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Kempf E, Chatellier G. [Social deprivation: A key risk marker in oncology, even in rich countries]. Bull Cancer 2024; 111:625-627. [PMID: 38821773 DOI: 10.1016/j.bulcan.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Affiliation(s)
- Emmanuelle Kempf
- Département d'oncologie médicale, GHU Henri-Mondor, université Paris-Est Créteil, Assistance publique-Hôpitaux de Paris, Créteil, France.
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Servadio M, Rosa AC, Addis A, Kirchmayer U, Cozzi I, Michelozzi P, Cipelli R, Heiman F, Davoli M, Belleudi V. Investigating socioeconomic disparities in lung cancer diagnosis, treatment and mortality: an Italian cohort study. BMC Public Health 2024; 24:1543. [PMID: 38849792 PMCID: PMC11161996 DOI: 10.1186/s12889-024-19041-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 06/03/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Lung cancer is one of the most lethal cancers worldwide and patient clinical outcomes seem influenced by their socioeconomic position (SEP). Since little has been investigated on this topic in the Italian context, our aim was to investigate the role of SEP in the care pathway of lung cancer patients in terms of diagnosis, treatment and mortality. METHODS This observational retrospective cohort study included patients discharged in the Lazio Region with a lung cancer diagnosis between 2014 and 2017. In the main analysis, educational level was used as SEP measure. Multivariate models, adjusted for demographic and clinical variables, were applied to evaluate the association between SEP and study outcomes, stratified for metastatic (M) and non-metastatic (NM) cancer. We defined a diagnosis as 'delayed' when patients received their initial cancer diagnosis after an emergency department admission. Access to advanced lung cancer treatments (high-cost, novel and innovative treatments) and mortality were investigated within the 24-month period post-diagnosis. Moreover, two additional indicators of SEP were examined in the sensitivity analysis: one focusing on area deprivation and the other on income-based exemption. RESULTS A total of 13,251 patients were identified (37.3% with metastasis). The majority were males (> 60%) and over half were older than 70 years. The distribution of SEP levels among patients was as follow: 31% low, 29% medium-low, 32% medium-high and 7% high. As SEP increased, the risks of receiving a delayed diagnosis ((high vs low: M: OR = 0.29 (0.23-0.38), NM: OR = 0.20 (0.16-0.25)) and of mortality ((high vs low M: OR = 0.77 (0.68-0.88) and NM: 0.61 (0.54-0.69)) decreased. Access to advanced lung cancer treatments increased in accordance with SEP only in the M cohort (high vs low: M: OR = 1.57 (1.18-2.09)). The primary findings were corroborated by sensitivity analysis. CONCLUSIONS Our study highlighted the need of public health preventive and educational programs in Italy, a country where the care pathway of lung cancer patients, especially in terms of diagnosis and mortality, appears to be negatively affected by SEP level.
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Affiliation(s)
- Michela Servadio
- Department of Epidemiology, Regional Health Service Lazio, Rome, Italy
| | - Alessandro C Rosa
- Department of Epidemiology, Regional Health Service Lazio, Rome, Italy.
| | - Antonio Addis
- Department of Epidemiology, Regional Health Service Lazio, Rome, Italy
| | - Ursula Kirchmayer
- Department of Epidemiology, Regional Health Service Lazio, Rome, Italy
| | - Ilaria Cozzi
- Department of Epidemiology, Regional Health Service Lazio, Rome, Italy
| | - Paola Michelozzi
- Department of Epidemiology, Regional Health Service Lazio, Rome, Italy
| | | | | | - Marina Davoli
- Department of Epidemiology, Regional Health Service Lazio, Rome, Italy
| | - Valeria Belleudi
- Department of Epidemiology, Regional Health Service Lazio, Rome, Italy
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Exarchakou A, Rachet B, Lyratzopoulos G, Maringe C, Rubio FJ. What can hospital emergency admissions prior to cancer diagnosis tell us about socio-economic inequalities in cancer diagnosis? Evidence from population-based data in England. Br J Cancer 2024; 130:1960-1968. [PMID: 38671209 PMCID: PMC11182764 DOI: 10.1038/s41416-024-02688-6] [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: 10/07/2022] [Revised: 04/07/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND More deprived cancer patients are at higher risk of Emergency Presentation (EP) with most studies pointing to lower symptom awareness and increased comorbidities to explain those patterns. With the example of colon cancer, we examine patterns of hospital emergency admissions (HEAs) history in the most and least deprived patients as a potential precursor of EP. METHODS We analysed the rates of hospital admissions and their admission codes (retrieved from Hospital Episode Statistics) in the two years preceding cancer diagnosis by sex, deprivation and route to diagnosis (EP, non-EP). To select the conditions (grouped admission codes) that best predict emergency admission, we adapted the purposeful variable selection to mixed-effects logistic regression. RESULTS Colon cancer patients diagnosed through EP had the highest number of HEAs than all the other routes to diagnosis, especially in the last 7 months before diagnosis. Most deprived patients had an overall higher rate and higher probability of HEA but fewer conditions associated with it. CONCLUSIONS Our findings point to higher use of emergency services for non-specific symptoms and conditions in the most deprived patients, preceding colon cancer diagnosis. Health system barriers may be a shared factor of socio-economic inequalities in EP and HEAs.
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Affiliation(s)
- Aimilia Exarchakou
- Inequalities in Cancer Outcomes Network (ICON), Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | - Bernard Rachet
- Inequalities in Cancer Outcomes Network (ICON), Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare and Outcomes (ECHO), Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Camille Maringe
- Inequalities in Cancer Outcomes Network (ICON), Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Pickwell-Smith BA, Spencer K, Sadeghi MH, Greenley S, Lind M, Macleod U. Where are the inequalities in colorectal cancer care in a country with universal healthcare? A systematic review and narrative synthesis. BMJ Open 2024; 14:e080467. [PMID: 38171631 PMCID: PMC10773363 DOI: 10.1136/bmjopen-2023-080467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/23/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE Patients diagnosed with colorectal cancer living in more deprived areas experience worse survival than those in more affluent areas. Those living in more deprived areas face barriers to accessing timely, quality healthcare. These barriers may contribute to socioeconomic inequalities in survival. We evaluated the literature for any association between socioeconomic group, hospital delay and treatments received among patients with colorectal cancer in the UK, a country with universal healthcare. DESIGN MEDLINE, EMBASE, CINAHL, CENTRAL, SCIE, AMED and PsycINFO were searched from inception to January 2023. Grey literature, including HMIC, BASE and Google Advanced Search, and forward and backward citation searches were conducted. Two reviewers independently reviewed titles, abstracts and full-text articles. Observational UK-based studies were included if they reported socioeconomic measures and an association with either hospital delay or treatments received. The QUIPS tool assessed bias risk, and a narrative synthesis was conducted. The review is reported to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. RESULTS 41 of the 7209 identified references were included. 12 studies evaluated 7 different hospital intervals. There was a significant association between area-level deprivation and a longer time from first presentation in primary care to diagnosis. 32 studies evaluated treatments received. There were socioeconomic inequalities in surgery and chemotherapy but not radiotherapy. CONCLUSION Patients with colorectal cancer face inequalities across the cancer care continuum. Further research is needed to understand why and what evidence-based actions can reduce these inequalities in treatment. Qualitative research of patients and clinicians conducted across various settings would provide a rich understanding of the complex factors that drive these inequalities. Further research should also consider using a causal approach to future studies to considerably strengthen the interpretation. Clinicians can try and mitigate some potential causes of colorectal cancer inequalities, including signposting to financial advice and patient transport schemes. PROSPERO REGISTRATION NUMBER CRD42022347652.
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Affiliation(s)
| | - Katie Spencer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | - Michael Lind
- University of Hull, Hull, UK
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
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Vallome G, Cafaro I, Bottini A, Dellepiane C, Rossi G, Bennicelli E, Parisi F, Zullo L, Tagliamento M, Ballestrero A, Barisione E, Grazia Piroddi IM, Montecucco F, Carbone F, Pronzato P, Lambertini M, Spagnolo F, Barletta G, Barcellini L, Ferrante M, Nardin S, Coco S, Marconi S, Zinoli L, Moscatelli P, Arboscello E, Del Mastro L, Bellodi A, Genova C. Diagnosis of lung cancer following emergency admission: Examining care pathways, clinical outcomes, and advanced NSCLC treatment in an Italian cancer Center. Heliyon 2023; 9:e21177. [PMID: 37928020 PMCID: PMC10623281 DOI: 10.1016/j.heliyon.2023.e21177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/12/2023] [Accepted: 10/17/2023] [Indexed: 11/07/2023] Open
Abstract
Background Lung cancer patients diagnosed following emergency admission often present with advanced disease and poor performance status, leading to suboptimal treatment options and outcomes. This study aimed to investigate the clinical and molecular characteristics, treatment initiation, and survival outcomes of these patients. Methods We retrospectively analyzed data from 124 patients diagnosed with lung cancer following emergency admission at a single institution. Clinical characteristics, results of molecular analyses for therapeutic purpose, systemic treatment initiation, and survival outcomes were assessed. Correlations between patients' characteristics and treatment initiation were analyzed. Results Median age at admission was 73 years, and 79.0 % had at least one comorbidity. Most patients (87.1 %) were admitted due to cancer-related symptoms. Molecular analyses were performed in 89.5 % of advanced non-small cell lung cancer (NSCLC) cases. In this subgroup, two-thirds (66.2 %) received first-line therapy. Median overall survival (OS) was 3.9 months for the entire cohort, and 2.9 months for patients with metastatic lung cancer. Among patients with advanced NSCLC, OS was significantly longer for those with actionable oncogenic drivers and those who received first-line therapy. Improvement of performance status during hospitalization resulted in increased probability of receiving first-line systemic therapy. Discussion Patients diagnosed with lung cancer following emergency admission demonstrated poor survival outcomes. Treatment initiation, particularly for patients with actionable oncogenic drivers, was associated with longer OS. These findings highlight the need for proactive medical approaches, including improving access to molecular diagnostics and targeted treatments, to optimize outcomes in this patient population.
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Affiliation(s)
- Giacomo Vallome
- U.O. Oncologia Medica, Ospedale Padre Antero Micone, ASL3, Genoa, Italy
| | - Iacopo Cafaro
- U.O. Clinica di Medicina Interna a Indirizzo Oncologico, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Annarita Bottini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy
| | - Chiara Dellepiane
- U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giovanni Rossi
- U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisa Bennicelli
- U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesca Parisi
- U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lodovica Zullo
- U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marco Tagliamento
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy
| | - Alberto Ballestrero
- U.O. Clinica di Medicina Interna a Indirizzo Oncologico, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy
| | - Emanuela Barisione
- U.O. Pneumologia a Indirizzo Interventistico, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Fabrizio Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italian Cardiovascular Network, Genoa, Italy
| | - Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italian Cardiovascular Network, Genoa, Italy
| | - Paolo Pronzato
- U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy
- U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Spagnolo
- U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), Plastic Surgery Division, University of Genoa, Genoa, Italy
| | - Giulia Barletta
- U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lucrezia Barcellini
- U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Michele Ferrante
- U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Simone Nardin
- U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Simona Coco
- UO Tumori Polmonari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Silvia Marconi
- UO Tumori Polmonari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Linda Zinoli
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy
- U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paolo Moscatelli
- UO Medicina Interna, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Eleonora Arboscello
- Dipartimento di Emergenza Urgenza e Accettazione (DEA), IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy
- U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Bellodi
- U.O. Clinica di Medicina Interna a Indirizzo Oncologico, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Carlo Genova
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy
- U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Abraham S, Foreman N, Sidat Z, Sandhu P, Marrone D, Headley C, Akroyd C, Nicholson S, Brown K, Thomas A, Howells LM, Walter HS. Inequalities in cancer screening, prevention and service engagement between UK ethnic minority groups. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S14-S24. [PMID: 35648663 DOI: 10.12968/bjon.2022.31.10.s14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
More people in the UK are living with cancer than ever before. With an increasingly ethnically diverse population, greater emphasis must be placed on understanding factors influencing cancer outcomes. This review seeks to explore UK-specific variations in engagement with cancer services in minority ethnic groups and describe successful interventions. The authors wish to highlight that, despite improvement to engagement and education strategies, inequalities still persist and work to improve cancer outcomes across our communities still needs to be prioritised. There are many reasons why cancer healthcare inequities exist for minority communities, reported on a spectrum ranging from cultural beliefs and awareness, through to racism. Strategies that successfully enhanced engagement included language support; culturally-sensitive reminders; community-based health workers and targeted outreach. Focusing on the diverse city of Leicester the authors describe how healthcare providers, researchers and community champions have worked collectively, delivering targeted community-based strategies to improve awareness and access to cancer services.
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Affiliation(s)
- Shalin Abraham
- F2 Academic Foundation Doctor, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Nalini Foreman
- Quality Assistant, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Zahirah Sidat
- Senior Research Practitioner, Hope Clinical Trials Facility, University Hospitals of Leicester NHS Trust, Leicester
| | - Pavandeep Sandhu
- Research Technician, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Domenic Marrone
- Research Technician, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Catherine Headley
- Senior Cancer Services Manager, Leicester City Clinical Commissioning Group, Leicester
| | - Carol Akroyd
- Collaboration for Leadership in Applied Health Research and Care Equality and Diversity Theme Manager, Centre for Ethnic Health Research, University of Leicester, Leicester
| | - Sarah Nicholson
- Hope Clinical Trials Facility Manager/Cancer, Haematology, Urology, Gastroenterology, General Surgery Research Lead, Hope Clinical Trials Facility, University Hospitals of Leicester NHS Trust, Leicester
| | - Karen Brown
- Professor in Translational Cancer Research, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Anne Thomas
- Professor of Cancer Therapeutics, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Lynne M Howells
- Experimental Cancer Medicine Centre Translational Research Manager, Leicester Cancer Research Centre, University of Leicester, Leicester
| | - Harriet S Walter
- Associate Professor of Medical Oncology, Leicester Cancer Research Centre, University of Leicester, Leicester
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Guan Z, Webber C, Flemming JA, Mavor ME, Whitehead M, Chen BE, Groome PA. Real-world colorectal cancer diagnostic pathways in Ontario, Canada: A population-based study. Eur J Cancer Care (Engl) 2022; 31:e13603. [PMID: 35502982 DOI: 10.1111/ecc.13603] [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: 06/03/2021] [Revised: 01/21/2022] [Accepted: 04/18/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study aimed to identify colorectal cancer (CRC) diagnostic pathways and describe patients in those pathway groups. METHODS This was a cross-sectional study of CRC patients in Ontario, Canada, diagnosed 2009-2012 that used linked administrative data at ICES. We used cluster analysis on 11 pathway variables characterising patient presentation, symptoms, procedures and referrals. We assessed associations between patient- and disease-related characteristics and diagnostic pathway group. We further characterised the pathways by diagnostic interval and number of related physician visits. RESULTS Six diagnostic pathways were identified, with three adhering to provincial diagnostic guidelines: screening (N = 4494), colonoscopy (N = 10,066) and imaging plus colonoscopy (N = 3427). Non-adherent pathways were imaging alone (N = 2238), imaging and emergency presentation (N = 2849) and no pre-diagnostic workup (N = 887). Patients in adherent pathways were younger, had fewer comorbidities, lived in less deprived areas and had earlier stage disease. The median diagnostic interval length varied across pathways from 12 to 126 days, correlating with the number of CRC-related visits. CONCLUSIONS This study demonstrated substantial variations in real-world CRC diagnostic pathways and 25% were diagnosed through non-adherent pathways. Those patients were older, had more comorbid disease and had higher stage cancer. Further research needs to identify and describe the reasons for divergent diagnostic processes.
