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Fujita M, Fujisawa T, Suzuki K, Nagashima K, Kasai T, Hashimoto H, Yamaguchi K, Onouchi Y, Sato D, Hata A. Impact of the coronavirus disease 2019 pandemic on primary and metastatic lung cancer treatments in Japan: A nationwide study using an interrupted time series analysis. Cancer Epidemiol 2024; 90:102549. [PMID: 38447249 DOI: 10.1016/j.canep.2024.102549] [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: 10/06/2023] [Revised: 02/19/2024] [Accepted: 02/25/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND The coronavirus disease 2019 pandemic prompted healthcare providers to use different approaches from the current standards of care. We aimed to identify the changes in the number of treatments for primary non-small cell lung cancer (NSCLC) and metastatic lung cancer during the pandemic. METHODS We used nationwide insurance claims data from January 2015 to January 2021, and estimated changes in the number of treatments using an interrupted time series analysis. RESULTS The number of surgical resections for primary NSCLC significantly decreased in April 2020 (-888; 95% confidence interval [CI]: -1530 to -246) and July 2020 (-1314; 95% CI: -1935 to -694), while the number of stereotactic body radiotherapies (SBRTs) increased in April 2020 (95; 95% CI: 8-182) and July 2020 (111; 95% CI: 24-198). The total number of treatments for primary NSCLC remained unchanged; however, non-significant decreases were observed in 2020. The number of surgical resections for metastatic lung cancer significantly decreased in April 2020 (-201; 95% CI: -337 to -65), but it eventually increased in July 2020 (170; 95% CI: 32-308). Additionally, the number of SBRTs significantly increased in April 2020 (37; 95% CI: 3-71) and October 2020 (57; 95% CI: 23-91). The total number of treatments for metastatic lung cancer was maintained, with an initial decrease in April 2020 followed by a subsequent increase in July and October 2020. CONCLUSION In Japan, surgical triage for primary and metastatic lung cancer are likely to have been implemented during the pandemic. Despite these proactive measures, patients with primary NSCLC may have been untreated, likely owing to their undiagnosed disease, potentially leading to a deterioration in prognosis. By contrast, patients diagnosed with cancer prior to the pandemic are presumed to have received standard management throughout the course of the pandemic.
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Affiliation(s)
- Misuzu Fujita
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-ku, Chiba 261-0002, Japan; Department of Public Health, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Takehiko Fujisawa
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-ku, Chiba 261-0002, Japan
| | - Kiminori Suzuki
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-ku, Chiba 261-0002, Japan
| | - Kengo Nagashima
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Tokuzo Kasai
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-ku, Chiba 261-0002, Japan
| | - Hideyuki Hashimoto
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-ku, Chiba 261-0002, Japan
| | - Kazuya Yamaguchi
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-ku, Chiba 261-0002, Japan
| | - Yoshihiro Onouchi
- Department of Public Health, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Daisuke Sato
- Hospital and Health Administration, Fujita Health University Graduate School of Medicine, 1-98 Dengakugakubo, Kutukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Akira Hata
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-ku, Chiba 261-0002, Japan
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Teshome R, Yang I, Woldetsadik E, Girma E, Higgins M, Wells J. Survival Status and Predictors Among Women with Advanced Stage of Cervical Cancer. Int J Womens Health 2024; 16:605-617. [PMID: 38645983 PMCID: PMC11027928 DOI: 10.2147/ijwh.s455235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
Background Cervical cancer is one of the leading causes of cancer death in women, even though it is a preventable disease. Most deaths occur in low- and middle-income countries. In addition to early detection and receipt of standard treatments, survivorship is an important component of high quality of care across the cancer continuum. Objective To assess the survival status of advanced-stage cervical cancer patients after cancer treatment has started. Methods and Materials A one-year prospective cohort study was employed to assess the survival status of women with advanced stages of cervical cancer. A total of 180 cervical cancer patients were recruited, and the study was conducted from January 10, 2022, to September 20, 2023. Data entry and analysis were done in the SPSS 29 version. Descriptive statistics were used to examine participant characteristics. The Kaplan-Meier procedure and log rank test were used to estimate the duration of survival. Bivariate and multivariate Cox regression analyses were computed for predictor variables with survival status. Results Patients receiving cancer treatment at FIGO stages IVA and IVB had survived by 56% and 24%, respectively, whereas patients receiving treatment at stages IIB and IIIA had survived by 100%. The estimated mean survival time at one-year follow-up was 5.706 months (95% CI: 3.785-7.627) for patients with FIGO stage IVB, but 11.537 months (95% CI: 11.199-11.887) for those with stages II and III (P < 0.001). Women over 60 years old had a 1.5-fold higher risk of death than those under 60 (HR: 1.482, P = 0.040). Conclusion The one-year cumulative survival rate among advanced-stage cervical cancer patients was 77%. Major factors associated with survival were age, cancer stage, the presence of anemia, and waiting time for treatment.
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Affiliation(s)
- Roza Teshome
- Department of Midwifery, School of Nursing & Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Irene Yang
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Edom Woldetsadik
- Department of Oncology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eshetu Girma
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Jessica Wells
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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Tseng YC, Kung PT, Peng CY, Chou WY, Tsai WC. Effect of multidisciplinary team care on patient survival in chronic hepatitis B or C hepatocellular carcinoma. Front Oncol 2023; 13:1251571. [PMID: 38179172 PMCID: PMC10764426 DOI: 10.3389/fonc.2023.1251571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/31/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction Multidisciplinary team care coordinates with medical teams to improve the quality of cancer care. This study explored multidisciplinary team care in hepatitis B or hepatitis C virus-related hepatocellular carcinoma patients from the time of diagnosis to the first-time treatment interval and investigated treatment outcomes and prognosis. Methods This retrospective cohort study included data from a nationwide population from 2007 to 2016. Data were collected from the Taiwan Cancer Registry Database, linked to the Taiwan National Health Insurance Research Database. Propensity score matching was applied at a ratio of 1:2 to reduce the selection bias. A multiple regression model with generalized estimating equations was used to analyze whether multidisciplinary team care affected the diagnosis-to-treatment interval. The stratified Cox proportional hazards model examined whether involvement in multidisciplinary team care influenced survival status. Results A total of 10,928 and 21,856 patients with hepatocellular carcinoma received multidisciplinary and non-multidisciplinary care, respectively. Participants with multidisciplinary care had a longer diagnosis-to-treatment interval but a lower risk of cumulative cancer death (HR=0.88, 95% CI:0.84-0.92). In patients with intermediate- to advanced-stage hepatocellular carcinoma, multidisciplinary team care has obvious benefits for improving survival. Conclusion Patients with hepatocellular carcinoma who participated in multidisciplinary team care had a longer diagnosis-to-treatment interval but a lower risk of cancer death. Patients with intermediate- to advanced-stage hepatocellular carcinoma who received multidisciplinary team care significantly benefited from this outcome. Hospitals should provide HCC patients with multidisciplinary team care to improve cancer care.
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Affiliation(s)
- Yu-Chen Tseng
- Department of Public Health, China Medical University, Taichung, Taiwan
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Yuan Peng
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Yu Chou
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
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Tankel J, Spicer J, Chu Q, Fiset PO, Kidane B, Leighl NB, Joubert P, Maziak D, Palma D, McGuire A, Melosky B, Snow S, Bahig H, Blais N. Canadian Consensus Recommendations for the Management of Operable Stage II/III Non-Small-Cell Lung Cancer: Results of a Modified Delphi Process. Curr Oncol 2023; 30:10363-10384. [PMID: 38132389 PMCID: PMC10742991 DOI: 10.3390/curroncol30120755] [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: 10/31/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023] Open
Abstract
The treatment paradigm for patients with stage II/III non-small-cell lung cancer (NSCLC) is rapidly evolving. We performed a modified Delphi process culminating at the Early-stage Lung cancer International eXpert Retreat (ELIXR23) meeting held in Montreal, Canada, in June 2023. Participants included medical and radiation oncologists, thoracic surgeons and pathologists from across Quebec. Statements relating to diagnosis and treatment paradigms in the preoperative, operative and postoperative time periods were generated and modified until all held a high level of consensus. These statements are aimed to help guide clinicians involved in the treatment of patients with stage II/III NSCLC.
