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Vichapat V, Chantasartrassamee P, Reungwetwattana T. Impact of Waiting Times on Mortality in Advanced Stage Non-Small Cell Lung Cancer: A 10-Year Retrospective Cohort Study in Thailand. Asian Pac J Cancer Prev 2023; 24:3419-3428. [PMID: 37898846 PMCID: PMC10770679 DOI: 10.31557/apjcp.2023.24.10.3419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/20/2023] [Indexed: 10/30/2023] Open
Abstract
OBJECTIVE This study investigated the relationship between mortality and waiting times from diagnosis to first treatment while also considering other important risk factors associated with mortality. METHODS This is a cohort study including 497 patients diagnosed with advanced stage non-small cell lung cancer (NSCLC) between 1st January 2012 and 31st December 2021. The risk factors and waiting periods were analysed to determine their association with mortality. The waiting periods were recorded based on the timeline of patient visits, including the time between the 1st visit and imaging, the time between the 1st visit and tissue diagnosis, the time between the procedure and tissue diagnosis, the time between tissue diagnosis and treatment and the time from the 1st visit until treatment. The data were assessed using Cox regression with time-varying covariates. RESULTS Waiting time for tissue diagnosis had a modest effect on mortality, a waiting time of more than four weeks indicated poor prognosis both in univariate and multivariate analyses [HR 1.48 (95%CI 1.18-1.87), p = < 0.01), adjusted HR 1.007 (95%CI 1.002-1.010), p = 0.02]. Waiting time for other services was not shown to be associated with mortality. The mortality rate was 3 times higher in patients with poor ECOG performance status than good ECOG performance [adjusted HR 3.17(2.04-4.91)]. Patients with EGFR sensitizing mutation who were treated with EGFR TKI therapy had a lower risk of lung cancer death compared to those being treated with chemotherapy [adjusted HR 0.49 (0.33-0.72)]. CONCLUSION Molecular testing for EGFR sensitizing mutation and the TKI treatment were fundamental changes that assisted in improving survival rates for patients diagnosed with advanced stage lung cancer over the 10-year period. However, poor ECOG performance status remained a strong risk factor for lung cancer death. Longer waiting time for tissue diagnosis might indicate a poor prognosis.
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Affiliation(s)
- Voralak Vichapat
- Division of Medical Oncology, Department of Medicine, Saraburi Provincial Hospital, Thailand.
| | - Panpicha Chantasartrassamee
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Thanyanan Reungwetwattana
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Alrawashdh N, Sweasy J, Erstad B, McBride A, Persky DO, Abraham I. Survival trends in chronic lymphocytic leukemia across treatment eras: US SEER database analysis (1985-2017). Ann Hematol 2021; 100:2501-2512. [PMID: 34279676 DOI: 10.1007/s00277-021-04600-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/04/2021] [Indexed: 11/27/2022]
Abstract
In this population-based study, we used the SEER database (1985-2015) to examine survival outcomes in chronic lymphocytic leukemia (CLL) patients followed up to the era of advanced treatments including targeted therapies. Data were extracted for patients 15 years or older with a primary diagnosis of CLL. A period analysis was performed to estimate 5- and 10-year relative survival rates for patients diagnosed during different calendar periods from 1985 to 2015. A mixture cure model was used to examine long-term survivors' proportions among patients diagnosed in 1985-2015 and for two cohorts diagnosed in 2000-2003, followed up to 2012 and 2004-2007, and followed up to 2015. Cox proportional hazard modeling was used for the two cohorts to estimate hazard ratios (HRs) of death adjusted for gender and age. The 5-year and 10-year age-adjusted relative survival rate ranged between 73.7 and 89.4% and from 51.6% to "not reached," respectively, for calendar periods of 1985-1989 to 2010-2014. The long-term survivor proportions varied by age and gender from 0 to 59%. The HRs (95%CI) for the 2004-2007 cohort in comparison to the 2000-2003 cohort were 0.58 (0.43-0.78), 0.58 (0.48-0.70), 0.57 (0.49-0.0.67), 0.68 (0.54-0.85), and 0.83 (0.68-1.02) for the age categories of 45-54, 55-64, 65-74, 75-84, and ≥ 85 years, respectively. Overall, relative survival improved significantly for CLL patients diagnosed between 1985 and 2015. These improvements were markedly better following the introduction of targeted therapies.
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Affiliation(s)
- Neda Alrawashdh
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85721, USA.,Department of Clinical Translational Sciences, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Joann Sweasy
- University of Arizona Cancer Center, Tucson, AZ, USA
| | - Brian Erstad
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Ali McBride
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Daniel O Persky
- University of Arizona Cancer Center, Tucson, AZ, USA.,Banner University Medical Center, Tucson, AZ, USA
| | - Ivo Abraham
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85721, USA. .,Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA.