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Affiliation(s)
- Zhen Guan
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Colleen Webber
- Bruyère Research Institute, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jennifer A Flemming
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada.,Department of Medicine, Queen's University, Kingston, Ontario, Canada.,ICES Queen's, Kingston, Ontario, Canada
| | - Meaghan E Mavor
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | | | - Bingshu E Chen
- Canadian Cancer Trials Group (CCTG), Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Patti A Groome
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, Kingston, Ontario, Canada.,ICES Queen's, Kingston, Ontario, Canada
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Or Z, Shatrov K, Penneau A, Wodchis W, Abiona O, Blankart CR, Bowden N, Bernal‐Delgado E, Knight H, Lorenzoni L, Marino A, Papanicolas I, Riley K, Pellet L, Estupiñán‐Romero F, van Gool K, Figueroa JF. Within and across country variations in treatment of patients with heart failure and diabetes. Health Serv Res 2021; 56 Suppl 3:1358-1369. [PMID: 34409601 PMCID: PMC8579197 DOI: 10.1111/1475-6773.13854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/14/2021] [Accepted: 07/20/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To compare within-country variation of health care utilization and spending of patients with chronic heart failure (CHF) and diabetes across countries. DATA SOURCES Patient-level linked data sources compiled by the International Collaborative on Costs, Outcomes, and Needs in Care across nine countries: Australia, Canada, England, France, Germany, New Zealand, Spain, Switzerland, and the United States. DATA COLLECTION METHODS Patients were identified in routine hospital data with a primary diagnosis of CHF and a secondary diagnosis of diabetes in 2015/2016. STUDY DESIGN We calculated the care consumption of patients after a hospital admission over a year across the care pathway-ranging from primary care to home health nursing care. To compare the distribution of care consumption in each country, we use Gini coefficients, Lorenz curves, and female-male ratios for eight utilization and spending measures. PRINCIPAL FINDINGS In all countries, rehabilitation and home nursing care were highly concentrated in the top decile of patients, while the number of drug prescriptions were more uniformly distributed. On average, the Gini coefficient for drug consumption is about 0.30 (95% confidence interval (CI): 0.27-0.36), while it is, 0.50 (0.45-0.56) for primary care visits, and more than 0.75 (0.81-0.92) for rehabilitation use and nurse visits at home (0.78; 0.62-0.9). Variations in spending were more pronounced than in utilization. Compared to men, women spend more days at initial hospital admission (+5%, 1.01-1.06), have a higher number of prescriptions (+7%, 1.05-1.09), and substantially more rehabilitation and home care (+20% to 35%, 0.79-1.6, 0.99-1.64), but have fewer visits to specialists (-10%; 0.84-0.97). CONCLUSIONS Distribution of health care consumption in different settings varies within countries, but there are also some common treatment patterns across all countries. Clinicians and policy makers need to look into these differences in care utilization by sex and care setting to determine whether they are justified or indicate suboptimal care.
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Affiliation(s)
- Zeynep Or
- Institute for Research and Information in Health Economics (IRDES)ParisFrance
- Department of Economics (LEDa)University Dauphine PSLParisFrance
| | - Kosta Shatrov
- KPM Center for Public ManagementUniversity of BernBernSwitzerland
- Swiss Institute of Translational and Entrepreneurial MedicineBernSwitzerland
| | - Anne Penneau
- Institute for Research and Information in Health Economics (IRDES)ParisFrance
- Department of Economics (LEDa)University Dauphine PSLParisFrance
| | - Walter Wodchis
- Institute of Health Policy Management & EvaluationUniversity of TorontoTorontoOntarioCanada
- Institute for Better Health, Trillium Health PartnersMississaugaOntarioCanada
- ICESTorontoOntarioCanada
| | - Olukorede Abiona
- Centre for Health Economics Research and Evaluation (CHERE)University of TechnologySydneyNew South WalesAustralia
| | - Carl Rudolf Blankart
- KPM Center for Public ManagementUniversity of BernBernSwitzerland
- Swiss Institute of Translational and Entrepreneurial MedicineBernSwitzerland
- Hamburg Center for Health EconomicsUniversität HamburgHamburgGermany
| | - Nicholas Bowden
- Dunedin School of MedicineUniversity of OtagoDunedinNew Zealand
| | | | | | - Luca Lorenzoni
- Organisation for Economic Co‐operation and Development (OECD)ParisFrance
| | - Alberto Marino
- Organisation for Economic Co‐operation and Development (OECD)ParisFrance
- Department of Health PolicyLondon School of EconomicsLondonUK
| | | | - Kristen Riley
- Department of Health Policy and ManagementHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Leila Pellet
- Institute for Research and Information in Health Economics (IRDES)ParisFrance
| | | | - Kees van Gool
- Centre for Health Economics Research and Evaluation (CHERE)University of TechnologySydneyNew South WalesAustralia
| | - Jose F. Figueroa
- Department of Health Policy and ManagementHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
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Gowdhami B, Ambika S, Karthiyayini B, Ramya V, Kadalmani B, Vimala RTV, Akbarsha MA. Potential application of two cobalt (III) Schiff base complexes in cancer chemotherapy: Leads from a study using breast and lung cancer cells. Toxicol In Vitro 2021; 75:105201. [PMID: 34157415 DOI: 10.1016/j.tiv.2021.105201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/21/2021] [Accepted: 06/17/2021] [Indexed: 12/15/2022]
Abstract
Cobalt (III) Schiff base complexes are of attraction in the context of their potential application in cancer therapy. The aim of this study has been to find the mechanism of action of cobalt (III) Schiff base complexes 1 and 2, the synthesis and characterization of which have already been reported, in inhibiting growth of human breast cancer cell MCF-7 and lung cancer cell A549. The already proclaimed anti-proliferative effect of the cobalt complexes was ascertained using MTT cytotoxicity assay. More assays such as Acridine orange & Ethidium bromide staining, AnnexinV-Cy3 staining, Hoechst staining, comet assay, and Reactive Oxygen Species (ROS) assay- all supported the cytotoxic property of the complexes. Moreover, the expression levels of mRNA of pro- and antiapoptotic genes also supported the effectiveness of cobalt complexes by modifying the ratio of Bax: Bcl-2. In addition, the cobalt complexes induced apoptosis in MCF- 7 and A549 cells through modulation of pro-apoptotic, anti-apoptotic, and ROS modulatory gene expressions. The present study validates the scientific evidence for antiproliferative efficacy of cobalt complexes against MCF-7 and A549 cells. Thus, this study takes cobalt complexes 1 and 2 to a step higher towards their use as anticancer agents.
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Affiliation(s)
- Balakrishnan Gowdhami
- Department of Animal Science, Bharathidasan University, Tiruchirappalli, Tamilnadu, India; National Centre for Alternatives to Animal Experiments, Bharathidasan University, Tiruchirappalli, Tamilnadu, India
| | - Subramanian Ambika
- Department of Chemistry, Bishop Heber College, Tiruchirappalli, Tamilnadu, India
| | - Balakrishnan Karthiyayini
- National Centre for Alternatives to Animal Experiments, Bharathidasan University, Tiruchirappalli, Tamilnadu, India; Department of Microbiology, Bharathidasan University, Tiruchirappalli, Tamilnadu, India
| | - Venkatesan Ramya
- Department of Animal Science, Bharathidasan University, Tiruchirappalli, Tamilnadu, India
| | - Balamuthu Kadalmani
- Department of Animal Science, Bharathidasan University, Tiruchirappalli, Tamilnadu, India.
| | - R T V Vimala
- Department of Biotechnology, Bharathidasan University, Tiruchirappalli, Tamilnadu, India
| | - Mohammad A Akbarsha
- Mahatma Gandhi-Dorenkamp Centre, Bharathidasan University, Tiruchirappalli, Tamilnadu, India; Department of Biotechnology & Research Coordinator, National College (Autonomous), Tiruchirappalli, Tamilnadu, India.
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Wan YI, McGuckin D, Fowler AJ, Prowle JR, Pearse RM, Moonesinghe SR. Socioeconomic deprivation and long-term outcomes after elective surgery: analysis of prospective data from two observational studies. Br J Anaesth 2020; 126:642-651. [PMID: 33220938 DOI: 10.1016/j.bja.2020.10.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/01/2020] [Accepted: 10/18/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Socioeconomic deprivation is associated with health inequalities. We explored relationships between socioeconomic group and outcomes after elective surgery in the UK National Health Service (NHS). METHODS We combined data from two observational studies in 115 NHS hospitals and determined socioeconomic group using the Index of Multiple Deprivation (IMD) quintiles based on place of residence. Postoperative complications and 3-yr survival were assessed using logistic and Cox regression. Univariate analyses were adjusted for age differences between IMD quintiles. Multivariable analyses were used to account for other baseline risk factors including sex and comorbid disease. Results are reported as n (%), hazard ratios (HR) or odds ratios (OR) with 95% confidence intervals. RESULTS Postoperative complications developed in 971/9051 patients (10.7%) and 1597/9043 patients (17.7%) died within 3 yr. Complication rates increased with deprivation (reference group least-deprived IMD5): IMD1 (OR=1.44 [1.17-1.78]; P<0.001), IMD2 (OR=1.38 [1.12-1.70]; P<0.01), IMD3 (OR=1.09 [0.88-1.35]: P=0.44), IMD4 (OR=0.89 [0.71-1.11]; P=0.30). More patients from the most deprived quintile died (IMD1) (n=349, 18.8%) compared with the least deprived (IMD5) (n=297, 15.9%) with a trend across the socioeconomic spectrum (P=0.01). After age adjustment, patients in the most deprived areas experienced reduced 3-yr survival: IMD1 (HR=1.43 [1.23-1.67]; P<0.0001), IMD2 (HR=1.35 [1.15-1.57]; P<0.001), IMD3 (HR=1.04 [0.89-1.23]; P=0.60), and IMD4 (HR=1.11 [0.95-1.30]; P=0.19). This finding persisted in risk-adjusted analyses. Increased complication rates only partially explained this reduced survival. CONCLUSIONS Socioeconomic deprivation is associated with worse long-term outcomes after elective surgery. This risk factor should be considered when planning perioperative care for patients from deprived areas.
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Affiliation(s)
- Yize I Wan
- William Harvey Research Institute, Queen Mary University of London, London, UK; Acute Critical Care Research Team, Barts Health NHS Trust, London, UK.
| | - Dermot McGuckin
- Centre for Perioperative Medicine, Department of Targeted Intervention, UK; Surgical Outcomes Research Centre, University College London, London, UK
| | - Alexander J Fowler
- William Harvey Research Institute, Queen Mary University of London, London, UK; Acute Critical Care Research Team, Barts Health NHS Trust, London, UK
| | - John R Prowle
- William Harvey Research Institute, Queen Mary University of London, London, UK; Acute Critical Care Research Team, Barts Health NHS Trust, London, UK
| | - Rupert M Pearse
- William Harvey Research Institute, Queen Mary University of London, London, UK; Acute Critical Care Research Team, Barts Health NHS Trust, London, UK
| | - S Ramani Moonesinghe
- Centre for Perioperative Medicine, Department of Targeted Intervention, UK; Surgical Outcomes Research Centre, University College London, London, UK; Health Services Research Centre, National Institute of Academic Anaesthesia, London, UK
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11
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Dominguez RGS, Bierrenbach AL. HOSPITAL MORBIDITY AND COLORECTAL CANCER MORTALITY: IMPLICATIONS FOR PUBLIC HEALTH IN BRAZIL. ARQUIVOS DE GASTROENTEROLOGIA 2020; 57:182-187. [PMID: 32609160 DOI: 10.1590/s0004-2803.202000000-34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/25/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Colorectal cancer is a serious public health problem and one of the most common cancer worldwide. Countries around the world have shown different trends. While incidence and mortality rates for colorectal cancer are on an upward trend in developing countries, these rates have been on a downward trend in most developed countries. OBJECTIVE To analyze the temporal trend of morbimortality by colorectal cancer in Brazil between 2002 and 2016. METHODS Descriptive, time series research. Data were extracted from the national information systems for hospitalizations and deaths of the respective years. RESULTS There were increasing trends in hospital morbidity and mortality from colorectal cancer in all regions of the country, with the very elderly individuals dying at a higher rate. Women (52.1%) were more affected than men, but death rates were higher for males aged 60 years or more. Regional disparities were evident, with almost 80% of deaths occurring in the South and Southeast, with the largest annual increase in the South and the lowest in the North. Regarding hospitalization, South and Southeast presented higher annual growths. CONCLUSION These data add knowledge about the profile of public hospitalizations and deaths, reaffirming that colorectal cancer contributes to an important burden of disease and mortality in Brazil. These elements have implications for the review of colorectal cancer prevention and control strategies, as well as for public health investments.
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Affiliation(s)
| | - Ana Luiza Bierrenbach
- Instituto de Ensino e Pesquisa do Hospital Sírio Libanês (IEP-HSL), São Paulo, SP, Brasil
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12
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Weithorn D, Arientyl V, Solsky I, Umadat G, Levine R, Rapkin B, Leider J, In H. Diagnosis Setting and Colorectal Cancer Outcomes: The Impact of Cancer Diagnosis in the Emergency Department. J Surg Res 2020; 255:164-171. [PMID: 32563008 DOI: 10.1016/j.jss.2020.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/11/2020] [Accepted: 05/03/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The rate of diagnosis of colorectal cancer (CRC) in the emergency department (ED), its characteristics, and its effect on outcomes have been poorly described. MATERIALS AND METHODS Chart review was conducted to identify presenting clinical setting leading to diagnosis, symptoms, and history of colonoscopy for patients diagnosed with CRC at a single institution from 2012-2014. Patients diagnosed with CRC as a result of an ED visit (EDDx) were compared with those diagnosed after presentation to other settings (non-EDDx). RESULTS Of 638 patients meeting inclusion criteria, 271 (42.4%) were EDDx patients. These patients were more likely to be older than 80 y (29.89% versus 19.35%), have Medicare (59.78% versus 42.78%) or Medicaid (23.62% versus 12.81%) insurance, have stage IV cancer (45.02% versus 18.26%), and were symptomatic at the time of presentation (94.83% versus 64.03%). EDDx patients were less likely to ever have had a colonoscopy (21.77% versus 41.69%). In a model adjusted for patient demographics, cancer stage, presence of symptoms, and history of prior colonoscopy, EDDx was associated with increased mortality (hazard ratio, 1.89; 95% confidence interval, 1.3-2.8). On stratifying survival by stage, it was found that for all stages, EDDx was associated with decreased survival. CONCLUSIONS More than 40% of patients with CRC received their diagnosis through the ED. EDDx was associated with a nearly twofold mortality risk increase. EDDx should be considered a marker of poor outcomes for CRC and may be related to unaccounted patient-level or systems-level factors. Efforts should be made to identify modifiable risks of cancer diagnosis in the ED to improve cancer outcomes.
