0.050 ( P < .001, comparison 2); the AUC was > 0.80 at all assessed time points for models incorporating clinical text. Exploratory analysis of oncologist's narratives revealed recurring descriptors correlating with survival, including referral patterns, mobility, physical functions, and concomitant medications. CONCLUSION Applying ML to oncologists' narratives with or without including patient's PS significantly improved survival prediction to 12 months, suggesting the utility of clinical text in building prognostic support tools.
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Affiliation(s)
- Frank Po-Yen Lin
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, Australia
- NHMRC Clinical Trials Centre, Sydney University, Camperdown, Australia
- Department of Medical Oncology, Waikato Hospital, Hamilton, New Zealand
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Osama S.M. Salih
- Department of Medical Oncology, Waikato Hospital, Hamilton, New Zealand
- Auckland City Hospital, Auckland, New Zealand
| | - Nina Scott
- Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
| | - Michael B. Jameson
- Department of Medical Oncology, Waikato Hospital, Hamilton, New Zealand
- Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
| | - Richard J. Epstein
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
- Cancer Research Division, Garvan Institute of Medical Research, Sydney, Australia
- New Hope Cancer Centre, Beijing United Hospital, Beijing, China
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13
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Sifaki-Pistolla D, Chatzea VE, Mechili EA, Koinis F, Georgoulias V, Lionis C, Tzanakis N. Spatio-Temporal Variation of Lung Cancer in Crete, 1992-2013. Economic or Health Crisis? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12161. [PMID: 36231462 PMCID: PMC9565984 DOI: 10.3390/ijerph191912161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: This is the first population-based study in Greece, with the aim to measure the changing trends of lung cancer (LC) and the associated risk factors before and after the economic crisis. Among the main objectives were the identification of LC hot spots and high-risk areas; (2) Methods: The study was conducted in Crete, the biggest island in Greece. Data (5057 LC cases) were collected from the Cancer Registry of Crete (CRC). The age-standardized incidence and mortality rates (ASIR, ASMR/100,000/year) were estimated, while additional indexes were used, including the adjusted Charlson's comorbidity index (CCI%), the deprivation index (HPI-2), and the exposure to outdoor air pollution (OAP). The analysis was performed for two time periods (Period A: 1992-2008; Period B: 2009-2013); (3) Results: ASIR presented a significant increase during the economic crisis, while an even higher increase was observed in ASMR (Period A: ASMR = 30.5/100,000/year; Period B: ASMR = 43.8/100,000/year; p < 0.001). After 2009, a significant increase in the observed LC hot spots was identified in several sub-regions in Crete (p = 0.04). The risk of LC mortality increased even more for smokers (RR = 5.7; 95%CI = 5.2-6.3) and those living in highly deprived geographical regions (RR = 5.4; 95%CI = 5.1-5.8) during the austerity period. The multiple effect of LC predictors resulted in adjusted RRs ranging from 0.7 to 5.7 within the island (p < 0.05); (4) Conclusions: The increased LC burden after the onset of the economic crisis, along with a changing pattern of LC predictors stressed the urgent need of geographically oriented interventions and cancer control programs focusing on the most deprived or vulnerable population groups.
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14
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Wang M, Liu Y, Ma Y, Li Y, Sun C, Cheng Y, Cheng P, Liu G, Zhang X. Association Between Cancer Prevalence and Different Socioeconomic Strata in the US: The National Health and Nutrition Examination Survey, 1999–2018. Front Public Health 2022; 10:873805. [PMID: 35937239 PMCID: PMC9355719 DOI: 10.3389/fpubh.2022.873805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background Inequality in health outcomes in relation to Americans' socioeconomic status (SES) is rising. American Cancer Society depicts that the most common cancers are diagnosed in men and women in 2021. We aim to study socioeconomic inequalities in related cancers to investigate whether the cancer prevalence differs within the family income to poverty ratio (PIR). Methods The study investigated data from adults aged 20–85 years participated in the 1999–2018 National Health and Nutrition Examination Survey (NHANES) who had complete data available on PIR and cancer or malignancy information (n = 49,720). Participants were stratified into 3 categories of PIR: high income (PIR ≥ 4), middle income (>1 and <4), or at or below the federal poverty level (≤1). Results The prevalence of prostate cancer was higher in the middle-income (3.61% [n = 464]) and high-income groups (3.36% [n = 227]) than in the low-income group (1.83% [n = 84], all p < 0.001). The prevalence of breast cancer was higher in middle-income (2.86% [n = 390]) and high-income participants (3.48% [n = 218]) than in low-income participants (2.00% [n = 117], all p < 0.001). Compared with the low-income group in men (0.48% [n = 22]), a higher prevalence of colon and rectum cancer occurs in the middle-income (0.87% [n = 112], p = 0.012) and high-income groups (0.89% [n = 58], p = 0.018). The prevalence of lung cancer in women was lower in high-income participants than middle-income participants (0.10% [n = 6] vs. 0.29% [n = 39], p = 0.014). Conclusions Increasing disparities in cancer prevalence were identified across all socioeconomic categories analyzed in this study. To ensure the sustainable development goals, it is a global health priority to understand inequalities in health and to target interventions accordingly.
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Affiliation(s)
- Mingsi Wang
- Department of Health Economics, College of Health Management of Harbin Medical University, Harbin, China
| | - Yang Liu
- School of Public Health, Harbin Medical University, Harbin, China
| | - Yi Ma
- Department of Health Economics, College of Health Management of Harbin Medical University, Harbin, China
| | - Yue Li
- Department of Health Economics, College of Health Management of Harbin Medical University, Harbin, China
| | - Chengyao Sun
- Department of Health Economics, College of Health Management of Harbin Medical University, Harbin, China
| | - Yi Cheng
- Department of Health Economics, College of Health Management of Harbin Medical University, Harbin, China
| | - Pengxin Cheng
- Department of Health Economics, College of Health Management of Harbin Medical University, Harbin, China
| | - Guoxiang Liu
- Department of Health Economics, College of Health Management of Harbin Medical University, Harbin, China
- *Correspondence: Guoxiang Liu
| | - Xin Zhang
- Department of Health Economics, College of Health Management of Harbin Medical University, Harbin, China
- Xin Zhang
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15
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Korkes F, Smaidi K, Timoteo F, Glina S. Recommendations for prostate cancer diagnosis and treatment during COVID-19 outbreak were not followed in Brazil. Int Braz J Urol 2022; 48:712-718. [PMID: 35195387 PMCID: PMC9306370 DOI: 10.1590/s1677-5538.ibju.2021.0673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/19/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
- Fernando Korkes
- Disciplina de Urologia, Faculdade de Medicina do ABC - FMABC, Santo André, SP, Brasil.,Serviço de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Khalil Smaidi
- Disciplina de Urologia, Faculdade de Medicina do ABC - FMABC, Santo André, SP, Brasil
| | - Frederico Timoteo
- Disciplina de Urologia, Faculdade de Medicina do ABC - FMABC, Santo André, SP, Brasil.,Serviço de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Sidney Glina
- Disciplina de Urologia, Faculdade de Medicina do ABC - FMABC, Santo André, SP, Brasil
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16
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Baker J, Krebill H, Kuo H, Chen RC, Thompson JA, Mayo MS, Mudaranthakam DP, Chollet-Hinton L. Rural–Urban Disparities in Health Access Factors Over Time: Implications for Cancer Prevention and Health Equity in the Midwest. Health Equity 2022; 6:382-389. [PMID: 35651355 PMCID: PMC9148661 DOI: 10.1089/heq.2021.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/12/2022] Open
Abstract
Purpose: Population-level environmental and socioeconomic factors may influence cancer burden within communities, particularly in rural and urban areas that may be differentially impacted by factors related to health care access. Methods: The University of Kansas (KU) Cancer Center serves a geographically large diverse region with 75% of its 123 counties classified as rural. Using County Health Rankings data and joinpoint regression, we examined trends in four factors related to the socioeconomic environment and health care access from 2009 to 2017 in rural and urban counties across the KU Cancer Center catchment area. Findings: The adult health uninsurance rate declined significantly in rural and urban counties across the catchment area (rural annual percent change [APC]=−5.96; 95% CI=[−7.71 to −4.17]; urban APC=−5.72; 95% CI=[−8.03 to −3.35]). Childhood poverty significantly decreased in rural counties over time (APC=−2.94; 95% CI=[−4.52 to −1.33]); in contrast, urban childhood poverty rates did not significantly change before 2012 (APC=3.68; 95% CI=[−15.12 to 26.65]), after which rates declined (APC=−5.89; 95% CI=[−10.01 to −1.58]). The number of primary care providers increased slightly but significantly in both rural and urban counties (APC=0.54; 95% CI=[0.28 to 0.80]), although urban counties had more primary care providers than rural areas (76.1 per 100K population vs. 57.1 per 100K population, respectively; p=0.009). Unemployment declined significantly faster in urban counties (APC=−10.33; 95% CI=[−12.16 to −8.47]) compared with rural counties (APC=−6.71; 95% CI=[−8.22 to −5.18]) (p=0.02). Conclusion: Our findings reveal potential disparities in systemic factors that may contribute to differences in cancer prevention, care, and survivorship in rural and urban regions.
