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Oringtho S, Mwaka AD, Garimoi Orach C, Wabinga H. Awareness of cervical cancer risk factors and preventive approaches, and perceived causes of cervical cancer among secondary school girls: a cross-sectional study in Northern Uganda. Ann Med 2024; 56:2374860. [PMID: 38975806 PMCID: PMC11232641 DOI: 10.1080/07853890.2024.2374860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 06/18/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND The majority of women in low- and middle-income countries have low awareness of cervical cancer. This study sought to establish awareness of cervical cancer risk factors and preventive approaches, as well as sources of information and perceived causes of cervical cancer among secondary school girls in northern Uganda. METHODS This was a cross-sectional study conducted in rural northern Uganda. We collected data using an investigator administered pre-tested questionnaire. Analysis was done with STATA version 14.0. Multivariate analyses with logistic regressions models were used to determine magnitudes of association between independent and outcome variables. Odds ratios and accompanying 95% confidence intervals are reported. Statistical significance was considered if the two sided p-value <.05. RESULTS Most participants (97%; n = 624) had heard of cervical cancer before this study. The most common source of information about cervical cancer was friends (31.1%; n = 194). More than half of the participants (59%; n = 380) had heard about a vaccine that prevents cervical cancer, but only a third (33%; n = 124) had ever received a dose of the vaccine. The majority of participants (89%; n = 550) reported that cervical cancer could be prevented; however only half (52%; n = 290) knew that vaccination of girls aged 9-13 years could prevent cervical cancer. The majority of participants did not recognize the risk factors for cervical cancer; for example, only 15% (n = 98), 7% (n = 45), and 1.4% (n = 9) recognized early onset of sexual intercourse, infection by the human papillomavirus (HPV), and smoking respectively. On adjusting for age, students' class, and religion, students in schools with school health programs were twice (aOR = 2.24: 95%CI; 1.24-4.06) more likely to know that cervical cancer is preventable. CONCLUSION Secondary school girls need information on cervical cancer risk factors and approaches to prevention so that they may avoid exposures to the risk factors and promptly seek and undertake preventive approaches including HPV vaccinations.
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Affiliation(s)
- Stephen Oringtho
- Department of Community Health, Anaka General Hospital, Nwoya district, Gulu, Uganda
- Department of Public Health, School of Medicine, Uganda Christian University, Mukono, Uganda
| | | | - Christopher Garimoi Orach
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Henry Wabinga
- Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
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Peng X, Liu J. The relationship between household income and prognosis of patients with cervical adenocarcinoma in the United States: A retrospective cohort study based on the SEER database. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108516. [PMID: 38968853 DOI: 10.1016/j.ejso.2024.108516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/12/2024] [Accepted: 06/26/2024] [Indexed: 07/07/2024]
Abstract
OBJECTIVE To investigate the association between household income and overall survival (OS) of patients with cervical adenocarcinoma. METHODS We conducted a retrospective cohort study involving participants selected from the Surveillance, Epidemiology, and End Results (SEER) database. Data were collected on various variables, including demographic variables such as median household income and clinicopathological characteristics for all participants. Cox regression analysis was utilized to examine the association between household income and OS. Subgroup analysis, sensitivity analysis, and E-value were used to further confirm the association. RESULTS A total of 2217 patients were included in the study. Compared with low-income (<$35,000-$54,999), middle-income (55,000-$69,999) or high-income (≥$70,000) was significantly associated with a higher 5-year OS (70.8 %, 58.7 % vs 50 %) in patients with cervical adenocarcinoma. The HR was 0.49, 95 % CI 0.41-0.58, p < 0.001 and 0.66 (0.55-0.78), p < 0.001 respectively, in the unadjusted model. After adjustment for potential confounders, the results were similar (adjusted HR 0.54 (0.45-0.65), p < 0.001) and 0.79 (0.66-0.94), p = 0.01), respectively. This significant association was also present in the various adjusted models. Subgroup and sensitivity analyses suggested that the relationship remained robust and reliable. The E-value analysis indicated robustness to unmeasured confounding. There was evidence of an interaction between age at diagnosis, race, primary site, tumor grade, T, N, M, or Scope Reg LN Sur, and household income on increasing the 5-year OS of cervical adenocarcinoma. CONCLUSIONS Our study found that middle or high household income was significantly associated with a better 5-year OS compared with low household income in patients with cervical adenocarcinoma.
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Affiliation(s)
- Xiaolian Peng
- Department/Division Name: Obstetrics and Gynecology, Xiegang Branch, Dongguan Municipal People's Hospital, Guang Dong Province, China.
| | - Jie Liu
- Department/Division Name: Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China. http://
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Levinsen AKG, Dalton SO, Thygesen LC, Jakobsen E, Gögenur I, Borre M, Zachariae R, Christiansen P, Laurberg S, Christensen P, Hölmich LR, Brown PDN, Johansen C, Kjær SK, van de Poll-Franse L, Kjaer TK. Cohort Profile: The Danish SEQUEL cohort. Int J Epidemiol 2024; 53:dyad189. [PMID: 38205845 DOI: 10.1093/ije/dyad189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Indexed: 01/12/2024] Open
Affiliation(s)
| | - Susanne Oksbjerg Dalton
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
- Danish Research Center for Equality in Cancer, Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Erik Jakobsen
- Department of Thoracic surgery, Odense University Hospital, Odense, Denmark
| | - Ismail Gögenur
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Køge, Denmark
- Institute for Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Michael Borre
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Robert Zachariae
- Danish Breast Cancer Group Center, Clinic for Late Effects, Aarhus, Denmark
| | - Peer Christiansen
- Danish Breast Cancer Group Center, Clinic for Late Effects, Aarhus, Denmark
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Søren Laurberg
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Christensen
- Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Peter de Nully Brown
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark
- Danish Research Center for Equality in Cancer, Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Christoffer Johansen
- Cancer Late Effects, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Susanne K Kjær
- Unit of Virus, Lifestyle and Genes, Danish Cancer Institute, Copenhagen, Denmark
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lonneke van de Poll-Franse
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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Lacika JL, Wabinga H, Kagaayi J, Opito R, Orach CG, Mwaka AD. Diagnostic and pre-treatment intervals among patients with cervical cancer attending care at the Uganda Cancer Institute: a cross-sectional study. BMC Womens Health 2023; 23:633. [PMID: 38012615 PMCID: PMC10683271 DOI: 10.1186/s12905-023-02785-3] [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: 07/27/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Majority of patients with cervical cancer in the low- and middle-income countries experience long diagnostic and pre-treatment intervals. This study sought to determine the factors associated with the diagnostic and pre-treatment intervals among patients with cervical cancer. METHODS This was a cross-sectional study conducted at the Uganda Cancer Institute (UCI) during October 2019 to January 2020. Patients aged ≥ 18 years with histological diagnosis of cervical cancer were consecutively sampled. Data were collected using a pre-tested semi-structured questionnaire and a data abstraction form. Diagnostic intervals, defined as the time between first visit of a patient to a primary healthcare provider to time of getting confirmed diagnosis, of ≤ 3 months was defined as early & >3 months as late. Pre-treatment intervals, which is the time from histological diagnosis to starting cancer chemo-radiotherapy of ≤ 1 month was defined as early and > 1 month as late. Data were analysed using STATA version 14.0. We used modified Poisson regression models with robust variance to determine socio-demographic and clinical factors associated with the intervals. RESULTS The mean age of the participants was 50.0 ± 11.7 years. The median diagnostic and pre-treatment intervals were 3.1 (IQR: 1.4-8.2) months and 2.4 (IQR: 1.2-4.1) months respectively. Half of the participants, 49.6% (200/403) were diagnosed early; one in 5 patients, 20.1% (81/403) promptly (within one month) initiated cancer chemo-radiotherapy. Participants more likely to be diagnosed early included those referred from district hospitals (level 5) (aPR = 2.29; 95%CI: 1.60-3.26) and with squamous cell carcinomas (aPR = 1.55; 95%CI: 1.07-2.23). Participants more likely to be diagnosed late included those who first discussed their symptoms with relatives, (aPR = 0.77; 95%CI: (0.60-0.98), had > 2 pre-referral visits (aPR = 0.75; 95%CI (0.61-0.92), and had advanced stage (stages 3 or 4) (aPR = 0.68; 95%CI: 0.55-0.85). Participants more likely to initiate cancer chemo-radiotherapy early included older patients (≥ 60 years) (aPR = 2.44; 95%CI: 1.18-5.03). Patients likely to start treatment late were those who had ≥2 pre-referral visits (aPR = 0.63; 95%CI: 0.41-0.98) and those that took 3 - 6 months with symptoms before seeking healthcare (aPR = 0.52;95%CI: 0.29 - 0.95). CONCLUSION Interventions to promote prompt health-seeking and early diagnosis of cervical cancer need to target primary healthcare facilities and aim to enhance capacity of primary healthcare professionals to promptly initiate diagnostic investigations. Patients aged < 60 years require targeted interventions to promote prompt initiation of chemo-radiation therapy.
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Affiliation(s)
- Jackie Lalam Lacika
- Department of Community Health & Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Henry Wabinga
- Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Joseph Kagaayi
- Department of Community Health & Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Ronald Opito
- Department of Public Health, School of Health Sciences, Soroti University, P.O Box 211, Soroti, Uganda
| | - Christopher Garimoi Orach
- Department of Community Health & Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Amos Deogratius Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
- Department of Medicine, Faculty of Medicine, Gulu University, P.O Box 166, Gulu, Uganda.
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Jia X, Zhou J, Fu Y, Ma C. Establishment of prediction models to predict survival among patients with cervical cancer based on socioeconomic factors: a retrospective cohort study based on the SEER Database. BMJ Open 2023; 13:e072556. [PMID: 37827746 PMCID: PMC10582916 DOI: 10.1136/bmjopen-2023-072556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/31/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE To construct and validate predictive models based on socioeconomic factors for predicting overall survival (OS) in cervical cancer and compare them with the American Joint Council on Cancer (AJCC) staging system. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS We extracted data from 5954 patients who were diagnosed with cervical cancer between 2007 and 2011 from the Surveillance, Epidemiology, and End Results Database. This database holds data related to cancer incidence from 18 population-based cancer registries in the USA. OUTCOME MEASURES 1-year and 5-year OS. RESULTS Of the total 5954 patients, 5820 patients had 1-year mortality and 5460 patients had 5-year mortality. Lower local education level [Hazard ratios (HR): 1.15, 95% confidence interval (CI): 1.04 to 1.27, p= 0.005] and being widowed (HR 1.28, 95% CI 1.06 to 1.55, p=0.009) were associated with a worse OS for patients with cervical cancer. Having insurance (HR 0.75, 95% CI 0.62 to 0.90, p=0.002), earning a local median annual income of ≥US$56 270 (HR 0.83, 95% CI 0.75 to 0.92, p<0.001) and being married (HR 0.79, 95% CI 0.69 to 0.89, p<0.001) were related to better OS in patients with cervical cancer. The predictive models based on socioeconomic factors and the AJCC staging system had a favourable performance for predicting OS in cervical cancer compared with the AJCC staging system alone. CONCLUSION Our proposed predictive models exhibit superior predictive performance, which may highlight the potential clinical application of incorporating socioeconomic factors in predicting OS in cervical cancer.