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Soliman RM, Elhaddad A, Oke J, Eweida W, Sidhom I, Ahmed S, Abdelrahman H, Moussa E, Fawzy M, Zamzam M, Zekri W, Hafez H, Sedky M, Abdalla A, Hammad M, Elzomor H, Ahmed S, Awad M, Abdelhameed S, Mohsen E, Shalaby L, Fouad H, Tarek N, Abouelnaga S, Heneghan C. Temporal trends in childhood cancer survival in Egypt, 2007 to 2017: A large retrospective study of 14 808 children with cancer from the Children's Cancer Hospital Egypt. Int J Cancer 2020; 148:1562-1574. [PMID: 32997796 DOI: 10.1002/ijc.33321] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/24/2020] [Accepted: 09/08/2020] [Indexed: 12/28/2022]
Abstract
Childhood cancer is a priority in Egypt due to large numbers of children with cancer, suboptimal care and insufficient resources. It is difficult to evaluate progress in survival because of paucity of data in National Cancer Registry. In this study, we studied survival rates and trends in survival of the largest available cohort of children with cancer (n = 15 779, aged 0-18 years) from Egypt between 2007 and 2017, treated at Children's Cancer Hospital Egypt-(CCHE), representing 40% to 50% of all childhood cancers across Egypt. We estimated 5-year overall survival (OS) for 14 808 eligible patients using Kaplan-Meier method, and determined survival trends using Cox regression by single year of diagnosis and by diagnosis periods. We compared age-standardized rates to international benchmarks in England and the United States, identified cancers with inferior survival and provided recommendations for improvement. Five-year OS was 72.1% (95% CI 71.3-72.9) for all cancers combined, and survival trends increased significantly by single year of diagnosis (P < .001) and by calendar periods from 69.6% to 74.2% (P < .0001) between 2007-2012 and 2013-2017. Survival trends improved significantly for leukemias, lymphomas, CNS tumors, neuroblastoma, hepatoblastoma and Ewing Sarcoma. Survival was significantly lower by 9% and 11.2% (P < .001) than England and the United States, respectively. Significantly inferior survival was observed for the majority of cancers. Although survival trends are improving for childhood cancers in Egypt/CCHE, survival is still inferior in high-income countries. We provide evidence-based recommendations to improve survival in Egypt by reflecting on current obstacles in care, with further implications on practice and policy.
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Affiliation(s)
- Ranin M Soliman
- Department of Continuing Education, University of Oxford, Oxford, UK.,Health Economics and Value Unit, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt
| | - Alaa Elhaddad
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Jason Oke
- Nuffield Department of Primary Care Health Sciences, Centre for Evidence Based Medicine, University of Oxford, Oxford, UK
| | - Wael Eweida
- Chief Operating Office, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt
| | - Iman Sidhom
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Sonia Ahmed
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hany Abdelrahman
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Emad Moussa
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Clinical Oncology Department, Menoufia University, Al Minufya, Egypt
| | - Mohamed Fawzy
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Manal Zamzam
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Wael Zekri
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hanafy Hafez
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mohamed Sedky
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Department, National Research Centre, Giza, Egypt
| | - Amr Abdalla
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mahmoud Hammad
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hossam Elzomor
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Sahar Ahmed
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Madeha Awad
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Department of Paediatric Oncology, Nasser Institute for Research and Treatment, Cairo, Egypt
| | - Sayed Abdelhameed
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Enas Mohsen
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Clinical Oncology Department, Beni-Suef University, Beni-Suef, Egypt
| | - Lobna Shalaby
- Paediatric Oncology Department, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt.,Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Heba Fouad
- World Health Organization, Non-communicable Diseases Surveillance Unit, Eastern Mediterranean Regional Office (EMRO), Cairo, Egypt
| | - Nourhan Tarek
- Health Economics and Value Unit, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt
| | - Sherif Abouelnaga
- Paediatric Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt.,Chief Executive Office, Children's Cancer Hospital 57357 Egypt (CCHE), Cairo, Egypt
| | - Carl Heneghan
- Nuffield Department of Primary Care Health Sciences, Centre for Evidence Based Medicine, University of Oxford, Oxford, UK
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Mozumder SI, Dickman PW, Rutherford MJ, Lambert PC. InterPreT cancer survival: A dynamic web interactive prediction cancer survival tool for health-care professionals and cancer epidemiologists. Cancer Epidemiol 2018; 56:46-52. [PMID: 30032027 DOI: 10.1016/j.canep.2018.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/11/2018] [Accepted: 07/14/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are a variety of ways for quantifying cancer survival with each measure having advantages and disadvantages. Distinguishing these measures and how they should be interpreted has led to confusion among scientists, the media, health care professionals and patients. This motivates the development of tools to facilitate communication and interpretation of these statistics. METHODS "InterPreT Cancer Survival" is a newly developed, publicly available, online interactive cancer survival tool targeted towards health-care professionals and epidemiologists (http://interpret.le.ac.uk). It focuses on the correct interpretation of commonly reported cancer survival measures facilitated through the use of dynamic interactive graphics. Statistics presented are based on parameter estimates obtained from flexible parametric relative survival models using large population-based English registry data containing information on survival across 6 cancer sites; Breast, Colon, Rectum, Stomach, Melanoma and Lung. RESULTS Through interactivity, the tool improves understanding of various measures and how survival or mortality may vary by age and sex. Routine measures of cancer survival are reported, however, individualised estimates using crude probabilities are advocated, which is more appropriate for patients or health care professionals. The results are presented in various interactive formats facilitating understanding of individual risk and differences between various measures. CONCLUSIONS "InterPreT Cancer Survival" is presented as an educational tool which engages the user through interactive features to improve the understanding of commonly reported cancer survival statistics. The tool has received positive feedback from a Cancer Research UK patient sounding board and there are further plans to incorporate more disease characteristics, e.g. stage.
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Affiliation(s)
- Sarwar Islam Mozumder
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, UK.
| | - Paul W Dickman
- Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Mark J Rutherford
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, UK.
| | - Paul C Lambert
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, UK; Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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