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Affiliation(s)
- James Tankel
- Department of Thoracic Surgery, McGill University Health Center, Montreal, QC H3G 1A4, Canada
| | - Jonathan Spicer
- Department of Thoracic Surgery, McGill University Health Center, Montreal, QC H3G 1A4, Canada
| | - Quincy Chu
- Department of Medical Oncology, Cross Cancer Institute, Edmonton, AB T6G 1Z2, Canada
| | - Pierre Olivier Fiset
- Department of Pathology, McGill University Health Center, Montreal, QC H3G 1A4, Canada
| | - Biniam Kidane
- Section of Thoracic Surgery, University of Manitoba & Cancer Care Manitoba, Winnipeg, MB R3A 1R9, Canada
| | - Natasha B. Leighl
- Division of Medical Oncology, Princess Margaret Cancer Center, Toronto, ON M5G 2C4, Canada
| | - Philippe Joubert
- Department of Pathology, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université, Laval, QC G1V 4G5, Canada
| | - Donna Maziak
- Department of Thoracic Surgery, Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada
| | - David Palma
- Department of Radiation Oncology, London Health Services Center, London, ON N6A 5A5, Canada
| | - Anna McGuire
- Department of Thoracic Surgery, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Barbara Melosky
- Department of Medical Oncology, BCCA, Vancouver, BC V5Z 4E6, Canada
| | - Stephanie Snow
- Department of Medical Oncology, Queen Elizabeth II Health Sciences Center, Halifax, NS B3H 3A7, Canada
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 3E4, Canada
| | - Normand Blais
- Department of Medical Oncology, Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 3E4, Canada
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Kızılırmak D, Yılmaz Kaya Z, Gökçimen G, Havlucu Y, Cengiz Özyurt B, Gündoğuş B, Esendağlı D, Serez Kaya B, Yılmam İ, Aydemir Y, Çolak M, Afşin E, Çetin N, İdikut A, Değirmenci C, Oral Tapan Ö, Gündüz Gürkan C, Kocatürk Cİ, Ömeroğlu Şimşek G, Kalafat CE, Özgün Niksarlıoğlu EY, Ergün Serdaroğlu M, Karcıoğlu O, Özyurt S, Karahacıoğlu Madran E, Yaprak Bayrak B, Alasgarova Z, Baydar Toprak O, Yılmazel Uçar E, Topal BN, Argun Barış S, Guliyev E, Güzel E, Küçük S, Ocaklı B, Baran Ketencioğlu B, Selçuk NT, Sarı Akyüz M, Sercan Özgür E, Yetkin NA, Çetinkaya PD, Deniz PP, Atlı S, Çetindoğan H, Karakaş FG, Yılmaz ES, Ergün D, Ergün R, Tulay CM, Ünsal M, Demirkaya İ, Marım F, Kaya İ, Demirdöğen E, Görek Dilektaşlı A, Ursavaş A, Çelik P. Lung cancer from suspicion to treatment: An indicator of healthcare access in Turkey. Cancer Epidemiol 2023; 87:102480. [PMID: 37897971 DOI: 10.1016/j.canep.2023.102480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Lung cancer is the leading cause of cancer-related deaths worldwide. Before beginning lung cancer treatment, it is necessary to complete procedures such as suspecting lung cancer, obtaining a pathologic diagnosis, and staging. This study aimed to investigate the processes from suspicion of lung cancer to diagnosis, staging, and treatment initiation. METHODS The study was designed as a multicenter and cross-sectional study. Patients with lung cancer from various health institutions located in all geographic regions of Turkey were included in the study. The sociodemographic and clinical characteristics of the patients, the characteristics of the health institutions and geographic regions, and other variables of the lung cancer process were recorded. The time from suspicion of lung cancer to pathologic diagnosis, radiologic staging, and treatment initiation, as well as influencing factors, were investigated. RESULTS The study included 1410 patients from 29 different medical centers. The mean time from the initial suspicion of lung cancer to the pathologic diagnosis was 48.0 ± 52.6 days, 39.0 ± 52.7 days for radiologic staging, and 74.9 ± 65.5 days for treatment initiation. The residential areas with the most suspected lung cancer cases were highly developed socioeconomic zones. Primary healthcare services accounted for only 0.4% of patients with suspected lung cancer. The time to pathologic diagnosis was longer in the Marmara region, and the wait time for staging and treatment initiation was longer in Eastern and Southeastern Anatolia. Patients who presented to chest disease referral hospitals with peripheral lesions, those with early-stage disease, and those who were diagnosed surgically had significantly longer wait times. CONCLUSION The time between pathologic diagnosis, staging, and treatment initiation in lung cancer was longer than expected. Increasing the role of primary healthcare services and distributing socioeconomic resources more equally will contribute to shortening the time to diagnosis and improve treatment processes for lung cancer.
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Affiliation(s)
- Deniz Kızılırmak
- Manisa Celal Bayar University, Faculty of Medicine, Chest Diseases Department, Manisa, Turkey.
| | - Zeynep Yılmaz Kaya
- Manisa Celal Bayar University, Faculty of Medicine, Chest Diseases Department, Manisa, Turkey
| | - Gizem Gökçimen
- Manisa Celal Bayar University, Faculty of Medicine, Chest Diseases Department, Manisa, Turkey
| | - Yavuz Havlucu
- Manisa Celal Bayar University, Faculty of Medicine, Chest Diseases Department, Manisa, Turkey
| | - Beyhan Cengiz Özyurt
- Manisa Celal Bayar University, Faculty of Medicine, Department of Public Health, Manisa, Turkey
| | - Baran Gündoğuş
- Health Sciences University, Faculty of Medicine, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Chest Diseases Department, İstanbul, Turkey
| | - Dorina Esendağlı
- Başkent University Ankara Hospital, Faculty of Medicine, Chest Diseases Department, Ankara, Turkey
| | - Bilkay Serez Kaya
- Trakya University, Faculty of Medicine, Chest Diseases Department, Edirne, Turkey
| | - İlker Yılmam
- Trakya University, Faculty of Medicine, Chest Diseases Department, Edirne, Turkey
| | - Yusuf Aydemir
- Sakarya University, Faculty of Medicine, Chest Diseases Department, Sakarya, Turkey
| | - Mücahit Çolak
- Sakarya University, Faculty of Medicine, Chest Diseases Department, Sakarya, Turkey
| | - Emine Afşin
- Abant İzzet Baysal University, Faculty of Medicine, Chest Diseases Department, Bolu, Turkey
| | - Nazlı Çetin
- Pamukkale University, Faculty of Medicine, Chest Diseases Department, Denizli, Turkey
| | - Aytekin İdikut
- Hacettepe University, Faculty of Medicine, Chest Diseases Department, Ankara, Turkey
| | - Ceren Değirmenci
- Muğla Training and Research Hospital, Chest Diseases Department, Muğla, Turkey
| | - Özge Oral Tapan
- Muğla Sıtkı Koçman University, Faculty of Medicine, Chest Diseases Department, Muğla, Turkey
| | - Canan Gündüz Gürkan
- Health Sciences University, Faculty of Medicine, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Chest Diseases Department, İstanbul, Turkey
| | | | | | - Cem Emrah Kalafat
- Medicana Ataşehir Hospital, Thoracic Surgery Department, İstanbul, Turkey