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Affiliation(s)
- Xiaoping Jia
- Department of Gynecology, The First Affiliated Hospital of Xinjiang Medical University, State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi 830011, P.R. China
| | - Jing Zhou
- Department of Gynecology, Karamay Central Hospital of Xinjiang, Karamay, Xinjiang, China
| | - Yanyan Fu
- Department of Gynecology, Karamay Central Hospital of Xinjiang, Karamay, Xinjiang, China
| | - Cailing Ma
- Department of Gynecology, The First Affiliated Hospital of Xinjiang Medical University, State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi 830011, P.R. China
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Sokale IO, Oluyomi AO, Montealegre JR, Thrift AP. Racial/Ethnic Disparities in Cervical Cancer Stage at Diagnosis: Mediating Effects of Neighborhood-level Socioeconomic Deprivation. Cancer Epidemiol Biomarkers Prev 2023; 32:818-824. [PMID: 37067295 PMCID: PMC10233349 DOI: 10.1158/1055-9965.epi-23-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/10/2023] [Accepted: 03/30/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND Mortality from cervical cancer has declined steadily in the United States over the past several decades due to widespread screening for precancerous and early-stage cervical cancer (ECC), which are significantly easier to treat compared with late-stage cervical cancer (LCC). Unequal screening access continues to cause significant racial/ethnic disparities in cervical cancer diagnosis stage. This study examined the underlying role of neighborhood-level socioeconomic disadvantage as a potential mediator of the association between race/ethnicity and cervical cancer diagnosis stage. METHODS We analyzed Texas Cancer Registry data for cervical cancer cases diagnosed among women ages 18 or older from 2010 to 2018. We performed causal mediation analyses of the association between race/ethnicity and cervical cancer stage at diagnosis mediated by neighborhood-level socioeconomic disadvantage. RESULTS Of the 9,192 women with cervical cancer, 4,720 (51.3%) had LCC at diagnosis. Compared with non-Hispanic white (NHW) women (106.13, standard deviation (SD) = 13.32), non-Hispanic Black (NHB; 111.46, SD = 9.55) and Hispanic (112.32, SD = 9.42) women had higher area deprivation index (ADI) and had greater odds of LCC diagnosis [total effects: adjusted odds ratios (AOR) = 1.29 (95% CI, 1.11-1.46) and AOR 1.14 (95% CI, 1.03-1.25), respectively]. Approximately 34.7% and 71.6% of the disparity in LCC diagnosis were attributable to higher neighborhood socioeconomic disadvantage among NHB and Hispanic women, respectively. CONCLUSIONS LCC disparity varied by race/ethnicity and was partly attributable to neighborhood disadvantage. The disparity among Hispanic women due to neighborhood deprivation was twice as high among NHB women. IMPACT Findings may be used to develop targeted race- and place-specific interventions to improve cancer care equity.
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Affiliation(s)
- Itunu O. Sokale
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, Texas
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Abiodun O. Oluyomi
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, Texas
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Jane R. Montealegre
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Aaron P. Thrift
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, Texas
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
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Lauritsen TB, Østgård LSG, Grønbaek K, Dalton SO, Nørgaard JM. Socioeconomic position and clinical outcomes in patients with myelodysplastic syndromes: A population-based cohort study. Hematol Oncol 2022; 40:1056-1066. [PMID: 35997314 PMCID: PMC10087397 DOI: 10.1002/hon.3068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/13/2022] [Accepted: 08/15/2022] [Indexed: 12/13/2022]
Abstract
Low socioeconomic position (SEP) may be associated with adverse outcomes in patients with myelodysplastic syndromes (MDS) inherent to for example, delayed diagnosis or reduced treatment intensity, but firm evidence is limited. In this study, we examined the association between SEP and clinical outcomes. We conducted a population-based cohort study (2010-2018) of 2233 Danish patients with MDS. SEP measures included individual-level information on education, cohabitation status and income retrieved from Statistics Denmark. Associations between SEP measures and disease severity at diagnosis were examined using binomial regression analysis. Using time-to-event analysis, we examined the association between SEP measures and treatment with allogeneic stem cell transplantation (allo-HSCT), risk of progression to acute myeloid leukemia (AML), and death. Estimates were adjusted for covariates selected based on direct acyclic graphs and reported with 95% confidence intervals. Patients with a short education were more likely to be transfusion-dependent at diagnosis (RR = 1.25, 95% CI: 1.04-1.45) and more likely to be diagnosed with higher risk MDS according to the International Prognostic Scoring System (RR = 1.29, 95% CI: 1.03-1.62), than patients with a long education. We found no clear association between SEP and risk of progression to AML. In adjusted models, the 1-year risk of dying was higher in patients with short versus long education (RR = 1.34, 95% CI: 1.08-1.65), in patients with low versus high income (RR = 1.42, 95% CI: 1.14-1.77), and among patients who lived alone compared to those who lived with a partner (RR = 1.15, 0.98-1.35). These associations persisted after 3 years and 5 years of follow-up. Notably, patients with a short education had a markedly lower rate of undergoing treatment with allo-HSCT compared to patients with a long education (HR = 0.51, 95% CI: 0.31-0.84). In conclusion, low SEP and especially short education, were poor prognostic factors for adverse clinical outcomes among patients with MDS.
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Affiliation(s)
| | - Lene Sofie Granfeldt Østgård
- Department of Hematology, Odense University Hospital and Department of Clinical Epidemiology, Aarhus University Hospital, Odense, Denmark
| | - Kirsten Grønbaek
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, and Biotech Research and Innovation Centre, BRIC, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Køge, Denmark
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Ammitzbøll G, Levinsen AKG, Kjær TK, Ebbestad FE, Horsbøl TA, Saltbæk L, Badre-Esfahani SK, Joensen A, Kjeldsted E, Halgren Olsen M, Dalton SO. Socioeconomic inequality in cancer in the Nordic countries. A systematic review. Acta Oncol 2022; 61:1317-1331. [DOI: 10.1080/0284186x.2022.2143278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Gunn Ammitzbøll
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Danish Research Center for Equality in Cancer (COMPAS), Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark
| | | | - Trille Kristina Kjær
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Freja Ejlebæk Ebbestad
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Trine Allerslev Horsbøl
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lena Saltbæk
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Sara Koed Badre-Esfahani
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
| | - Andrea Joensen
- Section of Epidemiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Eva Kjeldsted
- Danish Research Center for Equality in Cancer (COMPAS), Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Maja Halgren Olsen
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Danish Research Center for Equality in Cancer (COMPAS), Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark
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Bolormaa E, Choe SA, Son M, Ki M, Paek D. Income-based disparities in the risk of distant-stage cervical cancer and 5-year mortality after the introduction of a National Cancer Screening Program in Korea. Epidemiol Health 2022; 44:e2022066. [PMID: 35989657 PMCID: PMC10089710 DOI: 10.4178/epih.e2022066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/11/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES This study assessed the socioeconomic gradient in the risk of distant-stage cervical cancer (CC) at presentation and 5-year mortality for new CC patients after the introduction of a national Cancer Screening Program (NCSP) in Korea. METHODS All new CC cases from 2007 to 2017 were retrieved from the Korea Central Cancer Registry database linked with the National Health Information Database of the National Health Insurance Service. The age-standardized cumulative incidence of CC, adjusted odds ratios (ORs) of distant metastasis at presentation, and adjusted all-cause mortality hazard ratios (HRs) within 5 years post-diagnosis were assessed according to the income gradient. RESULTS The 11-year age-standardized cumulative incidence of CC ranged from 48.9 to 381.5 per 100,000 women, with the richest quintile having the highest incidence. Of 31,391 new cases, 8.6% had distant metastasis on presentation, which was most frequent among Medical Aid beneficiaries (9.9%). Distant-stage CC was more likely when the income level was lower (OR, 1.46; 95% confidence interval [CI]), 1.28 to 1.67 for the lowest compared to the richest) and among Medical Aid beneficiaries (OR, 1.50; 95% CI, 1.24 to 1.82). The 5-year mortality was greater in the lower-income quintiles and Medical Aid beneficiaries than in the richest quintile. CONCLUSIONS The incidence of CC was higher in the richest quintile than in the lower income quintiles, while the risk of distant-stage CC and mortality was higher for women in lower income quintiles in the context of the NCSP. A more focused approach is needed to further alleviate disparities in the timely diagnosis and treatment of CC.
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Affiliation(s)
| | - Seung-Ah Choe
- Department of Public Health, Korea University, Seoul, Korea.,Division of Life Sciences, Korea University, Seoul, Korea
| | - Mia Son
- Department of Preventive Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Myung Ki
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Domyung Paek
- Wonjin Institute for Occupational and Environmental Health, Green Hospital, Seoul, Korea.,Graduate School of Public Health, Seoul National University, Seoul, Korea
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To what extent do age, stage and treatment influence survival after invasive cervical cancer: a French population-based study. Cancer Causes Control 2022; 33:403-415. [PMID: 35079925 DOI: 10.1007/s10552-021-01536-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE In an attempt to understand why cervical cancer (CC) survival is decreasing with diagnosis period among older women in France, this study aimed to estimate the effects of main prognostic factors on net survival in CC according to age. METHODS French cancer registries databases were used to retrospectively analyze women diagnosed with CC in 2011-2012. Net survival was estimated with the Pohar-Perme method and prognostic factors (socio-demographic, clinical variables, stage at diagnosis, therapeutic management) were analyzed with Lambert and Royston's flexible parametric model. RESULTS One thousand one hundred fifty three women with CC were identified. 30.4% were < 45, 41.4% 45-64, and 28.3% ≥ 65 years. Older women were diagnosed at a more advanced stage than younger women: 54.8% regional (FIGO IB2-IVA), 33.0% distant (IVB) in women ≥ 65 years vs 33.7% and 8.0%, respectively in women < 45 years. Half of women with regional stage of CC received recommended treatment; this rate decreased with increasing age (< 45: 66.1%, 45-64: 62.7%, ≥ 65: 29.2%). Older age was significantly associated with increased risk of death: hazard ratio 1.89 for age ≥ 65, as were regional stage (2.81), distant stage (15.99), and not receiving recommended treatment (2.26). CONCLUSION Older women with CC diagnosed at advanced stage who do not receive standard of care are at markedly increased risk of death. Special attention to the management of older women is warranted in France, not only to diagnose cancer at an earlier stage (via gynecological follow-up in these menopaused women who remain at risk of CC), but also to ensure they receive standard of care, taking into account their overall state of health.
