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Giannoula A, Comas M, Castells X, Estupiñán-Romero F, Bernal-Delgado E, Sanz F, Sala M. Exploring long-term breast cancer survivors' care trajectories using dynamic time warping-based unsupervised clustering. J Am Med Inform Assoc 2024; 31:820-831. [PMID: 38193340 PMCID: PMC10990519 DOI: 10.1093/jamia/ocad251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/10/2023] [Accepted: 12/18/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVES Long-term breast cancer survivors (BCS) constitute a complex group of patients, whose number is estimated to continue rising, such that, a dedicated long-term clinical follow-up is necessary. MATERIALS AND METHODS A dynamic time warping-based unsupervised clustering methodology is presented in this article for the identification of temporal patterns in the care trajectories of 6214 female BCS of a large longitudinal retrospective cohort of Spain. The extracted care-transition patterns are graphically represented using directed network diagrams with aggregated patient and time information. A control group consisting of 12 412 females without breast cancer is also used for comparison. RESULTS The use of radiology and hospital admission are explored as patterns of special interest. In the generated networks, a more intense and complex use of certain healthcare services (eg, radiology, outpatient care, hospital admission) is shown and quantified for the BCS. Higher mortality rates and numbers of comorbidities are observed in various transitions and compared with non-breast cancer. It is also demonstrated how a wealth of patient and time information can be revealed from individual service transitions. DISCUSSION The presented methodology permits the identification and descriptive visualization of temporal patterns of the usage of healthcare services by the BCS, that otherwise would remain hidden in the trajectories. CONCLUSION The results could provide the basis for better understanding the BCS' circulation through the health system, with a view to more efficiently predicting their forthcoming needs and thus designing more effective personalized survivorship care plans.
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Affiliation(s)
- Alexia Giannoula
- Epidemiology and Evaluation Department, Hospital del Mar Research Institute (IMIM), Barcelona, 08003, Spain
- Research Programme on Biomedical Informatics (GRIB), Department of Medicine and Life Sciences (MELIS), Hospital del Mar Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
- RICAPPS Red de Investigación en Cronicidad, Atención Primaria Y Promoción de la Salud, Spain
| | - Mercè Comas
- Epidemiology and Evaluation Department, Hospital del Mar Research Institute (IMIM), Barcelona, 08003, Spain
- RICAPPS Red de Investigación en Cronicidad, Atención Primaria Y Promoción de la Salud, Spain
| | - Xavier Castells
- Epidemiology and Evaluation Department, Hospital del Mar Research Institute (IMIM), Barcelona, 08003, Spain
- RICAPPS Red de Investigación en Cronicidad, Atención Primaria Y Promoción de la Salud, Spain
| | - Francisco Estupiñán-Romero
- RICAPPS Red de Investigación en Cronicidad, Atención Primaria Y Promoción de la Salud, Spain
- Data Science for Health Services and Policy Research Group, Institute for Health Sciences (IACS), Zaragoza, Aragon, 50009, Spain
| | - Enrique Bernal-Delgado
- RICAPPS Red de Investigación en Cronicidad, Atención Primaria Y Promoción de la Salud, Spain
- Data Science for Health Services and Policy Research Group, Institute for Health Sciences (IACS), Zaragoza, Aragon, 50009, Spain
| | - Ferran Sanz
- Epidemiology and Evaluation Department, Hospital del Mar Research Institute (IMIM), Barcelona, 08003, Spain
- Research Programme on Biomedical Informatics (GRIB), Department of Medicine and Life Sciences (MELIS), Hospital del Mar Research Institute (IMIM), Universitat Pompeu Fabra, Barcelona, Spain
| | - Maria Sala
- Epidemiology and Evaluation Department, Hospital del Mar Research Institute (IMIM), Barcelona, 08003, Spain
- RICAPPS Red de Investigación en Cronicidad, Atención Primaria Y Promoción de la Salud, Spain
