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Baas L, Meijer K, Bredenoord AL, van der Graaf R. What is a cure through gene therapy? An analysis and evaluation of the use of "cure". MEDICINE, HEALTH CARE, AND PHILOSOPHY 2024:10.1007/s11019-024-10223-w. [PMID: 39172342 DOI: 10.1007/s11019-024-10223-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Accepted: 08/05/2024] [Indexed: 08/23/2024]
Abstract
The development of gene therapy has always come with the expectation that it will offer a cure for various disorders, of which hemophilia is a paradigm example. However, although the term is used regularly, it is unclear what exactly is meant with "cure". Therefore, the aim of this paper is to analyse how the concept of cure is used in practice and evaluate which of the interpretations is most suitable in discussions surrounding gene therapy. We analysed how cure is used in four different medical fields where the concept raises discussion. We show that cure can be used in three different ways: cure as normalization of the body, cure as obtaining a normal life, or cure as a change in identity. We argue that since cure is a practical term, its interpretation should be context-specific and the various uses can exist simultaneously, as long as their use is suitable to the function the notion of cure plays in each of the settings. We end by highlighting three different settings in the domain of hemophilia gene therapy in which the term cure is used and explore the function(s) it serves in each setting. We conclude that in the clinical application of gene therapy, it could be better to abandon the term cure, whereas more modest and specified definitions of cure are required in the context of health resource allocation decisions and decisions on research funding.
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Affiliation(s)
- Lieke Baas
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Karina Meijer
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Annelien L Bredenoord
- Erasmus School of Philosophy, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Rieke van der Graaf
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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2
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Li M, Meheus F, Polazzi S, Delafosse P, Borson-Chazot F, Seigneurin A, Simon R, Combes JD, Dal Maso L, Colonna M, Duclos A, Vaccarella S. The Economic Cost of Thyroid Cancer in France and the Corresponding Share Associated With Treatment of Overdiagnosed Cases. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1175-1182. [PMID: 36921898 DOI: 10.1016/j.jval.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Thyroid cancer incidence in France has increased rapidly in recent decades. Most of this increase has been attributed to overdiagnosis, the major consequence of which is overtreatment. We aimed to estimate the cost of thyroid cancer management in France and the corresponding cost proportion attributable to the treatment of overdiagnosed cases. METHODS Multiple data sources were integrated: the mean cost per patient with thyroid cancer was estimated by using the Echantillon Généraliste des Bénéficiaires data set; thyroid cancer cases attributable to overdiagnosis were estimated for 21 departments using data from the French network of cancer registries and extrapolated to the whole country; medical records from 6 departments were used to refine the diagnosis and care pathway. RESULTS Between 2011 and 2015, 33 911 women and 10 846 men in France were estimated to be diagnosed of thyroid cancer, with mean cost per capita of €6248. Among those treated, 8114 to 14 925 women and 1465 to 3626 men were due to overdiagnosis. The total cost of thyroid cancer patient management was €203.5 million (€154.3 million for women and €49.3 million for men), of which between €59.9 million (or 29.4% of the total cost, lower bound) and €115.9 million (or 56.9% of the total cost, upper bound) attributable to treatment of overdiagnosed cases. CONCLUSIONS The management of thyroid cancer represents not only a relevant clinical and public health problem in France but also a potentially important economic burden. Overdiagnosis and corresponding associated treatments play an important role on the total costs of thyroid cancer management.
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Affiliation(s)
- Mengmeng Li
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France; Department of Cancer Prevention, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Filip Meheus
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France; Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | - Stephanie Polazzi
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France; Health Data Department, Hospices Civils de Lyon, Lyon, France
| | | | - Françoise Borson-Chazot
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France; Fédération d'Endocrinologie, Groupement Hospitalier Est and Registre des Cancers Thyroïdiens du Rhône, Hospices Civils de Lyon, Lyon, France
| | | | - Raphael Simon
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Jean-Damien Combes
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
| | | | - Antoine Duclos
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France; Health Data Department, Hospices Civils de Lyon, Lyon, France
| | - Salvatore Vaccarella
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France.
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3
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Toffolutti F, Guzzinati S, De Paoli A, Francisci S, De Angelis R, Crocetti E, Botta L, Rossi S, Mallone S, Zorzi M, Manneschi G, Bidoli E, Ravaioli A, Cuccaro F, Migliore E, Puppo A, Ferrante M, Gasparotti C, Gambino M, Carrozzi G, Stracci F, Michiara M, Cavallo R, Mazzucco W, Fusco M, Ballotari P, Sampietro G, Ferretti S, Mangone L, Rizzello RV, Mian M, Cascone G, Boschetti L, Galasso R, Piras D, Pesce MT, Bella F, Seghini P, Fanetti AC, Pinna P, Serraino D, Dal Maso L. Complete prevalence and indicators of cancer cure: enhanced methods and validation in Italian population-based cancer registries. Front Oncol 2023; 13:1168325. [PMID: 37346072 PMCID: PMC10280813 DOI: 10.3389/fonc.2023.1168325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/09/2023] [Indexed: 06/23/2023] Open
Abstract
Objectives To describe the procedures to derive complete prevalence and several indicators of cancer cure from population-based cancer registries. Materials and methods Cancer registry data (47% of the Italian population) were used to calculate limited duration prevalence for 62 cancer types by sex and registry. The incidence and survival models, needed to calculate the completeness index (R) and complete prevalence, were evaluated by likelihood ratio tests and by visual comparison. A sensitivity analysis was conducted to explore the effect on the complete prevalence of using different R indexes. Mixture cure models were used to estimate net survival (NS); life expectancy of fatal (LEF) cases; cure fraction (CF); time to cure (TTC); cure prevalence, prevalent patients who were not at risk of dying as a result of cancer; and already cured patients, those living longer than TTC at a specific point in time. CF was also compared with long-term NS since, for patients diagnosed after a certain age, CF (representing asymptotical values of NS) is reached far beyond the patient's life expectancy. Results For the most frequent cancer types, the Weibull survival model stratified by sex and age showed a very good fit with observed survival. For men diagnosed with any cancer type at age 65-74 years, CF was 41%, while the NS was 49% until age 100 and 50% until age 90. In women, similar differences emerged for patients with any cancer type or with breast cancer. Among patients alive in 2018 with colorectal cancer at age 55-64 years, 48% were already cured (had reached their specific TTC), while the cure prevalence (lifelong probability to be cured from cancer) was 89%. Cure prevalence became 97.5% (2.5% will die because of their neoplasm) for patients alive >5 years after diagnosis. Conclusions This study represents an addition to the current knowledge on the topic providing a detailed description of available indicators of prevalence and cancer cure, highlighting the links among them, and illustrating their interpretation. Indicators may be relevant for patients and clinical practice; they are unambiguously defined, measurable, and reproducible in different countries where population-based cancer registries are active.