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Alem A, Edae CK, Kelta Wabalo E, Abera Tareke A, Ayalew Bedanie A, Reta W, Bariso M, Bekele G, Zawdie B. Factors influencing the occurrence of electrolyte disorders in cancer patients. SAGE Open Med 2021; 9:20503121211052861. [PMID: 34691474 PMCID: PMC8532243 DOI: 10.1177/20503121211052861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 09/25/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: The objective of this study was to determine the magnitude of electrolyte disorders and influencing factors among cancer patients in Southwest Ethiopia. Methods: Facility-based cross-sectional study was conducted in Jimma Medical Center (JMC). Eighty-four cancer patients admitted to JMC were recruited for this study. A structured questionnaire and serum electrolyte measurements were used for data collection. Bivariate and multiple logistic regression was employed to determine the association between electrolyte disorders and associated factors among admitted cancer patients. P value ⩽ 0.05 was used as a cut point to declare statistical significance. Result: The overall prevalence of electrolyte disorders was 60.7%. The presence or absence of comorbid diseases, age, body mass index (BMI), nutritional status, and current prescribed medication use were associated with electrolyte disorders. Younger patients had lower odds for electrolyte disorders (odds ratio (OR) = 0.128 (P value = 0.05) and OR = 0.08 (P value = 0.033)) for the first and the second quartile, respectively. Underweight patients had a threefold likelihood to develop electrolyte disorders (OR = 3.13 (P value = 0.043)) than having normal BMI. Compared with those in need of nutritional intervention, patients not in need of nutritional intervention had lower odds for the disorders (OR = 0.109 (P value = 0.006)). Medication had increased the likelihood of electrolyte disorders by 5.5 times than with no medication (P value = 0.023). Those who had comorbid disease had 10 times likely to develop electrolyte disorders than those who did not have comorbid diseases (P value = 0.004). Conclusion: Electrolyte disorders were prevalent in cancer patients. Age, BMI, nutritional condition, comorbid disease, and prescribed drugs were the predictors of electrolyte disorders in cancer patients. Authors recommend routine screening of electrolyte disorders in cancer patients and special emphasis on controlling and managing risk factors.
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Affiliation(s)
- Addis Alem
- Biochemistry Unit, Department of Biomedical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Chala Kenenisa Edae
- Biochemistry Unit, Department of Biomedical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Endriyas Kelta Wabalo
- Biochemistry Unit, Department of Biomedical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Amare Abera Tareke
- Physiology Unit, Department of Biomedical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Almaz Ayalew Bedanie
- Physiology Unit, Department of Biomedical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Wondu Reta
- Physiology Unit, Department of Biomedical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Moyeta Bariso
- Physiology Unit, Department of Biomedical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Gadisa Bekele
- Department of Nursing, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Belay Zawdie
- Biochemistry Unit, Department of Biomedical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
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12
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Poiseuil M, Tron L, Woronoff AS, Trétarre B, Dabakuyo-Yonli TS, Fauvernier M, Roche L, Dejardin O, Molinié F, Launoy G. How do age and social environment affect the dynamics of death hazard and survival in patients with breast or gynecological cancer in France? Int J Cancer 2021; 150:253-262. [PMID: 34520579 DOI: 10.1002/ijc.33803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/22/2021] [Accepted: 08/04/2021] [Indexed: 11/07/2022]
Abstract
Several studies have investigated the association between net survival (NS) and social inequalities in people with cancer, highlighting a varying influence of deprivation depending on the type of cancer studied. However, few of these studies have accounted for the effect of social inequalities over the follow-up period, and/or according to the age of the patients. Thus, using recent and more relevant statistical models, we investigated the effect of social environment on NS in women with breast or gynecological cancer in France. The data were derived from population-based cancer registries, and women diagnosed with breast or gynecological cancer between 2006 and 2009 were included. We used the European deprivation index (EDI), an aggregated index, to define the social environment of the women included. Multidimensional penalized splines were used to model excess mortality hazard. We observed a significant effect of the EDI on NS in women with breast cancer throughout the follow-up period, and especially at 1.5 years of follow-up in women with cervical cancer. Regarding corpus uteri and ovarian cancer patients, the effect of deprivation on NS was less pronounced. These results highlight the impact of social environment on NS in women with breast or gynecological cancer in France thanks to a relevant statistical approach, and identify the follow-up periods during which the social environment may have a particular influence. These findings could help investigate targeted actions for each cancer type, particularly in the most deprived areas, at the time of diagnosis and during follow-up.
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Affiliation(s)
- Marie Poiseuil
- Univ. Bordeaux, Gironde General Cancer Registry, Bordeaux, France.,Inserm, Bordeaux Population Health, Research Center U1219, Team EPICENE, Bordeaux, France
| | - Laure Tron
- 'ANTICIPE' U1086 INSERM-UCN, Normandie Université UNICAEN, Centre François Baclesse, Caen, France
| | - Anne-Sophie Woronoff
- Doubs Cancer Registry, Besançon University Hospital, Besançon, France.,Research Unit EA3181, University of Burgundy Franche-Comté, Besançon, France.,French Network of Cancer Registries (FRANCIM), Toulouse, France
| | - Brigitte Trétarre
- French Network of Cancer Registries (FRANCIM), Toulouse, France.,Hérault Cancer Registry, Montpellier, France
| | - Tienhan Sandrine Dabakuyo-Yonli
- French Network of Cancer Registries (FRANCIM), Toulouse, France.,Breast and Gynecologic Cancer Registry of Côte d'Or, Georges Francois Leclerc Comprehensive Cancer Centre, Dijon, France.,Epidemiology and Quality of Life Research Unit, INSERM U1231, Dijon, France
| | - Mathieu Fauvernier
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique - Bioinformatique, Lyon, France.,Lyon University, Lyon 1 University, CNRS, UMR 5558, Biometrics and Evolutionary Biology Laboratory, Biostatistics and Health Team, Villeurbanne, France
| | - Laurent Roche
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique - Bioinformatique, Lyon, France.,Lyon University, Lyon 1 University, CNRS, UMR 5558, Biometrics and Evolutionary Biology Laboratory, Biostatistics and Health Team, Villeurbanne, France
| | - Olivier Dejardin
- 'ANTICIPE' U1086 INSERM-UCN, Normandie Université UNICAEN, Centre François Baclesse, Caen, France.,Research Department, Caen University Hospital Centre, Caen, France
| | - Florence Molinié
- French Network of Cancer Registries (FRANCIM), Toulouse, France.,Loire-Atlantique/Vendée Cancer Registry, Nantes, France.,SIRIC-ILIAD, INCA-DGOS-Inserm_12558, CHU Nantes, Nantes, France
| | - Guy Launoy
- 'ANTICIPE' U1086 INSERM-UCN, Normandie Université UNICAEN, Centre François Baclesse, Caen, France.,French Network of Cancer Registries (FRANCIM), Toulouse, France.,Research Department, Caen University Hospital Centre, Caen, France
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13
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Donkers H, McGrane J, Eleuteri A, Giamougiannis P, Bekkers R, Galaal K. The impact of socioeconomic deprivation on mortality in cervical cancer patients in Cornwall (England). Eur J Cancer Care (Engl) 2021; 30:e13463. [PMID: 34028120 DOI: 10.1111/ecc.13463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 04/19/2021] [Accepted: 05/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the association between risk factors, including socioeconomic deprivation, and mortality, recurrence and chemo- or radiation toxicity in cervical cancer patients. METHODS Retrospective study of cervical cancer patients diagnosed between January 2007 and July 2018. Patient characteristics and mortality data, including recurrence, were assessed, together with socioeconomic deprivation measures evaluated using the English Indices of Multiple Deprivation. Markov multi-state models were used to model mortality and recurrence, and logistic regression models were used to model chemo- or radiation toxicity. RESULTS Included were 243 women with a median age of 49 years. A total of 57 patients died (23%), of which 41 due to cervical cancer, and 21 (9%) had recurrent disease. Hazard ratios (HR) showed no evidence of association between socioeconomic deprivation and cancer-specific hazard of mortality from diagnosis or recurrence, hazard of mortality due to other causes or hazard of cancer recurrence. Furthermore, there was no evidence of association between socioeconomic deprivation and chemo- or radiation toxicity (bowel, bladder or vaginal stenosis). CONCLUSIONS No associations were found between socioeconomic deprivation and cancer mortality or recurrence in cervical cancer patients in the population of Cornwall. In addition, no association was found between socioeconomic deprivation and chemo- or radiation toxicity.
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Affiliation(s)
| | - John McGrane
- Royal Cornwall Hospital NHS Trust, Truro, Cornwall, UK
| | - Antonio Eleuteri
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Department of Physics, University of Liverpool, Liverpool, UK
| | | | - Ruud Bekkers
- Grow School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.,Catharina Hospital, Eindhoven, The Netherlands
| | - Khadra Galaal
- Royal Cornwall Hospital NHS Trust, Truro, Cornwall, UK
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14
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Afshar N, English DR, Milne RL. Factors Explaining Socio-Economic Inequalities in Cancer Survival: A Systematic Review. Cancer Control 2021; 28:10732748211011956. [PMID: 33929888 PMCID: PMC8204531 DOI: 10.1177/10732748211011956] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND There is strong and well-documented evidence that socio-economic inequality in cancer survival exists within and between countries, but the underlying causes of these differences are not well understood. METHODS We systematically searched the Ovid Medline, EMBASE, and CINAHL databases up to 31 May 2020. Observational studies exploring pathways by which socio-economic position (SEP) might causally influence cancer survival were included. RESULTS We found 74 eligible articles published between 2005 and 2020. Cancer stage, other tumor characteristics, health-related lifestyle behaviors, co-morbidities and treatment were reported as key contributing factors, although the potential mediating effect of these factors varied across cancer sites. For common cancers such as breast and prostate cancer, stage of disease was generally cited as the primary explanatory factor, while co-morbid conditions and treatment were also reported to contribute to lower survival for more disadvantaged cases. In contrast, for colorectal cancer, most studies found that stage did not explain the observed differences in survival by SEP. For lung cancer, inequalities in survival appear to be partly explained by receipt of treatment and co-morbidities. CONCLUSIONS Most studies compared regression models with and without adjusting for potential mediators; this method has several limitations in the presence of multiple mediators that could result in biased estimates of mediating effects and invalid conclusions. It is therefore essential that future studies apply modern methods of causal mediation analysis to accurately estimate the contribution of potential explanatory factors for these inequalities, which may translate into effective interventions to improve survival for disadvantaged cancer patients.