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Risk stratification of young adult survivors of cancer to estimate hospital morbidity burden: applicability of a pediatric therapy-based approach. J Cancer Surviv 2020; 15:452-460. [PMID: 32939686 PMCID: PMC8134299 DOI: 10.1007/s11764-020-00939-y] [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: 05/15/2020] [Accepted: 09/05/2020] [Indexed: 11/05/2022]
Abstract
Purpose Children and young adults (CYA) are at risk of late morbidity following cancer treatment, with risk varying by disease type and treatment received. Risk-stratified levels of aftercare which stratify morbidity burden to inform the intensity of long-term follow-up care, are well established for survivors of cancer under the age of 18 years, utilizing the National Cancer Survivor Initiative (NCSI) approach. We investigated the applicability of risk-stratified levels of aftercare in predicting long-term morbidity in young adults (YA), aged 18–29 years. Methods Long-term CYA survivors followed-up at a regional center in the North of England were risk-stratified by disease and treatments received into one of three levels. These data were linked with local cancer registry and administrative health data (Hospital Episode Statistics), where hospital activity was used as a marker of late morbidity burden. Results Poisson modelling with incident rate ratios (IRR) demonstrated similar trends in hospital activity for childhood (CH) and YA cancer survivors across NCSI risk levels. NCSI levels independently predicted long-term hospitalization risk in both CH and YA survivors. Risk of hospitalization was significantly reduced for levels 1 (CH IRR 0.32 (95% CI 0.26–0.41), YA IRR 0.06 (95% CI 0.01–0.43)) and 2; CH IRR 0.46 (95% CI 0.42-0.50), YA IRR 0.49 (95% CI 0.37-0.50)), compared with level 3. Conclusions The NCSI pediatric late-effects risk stratification system can be effectively and safely applied to cancer patients aged 18–29, independent of ethnicity or socioeconomic position. Implications for Cancer Survivors To enhance quality of care and resource utilization, long-term aftercare of survivors of YA cancer can and should be risk stratified through adoption of approaches such as the NCSI risk-stratification model. Electronic supplementary material The online version of this article (10.1007/s11764-020-00939-y) contains supplementary material, which is available to authorized users.
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Health care services use among long-term breast cancer survivors: a systematic review. J Cancer Surviv 2019; 13:477-493. [PMID: 30968367 DOI: 10.1007/s11764-019-00755-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 03/21/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE Long-term breast cancer survivors are women surviving at least 5 years after diagnosis. This systematic review aimed to summarize the main characteristics and patterns of healthcare service use (frequency of visits, health providers visited, and preventive care performed) among long-term breast cancer survivors. METHODS We used standard Cochrane Collaboration methods and searched the MEDLINE and EMBASE databases up to January 2018. We included English language observational studies reporting health service use among long-term cancer survivors. The quality of the studies was appraised through the ROBINS-I assessment tool. Two independent reviewers performed both the study quality assessment and the data extraction. RESULTS A total of 23 observational studies were included that reported data on health services use by long-term breast cancer survivors. Despite heterogeneity among studies, about half of them reported that breast cancer survivors visited a medical provider at least once a year, as recommended by breast cancer survival guidelines. Although survivors visited medical providers with the recommended frequency, a substantial number used specialist care instead of primary care during follow-up. The results showed underuse of the recommended annual mammogram. CONCLUSIONS Long-term breast cancer survivors differ in their health services use with regard to the frequency of visits as well as the health providers seen. Our results indicate the need for active surveillance through primary care providers in coordination with specialized care. IMPLICATIONS FOR CANCER SURVIVORS This review could help to standardize the management of breast cancer survivors and decision-makers to adapt their guidelines and clinical protocols.