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Affiliation(s)
- Jordan Baker
- Department of Biostatistics & Data Science, School of Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Hope Krebill
- University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, Kansas, USA
- Masonic Cancer Alliance, Fairway, Kansas, USA
| | - Hanluen Kuo
- University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, Kansas, USA
- Masonic Cancer Alliance, Fairway, Kansas, USA
| | - Ronald C. Chen
- University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, Kansas, USA
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jeffrey A. Thompson
- Department of Biostatistics & Data Science, School of Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
- University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Matthew S. Mayo
- Department of Biostatistics & Data Science, School of Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
- University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Dinesh Pal Mudaranthakam
- Department of Biostatistics & Data Science, School of Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
- University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Lynn Chollet-Hinton
- Department of Biostatistics & Data Science, School of Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
- University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, Kansas, USA
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17
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Khene ZE, Guérin S, Khene F, Pradère B, Roumiguié M, Mathieu R, Pignot G, Massard C, Neuzillet Y, Ploussard G, Bigot P, De la taille A, Rouprêt M, Bensalah K. Online Public Interest in Urological Cancers During the COVID-19 Pandemic: What Can “Dr. Google” Teach Us? EUR UROL SUPPL 2022; 37:73-79. [PMID: 35072118 PMCID: PMC8761543 DOI: 10.1016/j.euros.2022.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 01/23/2023] Open
Abstract
Background Objective Design, setting, and participants Outcome measurements and statistical analysis Results and limitations Conclusions Patient summary
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18
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CUNHA ARD, BIGONI A, ANTUNES JLF, HUGO FN. Impact of redistributing deaths by ill-defined causes in oral and oropharyngeal cancer mortality in Brazil. Braz Oral Res 2022; 36:e0117. [DOI: 10.1590/1807-3107bor-2022.vol36.0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 05/02/2022] [Indexed: 12/23/2022] Open
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19
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Ozturk H, Gumus C. COVID-19 outbreak may increase mortality rates in genitourinary cancers. Urol Ann 2022; 14:105-107. [PMID: 35711479 PMCID: PMC9197015 DOI: 10.4103/ua.ua_11_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/28/2021] [Indexed: 11/07/2022] Open
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20
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Bigoni A, Cunha ARD, Antunes JLF. Redistributing deaths by ill-defined and unspecified causes on cancer mortality in Brazil. Rev Saude Publica 2021; 55:106. [PMID: 34932696 PMCID: PMC8664061 DOI: 10.11606/s1518-8787.2021055003319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/25/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to discuss the impact four different redistribution strategies have on the quantitative and temporal trends of cancer mortality assessment in Brazil. METHODOLOGY This study used anonymized and georeferenced data provided by the Brazilian Ministry of Health (BMoH). Four different approaches were used to conduct the redistribution of ill-defined deaths and garbage codes. Age-standardized mortality rates used the world population as reference. Prais-Winsten autoregression allowed the calculation of region, sex, and cancer type trends. RESULTS Death rates increased considerably in all regions after redistribution. Overall, Elisabeth B. França’s and the World Health Organization methods had a milder impact on trends and rate magnitudes when compared to the Global Burden of Disease (GBD) 2010 method. This study also observed that, when the BMoH dealt with the problem of redistributing ill-defined deaths, results were similar to those obtained by the GBD method. The redistribution methods also influenced the assessment of trends; however, differences were less pronounced. CONCLUSIONS Since developing a comparative gold standard is impossible, matching global techniques to local realities may be an alternative for methodological selection. In our study, the compatibility of the findings suggests how valid the GBD method is to the Brazilian context. However, caution is needed. Future studies should assess the impact of these methods as applied to the redistribution of deaths to type-specific neoplasms.
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Affiliation(s)
- Alessandro Bigoni
- Universidade de São Paulo. Faculdade de Saúde Pública. São Paulo, SP, Brasil.,Harvard T.H. Chan School of Public Health. Fulbright Fellow. Boston, MA, United States of America
| | - Amanda Ramos da Cunha
- Universidade Federal do Rio Grande do Sul. Faculdade de Odontologia. Porto Alegre, RS, Brasil
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21
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Hu S, Zhang W, Guo Q, Ye J, Zhang D, Zhang Y, Zeng W, Yu D, Peng J, Wei Y, Xu J. Prognosis and Survival Analysis of 922,317 Lung Cancer Patients from the US Based on the Most Recent Data from the SEER Database (April 15, 2021). Int J Gen Med 2021; 14:9567-9588. [PMID: 34916838 PMCID: PMC8670860 DOI: 10.2147/ijgm.s338250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 11/30/2021] [Indexed: 12/24/2022] Open
Abstract
Background On April 15, 2021, the Surveillance, Epidemiology, and End Results (SEER) database released the latest lung cancer follow-up data. We selected 922,317 lung cancer patients diagnosed from 2000 to 2017 for survival analysis to provide updated data for lung cancer researchers. Research Question This study explored the latest trends of survival time in terms of gender, race, nationality, age, income, address, histological type and primary site. Study Design and Methods The SEER database covers 27.8% of the US population. We used life table, Kaplan-Meier, log-rank, Breslow and Tarone-Ware tests to calculate survival rate, time, and curve and to compare differences in survival distribution. We performed univariate and multivariate Cox proportional hazards analyses. Results The median survival time of all lung cancer patients diagnosed in 2017 increased by 41.72% compared to 2000. Median survival time of female patients diagnosed in 2017 increased by 70.94% compared to 2000. Median survival time of those diagnosed in 2017 for different primary sites was as follows: right middle lobe was the longest, then left lower lobe, right upper lobe, right lower lobe, and left upper lobe. Lung cancer patients older than 75 years had a significantly shorter median survival time. Patients living in metropolitan areas of 250,000 to 1 million had a longer median survival time. Median survival time in the adenocarcinoma group was significantly greater than other patients. Median survival of Asian and other races diagnosed in 2017 was 97.87% higher than those diagnosed in 2000. Survival rate of lung cancer increased gradually with the year of diagnosis. Interpretation The rapid improvement of the prognosis of female and young lung cancer patients contributes to the improvement of the overall prognosis. Primary lung cancer in the right middle lobe has the best prognosis.
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Affiliation(s)
- Sheng Hu
- Department of Thoracic Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Wenxiong Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Qiang Guo
- Department of Thoracic Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Jiayue Ye
- Department of Thoracic Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Deyuan Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Yang Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Weibiao Zeng
- Department of Thoracic Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Dongliang Yu
- Department of Thoracic Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Jinhua Peng
- Department of Thoracic Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Yiping Wei
- Department of Thoracic Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Jianjun Xu
- Department of Thoracic Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People's Republic of China
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22
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Fedewa SA, Yabroff KR, Bandi P, Smith RA, Nargis N, Zheng Z, Drope J, Jemal A. Unemployment and cancer screening: Baseline estimates to inform health care delivery in the context of COVID-19 economic distress. Cancer 2021; 128:737-745. [PMID: 34747008 PMCID: PMC8653134 DOI: 10.1002/cncr.33966] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/03/2021] [Accepted: 09/13/2021] [Indexed: 11/22/2022]
Abstract
Background During the coronavirus disease 2019 pandemic, US unemployment rates rose to historic highs, and they remain nearly double those of prepandemic levels. Employers are the most common source of health insurance among nonelderly adults. Thus, job loss may lead to a loss of health insurance and reduce access to cancer screening. This study examined associations between unemployment, health insurance, and cancer screening to inform the pandemic's potential impacts on early cancer detection. Methods Up‐to‐date and past‐year breast, cervical, colorectal, and prostate cancer screening prevalences were computed for nonelderly respondents (aged <65 years) with 2000‐2018 National Health Interview Survey data. Multivariable logistic regression models with marginal probabilities were used to estimate unemployed‐versus‐employed unadjusted and adjusted prevalence ratios. Results Unemployed adults (2000‐2018) were 4 times more likely to lack insurance than employed adults (41.4% vs 10.0%; P < .001). Unemployed adults had a significantly lower up‐to‐date prevalence of screening for cervical cancer (78.5% vs 86.2%; P < .001), breast cancer (67.8% vs 77.5%; P < .001), colorectal cancer (41.9 vs 48.5%; P < .001), and prostate cancer (25.4% vs 36.4%; P < .001). These differences were eliminated after accounting for health insurance coverage. Conclusions Unemployment was adversely associated with up‐to‐date cancer screening, and this was fully explained by a lack of health insurance. Ensuring the continuation of health insurance coverage after job loss may mitigate the pandemic's economic distress and future economic downturns' impact on cancer screening. Unemployment is adversely associated with up‐to‐date cancer screening, and this is fully explained by a lack of health insurance.