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Affiliation(s)
- Nina Afshar
- Cancer Epidemiology Division, 56367Cancer Council Victoria, Melbourne, Victoria, Australia.,Cancer Health Services Research Unit, Centre for Health Policy, 50066School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dallas R English
- Cancer Epidemiology Division, 56367Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, 50066School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Roger L Milne
- Cancer Epidemiology Division, 56367Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, 50066School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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15
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Regional inequalities in cervical cancer survival in Minas Gerais State, Brazil. Cancer Epidemiol 2021; 71:101899. [PMID: 33548845 DOI: 10.1016/j.canep.2021.101899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/05/2020] [Accepted: 01/23/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cervical cancer survival is marked by socioeconomic and demographic inequalities. We investigated differences in survival across health regions in Minas Gerais, Brazil, in cervical cancer patients who underwent treatment in the Brazilian Public Health System. METHODS From a database developed through probabilistic and deterministic linkage of data from information systems of the Brazilian Public Health System, we identified cervical cancer cases, diagnosed between 2002 and 2010, who underwent radiation and/or chemotherapy and lived in Minas Gerais, Brazil. Five-year overall and cause-specific survivals were estimated by the Kaplan-Meier method and compared using the log-rank test. We used extended Cox models to assess the relationship between the health region of residence and the overall and cause-specific death risk, adjusting for relevant variables. RESULTS We included 5613 patients with a median age of 55.0 years. Median follow-up time was 70.0 months. Five-year overall and cause-specific survivals were 56.3 % and 63.6 %, respectively. Across the 13 health regions, 5-year survival ranged from 46.6%-64.2% (p < 0.001) in the overall analysis and from 52.0% to 72.0% (p < 0.001) in the cause-specific analysis. Multivariate models revealed a significantly higher death risk for most health regions in comparison to the reference health region (Norte). Adjustment by age, tumor stage, comorbidity, treatment, travel time, and year of diagnosis had little effect on the association. CONCLUSION We found regional disparities in cervical cancer survival that persisted after relevant adjustments. Uneven regional provision of health services might be implicated in these disparities, affecting timely access to treatment for cervical cancer patients.
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Lago-Peñas S, Rivera B, Cantarero D, Casal B, Pascual M, Blázquez-Fernández C, Reyes F. The impact of socioeconomic position on non-communicable diseases: what do we know about it? Perspect Public Health 2020; 141:158-176. [PMID: 32449467 DOI: 10.1177/1757913920914952] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
AIMS Non-communicable diseases (NCDs) have become a primary health concern for most countries around the world. The aim of this research is to analyze the relevant evidence that determines the effect of socioeconomic position (SEP) on the incidence and prevalence of NCDs. METHODS A systematic literature search was performed using PubMed, Cochrane Library, and Web of Science to identify evidence regarding the relationship between income inequalities and NCDs, between 2005 and 2015. The final selection of papers was based on applied studies focusing on Organisation for Economic Co-operation and Development (OECD) countries and articles referring to three main groups of chronic diseases: cardiovascular and heart diseases, cancer, and diabetes. RESULTS A final set of 47 selected studies were fully taken into account in this review. Despite significant heterogeneity in exposure and outcomes measures, overall the evidence suggests that having low SEP increases the risk of developing cardiovascular diseases (CVDs), lung and breast cancer, and type 2 diabetes. SEP is also associated with multiple NCD risk factors such as smoking and physical inactivity. CONCLUSION Low socioeconomic status appears to have a significant consistent impact on mortality and morbidity caused by NCDs in OECD countries. Social and economic disadvantages are associated with health inequalities in terms of access to care, increased incident risk of NCDs, and early death. These findings point to the need for public health strategies and research to address socioeconomic status disparity among individuals.
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Affiliation(s)
- S Lago-Peñas
- GEN Governance and Economics Network-Spain, Faculty of Business Sciences and Tourism, University of Vigo, Ourense, Spain.,Department of Applied Economics, Faculty of Business Sciences and Tourism, University of Vigo, Ourense, Spain
| | - B Rivera
- Department of Economics, Faculty of Economics and Business, University of A Coruña, Campus de Elviña, A Coruña 15071, Spain.,GEN Governance and Economics Network-Spain, Faculty of Business Sciences and Tourism, University of Vigo, Ourense, Spain
| | - D Cantarero
- GEN Governance and Economics Network-Spain, Faculty of Business Sciences and Tourism, University of Vigo, Ourense, Spain.,Department of Economics, Faculty of Business and Economics, University of Cantabria, Santander, Spain
| | - B Casal
- GEN Governance and Economics Network-Spain, Faculty of Business Sciences and Tourism, University of Vigo, Ourense, Spain.,Department of Economics, Faculty of Economics and Business, University of A Coruña, A Coruña, Spain
| | - M Pascual
- GEN Governance and Economics Network-Spain, Faculty of Business Sciences and Tourism, University of Vigo, Ourense, Spain.,Department of Economics, Faculty of Business and Economics, University of Cantabria, Santander, Spain
| | - C Blázquez-Fernández
- GEN Governance and Economics Network-Spain, Faculty of Business Sciences and Tourism, University of Vigo, Ourense, Spain.,Department of Economics, Faculty of Business and Economics, University of Cantabria, Santander, Spain
| | - F Reyes
- GEN Governance and Economics Network-Spain, Faculty of Business Sciences and Tourism, University of Vigo, Ourense, Spain.,Department of Applied Economics, Faculty of Business Sciences and Tourism, University of Vigo, Ourense, Spain
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17
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Kumar D, Dey T, Bansal P, Srinivasa GY, Rai B. Sociodemographic and clinical profile of geriatric patients with cervical cancer-An audit from a tertiary cancer center in India. J Family Med Prim Care 2020; 9:1528-1532. [PMID: 32509644 PMCID: PMC7266183 DOI: 10.4103/jfmpc.jfmpc_1067_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 12/24/2022] Open
Abstract
Background and Aim: Cervical cancer is a major health problem among the female population worldwide. Its incidence among the elderly group of patients seems to be increasing. Sociodemographic along with clinical profile of patients is the first step in planning preventive and curative measures; we thus conducted a retrospective analysis of demographic and clinical profile of elderly patients suffering from cervical cancer visiting at our institute. Patients and Methods: Records of 88 elderly patients (age> =65 years) suffering from cervical cancer from the year 2011 to 2014 were analyzed for a sociodemographic profile, symptoms, histology, and staging. Fisher's exact test was applied using R software (version 3.5.2) for statistical analysis. Results: The median age of the cohort was 74 years. The majority of patients were from a rural background and were nonsmokers. All patients were multiparous. The most common presenting symptoms were discharge, bleeding from vagina and pain in the abdomen; present in 45 (51.13%), 25 (28.40%) and 18 (20.45%) patients, respectively. 78 (88.63%) patients' had advanced stage (II, III, IV) at the time of presentation while the number of cases diagnosed at early stage were only 10 (11.36%). 69% had associated comorbidities. Prolonged duration of symptoms was also found to be associated with higher stage (P < 0.05). Conclusion: The study brings forth the background profile of the elderly patients suffering from cervical cancer. Since the majority of patients present in an advanced stage of disease appropriate preventive steps and also the possibility of initiating screening measures should be sought among an elderly group of cervical cancer patients.
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Affiliation(s)
- Divyesh Kumar
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Treshita Dey
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pooja Bansal
- Department of Biostatistics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - G Y Srinivasa
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhavana Rai
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Wassie M, Argaw Z, Tsige Y, Abebe M, Kisa S. Survival status and associated factors of death among cervical cancer patients attending at Tikur Anbesa Specialized Hospital, Addis Ababa, Ethiopia: a retrospective cohort study. BMC Cancer 2019; 19:1221. [PMID: 31842805 PMCID: PMC6916089 DOI: 10.1186/s12885-019-6447-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 12/09/2019] [Indexed: 12/24/2022] Open
Abstract
Background Cervical cancer is a cancer of uterine cervix caused mostly by sexually-acquired infection called Human papillomavirus (HPV. In developing region of the globe, fewer than 50% of women with cervical malignancy survive more than 5 years. Therefore, the objective of this study was to assess survival status and associated factors of death among cervical cancer patients attending at Tikur Anbesa Specialized Hospital (TASH), Ethiopia. Methods Facility based retrospective cohort study was conducted from March to April 2019 at Tikur Anbesa Specialized Hospital oncology center. Data was collected from patient’s chart using pre-tested and structured checklist prepared in English and analyzed using STATA14.2. Cox regression model was used to identify Variables that affected survival. Result The overall survival rate was 38.62% at 5 years. There were a significance differences in survival experience between categories of stage of cervical cancer, age of patients, comorbidity, substance use, base line anemia and treatment modalities. Being stage IV [AHR = 11.76; 95% CI (4.02–34.4)],being advanced age [AHR = 5.99; 95% CI (2.1–17.08)], being comorbid [AHR = 1.58; 95%CI(1.14–2.19)], using substance [AHR = 1.56;95% CI(1.09–2.22)] and being anemic [AHR = 1.6;95% CI(1.11–2.36)] increased the risk of death. Conclusion The overall survival rate was lower than high- and middle-income countries and Significant factors of death after diagnosis of cervical cancer were; advanced FIGO stage, base line anemia, comorbidity, substance use, advanced age and treatment modality. Authors recommend that it is better to expand cervical cancer early screening programs and treatment facilities, strengthen awareness in collaboration with public medias about cervical cancer prevention, screening and treatment options.