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Affiliation(s)
- Federica Toffolutti
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | | | | | - Silvia Francisci
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Roberta De Angelis
- Department of Oncology and Molecular Medicine, National Institute of Health, Rome, Italy
| | - Emanuele Crocetti
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Laura Botta
- Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Silvia Rossi
- Department of Oncology and Molecular Medicine, National Institute of Health, Rome, Italy
| | - Sandra Mallone
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Manuel Zorzi
- Epidemiological Department, Azienda Zero, Padua, Italy
| | - Gianfranco Manneschi
- Tuscany Cancer Registry, Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Ettore Bidoli
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Alessandra Ravaioli
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Forlì, Italy
| | - Francesco Cuccaro
- Registro Tumori Puglia - Sezione Azienda Sanitaria Locale (ASL) Barletta-Andria-Trani, Epidemiologia e Statistica, Barletta, Italy
| | - Enrica Migliore
- Piedmont Cancer Registry, Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica (CPO) Piemonte and University of Turin, Turin, Italy
| | - Antonella Puppo
- Liguria Cancer Registry, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Margherita Ferrante
- Registro tumori integrato di Catania-Messina-Enna, Igiene Ospedaliera, Azienda Ospedaliero-Universitaria Policlinico G. Rodolico-San Marco, Catania, Italy
| | - Cinzia Gasparotti
- Struttura Semplice Epidemiologia, Agenzia di Tutela della Salute (ATS) Brescia, Brescia, Italy
| | - Maria Gambino
- Registro tumori ATS Insubria (Provincia di Como e Varese) Responsabile S.S. Epidemiologia Registri Specializzati e Reti di Patologia, Varese, Italy
| | - Giuliano Carrozzi
- Emilia-Romagna Cancer Registry, Modena Unit, Public Health Department, Local Health Authority, Modena, Italy
| | - Fabrizio Stracci
- Umbria Cancer Registry, Public Health Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Maria Michiara
- Emilia-Romagna Cancer Registry, Parma Unit, Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Rossella Cavallo
- Cancer Registry Azienda Sanitaria Locale (ASL) Salerno- Dipartimento di Prevenzione, Salerno, Italy
| | - Walter Mazzucco
- Clinical Epidemiology and Cancer Registry Unit, Azienda Ospedaliera Universitaria Policlinico (AOUP) di Palermo, Palermo, Italy
| | - Mario Fusco
- Registro Tumori ASL Napoli 3 Sud, Napoli, Italy
| | | | | | - Stefano Ferretti
- Emilia-Romagna Cancer Registry, Ferrara Unit, Local Health Authority, Ferrara, and University of Ferrara, Ferrara, Italy
| | - Lucia Mangone
- Emilia-Romagna Cancer Registry, Reggio Emilia Unit, Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Michael Mian
- Innovation, Research and Teaching Service (SABES-ASDAA), Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Bolzano-Bozen, Italy
| | - Giuseppe Cascone
- Azienda Sanitaria Provinciale (ASP) Ragusa - Dipartimento di Prevenzione -Registro Tumori, Ragusa, Italy
| | | | - Rocco Galasso
- Unit of Regional Cancer Registry, Clinical Epidemiology and Biostatistics, IRCCS Centro di Riferimento Oncologico di Basilicata (CROB), Rionero in Vulture, Italy
| | | | - Maria Teresa Pesce
- Monitoraggio rischio ambientale e Registro Tumori ASL Caserta, Caserta, Italy
| | - Francesca Bella
- Siracusa Cancer Registry, Provincial Health Authority of Siracusa, Siracusa, Italy
| | - Pietro Seghini
- Emilia-Romagna Cancer Registry, Piacenza Unit, Public Health Department, AUSL Piacenza, Piacenza, Italy
| | - Anna Clara Fanetti
- Sondrio Cancer Registry, Agenzia di Tutela della Salute della Montagna, Sondrio, Italy
| | - Pasquala Pinna
- Nuoro Cancer Registry, RT Nuoro, Servizio Igiene e Sanità Pubblica, ASL Nuoro, Nuoro, Italy
| | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
| | - Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Aviano, Italy
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Tralongo P, Cappuccio F, Gori S, Donato V, Beretta G, Elia A, Romano F, Iacono M, Tralongo AC, Bordonaro S, Di Mari A, Giuliano SR, Buccafusca G, Careri MC, Santoro A. Clinicians' and Patients' Perceptions and Use of the Word "Cured" in Cancer Care: An Italian Survey. Curr Oncol 2023; 30:1332-1353. [PMID: 36826064 PMCID: PMC9955737 DOI: 10.3390/curroncol30020103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The words "hope" and "cure" were used in a greater number of articles and sentences in narrative and editorial papers than in primary research. Despite concomitant improvements in cancer outcomes, the related reluctance to use these terms in more scientifically oriented original reports may reflect a bias worthy of future exploration. This study aims to survey a group of physicians and cancer patients regarding their perception and use of the word cure. MATERIALS AND METHOD An anonymous online and print survey was conducted to explore Italian clinicians' (the sample includes medical oncologists, radiotherapists, and oncological surgeons) and cancer patients' approach to the perception and use of the word "cure" in cancer care. The participants received an email informing them of the study's purpose and were invited to participate in the survey via a linked form. A portion, two-thirds, of questionnaires were also administered to patients in the traditional paper form. RESULTS The survey was completed by 224 clinicians (54 oncologists, 78 radiotherapists, and 92 cancer surgeons) and 249 patients. The results indicate a favourable attitude for patients in favour of a new language ("cured" vs. "complete remission") of the disease experience. CONCLUSIONS The use of the word cured is substantially accepted and equally shared by doctors and patients. Its use can facilitate the elimination of metaphoric implications and toxic cancer-related connotations registered in all cultures that discourage patients from viewing cancer as a disease with varied outcomes, including cure.