| | - Elif Yelda Özgün Niksarlıoğlu
- Health Sciences University, Faculty of Medicine, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Chest Diseases Department, İstanbul, Turkey
| | - Merdiye Ergün Serdaroğlu
- Health Sciences University, Faculty of Medicine, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Chest Diseases Department, İstanbul, Turkey
| | - Oğuz Karcıoğlu
- Hacettepe University, Faculty of Medicine, Chest Diseases Department, Ankara, Turkey
| | - Songül Özyurt
- Recep Tayyip Erdoğan University, Faculty of Medicine, Chest Diseases Department, Rize, Turkey
| | | | - Büşra Yaprak Bayrak
- Kocaeli University, Faculty of Medicine, Departmant of Medical Pathology, Kocaeli, Turkey
| | | | - Oya Baydar Toprak
- Çukurova University, Faculty of Medicine, Chest Diseases Department, Adana, Turkey
| | - Elif Yılmazel Uçar
- Atatürk University, Faculty of Medicine, Chest Diseases Department, Erzurum, Turkey
| | - Burcu Nur Topal
- Atatürk University, Faculty of Medicine, Chest Diseases Department, Erzurum, Turkey
| | - Serap Argun Barış
- Kocaeli University, Faculty of Medicine, Chest Diseases Department, Kocaeli, Turkey
| | - Elif Guliyev
- Kocaeli University, Faculty of Medicine, Chest Diseases Department, Kocaeli, Turkey
| | - Efraim Güzel
- Çukurova University, Faculty of Medicine, Chest Diseases Department, Adana, Turkey
| | - Salih Küçük
- Kocaeli City Hospital, Chest Diseases Department, Kocaeli, Turkey
| | - Birsen Ocaklı
- Health Sciences University, Faculty of Medicine, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Chest Diseases Department, İstanbul, Turkey
| | | | | | - Merve Sarı Akyüz
- Antalya Training and Research Hospital, Chest Diseases Department, Antalya, Turkey
| | - Eylem Sercan Özgür
- Mersin University, Faculty of Medicine, Chest Diseases Department, Mersin, Turkey
| | - Nur Aleyna Yetkin
- Erciyes University, Faculty of Medicine, Chest Diseases Department, Kayseri, Turkey
| | - Pelin Duru Çetinkaya
- Çukurova University, Faculty of Medicine, Chest Diseases Department, Adana, Turkey
| | - Pelin Pınar Deniz
- Çukurova University, Faculty of Medicine, Chest Diseases Department, Adana, Turkey
| | - Siahmet Atlı
- Van Training and Research Hospital, Chest Diseases Department, Van, Turkey
| | - Hatice Çetindoğan
- Dr. Ersin Arslan Training and Research Hospital, Chest Diseases Department, Gaziantep, Turkey
| | | | - Emine Serap Yılmaz
- Ordu University, Faculty of Medicine, Chest Diseases Department, Ordu, Turkey
| | - Dilek Ergün
- Selçuk University, Faculty of Medicine, Chest Diseases Department, Konya, Turkey
| | - Recai Ergün
- Selçuk University, Faculty of Medicine, Chest Diseases Department, Konya, Turkey
| | - Cumhur Murat Tulay
- Manisa Celal Bayar University, Faculty of Medicine, Department of Thoracic Surgery, Manisa, Turkey
| | - Meftun Ünsal
- Ondokuz Mayıs University, Faculty of Medicine, Chest Diseases Department, Samsun, Turkey
| | - İlker Demirkaya
- Ondokuz Mayıs University, Faculty of Medicine, Chest Diseases Department, Samsun, Turkey
| | - Feride Marım
- Kütahya Health Sciences University, Faculty of Medicine, Chest Diseases Department, Kütahya, Turkey
| | - İlknur Kaya
- Kütahya Health Sciences University, Faculty of Medicine, Chest Diseases Department, Kütahya, Turkey
| | - Ezgi Demirdöğen
- Uludağ University, Faculty of Medicine, Chest Diseases Department, Bursa, Turkey
| | | | - Ahmet Ursavaş
- Uludağ University, Faculty of Medicine, Chest Diseases Department, Bursa, Turkey
| | - Pınar Çelik
- Manisa Celal Bayar University, Faculty of Medicine, Chest Diseases Department, Manisa, Turkey
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Liu HC, Lin MH, Chang WC, Zeng RC, Wang YM, Sun CW. Rapid On-Site AI-Assisted Grading for Lung Surgery Based on Optical Coherence Tomography. Cancers (Basel) 2023; 15:5388. [PMID: 38001648 PMCID: PMC10670228 DOI: 10.3390/cancers15225388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/02/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
The determination of resection extent traditionally relies on the microscopic invasiveness of frozen sections (FSs) and is crucial for surgery of early lung cancer with preoperatively unknown histology. While previous research has shown the value of optical coherence tomography (OCT) for instant lung cancer diagnosis, tumor grading through OCT remains challenging. Therefore, this study proposes an interactive human-machine interface (HMI) that integrates a mobile OCT system, deep learning algorithms, and attention mechanisms. The system is designed to mark the lesion's location on the image smartly and perform tumor grading in real time, potentially facilitating clinical decision making. Twelve patients with a preoperatively unknown tumor but a final diagnosis of adenocarcinoma underwent thoracoscopic resection, and the artificial intelligence (AI)-designed system mentioned above was used to measure fresh specimens. Results were compared to FSs benchmarked on permanent pathologic reports. Current results show better differentiating power among minimally invasive adenocarcinoma (MIA), invasive adenocarcinoma (IA), and normal tissue, with an overall accuracy of 84.9%, compared to 20% for FSs. Additionally, the sensitivity and specificity, the sensitivity and specificity were 89% and 82.7% for MIA and 94% and 80.6% for IA, respectively. The results suggest that this AI system can potentially produce rapid and efficient diagnoses and ultimately improve patient outcomes.
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Affiliation(s)
- Hung-Chang Liu
- Section of Thoracic Surgery, Mackay Memorial Hospital, Taipei City 10449, Taiwan;
- Intensive Care Unit, Mackay Memorial Hospital, Taipei City 10449, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan
- Department of Optometry, Mackay Junior College of Medicine, Nursing, and Management, Taipei City 11260, Taiwan
| | - Miao-Hui Lin
- Biomedical Optical Imaging Lab, Department of Photonics, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu City 30010, Taiwan; (M.-H.L.); (R.-C.Z.); (Y.-M.W.)
| | - Wei-Chin Chang
- Department of Pathology, Mackay Memorial Hospital, New Taipei City 25160, Taiwan;
- Department of Pathology, Taipei Medical University Hospital, Taipei City 11030, Taiwan
- Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 11030, Taiwan
| | - Rui-Cheng Zeng
- Biomedical Optical Imaging Lab, Department of Photonics, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu City 30010, Taiwan; (M.-H.L.); (R.-C.Z.); (Y.-M.W.)
| | - Yi-Min Wang
- Biomedical Optical Imaging Lab, Department of Photonics, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu City 30010, Taiwan; (M.-H.L.); (R.-C.Z.); (Y.-M.W.)
| | - Chia-Wei Sun
- Biomedical Optical Imaging Lab, Department of Photonics, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu City 30010, Taiwan; (M.-H.L.); (R.-C.Z.); (Y.-M.W.)