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Affiliation(s)
- David Weithorn
- Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Vanessa Arientyl
- Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ian Solsky
- Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Goyal Umadat
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Rebecca Levine
- Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Bruce Rapkin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Jason Leider
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Haejin In
- Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.
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Poulton TE, Moonesinghe R, Raine R, Martin P, Anderson ID, Bassett MG, Cromwell DA, Davies E, Eugene N, Grocott MP, Johnston C, Kuryba A, Lockwood S, Lourtie J, Murray D, Oliver C, Peden C, Salih T, Walker K. Socioeconomic deprivation and mortality after emergency laparotomy: an observational epidemiological study. Br J Anaesth 2020; 124:73-83. [DOI: 10.1016/j.bja.2019.08.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/05/2019] [Accepted: 08/22/2019] [Indexed: 11/28/2022] Open
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Donnelly C, Hart N, McCrorie AD, Donnelly M, Anderson L, Ranaghan L, Gavin A. Predictors of an early death in patients diagnosed with colon cancer: a retrospective case-control study in the UK. BMJ Open 2019; 9:e026057. [PMID: 31221871 PMCID: PMC6588982 DOI: 10.1136/bmjopen-2018-026057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 03/20/2019] [Accepted: 05/02/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Despite considerable improvements, 5-year survival rates for colon cancer in the UK remain poor when compared with other socioeconomically similar countries. Variation in 5-year survival can be partly explained by higher rates of death within 3 months of diagnosis in the UK. This study investigated the characteristics of patients who died within 3 months of a diagnosis of colon cancer with the aim of identifying specific patient factors that can be addressed or accounted for to improve survival outcomes. DESIGN A retrospective case-control study design was applied with matching on age, sex and year diagnosed. Patient, disease, clinical and service characteristics of patients diagnosed with colon cancer in a UK region (2005-2010) who survived less than 3 months from diagnosis (cases) were compared with patients who survived between 6 and 36 months (controls). Patient and clinical data were sourced from general practice notes and hospital databases 1-3 years prediagnosis. RESULTS Being older (aged ≥78 years) and living in deprivation quintile 5 (OR=2.64, 95% CI 1.15 to 6.06), being unmarried and living alone (OR=1.64, 95% CI 1.07 to 2.50), being underweight compared with normal weight or obese (OR=3.99, 95% CI 1.14 to 14.0), and being older and living in a rural as opposed to urban area (OR=1.96, 95% CI 1.21 to 3.17) were all independent predictors of early death from colon cancer. Missing information was also associated with early death, including unknown stage, histological type and marital/accommodation status after accounting for other factors. CONCLUSION Several factors typically associated with social isolation were a recurring theme in patients who died early from colon cancer. This association is unexplained by clinical or diagnostic pathway characteristics. Socially isolated patients are a key target group to improve outcomes of the worst surviving patients, but further investigation is required to determine if being isolated itself is actually a cause of early death from colon cancer.
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Affiliation(s)
- Conan Donnelly
- University of Cork, National Cancer Registry Ireland, Cork, Ireland
| | - Nigel Hart
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Alan David McCrorie
- Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, UK
| | - Michael Donnelly
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - Lesley Anderson
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - Lisa Ranaghan
- Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Anna Gavin
- N Ireland Cancer Registry, Queen’s University Belfast, Belfast, UK
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15
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Murage P, Bachmann MO, Crawford SM, McPhail S, Jones A. Geographical access to GPs and modes of cancer diagnosis in England: a cross-sectional study. Fam Pract 2019; 36:284-290. [PMID: 30452584 DOI: 10.1093/fampra/cmy077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Poor geographical access to health services and routes to a cancer diagnosis such as emergency presentations have previously been associated with worse cancer outcomes. However, the extent to which access to GPs determines the route that patients take to obtain a cancer diagnosis is unknown. METHODS We used a linked dataset of cancer registry and hospital records of patients with a cancer diagnosis between 2006 and 2010 across eight different cancer sites. Primary outcomes were defined as 'desirable routes to diagnosis' [screen-detected and 2-week wait (TWW) referrals] and 'less desirable routes' [emergency presentations and death certificate only (DCO)]. All other routes (GP referral, inpatient elective and other outpatient) were specified as the reference category. Geographical access was measured as travel time in minutes from patients to their GP, and multinomial logistic regression was used to estimate relative risk ratios (RRR). RESULTS Longer travel was associated with increased risk of diagnosis via emergency and DCO, but decreased risk of diagnosis via screening and TWW. Patients travelling over 30 minutes had the highest risk of a DCO diagnosis, which was statistically significant for breast, colorectal, lung, prostate, stomach and ovarian cancers (compared with patients with travel times ≤10 minutes: RRR 5.89, 7.02, 2.30, 4.75, 10.41; P < 0.01 and 3.51, P < 0.05). DISCUSSION Poor access to GPs may discourage early engagement with health services, decreasing the likelihood of screening uptake and increasing the likelihood of emergency presentations. Extra effort is needed to promote early diagnosis in more distant patients.
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Affiliation(s)
- Peninah Murage
- Norwich Medical School, Department of Public Health and Primary Care, University of East Anglia, Norwich, UK
| | - Max O Bachmann
- Norwich Medical School, Department of Public Health and Primary Care, University of East Anglia, Norwich, UK
| | | | - Sean McPhail
- National Cancer Registration and Analysis Services, Public Health England, Bristol, UK
| | - Andy Jones
- Norwich Medical School, Department of Public Health and Primary Care, University of East Anglia, Norwich, UK
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16
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Belot A, Fowler H, Njagi EN, Luque-Fernandez MA, Maringe C, Magadi W, Exarchakou A, Quaresma M, Turculet A, Peake MD, Navani N, Rachet B. Association between age, deprivation and specific comorbid conditions and the receipt of major surgery in patients with non-small cell lung cancer in England: A population-based study. Thorax 2019; 74:51-59. [PMID: 30100577 DOI: 10.1136/thoraxjnl-2017-211395] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 06/05/2018] [Accepted: 07/16/2018] [Indexed: 11/04/2022]
Abstract
INTRODUCTION We investigated socioeconomic disparities and the role of the main prognostic factors in receiving major surgical treatment in patients with lung cancer in England. METHODS Our study comprised 31 351 patients diagnosed with non-small cell lung cancer in England in 2012. Data from the national population-based cancer registry were linked to Hospital Episode Statistics and National Lung Cancer Audit data to obtain information on stage, performance status and comorbidities, and to identify patients receiving major surgical treatment. To describe the association between prognostic factors and surgery, we performed two different analyses: one using multivariable logistic regression and one estimating cause-specific hazards for death and surgery. In both analyses, we used multiple imputation to deal with missing data. RESULTS We showed strong evidence that the comorbidities 'congestive heart failure', 'cerebrovascular disease' and 'chronic obstructive pulmonary disease' reduced the receipt of surgery in early stage patients. We also observed gender differences and substantial age differences in the receipt of surgery. Despite accounting for sex, age at diagnosis, comorbidities, stage at diagnosis, performance status and indication of having had a PET-CT scan, the socioeconomic differences persisted in both analyses: more deprived people had lower odds and lower rates of receiving surgery in early stage lung cancer. DISCUSSION Comorbidities play an important role in whether patients undergo surgery, but do not completely explain the socioeconomic difference observed in early stage patients. Future work investigating access to and distance from specialist hospitals, as well as patient perceptions and patient choice in receiving surgery, could help disentangle these persistent socioeconomic inequalities.
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Affiliation(s)
- Aurélien Belot
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Fowler
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Edmund Njeru Njagi
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Miguel-Angel Luque-Fernandez
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Camille Maringe
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Winnie Magadi
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Aimilia Exarchakou
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Manuela Quaresma
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Adrian Turculet
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael D Peake
- Department of Respiratory Medicine, University Hospitals of Leicester, Leicester, UK
- National Cancer Registration and Analysis Service, Public Health England, London, UK
- Centre for Cancer Outcomes, University College London Hospitals, London, UK
| | - Neal Navani
- UCL Respiratory, University College London, London, UK
- Department of Thoracic Medicine, University College London Hospital, London, UK
| | - Bernard Rachet
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Rich A, Baldwin D, Alfageme I, Beckett P, Berghmans T, Brincat S, Burghuber O, Corlateanu A, Cufer T, Damhuis R, Danila E, Domagala-Kulawik J, Elia S, Gaga M, Goksel T, Grigoriu B, Hillerdal G, Huber RM, Jakobsen E, Jonsson S, Jovanovic D, Kavcova E, Konsoulova A, Laisaar T, Makitaro R, Mehic B, Milroy R, Moldvay J, Morgan R, Nanushi M, Paesmans M, Putora PM, Samarzija M, Scherpereel A, Schlesser M, Sculier JP, Skrickova J, Sotto-Mayor R, Strand TE, Van Schil P, Blum TG. Achieving Thoracic Oncology data collection in Europe: a precursor study in 35 Countries. BMC Cancer 2018; 18:1144. [PMID: 30458807 PMCID: PMC6247748 DOI: 10.1186/s12885-018-5009-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 10/29/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND A minority of European countries have participated in international comparisons with high level data on lung cancer. However, the nature and extent of data collection across the continent is simply unknown, and without accurate data collection it is not possible to compare practice and set benchmarks to which lung cancer services can aspire. METHODS Using an established network of lung cancer specialists in 37 European countries, a survey was distributed in December 2014. The results relate to current practice in each country at the time, early 2015. The results were compiled and then verified with co-authors over the following months. RESULTS Thirty-five completed surveys were received which describe a range of current practice for lung cancer data collection. Thirty countries have data collection at the national level, but this is not so in Albania, Bosnia-Herzegovina, Italy, Spain and Switzerland. Data collection varied from paper records with no survival analysis, to well-established electronic databases with links to census data and survival analyses. CONCLUSION Using a network of committed clinicians, we have gathered validated comparative data reporting an observed difference in data collection mechanisms across Europe. We have identified the need to develop a well-designed dataset, whilst acknowledging what is feasible within each country, and aspiring to collect high quality data for clinical research.
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Affiliation(s)
- Anna Rich
- Department of Respiratory Medicine, Nottingham University Hospitals, City campus, Hucknall Road, Nottingham, NG5 1PB UK
| | - David Baldwin
- Department of Respiratory Medicine, Nottingham University Hospitals, City campus, Hucknall Road, Nottingham, NG5 1PB UK
| | | | - Paul Beckett
- Department of Respiratory Medicine, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | - Thierry Berghmans
- Intensive Care and Thoracic Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Stephen Brincat
- Sir Anthony Mamo oncology centre, Mater Dei hospital, Msida, Malta
| | - Otto Burghuber
- Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
| | - Alexandru Corlateanu
- Department of Respiratory Medicine, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Moldova
| | - Tanja Cufer
- University Clinic Golnik, Medical Faculty Ljubljana, Golnik, Slovenia
| | - Ronald Damhuis
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Edvardas Danila
- Clinic of Infectious and Chest Diseases, Dermatovenereology and Allergology, Vilnius University, Vilnius, Lithuania
- Centre of Pulmonology and Allergology, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania
| | | | - Stefano Elia
- Department of Thoracic Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Mina Gaga
- 7th Respiratory Medicine Department, Athens Chest Hospital, 152 Mesogion Ave Athens, 11527 Athens, Greece
| | - Tuncay Goksel
- Department of Pulmonary Medicine, School of Medicine, Ege University, Izmir, Turkey
| | - Bogdan Grigoriu
- Regional Institute of Oncology, University of Medicine and Pharmacy, Iasi, Romania
| | - Gunnar Hillerdal
- Department of Respiratory Diseases, Karolinska Hospital, Stockholm, Sweden
| | - Rudolf Maria Huber
- Division of Respiratory Medicine and Thoracic Oncology, University of Munich and Thoracic Oncology Centre, Munich, Germany
| | - Erik Jakobsen
- Department of Thoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Steinn Jonsson
- Department of Medicine, Landspitali, University of Iceland, Reykjavik, Iceland
| | - Dragana Jovanovic
- University Hospital of Pulmonology, Clinical Center of Serbia, Belgrade, Serbia
| | - Elena Kavcova
- Clinic of Pneumology and Phthisiology, Comenius University Bratislava, Jessenius Faculty of Medicine Martin, University Hospital, Martin, Slovak Republic
| | - Assia Konsoulova
- Medical Oncology Department, University Hospital Sveta Marina, Varna, Bulgaria
| | - Tanel Laisaar
- Department of Thoracic Surgery, Tartu University Hospital, Tartu, Estonia
| | - Riitta Makitaro
- Department of Internal Medicine, Respiratory Research Unit, Medical Research Center Oulu, Oulu, Finland
- University Hospital and University of Oulu, POB 20, 90029 Oulu, Finland
| | - Bakir Mehic
- Clinic of Lung Diseases and TB, Sarajevo University Clinical Centre, Sarajevo, Bosnia and Herzegovina
| | - Robert Milroy
- Consultant Respiratory Physician & Chair, Scottish Lung Cancer Forum, Glasgow Royal Infirmary, Glasgow, Scotland
| | - Judit Moldvay
- Department of Tumor Biology, National Koranyi Institute, Semmelweis University, Budapest, Hungary
| | - Ross Morgan
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, 9 Ireland
| | - Milda Nanushi
- University of Tirana, Service of Pulmonology, Tirana, Albania
| | - Marianne Paesmans
- Data Centre, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Paul Martin Putora
- Department of Radiation Oncology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland
| | - Miroslav Samarzija
- Department of Respiratory medicine, Klinički bolnički centar Zagreb, Zagreb, Croatia
| | - Arnaud Scherpereel
- Pulmonary and Thoracic Oncology, Univ. Lille, Inserm, CHU Lille, U1019 – CIIL, F-59000 Lille, France
| | - Marc Schlesser
- Respiratory Medicine Department, Centre Hospitalier Luxembourg, Luxembourg City, Luxembourg
| | - Jean-Paul Sculier
- Intensive Care and Thoracic Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Jana Skrickova
- Department Pulmonary Disease and TB, Masaryk University Faculty of Medicine & University Hospital, Brno, Czech Republic
| | - Renato Sotto-Mayor
- Pulmonology Service, Thoracic Department, North Lisbon Hospital Centre, Lisbon, Portugal
| | | | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Antwerp Belgium
| | - Torsten-Gerriet Blum
- Klinik für Pneumologie, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
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McCormick B, Hill PS, Redding S. Comparative morbidities and the share of emergencies in hospital admissions in deprived areas: a method and evidence from English administrative data. BMJ Open 2018; 8:e022573. [PMID: 30127052 PMCID: PMC6104760 DOI: 10.1136/bmjopen-2018-022573] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Various studies find that the share of emergencies in hospital admissions is higher in deprived areas, but both the explanation and policy implications are unclear. We estimate the extent to which this finding is due to a different disease mix in deprived areas, rather than other explanations such as patient behaviour and general practitioner effectiveness. DESIGN Secondary analysis using English Hospital Episode Statistics data, with disease for elective and emergency admissions in 2008/2009 coded at 186 blocks or 1230 categories and aggregated to lower layer super output area of residence. It is then linked to an appropriate measure of deprivation. OUTCOME MEASURES The difference in the share of emergencies in hospital admissions between communities in the highest and lowest deciles of deprivation; and the percentage of this difference that is explained if areas in the least deprived decile have the same disease mix as those in the most deprived decile. RESULTS Using the finest disease classification scheme (1230 categories), 71% of the higher share of admissions that were emergencies in decile 1 areas relative to decile 10, is explained by the "adverse" case mix (CM) in deprived areas. The remainder reflects the higher relative use of emergency care in deprived areas for the same conditions. Higher incidence of respiratory and circulatory diseases in deprived areas explains about 30% of the CM contribution. Diseases of the digestive system and abdomen have a high relative use of emergency care in deprived areas. CONCLUSIONS The higher use of emergency care in deprived areas is primarily a symptom of the higher prevalence of diseases which have high national rates of emergency to elective care-especially respiratory diseases-rather than an indication of less effective primary care. Nevertheless, there is a higher share of emergency care in admissions in deprived areas for several diseases, most notably of the digestive system.