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Affiliation(s)
- Paolo Tralongo
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
- Correspondence:
| | - Francesco Cappuccio
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | - Stefania Gori
- Medical Oncology Unit, IRCCS Sacro Cuore Don Calabria, Negrar di Valpolicella, 37024 Verona, Italy
| | - Vittorio Donato
- Radiotherapy Unit, San Camillo Forlanini Hospital, 00152 Rome, Italy
| | - Giordano Beretta
- Medical Oncology Unit, Santo Spirito Hospital, 65124 Pescara, Italy
| | - Ausilia Elia
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | - Fabrizio Romano
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | - Margherita Iacono
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | | | - Sebastiano Bordonaro
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | - Annamaria Di Mari
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | | | - Gabriella Buccafusca
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | - Maria Carmela Careri
- Medical Oncology Unit, Medical Oncology Department, Umberto I Hospital, RAO, 96011 Siracusa, Italy
| | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital and Humanitas Cancer Center, 20089 Milan, Italy
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5
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Dal Maso L, Santoro A, Iannelli E, De Paoli P, Minoia C, Pinto M, Bertuzzi AF, Serraino D, De Angelis R, Trama A, Haupt R, Pravettoni G, Perrone M, De Lorenzo F, Tralongo P. Cancer Cure and Consequences on Survivorship Care: Position Paper from the Italian Alliance Against Cancer (ACC) Survivorship Care Working Group. Cancer Manag Res 2022; 14:3105-3118. [PMID: 36340999 PMCID: PMC9635309 DOI: 10.2147/cmar.s380390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/08/2022] [Indexed: 02/05/2023] Open
Abstract
A multidisciplinary panel of experts and cancer patients developed a position paper to highlight recent evidence on "cancer cure" (ie, the possibility of achieving the same life expectancy as the general population) and discuss the consequences of this concept on follow-up and rehabilitation strategies. The aim is to inform clinicians, patients, and health-care policy makers about strategies of survivorship care for cured cancer patients and consequences impacting patient lives, spurring public health authorities and research organizations to implement resources to the purpose. Two identifiable, measurable, and reproducible indicators of cancer cure are presented. Cure fraction (CF) is >60% for breast and prostate cancer patients, >50% for colorectal cancer patients, and >70% for patients with melanoma, Hodgkin lymphoma, and cancers of corpus uteri, testis (>90%), and thyroid. CF was >65% for patients diagnosed at ages 15-44 years and 30% for those aged 65-74 years. Time-to-cure was consistently <1 year for thyroid and testicular cancer patients and <10 years for patients with colorectal and cervical cancers, melanoma, and Hodgkin lymphoma. The working group agrees that the evidence allows risk stratification of cancer patients and implementation of personalized care models for timely diagnosis, as well as treatment of possible cancer relapses or related long-term complications, and preventive measures aimed at maintaining health status of cured patients. These aspects should be integrated to produce an appropriate follow-up program and survivorship care plan(s), avoiding stigma and supporting return to work, to a reproductive life, and full rehabilitation. The "right to be forgotten" law, adopted to date only in a few European countries, may contribute to these efforts for cured patients.