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Affiliation(s)
- Mulugeta Wassie
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Zeleke Argaw
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yosief Tsige
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mesfin Abebe
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sezer Kisa
- Oslo University Collaboration Unit, Oslo, Norway
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Huynh-Le MP, Klapheke A, Cress R, Mell LK, Yashar CM, Einck JP, Mundt AJ, Mayadev JS. Impact of marital status on receipt of brachytherapy and survival outcomes in locally advanced cervical cancer. Brachytherapy 2019; 18:612-619. [PMID: 31153760 DOI: 10.1016/j.brachy.2019.04.273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/25/2019] [Accepted: 04/29/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Marriage has been associated with enhanced survival among cancer patients, but conflicting correlations have been suggested in cervical cancer. We assessed the impact of marital status on receipt of brachytherapy and survival in women with locally advanced cervical cancer. METHODS AND MATERIALS Three thousand, eight hundred and twelve patients with Stage IB2-IVA cervical cancer diagnosed from 2006 to 2015 treated with external beam radiotherapy were identified from the California Cancer Registry. Chi-square tests were used to compare patient characteristics by marital status and boost type. The association of marital status with brachytherapy (BT) receipt was assessed using multiple logistic regression. Fine and Gray competing risks and Cox proportional hazards regressions were used to estimate cervical cancer-specific survival (CCSS) and overall survival (OS), respectively. RESULTS Most women were unmarried (58.8%). Half (50.4%) received BT, while 33.1% received no boost; most (86.3%) received chemotherapy. Unmarried women had similar odds of receiving BT as married women (OR = 1.07, 95% CI: 0.90-1.28, p = 0.4370) but were less likely to receive chemotherapy (84.3% vs. 89.1%, p < 0.0001). Singlehood was significantly associated with worse CCSS (subdistribution hazard ratio = 1.21, 95% CI: 1.03-1.42, p < 0.0174) and OS (hazard ratio = 1.18, 95% CI: 1.03-1.36, p < 0.0153). Not receiving a radiation boost was also significantly associated with worse CCSS (subdistribution hazard ratio = 1.21, 95% CI: 1.02-1.43, p = 0.0317) and OS (hazard ratio = 1.21, 95% CI: 1.05-1.40, p = 0.0100). CONCLUSIONS There were no differences in BT receipt in married vs. unmarried patients. However, unmarried patients had worse CCSS and OS and were less likely to receive chemotherapy. Interventions targeting social factors are needed to improve outcomes in this vulnerable population.
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Affiliation(s)
- Minh-Phuong Huynh-Le
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Amy Klapheke
- Public Health Institute, Cancer Registry of Greater California, Sacramento, CA
| | - Rosemary Cress
- Public Health Institute, Cancer Registry of Greater California, Sacramento, CA; Department of Public Health Sciences, UC Davis School of Medicine, Davis, CA
| | - Loren K Mell
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Catheryn M Yashar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - John P Einck
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Arno J Mundt
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Jyoti S Mayadev
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA.
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20
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Dalton SO, Olsen MH, Johansen C, Olsen JH, Andersen KK. Socioeconomic inequality in cancer survival - changes over time. A population-based study, Denmark, 1987-2013. Acta Oncol 2019; 58:737-744. [PMID: 30741062 DOI: 10.1080/0284186x.2019.1566772] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: Socioeconomic inequality in survival after cancer have been reported in several countries and also in Denmark. Changes in cancer diagnostics and treatment may have changed the gap in survival between affluent and deprived patients and we investigated if the differences in relative survival by income has changed in Danish cancer patients over the past 25 years. Methods: The 1- and 5-year relative survival by income quintile is computed by comparing survival among cancer patients diagnosed 1987-2009 to the survival of a cancer-free matched sample of the background population. The comparison is done within the 15 most common cancers and all cancers combined. The gap in relative survival due to socioeconomic inequality for the period 1987-1991 is compared the period 2005-2009. Results: The relative 5-year survival increased for all 15 cancer sites investigated in the study period. In general, low-income patients diagnosed in 1987-1991 had between 0% and 11% units lower 5-year relative survival compared with high-income patients; however, only four sites (breast, prostate, bladder and head & neck) were statistically different. In patients diagnosed 2005-2009, the gap in 5-year RS was ranging from 2% to 22% units and statistically significantly different for 9 out of 15 sites. The results for 1-year relative survival were similar to the 5-year survival gap. An estimated 22% of all deaths at five years after diagnosis could be avoided had patients in all income groups had same survival as the high-income group. Conclusion: In this nationwide population-based study, we observed that the large improvements in both short- and long-term cancer survival among patients diagnosed 1987-2009. The improvements have been most pronounced for high-income cancer patients, leading to stable or even increasing survival differences between richest and poorest patients. Improving survival among low-income patients would improve survival rates among Danish cancer patients overall and reduce differences in survival when compared to other Western European countries.
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Affiliation(s)
- Susanne Oksbjerg Dalton
- Danish Cancer Society Research Center, Survivorship, Copenhagen, Denmark
- Department of Oncology, Zealand University Hospital, Naestved, Denmark
| | - Maja Halgren Olsen
- Danish Cancer Society Research Center, Survivorship, Copenhagen, Denmark
| | - Christoffer Johansen
- Danish Cancer Society Research Center, Survivorship, Copenhagen, Denmark
- Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jørgen H. Olsen
- Danish Cancer Society Research Center, Survivorship, Copenhagen, Denmark
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Hammer A, Kahlert J, Gravitt PE, Rositch AF. Hysterectomy‐corrected cervical cancer mortality rates in Denmark during 2002‐2015: A registry‐based cohort study. Acta Obstet Gynecol Scand 2019; 98:1063-1069. [DOI: 10.1111/aogs.13608] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/08/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Anne Hammer
- Department of Obstetrics and Gynecology Aarhus University Hospital Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Johnny Kahlert
- Department of Clinical Epidemiology Aarhus University Hospital Aarhus Denmark
| | - Patti E. Gravitt
- Department of Global Health Milken Institute School of Public Healththe George Washington University Washington District of Columbia, USA
| | - Anne F. Rositch
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore Maryland, USA
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Kristiansen BK, Andersen B, Bro F, Svanholm H, Vedsted P. Direct notification of cervical cytology results to women improves follow-up in cervical cancer screening - A cluster-randomised trial. Prev Med Rep 2018; 13:118-125. [PMID: 30568870 PMCID: PMC6296289 DOI: 10.1016/j.pmedr.2018.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/23/2018] [Accepted: 11/22/2018] [Indexed: 11/27/2022] Open
Abstract
Up to half of all women do not receive follow-up as recommended after cervical cytology testing and are thus at increased risk of dysplasia progression. Women from lower social positions are at increased risk of not receiving follow-up. Sample takers, often general practitioners, convey results to women, but communication problems constitute a challenge. We aimed to investigate the effect of direct notification of cervical cytology results on follow-up rates. In a 1:1 cluster-randomised controlled trial, we assessed if having the pathology department convey cervical cytology results directly to the investigated women improved timely follow-up, compared with conveying the results via the general practitioner as usual. All women with a cervical cytology performed in a general practice in the Central Denmark Region (2013-2014) and receiving follow-up recommendation were included (n = 11,833). The proportion of women without timely follow-up was lower in the group with direct notifications than in the control group of women receiving usual care, regardless of age, educational status, cohabitation status and ethnicity. Among the women with the most severe cervical cytology diagnoses who are recommended gynaecological follow-up within 3 months, the percentage without timely follow-up was 15.1% in the intervention group and 19.5% in the control group (prevalence difference: -0.04 (95%CI: -0.07; -0.02)). Improved timely follow-up was also observed for women with a recommendation to have follow-up performed at 3 and 12 months. Cervical cytology results conveyed directly by letter to women increased the proportion of women with timely follow-up without raising inequality in follow-up measured by social position. Trial registration: ClinicalTrials.gov (TRN: NCT02002468) 29 November 2013.
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Key Words
- AGC, Atypical Glandular Cells
- AIS, adenocarcinoma in situ
- ASC-H, atypical squamous cells cannot exclude HSIL
- ASC-US, Atypical Squamous Cells of Undetermined Significance
- CCU, cancer of the cervix uteri
- CDR, Central Denmark Region
- DPDB, Danish National Pathology Registry and Data Bank
- Early detection of cancer
- GP, general practitioner
- General practice
- HSIL, High-grade Squamous Intraepithelial Lesion
- ICC, intra-cluster correlation coefficient
- LSIL, Low-grade Squamous Intraepithelial Lesion
- Mass screening
- PD, prevalence differences
- PR, prevalence ratio
- Quality of health care
- SNOMED, Systematized Nomenclature of Medicine
- Socioeconomic factors
- Uterine cervical dysplasia
- hrHPV-pos., high-risk Human Papilloma Virus positive
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Affiliation(s)
- Bettina Kjær Kristiansen
- Research Unit for General Practice, Department of Public Health, Aarhus University, 8000 Aarhus, Denmark.,Department for Public Health Programmes, Randers Regional Hospital, 8930 Randers, Denmark
| | - Berit Andersen
- Department for Public Health Programmes, Randers Regional Hospital, 8930 Randers, Denmark
| | - Flemming Bro
- Research Unit for General Practice, Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
| | - Hans Svanholm
- Department of Pathology, Randers Regional Hospital, 8930 Randers, Denmark
| | - Peter Vedsted
- Research Centre for Cancer Diagnosis in Primary Care (CaP), Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
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Harder E, Thomsen LT, Hertzum-Larsen R, Albieri V, Hessner MV, Juul KE, Bonde J, Frederiksen K, Kjaer SK. Determinants for Participation in Human Papillomavirus Self-Sampling among Nonattenders to Cervical Cancer Screening in Denmark. Cancer Epidemiol Biomarkers Prev 2018; 27:1342-1351. [DOI: 10.1158/1055-9965.epi-18-0480] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/25/2018] [Accepted: 08/03/2018] [Indexed: 11/16/2022] Open
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Five-year survival and associated factors in women treated for cervical cancer at a reference hospital in the Brazilian Amazon. PLoS One 2017; 12:e0187579. [PMID: 29145414 PMCID: PMC5690614 DOI: 10.1371/journal.pone.0187579] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/23/2017] [Indexed: 11/19/2022] Open
Abstract
Cervical cancer (CC) is the most common type of cancer in women and is the third leading cause of death in most developing countries, causing more than 288,000 deaths in women worldwide each year. The most favourable survival rate is in developed countries, since CC mortality has recently declined in those countries. The purpose of this study was to determine the survival rate and associated factors of CC patients at a reference hospital in the Amazon region. The patient sample included records of 339 patients with cervical cancer who had been hospitalized in Belém, Pará, Brazil from January 2005 to December 2010; the socioeconomic and clinical data were collected between June and September 2016. A survival rate of approximately 84% was observed, and it was found that disease stage (p <0.01), metastasis (p <0.01) and readmission (p <0.01) had significant influences on patient outcome. The impact of these factors on the general survival rate was higher in the Amazon region compared with other regions of Brazil, and the primary survival factors were associated with earlier stages of the disease. However, more national studies are needed on this subject. Our findings may contribute to the development of regional strategies for the prevention of cervical cancer, a reduction in its incidence and mortality rate, an increase in survival time and an improvement in the quality of life of these women.
