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Dal Maso L, Toffolutti F, De Paoli A, Giudici F, Francisci S, Bucchi L, Zorzi M, Fusco M, Caldarella A, Rossi S, De Angelis R, Botta L, Ravaioli A, Casella C, Musolino A, Vitale MF, Mangone L, Fanetti AC, Carpin E, Burgio Lo Monaco MG, Migliore E, Gambino ML, Ferrante M, Stracci F, Gasparotti C, Carrozzi G, Cavallo R, Mazzucco W, Ballotari P, Ferretti S, Sampietro G, Rizzello RV, Boschetti L, Cascone G, Mian M, Pesce MT, Piras D, Galasso R, Bella F, Seghini P, Pinna P, Crocetti E, Serraino D, Guzzinati S. Cure indicators and prevalence by stage at diagnosis for breast and colorectal cancer patients: A population-based study in Italy. Int J Cancer 2024; 155:270-281. [PMID: 38520231 DOI: 10.1002/ijc.34923] [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: 10/26/2023] [Revised: 01/15/2024] [Accepted: 02/20/2024] [Indexed: 03/25/2024]
Abstract
People alive many years after breast (BC) or colorectal cancer (CRC) diagnoses are increasing. This paper aimed to estimate the indicators of cancer cure and complete prevalence for Italian patients with BC and CRC by stage and age. A total of 31 Italian Cancer Registries (47% of the population) data until 2017 were included. Mixture cure models allowed estimation of net survival (NS); cure fraction (CF); time to cure (TTC, 5-year conditional NS >95%); cure prevalence (who will not die of cancer); and already cured (prevalent patients living longer than TTC). 2.6% of all Italian women (806,410) were alive in 2018 after BC and 88% will not die of BC. For those diagnosed in 2010, CF was 73%, 99% when diagnosed at stage I, 81% at stage II, and 36% at stages III-IV. For all stages combined, TTC was >10 years under 45 and over 65 years and for women with advanced stages, but ≤1 year for all BC patients at stage I. The proportion of already cured prevalent BC women was 75% (94% at stage I). Prevalent CRC cases were 422,407 (0.7% of the Italian population), 90% will not die of CRC. For CRC patients, CF was 56%, 92% at stage I, 71% at stage II, and 35% at stages III-IV. TTC was ≤10 years for all age groups and stages. Already cured were 59% of all prevalent CRC patients (93% at stage I). Cancer cure indicators by stage may contribute to appropriate follow-up in the years after diagnosis, thus avoiding patients' discrimination.
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Affiliation(s)
- Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Federica Toffolutti
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | | | - Fabiola Giudici
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Silvia Francisci
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Lauro Bucchi
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Manuel Zorzi
- Epidemiological Department, Azienda Zero, Padua, Italy
| | - Mario Fusco
- Registro Tumori ASL Napoli 3 Sud, Napoli, Italy
| | - Adele Caldarella
- Tuscany Cancer Registry, Institute for Cancer Research, Prevention and Clinical Network, Florence, Italy
| | - Silvia Rossi
- Department of Oncology and Molecular Medicine, National Institute of Health, Rome, Italy
| | - Roberta De Angelis
- Department of Oncology and Molecular Medicine, National Institute of Health, Rome, Italy
| | - Laura Botta
- Evaluative Epidemiology Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandra Ravaioli
- Emilia-Romagna Cancer Registry, Romagna Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Claudia Casella
- Liguria Cancer Registry, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Antonino Musolino
- Emilia-Romagna Cancer Registry, Parma Unit, Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | - Lucia Mangone
- Emilia-Romagna Cancer Registry, Reggio Emilia Unit, Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Anna Clara Fanetti
- Sondrio Cancer Registry, Agenzia di Tutela della Salute della Montagna, Sondrio, Italy
| | - Eva Carpin
- Epidemiological Department, Azienda Zero, Padua, Italy
| | - Maria Giovanna Burgio Lo Monaco
- Coordination Centre of the Cancer Registry of Puglia-Strategic Regional Agency for Health and Social Care (AReSS), Bari, Italy
| | - Enrica Migliore
- Piedmont Cancer Registry, Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica (CPO) Piemonte and University of Turin, Turin, Italy
| | - Maria Letizia Gambino
- Registro tumori ATS Insubria (Provincia di Como e Varese) S.S. Epidemiologia Registri Specializzati e Reti di Patologia, Varese, Italy
| | - Margherita Ferrante
- Registro Tumori Integrato di Catania-Messina-Enna, Igiene Ospedaliera, Azienda Ospedaliero-Universitaria Policlinico G. Rodolico-San Marco, Catania, Italy
| | - Fabrizio Stracci
- Umbria Cancer Registry, Public Health Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Cinzia Gasparotti
- Registro tumori ATS Brescia, Struttura Semplice Epidemiologia, ATS, Brescia, Italy
| | - Giuliano Carrozzi
- Emilia-Romagna Cancer Registry, Modena Unit, Public Health Department, Local Health Authority, Modena, Italy
| | - Rossella Cavallo
- Cancer Registry Azienda Sanitaria Locale (ASL) Salerno, Dipartimento di Prevenzione, Salerno, Italy
| | - Walter Mazzucco
- Clinical Epidemiology and Cancer Registry Unit, Azienda Ospedaliera Universitaria Policlinico (AOUP) di Palermo, Palermo, Italy
| | | | - Stefano Ferretti
- Emilia-Romagna Cancer Registry, Ferrara Unit, Local Health Authority, Ferrara, University of Ferrara, Ferrara, Italy
| | - Giuseppe Sampietro
- Bergamo Cancer Registry, Epidemiological Service, Agenzia di Tutela della Salute, Bergamo, Italy
| | | | | | - Giuseppe Cascone
- Azienda Sanitaria Provinciale (ASP) Ragusa-Dipartimento di Prevenzione-Registro Tumori, Ragusa, Italy
| | - Michael Mian
- Innovation, Research and Teaching Service (SABES-ASDAA), Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Bolzano-Bozen, Italy
| | - Maria Teresa Pesce
- Monitoraggio Rischio Ambientale e Registro Tumori ASL Caserta, Caserta, Italy
| | | | - Rocco Galasso
- Unit of Regional Cancer Registry, Clinical Epidemiology and Biostatistics, IRCCS Centro di Riferimento Oncologico di Basilicata (CROB), Rionero in Vulture, Italy
| | - Francesca Bella
- Siracusa Cancer Registry, Provincial Health Authority of Siracusa, Siracusa, Italy
| | - Pietro Seghini
- Emilia-Romagna Cancer Registry, Piacenza Unit, Public Health Department, AUSL Piacenza, Piacenza, Italy
| | - Pasquala Pinna
- Nuoro Cancer Registry, RT Nuoro, Servizio Igiene e Sanità Pubblica, ASL Nuoro, Nuoro, Italy
| | - Emanuele Crocetti
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
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BREAST-Q Breast-Conserving Therapy Module: Normative Data from a Dutch Sample of 9059 Women. Plast Reconstr Surg 2022; 150:985-993. [PMID: 35994350 PMCID: PMC9586822 DOI: 10.1097/prs.0000000000009607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND BREAST-Q, a patient-reported outcome measure for cosmetic and reconstructive breast surgery, is widely used in both clinical research and practice. The aim of this study was to acquire normative data of BREAST-Q's Breast-Conserving Therapy Module from a Dutch population sample and to compare it with existing normative BREAST-Q values. METHODS Flyers with QR codes, WhatsApp, and one academic center's Facebook and LinkedIn platforms were used to direct participants to self-complete an online version of four domains of the preoperative BREAST-Q Breast-Conserving Therapy Module. BREAST-Q domain scores were log transformed to normalize the distribution. Univariable regression analyses were used to assess (nonlinear) associations between age and BREAST-Q domain scores. RESULTS Overall, 9059 questionnaire responses were analyzed. Median (±SD) BREAST-Q domain scores were 64.0 ± 18.0 (satisfaction with breasts), 69.0 ± 21.0 (psychosocial well-being), 92.0 ± 20 (physical well-being), and 59.0 ± 15.0 (sexual well-being). Age as a linear term was associated with log-transformed satisfaction with breasts, psychosocial well-being, and physical well-being; sexual well-being was a quadratic function of age. Previous breast surgery unrelated to breast cancer was a significant predictor for higher log-transformed satisfaction with breasts (β = 0.04, p < 0.001) and higher sexual well-being score (β = -0.05, p < 0.001). Compared with previously published normative data, small differences were found in mean BREAST-Q domain scores (mean differences ranging between 2.45 and 6.24). CONCLUSIONS Normative Dutch BREAST-Q scores follow similar patterns across domains in comparison with previously published normative data. Normative Dutch BREAST-Q data enable future comparisons in breast-related satisfaction and quality of life issues of Dutch patients with breast cancer compared with their age-matched peers.
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Xiao Y, Deng Z, Li Y, Wei B, Chen X, Zhao Z, Xiu Y, Hu M, Alahdal M, Deng Z, Wang D, Liu J, Li W. ANLN and UBE2T are prognostic biomarkers associated with immune regulation in breast cancer: a bioinformatics analysis. Cancer Cell Int 2022; 22:193. [PMID: 35578283 PMCID: PMC9109316 DOI: 10.1186/s12935-022-02611-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 05/09/2022] [Indexed: 05/02/2023] Open
Abstract
OBJECTIVES To screen and verify differential genes affecting the prognosis of breast cancer. METHODS Breast cancer gene expression datasets were downloaded from the GEO database, and original data were analyzed in R. The TIMER database was used to analyze the relationship between ANLN and UBE2T and immune cell infiltration. RESULTS Ten hub-key genes were identified, and survival analysis showed that UBE2T and ANLN were upregulated in breast cancer and their upregulation was associated with a poor prognosis. ANLN and UBE2T upregulation was associated with the prevalence of Th1 and Th2 cells, shifting the Th1/Th2 balance to Th2 in Basal and Luminal-B breast cancers, which indicates a poor prognosis (P < 0.05). CONCLUSION ANLN and UBE2T are potential biomarkers for predicting the prognosis of breast cancer.