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Meehan E, Reid SM, Williams K, Freed GL, Sewell JR, Vidmar S, Donath S, Reddihough DS. Hospital admissions in children with cerebral palsy: a data linkage study. Dev Med Child Neurol 2017; 59:512-519. [PMID: 27900776 DOI: 10.1111/dmcn.13350] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2016] [Indexed: 01/06/2023]
Abstract
AIM The overall aim was to investigate the feasibility and utility of linking a cerebral palsy (CP) register to an administrative data set for health services research purposes. We sought to compare CP hospital admissions to general childhood population admissions, and identify factors associated with type and frequency of admissions in a CP cohort. METHOD The CP register for Victoria, Australia was linked to the state's hospital admissions database. Data pertaining to the admissions of a CP cohort (n=1748) that took place between 2007 and 2014 were extracted. Population data were also obtained. RESULTS Overall, 80% of the CP cohort (n=1401) had at least admission between 2007 and 2014, accounting for 11 012 admissions or 1.5% of all admissions in their age group. Compared to general population admissions, CP admissions were more costly and more likely to be elective (66% vs 57%; p<0.001), medical (71% vs 57%; p<0.001), and to take place in metropolitan hospitals (92% vs 78%; p<0.001). Increased CP severity and complexity were associated with having more admissions and a higher proportion of admissions attributable to respiratory illness. INTERPRETATION By linking with administrative data sets, CP registers may be useful for health services research and inform health service delivery.
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Affiliation(s)
- Elaine Meehan
- Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Developmental Disability and Rehabilitation Research, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Vic., Australia
| | - Susan M Reid
- Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Developmental Disability and Rehabilitation Research, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Vic., Australia
| | - Katrina Williams
- Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Developmental Disability and Rehabilitation Research, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,Developmental Medicine, The Royal Children's Hospital, Melbourne, Vic., Australia
| | - Gary L Freed
- Health Systems and Workforce Unit, Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, Vic., Australia
| | - Jillian R Sewell
- Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Centre for Community Child Health, Royal Children's Hospital, Melbourne, Vic., Australia
| | - Suzanna Vidmar
- Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Clinical Epidemiology and Biostatistics Unit, Data Science, Murdoch Childrens Research Institute, Melbourne, Vic., Australia
| | - Susan Donath
- Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Clinical Epidemiology and Biostatistics Unit, Data Science, Murdoch Childrens Research Institute, Melbourne, Vic., Australia
| | - Dinah S Reddihough
- Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Developmental Disability and Rehabilitation Research, Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,Developmental Medicine, The Royal Children's Hospital, Melbourne, Vic., Australia
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Wulaningsih W, Astuti Y, Matsuguchi T, Anggrandariyanny P, Watkins J. Circulating Prostate-Specific Antigen and Telomere Length in a Nationally Representative Sample of Men Without History of Prostate Cancer. Prostate 2017; 77:22-32. [PMID: 27566127 DOI: 10.1002/pros.23245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 07/27/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND We investigated the association of prostate-specific antigen (PSA) with leukocyte telomere length, which may be altered in preclinical prostate malignancies. METHODS This study was based on the 2001-2002 U.S. National Health and Nutrition Examination Survey (NHANES). A subsample of 1,127 men aged 40-85 years without prior history of prostate cancer who provided informed consent and blood samples were selected. Leukocyte telomere length (LTL) relative to standard DNA reference (T/S ratio) was quantified by polymerase chain reaction (PCR). Survey-weighted multivariable linear regression was performed to examine T/S ratio across quintiles of total and free PSA and free-to-total PSA ratio (%fPSA). A sensitivity analysis was performed by excluding men dying from prostate cancer during follow-up through to December 31, 2006. Stratification analyses were carried out to assess any effect modification by age group, race, body mass index (BMI), and levels of C-reactive protein (CRP), a marker of inflammation. RESULTS Higher total PSA levels were associated to longer LTL, with approximately 8% increase in log-transformed T/S ratio (95% confidence interval [CI]: 2-13%) among men in the highest quintile of total PSA compared to the lowest in the fully adjusted model (Ptrend = 0.01). No significant association was found for free PSA or %fPSA, although nonlinearity between all PSA measures and T/S ratio was indicated. Similar results were found after excluding men who died from prostate cancer during follow-up. We also found the associations between total PSA and T/S ratio to be strongest among non-Hispanic blacks, non-obese men (BMI <30 kg/m2 ), and those with low CRP. However, a significant interaction was only found between total PSA and race/ethnicity (Pinteraction = 0.01). CONCLUSION Total PSA levels were strongly associated to LTL, particularly among non-Hispanic blacks. Our findings support a potential link between PSA and specific mechanisms contributing to prostate cancer development. Prostate 77:22-32, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Wahyu Wulaningsih
- MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
- Division of Haematology/Oncology, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
- PILAR Research and Education, Cambridge, United Kingdom
| | - Yuliana Astuti
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Department of Obstetrics/Gynaecology, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - Tetsuya Matsuguchi
- Department of Biochemistry and Biophysics, University of California, Driver Group, L.L.C., San Francisco, California
| | - Putri Anggrandariyanny
- Division of Haematology/Oncology, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - Johnathan Watkins
- PILAR Research and Education, Cambridge, United Kingdom
- Institute for Mathematical and Molecular Biomedicine, King's College London, London, United Kingdom
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Rashbass J, Peake M. The evolution of cancer registration. Eur J Cancer Care (Engl) 2015; 23:757-9. [PMID: 25352464 DOI: 10.1111/ecc.12259] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2014] [Indexed: 11/29/2022]
Affiliation(s)
- J Rashbass
- Disease Registration, Public Health England, London, UK
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A Population-Based, Nationwide Cross-Sectional Study on Influenza Vaccination Status among Cancer Survivors in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:10133-49. [PMID: 26308031 PMCID: PMC4555334 DOI: 10.3390/ijerph120810133] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/04/2015] [Accepted: 08/18/2015] [Indexed: 12/03/2022]
Abstract
Cancer survivors are at increased risk of developing influenza-related complications. The purpose of this study was to investigate the vaccination coverage among cancer survivors in Korea using the Korea National Health and Nutrition Examination Survey (KNHANES). Adult cancer survivors were selected from fourth (2007–2009) and fifth (2010–2012) KNHANES (n = 1156) datasets. General characteristics, cancer-related data, and influenza vaccination status were collected using self-report questionnaires. Chi-square tests and multiple logistic regression analyses were performed to investigate the association between influenza vaccination coverage and associated factors. Overall, 51% of survivors were vaccinated. Vaccine prevalence exceeded 75% in those more than 65 years but was only 26% in survivors aged 19–44. Increasing age, low frequency of alcohol consumption, having poor self-rated health, and having a shorter duration since cancer diagnosis were significant predictors of vaccination status among cancer survivors under 65 years of age. Influenza vaccine coverage remains much lower than recommended among cancer survivors, particularly in the younger age groups. Further study is needed to determine the factors that contribute to the lack of vaccination in cancer survivors, despite their increased risk for influenza.
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Richardson DP, Daly C, Sutradhar R, Paszat LF, Wilton AS, Rabeneck L, Baxter NN. Hospitalization Rates Among Survivors of Young Adult Malignancies. J Clin Oncol 2015; 33:2655-9. [DOI: 10.1200/jco.2014.60.1914] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose There are limited data on health care use among survivors of young adult cancers. We aimed to describe patterns of hospitalization among a cohort of long-term survivors compared with noncancer controls. Methods Persons diagnosed between the ages of 20 and 44 years with malignancies in Ontario, Canada, from 1992 to 1999, who lived at least 5 years recurrence free, were identified using the Ontario Cancer Registry and matched to noncancer controls. Hospitalizations were determined using hospital discharges, and rates were compared between survivors and controls. The absolute excess rate of hospitalizations was determined for each type of malignancy in survivors per 100 person-years of follow-up. Results The cohort included 20,275 survivors and 101,344 noncancer controls. During the study period, 6,948 (34.3%) survivors were admitted to the hospital and the adjusted relative rate (ARR) of hospitalizations in survivors compared with controls was 1.51 (95% CI, 1.48 to 1.54). The rate of hospitalization was highest for survivors of upper GI, leukemia, and urologic malignancies. The hospitalization rate (per person) for survivors significantly decreased from 0.22 in the first time period examined (5 to 8 years after diagnosis) to 0.15 in the last time period examined (18 to 20 years after diagnosis, P < .0001). However, at all time periods, survivors were more likely to be hospitalized than controls (ARR at 5 to 8 years, 1.67 [95% CI, 1.57 to 1.81]; ARR at 18 to 20 years, 1.22 [95% CI, 1.08 to 1.37]). Conclusion Survivors of young adult cancers have an increased rate of hospitalization compared with controls. The rate of hospitalization for 20-year survivors did not return to baseline, indicating a substantial and persistent burden of late effects among this generally young population.