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Affiliation(s)
- Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
| | - Elisabetta Iannelli
- Italian Federation of Cancer Patients Organisations (FAVO), Rome, Italy
- Italian Association of Cancer Patients (Aimac), Rome, Italy
| | | | - Carla Minoia
- SC Haematology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Monica Pinto
- Rehabilitation Medicine Unit, Strategic Health Services Department, Istituto Nazionale Tumori-IRCCS Fondazione G. Pascale, Naples, Italy
| | | | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Roberta De Angelis
- Department of Oncology and Molecular Medicine, Italian National Institute of Health (ISS), Rome, Italy
| | - Annalisa Trama
- Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Riccardo Haupt
- DOPO Clinic, Department of Pediatric Haematology/Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Maria Perrone
- Psychology Unit, IRCCS Regina Elena Cancer Institute, Rome, Italy
| | - Francesco De Lorenzo
- Italian Federation of Cancer Patients Organisations (FAVO), Rome, Italy
- Italian Association of Cancer Patients (Aimac), Rome, Italy
| | - Paolo Tralongo
- Medical Oncology Unit, Umberto I Hospital, Department of Oncology, RAO, Siracusa, Italy
| | - On behalf of the Alliance Against Cancer (ACC) Survivorship Care and Nutritional Support Working Group
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
- Italian Federation of Cancer Patients Organisations (FAVO), Rome, Italy
- Italian Association of Cancer Patients (Aimac), Rome, Italy
- Alleanza Contro il Cancro, Rome, Italy
- SC Haematology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
- Rehabilitation Medicine Unit, Strategic Health Services Department, Istituto Nazionale Tumori-IRCCS Fondazione G. Pascale, Naples, Italy
- Department of Oncology and Molecular Medicine, Italian National Institute of Health (ISS), Rome, Italy
- Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
- DOPO Clinic, Department of Pediatric Haematology/Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
- Psychology Unit, IRCCS Regina Elena Cancer Institute, Rome, Italy
- Medical Oncology Unit, Umberto I Hospital, Department of Oncology, RAO, Siracusa, Italy
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6
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Assogba ELF, Dumas A, Woronoff AS, Mollévi C, Coutant C, Ladoire S, Desmoulins I, Dabakuyo-Yonli TS. Cross-sectional nationwide mixed-methods population-based study of living conditions, and identification of sexual and fertility profiles among young women after breast cancer in France: the Candy study protocol. BMJ Open 2022; 12:e056834. [PMID: 36171047 PMCID: PMC9528580 DOI: 10.1136/bmjopen-2021-056834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 07/20/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION At the end of the treatment, many young breast cancer (BC) survivors face difficulties related to fertility and sexuality, mainly due to the side effects of treatment. Integrating patient needs into medical decisions is becoming increasingly essential for high quality care. To this end, there is a compelling need to elicit patients' perspectives through qualitative studies, to understand their experiences and needs in the aftermath of cancer. We aim to: (1) identify clinical, social and economic determinants of sexuality and fertility, and describe other living conditions of young BC survivors in France; and (2) explore young women's experience after BC in relation to clinical and information needs about fertility preservation and sexual health. METHODS AND ANALYSIS This is a mixed-methods, cross-sectional, population-based study. In the quantitative component, women diagnosed with non-metastatic BC between 2009 and 2016 and aged 40 years or younger at diagnosis will be identified through the French network of cancer registries (FRANCIM). Participants will complete self-report questionnaires including standardised measures of sexuality, health-related quality of life (HRQoL), anxiety, depression, social deprivation and social support. Fertility and professional reintegration issues will also be assessed. Sexuality profiles will be identified by ascending hierarchical classification and fertility profiles will be identified by latent class models. Determinants of sexuality, fertility and HRQoL will be identified using a mixed regression model. Subsequently, semistructured interviews will be performed with a sample of 30 women who participated in the quantitative study. Interviews will be recorded, transcribed synthetically and content analysis will be performed, with the aid of NVivo software. ETHICS AND DISSEMINATION This study will be performed in accordance with the declaration of Helsinki. The protocol was approved in October 2020 by the Committee for the Protection of Persons North-West III (20.07.16.44445) and by the French national data protection authority (CNIL-MR003 No1989764-v0).The results of this project will be communicated to the scientific community through publications in international scientific peer-reviewed journals and communications to national and international congresses. Popularised results will also be provided to patient associations. The results of Candy project will also be published on the website of the sponsor, www.cgfl.fr.
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Affiliation(s)
- Emerline L F Assogba
- Breast and Gynaecologic Cancer Registry of Côte d'Or, Epidemiology and Quality of Life Research Unit, Georges François Leclerc Comprehensive Cancer Centre - UNICANCER, Dijon, Bourgogne-Franche-Comté, France
- Lipids, Nutrition, Cancer Research Center, French National Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale [INSERM]) U1231, Dijon, Bourgogne-Franche-Comté, France
| | - Agnès Dumas
- Clinical Epidemiology and Economic Evaluation Applied to Vulnerable Populations (Epidémiologie Clinique et Évaluation Économique appliquée aux Populations Vulnérables [ECEVE])-INSERM UMR 1123, University of Paris, Paris, Île-de-France, France
| | - Anne-Sophie Woronoff
- Cancer Registry of Doubs, Besançon Regional University Hospital Centre, Besançon, Bourgogne-Franche-Comté, France
- EA3181, Burgundy Franche-Comté University, Besançon, Bourgogne-Franche-Comté, France
| | - Caroline Mollévi
- Biometrics Unit, Montpellier Cancer Research Institute, Montpellier, Languedoc-Roussillon-Midi-Pyrénées, France
- University of Montpellier, Montpellier, Languedoc-Roussillon-Midi-Pyrénées, France
| | - Charles Coutant
- Department of Surgical Oncology, Georges François Leclerc Comprehensive Cancer Centre - UNICANCER, Dijon, Bourgogne-Franche-Comté, France
- Faculty of Medicine and Pharmacy, Burgundy Franche-Comté University, Dijon, Bourgogne-Franche-Comté, France