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Affiliation(s)
- Yu Xiao
- Department of Breast and Thyroid Surgery, Shenzhen Second People's Hospital/The First Hospital Affiliated to Shenzhen University, Shenzhen, 518000, China
| | - Zhiqin Deng
- Hand and Foot Surgery Department, Shenzhen Second People's Hospital/The First Hospital Affiliated to Shenzhen University, 3002 Sungang West Road, Shenzhen, 518000, China
| | - Yongshen Li
- Hand and Foot Surgery Department, Shenzhen Second People's Hospital/The First Hospital Affiliated to Shenzhen University, 3002 Sungang West Road, Shenzhen, 518000, China
| | - Baoting Wei
- Hand and Foot Surgery Department, Shenzhen Second People's Hospital/The First Hospital Affiliated to Shenzhen University, 3002 Sungang West Road, Shenzhen, 518000, China
| | - Xiaoqiang Chen
- Hand and Foot Surgery Department, Shenzhen Second People's Hospital/The First Hospital Affiliated to Shenzhen University, 3002 Sungang West Road, Shenzhen, 518000, China
| | - Zhe Zhao
- Hand and Foot Surgery Department, Shenzhen Second People's Hospital/The First Hospital Affiliated to Shenzhen University, 3002 Sungang West Road, Shenzhen, 518000, China
| | - Yingjie Xiu
- Department of Pathology, Shenzhen Second People's Hospital/The First Hospital Affiliated to Shenzhen University, Shenzhen, 518000, China
| | - Meifang Hu
- Department of Pathology, Shenzhen Second People's Hospital/The First Hospital Affiliated to Shenzhen University, Shenzhen, 518000, China
| | - Murad Alahdal
- Hand and Foot Surgery Department, Shenzhen Second People's Hospital/The First Hospital Affiliated to Shenzhen University, 3002 Sungang West Road, Shenzhen, 518000, China
| | - Zhenhan Deng
- Department of Sports Medicine, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518000, Guangdong, China
| | - Daping Wang
- Hand and Foot Surgery Department, Shenzhen Second People's Hospital/The First Hospital Affiliated to Shenzhen University, 3002 Sungang West Road, Shenzhen, 518000, China.,Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Jianquan Liu
- Hand and Foot Surgery Department, Shenzhen Second People's Hospital/The First Hospital Affiliated to Shenzhen University, 3002 Sungang West Road, Shenzhen, 518000, China.
| | - Wencui Li
- Hand and Foot Surgery Department, Shenzhen Second People's Hospital/The First Hospital Affiliated to Shenzhen University, 3002 Sungang West Road, Shenzhen, 518000, China.
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van Maaren MC, Rachet B, Sonke GS, Mauguen A, Rondeau V, Siesling S, Belot A. Socioeconomic status and its relation with breast cancer recurrence and survival in young women in the Netherlands. Cancer Epidemiol 2022; 77:102118. [PMID: 35131686 PMCID: PMC9422085 DOI: 10.1016/j.canep.2022.102118] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/06/2022] [Accepted: 01/27/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Associations between socioeconomic status (SES) and breast cancer survival are most pronounced in young patients. We further investigated the relation between SES, subsequent recurrent events and mortality in breast cancer patients < 40 years. Using detailed data on all recurrences that occur between date of diagnosis of the primary tumor and last observation, we provide a unique insight in the prognosis of young breast cancer patients according to SES. METHODS All women < 40 years diagnosed with primary operated stage I-III breast cancer in 2005 were selected from the nationwide population-based Netherlands Cancer Registry. Data on all recurrences within 10 years from primary tumor diagnosis were collected directly from patient files. Recurrence patterns and absolute risks of recurrence, contralateral breast cancer (CBC) and mortality - accounting for competing risks - were analysed according to SES. Relationships between SES, recurrence patterns and excess mortality were estimated using a multivariable joint model, wherein the association between recurrent events and excess mortality (expected mortality derived from the general population) was included. RESULTS We included 525 patients. The 10-year recurrence risk was lowest in high SES (18.1%), highest in low SES (29.8%). Death and CBC as first events were rare. In high, medium and low SES 13.2%, 15.3% and 19.1% died following a recurrence. Low SES patients had shorter median time intervals between diagnosis, first recurrence and 10-year mortality (2.6 and 2.7 years, respectively) compared to high SES (3.5 and 3.3 years, respectively). In multivariable joint modeling, high SES was significantly related to lower recurrence rates over 10-year follow-up, compared to low SES. A strong association between the recurrent event process and excess mortality was found. CONCLUSIONS High SES is associated with lower recurrence risks, less subsequent events and better prognosis after recurrence over 10 years than low SES. Breast cancer risk factors, adjuvant treatment adherence and treatment of recurrence may possibly play a role in this association.
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Affiliation(s)
- Marissa C van Maaren
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands; Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
| | - Bernard Rachet
- Inequalities in Cancer Outcomes Network (ICON), Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Gabe S Sonke
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Audrey Mauguen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, United States.
| | - Virginie Rondeau
- INSERM U1219, Biostatistics team, University of Bordeaux, Bordeaux, France.
| | - Sabine Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands; Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
| | - Aurélien Belot
- Inequalities in Cancer Outcomes Network (ICON), Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Dal Maso L, Santoro A, Iannelli E, De Paoli P, Minoia C, Pinto M, Bertuzzi AF, Serraino D, De Angelis R, Trama A, Haupt R, Pravettoni G, Perrone M, De Lorenzo F, Tralongo P. Cancer Cure and Consequences on Survivorship Care: Position Paper from the Italian Alliance Against Cancer (ACC) Survivorship Care Working Group. Cancer Manag Res 2022; 14:3105-3118. [PMID: 36340999 PMCID: PMC9635309 DOI: 10.2147/cmar.s380390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/08/2022] [Indexed: 02/05/2023] Open
Abstract
A multidisciplinary panel of experts and cancer patients developed a position paper to highlight recent evidence on "cancer cure" (ie, the possibility of achieving the same life expectancy as the general population) and discuss the consequences of this concept on follow-up and rehabilitation strategies. The aim is to inform clinicians, patients, and health-care policy makers about strategies of survivorship care for cured cancer patients and consequences impacting patient lives, spurring public health authorities and research organizations to implement resources to the purpose. Two identifiable, measurable, and reproducible indicators of cancer cure are presented. Cure fraction (CF) is >60% for breast and prostate cancer patients, >50% for colorectal cancer patients, and >70% for patients with melanoma, Hodgkin lymphoma, and cancers of corpus uteri, testis (>90%), and thyroid. CF was >65% for patients diagnosed at ages 15-44 years and 30% for those aged 65-74 years. Time-to-cure was consistently <1 year for thyroid and testicular cancer patients and <10 years for patients with colorectal and cervical cancers, melanoma, and Hodgkin lymphoma. The working group agrees that the evidence allows risk stratification of cancer patients and implementation of personalized care models for timely diagnosis, as well as treatment of possible cancer relapses or related long-term complications, and preventive measures aimed at maintaining health status of cured patients. These aspects should be integrated to produce an appropriate follow-up program and survivorship care plan(s), avoiding stigma and supporting return to work, to a reproductive life, and full rehabilitation. The "right to be forgotten" law, adopted to date only in a few European countries, may contribute to these efforts for cured patients.
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Affiliation(s)
- Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
- Correspondence: Luigino Dal Maso, Epidemiologia Oncologica, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Via Franco Gallini 2, Aviano (PN), 33081, Italy, Tel +39 0434 659354, Email
| | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
| | - Elisabetta Iannelli
- Italian Federation of Cancer Patients Organisations (FAVO), Rome, Italy
- Italian Association of Cancer Patients (Aimac), Rome, Italy
| | | | - Carla Minoia
- SC Haematology, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Monica Pinto
- Rehabilitation Medicine Unit, Strategic Health Services Department, Istituto Nazionale Tumori-IRCCS Fondazione G. Pascale, Naples, Italy
| | | | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Roberta De Angelis
- Department of Oncology and Molecular Medicine, Italian National Institute of Health (ISS), Rome, Italy
| | - Annalisa Trama
- Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Riccardo Haupt
- DOPO Clinic, Department of Pediatric Haematology/Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Maria Perrone
- Psychology Unit, IRCCS Regina Elena Cancer Institute, Rome, Italy
| | - Francesco De Lorenzo
- Italian Federation of Cancer Patients Organisations (FAVO), Rome, Italy
- Italian Association of Cancer Patients (Aimac), Rome, Italy
| | - Paolo Tralongo
- Medical Oncology Unit, Umberto I Hospital, Department of Oncology, RAO, Siracusa, Italy
- Paolo Tralongo, Medical Oncology Unit, Umberto I Hospital, Department of Oncology, RAO, Via Giuseppe Testaferrata 1, Siracusa, 96100, Italy, Tel +39 0931 724 464, Email
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Vrieling C, Assele SY, Moser L, Sauvé N, Litière S, Fourquet A, Poortmans P, Struikmans H, van Tienhoven G, Bartelink H, Collette L. The impact of isolated local recurrence on long-term outcome in early-breast cancer patients after breast-conserving therapy. Eur J Cancer 2021; 155:28-37. [PMID: 34333446 DOI: 10.1016/j.ejca.2021.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/08/2021] [Accepted: 06/12/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE To analyse the prognostic impact of isolated local recurrence (ILR) on long-term outcome for early-breast cancer patients treated with breast-conserving therapy. MATERIAL AND METHODS The data of the EORTC 22881-10882 'boost-no boost' and 22922-10925 'IM-MS' trials were used to analyse the prevalence and outcome following ILR. A multistate model described the impact of intermediate events on long-term outcomes, taking into account various prognostic factors. This model was used to predict long-term outcomes after ILR. RESULTS Of the 8367 patients included, 726 experienced an ILR, 11.6% of them within the first 2 years and 30.0% after 10 years. Ten-year cumulative breast cancer mortality rates after ILR were 58.2% in patients with an ILR within 2 years, 31.0% for ILR between 2 and 4 years, 17.6% in patients with an ILR between 4 and 10 years, and 29.7% for ILR after year 10 (p < 0.001). The multistate model showed that when tumour-free, younger breast cancer patients had a higher probability of developing ILR compared to older patients. Shorter time to ILR was associated with a higher chance to develop distant metastases (DM), and a shorter time to development of DM were associated with an increased hazard of breast cancer-related death. The multistate model enabled prediction of long-term outcome based on individual patient covariates, length of follow-up without recurrence and timing of ILR since randomisation. CONCLUSIONS Outcome of early-breast cancer changed not only according to baseline risk factors but also according to the presence of intermediate events, time to these events, and subsequent follow-up without any further events.