- Institute of Biomedical Engineering, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu City 30010, Taiwan
- Medical Device Innovation and Translation Center, National Yang Ming Chiao Tung University, Taipei City 11259, Taiwan
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King J, Taylor M, Booton R, Crosbie P, Shah D, Evison M, Ng C, Rammohan K, Shah R, Shackcloth M, Grant SW, Sinnott N. Safety of curative-intent lung cancer surgery in older patients (octogenarians): A contemporary multicentre cohort study. J Geriatr Oncol 2023; 14:101635. [PMID: 37812970 DOI: 10.1016/j.jgo.2023.101635] [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: 05/24/2023] [Revised: 09/01/2023] [Accepted: 09/18/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION Despite octogenarians representing an ever-increasing proportion of patients with lung cancer, there is a paucity of evidence describing outcomes after lung resection for these patients. We aimed to evaluate short and mid-term outcomes for octogenarians after lung resection. MATERIALS AND METHODS A total of 5,470 consecutive patients undergoing lung resection for primary lung cancer from 2012-2019 in two UK centres were included. Primary outcomes were perioperative, 90-day, and one-year mortality in the octogenarian vs. non-octogenarian cohort. Appropriate statistical tests were used to compare outcomes between octogenarian and non-octogenarian patients. Secondary outcomes were post-operative complications and to validate the performance of the Thoracoscore model in the octogenarian cohort. RESULTS Overall, 9.4% (n=513) of patients were aged ≥80. The rates of 90-day mortality, one-year mortality, and post-operative atrial fibrillation were significantly higher for octogenarians. The one-year mortality rate for octogenarians fell significantly over time (2012-2015: 16.5% vs 2016-2019: 10.2%, p=0.034). Subgroup analysis (2016-2019 only) demonstrated no significant difference in peri-operative, 90-day, or one-year mortality between octogenarian and non-octogenarian patients. Validation of the Thoracoscore model demonstrated modest discrimination and acceptable calibration. DISCUSSION Mortality for octogenarians fell significantly over time in this study. Indeed, when confined to the most recent time period, comparable rates of both 90-day and one-year mortality for octogenarian and non-octogenarian patients were seen. Whilst preventative strategies to reduce the incidence of post-operative atrial fibrillation in octogenarians should be considered, these findings demonstrate that following appropriate patient selection, octogenarians can safely undergo lung resection for lung cancer.
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Affiliation(s)
- Jenny King
- Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.
| | - Marcus Taylor
- Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Richard Booton
- Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Phil Crosbie
- Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Dinakshi Shah
- Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Matthew Evison
- Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Cassandra Ng
- Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Kandadai Rammohan
- Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Rajesh Shah
- Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Michael Shackcloth
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Stuart W Grant
- Division of Cardiovascular Sciences, University of Manchester, ERC, Manchester, UK
| | - Nicola Sinnott
- Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
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8
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Klarenbeek SE, Aarts MJ, van den Heuvel MM, Prokop M, Tummers M, Schuurbiers-Siebers OCJ. Impact of time-to-treatment on survival for early-stage non-small cell lung cancer in The Netherlands-a nationwide observational cohort study. Transl Lung Cancer Res 2023; 12:2015-2029. [PMID: 38025812 PMCID: PMC10654436 DOI: 10.21037/tlcr-23-256] [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: 04/17/2023] [Accepted: 08/29/2023] [Indexed: 12/01/2023]
Abstract
Background Varied outcomes on the relation between time-to-treatment and survival in early-stage non-small cell lung cancer (NSCLC) patients are reported. We examined this relation in a large multicentric retrospective cohort study and identified factors associated with extended time-to-treatment. Methods We included 9,536 patients with clinical stage I-II NSCLC, diagnosed and treated in 2014-2019, from the Netherlands Cancer Registry that includes nation-wide data. Time-to-treatment was defined as the number of days between first outpatient visit for suspected lung cancer and start of treatment. The effect of extended time-to-treatment beyond the first quartile and survival was studied with Cox proportional hazard regression. Analyses were stratified for stage and type of therapy. Time-to-treatment was adjusted for multiple covariates including performance status and socioeconomic status. Factors associated with treatment delay were identified by multilevel logistic regression. Results Median time-to-treatment was 47 days [interquartile range (IQR): 34-65] for stage I and 46 days (IQR: 34-62) for stage II. The first quartile extended to 33 days for both stages. Risk of death increased significantly with extended time-to-treatment for surgical treatment of clinical stage II patients [adjusted hazard ratio (aHR) >33 days: 1.36, 95% confidence intervals (CI): 1.09-1.70], but not in stage II patients treated with radiotherapy or in stage I patients. Causes of prolonged time-to-treatment were multifactorial including diagnostic tests, such as endoscopic ultrasound (EUS) or endobronchial ultrasound (EBUS). Conclusions Clinical stage II patients benefit from fast initiation of surgical treatment. Surprisingly this appears to be accounted for by patients who are clinically stage II but pathologically stage I. Further study is needed on characterizing these patients and the significance of lymph node- or distant micrometastasis in guiding time-to-treatment and treatment strategy.
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Affiliation(s)
- Sosse E. Klarenbeek
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mieke J. Aarts
- Netherlands Cancer Registry, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Michel M. van den Heuvel
- Department of Pulmonary Diseases, Radboud Institute for Molecular Life Sciences, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mathias Prokop
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcia Tummers
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Olga C. J. Schuurbiers-Siebers
- Department of Pulmonary Diseases, Radboud Institute for Molecular Life Sciences, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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9
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Rodriguez-Lara V, Soca-Chafre G, Avila-Costa MR, Whaley JJJV, Rodriguez-Cid JR, Ordoñez-Librado JL, Rodriguez-Maldonado E, Heredia-Jara NA. Role of sex and sex hormones in PD-L1 expression in NSCLC: clinical and therapeutic implications. Front Oncol 2023; 13:1210297. [PMID: 37941543 PMCID: PMC10628781 DOI: 10.3389/fonc.2023.1210297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/28/2023] [Indexed: 11/10/2023] Open
Abstract
Currently, immunotherapy based on PD-1/PD-L1 pathway blockade has improved survival of non-small cell lung cancer (NSCLC) patients. However, differential responses have been observed by sex, where men appear to respond better than women. Additionally, adverse effects of immunotherapy are mainly observed in women. Studies in some types of hormone-dependent cancer have revealed a role of sex hormones in anti-tumor response, tumor microenvironment and immune evasion. Estrogens mainly promote immune tolerance regulating T-cell function and modifying tumor microenvironment, while androgens attenuate anti-tumor immune responses. The precise mechanism by which sex and sex hormones may modulate immune response to tumor, modify PD-L1 expression in cancer cells and promote immune escape in NSCLC is still unclear, but current data show how sexual differences affect immune therapy response and prognosis. This review provides update information regarding anti-PD-1/PD-L immunotherapeutic efficacy in NSCLC by sex, analyzing potential roles for sex hormones on PD-L1 expression, and discussing a plausible of sex and sex hormones as predictive response factors to immunotherapy.
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Affiliation(s)
- Vianey Rodriguez-Lara
- Department of Cell and Tissue Biology, Faculty of Medicine, UNAM, Mexico City, Mexico
| | - Giovanny Soca-Chafre
- Oncological Diseases Research Unit (UIEO), Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Maria Rosa Avila-Costa
- Neuromorphology Laboratory, Facultad de Estudios Superiores Iztacala, UNAM, Mexico City, Mexico
| | | | | | | | - Emma Rodriguez-Maldonado
- Traslational Medicine Laboratory, Research Unit UNAM-INC, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
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10
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Earnest A, Tesema GA, Stirling RG. Machine Learning Techniques to Predict Timeliness of Care among Lung Cancer Patients. Healthcare (Basel) 2023; 11:2756. [PMID: 37893830 PMCID: PMC10606192 DOI: 10.3390/healthcare11202756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 09/27/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Delays in the assessment, management, and treatment of lung cancer patients may adversely impact prognosis and survival. This study is the first to use machine learning techniques to predict the quality and timeliness of care among lung cancer patients, utilising data from the Victorian Lung Cancer Registry (VLCR) between 2011 and 2022, in Victoria, Australia. Predictor variables included demographic, clinical, hospital, and geographical socio-economic indices. Machine learning methods such as random forests, k-nearest neighbour, neural networks, and support vector machines were implemented and evaluated using 20% out-of-sample cross validations via the area under the curve (AUC). Optimal model parameters were selected based on 10-fold cross validation. There were 11,602 patients included in the analysis. Evaluated quality indicators included, primarily, overall proportion achieving "time from referral date to diagnosis date ≤ 28 days" and proportion achieving "time from diagnosis date to first treatment date (any intent) ≤ 14 days". Results showed that the support vector machine learning methods performed well, followed by nearest neighbour, based on out-of-sample AUCs of 0.89 (in-sample = 0.99) and 0.85 (in-sample = 0.99) for the first indicator, respectively. These models can be implemented in the registry databases to help healthcare workers identify patients who may not meet these indicators prospectively and enable timely interventions.