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25
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Laan JJ, van Lonkhuijzen LRCW, van Os RM, Tytgat KM, Dávila Fajardo R, Pieters BR, Stalpers LJA, Westerveld GH. Socioeconomic status as an independent risk factor for severe late bowel toxicity after primary radiotherapy for cervical cancer. Gynecol Oncol 2017; 147:684-689. [PMID: 29074259 DOI: 10.1016/j.ygyno.2017.10.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the frequency of and risk factors for severe late bowel toxicity after curative radiotherapy in women treated for locally advanced cervical cancer. METHODS Included were 515 women treated for locally advanced cervical cancer with primary radiotherapy with curative intent from 1992 to 2013. Bowel toxicity was graded according to the Common Terminology Criteria for Adverse Events. Associations between risk factors and severe late bowel toxicity were assessed using Cox proportional hazards regression models. RESULTS Median follow-up was 78months. Fifty-nine patients developed severe late bowel toxicity. The actuarial 3-year and 5-year severe late bowel toxicity rates were both 13%. In the multivariable analysis, factors significantly associated with severe late bowel toxicity were: smoking (HR 2.59 [1.48-4.55]), severe acute bowel toxicity (HR 2.46 [1.24-4.49]), previous major abdominal surgery (HR 2.35 [1.20-4.60]), hypertension (HR 2.33 [1.23-4.40]), parametrial boost (HR 2.18 [1.10-4.33]), low socioeconomic status (HR 2.05 [1.17-3.59]) and low BMI (HR 0.93 [0.88-0.99]). First symptoms of severe late bowel toxicity were reported after a median follow-up of 9months, but occurred up to 10years after end of treatment. Only one third of the patients with severe late bowel toxicity were referred to a gastroenterologist. CONCLUSIONS Severe late bowel toxicity is a frequent complication of definitive radiotherapy for cervical cancer. Several independent risk factors were found which warrant further research. A standardized and structured approach in the early diagnostics and management of bowel toxicity is needed.
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Affiliation(s)
- J J Laan
- Department of Radiotherapy/Radiation Oncology, Academic Medical Center - Cancer Center Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - L R C W van Lonkhuijzen
- Department of Gynecology, Academic Medical Center - Cancer Center Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - R M van Os
- Department of Radiotherapy/Radiation Oncology, Academic Medical Center - Cancer Center Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - K M Tytgat
- Department of Gastroenterology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - R Dávila Fajardo
- Department of Radiotherapy/Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - B R Pieters
- Department of Radiotherapy/Radiation Oncology, Academic Medical Center - Cancer Center Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - L J A Stalpers
- Department of Radiotherapy/Radiation Oncology, Academic Medical Center - Cancer Center Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - G H Westerveld
- Department of Radiotherapy/Radiation Oncology, Academic Medical Center - Cancer Center Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Impact of GP reminders on follow-up of abnormal cervical cytology: a before-after study in Danish general practice. Br J Gen Pract 2017; 67:e580-e587. [PMID: 28716995 DOI: 10.3399/bjgp17x691913] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 04/12/2017] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Dysplasia may progress because of a loss to follow-up after an abnormal cervical cytology. Approximately 18% of Danish women postpone the recommended follow-up, which depends on the cytology results. AIM To investigate if a reminder to the GP about missed follow-up could reduce the proportion of women who fail to act on a recommended follow-up, and to analyse the effect on sociodemographic and general practice variations. DESIGN AND SETTING A national electronic GP reminder system was launched in Denmark in 2012 to target missed follow-up after screening, opportunistic testing, or surveillance indication. The authors compared follow-up proportions in a national observational before-after study. METHOD From national registries, 1.5 million cervical cytologies (from 2009 to 2013) were eligible for inclusion. Approximately 10% had a recommendation for follow-up. The proportion of cervical cytologies without follow-up was calculated at different time points. Results were stratified by follow-up recommendations and sociodemographic characteristics, and changes in practice variation for follow-up were analysed. RESULTS Fewer women with a recommendation for follow-up missed follow-up 6 months after a GP reminder. Follow-up improved in all investigated sociodemographic groups (age, ethnicity, education, and cohabitation status). Interaction was found for age and cohabitation status. Variation between practices in loss to follow-up was significantly reduced. CONCLUSION An electronic GP reminder system showed potential to improve the quality of cervical cancer screening through reduced loss to follow-up.
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Jain A, Ganesh B, Bobdey SC, Sathwara JA, Saoba S. Sociodemographic and Clinical Profile of Cervical Cancer Patients Visiting in a Tertiary Care Hospital in India. Indian J Med Paediatr Oncol 2017; 38:291-295. [PMID: 29200676 PMCID: PMC5686969 DOI: 10.4103/ijmpo.ijmpo_20_16] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context Cancer of the cervix is the most common genital tract malignancy in the female and is a major public health problem in the developing countries. Study of the sociodemographic and clinical profile of patients is the first step in planning control measures and treatment facilities. Aims The aims of the study were to determine the sociodemographic and clinical profile of cervical cancer patients and study their association with other tumor-related factors. Settings and Design This is a record-based retrospective study from a single institution. Subjects and Methods The data on sociodemographic and clinical factors of 765 cervical cancer patients visited and treated at tertiary care cancer hospital in Mumbai in 1 year period were analyzed. Statistical Analysis Data were analyzed using descriptive statistics. Kruskal-Wallis and Chi-square test were used to assess relationship between variables. Results The median age of the cohort was 54 years and interquartile range was 16 years. Nearly 53.6% of patients were illiterate. About 88.10% of patient's had squamous cell carcinoma. Only 13% of cases had early stage disease and 77% of patient's had not taken any treatment before coming to the hospital. Of the total, about 26% patients also had concomitant comorbidities, of which hypertension was found to be the leading comorbid condition. Stage of disease was found to be significantly (P < 0.05) associated with age and educational status. Conclusion This study highlights certain important baseline characteristics of cervical cancer patients. This basic information on profile of patients can help plan and optimum utilization of hospital services, especially in resource-poor countries like India.
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Affiliation(s)
- Aanchal Jain
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Balasubramaniam Ganesh
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Saurabh C Bobdey
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Jignasa A Sathwara
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sushma Saoba
- Department of Medical Records, Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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28
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Nascimento MID, Silva GAE. [Effect of waiting time for radiotherapy on five-year overall survival in women with cervical cancer, 1995-2010]. CAD SAUDE PUBLICA 2016; 31:2437-48. [PMID: 26840822 DOI: 10.1590/0102-311x00004015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 05/21/2015] [Indexed: 11/21/2022] Open
Abstract
Overall 5-year survival and factors associated with death were evaluated in a cohort of 342 women with cervical cancer referred to radiotherapy in the Baixada Fluminense, in Greater Metropolitan Rio de Janeiro State, Brazil. Overall 5-year survival was 25.3%, reaching 60.8% in women with stage IIA or less. The model adjusted by extended Cox proportional regression showed an increase in mortality risk for patients with stages IIB-IIIB (HR = 1.89; 95%CI: 1.214; 2.957) and IVA-IVB (HR = 5.78; 95%CI: 2.973; 11.265). Cytology in asymptomatic women (HR = 0.58; 95%CI: 0.362; 0.961) and referral for first consultation in an oncology service in the Baixada Fluminense (HR = 0.60; 95%CI: 0.418; 0.875) were the main protective factors identified by the study. Waiting time (> 60 versus ≤ 60 days) was not statistically significant, but a delay of 4 days worsened the outcome. The 60-day limit for initiating radiotherapy should be respected, because delay greater than 64 days showed a significant association between all waiting time cut-off points and 5-year mortality risk.
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Affiliation(s)
| | - Gulnar Azevedo E Silva
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
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29
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Naimi AI, Schnitzer ME, Moodie EEM, Bodnar LM. Mediation Analysis for Health Disparities Research. Am J Epidemiol 2016; 184:315-24. [PMID: 27489089 DOI: 10.1093/aje/kwv329] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 11/19/2015] [Indexed: 12/21/2022] Open
Abstract
Social epidemiologists often seek to determine the mechanisms that underlie health disparities. This work is typically based on mediation procedures that may not be justified with exposures of common interest in social epidemiology. In this analysis, we explored the consequences of using standard approaches, referred to as the difference and generalized product methods, when mediator-outcome confounders are associated with the exposure. We compared these with inverse probability-weighted marginal structural models, the structural transformation method, doubly robust g-estimation of a structural nested model, and doubly robust targeted minimum loss-based estimation. We used data on 900,726 births from 2003 to 2007 in the Penn Moms study, conducted in Pennsylvania, to assess the extent to which breastfeeding prior to hospital discharge explained the racial disparity in infant mortality. Overall, for every 1,000 births, 3.36 more infant deaths occurred among non-Hispanic black women relative to all other women (95% confidence interval: 2.78, 3.93). Using the difference and generalized product methods to assess the disparity that would remain if everyone breastfed prior to discharge suggested a complete elimination of the disparity (risk difference = -0.87 per 1,000 births; 95% confidence interval: -1.39, -0.35). In contrast, doubly robust methods suggested a reduction in the disparity to 2.45 (95% confidence interval: 2.20, 2.71) more infant deaths per 1,000 births among non-Hispanic black women. Standard approaches for mediation analysis in health disparities research can yield misleading results.