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Affiliation(s)
- Stacey A Fedewa
- Surveillance and Health Equity Sciences, Office of Cancer Research and Implementation, American Cancer Society, Atlanta, Georgia
| | - K Robin Yabroff
- Surveillance and Health Equity Sciences, Office of Cancer Research and Implementation, American Cancer Society, Atlanta, Georgia
| | - Priti Bandi
- Surveillance and Health Equity Sciences, Office of Cancer Research and Implementation, American Cancer Society, Atlanta, Georgia
| | - Robert A Smith
- Early Detection and Screening, Office of Cancer Research and Implementation, American Cancer Society, Atlanta, Georgia
| | - Nigar Nargis
- Surveillance and Health Equity Sciences, Office of Cancer Research and Implementation, American Cancer Society, Atlanta, Georgia
| | - Zhiyuan Zheng
- Surveillance and Health Equity Sciences, Office of Cancer Research and Implementation, American Cancer Society, Atlanta, Georgia
| | - Jeffrey Drope
- Healthy Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Ahmedin Jemal
- Surveillance and Health Equity Sciences, Office of Cancer Research and Implementation, American Cancer Society, Atlanta, Georgia
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23
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Duggan C, Trapani D, Ilbawi AM, Fidarova E, Laversanne M, Curigliano G, Bray F, Anderson BO. National health system characteristics, breast cancer stage at diagnosis, and breast cancer mortality: a population-based analysis. Lancet Oncol 2021; 22:1632-1642. [PMID: 34653370 DOI: 10.1016/s1470-2045(21)00462-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND In some countries, breast cancer age-standardised mortality rates have decreased by 2-4% per year since the 1990s, but others have yet to achieve this outcome. In this study, we aimed to characterise the associations between national health system characteristics and breast cancer age-standardised mortality rate, and the degree of breast cancer downstaging correlating with national age-standardised mortality rate reductions. METHODS In this population-based study, national age-standardised mortality rate estimates for women aged 69 years or younger obtained from GLOBOCAN 2020 were correlated with a broad panel of standardised national health system data as reported in the WHO Cancer Country Profiles 2020. These health system characteristics include health expenditure, the Universal Health Coverage Service Coverage Index (UHC Index), dedicated funding for early detection programmes, breast cancer early detection guidelines, referral systems, cancer plans, number of dedicated public and private cancer centres per 10 000 patients with cancer, and pathology services. We tested for differences between continuous variables using the non-parametric Kruskal-Wallis test, and for categorical variables using the Pearson χ2 test. Simple and multiple linear regression analyses were fitted to identify associations between health system characteristics and age-standardised breast cancer mortality rates. Data on TNM stage at diagnosis were obtained from national or subnational cancer registries, supplemented by a literature review of PubMed from 2010 to 2020. Mortality trends from 1950 to 2016 were assessed using the WHO Cancer Mortality Database. The threshold for significance was set at a p value of 0·05 or less. FINDINGS 148 countries had complete health system data. The following variables were significantly higher in high-income countries than in low-income countries in unadjusted analyses: health expenditure (p=0·0002), UHC Index (p<0·0001), dedicated funding for early detection programmes (p=0·0020), breast cancer early detection guidelines (p<0·0001), breast cancer referral systems (p=0·0030), national cancer plans (p=0·014), cervical cancer early detection programmes (p=0·0010), number of dedicated public (p<0·0001) and private (p=0·027) cancer centres per 10 000 patients with cancer, and pathology services (p<0·0001). In adjusted multivariable regression analyses in 141 countries, two health system characteristics were significantly associated with lower age-standardised mortality rates: higher UHC Index levels (β=-0·12, 95% CI -0·16 to -0·08) and increasing numbers of public cancer centres (β=-0·23, -0·36 to -0·10). These findings indicate that each unit increase in the UHC Index was associated with a 0·12-unit decline in age-standardised mortality rates, and each additional public cancer centre per 10 000 patients with cancer was associated with a 0·23-unit decline in age-standardised mortality rate. Among 35 countries with available breast cancer TNM staging data, all 20 that achieved sustained mean reductions in age-standardised mortality rate of 2% or more per year for at least 3 consecutive years since 1990 had at least 60% of patients with invasive breast cancer presenting as stage I or II disease. Some countries achieved this reduction without most women having access to population-based mammographic screening. INTERPRETATION Countries with low breast cancer mortality rates are characterised by increased levels of coverage of essential health services and higher numbers of public cancer centres. Among countries achieving sustained mortality reductions, the majority of breast cancers are diagnosed at an early stage, reinforcing the value of clinical early diagnosis programmes for improving breast cancer outcomes. FUNDING None.
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Affiliation(s)
- Catherine Duggan
- Breast Health Global Initiative, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Dario Trapani
- World Health Organization, Geneva, Switzerland; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; European Institute of Oncology, IRCCS, Milan, Italy
| | | | | | | | - Giuseppe Curigliano
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; European Institute of Oncology, IRCCS, Milan, Italy
| | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | - Benjamin O Anderson
- Breast Health Global Initiative, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; World Health Organization, Geneva, Switzerland; Departments of Surgery and Global Health, University of Washington, Seattle, WA, USA.
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Campbell C, Sommerfield T, Clark GRC, Porteous L, Milne AM, Millar R, Syme T, Thomson CS. COVID-19 and cancer screening in Scotland: A national and coordinated approach to minimising harm. Prev Med 2021; 151:106606. [PMID: 34217418 PMCID: PMC8241681 DOI: 10.1016/j.ypmed.2021.106606] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023]
Abstract
Screening is an important component of cancer control internationally. In Scotland, the National Health Service Scotland provides screening programmes for cervical, bowel and breast cancers. The COVID-19 pandemic resulted in the suspension of these programmes in March 2020. We describe the integrated approach to managing the impact of the pandemic on cancer screening programmes in Scotland throughout 2020. We outline the policy context and decision-making process leading to suspension, and the criteria and framework informing the subsequent, staggered, restart in subsequent months. The decision to suspend screening services in order to protect screening invitees and staff, and manage NHS capacity, was made after review of numbers of screening participants likely to be affected, and the potential number of delayed cancer diagnoses. Restart principles and a detailed route map plan were developed for each programme, seeking to ensure broad consistency of approach across the programmes and nationally. Early data indicates bowel, breast and cervical screening participation has increased since restart. Primary care has had to adapt to new infection prevention control measures for delivery of cervical screening. Cancer charities provided cancer intelligence and policy briefs to national bodies and Scottish Government, as well as supporting the public, patients and screening invitees through information and awareness campaigns. Emerging from the pandemic, there is recognition of the need and the opportunity to transform and renew both cancer and screening services in Scotland, and in particular to address long-standing workforce capacity problems through innovation and investment, and to continue to prioritise addressing health inequalities.
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Affiliation(s)
| | - Tasmin Sommerfield
- Consultant in Public Health Medicine for National Screening Programmes, NHS National Services Scotland, 1 South Gyle Crescent, Edinburgh EH12 9EB, UK
| | - Gavin R C Clark
- Public Health Scotland, Edinburgh, Gyle Square, 1 South Gyle Crescent, Edinburgh EH12 9EB, UK
| | - Lorna Porteous
- GP Lead Cancer and Palliative Care, NHS Lothian, Waverley Gate, 2-4 Waterloo Place, Edinburgh EH1 3EG, UK
| | - Alison M Milne
- Detect Cancer Early, NHS Lothian, Waverley Gate, 2-4 Waterloo Place, Edinburgh EH1 3EG, UK
| | - Rosemary Millar
- Consultant in Public Health Medicine for NHS Lothian, Public Health & Health Policy, Waverley Gate, 2-4 Waterloo Place, Edinburgh EH1 3EG, UK
| | - Tracey Syme
- National Specialist and Screening Directorate (NSD), NHS National Services Scotland, 1 South Gyle Crescent, Edinburgh EH12 9EB, UK
| | - Catherine S Thomson
- Public Health Scotland, Edinburgh, Gyle Square, 1 South Gyle Crescent, Edinburgh EH12 9EB, UK
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25
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Atalay K, Edwards R, Schurer S, Ubilava D. Lives saved during economic downturns: Evidence from Australia. HEALTH ECONOMICS 2021; 30:2452-2467. [PMID: 34268828 DOI: 10.1002/hec.4394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 04/02/2021] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
Worldwide, countries have been restricting work and social activities to counter the emerging public health crisis due to the coronavirus pandemic. These measures have caused dramatic increases in unemployment. Some commentators argue that the "draconian measures" will do more harm than good due to the economic contraction, despite a large literature that finds mortality rates decline during recessions. We estimate the relationship between unemployment, a proxy for economic climate, and mortality in Australia, a country with universal health care. Using administrative time-series data on mortality by state, age, sex, and cause of death for 1979-2017, we find no relationship between unemployment and mortality on average. However, we observe beneficial health effects in economic downturns for young men, associated with a reduction in transport accidents. Our estimates imply 431 fewer deaths in 2020 if unemployment rates double as forecast. For the early 1980s, we find a procyclical pattern in infant mortality rates. However, this pattern disappears starting from the mid-1980s, coincident with the 1984 implementation of universal health care. Our results suggest that universal health care may insulate individuals from the health effects of macroeconomic fluctuations.
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Affiliation(s)
- Kadir Atalay
- The University of Sydney, School of Economics, Sydney, Australia
| | - Rebecca Edwards
- The University of Sydney, School of Economics, Sydney, Australia
| | - Stefanie Schurer
- The University of Sydney, School of Economics, Sydney, Australia
- IZA Bonn, Bonn, Germany
| | - David Ubilava
- The University of Sydney, School of Economics, Sydney, Australia
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26
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Lu PW, Semeniv S, Shabat G, Welten V, Pylypchuk VI, Galyuk V, Fields AC, Melnitchouk N. Barriers to Evidence-Based Colorectal Cancer Care in Ukraine. World J Surg 2021; 45:3288-3294. [PMID: 34342687 DOI: 10.1007/s00268-021-06267-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The incidence of colorectal cancer (CRC) is increasing in many low- to middle-income countries, including Ukraine. Ukraine reports high mortality rates in CRC patients. To identify potential areas for targeted interventions to improve CRC care in Ukraine, we investigated Ukrainian clinician perspectives on evidence-based CRC treatment guidelines. METHODS An explanatory sequential mixed-methods study design was used. A survey was administered to attendees of a regional surgical conference. Semi-structured interviews were subsequently performed with practicing clinicians in Ukraine. Interviews were coded to identify prominent themes. RESULTS Quantitative: 105 clinicians completed the survey. 76% of respondents reported using guidelines in daily practice. Lack of English proficiency was cited by 28.6% of respondents as a barrier to guideline use. Improved knowledge and additional financial resources were reported as factors that would be helpful in providing evidence-based care. QUANTITATIVE 15 clinicians were interviewed. Two major themes were identified: limitations in access to the medical literature resources (language barriers and financial barriers), and sense of clinician initiative and willingness to learn despite hardships. CONCLUSIONS Clinicians in Ukraine have positive perspectives on utilization of evidence-based CRC treatment guidelines. However, they face major barriers in accessing resources needed to keep up-to-date on the current literature. Fortunately, there exists both willingness and initiative on the clinician level to pursue continuing education. Efforts should be made on the international society level to improve open-access and foreign language translation availability to support physicians in Ukraine and other low- to middle-income countries.