| | - Sylvain Ladoire
- Medical Oncology Unit, Georges François Leclerc Comprehensive Cancer Centre - UNICANCER, Dijon, Bourgogne-Franche-Comté, France
- Chemotherapy and Immune Response Team, Lipides Nutrition Cancer, Dijon, Bourgogne-Franche-Comté, France
| | - Isabelle Desmoulins
- Medical Oncology Unit, Georges François Leclerc Comprehensive Cancer Centre - UNICANCER, Dijon, Bourgogne-Franche-Comté, France
| | - Tienhan Sandrine Dabakuyo-Yonli
- Breast and Gynaecologic Cancer Registry of Côte d'Or, Epidemiology and Quality of Life Research Unit, Georges François Leclerc Comprehensive Cancer Centre - UNICANCER, Dijon, Bourgogne-Franche-Comté, France
- Lipids, Nutrition, Cancer Research Center, French National Institute of Health and Medical Research (Institut National de la Santé et de la Recherche Médicale [INSERM]) U1231, Dijon, Bourgogne-Franche-Comté, France
- National Quality of Life and Cancer Clinical Research Platform, Dijon, Bourgogne-Franche-Comté, France
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7
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Maso LD, Serraino D, Guzzinati S. Is survivorship an endless experience? Cancer 2022; 128:3597-3598. [PMID: 35972229 DOI: 10.1002/cncr.34412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Luigino Dal Maso
- Cancer Epidemiology Unit, IRCCS, National Cancer Institute, CRO, IRCCS, Aviano, Pordenone, Italy
| | - Diego Serraino
- Cancer Epidemiology Unit, IRCCS, National Cancer Institute, CRO, IRCCS, Aviano, Pordenone, Italy
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8
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Hendriks MJ, Harju E, Roser K, Ienca M, Michel G. The long shadow of childhood cancer: a qualitative study on insurance hardship among survivors of childhood cancer. BMC Health Serv Res 2021; 21:503. [PMID: 34034742 PMCID: PMC8152348 DOI: 10.1186/s12913-021-06543-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The long-term consequences of childhood cancer have received increasing attention due to the growing number of survivors over the past decades. However, insurance hardships of survivors are mostly unknown. This study explored qualitatively, in a sample of childhood cancer survivors (CCS), (i) the experiences and needs of CCS living in Switzerland with a special focus on hardships related to insurance; and (ii) the views of insurance and law experts with experience on childhood cancer. METHODS Semi-structured interviews were conducted with 28 childhood cancer survivors and 3 experts (one legal expert, two insurance experts). Data was analysed using qualitative content analysis. RESULTS Three key themes emerged from the interviews with the CCS: 1) experiences with insurance, 2) perception of discrimination, and 3) needs and barriers for support. The interviewed experts provided further detailed clarification of CCS' concerns. Our findings indicated that some CCS can move past their cancer history, while others continue to face hardships. CCS reported confusion about the opportunities and services within the social security system and most relied on their personal contacts for guidance. Finally, CCS expressed a strong need for socio-economic and legal support for social insurance questions, especially related to disability insurance. CONCLUSIONS With the growing population of CCS, it is essential to further assess the interplay between medical and psychosocial health and socio-economic hardship. Supportive psychosocial services should aim to ameliorate insurance hardships. Better understanding of the relationship between childhood cancer and insurance hardships during survivorship will inform efforts to improve long-term financial security and health outcomes for survivors. We call for the public, lawmakers, researchers, insurers, and patient organizations to come together and discuss future perspectives to avoid the risk of discrimination for cancer survivors.
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Affiliation(s)
- Manya Jerina Hendriks
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, PO Box 4466, 6002, Lucerne, Switzerland.,Clinical Ethics, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Erika Harju
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, PO Box 4466, 6002, Lucerne, Switzerland
| | - Katharina Roser
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, PO Box 4466, 6002, Lucerne, Switzerland
| | - Marcello Ienca
- Department of Health Science and Technology, Technical University of Zurich, Zurich, Switzerland
| | - Gisela Michel
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, PO Box 4466, 6002, Lucerne, Switzerland.
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9
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Dal Maso L, Panato C, Tavilla A, Guzzinati S, Serraino D, Mallone S, Botta L, Boussari O, Capocaccia R, Colonna M, Crocetti E, Dumas A, Dyba T, Franceschi S, Gatta G, Gigli A, Giusti F, Jooste V, Minicozzi P, Neamtiu L, Romain G, Zorzi M, De Angelis R, Francisci S. Cancer cure for 32 cancer types: results from the EUROCARE-5 study. Int J Epidemiol 2021; 49:1517-1525. [PMID: 32984907 DOI: 10.1093/ije/dyaa128] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Few studies have estimated the probability of being cured for cancer patients. This study aims to estimate population-based indicators of cancer cure in Europe by type, sex, age and period. METHODS 7.2 million cancer patients (42 population-based cancer registries in 17 European countries) diagnosed at ages 15-74 years in 1990-2007 with follow-up to 2008 were selected from the EUROCARE-5 dataset. Mixture-cure models were used to estimate: (i) life expectancy of fatal cases (LEF); (ii) cure fraction (CF) as proportion of patients with same death rates as the general population; (iii) time to cure (TTC) as time to reach 5-year conditional relative survival (CRS) >95%. RESULTS LEF ranged from 10 years for chronic lymphocytic leukaemia patients to <6 months for those with liver, pancreas, brain, gallbladder and lung cancers. It was 7.7 years for patients with prostate cancer at age 65-74 years and >5 years for women with breast cancer. The CF was 94% for testis, 87% for thyroid cancer in women and 70% in men, 86% for skin melanoma in women and 76% in men, 66% for breast, 63% for prostate and <10% for liver, lung and pancreatic cancers. TTC was <5 years for testis and thyroid cancer patients diagnosed below age 55 years, and <10 years for stomach, colorectal, corpus uteri and melanoma patients of all ages. For breast and prostate cancers, a small excess (CRS < 95%) remained for at least 15 years. CONCLUSIONS Estimates from this analysis should help to reduce unneeded medicalization and costs. They represent an opportunity to improve patients' quality of life.