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Affiliation(s)
- Devon P. Richardson
- Devon P. Richardson, Rinku Sutradhar, Lawrence F. Paszat, Linda Rabeneck, and Nancy N. Baxter, University of Toronto, Toronto, Ontario, Canada; Rinku Sutradhar, Lawrence F. Paszat, Andrew S. Wilton, Linda Rabeneck, and Nancy N. Baxter, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Corinne Daly and Nancy N. Baxter, St Michael's Hospital, Toronto, Ontario, Canada; Lawrence F. Paszat and Linda Rabeneck, Sunnybrook Research Institute, Toronto, Ontario, Canada; and Linda Rabeneck,
| | - Corinne Daly
- Devon P. Richardson, Rinku Sutradhar, Lawrence F. Paszat, Linda Rabeneck, and Nancy N. Baxter, University of Toronto, Toronto, Ontario, Canada; Rinku Sutradhar, Lawrence F. Paszat, Andrew S. Wilton, Linda Rabeneck, and Nancy N. Baxter, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Corinne Daly and Nancy N. Baxter, St Michael's Hospital, Toronto, Ontario, Canada; Lawrence F. Paszat and Linda Rabeneck, Sunnybrook Research Institute, Toronto, Ontario, Canada; and Linda Rabeneck,
| | - Rinku Sutradhar
- Devon P. Richardson, Rinku Sutradhar, Lawrence F. Paszat, Linda Rabeneck, and Nancy N. Baxter, University of Toronto, Toronto, Ontario, Canada; Rinku Sutradhar, Lawrence F. Paszat, Andrew S. Wilton, Linda Rabeneck, and Nancy N. Baxter, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Corinne Daly and Nancy N. Baxter, St Michael's Hospital, Toronto, Ontario, Canada; Lawrence F. Paszat and Linda Rabeneck, Sunnybrook Research Institute, Toronto, Ontario, Canada; and Linda Rabeneck,
| | - Lawrence F. Paszat
- Devon P. Richardson, Rinku Sutradhar, Lawrence F. Paszat, Linda Rabeneck, and Nancy N. Baxter, University of Toronto, Toronto, Ontario, Canada; Rinku Sutradhar, Lawrence F. Paszat, Andrew S. Wilton, Linda Rabeneck, and Nancy N. Baxter, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Corinne Daly and Nancy N. Baxter, St Michael's Hospital, Toronto, Ontario, Canada; Lawrence F. Paszat and Linda Rabeneck, Sunnybrook Research Institute, Toronto, Ontario, Canada; and Linda Rabeneck,
| | - Andrew S. Wilton
- Devon P. Richardson, Rinku Sutradhar, Lawrence F. Paszat, Linda Rabeneck, and Nancy N. Baxter, University of Toronto, Toronto, Ontario, Canada; Rinku Sutradhar, Lawrence F. Paszat, Andrew S. Wilton, Linda Rabeneck, and Nancy N. Baxter, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Corinne Daly and Nancy N. Baxter, St Michael's Hospital, Toronto, Ontario, Canada; Lawrence F. Paszat and Linda Rabeneck, Sunnybrook Research Institute, Toronto, Ontario, Canada; and Linda Rabeneck,
| | - Linda Rabeneck
- Devon P. Richardson, Rinku Sutradhar, Lawrence F. Paszat, Linda Rabeneck, and Nancy N. Baxter, University of Toronto, Toronto, Ontario, Canada; Rinku Sutradhar, Lawrence F. Paszat, Andrew S. Wilton, Linda Rabeneck, and Nancy N. Baxter, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Corinne Daly and Nancy N. Baxter, St Michael's Hospital, Toronto, Ontario, Canada; Lawrence F. Paszat and Linda Rabeneck, Sunnybrook Research Institute, Toronto, Ontario, Canada; and Linda Rabeneck,