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Affiliation(s)
- Pamela W Lu
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Solomiia Semeniv
- National Children's Specialized Hospital "Ohmatdyt", Kyiv, Ukraine
| | - Galyna Shabat
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.,Department of Surgery, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Vanessa Welten
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Volodymyr I Pylypchuk
- Department of Surgery, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Volodymyr Galyuk
- Department of Surgery, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Adam C Fields
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Nelya Melnitchouk
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. .,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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27
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Vasta LM, Zanetti RC, Anderson AB, Zhu K, Potter BK, Park AB, Lin J, Shriver CD, Warwick AB. Survival in Pediatric, Adolescent, and Young Adult Patients With Sarcoma in the Military Health System: Comparison With the SEER Population. J Pediatr Hematol Oncol 2021; 43:e832-e840. [PMID: 34397617 DOI: 10.1097/mph.0000000000002188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 03/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND We sought to compare survival outcomes of sarcomas in the pediatric and adolescent/young adult populations with universal care access in the Military Health System (MHS) to those from the United States general population. METHODS We compared data from the Department of Defense's (DoD) Automated Central Tumor Registry (ACTUR) and the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) program on the overall survival of patients 24 years or younger with histologically or microscopically confirmed sarcoma between diagnosed between January 1, 1987, and December 31, 2013. The Kaplan-Meier survival curves were used to compare survival between the 2 patient populations. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) comparing ACTUR relative to SEER. RESULTS The final analysis included 309 and 1236 bone sarcoma cases and 465 and 1860 soft tissue sarcoma cases from ACTUR and SEER, respectively. Cox proportional hazards analysis showed soft tissue sarcoma patients in ACTUR had significantly better overall (HR=0.73, 95% CI=0.55-0.98) and 5-year overall (HR=0.63, 95% CI=0.46-0.86) survival compared with SEER patients, but no significant difference in overall or 5-year overall survival between ACTUR and SEER patients with bone sarcoma. CONCLUSION Survival data from the ACTUR database demonstrated significantly improved overall survival for soft tissue sarcomas and equivalent survival in bone sarcomas compared with that reported by SEER.
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Affiliation(s)
- Lauren M Vasta
- Departments of Pediatrics (Hematology and Oncology)
- National Capital Consortium, Walter Reed National Military Medical Center
| | - Richard C Zanetti
- Departments of Pediatrics (Hematology and Oncology)
- National Capital Consortium, Walter Reed National Military Medical Center
| | | | - Kangmin Zhu
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center
- Department of Surgery, Uniformed Services University of the Health Sciences
- Henry M. Jackson Foundation for the Advancement of Military Medicine
- Departments of Preventative Medicine and Biostatistics
| | | | - Amie B Park
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center
- Henry M. Jackson Foundation for the Advancement of Military Medicine
| | - Jie Lin
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center
- Department of Surgery, Uniformed Services University of the Health Sciences
- Henry M. Jackson Foundation for the Advancement of Military Medicine
| | - Craig D Shriver
- John P. Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center
- Department of Surgery, Uniformed Services University of the Health Sciences
| | - Anne B Warwick
- Departments of Pediatrics (Hematology and Oncology)
- Pediatrics, Uniformed Services University, Bethesda, MD
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Risk of COVID-19 variant importation - How useful are travel control measures? Infect Dis Model 2021; 6:875-897. [PMID: 34308002 PMCID: PMC8272889 DOI: 10.1016/j.idm.2021.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/18/2021] [Accepted: 06/20/2021] [Indexed: 12/24/2022] Open
Abstract
We consider models for the importation of a new variant COVID-19 strain in a location already seeing propagation of a resident variant. By distinguishing contaminations generated by imported cases from those originating in the community, we are able to evaluate the contribution of importations to the dynamics of the disease in a community. We find that after an initial seeding, the role of importations becomes marginal compared to that of community-based propagation. We also evaluate the role of two travel control measures, quarantine and travel interruptions. We conclude that quarantine is an efficacious way of lowering importation rates, while travel interruptions have the potential to delay the consequences of importations but need to be applied within a very tight time window following the initial emergence of the variant.
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29
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Lu B, Li N, Luo CY, Cai J, Lu M, Zhang YH, Chen HD, Dai M. Colorectal cancer incidence and mortality: the current status, temporal trends and their attributable risk factors in 60 countries in 2000-2019. Chin Med J (Engl) 2021; 134:1941-1951. [PMID: 34238851 PMCID: PMC8382382 DOI: 10.1097/cm9.0000000000001619] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Globally, colorectal cancer (CRC) imposes a substantial burden on healthcare systems and confers considerable medical expenditures. We aimed to evaluate the global and regional burden in epidemiological trends and factors associated with the incidence and mortality of CRC. METHODS We used data from the GLOBOCAN database to estimate CRC incidence and mortality worldwide in 2020 and their association with the human development index (HDI). Trends of age-standardized rates of incidence and mortality in 60 countries (2000-2019) were evaluated by Joinpoint regression analysis using data of Global Burden of Disease 2019. The association between exposure to country-level lifestyle, metabolic and socioeconomic factors obtained from the World Health Organization Global Health Observatory and World Bank DataBank data and CRC incidence and mortality was determined by multivariable linear regression. RESULTS CRC incidence and mortality varied greatly in the 60 selected countries, and much higher incidence and mortality were observed in countries with higher HDIs, and vice versa. From 2000 to 2019, significant increases of incidence and mortality were observed for 33 countries (average annual percent changes [AAPCs], 0.24-3.82) and 18 countries (AAPCs, 0.41-2.22), respectively. A stronger increase in incidence was observed among males (AAPCs, 0.36-4.54) and individuals <50 years (AAPCs, 0.56-3.86). Notably, 15 countries showed significant decreases in both incidence (AAPCs, -0.24 to -2.19) and mortality (AAPCs, -0.84 to -2.74). A significant increase of incidence among individuals <50 years was observed in 30 countries (AAPCs, 0.28-3.62). Countries with higher incidence were more likely to have a higher prevalence of alcohol drinking, higher level of cholesterol level, higher level of unemployment, and a poorer healthcare system. CONCLUSIONS Some high-HDI countries showed decreasing trends in CRC incidence and mortality, whereas developing countries that previously had low disease burden showed significantly increased incidence and mortality trends, especially in males and populations ≥50 years, which require targeted preventive health programs.
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Affiliation(s)
- Bin Lu
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Na Li
- Department of Cancer Prevention, Hunan Cancer Hospital, Changsha, Hunan 410006, China
| | - Chen-Yu Luo
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jie Cai
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Ming Lu
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yu-Han Zhang
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Hong-Da Chen
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Min Dai
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Vázquez Rosas T, Cazap E, Delgado L, Ismael J, Bejarano S, Castro C, Castro H, Müller B, Gutiérrez-Delgado F, Santini LA, Vallejos Sologuren C. Social Distancing and Economic Crisis During COVID-19 Pandemic Reduced Cancer Control in Latin America and Will Result in Increased Late-Stage Diagnoses and Expense. JCO Glob Oncol 2021; 7:694-703. [PMID: 33999696 PMCID: PMC8162975 DOI: 10.1200/go.21.00016] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Since December 2019, the world has been mired in an infectious pandemic that has displaced other health priorities for 21st century populations. Concerned about this situation, Latin American experts on cancer decided to evaluate the impact of the pandemic on cancer control in the region. The analysis was based on information obtained from public sources and scientific publications and included the characteristics of the health care and cancer control prior to the pandemic, the COVID-19 pandemic and measures implemented by the governments of the region, and the regional impact of the pandemic on cancer control together with the costs of cancer care and possible impact of the pandemic on cancer expense. We compared 2019 and 2020 data corresponding to the period March 16-June 30 and found a significant reduction in the number of first-time visits to oncology services (variable depending on the country between –28% and –38%) and a corresponding reduction in pathology (between –6% and –50%), cancer surgery (between –28% and –70%), and chemotherapy (between –2% and –54%). Furthermore, a significant reduction in cancer screening tests was found (PAP smear test studies: between –46% and –100%, mammography: between –32% and –100%, and fecal occult blood test: –73%). If this situation becomes a trend, the health and economic impact will be compounded in the postpandemic period, with an overload of demand on health services to ensure diagnostic tests and consequent treatments. On the basis of this information, a set of prevention and mitigation measures to be immediately implemented and also actions to progressively strengthen health systems are proposed.
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Affiliation(s)
| | - Eduardo Cazap
- Latin-American and Caribbean Society of Medical Oncology-SLACOM, Buenos Aires, Argentina
| | - Lucía Delgado
- Clinical Oncology, Universidad de la República, Former Director of the National Cancer Control Program, Montevideo, Uruguay
| | - Julia Ismael
- Clinical Oncology, Former Director of National Cancer Institute, Buenos Aires, Argentina
| | | | | | | | | | | | - Luiz Antonio Santini
- Oswaldo Cruz Foundation (Fiocruz), Former Director of National Cancer Institute, Rio de Janeiro, Brazil
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Abstract
Seasonal influenza kills many hundreds of thousands of people every year. We argue that the current pandemic has lessons we should learn concerning how we should respond to it. Our response to the COVID-19 not only provides us with tools for confronting influenza; it also changes our sense of what is possible. The recognition of how dramatic policy responses to COVID-19 were and how widespread their general acceptance has been allowed us to imagine new and more sweeping responses to influenza. In fact, we not only can grasp how we can reduce its toll; this new knowledge entails new responsibilities to do so. We outline a range of potential interventions to alter social norms and to change structures to reduce influenza transmission, and consider ethical objections to our proposals.