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Affiliation(s)
- Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Chiara Panato
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Andrea Tavilla
- National Center for Prevention and Health Promotion, Italian National Institute of Health (ISS), Rome, Italy
| | | | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Sandra Mallone
- National Center for Prevention and Health Promotion, Italian National Institute of Health (ISS), Rome, Italy
| | - Laura Botta
- Evaluative Epidemiology Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Olayidé Boussari
- Registre Bourguignon des Cancers Digestifs, INSERM UMR 1231, CHU de Dijon, Université de Bourgogne, Dijon, France
| | | | | | - Emanuele Crocetti
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, ItalyAzienda Usl della Romagna, Forlì, Italy
| | - Agnes Dumas
- National Institute for Health and Medical Research (INSERM), Paris, France
| | - Tadek Dyba
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Silvia Franceschi
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Gemma Gatta
- Evaluative Epidemiology Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Anna Gigli
- Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
| | | | - Valerie Jooste
- Registre Bourguignon des Cancers Digestifs, INSERM UMR 1231, CHU de Dijon, Université de Bourgogne, Dijon, France
| | - Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Luciana Neamtiu
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Gaëlle Romain
- Registre Bourguignon des Cancers Digestifs, INSERM UMR 1231, CHU de Dijon, Université de Bourgogne, Dijon, France
| | - Manuel Zorzi
- Veneto Tumour Registry, Azienda Zero, Padua, Italy
| | - Roberta De Angelis
- Department of Oncology and Molecular Medicine, Italian National Institute of Health (ISS), Rome, Italy
| | - Silvia Francisci
- National Center for Prevention and Health Promotion, Italian National Institute of Health (ISS), Rome, Italy
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10
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Scocca G, Meunier F. A right to be forgotten for cancer survivors: A legal development expected to reflect the medical progress in the fight against cancer. J Cancer Policy 2020. [DOI: 10.1016/j.jcpo.2020.100246] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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11
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Mamguem Kamga A, Dumas A, Joly F, Simon J, Billa O, Poillot ML, Jolimoy G, Roignot P, Coutant C, Arveux P, Dabakuyo-Yonli TS. Socio-economic and occupational outcomes of long-term survivors of gynaecological cancer: A French population-based study. Eur J Cancer Care (Engl) 2020; 29:e13235. [PMID: 32215988 DOI: 10.1111/ecc.13235] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/18/2020] [Accepted: 02/18/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe socio-economic and professional outcomes in long-term survivors of cervical, endometrial or ovarian cancer, including return to work and problems related to obtaining loans and insurance. METHODS Women with cervical, endometrial or ovarian cancers diagnosed from 2006 to 2013 were selected through the French gynaecological cancer registry of Côte d'Or, in a cross-sectional survey. Using a questionnaire established with the help of sociologists and psychologists, social and cancer-related work issues were collected among women aged less than 60 years at the time of cancer diagnosis. The socio-economic status was also assessed, at the time of the survey using the EPICES questionnaire. RESULTS A total of 92 gynaecological cancer survivors (CS) participated in this survey. Gynaecological CS reported a decrease in income since cancer diagnosis, difficulties obtaining loans, and a decrease in ability to work, both in the short term after treatment and at the time of survey, on average 6 years after diagnosis. Fatigue, emotional and cognitive difficulties were the reasons cited to explain the decreased ability to work, both immediately after treatment and in the long term. CONCLUSIONS Gynaecological CS experienced many problems, such as decreased work capacity, decreased income and difficulty obtaining loans.
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Affiliation(s)
- Ariane Mamguem Kamga
- Breast and Gynaecologic Cancer Registry of Côte d'Or, Georges-François Leclerc Cancer Centre-UNICANCER, Dijon, France
| | - Agnès Dumas
- Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, Université Paris-Sud, University of Paris-Saclay, Villejuif, France.,Department of Clinical Research, Gustave Roussy, Villejuif, France
| | - Florence Joly
- Medical Oncology Department, François Baclesse Cancer Centre-UNICANCER, University Hospital Côte de Nacre, Caen, France
| | - Julien Simon
- Breast and Gynaecologic Cancer Registry of Côte d'Or, Georges-François Leclerc Cancer Centre-UNICANCER, Dijon, France
| | - Oumar Billa
- Breast and Gynaecologic Cancer Registry of Côte d'Or, Georges-François Leclerc Cancer Centre-UNICANCER, Dijon, France
| | - Marie-Laure Poillot
- Breast and Gynaecologic Cancer Registry of Côte d'Or, Georges-François Leclerc Cancer Centre-UNICANCER, Dijon, France
| | | | | | - Charles Coutant
- Medical Oncology, Georges-François Leclerc Cancer Centre-UNICANCER, Dijon, France.,Burgundy Franche-Comté University, Dijon, France
| | - Patrick Arveux
- Breast and Gynaecologic Cancer Registry of Côte d'Or, Georges-François Leclerc Cancer Centre-UNICANCER, Dijon, France
| | - Tienhan Sandrine Dabakuyo-Yonli
- Breast and Gynaecologic Cancer Registry of Côte d'Or, Georges-François Leclerc Cancer Centre-UNICANCER, Dijon, France.,National Quality of Life and Cancer Platform, Dijon, France
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12
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Tralongo P, Surbone A, Serraino D, Dal Maso L. Major patterns of cancer cure: Clinical implications. Eur J Cancer Care (Engl) 2019; 28:e13139. [DOI: 10.1111/ecc.13139] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 06/26/2019] [Accepted: 07/18/2019] [Indexed: 01/01/2023]
Affiliation(s)
| | | | - Diego Serraino
- Cancer Epidemiology Unit Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy
| | - Luigino Dal Maso
- Cancer Epidemiology Unit Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy
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13
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Dal Maso L, Panato C, Guzzinati S, Serraino D, Francisci S, Botta L, Capocaccia R, Tavilla A, Gigli A, Crocetti E, Rugge M, Tagliabue G, Filiberti RA, Carrozzi G, Michiara M, Ferretti S, Cesaraccio R, Tumino R, Falcini F, Stracci F, Torrisi A, Mazzoleni G, Fusco M, Rosso S, Tisano F, Fanetti AC, Sini GM, Buzzoni C, De Angelis R. Prognosis and cure of long-term cancer survivors: A population-based estimation. Cancer Med 2019; 8:4497-4507. [PMID: 31207165 PMCID: PMC6675712 DOI: 10.1002/cam4.2276] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 05/06/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Increasing evidence of cure for some neoplasms has emerged in recent years. The study aimed to estimate population-based indicators of cancer cure. METHODS Information on more than half a million cancer patients aged 15-74 years collected by population-based Italian cancer registries and mixture cure models were used to estimate the life expectancy of fatal tumors (LEFT), proportions of patients with similar death rates of the general population (cure fraction), and time to reach 5-year conditional relative survival (CRS) >90% or 95% (time to cure). RESULTS Between 1990 and 2000, the median LEFT increased >1 year for breast (from 8.1 to 9.4 years) and prostate cancers (from 5.2 to 7.4 years). Median LEFT in 1990 was >5 years for testicular cancers (5.8) and Hodgkin lymphoma (6.3) below 45 years of age. In both sexes, it was ≤0.5 years for pancreatic cancers and NHL in 1990 and in 2000. The cure fraction showed a 10% increase between 1990 and 2000. It was 95% for thyroid cancer in women, 94% for testis, 75% for prostate, 67% for breast cancers, and <20% for liver, lung, and pancreatic cancers. Time to 5-year CRS >95% was <10 years for testis, thyroid, colon cancers, and melanoma. For breast and prostate cancers, the 5-year CRS >90% was reached in <10 years but a small excess remained for >15 years. CONCLUSIONS The study findings confirmed that several cancer types are curable. Became aware of the possibility of cancer cure has relevant clinical and social impacts.