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30
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Præstegaard C, Kjaer SK, Nielsen TSS, Jensen SM, Webb PM, Nagle CM, Høgdall E, Risch HA, Rossing MA, Doherty JA, Wicklund KG, Goodman MT, Modugno F, Moysich K, Ness RB, Edwards RP, Goode EL, Winham SJ, Fridley BL, Cramer DW, Terry KL, Schildkraut JM, Berchuck A, Bandera EV, Paddock L, Kiemeney LA, Massuger LF, Wentzensen N, Pharoah P, Song H, Whittemore AS, McGuire V, Sieh W, Rothstein J, Anton-Culver H, Ziogas A, Menon U, Gayther SA, Ramus SJ, Gentry-Maharaj A, Wu AH, Pearce CL, Pike MC, Lee AW, Chang-Claude J, Jensen A. The association between socioeconomic status and tumour stage at diagnosis of ovarian cancer: A pooled analysis of 18 case-control studies. Cancer Epidemiol 2016; 41:71-9. [PMID: 26851750 PMCID: PMC4993452 DOI: 10.1016/j.canep.2016.01.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/15/2016] [Accepted: 01/20/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE Socioeconomic status (SES) is a known predictor of survival for several cancers and it has been suggested that SES differences affecting tumour stage at diagnosis may be the most important explanatory factor for this. However, only a limited number of studies have investigated SES differences in tumour stage at diagnosis of ovarian cancer. In a pooled analysis, we investigated whether SES as represented by level of education is predictive for advanced tumour stage at diagnosis of ovarian cancer, overall and by histotype. The effect of cigarette smoking and body mass index (BMI) on the association was also evaluated. METHODS From 18 case-control studies, we obtained information on 10,601 women diagnosed with epithelial ovarian cancer. Study specific odds ratios (ORs) with corresponding 95% confidence intervals (CI) were obtained from logistic regression models and combined into a pooled odds ratio (pOR) using a random effects model. RESULTS Overall, women who completed ≤high school had an increased risk of advanced tumour stage at diagnosis compared with women who completed >high school (pOR 1.15; 95% CI 1.03-1.28). The risk estimates for the different histotypes of ovarian cancer resembled that observed for ovarian cancers combined but did not reach statistical significance. Our results were unchanged when we included BMI and cigarette smoking. CONCLUSION Lower level of education was associated with an increased risk of advanced tumour stage at diagnosis of ovarian cancer. The observed socioeconomic difference in stage at diagnosis of ovarian cancer calls for further studies on how to reduce this diagnostic delay.
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Affiliation(s)
- Camilla Præstegaard
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark
| | - Susanne K Kjaer
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark; Department of Gynecology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Thor S S Nielsen
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark
| | - Signe M Jensen
- Statistics, Bioinformatics and Registry, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark
| | - Penelope M Webb
- Population Health Department, QIMR Berghofer Medical Research Institute, 300 Herston Rd, Herston, Queensland 4006, Brisbane, Australia; Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Christina M Nagle
- Population Health Department, QIMR Berghofer Medical Research Institute, 300 Herston Rd, Herston, Queensland 4006, Brisbane, Australia
| | - Estrid Høgdall
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark; Molecular Unit, Department of Pathology, Herlev Hospital, Copenhagen University Hospital, Herlev Ringvej 75, DK-2730 Herlev, Denmark
| | - Harvey A Risch
- Department of Chronic Disease Epidemiology, Yale School of Public Health, LEPH 413, 60 College Street, New Haven, CT 06510, USA
| | - Mary Anne Rossing
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, PO Box 19024, Seattle, WA 98109-1024, USA; Department of Epidemiology, University of Washington, PO Box 19024, Seattle, WA 98109-1024, USA
| | - Jennifer A Doherty
- Department of Community and Family Medicine, Section of Biostatistics & Epidemiology, Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive, 7927 Rubin Building, Room 884, Lebanon, Hanover, NH 03756, USA
| | - Kristine G Wicklund
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, PO Box 19024, Seattle, WA 98109-1024, USA
| | - Marc T Goodman
- Cancer Prevention and Control, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Room 1S37, Los Angeles 90048, CA, USA; Community and Population Health Research Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Room 1S37, Los Angeles 90048, CA, USA
| | - Francesmary Modugno
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Pittsburgh School of Medicine, Magee-Womens Hospital, 300 Halket Street (Room #2130), Pittsburgh, PA 15222, USA; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Magee-Womens Hospital, 300 Halket Street (Room #2130), Pittsburgh, PA 15222, USA; Womens Cancer Research Program, Magee-Womens Research Institute and University of Pittsburgh Cancer Institute, Magee-Womens Hospital, 300 Halket Street (Room #2130), Pittsburgh, PA 15222, USA
| | - Kirsten Moysich
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
| | - Roberta B Ness
- The University of Texas, School of Public Health, P.O. Box 20186, Houston, TX 77225, USA
| | - Robert P Edwards
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital, 300 Halket Street (Room #2130), Pittsburgh, PA 15222, USA
| | - Ellen L Goode
- Department of Health Science Research, Division of Epidemiology, Mayo Clinic, 200 First Street SW, Charlton 6, Rochester, MN, USA
| | - Stacey J Winham
- Department of Biostatistics, University of Kansas, 5028B Robinson Building, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Brooke L Fridley
- Department of Biostatistics, University of Kansas, 5028B Robinson Building, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Daniel W Cramer
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, 221 Longwood Avenue, RFB 368, Boston, MA 02115, USA
| | - Kathryn L Terry
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, 221 Longwood Avenue, RFB 368, Boston, MA 02115, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 221 Longwood Avenue, RFB 368, Boston, MA 02115, USA
| | - Joellen M Schildkraut
- Department of Public Health Sciences, School of Medicine, University of Virginia, Box: 800717, Charlottesville, VA 22908, USA
| | - Andrew Berchuck
- Department of Obstetrics and Gynecology, Duke University Medical Center, 3079, Durham, NC 27710, USA
| | - Elisa V Bandera
- Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, Room 5568, New Brunswick, NJ 08903, USA
| | - Lisa Paddock
- New Jersey State Cancer registry, PO Box 369, Trenton, NJ 08625-0369, USA; Rutgers School of Public Health, Piscataway, NJ, USA
| | - Lambertus A Kiemeney
- Department for Health Evidence, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands; Department of Urology, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Leon F Massuger
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Blvd, Rockville, MD 20852, USA
| | - Paul Pharoah
- Department of Oncology, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Wortscauseway, Cambridge, CB1 8RN, United Kingdom
| | - Honglin Song
- Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Wortscauseway, Cambridge, CB1 8RN, United Kingdom
| | - Alice S Whittemore
- Department of Health Research and Policy-Epidemiology, Stanford University School of Medicine, 259 Campus Drive, Stanford, CA 94305-5405, USA
| | - Valerie McGuire
- Department of Health Research and Policy-Epidemiology, Stanford University School of Medicine, 259 Campus Drive, Stanford, CA 94305-5405, USA
| | - Weiva Sieh
- Department of Health Research and Policy-Epidemiology, Stanford University School of Medicine, 259 Campus Drive, Stanford, CA 94305-5405, USA
| | - Joseph Rothstein
- Department of Health Research and Policy-Epidemiology, Stanford University School of Medicine, 259 Campus Drive, Stanford, CA 94305-5405, USA
| | - Hoda Anton-Culver
- Department of Epidemiology, University of California Irvine, Center for Cancer Genetics Research & Prevention, School of Medicine, 224 Irvine Hall, Irvine, CA 92697-7550, USA
| | - Argyrios Ziogas
- Department of Epidemiology, University of California Irvine, 224 Irvine Hall, Irvine, CA 92697-7550, USA
| | - Usha Menon
- Women's Cancer, UCL EGA Institute for Women's Health, Maple House 1st Floor, 149 Tottenham Court Road, London W1T 7DN, United Kingdom
| | - Simon A Gayther
- Women's Cancer, UCL EGA Institute for Women's Health, Maple House 1st Floor, 149 Tottenham Court Road, London W1T 7DN, United Kingdom
| | - Susan J Ramus
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Harlyne Norris Research Tower 1450 Biggy Street, Office 2517G, Los Angeles, CA 90033, USA
| | - Aleksandra Gentry-Maharaj
- Women's Cancer, UCL EGA Institute for Women's Health, Maple House 1st Floor, 149 Tottenham Court Road, London W1T 7DN, United Kingdom
| | - Anna H Wu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Harlyne Norris Research Tower 1450 Biggy Street, Office 2517G, Los Angeles, CA 90033, USA
| | - Celeste L Pearce
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Harlyne Norris Research Tower 1450 Biggy Street, Office 2517G, Los Angeles, CA 90033, USA; Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, SPH Tower, Office #4642, Ann Arbor, MI 48109-2029, USA
| | - Malcolm C Pike
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Harlyne Norris Research Tower 1450 Biggy Street, Office 2517G, Los Angeles, CA 90033, USA; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 307 East 63rd Street, New York, NY 10065, USA
| | - Alice W Lee
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Harlyne Norris Research Tower 1450 Biggy Street, Office 2517G, Los Angeles, CA 90033, USA
| | - Jenny Chang-Claude
- German Cancer Research Center, Division of Cancer Epidemiology, Postfach 101949, 69009 Heidelberg, Germany
| | - Allan Jensen
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark.
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Nørgaard M, Johnsen SP. How can the research potential of the clinical quality databases be maximized? The Danish experience. J Intern Med 2016; 279:132-40. [PMID: 26785952 DOI: 10.1111/joim.12437] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In Denmark, the need for monitoring of clinical quality and patient safety with feedback to the clinical, administrative and political systems has resulted in the establishment of a network of more than 60 publicly financed nationwide clinical quality databases. Although primarily devoted to monitoring and improving quality of care, the potential of these databases as data sources in clinical research is increasingly being recognized. In this review, we describe these databases focusing on their use as data sources for clinical research, including their strengths and weaknesses as well as future concerns and opportunities. The research potential of the clinical quality databases is substantial but has so far only been explored to a limited extent. Efforts related to technical, legal and financial challenges are needed in order to take full advantage of this potential.
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Affiliation(s)
- M Nørgaard
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - S P Johnsen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Zheng ZX, Zheng RS, Zhang SW, Chen WQ. Colorectal cancer incidence and mortality in China, 2010. Asian Pac J Cancer Prev 2015; 15:8455-60. [PMID: 25339046 DOI: 10.7314/apjcp.2014.15.19.8455] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The National Central Cancer Registry of China (NCCR) affiliated to the Bureau of Disease Control, National Health and Family Planning Commission of China is responsible for cancer surveillance in the entire country. Cancer registration data from each local registry located in each province are collected by NCCR annually to be analyzed and published to provide useful information for policy makers and cancer researchers. MATERIALS AND METHODS Until 1st June, 2013, 219 population-based cancer registries submitted data of 2010 to the National Central Cancer Registry of China covering about 207,229,403 population, and 145 cancer registries were selected after quality evaluation for this study. Colorectal cancer cases were selected from the database according to ICD-10 coded as "C18-C20". We calculated the crude incidence and mortality rates by sex, age groups and location (urban/rural). The China population in 2000 and Segi's population were used as standardized populations for the calculation of age-standardized rates. The 6th National Population Census data of China was used to combined with the cancer registries' data to estimate the colorectal cancer burden in China in 2010. RESULTS Colorectal cancer was the sixth most common cancer in China. It was estimated that there were 274,841 new cases diagnosed in 2010 (157,355 in males and 117,486 in females), with the crude incidence rate of 20.1/100,000, highest in males in urban areas. Age-standardized rates by China standard population of 2000 (ASRcn) and World standard population (Segi's population, ASRwld) for incidence were 16.1/100,000 and 15.9/100,000 respectively. There were 132,110 cases estimated to have died from colorectal cancer in China in 2010 (76,646 men and 55,464 women) with the crude mortality rate of 10.1/100,000. The ASRcn and ASRwld for mortality were 7.55/100,000 and 7.44/100,000 respectively, higher in males and urban areas than in females and rural areas. The incidence and mortality rates increased with age, reaching peaksin the 80-84 year old, and oldest age groups, respectively. CONCLUSIONS Colorectal cancer is one of the most common incident cancers and cause of cancer death in China. Primary and secondary prevention, with attention to a health lifestyle, physical activity and screening should be enhanced in the general population.