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Affiliation(s)
- Neil Levy
- Uehiro Centre for Practical Ethics, University of Oxford
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Gheorghe A, Maringe C, Spice J, Purushotham A, Chalkidou K, Rachet B, Sullivan R, Aggarwal A. Economic impact of avoidable cancer deaths caused by diagnostic delay during the COVID-19 pandemic: A national population-based modelling study in England, UK. Eur J Cancer 2021; 152:233-242. [PMID: 34049776 PMCID: PMC8530528 DOI: 10.1016/j.ejca.2021.04.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/08/2021] [Accepted: 04/20/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Delays in cancer diagnosis arose from the commencement of non-pharmaceutical interventions (NPI) introduced in the UK in March 2020 in response to the COVID-19 pandemic. Our earlier work predicted this will lead to approximately 3620 avoidable deaths for four major tumour types (breast, bowel, lung, and oesophageal cancer) in the next 5 years. Here, using national population-based modelling, we estimate the health and economic losses resulting from these avoidable cancer deaths. We also compare these with the impact of an equivalent number of COVID-19 deaths to understand the welfare consequences of the different health conditions. METHODS We estimate health losses using quality-adjusted life years (QALYs) and lost economic productivity using the human capital (HC) approach. The analysis uses linked English National Health Service (NHS) cancer registration and hospital administrative datasets for patients aged 15-84 years, diagnosed with breast, colorectal, and oesophageal cancer between 1st Jan to 31st Dec 2010, with follow-up data until 31st Dec 2014, and diagnosed with lung cancer between 1st Jan to 31st Dec 31 2012, with follow-up data until 31st Dec 2015. Productivity losses are based on the estimation of excess additional deaths due to cancer at 1, 3 and 5 years for the four cancer types, which were derived from a previous analysis using this dataset. A total of 500 random samples drawn from the total number of COVID-19 deaths reported by the Office for National Statistics, stratified by gender, were used to estimate productivity losses for an equivalent number of deaths (n = 3620) due to SARS-CoV-2 infection. RESULTS We collected data for 32,583 patients with breast cancer, 24,975 with colorectal cancer, 6744 with oesophageal cancer, and 29,305 with lung cancer. We estimate that across the four site-specific cancers combined in England alone, additional excess cancer deaths would amount to a loss of 32,700 QALYs (95% CI 31,300-34,100) and productivity losses of £103.8million GBP (73.2-132.2) in the next five years. For breast cancer, we estimate a loss of 4100 QALYS (3900-4400) and productivity losses of £23.2 m (18.2-28.6); for colorectal cancer, 15,000 QALYS (14,100-16,000) lost and productivity losses of £35.7 m (22.4-48.7); for lung cancer 10,900 QALYS (9,900-11,700) lost and productivity losses of £38.3 m (14.0-59.9) for lung cancer; and for oesophageal cancer, 2700 QALYS (2300-3,100) lost and productivity losses of £6.6 m (-6 to -17.6). In comparison, the equivalent number of COVID-19 deaths caused approximately 21,450 QALYs lost, as well as productivity losses amounting to £76.4 m (73.5-79.2). CONCLUSION Premature cancer deaths resulting from diagnostic delays during the first wave of the COVID-19 pandemic in the UK will result in significant economic losses. On a per-capita basis, this impact is, in fact, greater than that of deaths directly attributable to COVID-19. These results emphasise the importance of robust evaluation of the trade-offs of the wider health, welfare and economic effects of NPI to support both resource allocation and the prioritisation of time-critical health services directly impacted in a pandemic, such as cancer care.
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Affiliation(s)
- Adrian Gheorghe
- Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London
| | - Camille Maringe
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - James Spice
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom; Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Arnie Purushotham
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom; Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Kalipso Chalkidou
- Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London
| | - Bernard Rachet
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Richard Sullivan
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom; Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Institute of Cancer Policy, King's College London, London, United Kingdom
| | - Ajay Aggarwal
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Institute of Cancer Policy, King's College London, London, United Kingdom; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Whittaker TM, Abdelrazek MEG, Fitzpatrick AJ, Froud JLJ, Kelly JR, Williamson JS, Williams GL. Delay to elective colorectal cancer surgery and implications for survival: a systematic review and meta-analysis. Colorectal Dis 2021; 23:1699-1711. [PMID: 33714235 PMCID: PMC8251304 DOI: 10.1111/codi.15625] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/26/2021] [Accepted: 02/21/2021] [Indexed: 12/11/2022]
Abstract
AIM The Covid-19 pandemic has delayed elective colorectal cancer (CRC) surgery. The aim of this study was to see whether or not this may affect overall survival (OS) and disease-free survival (DFS). METHOD A systematic review was carried out according to PRISMA guidelines (PROSPERO ID: CRD42020189158). Medline, EMBASE and Scopus were interrogated. Patients aged over 18 years with a diagnosis of colon or rectal cancer who received elective surgery as their primary treatment were included. Delay to elective surgery was defined as the period between CRC diagnosis and the day of surgery. Meta-analysis of the outcomes OS and DFS were conducted. Forest plots, funnel plots and tests of heterogeneity were produced. An estimated number needed to harm (NNH) was calculated for statistically significant pooled hazard ratios (HRs). RESULTS Of 3753 articles identified, seven met the inclusion criteria. Encompassing 314 560 patients, three of the seven studies showed that a delay to elective resection is associated with poorer OS or DFS. OS was assessed at a 1 month delay, the HR for six datasets was 1.13 (95% CI 1.02-1.26, p = 0.020) and at 3 months the pooled HR for three datasets was 1.57 (95% CI 1.16-2.12, p = 0.004). The estimated NNH for a delay at 1 month and 3 months was 35 and 10 respectively. Delay was nonsignificantly negatively associated with DFS on meta-analysis. CONCLUSION This review recommends that elective surgery for CRC patients is not postponed longer than 4 weeks, as available evidence suggests extended delays from diagnosis are associated with poorer outcomes. Focused research is essential so patient groups can be prioritized based on risk factors in future delays or pandemics.
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da Cunha AR, Bigoni A, Antunes JLF, Hugo FN. The impact of inequalities and health expenditure on mortality due to oral and oropharyngeal cancer in Brazil. Sci Rep 2021; 11:12845. [PMID: 34145332 PMCID: PMC8213849 DOI: 10.1038/s41598-021-92207-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/07/2021] [Indexed: 11/30/2022] Open
Abstract
This study aims to assess the magnitude and trend of mortality rates due to oral (OC) and oropharyngeal cancer (OPC) in the 133 Intermediate Geographic Regions (IGR) of Brazil between 1996 and 2018 and to analyze its association with sociodemographic variables and provision of health services. It also aims to compare the trend of mortality from neoplasms that have been reported as associated with HPV (OPC) with the trend of neoplasms that have been reported as not associated with HPV (OC). We obtained mortality data from the Mortality Information System in Brazil and analyzed the trends using the Prais-Winsten method. Then, we assessed the relationship between mortality trends and socioeconomic, health spending, and health services provision variables. The median of the annual percent change of the country’s mortality rates was 0.63% for OC and 0.83% for OPC. Trends in mortality in the IGRs correlated significantly with the Human Development Index and government expenditure on ambulatory health care and hospitalizations. Mortality from both types of cancer decreased in those IGR in which the government spent more on health and in the more socioeconomically developed ones. This study found no epidemiological indication that HPV plays the leading etiological factor in OPC in Brazil.
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Affiliation(s)
- Amanda Ramos da Cunha
- Faculty of Dentistry, Federal University of Rio Grande do Sul, 2492 Ramiro Barcelos St, Porto Alegre, RS, 90035-003, Brazil.
| | - Alessandro Bigoni
- School of Public Health, University of São Paulo, 715 Doutor Arnaldo Ave, São Paulo, SP, 01246-904, Brazil
| | | | - Fernando Neves Hugo
- Faculty of Dentistry, Federal University of Rio Grande do Sul, 2492 Ramiro Barcelos St, Porto Alegre, RS, 90035-003, Brazil
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DeBoer RJ, Mutoniwase E, Nguyen C, Ho A, Umutesi G, Nkusi E, Sebahungu F, Van Loon K, Shulman LN, Shyirambere C. Moral Distress and Resilience Associated with Cancer Care Priority Setting in a Resource-Limited Context. Oncologist 2021; 26:e1189-e1196. [PMID: 33969927 PMCID: PMC8265342 DOI: 10.1002/onco.13818] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 05/05/2021] [Indexed: 12/24/2022] Open
Abstract
Background Moral distress and burnout are highly prevalent among oncology clinicians. Research is needed to better understand how resource constraints and systemic inequalities contribute to moral distress in order to develop effective mitigation strategies. Oncology providers in low‐ and middle‐income countries are well positioned to provide insight into the moral experience of cancer care priority setting and expertise to guide solutions. Methods Semistructured interviews were conducted with a purposive sample of 22 oncology physicians, nurses, program leaders, and clinical advisors at a cancer center in Rwanda. Interviews were recorded, transcribed verbatim, and analyzed using the framework method. Results Participants identified sources of moral distress at three levels of engagement with resource prioritization: witnessing program‐level resource constraints drive cancer disparities, implementing priority setting decisions into care of individual patients, and communicating with patients directly about resource prioritization implications. They recommended individual and organizational‐level interventions to foster resilience, such as communication skills training and mental health support for clinicians, interdisciplinary team building, fair procedures for priority setting, and collective advocacy for resource expansion and equity. Conclusion This study adds to the current literature an in‐depth examination of the impact of resource constraints and inequities on clinicians in a low‐resource setting. Effective interventions are urgently needed to address moral distress, reduce clinician burnout, and promote well‐being among a critical but strained oncology workforce. Collective advocacy is concomitantly needed to address the structural forces that constrain resources unevenly and perpetuate disparities in cancer care and outcomes. Implications for Practice For many oncology clinicians worldwide, resource limitations constrain routine clinical practice and necessitate decisions about prioritizing cancer care. To the authors’ knowledge, this study is the first in‐depth analysis of how resource constraints and priority setting lead to moral distress among oncology clinicians in a low‐resource setting. Effective individual and organizational interventions and collective advocacy for equity in cancer care are urgently needed to address moral distress and reduce clinician burnout among a strained global oncology workforce. Lessons from low‐resource settings can be gleaned as high‐income countries face growing needs to prioritize oncology resources. Oncology providers in low‐ and middle‐income countries face resource priority setting decisions on a routine basis. This article describes the moral experience and recommendations of oncology clinicians, advisors, and program leaders engaged in clinical priority setting at a cancer center in Rwanda.