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Affiliation(s)
- Conny Vrieling
- Hirslanden Clinique des Grangettes, Geneva, Switzerland.
| | - Samson Y Assele
- Research Centre for Operations Research and Statistics (ORSTAT), Leuven, Belgium; EORTC Headquarters, Brussels, Belgium
| | | | | | | | | | - Philip Poortmans
- Iridium Netwerk, Wilrijk-Antwerp, Belgium; University of Antwerp, Center for Oncological Research (CORE), Wilrijk-Antwerp, Belgium
| | | | - Geertjan van Tienhoven
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Harry Bartelink
- The Netherlands Cancer Institute, Amsterdam, the Netherlands
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Dal Maso L, Panato C, Tavilla A, Guzzinati S, Serraino D, Mallone S, Botta L, Boussari O, Capocaccia R, Colonna M, Crocetti E, Dumas A, Dyba T, Franceschi S, Gatta G, Gigli A, Giusti F, Jooste V, Minicozzi P, Neamtiu L, Romain G, Zorzi M, De Angelis R, Francisci S. Cancer cure for 32 cancer types: results from the EUROCARE-5 study. Int J Epidemiol 2021; 49:1517-1525. [PMID: 32984907 DOI: 10.1093/ije/dyaa128] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Few studies have estimated the probability of being cured for cancer patients. This study aims to estimate population-based indicators of cancer cure in Europe by type, sex, age and period. METHODS 7.2 million cancer patients (42 population-based cancer registries in 17 European countries) diagnosed at ages 15-74 years in 1990-2007 with follow-up to 2008 were selected from the EUROCARE-5 dataset. Mixture-cure models were used to estimate: (i) life expectancy of fatal cases (LEF); (ii) cure fraction (CF) as proportion of patients with same death rates as the general population; (iii) time to cure (TTC) as time to reach 5-year conditional relative survival (CRS) >95%. RESULTS LEF ranged from 10 years for chronic lymphocytic leukaemia patients to <6 months for those with liver, pancreas, brain, gallbladder and lung cancers. It was 7.7 years for patients with prostate cancer at age 65-74 years and >5 years for women with breast cancer. The CF was 94% for testis, 87% for thyroid cancer in women and 70% in men, 86% for skin melanoma in women and 76% in men, 66% for breast, 63% for prostate and <10% for liver, lung and pancreatic cancers. TTC was <5 years for testis and thyroid cancer patients diagnosed below age 55 years, and <10 years for stomach, colorectal, corpus uteri and melanoma patients of all ages. For breast and prostate cancers, a small excess (CRS < 95%) remained for at least 15 years. CONCLUSIONS Estimates from this analysis should help to reduce unneeded medicalization and costs. They represent an opportunity to improve patients' quality of life.
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Affiliation(s)
- Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Chiara Panato
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Andrea Tavilla
- National Center for Prevention and Health Promotion, Italian National Institute of Health (ISS), Rome, Italy
| | | | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Sandra Mallone
- National Center for Prevention and Health Promotion, Italian National Institute of Health (ISS), Rome, Italy
| | - Laura Botta
- Evaluative Epidemiology Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Olayidé Boussari
- Registre Bourguignon des Cancers Digestifs, INSERM UMR 1231, CHU de Dijon, Université de Bourgogne, Dijon, France
| | | | | | - Emanuele Crocetti
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, ItalyAzienda Usl della Romagna, Forlì, Italy
| | - Agnes Dumas
- National Institute for Health and Medical Research (INSERM), Paris, France
| | - Tadek Dyba
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Silvia Franceschi
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy
| | - Gemma Gatta
- Evaluative Epidemiology Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Anna Gigli
- Institute for Research on Population and Social Policies, National Research Council, Rome, Italy
| | | | - Valerie Jooste
- Registre Bourguignon des Cancers Digestifs, INSERM UMR 1231, CHU de Dijon, Université de Bourgogne, Dijon, France
| | - Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Research Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Luciana Neamtiu
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Gaëlle Romain
- Registre Bourguignon des Cancers Digestifs, INSERM UMR 1231, CHU de Dijon, Université de Bourgogne, Dijon, France
| | - Manuel Zorzi
- Veneto Tumour Registry, Azienda Zero, Padua, Italy
| | - Roberta De Angelis
- Department of Oncology and Molecular Medicine, Italian National Institute of Health (ISS), Rome, Italy
| | - Silvia Francisci
- National Center for Prevention and Health Promotion, Italian National Institute of Health (ISS), Rome, Italy
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8
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Moossdorff M, Vane MLG, van Nijnatten TJA, van Maaren MC, Goorts B, Heuts EM, Strobbe LJA, Smidt ML. Conditional local recurrence risk: the effect of event-free years in different subtypes of breast cancer. Breast Cancer Res Treat 2021; 186:863-870. [PMID: 33689058 PMCID: PMC8019423 DOI: 10.1007/s10549-020-06040-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/25/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND After breast cancer treatment, follow-up consists of physical examination and mammography for at least 5 years, to detect local and regional recurrence. The risk of recurrence may decrease after event-free time. This study aims to determine the risk of local recurrence (LR) as a first event until 5 years after diagnosis, conditional on being event-free for 1, 2, 3 and 4 years. METHODS From the Netherlands Cancer Registry, all M0 breast cancers diagnosed between 2005 and 2008 were included. LR risk was calculated with Kaplan-Meier analysis, overall and for different subtypes. Conditional LR (assuming x event-free years) was determined by selecting event-free patients at x years, and calculating their LR risk within 5 years after diagnosis. RESULTS Five-year follow-up was available for 34,453 patients. Overall, five-year LR as a first event occurred in 3.0%. This risk varied for different subtypes and was highest for triple negative (6.8%) and lowest for ER+PR+Her2- (2.2%) tumors. After 1, 2, 3 and 4 event-free years, the average risk of LR before 5 years after diagnosis decreased from 3.0 to 2.4, 1.6, 1.0, and 0.6%. The risk decreased in all subtypes, the effect was most pronounced in subtypes with the highest baseline risk (ER-Her2+ and triple negative breast cancer). After three event-free years, LR risk in the next 2 years was 1% or less in all subtypes except triple negative (1.6%). CONCLUSION The risk of 5-year LR as a first event was low and decreased with the number of event-free years. After three event-free years, the overall risk was 1%. This is reassuring to patients and also suggests that follow-up beyond 3 years may produce low yield of LR, both for individual patients and studies using LR as primary outcome. This can be used as a starting point to tailor follow-up to individual needs.
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Affiliation(s)
- M Moossdorff
- Department of Surgical Oncology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marissa L G Vane
- Department of Surgical Oncology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - T J A van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M C van Maaren
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Health, Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - B Goorts
- Department of Surgical Oncology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - E M Heuts
- Department of Surgical Oncology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - L J A Strobbe
- Department of Surgical Oncology, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - M L Smidt
- Department of Surgical Oncology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
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9
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Huang CC, Chou CH, Yang YS, Ho HN, Shun CT, Wen WF, Chen SU, Chen MJ. Metformin: a novel promising option for fertility preservation during cyclophosphamide-based chemotherapy. Mol Hum Reprod 2021; 27:gaaa084. [PMID: 33543290 PMCID: PMC8494485 DOI: 10.1093/molehr/gaaa084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 11/22/2020] [Indexed: 12/19/2022] Open
Abstract
Cyclophosphamide (CP) could cause severe gonadotoxicity via imbalanced activation of primordial follicles through PI3K/AKT/mTOR activation. Whether metformin, a widely prescribed anti-diabetes agent with mTOR inhibitory effect, could preserve ovarian function against CP toxicity is unknown. Female C57BL/6 mice were randomized into seven groups (n = 11), including control, CP-alone, CP + metformin, CP + sirolimus or everolimus, metformin-alone and sirolimus-alone groups. The duration of pharmaceutical treatment was 4 weeks. CP treatment significantly impaired ovarian function and fertility in mice. CP + metformin treatment significantly attenuated the gonadotoxicity comparing to CP-alone treatment (primordial follicle count: 17.6 ± 4.2 versus 10.3 ± 2.7 follicles/high-power field; P = 0.027). CP + metformin treatment also tended to increase antral follicular count (5.4 ± 1.1 versus 2.5 ± 1.6 follicles/section), serum AMH levels (4.6 ± 1.2 versus 2.0 ± 0.8 ng/ml) and the litter size (4.2 ± 1.3 versus 1.5 ± 1.0 mice per pregnancy), compared with CP-alone group. Expression of phospho-mTOR and the number of TUNEL-positive granulosa cells increased after CP treatment and decreased in the CP + metformin groups, suggesting the mTOR inhibitory and anti-apoptotic effects of metformin. In in-vitro granulosa cell experiments, the anti-apoptotic effect of metformin was blocked after inhibiting p53 or p21 function, and the expression of p53 mRNA was blocked with AMPK inhibitor, suggesting that the anti-apoptotic effect was AMPK/p53/p21-mediated. In conclusion, concurrent metformin treatment during CP therapy could significantly preserve ovarian function and fertility and could be a promising novel fertility preserving agent during chemotherapy. The relatively acceptable cost and well-established long-term safety profiles of this old drug might prompt its further clinical application at a faster pace.