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Affiliation(s)
- Luigino Dal Maso
- Cancer Epidemiology UnitCentro di Riferimento Oncologico di Aviano (CRO) IRCCSAvianoItaly
| | - Chiara Panato
- Cancer Epidemiology UnitCentro di Riferimento Oncologico di Aviano (CRO) IRCCSAvianoItaly
| | | | - Diego Serraino
- Cancer Epidemiology UnitCentro di Riferimento Oncologico di Aviano (CRO) IRCCSAvianoItaly
| | - Silvia Francisci
- National Center for Prevention and Health PromotionItalian National Institute of Health (ISS)RomeItaly
| | - Laura Botta
- Evaluative Epidemiology Unit, Department of Preventive and Predictive MedicineFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Riccardo Capocaccia
- Cancer Epidemiology UnitCentro di Riferimento Oncologico di Aviano (CRO) IRCCSAvianoItaly
| | - Andrea Tavilla
- National Center for Prevention and Health PromotionItalian National Institute of Health (ISS)RomeItaly
| | - Anna Gigli
- Institute for Research on Population and Social PoliciesNational Research CouncilRomeItaly
| | - Emanuele Crocetti
- Romagna Cancer RegistryIstituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS and Azienda Usl della RomagnaMeldola (Forlì)Italy
| | - Massimo Rugge
- Veneto Tumour RegistryAzienda ZeroPaduaItaly
- Department of Medicine (DIMED)University of PaduaPaduaItaly
| | - Giovanna Tagliabue
- Lombardy Cancer Registry-Varese Province, Cancer Registry Unit, Department of ResearchFondazione IRCCS Istituto Nazionale TumoriMilanItaly
| | - Rosa Angela Filiberti
- Liguria Cancer Registry, Clinical EpidemiologyIRCCS Policlinico San MartinoGenovaItaly
| | - Giuliano Carrozzi
- Modena Cancer Registry, Public Health DepartmentAUSL ModenaModenaItaly
| | - Maria Michiara
- Parma Cancer Registry, Oncology UnitAzienda Ospedaliera Universitaria di ParmaParmaItaly
| | - Stefano Ferretti
- Romagna Cancer Registry ‐ Section of Ferrara. Local Health UnitUniversity of FerraraFerraraItaly
| | - Rosaria Cesaraccio
- North Sardinia Cancer RegistryAzienda Regionale per la Tutela della SaluteSassariItaly
| | | | - Fabio Falcini
- Romagna Cancer RegistryIstituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS and Azienda Usl della RomagnaMeldola (Forlì)Italy
| | - Fabrizio Stracci
- Public Health Section, Department of Experimental MedicineUniversity of PerugiaPerugiaItaly
| | | | | | - Mario Fusco
- Cancer Registry of ASL Napoli 3 SudNapoliItaly
| | - Stefano Rosso
- Registro Tumori PiemonteProvincia di Biella CPOBiellaItaly
| | - Francesco Tisano
- Cancer Registry of the Province of SiracusaLocal Health Unit of SiracusaSiracusaItaly
| | - Anna Clara Fanetti
- Sondrio Cancer Registry, Epidemiology unitATS della MontagnaSondrioItaly
| | | | - Carlotta Buzzoni
- Tuscany Cancer RegistryClinical and Descriptive Epidemiology Unit, Cancer Prevention and Research Institute (ISPO)FlorenceItaly
- AIRTUM DatabaseFlorenceItaly
| | - Roberta De Angelis
- Department of Oncology and Molecular MedicineItalian National Institute of Health (ISS)RomeItaly
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14
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Erdmann F, Feychting M, Mogensen H, Schmiegelow K, Zeeb H. Social Inequalities Along the Childhood Cancer Continuum: An Overview of Evidence and a Conceptual Framework to Identify Underlying Mechanisms and Pathways. Front Public Health 2019; 7:84. [PMID: 31106186 PMCID: PMC6492628 DOI: 10.3389/fpubh.2019.00084] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 03/26/2019] [Indexed: 12/13/2022] Open
Abstract
Inequalities in health according to social conditions are regarded as unnecessary and unjust. There is a large body of evidence on inequalities in adult cancer, observable throughout the societies on a national level as well as on a global scale. Socioeconomic influences on health matter at all ages including childhood, for which childhood cancer is the leading cause of disease related death in high-income countries (HICs). Substantial differences in the reported incidence of childhood cancers have been observed globally by socioeconomic development of a population. This is reflected in the higher incidence rates reported for HICs, particularly for acute lymphoblastic leukemia, and for cancer in infants (below 1 year), compared to low- and middle-income countries (LMICs). Considerable inequalities between populations and degree of socioeconomic development are also noted for survival from childhood cancer, with substantially lower survival rates seen in most LMICs compared to HICs. With respect to inequalities by socioeconomic position (SEP) within countries, findings of an association between SEP and childhood cancer risk are diverse and limited to studies from HICs. On the contrary, observations on social inequalities in survival within countries are accumulating and indicate that survival inequalities do not only concern resource-poor countries but also high-income populations including European countries. In turn, a childhood cancer diagnosis in itself may have implications on the parents' socioeconomic situation as well as on the later socioeconomic life after having survived the disease. The underlying mechanisms and causal pathways of these empirically demonstrated social inequalities are poorly understood, although it is of significant public health relevance for any actions or strategies to reduce childhood cancer-related inequity. We propose a conceptual framework on potential underlying mechanism and pathways specifically addressing social inequalities in childhood cancer and after childhood cancer to (i) illustrate potential pathways by which social determinants may create health inequities at different points of the childhood cancer continuum; (ii) illustrate potential pathways by which a childhood cancer diagnosis may impact the socioeconomic situation of the concerned family or the later life of a childhood survivor; and (iii) point out how major determinants may relate to each other.