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Affiliation(s)
- Rebecca J DeBoer
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| | | | - Cam Nguyen
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda
| | - Anita Ho
- Program in Bioethics, University of California, San Francisco, California, USA.,University of British Columbia, Vancouver, Canada
| | - Grace Umutesi
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda
| | - Eugene Nkusi
- Republic of Rwanda Ministry of Health, Kigali, Rwanda
| | | | - Katherine Van Loon
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| | - Lawrence N Shulman
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Sun TT, Tao R, Su CW, Umar M. How Do Economic Fluctuations Affect the Mortality of Infectious Diseases? Front Public Health 2021; 9:678213. [PMID: 33968891 PMCID: PMC8100195 DOI: 10.3389/fpubh.2021.678213] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/25/2021] [Indexed: 11/24/2022] Open
Abstract
This paper uses the mixed frequency vector autoregression model to explore the impact of economic fluctuations on infectious diseases mortality (IDM) from China perspective. We find that quarterly gross domestic product (GDP) fluctuations have a negative impact on the annual IDM, indicating that the mortality of infectious diseases varies counter-cyclically with the business cycle in China. Specifically, IDM usually increases with deterioration in economic conditions, and vice versa. The empirical results are consistent with the hypothesis I derived from the theoretical analysis, which highlights that economic fluctuations can negatively affect the mortality of infectious diseases. The findings can offer revelations for the government to consider the role of economic conditions in controlling the epidemic of infectious diseases. Policymakers should adopt appropriate and effective strategies to mitigate the potential negative effects of macroeconomic downturns on the mortality of infectious diseases. In the context of the COVID-19 pandemic, these analyses further emphasize the importance of promoting economic growth, increasing public health expenditure, and preventing and controlling foreign infectious diseases.
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Affiliation(s)
- Ting-Ting Sun
- School of Economics, Qingdao University, Qingdao, China
| | - Ran Tao
- Qingdao Municipal Center for Disease Control and Preventation, Qingdao, China
| | - Chi-Wei Su
- School of Economics, Qingdao University, Qingdao, China
| | - Muhammad Umar
- School of Economics, Qingdao University, Qingdao, China
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Insurance status and risk of suicide mortality among patients with cancer: a retrospective study based on the SEER database. Public Health 2021; 194:89-95. [PMID: 33866150 DOI: 10.1016/j.puhe.2021.02.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Given that the presence of insurance may affect the risk of suicide mortality in cancer patients, we aimed to examine the association in a population-based study using the Surveillance, Epidemiologic, and End Results (SEER) database. STUDY DESIGN A retrospective analysis of data from the SEER database. METHODS We conducted a retrospective study using the SEER database. Hazard ratios (HRs), adjusted HRs (aHRs), and 95% confidence intervals (95% CIs) of suicide death were calculated using Cox proportional hazard models to evaluate the risk of suicide mortality among the cohorts. RESULTS Multivariable analysis revealed that cancer patients without insurance had an increased risk of suicide death compared with patients with private insurance (aHR, 1.37; 95% CI, 1.01-1.72), whereas no significant result was observed in patients with any Medicaid (aHR, 1.10; 95% CI, 0.93-1.30; P = 0.27). In addition, the stratified analysis indicated that the risk of suicide death in patients in the uninsured and Medicaid groups presented with localized stage of disease (aHR, 1.32; 95% CI, 1.02, 1.69), White (aHR, 1.34; 95% CI, 1.05, 1.71), and American Indian/Alaska Native and Asian/Pacific Islander (aHR, 1.89; 95% CI, 1.08, 3.30) were greater than insured patients. CONCLUSION Overall, our results indicated that insurance status was a statistically significant predictor of suicide death in patients with cancer. Healthcare providers should identify those patients at high risk of suicide and provide appropriate mental health and psychosocial oncology services in time.
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Economic Crisis: A Factor for the Delayed Diagnosis of Breast Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083998. [PMID: 33920282 PMCID: PMC8069543 DOI: 10.3390/ijerph18083998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/31/2021] [Accepted: 04/08/2021] [Indexed: 12/24/2022]
Abstract
Considering the constant increase in breast cancer patients, identifying factors that influence the moment of diagnosis is essential for optimizing therapeutic management and associated cost. The purpose of the study is to evaluate the impact of the economic crisis on the moment of a breast cancer diagnosis. This retrospective observational study analyzed a cohort of 4929 patients diagnosed with breast cancer over the course of 19 years in the Western region of Romania. The time interval was divided based on the onset of the economic crisis into 3 periods: pre-crisis (2001–2006), crisis (2007–2012), and post-crisis (2013–2019). The disease stage at the moment of diagnosis was considered either early (stages 0, I, II) or advanced (stages III, IV). Although recording a similar mean number of patients diagnosed per year during the pre- and crisis periods, a significantly higher percentage of patients were diagnosed with late-stage breast cancer during the economic crisis period compared to the previous interval (46.9% vs. 56.3%, p < 0.01). This difference was further accentuated when accounting for environmental setting, with 65.2% of patients from a rural setting being diagnosed with advanced disease during the crisis interval. An overall improvement of 12% in early-stage breast cancer diagnosis was recorded in the post-crisis period (55.7%, p < 0.001). The findings of this study support periods of economic instability as potential factors for a delay in breast cancer diagnosis and highlight the need for the development of specific strategies aimed at reducing cancer healthcare and associated financial burden in times of economic crisis.
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Jarroch R, Tajik B, Tuomainen TP, Kauhanen J. ECONOMIC RECESSION AND THE RISK OF CANCER - A Cohort Study from Eastern Finland. J Epidemiol 2021; 32:384-390. [PMID: 33716271 PMCID: PMC9263616 DOI: 10.2188/jea.je20200595] [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] [Indexed: 11/18/2022] Open
Abstract
BackgroundLittle is known about the role of economic recessions in the risk of cancer. Therefore, we evaluated the impact of the severe economic recession in Finland between 1991-1994 on the incidence of all cancers and cancer subtypes among middle-age and older population.MethodsFrom the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD), a population-based sample of 1620 women and men aged 53-73 years were examined between 1998-2001. The cancer-free participants completed a questionnaire on the possible impact of the 1990s recession in Finland on their lives. Incident cases of cancer were obtained through record linkage with the Finnish Cancer Registry. Cox proportional hazards regression was used to estimate hazard ratios (HR) of incident cancer events after adjusting for possible confounders.ResultsA total of 1096 cancer-free participants had experienced socioeconomic hardships due to the recession at the baseline. During 20 years of follow-up, 473 participants developed cancer. After adjustment for age, baseline socioeconomic position and lifestyle factors, the risk of all cancers was 32% higher among men who experienced socioeconomic hardships compared to those who did not (HR 1.32, 95%CI, 0.99-1.75, p=0.05). Prostate-genital cancer was 71% higher among men with hardships (n=103, HR=1.71, 95%CI, 1.06-2.74, p=0.02). No association was observed between socioeconomic hardships and subsequent risk of total or any subtype of cancer among women.Conclusions:The 1990s economic recession was associated with increased risk of all cancers, especially prostate-genital cancer among Finnish middle-age and older men, but no association with cancer was observed in women.
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Affiliation(s)
- Rand Jarroch
- University of Eastern Finland, Institute of Public Health and Clinical Nutrition
| | - Behnam Tajik
- University of Eastern Finland, Institute of Public Health and Clinical Nutrition
| | - Tomi-Pekka Tuomainen
- University of Eastern Finland, Institute of Public Health and Clinical Nutrition
| | - Jussi Kauhanen
- University of Eastern Finland, Institute of Public Health and Clinical Nutrition
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Torode J, Kithaka B, Chowdhury R, Simelela N, Cruz JL, Tsu VD. National action towards a world free of cervical cancer for all women. Prev Med 2021; 144:106313. [PMID: 33678227 PMCID: PMC8201602 DOI: 10.1016/j.ypmed.2020.106313] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Julie Torode
- Union for International Cancer Control, Avenue Giuseppe Motta 31-33, 1202 Geneva, Switzerland.
| | - Benda Kithaka
- Women 4 Cancer, Biblica House, Dennis Pritt Road, P.O. Box 13263-00100, Nairobi, Kenya
| | - Raveena Chowdhury
- Marie Stopes International, 1 Conway Street, Fitzroy Square, London W1T 6LP, UK
| | - Nothemba Simelela
- World Health Organization, 20 Avenue Appia 1211, Geneva 27, Switzerland
| | - Jennifer L Cruz
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Vivien D Tsu
- Department of Global Health, University of Washington, Harris Hydraulics Laboratory, 1510 San Juan Rd NE, Box 357965, Seattle, WA 98195-7965, USA
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McCormack V, Aggarwal A. Early cancer diagnosis: reaching targets across whole populations amidst setbacks. Br J Cancer 2021; 124:1181-1182. [PMID: 33558710 PMCID: PMC8007614 DOI: 10.1038/s41416-021-01276-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/08/2021] [Accepted: 01/13/2021] [Indexed: 01/03/2023] Open
Abstract
Early diagnosis of cancer, followed by timely and appropriate therapy, are the cornerstones of the secondary prevention of cancer, thus the NHS has set a 2028 target to achieve 75% early stage (TNM I/II) at cancer diagnosis. In this context, Barclay et al. evaluated overall, sex, age and deprivation-group-specific progress towards this target based on 202,000 cancer patients diagnosis in 2015. Herein, we discuss their findings which form a valuable pre-COVID-19 pandemic status. We discuss the impact of the pandemic and the efforts being made in innovative early detection and diagnosis research.