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Affiliation(s)
- Chu-Chun Huang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei 100, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Chia-Hung Chou
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Yu-Shih Yang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei 100, Taiwan
- Department of Obstetrics and Gynecology, Fu Jen Catholic University Hospital, New Taipei 243, Taiwan
| | - Hong-Nerng Ho
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei 100, Taiwan
- Graduate Institute of Medical Genomics and Proteomics, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Taipei Medical University, Taipei 110, Taiwan
| | - Chia-Tung Shun
- Departments of Forensic Medicine and Pathology, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Wen-Fen Wen
- Departments of Pathology, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Shee-Uan Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Mei-Jou Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei 100, Taiwan
- Livia Shangyu Wan Scholar, College of Medicine, National Taiwan University, Taipei 100, Taiwan
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10
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Vane MLG, Moossdorff M, van Maaren MC, van Kuijk SMJ, van Nijnatten TJA, van Roozendaal LM, Boerma EJG, de WIlt JHW, Smidt ML. Conditional regional recurrence risk: The effect of event-free years in different subtypes of breast cancer. Eur J Surg Oncol 2020; 47:1292-1298. [PMID: 33349525 DOI: 10.1016/j.ejso.2020.11.122] [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: 09/10/2020] [Revised: 11/05/2020] [Accepted: 11/13/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Regional recurrence (RR), also known as lymph node recurrence, is an endpoint in several trials concerning reducing axillary treatment in cT1-2N0 breast cancer patients. The risk of RR may decrease with each subsequent event-free year, affecting the yield and consequently usefulness of long (er) follow-up. The aim of this study is to determine the risk of RR as a first event within five years after diagnosis in subtypes of breast cancer, conditional to being event-free for one, two, three and four years. METHODS From the Netherlands Cancer Registry, cT1-2N0 breast cancer patients diagnosed from 2005 to 2008 were analyzed. Subgroup analysis was performed for pT1-2N+(sn) patients. RR risk was calculated with Kaplan-Meier analysis. Conditional RR (assuming x event-free years) was determined by selecting patients without an event at x years, and calculating the remaining risk for RR within five years after diagnosis. RESULTS A total of 18,009 cT1-2N0 (all pN stages) breast cancer patients were included. RR occurred in 1.3% of cT1-2N0 and 1.5% of pT1-2N+(sn) patients. The risk of RR varied between subtypes; it was highest for triple negative tumors and lowest for ER + PR + Her2-and ER + Her2+ tumors. After event-free years, the risk of RR decreased subsequently in both groups and in all subtypes. After two event-free years, the risk of RR was 0.8%. CONCLUSION The absolute yield of follow-up to detect RR beyond two years is low; for every 125 event-free patients, one RR can be expected until five years. This suggests that follow-up longer than two years is of limited value for detecting RR in both clinical and research setting.
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Affiliation(s)
- Marissa L G Vane
- Department of Surgical Oncology, Maastricht University Medical Centre, Maastricht, the Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, the Netherlands.
| | - Martine Moossdorff
- Department of Surgical Oncology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Marissa C van Maaren
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department of Health, Technology and Services Research. Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Thiemo J A van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Lori M van Roozendaal
- Department of Surgical Oncology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - Johannes H W de WIlt
- Department of Surgical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Marjolein L Smidt
- Department of Surgical Oncology, Maastricht University Medical Centre, Maastricht, the Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, the Netherlands
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11
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Long-Term Health-Related Quality of Life after Four Common Surgical Treatment Options for Breast Cancer and the Effect of Complications: A Retrospective Patient-Reported Survey among 1871 Patients. Plast Reconstr Surg 2020; 146:1-13. [DOI: 10.1097/prs.0000000000006887] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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12
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de Ligt KM, Heins M, Verloop J, Ezendam NPM, Smorenburg CH, Korevaar JC, Siesling S. The impact of health symptoms on health-related quality of life in early-stage breast cancer survivors. Breast Cancer Res Treat 2019; 178:703-711. [PMID: 31512091 PMCID: PMC6817812 DOI: 10.1007/s10549-019-05433-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 08/30/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE In breast cancer patients, treatment-related health symptoms can occur that may affect their health-related quality of life (HRQoL). This study aimed to determine the impact of health symptoms on HRQoL in breast cancer patients up to 5 years after diagnosis. METHODS Females surgically treated for early-stage breast cancer diagnosed between 2012 and 2016 (n = 876) were selected from the Netherlands Cancer Registry and invited for a survey about current health symptoms ('Symptoms and Perceptions questionnaire', SaP) and HRQoL ('EORTC-QLQ-C30'). From the latter, functioning and global health were included. Mean scores were compared to norm population scores (T test). Multivariable linear regression analyses were performed to determine the association between health symptoms and global health and functioning. RESULTS 404 patients (46%) responded. The median age was 62.2 ± 10.9 years. Respondents had significantly lower mean scores for role, cognitive, emotional, and social functioning than the general population. The most frequently reported health symptoms were musculoskeletal (including pain/complaints in lower/upper extremities/back/neck; 71%) and central nervous system symptoms (including concentration impairment, dizziness, neuralgia; 66%), and fatigue (63%). While most symptoms affected functioning, irrespective of time since diagnosis, especially fatigue, musculoskeletal, central nervous system, and gastrointestinal symptoms were significantly associated (p < 0.05) with lower functioning. CONCLUSIONS The majority of health symptoms that occur after breast cancer treatment were associated with lower functioning of patients in daily life. This paper urges healthcare providers to support breast cancer patients in alleviating or coping with health symptoms, even years after end of treatment, to improve their functioning.
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Affiliation(s)
- K M de Ligt
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, PO Box 19079, 3501 DB, Utrecht, The Netherlands.
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
| | - M Heins
- NIVEL Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - J Verloop
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, PO Box 19079, 3501 DB, Utrecht, The Netherlands
| | - N P M Ezendam
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, PO Box 19079, 3501 DB, Utrecht, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - C H Smorenburg
- Department of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - J C Korevaar
- NIVEL Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - S Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, PO Box 19079, 3501 DB, Utrecht, The Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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13
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Tralongo P, Surbone A, Serraino D, Dal Maso L. Major patterns of cancer cure: Clinical implications. Eur J Cancer Care (Engl) 2019; 28:e13139. [DOI: 10.1111/ecc.13139] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 06/26/2019] [Accepted: 07/18/2019] [Indexed: 01/01/2023]
Affiliation(s)
| | | | - Diego Serraino
- Cancer Epidemiology Unit Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy
| | - Luigino Dal Maso
- Cancer Epidemiology Unit Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy
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14
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Dal Maso L, Panato C, Guzzinati S, Serraino D, Francisci S, Botta L, Capocaccia R, Tavilla A, Gigli A, Crocetti E, Rugge M, Tagliabue G, Filiberti RA, Carrozzi G, Michiara M, Ferretti S, Cesaraccio R, Tumino R, Falcini F, Stracci F, Torrisi A, Mazzoleni G, Fusco M, Rosso S, Tisano F, Fanetti AC, Sini GM, Buzzoni C, De Angelis R. Prognosis and cure of long-term cancer survivors: A population-based estimation. Cancer Med 2019; 8:4497-4507. [PMID: 31207165 PMCID: PMC6675712 DOI: 10.1002/cam4.2276] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 05/06/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Increasing evidence of cure for some neoplasms has emerged in recent years. The study aimed to estimate population-based indicators of cancer cure. METHODS Information on more than half a million cancer patients aged 15-74 years collected by population-based Italian cancer registries and mixture cure models were used to estimate the life expectancy of fatal tumors (LEFT), proportions of patients with similar death rates of the general population (cure fraction), and time to reach 5-year conditional relative survival (CRS) >90% or 95% (time to cure). RESULTS Between 1990 and 2000, the median LEFT increased >1 year for breast (from 8.1 to 9.4 years) and prostate cancers (from 5.2 to 7.4 years). Median LEFT in 1990 was >5 years for testicular cancers (5.8) and Hodgkin lymphoma (6.3) below 45 years of age. In both sexes, it was ≤0.5 years for pancreatic cancers and NHL in 1990 and in 2000. The cure fraction showed a 10% increase between 1990 and 2000. It was 95% for thyroid cancer in women, 94% for testis, 75% for prostate, 67% for breast cancers, and <20% for liver, lung, and pancreatic cancers. Time to 5-year CRS >95% was <10 years for testis, thyroid, colon cancers, and melanoma. For breast and prostate cancers, the 5-year CRS >90% was reached in <10 years but a small excess remained for >15 years. CONCLUSIONS The study findings confirmed that several cancer types are curable. Became aware of the possibility of cancer cure has relevant clinical and social impacts.