| | - Nancy N. Baxter
- Devon P. Richardson, Rinku Sutradhar, Lawrence F. Paszat, Linda Rabeneck, and Nancy N. Baxter, University of Toronto, Toronto, Ontario, Canada; Rinku Sutradhar, Lawrence F. Paszat, Andrew S. Wilton, Linda Rabeneck, and Nancy N. Baxter, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Corinne Daly and Nancy N. Baxter, St Michael's Hospital, Toronto, Ontario, Canada; Lawrence F. Paszat and Linda Rabeneck, Sunnybrook Research Institute, Toronto, Ontario, Canada; and Linda Rabeneck,
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Yip K, McConnell H, Alonzi R, Maher J. Using routinely collected data to stratify prostate cancer patients into phases of care in the United Kingdom: implications for resource allocation and the cancer survivorship programme. Br J Cancer 2015; 112:1594-602. [PMID: 25791873 PMCID: PMC4453665 DOI: 10.1038/bjc.2014.650] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 11/20/2014] [Accepted: 12/01/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Prostate cancer is the most commonly diagnosed malignancy in British men. The increasing use of PSA screening test has resulted in many more patients being diagnosed with this condition. Advances in its treatment have improved the survival rate among these patients. By 2040, the prevalence of prostate cancer survivors is expected to reach 830 000. Many of them will require medical support for the management of their progressive disease or long-term toxicities from previous treatments. Successful implementation of the cancer survivorship programme among these patients depends on a good understanding of their demand on the health care system. The aim of this study is to segment the population of prostate cancer survivors into different needs groups and to quantify them with respect to their phase of care. METHODS Incidence, survival, prevalence and mortality data collected and reported by cancer registries across the United Kingdom have been used for the current study to provide indicative estimates as to the number of prostate cancer patients in each phase of the care pathway in a year. RESULTS The majority of prostate cancer patients are in the post-treatment monitoring phase. Around a fifth of the patients are either receiving treatment or in the recovery and readjustment phase having completed their treatment in the preceding year. Thirteen percent have not received any anticancer treatment, a further 12% (32 000) have developed metastatic disease and 4% are in the final stage of their lives. CONCLUSION On the basis of our estimates, patients undergoing post-treatment monitoring phase will constitute the biggest group among prostate cancer survivors. The pressure to provide adequate follow-up care to these patients will be a challenge. There is limited data available to definitively quantify the number of prostate cancer patients who follow different pathways of care, and we hope this study has highlighted the importance of collecting and reporting of such data to help future health care planning for these patients.