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Affiliation(s)
- Valerie McCormack
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, Lyon, France.
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Affiliation(s)
- Johnny Ludvigsson
- Crown Princess Victoria Children´s Hospital and Div of Pediatrics Dept of Biomedical and Clinical Sciences Linköping University Linköping Sweden
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Giles AE, Teferi Y, Kidane B, Bayaraa B, Tan L, Buduhan G, Srinathan S. Lung Resection Without Tissue Diagnosis: A Pragmatic Perspective on the Indeterminate Pulmonary Nodule. Clin Lung Cancer 2021; 22:e774-e781. [PMID: 33773938 DOI: 10.1016/j.cllc.2021.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/04/2020] [Accepted: 02/15/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The indeterminate pulmonary nodule is a common clinical problem. Preoperative tissue diagnosis is not always possible, despite all attempts. The objectives of this study were to determine the frequency of a malignant diagnosis in this scenario and whether attempted preoperative biopsy impacted estimation of the risk of malignancy. PATIENTS AND METHODS We reviewed 500 consecutive cases of pulmonary resection without a preoperative tissue diagnosis at a tertiary care center from 2009 to 2013. Age, sex, smoking status, prior malignancy, tumor size, and whether or not tissue diagnosis had been attempted were recorded. Logistic regression models were constructed to determine factors associated with a malignant diagnosis. RESULTS There were 297 males (59.4%), the mean age was 64.9 years, and 412 had a smoking history (82.4%). Also, 203 patients (40.6%) had a malignancy history, and 36 patients (7.2%) had previous lung cancer. Biopsy was attempted for 102 patients (20.5%). The final diagnosis was lung cancer in 336 patients (67.2%), metastatic cancer in 93 patients (18.6%), and benign tumour in 71 patients (14.2%). Male sex, increasing age, smoking history, and prior lung cancer were positive predictors of lung cancer. Model discrimination was good (c-statistic, 0.83). Attempted biopsy did not alter model discrimination. CONCLUSION In this cohort, 86% of resected lesions were malignant. The decision to pursue preoperative tissue diagnosis did not change the predictive ability offered by clinical factors. These findings are reassuring in the scenario when a patient is operable but the diagnosis remains unknown.
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Affiliation(s)
- Andrew E Giles
- Section of Thoracic Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Yohannes Teferi
- Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Biniam Kidane
- Section of Thoracic Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Bayasgalan Bayaraa
- Section of Thoracic Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lawrence Tan
- Section of Thoracic Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gordon Buduhan
- Section of Thoracic Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sadeesh Srinathan
- Section of Thoracic Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
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Patel R, Pickering L, Afshar M. New Approaches to Cancer Care in a COVID-19 World-The Role of Health and Social Protection Policies. JAMA Oncol 2021; 7:137-138. [PMID: 33237315 DOI: 10.1001/jamaoncol.2020.5853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Reena Patel
- St George's Medical School, University of London, London, United Kingdom
| | - Lisa Pickering
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Mehran Afshar
- St George's Medical School, University of London, London, United Kingdom.,Department of Oncology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
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Gaffney AW, Hawks L, Bor D, White AC, Woolhandler S, McCormick D, Himmelstein DU. National Trends and Disparities in Health Care Access and Coverage Among Adults With Asthma and COPD: 1997-2018. Chest 2021; 159:2173-2182. [PMID: 33497651 DOI: 10.1016/j.chest.2021.01.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/31/2020] [Accepted: 01/09/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Racial and ethnic as well as economic disparities in access to care among persons with asthma and COPD have been described, but long-term access trends are unclear. RESEARCH QUESTION Have health coverage and access to care and medications among adults with airways disease improved, and have disparities narrowed? STUDY DESIGN AND METHODS Using the 1997 through 2018 National Health Interview Survey, we examined time trends in health coverage and the affordability of medical care and prescription drugs for adults with asthma and COPD, overall and by income and by race and ethnicity. We performed multivariate linear probability regressions comparing coverage and access in 2018 with that in 1997. RESULTS Our sample included 76,843 adults with asthma and 30,548 adults with COPD. Among adults with asthma, lack of insurance rose in the first decade of the twenty-first century, peaking with the Great Recession, but fell after implementation of the Affordable Care Act (ACA). From 1997 through 2018, the uninsured rate among adults with asthma decreased from 19.4% to 9.6% (adjusted 9.27 percentage points; 95% CI, 7.1%-11.5%). However, the proportions delaying or foregoing medical care because of cost or going without medications did not improve. Racial and ethnic as well as economic disparities present in 1997 persisted over the study period. Trends and disparities among those with COPD were similar, although the proportion going without needed medications worsened, rising by an adjusted 7.8 percentage points. INTERPRETATION Coverage losses among persons with airways disease in the first decade of the twenty-first century were reversed by the ACA, but neither care affordability nor disparities improved. Further reform is needed to close these gaps.
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Affiliation(s)
- Adam W Gaffney
- Cambridge Health Alliance, Cambridge, MA; Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA.
| | - Laura Hawks
- Cambridge Health Alliance, Cambridge, MA; Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA
| | - David Bor
- Cambridge Health Alliance, Cambridge, MA; Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Alexander C White
- Cambridge Health Alliance, Cambridge, MA; Tufts Medical School, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Steffie Woolhandler
- Cambridge Health Alliance, Cambridge, MA; Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA; City University of New York at Hunter College, New York, NY
| | - Danny McCormick
- Cambridge Health Alliance, Cambridge, MA; Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA
| | - David U Himmelstein
- Cambridge Health Alliance, Cambridge, MA; Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA; City University of New York at Hunter College, New York, NY
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Ng J, Stovezky YR, Brenner DJ, Formenti SC, Shuryak I. Development of a Model to Estimate the Association Between Delay in Cancer Treatment and Local Tumor Control and Risk of Metastases. JAMA Netw Open 2021; 4:e2034065. [PMID: 33502482 PMCID: PMC7841466 DOI: 10.1001/jamanetworkopen.2020.34065] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE The coronavirus disease 2019 (COVID-19) pandemic has led to treatment delays for many patients with cancer. While published guidelines provide suggestions on which cases are appropriate for treatment delay, there are no good quantitative estimates on the association of delays with tumor control or risk of new metastases. OBJECTIVES To develop a simplified mathematical model of tumor growth, control, and new metastases for cancers with varying doubling times and metastatic potential and to estimate tumor control probability (TCP) and metastases risk as a function of treatment delay interval. DESIGN, SETTING, AND PARTICIPANTS This decision analytical model describes a quantitative model for 3 tumors (ie, head and neck, colorectal, and non-small cell lung cancers). Using accepted ranges of tumor doubling times and metastatic development from the clinical literature from 2001 to 2020, estimates of tumor growth, TCP, and new metastases were analyzed for various treatment delay intervals. MAIN OUTCOMES AND MEASURES Risk estimates for potential decreases in local TCP and increases in new metastases with each interval of treatment delay. RESULTS For fast-growing head and neck tumors with a 2-month treatment delay, there was an estimated 4.8% (95% CI, 3.4%-6.4%) increase in local tumor control risk and a 0.49% (0.47%-0.51%) increase in new distal metastases risk. A 6-month delay was associated with an estimated 21.3% (13.4-30.4) increase in local tumor control risk and a 6.0% (5.2-6.8) increase in distal metastases risk. For intermediate-growing colorectal tumors, there was a 2.1% (0.7%-3.5%) increase in local tumor control risk and a 2.7% (2.6%-2.8%) increase in distal metastases risk at 2 months and a 7.6% (2.2%-14.2%) increase in local tumor control risk and a 24.7% (21.9%-27.8%) increase in distal metastases risk at 6 months. For slower-growing lung tumors, there was a 1.2% (0.0%-2.8%) increase in local tumor control risk and a 0.19% (0.18%-0.20%) increase in distal metastases risk at 2 months, and a 4.3% (0.0%-10.6%) increase in local tumor control risk and a 1.9% (1.6%-2.2%) increase in distal metastases risk at 6 months. CONCLUSIONS AND RELEVANCE This study proposed a model to quantify the association of treatment delays with local tumor control and risk of new metastases. The detrimental associations were greatest for tumors with faster rates of proliferation and metastasis. The associations were smaller, but still substantial, for slower-growing tumors.
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Affiliation(s)
- John Ng
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York
| | | | - David J. Brenner
- Center for Radiological Research, Columbia University Irving Medical Center, New York, New York
| | - Silvia C. Formenti
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York
| | - Igor Shuryak
- Center for Radiological Research, Columbia University Irving Medical Center, New York, New York
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Abstract
"Starting in Wuhan, China, followed quickly in the United States in January 2020, an outbreak of a novel coronavirus, or COVID-19, escalated to a global pandemic by March. Significant disruptions occurred to breast imaging, including deferred screening mammography, triaging diagnostic breast imaging, and changes in breast cancer care algorithms. This article summarizes the effect of the global pandemic-and efforts to curtail its spread-on both breast cancer care and on breast imaging practices including effects on patients, clinical workflow, education, and research."