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Affiliation(s)
- Luigino Dal Maso
- Cancer Epidemiology UnitCentro di Riferimento Oncologico di Aviano (CRO) IRCCSAvianoItaly
| | - Chiara Panato
- Cancer Epidemiology UnitCentro di Riferimento Oncologico di Aviano (CRO) IRCCSAvianoItaly
| | | | - Diego Serraino
- Cancer Epidemiology UnitCentro di Riferimento Oncologico di Aviano (CRO) IRCCSAvianoItaly
| | - Silvia Francisci
- National Center for Prevention and Health PromotionItalian National Institute of Health (ISS)RomeItaly
| | - Laura Botta
- Evaluative Epidemiology Unit, Department of Preventive and Predictive MedicineFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | - Riccardo Capocaccia
- Cancer Epidemiology UnitCentro di Riferimento Oncologico di Aviano (CRO) IRCCSAvianoItaly
| | - Andrea Tavilla
- National Center for Prevention and Health PromotionItalian National Institute of Health (ISS)RomeItaly
| | - Anna Gigli
- Institute for Research on Population and Social PoliciesNational Research CouncilRomeItaly
| | - Emanuele Crocetti
- Romagna Cancer RegistryIstituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS and Azienda Usl della RomagnaMeldola (Forlì)Italy
| | - Massimo Rugge
- Veneto Tumour RegistryAzienda ZeroPaduaItaly
- Department of Medicine (DIMED)University of PaduaPaduaItaly
| | - Giovanna Tagliabue
- Lombardy Cancer Registry-Varese Province, Cancer Registry Unit, Department of ResearchFondazione IRCCS Istituto Nazionale TumoriMilanItaly
| | - Rosa Angela Filiberti
- Liguria Cancer Registry, Clinical EpidemiologyIRCCS Policlinico San MartinoGenovaItaly
| | - Giuliano Carrozzi
- Modena Cancer Registry, Public Health DepartmentAUSL ModenaModenaItaly
| | - Maria Michiara
- Parma Cancer Registry, Oncology UnitAzienda Ospedaliera Universitaria di ParmaParmaItaly
| | - Stefano Ferretti
- Romagna Cancer Registry ‐ Section of Ferrara. Local Health UnitUniversity of FerraraFerraraItaly
| | - Rosaria Cesaraccio
- North Sardinia Cancer RegistryAzienda Regionale per la Tutela della SaluteSassariItaly
| | | | - Fabio Falcini
- Romagna Cancer RegistryIstituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS and Azienda Usl della RomagnaMeldola (Forlì)Italy
| | - Fabrizio Stracci
- Public Health Section, Department of Experimental MedicineUniversity of PerugiaPerugiaItaly
| | | | | | - Mario Fusco
- Cancer Registry of ASL Napoli 3 SudNapoliItaly
| | - Stefano Rosso
- Registro Tumori PiemonteProvincia di Biella CPOBiellaItaly
| | - Francesco Tisano
- Cancer Registry of the Province of SiracusaLocal Health Unit of SiracusaSiracusaItaly
| | - Anna Clara Fanetti
- Sondrio Cancer Registry, Epidemiology unitATS della MontagnaSondrioItaly
| | | | - Carlotta Buzzoni
- Tuscany Cancer RegistryClinical and Descriptive Epidemiology Unit, Cancer Prevention and Research Institute (ISPO)FlorenceItaly
- AIRTUM DatabaseFlorenceItaly
| | - Roberta De Angelis
- Department of Oncology and Molecular MedicineItalian National Institute of Health (ISS)RomeItaly
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McBride ML, Groome PA, Decker K, Kendell C, Jiang L, Whitehead M, Li D, Grunfeld E. Adherence to quality breast cancer survivorship care in four Canadian provinces: a CanIMPACT retrospective cohort study. BMC Cancer 2019; 19:659. [PMID: 31272420 PMCID: PMC6610964 DOI: 10.1186/s12885-019-5882-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/26/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In order to maximize later health, there are established components and guidelines for quality follow-up care of breast cancer survivors. However, adherence to quality follow-up in Canada may not be optimal, and may vary by province. We determined and compared the proportion of patients in each province who received adherent and non-adherent surveillance for recurrence, new cancers and late effects, recommended preventive care, and recommended physician visits for comorbidities. METHODS Cohorts consisted of all adult women diagnosed with incident invasive breast cancer between 2007 and 2010/2012 in four Canadian provinces (British Columbia (BC) N = 9338; Manitoba N = 2688; Ontario N = 23,700; Nova Scotia (NS) N = 2735), identified from provincial cancer registries, alive and cancer-free at 30 months post-diagnosis. Their healthcare utilization was determined from one to 5 years post-treatment, using linked administrative databases. Adherence, underuse, and overuse of recommended services were evaluated yearly and compared using descriptive statistics. RESULTS In all provinces and follow-up years, the majority of survivors had more than the recommended number of visits to either an oncologist or primary care physician (range 53.8% NS Year 3; 85.8% Ontario Year 4). The proportion of patients with the guideline-recommended number of oncologist visits varied by province (range 29.8% BC Year 5; 74.8% Ontario Year 5), and the proportion of patients with less than the recommended number of specified breast cancer-related visits with either an oncologist or primary care physician ranged from 32.6% (Ontario Year 2) to 84.4% (NS Year 3). Underuse of surveillance breast imaging was identified in NS and BC. The proportion of patients receiving imaging for metastatic disease (not recommended in the guidelines) in BC, Manitoba, and Ontario (not reported in NS) ranged from 20.3% (BC Year 5) to 53.3% (Ontario Year 2). Compliance with recommended physician visits for patients with several chronic conditions was high in Ontario and NS. Preventive care was less than optimal in all provinces with available data. CONCLUSIONS Quality of breast cancer survivor follow-up care varies among provinces. Results point to exploration of factors affecting differences, province-specific opportunities for care improvement, and the value of administrative datasets for health system assessment.
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Affiliation(s)
- Mary L McBride
- Cancer Control Research, BC Cancer, 675 West 10th Avenue, Room 2.107, Vancouver, BC, V5Z 1L3, Canada.
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.
| | - Patti A Groome
- Department of Public Health Sciences, Queen's University, Kingston, Canada
- Cancer Research Institute, Queen's University, Kingston, Canada
- Institute of Clinical Evaluative Sciences, Queen's University, Kingston, Canada
| | - Kathleen Decker
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Canada
| | - Cynthia Kendell
- Cancer Outcomes Research Program, Dalhousie University and Nova Scotia Health Authority, Halifax, Canada
| | - Li Jiang
- Institute of Clinical Evaluative Sciences, Queen's University, Kingston, Canada
- Critical Care Services Ontario, Toronto, Canada
| | - Marlo Whitehead
- Institute of Clinical Evaluative Sciences, Queen's University, Kingston, Canada
| | - Dongdong Li
- Cancer Control Research, BC Cancer, 675 West 10th Avenue, Room 2.107, Vancouver, BC, V5Z 1L3, Canada
| | - Eva Grunfeld
- Institute of Clinical Evaluative Sciences, Queen's University, Kingston, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
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16
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de Ligt KM, van Egdom LS, Koppert LB, Siesling S, van Til JA. Opportunities for personalised follow‐up care among patients with breast cancer: A scoping review to identify preference‐sensitive decisions. Eur J Cancer Care (Engl) 2019; 28:e13092. [PMID: 31074162 PMCID: PMC9285605 DOI: 10.1111/ecc.13092] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/21/2019] [Accepted: 04/20/2019] [Indexed: 12/24/2022]
Abstract
Introduction Current follow‐up arrangements for breast cancer do not optimally meet the needs of individual patients. We therefore reviewed the evidence on preferences and patient involvement in decisions about breast cancer follow‐up to explore the potential for personalised care. Methods Studies published between 2008 and 2017 were extracted from MEDLINE, PsycINFO and EMBASE. We then identified decision categories related to content and form of follow‐up. Criteria for preference sensitiveness and patient involvement were compiled and applied to determine the extent to which decisions were sensitive to patient preferences and patients were involved. Results Forty‐one studies were included in the full‐text analysis. Four decision categories were identified: “surveillance for recurrent/secondary breast cancer; consultations for physical and psychosocial effects; recurrence‐risk reduction by anti‐hormonal treatment; and improving quality of life after breast cancer.” There was little evidence that physicians treated decisions about anti‐hormonal treatment, menopausal symptoms, and follow‐up consultations as sensitive to patient preferences. Decisions about breast reconstruction were considered as very sensitive to patient preferences, and patients were usually involved. Conclusion Patients are currently not involved in all decisions that affect them during follow‐up, indicating a need for improvements. Personalised follow‐up care could improve resource allocation and the value of care for patients.
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Affiliation(s)
- Kelly M. de Ligt
- Department of Research Netherlands Comprehensive Cancer Organisation (IKNL) Utrecht The Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre University of Twente Enschede The Netherlands
| | - Laurentine S.E. van Egdom
- Department of Surgical Oncology Erasmus MC Cancer Institute, University Medical Centre Rotterdam Rotterdam The Netherlands
| | - Linetta B. Koppert
- Department of Surgical Oncology Erasmus MC Cancer Institute, University Medical Centre Rotterdam Rotterdam The Netherlands
| | - Sabine Siesling
- Department of Research Netherlands Comprehensive Cancer Organisation (IKNL) Utrecht The Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre University of Twente Enschede The Netherlands
| | - Janine A. van Til
- Department of Health Technology and Services Research, Technical Medical Centre University of Twente Enschede The Netherlands
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17
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Jung SY, Jung KW, Ha J, Won YJ, Kim YA, Kwon Y, Kong SY, Lee ES. Different Patterns of Conditional Survival of Breast Cancer Patients by Age and Histologic Types: Evidence from the Korean Nationwide Registry. Cancer Epidemiol Biomarkers Prev 2019; 28:1169-1176. [PMID: 31028082 DOI: 10.1158/1055-9965.epi-18-1072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/11/2018] [Accepted: 04/18/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Conditional relative survival (CRS), which is the survival estimate of patients who have already survived for a certain period of time after diagnosis, could provide more relevant information on the current prognosis of cancer survivors than the standard 5-year relative survival (RS). This study aimed to estimate the 5-year CRS of Korean breast cancer patients. METHODS We identified 145,083 breast cancer cases diagnosed between 2002 and 2013 in the Korea Central Cancer Registry. The CRS was estimated for every year after diagnosis, according to sex, age, histologic type, and stage. RESULTS The 5-year RS at diagnosis was 90.8%, and the 10-year RS was 85.7%. The 5-year CRS was 91.0% and 94.3% at 1 year and 5 years after diagnosis, respectively. Very young and very old patients had worse 5-year CRS after 5 years of survival than those of other age groups (92.2% in the <40-year and 92.6% in the ≥70-year groups vs. 95.4% in 40-49-year, 94.3% in 50-59-year, and 93.7% in 60-69-year groups). The 5-year CRS of metaplastic carcinoma increased from 82.0% at diagnosis to 95.2% at 5 years after diagnosis, compared with that of lobular carcinoma (from 93.1% to 92.5%). Hardly any excess mortality (5-year CRS ≥ 95%) was seen within 7 years after diagnosis. CONCLUSIONS This study shows that the CRS of breast cancer survivors in Korea has increased, but varies by sex, age, stage, and histologic type. IMPACT These findings provide more detailed information to breast cancer survivors and clinicians.