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Affiliation(s)
- Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia;
| | | | - Robert G. Stirling
- Department of Respiratory Medicine, Alfred Health, Melbourne, VIC 3004, Australia;
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3168, Australia
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11
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Gysling S, Morgan H, Ifesemen OS, West D, Conibear J, Navani N, O'Dowd EL, Baldwin DR, Humes D, Hubbard R. The Impact of COVID-19 on Lung Cancer Incidence in England: Analysis of the National Lung Cancer Audit 2019 and 2020 Rapid Cancer Registration Datasets. Chest 2023; 163:1599-1607. [PMID: 36640995 PMCID: PMC9833851 DOI: 10.1016/j.chest.2023.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 12/20/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has caused significant disruption to health-care services and delivery worldwide. The impact of the pandemic and associated national lockdowns on lung cancer incidence in England have yet to be assessed. RESEARCH QUESTION What was the impact of the first year of the COVID-19 pandemic on the incidence and presentation of lung cancer in England? STUDY DESIGN AND METHODS In this retrospective observational study, incidence rates for lung cancer were calculated from The National Lung Cancer Audit Rapid Cancer Registration Datasets for 2019 and 2020, using midyear population estimates from the Office of National Statistics as the denominators. Rates were compared using Poisson regression according to time points related to national lockdowns in 2020. RESULTS Sixty-four thousand four hundred fifty-seven patients received a diagnosis of lung cancer across 2019 (n = 33,088) and 2020 (n = 31,369). During the first national lockdown, a 26% reduction in lung cancer incidence was observed compared with the equivalent calendar period of 2019 (adjusted incidence rate ratio [IRR], 0.74; 95% CI, 0.71-0.78). This included a 23% reduction in non-small cell lung cancer (adjusted IRR, 0.77; 95% CI, 0.74-0.81) and a 45% reduction in small cell lung cancer (adjusted IRR, 0.55; 95% CI, 0.46-0.65) incidence. Thereafter, incidence rates almost recovered to baseline, without overcompensation (adjusted IRR, 0.96; 95% CI, 0.94-0.98). INTERPRETATION The incidence rates of lung cancer in England fell significantly by 26% during the first national lockdown in 2020 and did not compensate later in the year.
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Affiliation(s)
- Savannah Gysling
- Lifespan and Population Health, University of Nottingham, Nottingham, England.
| | - Helen Morgan
- Lifespan and Population Health, University of Nottingham, Nottingham, England
| | | | - Douglas West
- Department of Thoracic Surgery, University Hospitals Bristol and Weston NHS Trust, Bristol, England
| | - John Conibear
- Department of Clinical Oncology, Barts Health NHS Trust, London, England
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, England; Department of Thoracic Medicine, University College London Hospitals NHS Trust, London, England
| | - Emma Louise O'Dowd
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, City Hospital, Nottingham, England
| | - David R Baldwin
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, City Hospital, Nottingham, England
| | - David Humes
- Gastrointestinal Surgery, Gastrointestinal and Liver Theme, National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham School of Medicine, Queen's Medical Centre, Nottingham, England
| | - Richard Hubbard
- Lifespan and Population Health, University of Nottingham, Nottingham, England; Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, City Hospital, Nottingham, England
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12
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Damsees R, Jaghbir M, Salam M, Al-Omari A, Al-Rawashdeh N. Unravelling the predictors of late cancer presentation and diagnosis in Jordan: a cross-sectional study of patients with lung and colorectal cancers. BMJ Open 2023; 13:e069529. [PMID: 37130680 PMCID: PMC10163555 DOI: 10.1136/bmjopen-2022-069529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVES Late presentation or diagnosis of cancer results in a poor clinical prognosis, negatively affects treatment and subsequently lowers one's chances of survival. This study aimed to identify the factors associated with late lung and colorectal cancer presentation and diagnosis in Jordan. DESIGN This correlational cross-sectional study was based on face-to-face interviews and medical chart reviews from a cancer registry database. A structured questionnaire based on a review of the literature was used. SETTING AND PARTICIPANTS The study participants were a representative sample of adult patients with colorectal or lung cancer who visited the outpatient clinics at King Hussein Cancer Center in Amman, Jordan, between January 2019 and December 2020, to get their first medical consultation. RESULTS 382 study participants were surveyed, with a response rate of 82.3%. Of these, 162 (42.2%) reported a late presentation and 92 (24.1%) reported a late diagnosis of cancer. The results of backward multivariate logistic regression analyses showed that female gender and not seeking a medical advice when feeling ill combined was associated with an almost three times increased likelihood of reporting a late presentation with cancer (adjusted OR 2.97, 95% CI 1.19 to 7.43). Not having health insurance and not seeking medical advice combined was also associated with late presentation (2.5, 95% CI 1.02 to 6.12). For lung cancer, Jordanians living in rural areas were 9.29 (95% CI 2.46 to 35.1) times more likely to report late diagnosis. Jordanians who did not screen for cancer in the past were 7.02 (95% CI 1.69 to 29.18) times more likely to report late diagnosis. For colorectal cancer, those having no previous knowledge about cancers or screening programmes had increased odds of reporting late diagnosis (2.30, 95% CI 1.06 to 4.97). CONCLUSIONS This study highlights important factors associated with the late presentation and diagnosis of colorectal and lung cancers in Jordan. Investing in national screening and early detection programmes as well as public outreach and awareness campaigns will have a significant impact on early detection to improve treatment outcomes.
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Affiliation(s)
- Rana Damsees
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
- Department of Science, Technology and Research, UAE Ministry of Education, Abu Dhabi, UAE
| | - Madi Jaghbir
- Department of Family and Community Medicine, The University of Jordan, Amman, Jordan
| | - Mahmoud Salam
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | - Amal Al-Omari
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Nedal Al-Rawashdeh
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
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13
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Rak O, Urban D, Perlman S, Ziv-Baran T, Katorza E. Fast vs. Regular Track for Lung and Pancreatic Cancer Diagnosis-Time from Initial Finding to Final Diagnosis and Patient Survival. J Med Syst 2023; 47:48. [PMID: 37060494 DOI: 10.1007/s10916-023-01939-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 03/16/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Health systems around the world have begun implementing unique tracks to expedite diagnosis and improve survival of patients with suspected cancers. This study aimed to compare characteristics and survival between patients diagnosed by way of fast and regular diagnostic tracks. METHODS A historical cohort study of patients (age ≥ 18) diagnosed with lung or pancreatic cancers between 09/2017 and 03/2020 on a fast diagnostic track and treated in a tertiary hospital versus a random sample of patients with the same cancer types who began treatment in the hospital over the same period of time after being diagnosed utilizing the regular track in the community. RESULTS The study included 336 patients (108 fast-track diagnostics, 228 regular track diagnostics). Advanced stages III-IV at diagnosis were more likely in the fast-track group (94.4% vs. 81.1%, p = 0.001). The median time from initial cancer suspicion to diagnosis was 21 days (IQR 14-37) for the fast-track vs. 31 days (IQR 18-51) for the regular track (p < 0.001). During the follow-up period, 56 patients from the fast-track and 131 patients from the regular track died. No significant difference was found in the median survival time between the fast and regular tracks, whether from the onset of symptoms, diagnosis, or treatment initiation. CONCLUSION Patients referred to the fast-track were more likely to be diagnosed at a further advanced stage of their cancer. The fast-track shortened the time until diagnosis and treatment but no difference was found in median survival between the tracks, perhaps due to late referral and high fatality rates.