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Affiliation(s)
- Phoebe E Freer
- Breast Imaging, Department of Radiology and Imaging Sciences, University of Utah Health / Huntsman Cancer Institute, 30 North 1900 East #1A071, Salt Lake City, UT 84132, USA.
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Lai AG, Pasea L, Banerjee A, Hall G, Denaxas S, Chang WH, Katsoulis M, Williams B, Pillay D, Noursadeghi M, Linch D, Hughes D, Forster MD, Turnbull C, Fitzpatrick NK, Boyd K, Foster GR, Enver T, Nafilyan V, Humberstone B, Neal RD, Cooper M, Jones M, Pritchard-Jones K, Sullivan R, Davie C, Lawler M, Hemingway H. Estimated impact of the COVID-19 pandemic on cancer services and excess 1-year mortality in people with cancer and multimorbidity: near real-time data on cancer care, cancer deaths and a population-based cohort study. BMJ Open 2020; 10:e043828. [PMID: 33203640 PMCID: PMC7674020 DOI: 10.1136/bmjopen-2020-043828] [Citation(s) in RCA: 185] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To estimate the impact of the COVID-19 pandemic on cancer care services and overall (direct and indirect) excess deaths in people with cancer. METHODS We employed near real-time weekly data on cancer care to determine the adverse effect of the pandemic on cancer services. We also used these data, together with national death registrations until June 2020 to model deaths, in excess of background (pre-COVID-19) mortality, in people with cancer. Background mortality risks for 24 cancers with and without COVID-19-relevant comorbidities were obtained from population-based primary care cohort (Clinical Practice Research Datalink) on 3 862 012 adults in England. RESULTS Declines in urgent referrals (median=-70.4%) and chemotherapy attendances (median=-41.5%) to a nadir (lowest point) in the pandemic were observed. By 31 May, these declines have only partially recovered; urgent referrals (median=-44.5%) and chemotherapy attendances (median=-31.2%). There were short-term excess death registrations for cancer (without COVID-19), with peak relative risk (RR) of 1.17 at week ending on 3 April. The peak RR for all-cause deaths was 2.1 from week ending on 17 April. Based on these findings and recent literature, we modelled 40% and 80% of cancer patients being affected by the pandemic in the long-term. At 40% affected, we estimated 1-year total (direct and indirect) excess deaths in people with cancer as between 7165 and 17 910, using RRs of 1.2 and 1.5, respectively, where 78% of excess deaths occured in patients with ≥1 comorbidity. CONCLUSIONS Dramatic reductions were detected in the demand for, and supply of, cancer services which have not fully recovered with lockdown easing. These may contribute, over a 1-year time horizon, to substantial excess mortality among people with cancer and multimorbidity. It is urgent to understand how the recovery of general practitioner, oncology and other hospital services might best mitigate these long-term excess mortality risks.
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Affiliation(s)
- Alvina G Lai
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, University College London, London, UK
| | - Laura Pasea
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, University College London, London, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, University College London, London, UK
- Barts Health NHS Trust, The Royal London Hospital, Whitechapel Rd, London, UK
| | - Geoff Hall
- DATA-CAN, Health Data Research UK hub for cancer hosted by UCLPartners, London, UK
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, University College London, London, UK
- University College London Hospitals NIHR Biomedical Research Centre, London, UK
- The Alan Turing Institute, London, UK
| | - Wai Hoong Chang
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, University College London, London, UK
| | - Michail Katsoulis
- Institute of Health Informatics, University College London, London, UK
| | - Bryan Williams
- University College London Hospitals NIHR Biomedical Research Centre, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
- University College London Hospitals NHS Trust, London, UK
| | - Deenan Pillay
- Division of Infection and Immunity, University College London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - David Linch
- University College London Hospitals NIHR Biomedical Research Centre, London, UK
- Department of Hematology, University College London Cancer Institute, London, UK
| | - Derralynn Hughes
- University College London Cancer Institute, London, UK
- Royal Free NHS Foundation Trust, London, UK
| | - Martin D Forster
- University College London Hospitals NHS Trust, London, UK
- University College London Cancer Institute, London, UK
| | - Clare Turnbull
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - Natalie K Fitzpatrick
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, University College London, London, UK
| | - Kathryn Boyd
- Northern Ireland Cancer Network, Northern Ireland, UK
| | - Graham R Foster
- Barts Liver Centre, Blizard Institute, Queen Mary University of London, London, UK
| | - Tariq Enver
- University College London Cancer Institute, London, UK
| | | | | | - Richard D Neal
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Matt Cooper
- DATA-CAN, Health Data Research UK hub for cancer hosted by UCLPartners, London, UK
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Monica Jones
- DATA-CAN, Health Data Research UK hub for cancer hosted by UCLPartners, London, UK
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Kathy Pritchard-Jones
- DATA-CAN, Health Data Research UK hub for cancer hosted by UCLPartners, London, UK
- UCLPartners Academic Health Science Partnership, London, UK
- Centre for Cancer Outcomes, University College London Hospitals NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Richard Sullivan
- Conflict and Health Research Group, Institute of Cancer Policy, King's College London, London, UK
| | - Charlie Davie
- DATA-CAN, Health Data Research UK hub for cancer hosted by UCLPartners, London, UK
- Royal Free NHS Foundation Trust, London, UK
- UCLPartners Academic Health Science Partnership, London, UK
| | - Mark Lawler
- DATA-CAN, Health Data Research UK hub for cancer hosted by UCLPartners, London, UK
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Harry Hemingway
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, University College London, London, UK
- University College London Hospitals NIHR Biomedical Research Centre, London, UK
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49
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DeBoer RJ, Fadelu TA, Shulman LN, Van Loon K. Applying Lessons Learned From Low-Resource Settings to Prioritize Cancer Care in a Pandemic. JAMA Oncol 2020; 6:1429-1433. [PMID: 32761149 DOI: 10.1001/jamaoncol.2020.2976] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Importance The coronavirus disease 2019 (COVID-19) pandemic has forced oncology clinicians and administrators in the United States to set priorities for cancer care owing to resource constraints. As oncology practices adapt to a contracted health care system, expertise gained from partnerships in low-resource settings can be used for guidance. This article provides a primer on priority setting in oncology and ethical guidance based on lessons learned from experience with cancer care priority setting in low-resource settings. Observations Lessons learned from real-world experiences are myriad. First, in the setting of limited resources, a utilitarian approach to maximizing survival benefit should guide decision-making. Second, conflicting principles will often arise among stakeholders and decision makers. Third, fair decision-making procedures should be established to ensure moral legitimacy and accountability. Fourth, proactive safeguards must be implemented to protect vulnerable individuals, or disparities in cancer treatment and outcomes will only widen further. Fifth, communication with patients and families about priority setting decisions should be intentional and standardized. Sixth, moral distress among clinicians must be addressed to avoid burnout during a time when resilience is critical. Conclusions and Relevance Although the need to triage cancer care may be new to those who underwent training and now practice oncology in high-resource settings, it is familiar for those who practice in low- and middle-income countries. Oncologists in the United States facing unprecedented decisions about prioritization can draw on ethical frameworks and lessons learned from real-world cancer care priority setting in resource-constrained environments.
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Affiliation(s)
- Rebecca J DeBoer
- Division of Hematology/Oncology, University of California, San Francisco.,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Temidayo A Fadelu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Katherine Van Loon
- Division of Hematology/Oncology, University of California, San Francisco.,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
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50
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Savulescu J, Cameron J. Why lockdown of the elderly is not ageist and why levelling down equality is wrong. JOURNAL OF MEDICAL ETHICS 2020; 46:717-721. [PMID: 32561661 PMCID: PMC7335694 DOI: 10.1136/medethics-2020-106336] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/29/2020] [Accepted: 05/31/2020] [Indexed: 05/03/2023]
Abstract
In order to prevent the rapid spread of COVID-19, governments have placed significant restrictions on liberty, including preventing all non-essential travel. These restrictions were justified on the basis the health system may be overwhelmed by COVID-19 cases and in order to prevent deaths. Governments are now considering how they may de-escalate these restrictions. This article argues that an appropriate approach may be to lift the general lockdown but implement selective isolation of the elderly. While this discriminates against the elderly, there is a morally relevant difference-the elderly are far more likely to require hospitalisation and die than the rest of the population. If the aim is to ensure the health system is not overwhelmed and to reduce the death rate, preventing the elderly from contracting the virus may be an effective means of achieving this. The alternative is to continue to keep everyone in lockdown. It is argued that this is levelling down equality and is unethical. It suggests that in order for the elderly to avoid contracting the virus, the whole population should have their liberty deprived, even though the same result could be achieved by only restricting the liberty of the elderly. Similar arguments may also be applied to all groups at increased risk of COVID-19, such as men and those with comorbidities, the obese and people from ethnic minorities or socially deprived groups. This utilitarian concern must be balanced against other considerations, such as equality and justice, and the benefits gained from discriminating in these ways must be proportionately greater than the negative consequences of doing so. Such selective discrimination will be most justified when the liberty restriction to a group promotes the well-being of that group (apart from its wider social benefits).
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Affiliation(s)
- Julian Savulescu
- Faculty of Philosophy, Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
- Biomedical Ethics Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - James Cameron
- Biomedical Ethics Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Melbourne Law School, The University of Melbourne, Carlton, Victoria, Australia
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