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Affiliation(s)
- So-Youn Jung
- Center for Breast Cancer, National Cancer Center, Goyang, Korea.,Cancer Healthcare Research Branch, Research Institute, National Cancer Center, Goyang, Korea
| | - Kyu-Won Jung
- Cancer Registration and Statistics Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea.
| | - Johyun Ha
- Cancer Registration and Statistics Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Young-Joo Won
- Cancer Registration and Statistics Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Young Ae Kim
- Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Youngmee Kwon
- Center for Breast Cancer, National Cancer Center, Goyang, Korea
| | - Sun-Young Kong
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy.,Translational Cancer Research Branch, Research Institute, National Cancer Center, Goyang, Korea.,Department of Laboratory Medicine, Center for Diagnostic Oncology, Hospital, National Cancer Center, Goyang, Korea
| | - Eun Sook Lee
- Center for Breast Cancer, National Cancer Center, Goyang, Korea.,Immunotherapeutics Branch, Research Institute, National Cancer Center, Goyang, Korea.,National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea
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18
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van Maaren MC, Kneepkens RF, Verbaan J, Huijgens PC, Lemmens VEPP, Verhoeven RHA, Siesling S. A conditional model predicting the 10-year annual extra mortality risk compared to the general population: a large population-based study in Dutch breast cancer patients. PLoS One 2019; 14:e0210887. [PMID: 30677053 PMCID: PMC6345454 DOI: 10.1371/journal.pone.0210887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/03/2019] [Indexed: 11/28/2022] Open
Abstract
Objective Many cancer survivors are facing difficulties in getting a life insurance; raised premiums and declinatures are common. We generated a prediction model estimating the conditional extra mortality risk of breast cancer patients in the Netherlands. This model can be used by life insurers to accurately estimate the additional risk of an individual patient, conditional on the years survived. Methodology All women diagnosed with stage I-III breast cancer in 2005–2006, treated with surgery, were selected from the Netherlands Cancer Registry. For all stages separately, multivariable logistic regression was used to estimate annual mortality risks, conditional on the years survived, until 10 years after diagnosis, resulting in 30 models. The conditional extra mortality risk was calculated by subtracting mortality rates of the general Dutch population from the patient mortality rates, matched by age, gender and year. The final model was internally and externally validated, and tested by life insurers. Results We included 23,234 patients: 10,101 stage I, 9,868 stage II and 3,265 stage III. The final models included age, tumor stage, nodal stage, lateralization, location within the breast, grade, multifocality, hormonal receptor status, HER2 status, type of surgery, axillary lymph node dissection, radiotherapy, (neo)adjuvant systemic therapy and targeted therapy. All models showed good calibration and discrimination. Testing of the model by life insurers showed that insurability using the newly-developed model increased with 13%, ranging from 0%-24% among subgroups. Conclusion The final model provides accurate conditional extra mortality risks of breast cancer patients, which can be used by life insurers to make more reliable calculations. The model is expected to increase breast cancer patients’ insurability and transparency among life insurers.
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Affiliation(s)
- Marissa C. van Maaren
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands
- * E-mail:
| | | | - Joke Verbaan
- De Hoop Life Reinsurance, the Hague, the Netherlands
| | - Peter C. Huijgens
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Valery E. P. P. Lemmens
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
- Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Rob H. A. Verhoeven
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, the Netherlands
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19
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[Excess mortality among breast cancer patients in early stages in Tarragona and Gerona (Spain)]. GACETA SANITARIA 2018; 34:356-362. [PMID: 30573319 DOI: 10.1016/j.gaceta.2018.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/12/2018] [Accepted: 09/20/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To analyze the population-based survival of breast cancer (CM) diagnosed in early stages estimating the time trends of excess mortality (EM) in the long term in annual and five-year time intervals, and to determine, if possible, a proportion of patients who can be considered cured. METHOD We included women diagnosed with BC under the age of 60 years in stages I and II in Girona and Tarragona (N = 2453). The observed (OS) and relative survival (RS) were calculated up to 20 years of follow-up. RS was also estimated at annual (RSI) and in five-year intervals (RS5) to graphically assess the EM. The results are presented by age groups (≤49 and 50-59), stage (I/II) and diagnostic period (1985-1994 and 1995-2004). RESULTS In stage I, OS and RS were higher during 1995-2004 compared to 1985-1994: 3.5% at 15 years of follow-up and 4.5% at 20-years of follow-up. In 1995-2004, the OS surpassed 80% in stage I patients whereas in stage II it remained below 70%. During 1995-2004, the long-term EM did not level off towards 0 (RSI <1) independently of age group, stage and period of diagnosis. After 15 years of follow-up, the 5-year EM oscillated between 1 and 5% in stage I (RS5 ≥0.95) and between 5 and 10% in stage II. CONCLUSIONS In our cohort, after 15 years of follow-up, it was detected that the annual EM did not disappear and the five-year EM remained between 1 and 10%. Therefore, it was not possible to determine a cure rate of BC during the study period.
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van Maaren MC, Strobbe LJA, Smidt ML, Moossdorff M, Poortmans PMP, Siesling S. Ten-year conditional recurrence risks and overall and relative survival for breast cancer patients in the Netherlands: Taking account of event-free years. Eur J Cancer 2018; 102:82-94. [PMID: 30144661 DOI: 10.1016/j.ejca.2018.07.124] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/13/2018] [Accepted: 07/16/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Survival estimates from diagnosis are of limited importance for (ex-)breast cancer patients who survived several years, as it includes information on already deceased patients. This study analysed the 10-year conditional risk of recurrent breast cancer in specific prognostic subgroups. Second, we investigated 10-year conditional overall survival (OS) and relative survival (RS), adjusted for confounding. PATIENTS AND METHODS All women diagnosed in 2005 with operated T1-2N0-1 breast cancer were selected from the Netherlands Cancer Registry. Patients were classified into T1N0, T1N1, T2N0 and T2N1 stage. Ten-year conditional recurrence rates were calculated from diagnosis, and for patients without an event (local [LR], regional recurrence [RR], distant metastasis [DM] or death) every year following diagnosis. Ten-year conditional OS was calculated using multivariable Cox regression. RS was estimated by dividing patient survival rates by those of the general Dutch population. RESULTS We included 7969 patients: 52.3% had T1N0, 15.3% T1N1, 19.9% T2N0 and 12.5% T2N1 stage. For T1N0, 10-year LR rates changed from 4.6% at diagnosis to 0.5% in year 10. RR rates changed from 2.3% to 0.2%, and DM rates changed from 7.8% to 0.6%. For T2N1 stage, the LR, RR and DM rates changed from 6.2% to 0.8%, 5.2%-0.4% and 19.6%-1.5%, respectively. For the luminal A subtype, LR, RR and DM rates changed from 3.9% to 0.4%, 1.7%-0.5% and 7.3%-1.1%, while for triple negative, these rates changed from 5.6% to 0.7%, 4.9%-0.2% and 16.7%-0%, respectively. Differences between subgroups attenuated over time, and all recurrence rates became ≤1.5% in year 10. Ten-year OS and RS, adjusted for confounding, showed declining risk differences between subgroups over time. CONCLUSION Differences in recurrence rates, OS and RS between prognostic subgroups declined as years passed by. These results highlight the importance of taking into account disease-free years to more accurately predict (ex-)breast cancer patients' prognosis over time.
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Affiliation(s)
- Marissa C van Maaren
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands; Department of Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
| | - Luc J A Strobbe
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Marjolein L Smidt
- Department of Surgical Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Martine Moossdorff
- Department of Surgical Oncology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | | | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands; Department of Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
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21
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Anderson C, Smitherman AB, Nichols HB. Conditional relative survival among long-term survivors of adolescent and young adult cancers. Cancer 2018; 124:3037-3043. [PMID: 29742278 DOI: 10.1002/cncr.31529] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/23/2018] [Accepted: 04/08/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Many studies have examined long-term outcomes after childhood cancer, but few address outcomes for adolescent and young adult (AYA; those aged 15-39 years) cancer survivors. Conditional survival reflects changing mortality risk with time since cancer diagnosis and is a useful measure for planning long-term follow-up care. METHODS Using the Surveillance, Epidemiology, and End Results registry 9 database, the authors identified a cohort of AYA patients diagnosed with a first malignant cancer between 1973 and 2009 and followed through 2014. They estimated 5-year relative survival at the time of diagnosis and at each additional year survived up to 25 years after diagnosis, conditional on the individual being alive at the beginning of that year. RESULTS A total of 205,954 AYA patients with cancer were identified. Thyroid cancer, melanoma, testicular cancer, breast cancer, lymphoma, leukemia, and central nervous system (CNS) tumors comprised 67% of all cancers. For all cancers combined, 5-year relative survival was 84.5% (95% confidence interval, 84.3%-84.7%) at 1 year after diagnosis and 94.0% (95% CI, 93.9%-94.2%) at 5 years. The relative survival first exceeded 95%, reflecting minimal excess mortality compared with the general population, at 7 years. Patients with thyroid cancer, testicular cancer, melanoma, and breast cancer reached a relative survival of >95% at the time of diagnosis and at 1, 3, and 18 years after diagnosis, respectively. Estimates for those with Hodgkin lymphoma and leukemia were >95% at 6 and 13 years, respectively, but declined to <95% at 20 years. AYA individuals with CNS tumors did not reach 95% by 25 years after diagnosis. CONCLUSIONS For AYA survivors of breast cancer, CNS tumors, and hematologic malignancies, long-term excess mortality should be considered when planning follow-up care. Cancer 2018;124:3037-43. © 2018 American Cancer Society.
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Affiliation(s)
- Chelsea Anderson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Andrew B Smitherman
- Division of Pediatric Hematology and Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hazel B Nichols
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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22
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Boussari O, Romain G, Remontet L, Bossard N, Mounier M, Bouvier AM, Binquet C, Colonna M, Jooste V. A new approach to estimate time-to-cure from cancer registries data. Cancer Epidemiol 2018; 53:72-80. [PMID: 29414635 DOI: 10.1016/j.canep.2018.01.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 01/19/2018] [Accepted: 01/21/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Cure models have been adapted to net survival context to provide important indicators from population-based cancer data, such as the cure fraction and the time-to-cure. However existing methods for computing time-to-cure suffer from some limitations. METHODS Cure models in net survival framework were briefly overviewed and a new definition of time-to-cure was introduced as the time TTC at which P(t), the estimated covariate-specific probability of being cured at a given time t after diagnosis, reaches 0.95. We applied flexible parametric cure models to data of four cancer sites provided by the French network of cancer registries (FRANCIM). Then estimates of the time-to-cure by TTC and by two existing methods were derived and compared. Cure fractions and probabilities P(t) were also computed. RESULTS Depending on the age group, TTC ranged from to 8 to 10 years for colorectal and pancreatic cancer and was nearly 12 years for breast cancer. In thyroid cancer patients under 55 years at diagnosis, TTC was strikingly 0: the probability of being cured was >0.95 just after diagnosis. This is an interesting result regarding the health insurance premiums of these patients. The estimated values of time-to-cure from the three approaches were close for colorectal cancer only. CONCLUSIONS We propose a new approach, based on estimated covariate-specific probability of being cured, to estimate time-to-cure. Compared to two existing methods, the new approach seems to be more intuitive and natural and less sensitive to the survival time distribution.