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Affiliation(s)
- Orit Rak
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Center for Fast Diagnosis of Cancer, Sheba Medical Center, Ramat Gan, Israel
| | - Damien Urban
- Center for Fast Diagnosis of Cancer, Sheba Medical Center, Ramat Gan, Israel
| | - Saritte Perlman
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Ziv-Baran
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Eldad Katorza
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
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14
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Chittasupho C, Athikomkulchai S, Samee W, Na Takuathung M, Yooin W, Sawangrat K, Saenjum C. Phenylethanoid Glycoside-Enriched Extract Prepared from Clerodendrum chinense Leaf Inhibits A549 Lung Cancer Cell Migration and Apoptosis Induction through Enhancing ROS Production. Antioxidants (Basel) 2023; 12:antiox12020461. [PMID: 36830019 PMCID: PMC9952440 DOI: 10.3390/antiox12020461] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023] Open
Abstract
This study aims to investigate the antioxidant and anti-cancer activities of Clerodendrum chinense leaf ethanolic extract. The phenylethanoid glycoside-enriched extract, namely verbascoside and isoverbascoside, was determined in the ethanolic C. chinense leaf extract using the validated HPLC method. The ethanolic extract showed DPPH and ABTS free radical scavenging activities with the IC50 values of 334.2 ± 45.48 μg/mL and 1012.77 ± 61.86 µg/mL, respectively, and a FRAP value of 88.73 ± 4.59 to 2480.81 ± 0.00 µM. C. chinense leaf extract exhibited anti-proliferative activity against A549 lung cancer cells in a dose- and time-dependent manner, with the IC50 value of 340.63 ± 89.43, 210.60 ± 81.74, and 107.08 ± 28.90 µg/mL after treatment for 24, 48, and 72 h, respectively. The IC50 values of verbascoside, isoverbascoside, and hispidulin were 248.40 ± 15.82, 393.10 ± 15.27, and 3.86 ± 0.87 µg/mL, respectively, indicating that the anti-proliferative effects of the C. chinense leaf extract mainly resulted from hispidulin and verbascoside. The selectivity index (SI) of C. chinense leaf extract against A549 lung cancer cells vs. normal keratinocytes were 2.4 and 2.8 after incubation for 24 and 48 h, respectively, suggesting the cytotoxic selectivity of the extract toward the cancer cell line. Additionally, the C. chinense leaf extract at 250 µg/mL induced late apoptotic cells up to 21.67% with enhancing reactive oxygen species (ROS) induction. Furthermore, the lung cancer cell colony formation was significantly inhibited after being treated with C. chinense leaf extract in a dose-dependent manner. The C. chinense leaf extract at 250 µg/mL has also shown to significantly inhibit cancer cell migration compared with the untreated group. The obtained results provide evidence of the anti-lung cancer potentials of the C. chinense leaf ethanolic extract.
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Affiliation(s)
- Chuda Chittasupho
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Chiang Mai University, Mueang, Chiang Mai 50200, Thailand
| | - Sirivan Athikomkulchai
- Department of Pharmacognosy, Faculty of Pharmacy, Srinakharinwirot University, Ongkharak, Nakhon Nayok 26120, Thailand
| | - Weerasak Samee
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Srinakharinwirot University, Ongkharak, Nakhon Nayok 26120, Thailand
| | - Mingkwan Na Takuathung
- Department of Pharmacology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Clinical Research Center for Food and Herbal Product Trials and Development (CR-FAH), Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Wipawadee Yooin
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Chiang Mai University, Mueang, Chiang Mai 50200, Thailand
- Center of Excellence for Innovation in Analytical Science and Technology for Biodiversity-Based Economic and Society (I-ANALY-S-T_B.BES-CMU), Chiang Mai University, Chiang Mai 50200, Thailand
| | - Kasirawat Sawangrat
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Chiang Mai University, Mueang, Chiang Mai 50200, Thailand
- Center of Excellence for Innovation in Analytical Science and Technology for Biodiversity-Based Economic and Society (I-ANALY-S-T_B.BES-CMU), Chiang Mai University, Chiang Mai 50200, Thailand
| | - Chalermpong Saenjum
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Chiang Mai University, Mueang, Chiang Mai 50200, Thailand
- Center of Excellence for Innovation in Analytical Science and Technology for Biodiversity-Based Economic and Society (I-ANALY-S-T_B.BES-CMU), Chiang Mai University, Chiang Mai 50200, Thailand
- Correspondence: ; Tel.: +66-5394-4342; Fax: +66-5394-4390
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15
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Blum TG, Morgan RL, Durieux V, Chorostowska-Wynimko J, Baldwin DR, Boyd J, Faivre-Finn C, Galateau-Salle F, Gamarra F, Grigoriu B, Hardavella G, Hauptmann M, Jakobsen E, Jovanovic D, Knaut P, Massard G, McPhelim J, Meert AP, Milroy R, Muhr R, Mutti L, Paesmans M, Powell P, Putora PM, Rawlinson J, Rich AL, Rigau D, de Ruysscher D, Sculier JP, Schepereel A, Subotic D, Van Schil P, Tonia T, Williams C, Berghmans T. European Respiratory Society guideline on various aspects of quality in lung cancer care. Eur Respir J 2023; 61:13993003.03201-2021. [PMID: 36396145 DOI: 10.1183/13993003.03201-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 09/23/2022] [Indexed: 11/18/2022]
Abstract
This European Respiratory Society guideline is dedicated to the provision of good quality recommendations in lung cancer care. All the clinical recommendations contained were based on a comprehensive systematic review and evidence syntheses based on eight PICO (Patients, Intervention, Comparison, Outcomes) questions. The evidence was appraised in compliance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Evidence profiles and the GRADE Evidence to Decision frameworks were used to summarise results and to make the decision-making process transparent. A multidisciplinary Task Force panel of lung cancer experts formulated and consented the clinical recommendations following thorough discussions of the systematic review results. In particular, we have made recommendations relating to the following quality improvement measures deemed applicable to routine lung cancer care: 1) avoidance of delay in the diagnostic and therapeutic period, 2) integration of multidisciplinary teams and multidisciplinary consultations, 3) implementation of and adherence to lung cancer guidelines, 4) benefit of higher institutional/individual volume and advanced specialisation in lung cancer surgery and other procedures, 5) need for pathological confirmation of lesions in patients with pulmonary lesions and suspected lung cancer, and histological subtyping and molecular characterisation for actionable targets or response to treatment of confirmed lung cancers, 6) added value of early integration of palliative care teams or specialists, 7) advantage of integrating specific quality improvement measures, and 8) benefit of using patient decision tools. These recommendations should be reconsidered and updated, as appropriate, as new evidence becomes available.