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Affiliation(s)
- Barry McCormick
- Centre for Health Service Economics & Organisation, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Peter-Sam Hill
- Education Portfolio, Oxford Policy Management, Oxford, UK
| | - Stuart Redding
- Centre for Health Service Economics & Organisation, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Maringe C, Rachet B, Lyratzopoulos G, Rubio FJ. Persistent inequalities in unplanned hospitalisation among colon cancer patients across critical phases of their care pathway, England, 2011-13. Br J Cancer 2018; 119:551-557. [PMID: 30108292 PMCID: PMC6162238 DOI: 10.1038/s41416-018-0170-2] [Citation(s) in RCA: 6] [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: 02/26/2018] [Revised: 06/05/2018] [Accepted: 06/13/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Reducing hospital emergency admissions is a key target for all modern health systems. METHODS We analysed colon cancer patients diagnosed in 2011-13 in England. We screened their individual Hospital Episode Statistics records in the 90 days pre-diagnosis, the 90 days post-diagnosis, and the 90 days pre-death (in the year following diagnosis), for the occurrence of hospital emergency admissions (HEAs). RESULTS Between a quarter and two thirds of patients experience HEA in the three 90-day periods examined: pre-diagnosis, post-diagnosis and before death. Patients with tumour stage I-III from more deprived backgrounds had higher proportions of HEAs than less deprived patients during all studied periods. This remains even after adjusting for differing distributions of risk factors such as age, sex, comorbidity and stage at diagnosis. CONCLUSIONS Although in some cases HEAs might be unavoidable or even appropriate, the proportion of HEAs varies by socioeconomic status, even after controlling for the usual patient factors, suggestive of remediable causes of excess emergency healthcare utilisation in patients belonging to higher deprivation groups. Future inquiries should address the potential role of clinical complications, sub-optimal healthcare administration, premature discharge or a lack of social support as potential explanations for these patterns of inequality.
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Affiliation(s)
- Camille Maringe
- Cancer Survival Group, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Bernard Rachet
- Cancer Survival Group, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, London, WC1E 7HB, UK
| | - Francisco Javier Rubio
- Cancer Survival Group, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
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20
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Maringe C, Pashayan N, Rubio FJ, Ploubidis G, Duffy SW, Rachet B, Raine R. Trends in lung cancer emergency presentation in England, 2006-2013: is there a pattern by general practice? BMC Cancer 2018; 18:615. [PMID: 29855264 PMCID: PMC5984417 DOI: 10.1186/s12885-018-4476-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 05/02/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Emergency presentations (EP) represent over a third of all lung cancer admissions in England. Such presentations usually reflect late stage disease and are associated with poor survival. General practitioners (GPs) act as gate-keepers to secondary care and so we sought to understand the association between GP practice characteristics and lung cancer EP. METHODS Data on general practice characteristics were extracted for all practices in England from the Quality Outcomes Framework, the Health and Social Care Information Centre, the GP Patient Survey, the Cancer Commissioning Toolkit and the area deprivation score for each practice. After linking these data to lung cancer patient registrations in 2006-2013, we explored trends in three types of EP, patient-led, GP-led and 'other', by general practice characteristics and by socio-demographic characteristics of patients. RESULTS Overall proportions of lung cancer EP decreased from 37.9% in 2006 to 34.3% in 2013. Proportions of GP-led EP nearly halved during this period, from 28.3 to 16.3%, whilst patient-led emergency presentations rose from 62.1 to 66.7%. When focusing on practice-specific levels of EP, 14% of general practices had higher than expected proportions of EP at least once in 2006-13, but there was no evidence of clustering of patients within practice, meaning that none of the practice characteristics examined explained differing proportions of EP by practice. CONCLUSION We found that the high proportion of lung cancer EP is not the result of a few practices with very abnormal patterns of EP, but of a large number of practices susceptible to reaching high proportions of EP. This suggests a system-wide issue, rather than problems with specific practices. High proportions of lung cancer EP are mainly the result of patient-initiated attendances in A&E. Our results demonstrate that interventions to encourage patients not to bypass primary care must be system wide rather than targeted at specific practices.
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Affiliation(s)
- Camille Maringe
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel street, London, WC1E 7HT UK
| | - Nora Pashayan
- University College London, Department of Applied Health Research, London, UK
| | - Francisco Javier Rubio
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel street, London, WC1E 7HT UK
| | - George Ploubidis
- Centre for Longitudinal Studies, Department of Social Science, UCL - Institute of Education, University College London, London, UK
| | - Stephen W. Duffy
- Queen Mary University of London, Wolfson Institute of Preventive Medicine, Centre for Cancer Prevention, London, UK
| | - Bernard Rachet
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel street, London, WC1E 7HT UK
| | - Rosalind Raine
- University College London, Department of Applied Health Research, London, UK
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21
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Walsh B, Laudicella M. Disparities In Cancer Care And Costs At The End Of Life: Evidence From England's National Health Service. Health Aff (Millwood) 2018; 36:1218-1226. [PMID: 28679808 DOI: 10.1377/hlthaff.2017.0167] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In universal health care systems such as the English National Health Service, equality of access is a core principle, and health care is free at the point of delivery. However, even within a universal system, disparities in care and costs exist along a socioeconomic gradient. Little is known about socioeconomic disparities at the end of life and how they affect health care costs. This study examines disparities in end-of-life treatment costs for cancer patients in England. Analyzing data on over 250,000 colorectal, breast, prostate, and lung cancer patients from multiple national databases, we found evidence illustrating that disparities are driven largely by the greater use of emergency inpatient care among patients of lower socioeconomic status. Even within a system with free health care, differences in the use of care create disparities in cancer costs. While further studies of these barriers is required, our research suggests that disparities may be reduced through better management of needs through the use of less expensive and more effective health care settings and treatments.
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Affiliation(s)
- Brendan Walsh
- Brendan Walsh is a research officer at the Economic and Social Research Institute in Dublin, Ireland, and a research affiliate in the School of Health Sciences, City University of London, in England
| | - Mauro Laudicella
- Mauro Laudicella is a senior lecturer at City University of London
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22
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Henson KE, Fry A, Lyratzopoulos G, Peake M, Roberts KJ, McPhail S. Sociodemographic variation in the use of chemotherapy and radiotherapy in patients with stage IV lung, oesophageal, stomach and pancreatic cancer: evidence from population-based data in England during 2013-2014. Br J Cancer 2018; 118:1382-1390. [PMID: 29743552 PMCID: PMC5959922 DOI: 10.1038/s41416-018-0028-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 01/17/2018] [Accepted: 01/24/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Sociodemographic inequalities in cancer treatment have been generally described, but there is little evidence regarding patients with advanced cancer. Understanding variation in the management of these patients may provide insights into likely mechanisms leading to inequalities in survival. METHODS We identified 50,232 patients with stage IV lung, oesophageal, pancreatic and stomach cancer from the English national cancer registry. A generalised linear model with a Poisson error structure was used to explore variation in radiotherapy and chemotherapy within 6 months from diagnosis by age, sex, deprivation, ethnicity, cancer site, comorbidity and, additionally, performance status. RESULTS There was substantial variation by cancer site, large gradients by age, and non-trivial associations with comorbidity and deprivation. After full adjustment, more deprived patients were consistently least likely to be treated with chemotherapy alone or chemotherapy and radiotherapy combined compared with less deprived patients with equally advanced disease stage (treatment rate ratio: 0.82 95% CI (0.78, 0.87) for CT, 0.78 95% CI (0.71, 0.85) for CTRT p < 0.0001). CONCLUSIONS There was marked variation in the management of patients with stage IV cancer. Routinely collected data could be used for surveillance across all cancers to help reduce treatment variation and optimise outcomes among patients with advanced cancer.
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Affiliation(s)
- Katherine E Henson
- National Cancer Registration and Analysis Service, Public Health England, Skipton House, London, SE1 6LH, UK.
| | - Anna Fry
- National Cancer Registration and Analysis Service, Public Health England, Skipton House, London, SE1 6LH, UK
- Cancer Research UK, Angel Building, London, EC1V 4AD, UK
| | - Georgios Lyratzopoulos
- National Cancer Registration and Analysis Service, Public Health England, Skipton House, London, SE1 6LH, UK
- ECHO (Epidemiology of Cancer Healthcare and Outcomes) Group, Department of Behavioural Science and Health, University College London, Gower Street, Bloomsbury, London, WC1E 6BT, UK
| | - Michael Peake
- National Cancer Registration and Analysis Service, Public Health England, Skipton House, London, SE1 6LH, UK
- University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
- Centre for Cancer Outcomes, University College London Hospitals (UCLH) Cancer Collaborative, UCLH Cancer Division, 47 Wimpole Street, London, W1G 8SE, UK
| | - Keith J Roberts
- Nuffield House, University Hospitals Birmingham, Edgbaston, Birmingham, B15 2TH, UK
| | - Sean McPhail
- National Cancer Registration and Analysis Service, Public Health England, Skipton House, London, SE1 6LH, UK
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23
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Macdonald S, Cunningham Y, Patterson C, Robb K, Macleod U, Anker T, Hilton S. Mass media and risk factors for cancer: the under-representation of age. BMC Public Health 2018; 18:490. [PMID: 29695238 PMCID: PMC5918870 DOI: 10.1186/s12889-018-5341-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 03/20/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Increasing age is a risk factor for developing cancer. Yet, older people commonly underestimate this risk, are less likely to be aware of the early symptoms, and are more likely to be diagnosed with advanced stage cancer. Mass media are a key influence on the public's understanding health issues, including cancer risk. This study investigates how news media have represented age and other risk factors in the most common cancers over time. METHODS Eight hundred articles about the four most common cancers (breast, prostate, lung and colorectal) published within eight UK national newspapers in 2003, 2004, 2013 and 2014 were identified using the Nexis database. Relevant manifest content of articles was coded quantitatively and subjected to descriptive statistical analysis in SPSS to identify patterns across the data. RESULTS Risk was presented in half of the articles but this was rarely discussed in any depth and around a quarter of all articles introduced more than one risk factor, irrespective of cancer site. Age was mentioned as a risk factor in approximately 12% of all articles and this varied by cancer site. Age was most frequently reported in relation to prostate cancer and least often in articles about lung cancer. Articles featuring personal narratives more frequently focused on younger people and this was more pronounced in non-celebrity stories; only 15% of non-celebrity narratives were about people over 60. Other common risks discussed were family history and genetics, smoking, diet, alcohol, and environmental factors. Family history and genetics together featured as the most common risk factors. Risk factor reporting varied by site and family history was most commonly associated with breast cancer, diet with bowel cancer and smoking with lung cancer. CONCLUSION Age and older adults were largely obscured in media representation of cancer and cancer experience. Indeed common risk factors in general were rarely discussed in any depth. Our findings will usefully inform the development of future cancer awareness campaigns and media guidelines. It is important that older adults appreciate their heightened risk, particularly in the context of help-seeking decisions.
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Affiliation(s)
- Sara Macdonald
- Institute of Health & Wellbeing, General Practice and Primary Care, 1 Horselethill Rd, Glasgow, G12 9LX Scotland
| | - Yvonne Cunningham
- Institute of Health & Wellbeing, General Practice and Primary Care, 1 Horselethill Rd, Glasgow, G12 9LX Scotland
| | - Chris Patterson
- Institute of Health & Wellbeing, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB Scotland
| | - Katie Robb
- Institute of Health & WellbeingMental Health & Wellbeing, Gartnavel Royal Hospital, Administration Building, 1st floor, 1055 Great Western Road, Glasgow, G12 0XH Scotland
| | - Una Macleod
- Hull York Medical School, Allam Medical Building, Univrsity of Hull, Hull, HU6 7RX UK
| | - Thomas Anker
- Adam Smith Business School, Gilbert Scott Building, University of Glasgow, Glasgow, G12 8QQ Scotland
| | - Shona Hilton
- Institute of Health & Wellbeing, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB Scotland
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24
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Geraghty J, Shawihdi M, Devonport E, Sarkar S, Pearson MG, Bodger K. Reduced risk of emergency admission for colorectal cancer associated with the introduction of bowel cancer screening across England: a retrospective national cohort study. Colorectal Dis 2018; 20:94-104. [PMID: 28736972 DOI: 10.1111/codi.13822] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 06/13/2017] [Indexed: 02/08/2023]
Abstract
AIM We wanted to find out if roll-out of the bowel cancer screening programme (BCSP) across England was associated with a reduced risk of emergency hospital admission for people presenting with colorectal cancer (CRC) during this period. METHOD This is a retrospective cohort study of 27 763 incident cases of CRC over a 1-year period during the roll-out of screening across parts of England. The primary outcome was the number of emergency (unplanned) hospital admissions during the diagnostic pathway. The primary exposure was to those living in an area where the BCSP was active at the time of diagnosis. Patients were categorized into three exposure groups: BCSP not active (reference group), BCSP active < 6 months or BCSP active ≥ 6 months. RESULTS The risk of emergency admission for CRC in England was associated with increasing age, female gender, comorbidity and social deprivation. After adjusting for these factors in logistic regression, the odds ratio (OR) for emergency admission in patients diagnosed ≥ 6 months after the start-up of local screening was 0.83 (CI 0.76-0.90). The magnitude of risk reduction was greatest for cases of screening age (OR 0.75; CI 0.63-0.90) but this effect was apparent also for cases outside the 60-69-year age group (OR 0.85; CI 0.77-0.94). Living in an area with active BCSP conferred no reduction in risk of emergency admission for people diagnosed with oesophagogastric cancer during the same period. CONCLUSION The start-up of bowel cancer screening in England was associated with a substantial reduction in the risk of emergency admission for CRC in people of all ages. This suggests that the roll-out of the programme had indirect benefits beyond those related directly to participation in screening.