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Affiliation(s)
- Olayidé Boussari
- Dijon-Bourgogne University Hospital, Registre Bourguignon des Cancers Digestifs, Dijon F-21000, France; INSERM, U1231, EPICAD team, Univ Bourgogne-Franche-Comté, UMR 1231, Dijon F-21000, France; LabEX LipSTIC, ANR-11-LABX-0021, Dijon F-21000, France
| | - Gaëlle Romain
- Dijon-Bourgogne University Hospital, Registre Bourguignon des Cancers Digestifs, Dijon F-21000, France; INSERM, U1231, EPICAD team, Univ Bourgogne-Franche-Comté, UMR 1231, Dijon F-21000, France
| | - Laurent Remontet
- Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, Lyon F-69003, France; Université de Lyon, Lyon F-69000, France; Université Lyon 1, Villeurbanne F-69100, France; CNRS UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique Santé, Pierre-Bénite F-69310, France
| | - Nadine Bossard
- Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, Lyon F-69003, France; Université de Lyon, Lyon F-69000, France; Université Lyon 1, Villeurbanne F-69100, France; CNRS UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique Santé, Pierre-Bénite F-69310, France
| | - Morgane Mounier
- Dijon-Bourgogne University Hospital, Univ Bourgogne-Franche-Comté, Registre des Hémopathies Malignes de Côte d'Or, Dijon, France
| | - Anne-Marie Bouvier
- Dijon-Bourgogne University Hospital, Registre Bourguignon des Cancers Digestifs, Dijon F-21000, France; INSERM, U1231, EPICAD team, Univ Bourgogne-Franche-Comté, UMR 1231, Dijon F-21000, France
| | - Christine Binquet
- INSERM, U1231, EPICAD team, Univ Bourgogne-Franche-Comté, UMR 1231, Dijon F-21000, France; INSERM, CIC1432, Clinical Epidemiology Unit, Dijon F-21000, France; Dijon-Bourgogne University Hospital, Clinical Investigation Centre, Clinical Epidemiology/Clinical Trials Unit, Dijon F-21000, France
| | - Marc Colonna
- Registre du Cancer de l'Isère, Grenoble University Hospital, Grenoble F-38000, France
| | - Valérie Jooste
- Dijon-Bourgogne University Hospital, Registre Bourguignon des Cancers Digestifs, Dijon F-21000, France; INSERM, U1231, EPICAD team, Univ Bourgogne-Franche-Comté, UMR 1231, Dijon F-21000, France.
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23
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Clèries R, Ameijide A, Buxó M, Martínez JM, Marcos-Gragera R, Vilardell ML, Carulla M, Yasui Y, Vilardell M, Espinàs JA, Borràs JM, Galceran J, Izquierdo À. Long-term crude probabilities of death among breast cancer patients by age and stage: a population-based survival study in Northeastern Spain (Girona-Tarragona 1985-2004). Clin Transl Oncol 2018; 20:1252-1260. [PMID: 29511947 PMCID: PMC6153860 DOI: 10.1007/s12094-018-1852-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 02/23/2018] [Indexed: 12/13/2022]
Abstract
Background We provide population-based long-term survival indicators of breast cancer patients by quantifying the observed survival, and the probabilities of death due to breast cancer and to other causes by age and tumor stage at diagnosis. Methods We included a total of 10,195 female patients diagnosed before 85 years with invasive primary breast cancer in Girona and Tarragona during the periods 1985–1994 and 1995–2004 and followed-up until December 31st 2014. The survival indicators were estimated at 5, 10, 15 and 20 years of follow-up comparing diagnostic periods. Results Comparing diagnostic periods: I) the probability of death due to other causes did not change; II) the 20-year survival for women diagnosed ≤ 49 years increased 13% (1995–2004 = 68%; 1985–1994:55%), whereas their probability of death due to breast cancer decreased at the same pace (1995–2004 = 29%; 1985–1994 = 42%); III) at 10 years of follow-up, decreases in the probabilities of death due to breast cancer across age groups switched from 11 to 17% resulting in a risk of death reduction of 19% after adjusting by stage. During 1995–2004, the stage-specific 10-year probabilities of death due to breast cancer switched from: 3–6% in stage I, 18–20% in stage II, 34–46% in stage III and surpassed 70% in stage IV beyond 5 years after diagnosis. Conclusions In our study, women diagnosed with breast cancer had higher long-term probability to die from breast cancer than from other causes. The improvements in treatment and the lead-time bias in detecting cancer in an early stage resulted in a reduction of 19% in the risk of death between diagnostic periods. Electronic supplementary material The online version of this article (10.1007/s12094-018-1852-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R Clèries
- Pla Director d'Oncologia (GENCAT), IDIBELL, Hospital Duran i Reynals, Gran Via 199-203 1ª planta, L'Hospitalet de Llobregat, 08908, Barcelona, Spain.
- Departament de Ciències Clíniques, Universitat de Barcelona, Campus de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - A Ameijide
- Registre de Càncer de Tarragona, Fundació Lliga per a la Investigació i Prevenció del Càncer (FUNCA)-IISPV, Reus, Tarragona, Spain
| | - M Buxó
- Institut d'Investigació Biomèdica de Girona, IDIBGI, C/Dr.Castany s/n, Edifici M2, Parc Hospitalari Martí i Julià, 17190, Salt, Spain
| | - J M Martínez
- MC MUTUAL, Departamento de Investigación y Análisis de Prestaciones, C/Provenza, 321, 08037, Barcelona, Spain
| | - R Marcos-Gragera
- Unitat d'Epidemiologia i Registre del Càncer de Girona (UERGG), Institut d'Investigació Biomèdica Girona Josep Trueta (IDIBGI), Girona, Spain
- Institut Català d'Oncologia (ICO), Girona, Spain
- Departament d'Infermeria, Universitat de Girona (UdG), Girona, Spain
| | - M-L Vilardell
- Unitat d'Epidemiologia i Registre del Càncer de Girona (UERGG), Institut d'Investigació Biomèdica Girona Josep Trueta (IDIBGI), Girona, Spain
- Institut Català d'Oncologia (ICO), Girona, Spain
| | - M Carulla
- Registre de Càncer de Tarragona, Fundació Lliga per a la Investigació i Prevenció del Càncer (FUNCA)-IISPV, Reus, Tarragona, Spain
| | - Y Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - M Vilardell
- Sección de Estadística del Departamento de Genética, Microbiología y Estadística de la Facultad de Biología, Universidad de Barcelona, 08028, Barcelona, Spain
| | - J A Espinàs
- Pla Director d'Oncologia (GENCAT), IDIBELL, Hospital Duran i Reynals, Gran Via 199-203 1ª planta, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - J M Borràs
- Pla Director d'Oncologia (GENCAT), IDIBELL, Hospital Duran i Reynals, Gran Via 199-203 1ª planta, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
- Departament de Ciències Clíniques, Universitat de Barcelona, Campus de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - J Galceran
- Registre de Càncer de Tarragona, Fundació Lliga per a la Investigació i Prevenció del Càncer (FUNCA)-IISPV, Reus, Tarragona, Spain
- Departament de Medicina i Cirurgia, Universitat Rovira i Virgili, Reus, Tarragona, Spain
| | - À Izquierdo
- Unitat d'Epidemiologia i Registre del Càncer de Girona (UERGG), Institut d'Investigació Biomèdica Girona Josep Trueta (IDIBGI), Girona, Spain
- Institut Català d'Oncologia (ICO), Girona, Spain
- Departament d'Oncología Médica, Institut Català d'Oncologia, Hospital Universitari Doctor Josep Trueta, Girona, Spain
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Estimating long-term crude probability of death among young breast cancer patients: a Bayesian approach. TUMORI JOURNAL 2016; 102:555-561. [PMID: 27647229 DOI: 10.5301/tj.5000545] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2016] [Indexed: 12/19/2022]
Abstract
AIMS AND BACKGROUND Bayesian survival analysis was applied to assess the long-term survival and probability of death due to breast cancer (BC) in Girona, the Spanish region with the highest BC incidence. METHODS A Bayesian autoregressive model was implemented to compare survival indicators between the periods 1985-1994 and 1995-2004. We assessed the long-term excess hazard of death, relative survival (RS), and crude probability of death due to BC (PBC) up to 20 years after BC diagnosis, reporting the 95% credible intervals (CI) of these indicators. RESULTS Patients diagnosed from 1995 onwards showed lower 20-year excess hazards of death than those diagnosed earlier (RS during 1985-1994: local stage: 76.6%; regional stage: 44.9%; RS during 1995-2004: local stage: 85.2%; regional stage: 57.0%). The PBC after 20 years of BC diagnosis for patients diagnosed in 1995 and after might reach 14.4% (95% CI: 8.9%-21.2%) in local stage and 41.0% (95% CI: 36.1%-47.1%) in regional stage. CONCLUSIONS The method presented could be useful when dealing with population-based survival data from a small region. Better survival prospects were found in patients diagnosed after 1994, although we detected a non-decreasing long-term excess hazard of death, suggesting that these patients have higher mortality than the general population even 10 years after the diagnosis of BC.