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Affiliation(s)
- Friederike Erdmann
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
- Department of Prevention and Evaluation, Leibniz - Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Mogensen
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz - Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
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15
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Dumas A, Allodji R, Fresneau B, Valteau-Couanet D, El-Fayech C, Pacquement H, Laprie A, Nguyen TD, Bondiau PY, Diallo I, Guibout C, Rubino C, Haddy N, Oberlin O, Vassal G, de Vathaire F. The right to be forgotten: a change in access to insurance and loans after childhood cancer? J Cancer Surviv 2017; 11:431-437. [PMID: 28130711 DOI: 10.1007/s11764-017-0600-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/17/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Access to insurance for a loan or a mortgage is an important issue for childhood cancer survivors. The aim of this study was to describe difficulties experienced by adult survivors. METHODS A total of 1920 survivors treated before the age of 18 in five French cancer centers responded to a questionnaire in 2010. Survivors who had tried to obtain a loan were asked if they had experienced difficulties, which were defined as experiencing rejection, higher premiums, or exclusions. The questionnaire investigated health problems related to the circulatory, respiratory, digestive, urinary, endocrine, hormonal, and nervous systems. Second tumors, diabetes mellitus, cardiac disease, and stroke were ascertained from a physician's report or medical records. Multivariable analyses were conducted to identify the characteristics of survivors reporting difficulties. RESULTS Difficulties were experienced by 10.4% of those who had tried to obtain a small loan (n = 787) and by 30.1% of those who had tried to obtain a home loan (n = 909). Disclosure of childhood cancer to the insurer and amputation surgery were negatively associated with insurance accessibility, even when controlling for age, gender, education, health-related unemployment, familial situation, and severe or life-threatening conditions such as cardiovascular diseases, second cancers, or diabetes. CONCLUSION This study showed that the financial burden of cancer can extend decades after diagnosis. IMPLICATIONS FOR CANCER SURVIVORS Thanks to a 2016 law, French cancer survivors no longer have to disclose their cancer to insurers after a fixed number of years. This law will probably lessen the socioeconomic burden of cancer.
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Affiliation(s)
- Agnès Dumas
- Centre for Research in Epidemiology and Population Health (CESP), Cancer and Radiation team, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, 94807, Villejuif, France. .,Department of Clinical Research, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France.
| | - Rodrigue Allodji
- Centre for Research in Epidemiology and Population Health (CESP), Cancer and Radiation team, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, 94807, Villejuif, France.,Department of Clinical Research, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | - Brice Fresneau
- Centre for Research in Epidemiology and Population Health (CESP), Cancer and Radiation team, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, 94807, Villejuif, France.,Department of Clinical Research, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France.,Department of Paediatric and Adolescent Oncology, Gustave Roussy, 94805, Villejuif, France
| | | | - Chiraz El-Fayech
- Department of Paediatric and Adolescent Oncology, Gustave Roussy, 94805, Villejuif, France
| | - Hélène Pacquement
- Department of Paediatric Oncology, Institut Curie, 75005, Paris, France
| | - Anne Laprie
- Department of Radiation Oncology, Centre Claudius Regaud, 31059, Toulouse, France
| | - Tan Dat Nguyen
- Radiotherapy Department, Centre Jean Godinot, 51100, Reims, France
| | - Pierre-Yves Bondiau
- Department of Radiation Oncology, Centre Antoine Lacassagne, 06100, Nice, France
| | - Ibrahima Diallo
- Centre for Research in Epidemiology and Population Health (CESP), Cancer and Radiation team, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, 94807, Villejuif, France.,Department of Clinical Research, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | - Catherine Guibout
- Centre for Research in Epidemiology and Population Health (CESP), Cancer and Radiation team, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, 94807, Villejuif, France.,Department of Clinical Research, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | - Carole Rubino
- Centre for Research in Epidemiology and Population Health (CESP), Cancer and Radiation team, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, 94807, Villejuif, France.,Department of Clinical Research, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | - Nadia Haddy
- Centre for Research in Epidemiology and Population Health (CESP), Cancer and Radiation team, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, 94807, Villejuif, France.,Department of Clinical Research, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | - Odile Oberlin
- Department of Paediatric and Adolescent Oncology, Gustave Roussy, 94805, Villejuif, France
| | - Gilles Vassal
- Department of Clinical Research, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | - Florent de Vathaire
- Centre for Research in Epidemiology and Population Health (CESP), Cancer and Radiation team, INSERM U1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, 94807, Villejuif, France.,Department of Clinical Research, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
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