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Affiliation(s)
- Zhao-Xu Zheng
- Cancer Hospital and Institute, Chinese Academy of Medical Sciences, Beijing, China E-mail :
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Moustsen IR, Larsen SB, Vibe-Petersen J, Trier K, Bidstrup PE, Andersen KK, Johansen C, Dalton SO. Social position and referral to rehabilitation among cancer patients. Acta Oncol 2015; 54:720-6. [PMID: 25761091 DOI: 10.3109/0284186x.2014.997836] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES In Denmark, most healthcare services, including cancer treatment and rehabilitation, are offered free of charge by referral from a treating physician; thus, social equality should be expected. In a population-based cohort study of registry-based data, we examined the association between socioeconomic position, measured as educational level, and referral to rehabilitation services among cancer patients. MATERIAL AND METHODS Through the Danish Cancer Registry, we identified all people resident in the Municipality of Copenhagen with cancer diagnosed in 2007-2012. Information on all rehabilitation referrals was retrieved from the Municipal Centre for Cancer Rehabilitation for 2009-2012. Information on demographic and socioeconomic characteristics was obtained from national Danish registers. The Cox proportional hazards model was used to investigate associations between educational level and referral to rehabilitation with adjustment for sex, age, diagnosis, disposable income, cohabitation status and number of children living at home at the time of diagnosis. RESULTS A primary cancer was diagnosed in 13 840 people, of whom 2148 (16%) were referred to rehabilitation services during follow-up. In the fully adjusted model, we found education to be a predictor of referral, with a hazard ratio of 1.33 (95% CI 1.19-1.49) for patients with long education and a hazard ratio of 1.15 (95% CI 1.03-1.29) for patients with medium education as compared with patients with short education. CONCLUSIONS Our findings suggest that, even after differences in demographics and cancer characteristics are accounted for, referral to rehabilitation services is not equally distributed by social group. Higher educational level is associated with a higher probability of referral to rehabilitation services.
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Affiliation(s)
- Ida R Moustsen
- Danish Cancer Society Research Center, Survivorship Unit , Copenhagen , Denmark
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Legarth R, Omland LH, Dalton SO, Kronborg G, Larsen CS, Pedersen C, Pedersen G, Gerstoft J, Obel N. Association Between Educational Level and Risk of Cancer in HIV-infected Individuals and the Background Population: Population-based Cohort Study 1995-2011. J Infect Dis 2015; 212:1552-62. [PMID: 25904603 DOI: 10.1093/infdis/jiv247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 04/16/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-infected individuals have increased risk of cancer. To our knowledge, no previous study has examined the impact of socioeconomic position on risk and prognosis of cancer in HIV infection. METHODS Population-based cohort-study, including HIV-infected individuals diagnosed (without intravenous drug abuse or hepatitis C infection) (n = 3205), and a background population cohort matched by age, gender, and country of birth (n = 22 435) were analyzed. Educational level (low or high) and cancer events were identified in Danish national registers. Cumulative incidences, incidence rate ratios (IRRs), and survival using Kaplan-Meier methods were estimated. RESULTS Low educational level was associated with increased risk of cancer among HIV-infected individuals compared to population controls: all (adjusted-IRRs: 1.4 [95% confidence interval {CI}, 1.1-1.7] vs 1.1 [95% CI, .9-1.2]), tobacco- and alcohol-related (2.1 [95% CI, 1.3-3.4] vs 1.3 [95% CI, 1.1-1.6]), and other (1.7 [95% CI, 1.1-2.8] vs 0.9 [95% CI, .7-1.0]). Educational level was not associated with infection-related or ill-defined cancers. One-year-survival was not associated with educational level, but HIV-infected individuals with low educational level had lower 5-year-survival following infection-related and ill-defined cancers. CONCLUSIONS Education is associated with risk and prognosis of some cancers in HIV infection, and diverges from what is observed in the background population.
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Affiliation(s)
- Rebecca Legarth
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet
| | - Lars H Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet
| | | | - Gitte Kronborg
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre Hospital
| | | | - Court Pedersen
- Department of Infectious Diseases, Odense University Hospital
| | - Gitte Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Denmark
| | - Jan Gerstoft
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet
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Ibfelt EH, Dalton SO, Høgdall C, Fagö-Olsen CL, Steding-Jessen M, Osler M, Johansen C, Frederiksen K, Kjær SK. Do stage of disease, comorbidity or access to treatment explain socioeconomic differences in survival after ovarian cancer? - A cohort study among Danish women diagnosed 2005-2010. Cancer Epidemiol 2015; 39:353-9. [PMID: 25841586 DOI: 10.1016/j.canep.2015.03.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 03/16/2015] [Accepted: 03/18/2015] [Indexed: 01/19/2023]
Abstract
AIMS In order to reduce social inequality in cancer survival, knowledge is needed about where in the cancer trajectory disparities occur, and how social and health-related aspects may interact. We aimed to determine whether socioeconomic factors are related to cancer diagnosis stage, and whether socioeconomic disparities in survival after ovarian cancer can be explained by socioeconomic differences in cancer stage, comorbidity, treatment or lifestyle factors. METHODS In the Danish Gynaecological Cancer Database we identified 2873 cases of ovarian cancer diagnosed between 2005 and 2010. From this data we retrieved information on prognostic factors, treatment information and lifestyle factors. Age, vital status, comorbidity, education, income and cohabitation status were ascertained from nationwide administrative registers. Associations were analyzed with logistic regression and Cox regression models. RESULTS Educational level was weakly associated with cancer stage. Short education, lower income and living without a partner were related to poorer survival after ovarian cancer. Among women with early cancer stage, HR (95% CI) for death was 1.75 (1.20-2.54) in shorter compared to longer educated women. After adjustment for comorbid conditions, cancer stage, tumour histology, operation status and lifestyle factors, socioeconomic differences in survival persisted. CONCLUSIONS Socioeconomic disparities in survival after ovarian cancer were to some extent, but not fully explained by differences in important prognostic factors, suggesting further investigations into this problem, however implying that socially less advantaged ovarian cancer patients should receive attention during cancer treatment and rehabilitation.
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Affiliation(s)
- Else Helene Ibfelt
- Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark; Research Centre for Prevention and Health, Glostrup University Hospital, Nordre Ringvej 57, DK-2600 Glostrup, Denmark.
| | | | - Claus Høgdall
- The Gynecologic Clinic, The Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Carsten Lindberg Fagö-Olsen
- Department of Obstetrics and Gynecology, Hillerød Hospital, Copenhagen University Hospital, Dyrehavevej 29, DK-3400 Hillerød, Denmark
| | | | - Merete Osler
- Research Centre for Prevention and Health, Glostrup University Hospital, Nordre Ringvej 57, DK-2600 Glostrup, Denmark
| | - Christoffer Johansen
- Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark
| | - Kirsten Frederiksen
- Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark
| | - Susanne K Kjær
- Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark; The Gynecologic Clinic, The Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
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Ito Y, Nakaya T, Nakayama T, Miyashiro I, Ioka A, Tsukuma H, Rachet B. Socioeconomic inequalities in cancer survival: a population-based study of adult patients diagnosed in Osaka, Japan, during the period 1993-2004. Acta Oncol 2014; 53:1423-33. [PMID: 24865119 DOI: 10.3109/0284186x.2014.912350] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Long-term recession of the Japanese economy during the 1990s led to growing social inequalities whilst health inequalities also appeared. The 2007 National Cancer Control Program of Japan targeted "equalisation of cancer medical services", but the system to monitor health inequalities was still inadequate. We aimed to measure socioeconomic inequalities in cancer survival in Japan. MATERIAL AND METHODS We analysed 13 common invasive, primary, malignant tumours diagnosed from 1993 to 2004 and registered by the population-based Cancer Registry of Osaka Prefecture. An ecological socioeconomic deprivation index based on small area statistics, divided into quintile groups, was linked to patients according to their area of residence at the time of diagnosis. We estimated one-, five-year and conditional five-year net survival by sex, period of diagnosis (1993-1996/1997-2000/2001-2004) and deprivation group. Changes in survival over time, deprivation gap in survival, and change in deprivation gap were estimated at one and five years after diagnosis using variance-weighted least square regression. RESULTS The deprivation gap in one-year net survival was narrower than in five-year net survival and conditional five-year survival. During the study period, there was no change in deprivation gap, except for reductions for pancreas (men) and stomach (women), and an increase for lung (men) in one-year survival. We observed a linear association between level of survival and deprivation gap at five years and conditional five years, but no association at one-year survival. CONCLUSION A wide deprivation gap in survival was observed in most of the adult, solid, malignant tumours, within the universal healthcare system in Japan. Overall, cancer survival improved in Osaka without any widening of inequalities in cancer survival in 1993-2004, shortly after the long-term economic recession and deep modifications in the social and work environments in Japan. The longer term impact of the recession on inequalities in cancer survival needs to be monitored using population-based cancer registry data.
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Affiliation(s)
- Yuri Ito
- Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases , Osaka , Japan
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Manser CN, Bauerfeind P. Impact of socioeconomic status on incidence, mortality, and survival of colorectal cancer patients: a systematic review. Gastrointest Endosc 2014; 80:42-60.e9. [PMID: 24950641 DOI: 10.1016/j.gie.2014.03.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 03/05/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Christine N Manser
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Zurich University Hospital, Zurich, Switzerland
| | - Peter Bauerfeind
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Zurich University Hospital, Zurich, Switzerland
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