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Contribution of changes in demography and in the risk factors to the predicted pattern of cancer mortality among Spanish women by 2022. Cancer Epidemiol 2015; 40:113-8. [PMID: 26707236 DOI: 10.1016/j.canep.2015.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/20/2015] [Accepted: 12/03/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Changes in the burden of cancer mortality are expected to be observed among Spanish women. We predict those changes, in Spain, for breast cancer (BC), colorectal cancer (CRC), lung cancer (LC) and pancreatic cancer (PC) from 2013 to 2022. METHODS Bayesian age-period-cohort modeling was used to perform projections of the cancer burden in 2013-2022, extrapolating the trend of cancer mortality data from 1998 to 2012. We assessed the time trends of the crude rates (CRs) during 1998-2012, and compared the number of cancer deaths between the periods 2008-2012 and 2018-2022 to assess the contribution of demographic changes and changes in the risk factors for cancer. RESULTS During 1998-2012, CRs of cancer decreased for BC (0.3% per year) and increased for LC (4.7%), PC (2%) and CRC (0.7%). During 2013-2022, CRs might level off for CRC, whereas the time trends for the remaining cancers might continue at a similar pace. During 2018-2022, BC could be surpassed by CRC as the most frequent cause of cancer mortality among Spanish women, whereas LC could be the most common cause of cancer mortality among women aged 50-69 years (N/year=1960 for BC versus N/year=1981 for LC). Comparing 2018-2022 and 1998-2012, changes in the risk factors for cancer could contribute 37.93% and 18.36% to the burden of LC and PC, respectively, and demographic shifts - mainly due to ageing (19.27%) - will drive the burden of CRC. CONCLUSIONS During 2018-2022, demographic changes (ageing) and changes in risk factors could have a different impact on the lifetime risk of cancer among Spanish women.
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Relative mortality rates from incident chronic diseases among breast cancer survivors – A 14year follow-up of five-year survivors diagnosed in Denmark between 1994 and 2007. Eur J Cancer 2015; 51:767-75. [DOI: 10.1016/j.ejca.2015.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/27/2015] [Accepted: 02/03/2015] [Indexed: 01/12/2023]
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Offersen BV, Boersma LJ, Kirkove C, Hol S, Aznar MC, Biete Sola A, Kirova YM, Pignol JP, Remouchamps V, Verhoeven K, Weltens C, Arenas M, Gabrys D, Kopek N, Krause M, Lundstedt D, Marinko T, Montero A, Yarnold J, Poortmans P. ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer. Radiother Oncol 2015; 114:3-10. [PMID: 25630428 DOI: 10.1016/j.radonc.2014.11.030] [Citation(s) in RCA: 398] [Impact Index Per Article: 44.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 11/15/2014] [Accepted: 11/15/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Delineation of clinical target volumes (CTVs) is a weak link in radiation therapy (RT), and large inter-observer variation is seen in breast cancer patients. Several guidelines have been proposed, but most result in larger CTVs than based on conventional simulator-based RT. The aim was to develop a delineation guideline obtained by consensus between a broad European group of radiation oncologists. MATERIAL AND METHODS During ESTRO teaching courses on breast cancer, teachers sought consensus on delineation of CTV through dialogue based on cases. One teacher delineated CTV on CT scans of 2 patients, followed by discussion and adaptation of the delineation. The consensus established between teachers was sent to other teams working in the same field, both locally and on a national level, for their input. This was followed by developing a broad consensus based on discussions. RESULTS Borders of the CTV encompassing a 5mm margin around the large veins, running through the regional lymph node levels were agreed, and for the breast/thoracic wall other vessels were pointed out to guide delineation, with comments on margins for patients with advanced breast cancer. CONCLUSION The ESTRO consensus on CTV for elective RT of breast cancer, endorsed by a broad base of the radiation oncology community, is presented to improve consistency.
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Affiliation(s)
| | - Liesbeth J Boersma
- Department of Radiation Oncology, Maastricht University Medical Centre - GROW (MAASTRO), The Netherlands
| | - Carine Kirkove
- Department of Radiation Oncology, Catholic University of Louvain, Belgium
| | - Sandra Hol
- Department of Radiation Oncology, Institute Verbeeten, Tilburg, The Netherlands
| | | | - Albert Biete Sola
- Department of Radiation Oncology, Hospital Clinic i Provincial, Barcelona, Spain
| | - Youlia M Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Jean-Philippe Pignol
- Department of Radiation Oncology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Vincent Remouchamps
- Department of Radiation Oncology, Clinique Sainte Elisabeth (AMPR), Namur, Belgium
| | - Karolien Verhoeven
- Department of Radiation Oncology, University Hospitals Leuven, KU Leuven, Belgium
| | - Caroline Weltens
- Department of Radiation Oncology, University Hospitals Leuven, KU Leuven, Belgium
| | - Meritxell Arenas
- Department of Radiation Oncology, Hospital Universitari Sant Joan, Reus, Spain
| | - Dorota Gabrys
- Department of Radiation Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice, Poland
| | - Neil Kopek
- Department of Oncology, Division of Radiation Oncology, McGill University, Montréal, Canada
| | - Mechthild Krause
- German Cancer Consortium (DKTK) Dresden and German Cancer Research Center (DKFZ) Heidelberg, Dept. of Radiation Oncology and OncoRay, University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Dan Lundstedt
- Department of Oncology, Sahlgrenska Universitetssjukhuset, Gothenborg, Sweden
| | - Tanja Marinko
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Angel Montero
- Department of Radiation Oncology, Centro Integral Oncológico Clara Campal, Hospital Universitario Sanchinarro, Madrid, Spain
| | - John Yarnold
- Division of Radiotherapy and Imaging, Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Philip Poortmans
- Department of Radiation Oncology, Radboud university medical centre, The Netherlands
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Dal Maso L, Guzzinati S, Buzzoni C, Capocaccia R, Serraino D, Caldarella A, Dei Tos AP, Falcini F, Autelitano M, Masanotti G, Ferretti S, Tisano F, Tirelli U, Crocetti E, De Angelis R, Virdone S, Zucchetto A, Gigli A, Francisci S, Baili P, Gatta G, Castaing M, Zanetti R, Contiero P, Bidoli E, Vercelli M, Michiara M, Federico M, Senatore G, Pannozzo F, Vicentini M, Bulatko A, Pirino DR, Gentilini M, Fusco M, Giacomin A, Fanetti AC, Cusimano R. Long-term survival, prevalence, and cure of cancer: a population-based estimation for 818 902 Italian patients and 26 cancer types. Ann Oncol 2014; 25:2251-2260. [PMID: 25149707 PMCID: PMC4207730 DOI: 10.1093/annonc/mdu383] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Original, population-based estimates of indicators of long-term survival and cure in cancer patients are provided. More than a quarter of cancer patients in Italy have reached death rates similar to those of the general population. Nearly three quarters of them will not die as a result of cancer. These estimates are potentially helpful to health-care planners, clinicians, and patients. Background Persons living after a cancer diagnosis represent 4% of the whole population in high-income countries. The aim of the study was to provide estimates of indicators of long-term survival and cure for 26 cancer types, presently lacking. Patients and methods Data on 818 902 Italian cancer patients diagnosed at age 15–74 years in 1985–2005 were included. Proportions of patients with the same death rates of the general population (cure fractions) and those of prevalent patients who were not at risk of dying as a result of cancer (cure prevalence) were calculated, using validated mixture cure models, by cancer type, sex, and age group. We also estimated complete prevalence, conditional relative survival (CRS), time to reach 5- and 10-year CRS >95%, and proportion of patients living longer than those thresholds. Results The cure fractions ranged from >90% for patients aged <45 years with thyroid and testis cancers to <10% for liver and pancreatic cancers of all ages. Five- or 10-year CRS >95% were both reached in <10 years by patients with cancers of the stomach, colon–rectum, pancreas, corpus and cervix uteri, brain, and Hodgkin lymphoma. For breast cancer patients, 5- and 10-year CRSs reached >95% after 19 and 25 years, respectively, and in 15 and 18 years for prostate cancer patients. Five-year CRS remained <95% for >25 years after cancer diagnosis in patients with liver and larynx cancers, non-Hodgkin lymphoma, myeloma, and leukaemia. Overall, the cure prevalence was 67% for men and 77% for women. Therefore, 21% of male and 31% of female patients had already reached 5-year CRS >95%, whereas 18% and 25% had reached 10-year CRS >95%. Conclusions A quarter of Italian cancer patients can be considered cured. This observation has a high potential impact on health planning, clinical practice, and patients' perspective.
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Affiliation(s)
- L Dal Maso
- Epidemiology and Biostatistics Unit, CRO Aviano National Cancer Institute IRCCS, Aviano.
| | - S Guzzinati
- Veneto Tumour Registry, Veneto Region, Padua
| | - C Buzzoni
- AIRTUM Database, Florence; Tuscany Cancer Registry, Clinical and Descriptive Epidemiology Unit, Cancer Prevention and Research Institute (ISPO), Florence
| | - R Capocaccia
- National Centre for Epidemiology, Surveillance and Health Promotion (CNESPS), Italian National Institute of Health (ISS), Rome
| | - D Serraino
- Epidemiology and Biostatistics Unit, CRO Aviano National Cancer Institute IRCCS, Aviano
| | - A Caldarella
- Tuscany Cancer Registry, Clinical and Descriptive Epidemiology Unit, Cancer Prevention and Research Institute (ISPO), Florence
| | - A P Dei Tos
- Veneto Tumour Registry, Veneto Region, Padua; Department of Oncology, Anatomic Pathology Unit, General Hospital of Treviso, Treviso
| | - F Falcini
- Romagna Cancer Registry, Cancer Institute of Romagna (IRCSS), Meldola
| | - M Autelitano
- Milan Cancer Registry, Milan Health Authority, Epidemiology Unit, Milan
| | - G Masanotti
- Umbria Cancer Registry, Department of Medical and Surgical Specialties, and Public Health, Section of Public Health, Perugia University, Perugia
| | - S Ferretti
- Ferrara Cancer Registry, Ferrara University, Ferrara
| | - F Tisano
- Siracusa Cancer Registry, ASP of Siracusa, Siracusa
| | - U Tirelli
- Medical Oncology Unit, CRO Aviano National Cancer Institute IRCCS, Aviano, Italy
| | - E Crocetti
- Tuscany Cancer Registry, Clinical and Descriptive Epidemiology Unit, Cancer Prevention and Research Institute (ISPO), Florence
| | - R De Angelis
- National Centre for Epidemiology, Surveillance and Health Promotion (CNESPS), Italian National Institute of Health (ISS), Rome
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Affiliation(s)
- Philip Poortmans
- Department of Radiation Oncology, Institute Verbeeten, Tilburg, LA 5000, Netherlands.
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