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Affiliation(s)
- Torsten Gerriet Blum
- Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Valérie Durieux
- Bibliothèque des Sciences de la Santé, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Joanna Chorostowska-Wynimko
- Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - David R Baldwin
- Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | | | - Corinne Faivre-Finn
- Division of Cancer Sciences, University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | | | | | - Bogdan Grigoriu
- Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Georgia Hardavella
- Department of Respiratory Medicine, King's College Hospital London, London, UK
- Department of Respiratory Medicine and Allergy, King's College London, London, UK
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Neuruppin, Germany
| | - Erik Jakobsen
- Department of Thoracic Surgery, Odense University Hospital, Odense, Denmark
| | | | - Paul Knaut
- Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Gilbert Massard
- Faculty of Science, Technology and Medicine, University of Luxembourg and Department of Thoracic Surgery, Hôpitaux Robert Schuman, Luxembourg, Luxembourg
| | - John McPhelim
- Lung Cancer Nurse Specialist, Hairmyres Hospital, NHS Lanarkshire, East Kilbride, UK
| | - Anne-Pascale Meert
- Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Robert Milroy
- Scottish Lung Cancer Forum, Glasgow Royal Infirmary, Glasgow, UK
| | - Riccardo Muhr
- Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Luciano Mutti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- SHRO/Temple University, Philadelphia, PA, USA
| | - Marianne Paesmans
- Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Paul Martin Putora
- Departments of Radiation Oncology, Kantonsspital St Gallen, St Gallen and University of Bern, Bern, Switzerland
| | | | - Anna L Rich
- Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | - David Rigau
- Iberoamerican Cochrane Center, Barcelona, Spain
| | - Dirk de Ruysscher
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
- Erasmus Medical Center, Department of Radiation Oncology, Rotterdam, The Netherlands
| | - Jean-Paul Sculier
- Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Arnaud Schepereel
- Pulmonary and Thoracic Oncology, Université de Lille, Inserm, CHU Lille, Lille, France
| | - Dragan Subotic
- Clinic for Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Thierry Berghmans
- Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
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16
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Yankelevitz DF, Yip R, Henschke CI. Impact of Duration of Diagnostic Workup on Prognosis for Early Lung Cancer. J Thorac Oncol 2023; 18:527-537. [PMID: 36642158 DOI: 10.1016/j.jtho.2022.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/18/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Growth assessment for pulmonary nodules is an important diagnostic tool; however, the impact on prognosis due to time delay for follow-up diagnostic scans needs to be considered. METHODS Using the data between 2003 and 2019 from the International Early Lung Cancer Action Program, a prospective cohort study, we determined the size-specific, 10-year Kaplan-Meier lung cancer (LC) survival rates as surrogates for cure rates. We estimated the change in LC diameter after delays of 90, 180, and 365 days using three representative LC volume doubling times (VDTs) of 60 (fast), 120 (moderate), and 240 (slow). We then estimated the decrease in the LC cure rate resulting from time between computed tomography scans to assess for growth during the diagnostic workup. RESULTS Using a regression model of the 10-year LC survival rates on LC diameter, the estimated LC cure rate of a 4.0 mm LC with fast (60-d) VDT is 96.0% (95% confidence interval [CI]: 95.2%-96.7%) initially, but it would decrease to 94.3% (95% CI: 93.2%-95.0%), 92.0% (95% CI: 90.5%-93.4%), and 83.6%(95% CI: 80.6%-86.6%) after delays of 90, 180, and 365 days, respectively. A 20.0-mm LC with the same VDTs has a lower LC cure rate of 79.9% (95% CI: 76.2%-83.5%) initially and decreases more rapidly to 71.5% (95% CI: 66.4%-76.7%), 59.8% (95% CI: 52.4%-67.1%), and 17.9% (95% CI: 3.0%-32.8%) after the same delays of 90, 180, and 365 days, respectively. CONCLUSIONS Time between scans required to measure growth of lung nodules affects prognosis with the effect being greater for fast growing and larger cancers. Quantifying the extent of change in prognosis is required to understand efficiencies of different management protocols.
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Affiliation(s)
- David F Yankelevitz
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Rowena Yip
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Claudia I Henschke
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
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17
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Muslim Z, Stroever S, Razi SS, Poulikidis K, Baig MZ, Connery CP, Bhora FY. Increasing Time-to-Treatment for Lung Cancer: Are We Going Backward? Ann Thorac Surg 2023; 115:192-199. [PMID: 35780818 DOI: 10.1016/j.athoracsur.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 04/26/2022] [Accepted: 06/06/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Treatment delays in lung cancer care in the United States may be attributable to a diverse range of patient, provider, and institutional factors, the precise contributions of which remain unclear. The objective of our study was to use the National Cancer Database to investigate specific predictors of increased time-to-treatment initiation. METHODS We identified 567 783 patients undergoing treatment for stage I to stage IV non-small cell lung cancer during 2010 to 2018. Time-to-treatment initiation was defined as the number of days from radiologic diagnosis to initiation of first treatment. We used mixed effect negative binomial regression to determine predictors of time-to-treatment initiation. RESULTS We noted a steady rise in the overall mean time-to-treatment initiation interval from 33 days (2010) to 39 days (2018; P < .01). Black race, a later year at diagnosis, nonprivate insurance, and diagnosis and treatment at different facilities were independent predictors of increased time-to-treatment initiation, irrespective of disease stage. Compared with White race, Black race corresponded to a 15% to 20% increase in time-to-treatment initiation, depending on disease stage (P < .01). For stages I and II, radiation as first course of therapy corresponded with a 69% and 33% increase in time-to-treatment initiation, respectively, compared with surgery (P < .01). CONCLUSIONS Lung cancer treatment initiation times have seen an upward trajectory in recent years. Black patients encountered significantly longer treatment initiation times, regardless of treatment modality or disease stage. Prolonged initiation times appear to contribute to existing health care disparities by disproportionately affecting medically underserved communities.
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Affiliation(s)
- Zaid Muslim
- Division of Thoracic Surgery, Rudy L. Ruggles Biomedical Research Institute, Danbury, Connecticut.
| | - Stephanie Stroever
- Department of Research and Innovation, Nuvance Health, Danbury, Connecticut
| | - Syed S Razi
- Division of Thoracic Surgery, Department of Surgery, Memorial Healthcare System, Hollywood, Florida
| | | | - Mirza Zain Baig
- Division of Thoracic Surgery, Nuvance Health, Danbury, Connecticut
| | - Cliff P Connery
- Division of Thoracic Surgery, Nuvance Health, Poughkeepsie, New York
| | - Faiz Y Bhora
- Division of Thoracic Surgery, Rudy L. Ruggles Biomedical Research Institute, Danbury, Connecticut; Division of Thoracic Surgery, Nuvance Health, Danbury, Connecticut; Division of Thoracic Surgery, Nuvance Health, Poughkeepsie, New York
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18
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Min Y, Liu Z, Huang R, Li R, Jin J, Wei Z, He L, Pei Y, Li N, Su Y, Hu X, Peng X. Survival outcomes following treatment delays among patients with early-stage female cancers: a nationwide study. J Transl Med 2022; 20:560. [PMID: 36463201 PMCID: PMC9719121 DOI: 10.1186/s12967-022-03719-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/21/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) severely hindered the timely receipt of health care for patients with cancer, especially female patients. Depression and anxiety were more pronounced in female patients than their male counterparts with cancer during treatment wait-time intervals. Herein, investigating the impact of treatment delays on the survival outcomes of female patients with early-stage cancers can enhance the rational and precise clinical decisions of physicians. METHODS We analyzed five types of cancers in women from the Surveillance, Epidemiology, and End Results (SEER) program between Jan 2010 and Dec 2015. Univariate and multivariate Cox regression analyses were used to determine the impacts of treatment delays on the overall survival (OS) and cancer-specific survival (CSS) of the patients. RESULTS A total of 241,661 females with early-stage cancer were analyzed (12,617 cases of non-small cell lung cancer (NSCLC), 166,051 cases of infiltrating breast cancer, 31,096 cases of differentiated thyroid cancer, 23,550 cases of colorectal cancer, and 8347 cases of cervical cancer). Worse OS rates were observed in patients with treatment delays ≥ 3 months in stage I NSCLC (adjustedHazard ratio (HR) = 1.11, 95% Confidence Interval (CI): 1.01-1.23, p = 0.044) and stage I infiltrating breast cancer (adjustedHR = 1.23, 95% CI 1.11-1.37, p < 0.001). When the treatment delay intervals were analyzed as continuous variables, similar results were observed in patients with stage I NSCLC (adjustedHR = 1.04, 95% CI 1.01-1.06, p = 0.010) and in those with stage I breast cancer (adjustedHR = 1.03, 95% CI 1.00-1.06, p = 0.029). However, treatment delays did not reduce the OS of patients with differentiated thyroid cancer, cervical cancer, or colorectal cancer in the early-stage. Only intermediate treatment delays impaired the CSS of patients with cervical cancer in stage I (adjustedHR = 1.31, 95% CI 1.02-1.68, p = 0.032). CONCLUSION After adjusting for confounders, the prolonged time from diagnosis to the initiation of treatment (< 6 months) showed limited negative effects on the survival of most of the patients with early-stage female cancers. Whether our findings serve as evidence supporting the treatment deferral decisions of clinicians for patients with different cancers in resource-limited situations needs further validation.