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Affiliation(s)
- J Geraghty
- Department of Gastroenterology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - M Shawihdi
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - E Devonport
- Aintree Health Outcomes Partnership, Aintree University Hospital, Liverpool, UK
| | - S Sarkar
- Gastroenterology Department, Royal Liverpool Hospital, Liverpool, UK
| | - M G Pearson
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - K Bodger
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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25
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Lopez-de-Andres A, Jimenez-Trujillo I, Hernandez-Barrera V, de Miguel-Diez J, Mendez-Bailon M, de Miguel-Yanes JM, Perez-Farinos N, Salinero-fort MA, del Barrio JL, Romero-Maroto M, Jimenez-Garcia R. Association of type 2 diabetes with in-hospital complications among women undergoing breast cancer surgical procedures. A retrospective study using the Spanish National Hospital Discharge Database, 2013-2014. BMJ Open 2017; 7:e017676. [PMID: 29122795 PMCID: PMC5695447 DOI: 10.1136/bmjopen-2017-017676] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To compare the type of surgical procedures used, comorbidities, in-hospital complications (IHC) and in-hospital outcomes between women with type 2 diabetes mellitus (T2DM) and age-matched women without diabetes who were hospitalised with breast cancer. In addition, we sought to identify factors associated with IHC in women with T2DM who had undergone surgical procedures for breast cancer. DESIGN Retrospective study using the National Hospital Discharge Database, 2013-2014. SETTING Spain. PARTICIPANTS Women who were aged ≥40 years with a primary diagnosis of breast cancer and who had undergone a surgical procedure. We grouped admissions by T2DM status. We selected one matched control for each T2DM case. MAIN OUTCOME MEASURES The type of procedure (breast-conserving surgery (BCS) or mastectomy), clinical characteristics, complications, length of hospital stay and in-hospital mortality. RESULTS We identified 41 458 admissions (9.23% with T2DM). Overall, and in addition to the surgical procedure, we found that comorbidity, hypertension and obesity were more common among patients with T2DM. We also detected a higher incidence of mastectomy in women with T2DM (44.69% vs 42.42%) and a greater rate of BCS in patients without T2DM (57.58% vs 55.31%). Overall, non-infectious complications were more common among women with T2DM (6.40% vs 4.56%). Among women who had undergone BCS or a mastectomy, IHC were more frequent among diabetics (5.57% vs 3.04% and 10.60% vs 8.24%, respectively). Comorbidity was significantly associated with a higher risk of IHC in women with diabetes, independent of the specific procedure used.province CONCLUSIONS: Women with T2DM who undergo surgical breast cancer procedures have more comorbidity, risk factors and advanced cancer presentations than matched patients without T2DM. Mastectomies are more common in women with T2DM. Moreover, the procedures among women with T2DM were associated with greater IHC. Comorbidity was a strong predictor of IHC in women with T2DM.
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Affiliation(s)
- Ana Lopez-de-Andres
- Department of Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology, Nursing and Oral Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Isabel Jimenez-Trujillo
- Department of Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology, Nursing and Oral Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Valentin Hernandez-Barrera
- Department of Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology, Nursing and Oral Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Javier de Miguel-Diez
- Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel Mendez-Bailon
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jose M de Miguel-Yanes
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Jose L del Barrio
- Department of Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology, Nursing and Oral Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Martin Romero-Maroto
- Department of Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology, Nursing and Oral Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Rodrigo Jimenez-Garcia
- Department of Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology, Nursing and Oral Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
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26
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Solsky I, Rapkin B, Wong K, Friedmann P, Muscarella P, In H. Gastric cancer diagnosis after presentation to the ED: The independent association of presenting location and outcomes. Am J Surg 2017; 216:286-292. [PMID: 29108643 DOI: 10.1016/j.amjsurg.2017.10.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 10/04/2017] [Accepted: 10/10/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The impact of diagnosis location on gastric cancer (GC) outcomes is poorly defined. METHODS Detailed chart review was conducted to identify presenting location leading to diagnosis and treatment for GC patients at a single institution (2009-2013). Patients treated non-emergently following a diagnosis prompted by an ED visit (EDdx) were compared with those diagnosed at other locations (non-EDdx). RESULTS EDdx patients comprised 52% of 263 GC patients. They were older, had later cancer stages (stage IV: 50% vs. 24%), more comorbidities (≥3: 68% vs. 47%), and presented with non-specific symptoms like bleeding (21% vs. 5%). Both groups were of similar race and insurance status. In a model adjusted for stage, EDdx was associated with increased mortality (aHR 1.9; 95% CI: 1.2-2.9). CONCLUSION Half of GC patients had an ED visit prompting diagnosis, which is independently associated with increased mortality. Efforts should focus on reducing EDdx rates to improve GC outcomes.
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Affiliation(s)
- Ian Solsky
- Montefiore Medical Center/Albert Einstein College of Medicine, Department of Surgery, Bronx, NY, USA
| | - Bruce Rapkin
- Montefiore Medical Center/Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY, USA
| | - Kristen Wong
- Montefiore Medical Center/Albert Einstein College of Medicine, Department of Surgery, Bronx, NY, USA
| | - Patricia Friedmann
- Montefiore Medical Center/Albert Einstein College of Medicine, Department of Surgery, Bronx, NY, USA
| | - Peter Muscarella
- Montefiore Medical Center/Albert Einstein College of Medicine, Department of Surgery, Bronx, NY, USA
| | - Haejin In
- Montefiore Medical Center/Albert Einstein College of Medicine, Department of Surgery, Bronx, NY, USA.
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27
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Newsom-Davis T. The route to diagnosis: emergency presentation of lung cancer. Lung Cancer Manag 2017; 6:67-73. [PMID: 30643572 DOI: 10.2217/lmt-2017-0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 07/03/2017] [Indexed: 11/21/2022] Open
Abstract
A significant proportion of lung cancer patients are first diagnosed as part of an emergency presentation (EP) to acute medical services. This route to diagnosis is a strong negative predictor of survival, and is associated with age, deprivation and medical co-morbidities. Patients are less likely to receive anticancer treatment than those diagnosed through elective routes. The causes of EP of cancer are complex. When it is unavoidable, prompt input from specialist lung cancer services is needed. Preventing EP of lung cancer involves streamlined diagnostic pathways, public health campaigns about symptoms, decision-support tools for general practitioners, improved communication and access for primary and secondary care, and focus on vague symptoms. Reducing EP of lung cancer is important when improving outcomes and patient experience.
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Affiliation(s)
- Thomas Newsom-Davis
- Department of Oncology, Chelsea & Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
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28
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Sheringham J, Sequeira R, Myles J, Hamilton W, McDonnell J, Offman J, Duffy S, Raine R. Variations in GPs' decisions to investigate suspected lung cancer: a factorial experiment using multimedia vignettes. BMJ Qual Saf 2017; 26:449-459. [PMID: 27651515 DOI: 10.1136/bmjqs-2016-005679] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/24/2016] [Accepted: 08/18/2016] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Lung cancer survival is low and comparatively poor in the UK. Patients with symptoms suggestive of lung cancer commonly consult primary care, but it is unclear how general practitioners (GPs) distinguish which patients require further investigation. This study examined how patients' clinical and sociodemographic characteristics influence GPs' decisions to initiate lung cancer investigations. METHODS A factorial experiment was conducted among a national sample of 227 English GPs using vignettes presented as simulated consultations. A multimedia-interactive website simulated key features of consultations using actors ('patients'). GP participants made management decisions online for six 'patients', whose sociodemographic characteristics systematically varied across three levels of cancer risk. In low-risk vignettes, investigation (ie, chest X-ray ordered, computerised tomography scan or respiratory consultant referral) was not indicated; in medium-risk vignettes, investigation could be appropriate; in high-risk vignettes, investigation was definitely indicated. Each 'patient' had two lung cancer-related symptoms: one volunteered and another elicited if GPs asked. Variations in investigation likelihood were examined using multilevel logistic regression. RESULTS GPs decided to investigate lung cancer in 74% (1000/1348) of vignettes. Investigation likelihood did not increase with cancer risk. Investigations were more likely when GPs requested information on symptoms that 'patients' had but did not volunteer (adjusted OR (AOR)=3.18; 95% CI 2.27 to 4.70). However, GPs omitted to seek this information in 42% (570/1348) of cases. GPs were less likely to investigate older than younger 'patients' (AOR=0.52; 95% CI 0.39 to 0.7) and black 'patients' than white (AOR=0.68; 95% CI 0.48 to 0.95). CONCLUSIONS GPs were not more likely to investigate 'patients' with high-risk than low-risk cancer symptoms. Furthermore, they did not investigate everyone with the same symptoms equally. Insufficient data gathering could be responsible for missed opportunities in diagnosis.
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Affiliation(s)
| | | | - Jonathan Myles
- Queen Mary University of London, Centre for Cancer Prevention, London, UK
| | - William Hamilton
- University of Exeter, Peninsula College of Medicine and Dentistry, Exeter, UK
| | - Joe McDonnell
- Department of Public Health, London Borough of Waltham Forest, London, UK
| | - Judith Offman
- Queen Mary University of London, Centre for Cancer Prevention, London, UK
| | - Stephen Duffy
- Queen Mary University of London, Centre for Cancer Prevention, London, UK
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29
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Forrest LF, Sowden S, Rubin G, White M, Adams J. Socio-economic inequalities in stage at diagnosis, and in time intervals on the lung cancer pathway from first symptom to treatment: systematic review and meta-analysis. Thorax 2017; 72:430-436. [PMID: 27682330 PMCID: PMC5390856 DOI: 10.1136/thoraxjnl-2016-209013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/25/2016] [Accepted: 09/01/2016] [Indexed: 12/22/2022]
Abstract
Cancer diagnosis at an early stage increases the chance of curative treatment and of survival. It has been suggested that delays on the pathway from first symptom to diagnosis and treatment may be socio-economically patterned, and contribute to socio-economic differences in receipt of treatment and in cancer survival. This review aimed to assess the published evidence for socio-economic inequalities in stage at diagnosis of lung cancer, and in the length of time spent on the lung cancer pathway. MEDLINE, EMBASE and CINAHL databases were searched to locate cohort studies of adults with a primary diagnosis of lung cancer, where the outcome was stage at diagnosis or the length of time spent within an interval on the care pathway, or a suitable proxy measure, analysed according to a measure of socio-economic position. Meta-analysis was undertaken when there were studies available with suitable data. Of the 461 records screened, 39 papers were included in the review (20 from the UK) and seven in a final meta-analysis for stage at diagnosis. There was no evidence of socio-economic inequalities in late stage at diagnosis in the most, compared with the least, deprived group (OR=1.04, 95% CI=0.92 to 1.19). No socio-economic inequalities in the patient interval or in time from diagnosis to treatment were found. Socio-economic inequalities in stage at diagnosis are thought to be an important explanatory factor for survival inequalities in cancer. However, socio-economic inequalities in stage at diagnosis were not found in a meta-analysis for lung cancer. PROSPERO PROTOCOL REGISTRATION NUMBER CRD42014007145.
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Affiliation(s)
- Lynne F Forrest
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
- Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Sowden
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
- Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, UK
| | - Greg Rubin
- Wolfson Research Institute, Durham University, Queen’s Campus, Stockton on Tees, UK
- Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, UK
| | - Martin White
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge Biomedicine Campus, CB2 0QQ, UK
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge Biomedicine Campus, CB2 0QQ, UK
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Puyade M, Defossez G, Guilhot F, Leleu X, Ingrand P. Age-related health care disparities in multiple myeloma. Hematol Oncol 2017; 36:224-231. [DOI: 10.1002/hon.2422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 02/09/2017] [Accepted: 03/20/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Mathieu Puyade
- INSERM CIC 1402, CHU; Poitiers France
- Registre des Cancers Poitou-Charentes, Faculté de Médecine et Pharmacie; Université de Poitiers; Poitiers France
| | - Gautier Defossez
- INSERM CIC 1402, CHU; Poitiers France
- Registre des Cancers Poitou-Charentes, Faculté de Médecine et Pharmacie; Université de Poitiers; Poitiers France
| | | | - Xavier Leleu
- INSERM CIC 1402, CHU; Poitiers France
- Service d'Onco-Hématologie et Thérapie Cellulaire; CHU de Poitiers; France
| | - Pierre Ingrand
- INSERM CIC 1402, CHU; Poitiers France
- Registre des Cancers Poitou-Charentes, Faculté de Médecine et Pharmacie; Université de Poitiers; Poitiers France
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Liu C, Zhang YH, Huang T, Cai Y. Identification of transcription factors that may reprogram lung adenocarcinoma. Artif Intell Med 2017; 83:52-57. [PMID: 28377053 DOI: 10.1016/j.artmed.2017.03.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/19/2017] [Accepted: 03/22/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Lung adenocarcinoma is one of most threatening disease to human health. Although many efforts have been devoted to its genetic study, few researches have been focused on the transcription factors which regulate tumor initiation and progression by affecting multiple downstream gene transcription. It is proved that proper transcription factors may mediate the direct reprogramming of cancer cells, and reverse the tumorigenesis on the epigenetic and transcription levels. METHODS In this paper, a computational method is proposed to identify the core transcription factors that can regulate as many as possible lung adenocarcinoma associated genes with as little as possible redundancy. A greedy strategy is applied to find the smallest collection of transcription factors that can cover the differentially expressed genes by its downstream targets. The optimal subset which is mostly enriched in the differentially expressed genes is then selected. RESULTS Seven core transcription factors (MCM4, VWF, ECT2, RBMS3, LIMCH1, MYBL2 and FBXL7) are detected, and have been reported to contribute to tumorigenesis of lung adenocarcinoma. The identification of the transcription factors provides a new insight into its oncogenic role in tumor initiation and progression, and benefits the discovery of functional core set that may reverse malignant transformation and reprogram cancer cells.