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Affiliation(s)
- K Yip
- Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, London HA6 2RN, UK
| | - H McConnell
- Macmillan Cancer Support, 89 Albert Embankment, London SE1 7UQ, UK
| | - R Alonzi
- Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, London HA6 2RN, UK
| | - J Maher
- Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, London HA6 2RN, UK
- Macmillan Cancer Support, 89 Albert Embankment, London SE1 7UQ, UK
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Simmonds SJ, Syddall HE, Walsh B, Evandrou M, Dennison EM, Cooper C, Aihie Sayer A. Understanding NHS hospital admissions in England: linkage of Hospital Episode Statistics to the Hertfordshire Cohort Study. Age Ageing 2014; 43:653-60. [PMID: 24598084 DOI: 10.1093/ageing/afu020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND concern over the sustainability of the National Health Service (NHS) is often focussed on rising numbers of hospital admissions, particularly among older people. Hospital admissions are enumerated routinely by the Hospital Episode Statistics (HES) Service, but published data do not allow individual-level service use to be explored. This study linked information on Hertfordshire Cohort Study (HCS) participants with HES inpatient data, with the objective of describing patterns and predictors of admissions among individuals. METHODS 2,997 community-dwelling men and women aged 59-73 years completed a baseline HCS assessment between 1998 and 2004; HES and mortality data to 31 March 2010 were linked with the HCS database. This paper describes patterns of hospital use among the cohort at both the admission and individual person level. RESULTS the cohort experienced 8,741 admissions; rates were 391 per 1,000 person-years among men (95% CI: 380, 402) and 327 among women (95% CI: 316, 338), P < 0.0001 for gender difference. A total of 1,187 men (75%) and 981 women (69%) were admitted to hospital at least once; among these, median numbers of admissions were 3 in men (inter-quartile range, (IQR): 1, 6) and 2 in women (IQR: 1, 5). Forty-eight percent of those ever admitted had experienced an emergency admission and 70% had been admitted overnight. DISCUSSION It is possible to link routinely collected HES data with detailed information from a cohort study. Hospital admission is common among community-dwelling 'young-old' men and women. These linked datasets will facilitate research into lifecourse determinants of hospital admission and inform strategies to manage demand on the NHS.
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Affiliation(s)
- Shirley J Simmonds
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK
| | - Holly E Syddall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK
| | - Bronagh Walsh
- Faculty of Health Sciences, University of Southampton, Southampton SO17 1BJ, UK
| | - Maria Evandrou
- Centre for Research on Ageing, University of Southampton, Southampton SO17 1BJ, UK
| | - Elaine M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK
| | - Avan Aihie Sayer
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK Academic Geriatric Medicine, University of Southampton, Southampton SO16 6YD, UK
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Maddams J, Utley M, Møller H. Projections of cancer prevalence in the United Kingdom, 2010-2040. Br J Cancer 2012; 107:1195-202. [PMID: 22892390 PMCID: PMC3461160 DOI: 10.1038/bjc.2012.366] [Citation(s) in RCA: 301] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: There are currently two million cancer survivors in the United Kingdom, and in recent years this number has grown by 3% per annum. The aim of this paper is to provide long-term projections of cancer prevalence in the United Kingdom. Methods: National cancer registry data for England were used to estimate cancer prevalence in the United Kingdom in 2009. Using a model of prevalence as a function of incidence, survival and population demographics, projections were made to 2040. Different scenarios of future incidence and survival, and their effects on cancer prevalence, were also considered. Colorectal, lung, prostate, female breast and all cancers combined (excluding non-melanoma skin cancer) were analysed separately. Results: Assuming that existing trends in incidence and survival continue, the number of cancer survivors in the United Kingdom is projected to increase by approximately one million per decade from 2010 to 2040. Particularly large increases are anticipated in the oldest age groups, and in the number of long-term survivors. By 2040, almost a quarter of people aged at least 65 will be cancer survivors. Conclusion: Increasing cancer survival and the growing/ageing population of the United Kingdom mean that the population of survivors is likely to grow substantially in the coming decades, as are the related demands upon the health service. Plans must, therefore, be laid to ensure that the varied needs of cancer survivors can be met in the future.
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Affiliation(s)
- J Maddams
- King's College London, Thames Cancer Registry, 1st Floor, Capital House, 42 Weston Street, London SE1 3QD, UK.
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The National Cancer Survivorship Initiative: new and emerging evidence on the ongoing needs of cancer survivors. Br J Cancer 2011; 105 Suppl 1:S1-4. [PMID: 22048027 PMCID: PMC3251952 DOI: 10.1038/bjc.2011.416] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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