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Affiliation(s)
- Chenglin Liu
- School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai 200240, People's Republic of China.
| | - Yu-Hang Zhang
- Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, People's Republic of China.
| | - Tao Huang
- Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, People's Republic of China.
| | - Yudong Cai
- School of Life Sciences, Shanghai University, Shanghai 200444, People's Republic of China.
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Raine R, Atkin W, von Wagner C, Duffy S, Kralj-Hans I, Hackshaw A, Counsell N, Moss S, McGregor L, Palmer C, Smith SG, Thomas M, Howe R, Vart G, Band R, Halloran SP, Snowball J, Stubbs N, Handley G, Logan R, Rainbow S, Obichere A, Smith S, Morris S, Solmi F, Wardle J. Testing innovative strategies to reduce the social gradient in the uptake of bowel cancer screening: a programme of four qualitatively enhanced randomised controlled trials. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BackgroundBowel cancer screening reduces cancer-specific mortality. There is a socioeconomic gradient in the uptake of the English NHS Bowel Cancer Screening Programme (BCSP), which may lead to inequalities in cancer outcomes.ObjectiveTo reduce socioeconomic inequalities in uptake of the NHS BCSP’s guaiac faecal occult blood test (gFOBt) without compromising uptake in any socioeconomic group.DesignWorkstream 1 explored psychosocial determinants of non-uptake of gFOBt in focus groups and interviews. Workstream 2 developed and tested four theoretically based interventions: (1) ‘gist’ information, (2) a ‘narrative’ leaflet, (3) ‘general practice endorsement’ (GPE) and (4) an ‘enhanced reminder’ (ER). Workstream 3 comprised four national cluster randomised controlled trials (RCTs) of the cost-effectiveness of each intervention.MethodsInterventions were co-designed with user panels, user tested using interviews and focus groups, and piloted with postal questionnaires. RCTs compared ‘usual care’ (existing NHS BCSP invitations) with usual care plus each intervention. The four trials tested: (1) ‘gist’ leaflet (n = 163,525), (2) ‘narrative’ leaflet (n = 150,417), (3) GPE on the invitation letter (n = 265,434) and (4) ER (n = 168,480). Randomisation was based on day of mailing of the screening invitation. The Index of Multiple Deprivation (IMD) score associated with each individual’s home address was used as the marker of socioeconomic circumstances (SECs). Change in the socioeconomic gradient in uptake (interaction between treatment group and IMD quintile) was the primary outcome. Screening uptake was defined as the return of a gFOBt kit within 18 weeks of the invitation that led to a ‘definitive’ test result of either ‘normal’ (i.e. no further investigation required) or ‘abnormal’ (i.e. requiring referral for further testing). Difference in overall uptake was the secondary outcome.ResultsThe gist and narrative trials showed no effect on the SECs gradient or overall uptake (57.6% and 56.7%, respectively, compared with 57.3% and 58.5%, respectively, for usual care; allp-values > 0.05). GPE showed no effect on the gradient (p = 0.5) but increased overall uptake [58.2% vs. 57.5% in usual care, odds ratio (OR) = 1.07, 95% confidence interval (CI) 1.04 to 1.10;p < 0.0001]. ER showed a significant interaction with SECs (p = 0.005), with a stronger effect in the most deprived IMD quintile (14.1% vs. 13.3% in usual care, OR = 1.11, 95% CI 1.04 to 1.20;p = 0.003) than the least deprived (34.7% vs. 34.9% in usual care OR = 1.00, 95% CI 0.94 to 1.06;p = 0.98), and higher overall uptake (25.8% vs. 25.1% in usual care, OR = 1.07, 95% CI 1.03 to 1.11;p = 0.001). All interventions were inexpensive to provide.LimitationsIn line with NHS policy, the gist and narrative leaflets supplemented rather than replaced existing NHS BCSP information. This may have undermined their effect.ConclusionsEnhanced reminder reduced the gradient and modestly increased overall uptake, whereas GPE increased overall uptake but did not reduce the gradient. Therefore, given their effectiveness and very low cost, the findings suggest that implementation of both by the NHS BCSP would be beneficial. The gist and narrative results highlight the challenge of achieving equitable delivery of the screening offer when all communication is written; the format is universal and informed decision-making mandates extensive medical information.Future workSocioculturally tailored research to promote communication about screening with family and friends should be developed and evaluated.Trial registrationCurrent Controlled Trials ISRCTN74121020.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Wendy Atkin
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Christian von Wagner
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Stephen Duffy
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Ines Kralj-Hans
- Department of Biostatistics, King’s Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Allan Hackshaw
- University College London Cancer Trials Centre, London, UK
| | | | - Sue Moss
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Lesley McGregor
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Cecily Palmer
- Department of Applied Health Research, University College London, London, UK
| | - Samuel G Smith
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Mary Thomas
- Department of Applied Health Research, University College London, London, UK
| | - Rosemary Howe
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Gemma Vart
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Roger Band
- Patient and Public Involvement Representative, Evesham, UK
| | - Stephen P Halloran
- NHS Bowel Cancer Screening Programme Southern Hub, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Julia Snowball
- NHS Bowel Cancer Screening Programme Southern Hub, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Neil Stubbs
- NHS Bowel Cancer Screening Programme Southern Hub, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Graham Handley
- NHS Bowel Cancer Screening Programme North East Hub, Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead, UK
| | - Richard Logan
- NHS Bowel Cancer Screening Programme Eastern Hub, Nottingham University Hospitals, Nottingham, UK
| | - Sandra Rainbow
- NHS Bowel Cancer Screening Programme London Hub, Northwick Park and St Marks Hospitals NHS Trust, Harrow, UK
| | - Austin Obichere
- North Central London Bowel Cancer Screening Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Stephen Smith
- NHS Bowel Cancer Screening Programme Midlands and North West Hub, University Hospitals Coventry and Warwickshire NHS Trust, Hospital of St Cross, Rugby, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Francesca Solmi
- Department of Applied Health Research, University College London, London, UK
| | - Jane Wardle
- Department of Epidemiology and Public Health, University College London, London, UK
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Li H, Jiang X, Niu X. Long Non-Coding RNA Reprogramming (ROR) Promotes Cell Proliferation in Colorectal Cancer via Affecting P53. Med Sci Monit 2017; 23:919-928. [PMID: 28216611 PMCID: PMC5330205 DOI: 10.12659/msm.903462] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) remains one of the most common lethal malignant tumors worldwide. The correlation between lncRNAs expression and CRC development has not been well identified in the recent literature. This study focused on the role of lncRNA-ROR on CRC progression and development. MATERIAL AND METHODS Quantitative real-time PCR (qRT-PCR) assay was conducted to identify the expression level of lncRNA-ROR. Cell proliferation and viability were examined by MTT assay and colony formation assay. Cell cycle distribution and apoptosis were detected by flow cytometry. Expressions of p53, p21, and FAS protein levels were assessed by Western blotting. CRC cells transfected with lncRNA-shRNA were injection into nude mice to identify the function of lncRNA-ROR on tumorigenesis in vivo. RESULTS The expression level of lncRNA-ROR was elevated in CRC tissues when compared to adjacent tissues (n=78). lncRNA-ROR knockdown significantly suppressed cell proliferation and viability, while lncRNA-ROR overexpression had the opposite effect. Decreased lncRNA-ROR expression enhanced cell apoptosis and triggered cell cycle arrest in G0/G1 phase, while elevated lncRNA-ROR expression presented the opposite effect. Protein levels of p53 and p53 target genes were affected by lncRNA-ROR in vitro, and downregulation of lncRNA-ROR impeded tumorigenesis in vivo. CONCLUSIONS Our study demonstrates that lncRNA-ROR participates in controlling CRC proliferation, viability, and apoptosis, partially by modulating p53, which provides potential and prospective therapeutic targets for CRC.
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Affiliation(s)
- Hong Li
- Department of Oncology, Central Hospital of Weihai, Weihai, Shandong, China (mainland)
| | - Xiumei Jiang
- Department of Oncology, Central Hospital of Weihai, Weihai, Shandong, China (mainland)
| | - Xuemei Niu
- Department of Oncology, Central Hospital of Weihai, Weihai, Shandong, China (mainland)
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Crawford S, Skinner J, Coombes E, Jones A. Cancer of Unknown Primary: a Cancer Registry Study of Factors Affecting Access to Diagnosis. Clin Oncol (R Coll Radiol) 2017; 29:e39-e46. [DOI: 10.1016/j.clon.2016.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 08/11/2016] [Accepted: 08/23/2016] [Indexed: 11/15/2022]
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Zhou Y, Abel GA, Hamilton W, Pritchard-Jones K, Gross CP, Walter FM, Renzi C, Johnson S, McPhail S, Elliss-Brookes L, Lyratzopoulos G. Diagnosis of cancer as an emergency: a critical review of current evidence. Nat Rev Clin Oncol 2017; 14:45-56. [PMID: 27725680 DOI: 10.1038/nrclinonc.2016.155] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Many patients with cancer are diagnosed through an emergency presentation, which is associated with inferior clinical and patient-reported outcomes compared with those of patients who are diagnosed electively or through screening. Reducing the proportion of patients with cancer who are diagnosed as emergencies is, therefore, desirable; however, the optimal means of achieving this aim are uncertain owing to the involvement of different tumour, patient and health-care factors, often in combination. Most relevant evidence relates to patients with colorectal or lung cancer in a few economically developed countries, and defines emergency presentations contextually (that is, whether patients presented to emergency health-care services and/or received emergency treatment shortly before their diagnosis) as opposed to clinically (whether patients presented with life-threatening manifestations of their cancer). Consistent inequalities in the risk of emergency presentations by patient characteristics and cancer type have been described, but limited evidence is available on whether, and how, such presentations can be prevented. Evidence on patients' symptoms and health-care use before presentation as an emergency is sparse. In this Review, we describe the extent, causes and implications of a diagnosis of cancer following an emergency presentation, and provide recommendations for public health and health-care interventions, and research efforts aimed at addressing this under-researched aspect of cancer diagnosis.
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Affiliation(s)
- Yin Zhou
- The Primary Care Unit, Department of Public Health and Primary Care, Institute of Public Health, Forvie Site, Robinson Way, University of Cambridge, Cambridge CB2 0SR, UK
| | - Gary A Abel
- The Primary Care Unit, Department of Public Health and Primary Care, Institute of Public Health, Forvie Site, Robinson Way, University of Cambridge, Cambridge CB2 0SR, UK
- University of Exeter, College House, St Luke's Campus, Exeter EX2 4TE, UK
| | - Willie Hamilton
- University of Exeter, College House, St Luke's Campus, Exeter EX2 4TE, UK
| | - Kathy Pritchard-Jones
- Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
- University College London Partners Academic Health Science Network, 170 Tottenham Court Road, London W1T 7HA, UK
| | - Cary P Gross
- Section of General Medicine, Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, Yale University School of Medicine, New Haven, Connecticut 06519, USA
| | - Fiona M Walter
- The Primary Care Unit, Department of Public Health and Primary Care, Institute of Public Health, Forvie Site, Robinson Way, University of Cambridge, Cambridge CB2 0SR, UK
| | - Cristina Renzi
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK
| | - Sam Johnson
- National Cancer Registration and Analysis Service, Public Health England Zone A, 2nd Floor, Skipton House, 80 London Road, London SE1 6LH, UK
| | - Sean McPhail
- National Cancer Registration and Analysis Service, Public Health England Zone A, 2nd Floor, Skipton House, 80 London Road, London SE1 6LH, UK
| | - Lucy Elliss-Brookes
- National Cancer Registration and Analysis Service, Public Health England Zone A, 2nd Floor, Skipton House, 80 London Road, London SE1 6LH, UK
| | - Georgios Lyratzopoulos
- The Primary Care Unit, Department of Public Health and Primary Care, Institute of Public Health, Forvie Site, Robinson Way, University of Cambridge, Cambridge CB2 0SR, UK
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK
- National Cancer Registration and Analysis Service, Public Health England Zone A, 2nd Floor, Skipton House, 80 London Road, London SE1 6LH, UK
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Solsky I, Friedmann P, Muscarella P, In H. Poor Outcomes of Gastric Cancer Surgery After Admission Through the Emergency Department. Ann Surg Oncol 2016; 24:1180-1187. [PMID: 27909825 DOI: 10.1245/s10434-016-5696-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Outcomes after nonelective surgery for gastric cancer (GC) are poorly defined. Our objective was to compare outcomes of patients undergoing nonelective GC surgery after admission through the emergency department (EDSx) with patients receiving elective surgery or surgery after planned admission (non-EDSx) nationally. METHODS The Nationwide Inpatient Sample (NIS) database was used to examine patients undergoing GC surgery between 2008 and 2012. Demographics and outcomes were compared between EDSx and non-EDSx. Multivariable logistic regression was used to examine predictors of discharge to home. RESULTS Of 9279 patients, 1143 (12%) underwent EDSx. They were more likely to be female (42 vs. 35%), nonwhite (56 vs. 33%), aged ≥75 years (40 vs. 26%), in the lowest quartile for household income (31 vs. 25%), have one or more comorbidities (87 vs. 70%), treated at a nonteaching hospital (46 vs. 25%), and have a concomitant diagnosis of obstruction, perforation, or bleeding (30 vs. 6%). They had longer total length of stay (LOS; 16 vs. 9 days), longer median postoperative stays (10 vs. 9 days), higher in-hospital mortality (8 vs. 3%), and were less likely to be discharged home (63 vs. 82%). EDSx was more expensive ($125,300 vs. $83,604). EDSx was associated with a lower likelihood of discharge to home (odds ratio 0.52, 95% CI 0.43-0.62). CONCLUSIONS Nationally, 12% of GC surgeries are performed after emergency department admission, which occurs more frequently in vulnerable populations and results in worse outcomes. Understanding factors leading to increased EDSx and developing strategies to decrease EDSx may improve GC surgery outcomes.
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Affiliation(s)
- Ian Solsky
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Patricia Friedmann
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Peter Muscarella
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Haejin In
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
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Renzi C, Lyratzopoulos G, Card T, Chu TPC, Macleod U, Rachet B. Do colorectal cancer patients diagnosed as an emergency differ from non-emergency patients in their consultation patterns and symptoms? A longitudinal data-linkage study in England. Br J Cancer 2016; 115:866-75. [PMID: 27537389 PMCID: PMC5046207 DOI: 10.1038/bjc.2016.250] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/11/2016] [Accepted: 07/18/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND More than 20% of colorectal cancers are diagnosed following an emergency presentation. We aimed to examine pre-diagnostic primary-care consultations and related symptoms comparing patients diagnosed as emergencies with those diagnosed through non-emergency routes. METHODS Cohort study of colorectal cancers diagnosed in England 2005 and 2006 using cancer registration data individually linked to primary-care data (CPRD/GPRD), allowing a detailed analysis of clinical information referring to the 5-year pre-diagnostic period. RESULTS Emergency diagnosis occurred in 35% and 15% of the 1029 colon and 577 rectal cancers. 'Background' primary-care consultations (2-5 years before diagnosis) were similar for either group. In the year before diagnosis, >95% of emergency and non-emergency presenters had consulted their doctor, but emergency presenters had less frequently relevant symptoms (colon cancer: 48% vs 71% (P<0.001); rectal cancer: 49% vs 61% (P=0.043)). 'Alarm' symptoms were recorded less frequently in emergency presenters (e.g., rectal bleeding: 9 vs 24% (P=0.002)). However, about 1/5 of emergency presenters (18 and 23% for colon and rectal cancers) had 'alarm' symptoms the year before diagnosis. CONCLUSIONS Emergency presenters have similar 'background' consultation history as non-emergency presenters. Their tumours seem associated with less typical symptoms, however opportunities for earlier diagnosis might be present in a fifth of them.
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Affiliation(s)
- C Renzi
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, WC1E 6BT London, UK
- Cancer Survival Group, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, WC1E 7HT London, UK
| | - G Lyratzopoulos
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, WC1E 6BT London, UK
- Cambridge Centre for Health Services Research, University of Cambridge, CB2 0SR Cambridge, UK
| | - T Card
- Division of Epidemiology and Public Health, University of Nottingham, NG5 1PB Nottingham, UK
- Nottingham Digestive Diseases Centre Biomedical Research Unit, University of Nottingham, NG7 2UH Nottingham, UK
| | - T P C Chu
- Division of Child Health, Obstetrics and Gynaecology, University of Nottingham, NG7 2UH Nottingham, UK
| | - U Macleod
- Hull York Medical School, University of Hull, HU6 7RX Kingston upon Hull, UK
| | - B Rachet
- Cancer Survival Group, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, WC1E 7HT London, UK
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Ortiz-Ortiz KJ, Ríos-Motta R, Marín-Centeno H, Cruz-Correa M, Ortiz AP. Factors associated with late stage at diagnosis among Puerto Rico's government health plan colorectal cancer patients: a cross-sectional study. BMC Health Serv Res 2016; 16:344. [PMID: 27488381 PMCID: PMC4971714 DOI: 10.1186/s12913-016-1590-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 07/27/2016] [Indexed: 11/13/2022] Open
Abstract
Background Late stage at diagnosis of cancer is considered a key predictor factor for a lower survival rate. Knowing and understanding the barriers to an early diagnosis of colorectal cancer is critical in the fight to reduce the social and economic burden caused by cancer in Puerto Rico. This study evaluates factors associated to colorectal cancer stage at diagnosis among Puerto Rico’s Government Health Plan (GHP) patients. Methods We conducted a cross-sectional study based on a secondary data analysis using information from the Puerto Rico Central Cancer Registry (PRCCR) and the Puerto Rico Health Insurance Administration (PRHIA). Logistic regression models were used to estimate the unadjusted odds ratio (ORs) and adjusted odds ratio (AORs), and their 95 % confidence intervals (CIs). Colorectal cancer cases diagnosed between January 1, 2012 and December 31, 2012, among persons 50 to 64 years of age, participants of the GHP and with a cancer diagnosis reported to the PRCCR were included in the study. Results There were 68 (35.79 %) colorectal cancer patients diagnosed at early stage while 122 (64.21 %) where diagnosed at late stage. In the multivariate analysis having a diagnostic delay of more than 59 days (AOR 2.94, 95 % CI: 1.32 to 6.52) and having the first visit through the emergency room (AOR 3.48, 95 % CI: 1.60 to 7.60) were strong predictors of being diagnosed with colorectal cancer at a late stage. Conclusions These results are relevant to understand the factors that influence the outcomes of colorectal cancer patients in the GHP. Therefore, it is important to continue developing studies to understand the Government Health Plan patient’s pathways to a cancer diagnosis, in order to promote assertive decisions to improve patient outcomes.
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Affiliation(s)
- Karen J Ortiz-Ortiz
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico. .,Cancer Control and Population Sciences Program, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico.
| | - Ruth Ríos-Motta
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Heriberto Marín-Centeno
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Marcia Cruz-Correa
- Department of Surgery, Biochemistry and Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Ana Patricia Ortiz
- Cancer Control and Population Sciences Program, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico.,Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
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Open Surgery Against Laparoscopic Surgery for Mid-Rectal or Low-Rectal Cancer of Male Patients: Better Postoperative Genital Function of Laparoscopic Surgery. Surg Laparosc Endosc Percutan Tech 2016; 25:444-8. [PMID: 26429053 DOI: 10.1097/sle.0000000000000189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE To evaluate retrospectively the postoperative genital function, the local recurrence, and the survival rate impacted by laparoscopic or open surgery for rectal cancer (RC) in male patients. METHODS A total of 398 male RC patients after laparoscopic or open total mesorectal excision (TME) of rectomy (205 patients in the TME with laparoscopy group, and 193 patients in the control group) were included in our study, between October 1997 and December 2013. Postoperative genital function, local recurrence, and the 5-year survival rate were analyzed, retrospectively. RESULTS The rate of erection dysfunction was lower in the laparoscopic group (60.0%) than in the open group (82.4%, P<0.05); the rate of ejaculation dysfunction in the laparoscopic group (56.6%) was also lower than in the open group (82.4%, P<0.05). No significant difference was found regarding the local recurrence (P=0.87) and the survival rate (P=0.17). Interestingly, for patients with preoperative obstruction, the survival rate was lower in the laparoscopy group compared with the control group (P=0.002). CONCLUSIONS Laparoscopic surgery should be recommended for mid-RC or low-RC patients to preserve the postoperative genital function. However, for patients with preoperative obstruction, laparoscopy surgery was not recommended.
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Addressing unwarranted variations in colorectal cancer outcomes: a conceptual approach. Nat Rev Clin Oncol 2016; 13:706-712. [PMID: 27349194 DOI: 10.1038/nrclinonc.2016.94] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In the clinical setting, the term 'unwarranted variation' refers to variations in patient outcomes that cannot be explained by the patient's underlying illness or medical needs, or the dictates of evidence-based medicine. These types of variations persist even after adjusting for patient-specific factors. Unwarranted variation depends on a complex mix of disparities, including inequalities in access to appropriate care in a wide variety of geographical and cultural settings, in the uptake and application of clinical knowledge, in the prioritization and allocation of resources, and differences in organizational and professional culture. Nevertheless, unwarranted variation has been inexorably linked with clinical practice. Thus, awareness of the antecedents of unwarranted variations in clinical practice is strategically important. In this Perspective, we discuss these antecedents in colorectal cancer clinical care pathways with an emphasis upon the multidisciplinary team (MDT), and suggest pragmatic steps that could be taken to address latent unwarranted variation.
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Mennie JC, Mohanna PN, O’Donoghue JM, Rainsbury R, Cromwell DA. The Proportion of Women Who Have a Breast 4 Years after Breast Cancer Surgery: A Population-Based Cohort Study. PLoS One 2016; 11:e0153704. [PMID: 27148870 PMCID: PMC4858207 DOI: 10.1371/journal.pone.0153704] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 04/03/2016] [Indexed: 11/19/2022] Open
Abstract
Background There are numerous pathways in breast cancer treatment, many of which enable women to retain a breast after treatment. We evaluated the proportion of women who have a breast, either through conserving surgery (BCS) or reconstruction, at 4-years after diagnosis, and how this varied by patient group. Methods and Findings We identified women with breast cancer who underwent initial BCS or mastectomy in English National Health Service (NHS) hospitals between January 2008 and December 2009 using the Hospital Episode Statistics (HES) database. Women were assigned into one of four patient groups depending on their age at diagnosis and presence of comorbidities. The series of breast cancer procedure (BCS, mastectomy, immediate, or delayed reconstruction) undergone by each women was identified over four years, and the proportion of women with a breast calculated. Variation was examined across patient groups, and English Cancer Networks. Between 2008 and 2009, 60,959 women underwent BCS or mastectomy. The proportion with a breast at 4 years was 79.3%, and 64.0%, in women less than 70 years without, and with comorbidities. Whilst in women aged 70 and over without, and with comorbidities, proportions were 52.6%, and 38.2%, respectively. Comorbidities were associated with lower proportions of BCS, but had little effect on reconstruction rates unlike age. Networks variation of 15% or more was found within each patient group, and Cancer Networks tended to have either a high or low proportion across all four patient groups. However, while 14% of women under 70 years had undergone reconstruction, less than 2% of women aged 70 or more had this treatment option. Conclusion The proportion of women diagnosed with breast cancer who retain a breast at 4 years is strongly associated with age, and presence of comorbidities. There was significant variation between Cancer Networks indicating that women’s experience in England was dependent on their geographical location of treatment.
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Affiliation(s)
- Joanna C. Mennie
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
- Department of Plastic and Reconstructive Surgery, St Thomas Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Pari-Naz Mohanna
- Department of Plastic and Reconstructive Surgery, St Thomas Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Joseph M O’Donoghue
- Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle Upon Tyne NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Richard Rainsbury
- Department of Breast Surgery, Royal Hampshire County Hospital, Hampshire Hospitals NHS Foundation Trust, Winchester, United Kingdom
| | - David A. Cromwell
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
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Raine R, Fitzpatrick R, Barratt H, Bevan G, Black N, Boaden R, Bower P, Campbell M, Denis JL, Devers K, Dixon-Woods M, Fallowfield L, Forder J, Foy R, Freemantle N, Fulop NJ, Gibbons E, Gillies C, Goulding L, Grieve R, Grimshaw J, Howarth E, Lilford RJ, McDonald R, Moore G, Moore L, Newhouse R, O’Cathain A, Or Z, Papoutsi C, Prady S, Rycroft-Malone J, Sekhon J, Turner S, Watson SI, Zwarenstein M. Challenges, solutions and future directions in the evaluation of service innovations in health care and public health. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04160] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
HeadlineEvaluating service innovations in health care and public health requires flexibility, collaboration and pragmatism; this collection identifies robust, innovative and mixed methods to inform such evaluations.
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Affiliation(s)
- Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Ray Fitzpatrick
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Helen Barratt
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames, Department of Applied Health Research, University College London, London, UK
| | - Gywn Bevan
- Department of Management, London School of Economics and Political Science, London, UK
| | - Nick Black
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ruth Boaden
- Alliance Manchester Business School, University of Manchester, Manchester, UK
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester, Manchester, UK
| | - Peter Bower
- National Institute for Health Research (NIHR) School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Marion Campbell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jean-Louis Denis
- Canada Research Chair in Governance and Transformation of Health Organizations and Systems, École Nationale d’Administration Publique, Ville de Québec, QC, Canada
| | - Kelly Devers
- Health Policy Centre, Urban Institute, Washington, DC, USA
| | - Mary Dixon-Woods
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), University of Sussex, Brighton, UK
| | - Julien Forder
- School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK
| | - Robbie Foy
- Academic Unit of Primary Care, Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Nick Freemantle
- Department of Primary Care and Population Health, University College London, London, UK
| | - Naomi J Fulop
- Department of Applied Health Research, University College London, London, UK
| | - Elizabeth Gibbons
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Clare Gillies
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East Midlands and NIHR Research Design Service East Midlands, University of Leicester, Leicester, UK
| | - Lucy Goulding
- King’s Improvement Science, Centre for Implementation Science, King’s College London, London, UK
| | - Richard Grieve
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jeremy Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute and Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Emma Howarth
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, University of Cambridge, Cambridge, UK
| | | | - Ruth McDonald
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Graham Moore
- School of Social Sciences, Cardiff University, Cardiff, UK
| | - Laurence Moore
- Medical Research Council (MRC)/Chief Scientist Office (CSO) Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Robin Newhouse
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Alicia O’Cathain
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Zeynep Or
- Institut de Recherche et Documentation en Économie de la Santé, Paris, France
| | - Chrysanthi Papoutsi
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Northwest London, Imperial College London, London, UK
| | | | | | - Jasjeet Sekhon
- Department of Political Science and Statistics, University of California Berkeley, Berkeley, CA, USA
| | - Simon Turner
- Department of Applied Health Research, University College London, London, UK
| | | | - Merrick Zwarenstein
- Centre for Studies in Family Medicine, Department of Family Medicine, Western University, London, ON, Canada
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Wilcock A, Crosby V, Hussain A, McKeever TM, Manderson C, Farnan S, Freer S, Freemantle A, Littlewood F, Caswell G, Seymour J. Lung cancer diagnosed following an emergency admission: Mixed methods study of the management, outcomes and needs and experiences of patients and carers. Respir Med 2016; 114:38-45. [PMID: 27109809 DOI: 10.1016/j.rmed.2016.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 03/07/2016] [Accepted: 03/09/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND In the UK, although 40% of patients with lung cancer are diagnosed following an emergency admission (EA), data is limited on their needs and experiences as they progress through diagnostic and treatment pathways. METHODS Prospective data collection using medical records, questionnaires and in-depth interviews. Multivariate logistic regression explored associations between diagnosis following EA and aspects of interest. Questionnaire responses with 95% confidence intervals were compared with local and national datasets. A grounded theory approach identified patient and carer themes. RESULTS Of 401 patients, 154 (38%) were diagnosed following EA; 37 patients and six carers completed questionnaires and 13 patients and 10 carers were interviewed. Compared to those diagnosed electively, EA patients adjusted results found no difference in treatment recommendation, treatment intent or place of death. Time to diagnosis, review, or treatment was 7-14 days quicker but fewer EA patients had a lung cancer nurse present at diagnosis (37% vs. 62%). Palliative care needs were high (median [IQR] 21 [13-25] distressing or bothersome symptoms/issues) and various information and support needs unmet. Interviews highlighted in particular, perceived delays in obtaining investigations/specialist referral and factors influencing success or failure of the cough campaign. CONCLUSIONS Presentation as an EA does not appear to confer any inherent disadvantage regarding progress through lung cancer diagnostic and treatment pathways. However, given the frequent combination of advanced disease, poor performance status and prognosis, together with the high level of need and reported short-fall in care, we suggest that a specialist palliative care assessment is routinely offered.
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Affiliation(s)
- Andrew Wilcock
- Division of Cancer and Stem Cells, School of Medicine, University of Nottingham, Nottingham, UK
| | - Vincent Crosby
- Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Asmah Hussain
- Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Tricia M McKeever
- Division of Public Health and Epidemiology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Cathann Manderson
- Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sarah Farnan
- Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sarah Freer
- Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Alison Freemantle
- Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Fran Littlewood
- Department of Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Glenys Caswell
- Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, School of Health Sciences, University of Nottingham, Nottingham, UK.
| | - Jane Seymour
- Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, School of Health Sciences, University of Nottingham, Nottingham, UK
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Liu Z, Huang M, Kang L, Wang L, Lan P, Cui J, Wang J. Prognosis and postoperative genital function of function-preservative surgery of pelvic autonomic nerve preservation for male rectal cancer patients. BMC Surg 2016; 16:12. [PMID: 26971141 PMCID: PMC4789285 DOI: 10.1186/s12893-016-0127-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 03/10/2016] [Indexed: 01/04/2023] Open
Abstract
Background To retrospectively evaluate postoperative genital function, local recurrence rate and survival rate after total mesorectal excision (TME) combined with or without pelvic autonomic nerve preservation (PANP) in male patients with rectal cancer. Methods A total of 953 male patients with rectal cancer after TME (518 patients received TME combined with PANP [PANP group] and 434patients received TME alone [TME group]) were included. Assessments of postoperative genital function, local recurrence rate, and 5 year survival rate were collected. Results Rate of erection dysfunction in PANP group (41.9 %) was significantly lower than that in TME group (76.7 %, P < 0.05). Rate of ejaculation dysfunction in PANP group (42.5 %) was also significantly lower than that in TME group (67.3 %, P < 0.05). Local recurrence rate (P = 0.66) and survival rate (P = 0.26) did not differ between the two groups. For patients with preoperative obstruction, local recurrence rate was significantly higher (P = 0.01) and survival rate significantly lower (P = 0.03) in PANP group. Conclusions PANP surgery has significant advantage with respect to preservation of genital function and should be recommended as surgical treatment for rectal cancer patients. However, PANP surgery should be considered with caution in patients with preoperative obstruction in view of the poorer long-term outcomes in these patients.
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Affiliation(s)
- Zhihua Liu
- Gastrointestinal Institute of Sun Yat-Sen University, Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-Sen University (Guangdong Gastrointestinal Hospital), 26 Yuancun Erheng Road, Guangzhou, Guangdong, 510655, People's Republic of China
| | - Meijin Huang
- Gastrointestinal Institute of Sun Yat-Sen University, Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-Sen University (Guangdong Gastrointestinal Hospital), 26 Yuancun Erheng Road, Guangzhou, Guangdong, 510655, People's Republic of China
| | - Liang Kang
- Gastrointestinal Institute of Sun Yat-Sen University, Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-Sen University (Guangdong Gastrointestinal Hospital), 26 Yuancun Erheng Road, Guangzhou, Guangdong, 510655, People's Republic of China
| | - Lei Wang
- Gastrointestinal Institute of Sun Yat-Sen University, Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-Sen University (Guangdong Gastrointestinal Hospital), 26 Yuancun Erheng Road, Guangzhou, Guangdong, 510655, People's Republic of China
| | - Ping Lan
- Gastrointestinal Institute of Sun Yat-Sen University, Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-Sen University (Guangdong Gastrointestinal Hospital), 26 Yuancun Erheng Road, Guangzhou, Guangdong, 510655, People's Republic of China
| | - Ji Cui
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jianping Wang
- Gastrointestinal Institute of Sun Yat-Sen University, Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-Sen University (Guangdong Gastrointestinal Hospital), 26 Yuancun Erheng Road, Guangzhou, Guangdong, 510655, People's Republic of China.
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Rococo E, Mazouni C, Or Z, Mobillion V, Koon Sun Pat M, Bonastre J. Variation in rates of breast cancer surgery: A national analysis based on French Hospital Episode Statistics. Eur J Surg Oncol 2016; 42:51-8. [DOI: 10.1016/j.ejso.2015.09.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/17/2015] [Accepted: 09/21/2015] [Indexed: 11/25/2022] Open
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Nur U, Quaresma M, De Stavola B, Peake M, Rachet B. Inequalities in non-small cell lung cancer treatment and mortality. J Epidemiol Community Health 2015; 69:985-92. [PMID: 26047831 PMCID: PMC4602267 DOI: 10.1136/jech-2014-205309] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 05/10/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Non-small cell lung cancer (NSCLC) comprises approximately 85% of all lung cancer cases, and surgery is the preferred treatment for patients. The National Health Service established Primary Care Trusts (PCTs) in 2002 to manage local health needs. We investigate whether PCTs with a lower uptake of surgical treatment are those with above-average mortality 1 year after diagnosis. The applied methods can be used to monitor the performance of any administrative bodies responsible for the management of patients with cancer. METHODS All adults diagnosed with NSCLC lung cancer during 1998-2006 in England were identified. We fitted mixed effect logistic models to predict surgical treatment within 6 months after diagnosis, and mortality within 1 year of diagnosis. RESULTS Around 10% of the NCSLC patients received curative surgery. Older deprived patients and those who did not receive surgery had much higher odds of death 1 year after being diagnosed with cancer. In total, 69% of the PCTs were below the lower control limit of surgery and have predicted random intercepts above the mean value of zero of the random effect for mortality, whereas 40% were above the upper control limit of mortality within 1 year. CONCLUSIONS Our main results suggest the presence of clear geographical variation in the use of surgical treatment of NSCLC and mortality. Mixed-effects models combined with the funnel plot approach were useful for assessing the performance of PCTs that were above average in mortality and below average in surgery.
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Affiliation(s)
- Ula Nur
- CRUK Cancer Survival Group, Department of Non-communiicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Manuela Quaresma
- CRUK Cancer Survival Group, Department of Non-communiicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Bianca De Stavola
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael Peake
- National Cancer Intelligence Network, Public Health England, London, UK
| | - Bernard Rachet
- CRUK Cancer Survival Group, Department of Non-communiicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Rubin G, Berendsen A, Crawford SM, Dommett R, Earle C, Emery J, Fahey T, Grassi L, Grunfeld E, Gupta S, Hamilton W, Hiom S, Hunter D, Lyratzopoulos G, Macleod U, Mason R, Mitchell G, Neal RD, Peake M, Roland M, Seifert B, Sisler J, Sussman J, Taplin S, Vedsted P, Voruganti T, Walter F, Wardle J, Watson E, Weller D, Wender R, Whelan J, Whitlock J, Wilkinson C, de Wit N, Zimmermann C. The expanding role of primary care in cancer control. Lancet Oncol 2015; 16:1231-72. [PMID: 26431866 DOI: 10.1016/s1470-2045(15)00205-3] [Citation(s) in RCA: 355] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 07/25/2015] [Accepted: 07/27/2015] [Indexed: 12/21/2022]
Abstract
The nature of cancer control is changing, with an increasing emphasis, fuelled by public and political demand, on prevention, early diagnosis, and patient experience during and after treatment. At the same time, primary care is increasingly promoted, by governments and health funders worldwide, as the preferred setting for most health care for reasons of increasing need, to stabilise health-care costs, and to accommodate patient preference for care close to home. It is timely, then, to consider how this expanding role for primary care can work for cancer control, which has long been dominated by highly technical interventions centred on treatment, and in which the contribution of primary care has been largely perceived as marginal. In this Commission, expert opinion from primary care and public health professionals with academic and clinical cancer expertise—from epidemiologists, psychologists, policy makers, and cancer specialists—has contributed to a detailed consideration of the evidence for cancer control provided in primary care and community care settings. Ranging from primary prevention to end-of-life care, the scope for new models of care is explored, and the actions needed to effect change are outlined. The strengths of primary care—its continuous, coordinated, and comprehensive care for individuals and families—are particularly evident in prevention and diagnosis, in shared follow-up and survivorship care, and in end-of-life care. A strong theme of integration of care runs throughout, and its elements (clinical, vertical, and functional) and the tools needed for integrated working are described in detail. All of this change, as it evolves, will need to be underpinned by new research and by continuing and shared multiprofessional development.
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Affiliation(s)
- Greg Rubin
- School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK.
| | - Annette Berendsen
- Department of General Practice, University of Groningen, Groningen, Netherlands
| | | | - Rachel Dommett
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Craig Earle
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Jon Emery
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Tom Fahey
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Luigi Grassi
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Eva Grunfeld
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Sumit Gupta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | | | - David Hunter
- School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK
| | | | - Una Macleod
- Hull-York Medical School, University of Hull, Hull, UK
| | - Robert Mason
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Geoffrey Mitchell
- Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Richard D Neal
- North Wales Centre for Primary Care Research, Bangor University, Bangor, Wales
| | | | - Martin Roland
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Bohumil Seifert
- Department of General Practice, Charles University, Prague, Czech Republic
| | - Jeff Sisler
- Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | - Stephen Taplin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Peter Vedsted
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Teja Voruganti
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Fiona Walter
- Department of General Practice, University of Groningen, Groningen, Netherlands
| | - Jane Wardle
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Eila Watson
- Department of Clinical Health Care, Oxford Brookes University, Oxford, UK
| | - David Weller
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Jeremy Whelan
- Research Department of Oncology, University College London, London, UK
| | - James Whitlock
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Clare Wilkinson
- North Wales Centre for Primary Care Research, Bangor University, Bangor, Wales
| | - Niek de Wit
- Department of General Practice, University Medical Center Utrecht, Utrecht, Netherlands
| | - Camilla Zimmermann
- Division of Medical Oncology and Haematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Black G, Sheringham J, Spencer-Hughes V, Ridge M, Lyons M, Williams C, Fulop N, Pritchard-Jones K. Patients' Experiences of Cancer Diagnosis as a Result of an Emergency Presentation: A Qualitative Study. PLoS One 2015; 10:e0135027. [PMID: 26252203 PMCID: PMC4529308 DOI: 10.1371/journal.pone.0135027] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 07/16/2015] [Indexed: 12/11/2022] Open
Abstract
Introduction Cancers diagnosed following visits to emergency departments (ED) or emergency admissions (emergency presentations) are associated with poor survival and may result from preventable diagnostic delay. To improve outcomes for these patients, a better understanding is needed about how emergency presentations arise. This study sought to capture patients' experiences of this diagnostic pathway in the English NHS. Methods Eligible patients were identified in a service evaluation of emergency presentations and invited to participate. Interviews, using an open-ended biographical structure, captured participants' experiences of healthcare services before diagnosis and were analysed thematically, informed by the Walter model of Pathways to Treatment and NICE guidance in an iterative process. Results Twenty-seven interviews were conducted. Three typologies were identified: A: Rapid investigation and diagnosis, and B: Repeated cycles of healthcare seeking and appraisal without resolution, with two variants where B1 appears consistent with guidance and B2 has evidence that management was not consistent with guidance. Most patients’ (23/27) experiences fitted types B1 and B2. Potentially avoidable breakdowns in diagnostic pathways caused delays when patients were conflicted by escalating symptoms and a benign diagnosis given earlier by doctors. ED was sometimes used as a conduit to rapid testing by primary care clinicians, although this pathway was not always successful. Conclusions This study draws on patients' experiences of their diagnosis to provide novel insights into how emergency presentations arise. Through these typologies, we show that the typical experience of patients diagnosed through an emergency presentation diverges significantly from normative pathways even when there is no evidence of serious service failures. Consultations were not a conduit to diagnosis when they inhibited patients’ capacity to appraise their own symptoms appropriately and when they resulted in a reluctance to seek further healthcare. Recommendations The findings also point to potentially avoidable breakdowns in the diagnostic process. In particular, to encourage patients to return to the GP if symptoms escalate, a stronger emphasis is needed on diagnostic uncertainty in discussions between patients and doctors in both primary and secondary care. To improve appropriate access to rapid investigations, systems are needed for primary care to communicate directly with secondary care at the time of referral.
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Affiliation(s)
- Georgia Black
- UCL Department of Applied Health Research, UCL, London, England
| | - Jessica Sheringham
- UCL Department of Applied Health Research, UCL, London, England
- * E-mail:
| | - Vicki Spencer-Hughes
- LKSS Public Health Training Programme & Public Health Service, Lambeth and Southwark Local Authorities, London, England
| | | | | | | | - Naomi Fulop
- UCL Department of Applied Health Research, UCL, London, England
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Cook JA, Collins GS. The rise of big clinical databases. Br J Surg 2015; 102:e93-e101. [PMID: 25627139 DOI: 10.1002/bjs.9723] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 10/20/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND The routine collection of large amounts of clinical data, 'big data', is becoming more common, as are research studies that make use of these data source. The aim of this paper is to provide an overview of the uses of data from large multi-institution clinical databases for research. METHODS This article considers the potential benefits, the types of data source, and the use to which the data is put. Additionally, the main challenges associated with using these data sources for research purposes are considered. RESULTS Common uses of the data include: providing population characteristics; identifying risk factors and developing prediction (diagnostic or prognostic) models; observational studies comparing different interventions; exploring variation between healthcare providers; and as a supplementary source of data for another study. The main advantages of using such big data sources are their comprehensive nature, the relatively large number of patients they comprise, and the ability to compare healthcare providers. The main challenges are demonstrating data quality and confidently applying a causal interpretation to the study findings. CONCLUSION Large clinical database research studies are becoming ubiquitous and offer a number of potential benefits. However, the limitations of such data sources must not be overlooked; each research study needs to be considered carefully in its own right, together with the justification for using the data for that specific purpose.
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Affiliation(s)
- J A Cook
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
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Abstract
OBJECTIVE To identify patient and practitioner factors that influence cancer diagnosis via emergency presentation (EP). DESIGN Systematic review. DATA SOURCES MEDLINE, EMBASE, CINAHL, EBM Reviews, Science and Social Sciences Citation Indexes, Conference Proceedings Citation Index-Science and Conference Proceedings Citation Index-Social Science and Humanities. Searches were undertaken from 1996 to 2014. No language restrictions were applied. STUDY SELECTION Studies of any design assessing factors associated with diagnosis of colorectal or lung cancer via EP, or describing an intervention to impact on EP, were included. Studies involving previously diagnosed cancer patients, assessing only referral pathway effectiveness, outcomes related to diagnosis or post-EP management were excluded. The population was individual or groups of adult patients or primary care practitioners. Two authors independently screened studies for inclusion. RESULTS 22 studies with over 200,000 EPs were included, most providing strong evidence. Five were graded 'insufficient', primarily due to missing information rather than methodological weakness. Older patient age was associated with EP for lung and colorectal cancers (OR 1.11-11.03 and 1.19-5.85, respectively). Women were more at risk of EP for lung but not colorectal cancer. Higher deprivation increased the likelihood of lung cancer EP, but evidence for colorectal was less conclusive. Being unmarried (or divorced/widowed) increased the likelihood of EP for colorectal cancer, which was also associated with pain, obstruction and weight loss. Lack of a regular source of primary care, and lower primary care use were positively associated with EP. Only three studies considered practitioner factors, two involving diagnostic tests. No conclusive evidence was found. CONCLUSIONS Patient-related factors, such as age, gender and deprivation, increase the likelihood of cancer being diagnosed as the result of an EP, while cancer symptoms and patterns of healthcare utilisation are also relevant. Further work is needed to understand the context in which risk factors for EP exist and influence help-seeking.
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Affiliation(s)
- Elizabeth D Mitchell
- Centre for Health Services Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Una Macleod
- Supportive Care, Early Diagnosis and Advanced disease (SEDA) Research Group, Centre for Health and Population Sciences, Hull York Medical School, University of Hull, Hull, UK
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