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Affiliation(s)
- Yu Min
- grid.13291.380000 0001 0807 1581Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Zheran Liu
- grid.13291.380000 0001 0807 1581Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Rendong Huang
- grid.506977.a0000 0004 1757 7957School of Nursing, Hangzhou Medical College, Hangzhou, Zhejiang China
| | - Ruidan Li
- grid.13291.380000 0001 0807 1581Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Jing Jin
- grid.13291.380000 0001 0807 1581Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Zhigong Wei
- grid.13291.380000 0001 0807 1581Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Ling He
- grid.13291.380000 0001 0807 1581Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Yiyan Pei
- grid.13291.380000 0001 0807 1581Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Ning Li
- grid.410745.30000 0004 1765 1045Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu China
| | - Yongllin Su
- grid.13291.380000 0001 0807 1581Department of Rehabilitation, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Xiaolin Hu
- grid.13291.380000 0001 0807 1581West China School of Nursing, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
| | - Xingchen Peng
- grid.13291.380000 0001 0807 1581Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 Sichuan China
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19
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Hesso I, Kayyali R, Charalambous A, Lavdaniti M, Stalika E, Lelegianni M, Nabhani-Gebara S. Experiences of cancer survivors in Europe: Has anything changed? Can artificial intelligence offer a solution? Front Oncol 2022; 12:888938. [PMID: 36185207 PMCID: PMC9515410 DOI: 10.3389/fonc.2022.888938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Cancer is a major global health issue. Despite technological advancements in oncology, challenges remain in many aspects related to cancer management. This study constitutes one part of the user requirement definition of INCISIVE EU H2020 project, which has been designed to explore the full potential of artificial intelligence (AI) based technologies in cancer imaging. The study aimed to explore cancer survivors’ experiences of cancer care in five European countries. Methods A qualitative study employing semi-structured interviews was conducted. A purposive sampling strategy was used to recruit participants across the five validation countries of INCISIVE project: Greece, Cyprus, Spain, Italy, and Serbia. Forty cancer survivors were interviewed between November 2020 and March 2021. Data was analysed thematically using the framework approach and coded using NVivo12 software. Results The analysis yielded several gaps within the cancer care pathway which reflected on the participants experiences. Five key themes were revealed; (1) perceived challenges during the cancer journey, (2) the importance of accurate and prompt diagnosis, (3) perceived need for improving cancer diagnosis, (4) absence of well-established/designated support services within the pathway and (5) suggestions to improve cancer care pathway. Conclusion Cancer survivors experienced significant burdens pertaining to cancer diagnosis and treatment. Our findings underscored some main gaps within the cancer care pathway which contributed to the challenges articulated by the participants including lack of resources and delays in diagnostic and treatment intervals. Additionally, several suggestions were provided by the cancer survivors which could be considered towards the improvement of the current state of care, some of which can be optimised using new technologies involving AI such as the one proposed by INCISIVE.
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Affiliation(s)
- Iman Hesso
- School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames, United Kingdom
| | - Reem Kayyali
- School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames, United Kingdom
| | | | - Maria Lavdaniti
- Nursing Department, International Hellenic University, Thessaloniki, Greece
| | - Evangelia Stalika
- Nursing Department, International Hellenic University, Thessaloniki, Greece
- School of medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Lelegianni
- School of medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Shereen Nabhani-Gebara
- School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames, United Kingdom
- *Correspondence: Shereen Nabhani-Gebara,
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20
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Hall H, Tocock A, Burdett S, Fisher D, Ricketts WM, Robson J, Round T, Gorolay S, MacArthur E, Chung D, Janes SM, Peake MD, Navani N. Association between time-to-treatment and outcomes in non-small cell lung cancer: a systematic review. Thorax 2022; 77:762-768. [PMID: 34404753 PMCID: PMC9340041 DOI: 10.1136/thoraxjnl-2021-216865] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/16/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND National targets for timely diagnosis and management of a potential cancer are driven in part by the perceived risk of disease progression during avoidable delays. However, it is unclear to what extent time-to-treatment impacts prognosis for patients with non-small cell lung cancer, with previous reviews reporting mixed or apparently paradoxical associations. This systematic review focuses on potential confounders in order to identify particular patient groups which may benefit most from timely delivery of care. METHODS Medline, EMBASE and Cochrane databases were searched for publications between January 2012 and October 2020, correlating timeliness in secondary care pathways to patient outcomes. The protocol is registered with PROSPERO (the International Prospective Register of Systematic Reviews; ID 99239). Prespecified factors (demographics, performance status, histology, stage and treatment) are examined through narrative synthesis. RESULTS Thirty-seven articles were included. All but two were observational. Timely care was generally associated with a worse prognosis in those with advanced stage disease (6/8 studies) but with better outcomes for patients with early-stage disease treated surgically (9/12 studies). In one study, patients with squamous cell carcinoma referred for stereotactic ablative radiotherapy benefited more from timely care, compared with patients with adenocarcinoma. One randomised controlled trial supported timeliness as being advantageous in those with stage I-IIIA disease. CONCLUSION There are limitations to the available evidence, but observed trends suggest timeliness to be of particular importance in surgical candidates. In more advanced disease, survival trends are likely outweighed by symptom burden, performance status or clinical urgency dictating timeliness of treatment.
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Affiliation(s)
- Helen Hall
- Lungs for Living Research Centre, UCL Respiratory, UCL, London, UK
| | - Adam Tocock
- Barts Health Knowledge and Library Services, Barts Health NHS Trust, London, UK
| | | | - David Fisher
- MRC Clinical Trials Unit at UCL, UCL, London, UK
| | | | - John Robson
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Thomas Round
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Sarita Gorolay
- XX Place Health Centre, London Borough of Tower Hamlets, London, UK
| | - Emma MacArthur
- Centre for Cancer Outcomes, North Central and North East London Cancer Alliances, University College London Hospitals NHS Foundation Trust, London, UK
| | - Donna Chung
- Centre for Cancer Outcomes, North Central and North East London Cancer Alliances, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, UCL, London, UK
| | - Michael D Peake
- Centre for Cancer Outcomes, North Central and North East London Cancer Alliances, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Respiratory Medicine, University of Leicester, Leicester, UK
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, UCL, London, UK
- Department of Thoracic Medicine, University College London Hospital, London, UK
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21
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Finley C, Begum H, Akhtar-Danesh GG, Akhtar-Danesh N. Survival effects of time to surgery for Stage I lung cancer: A population-based study. Surg Oncol 2022; 42:101744. [DOI: 10.1016/j.suronc.2022.101744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 02/25/2022] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
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22
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Romine PE, Sun Q, Fedorenko C, Li L, Tang M, Eaton KD, Goulart BHL, Martins RG. Impact of Diagnostic Delays on Lung Cancer Survival Outcomes: A Population Study of the US SEER-Medicare Database. JCO Oncol Pract 2022; 18:e877-e885. [PMID: 35119911 DOI: 10.1200/op.21.00485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Time from diagnosis to treatment has been associated with worse survival outcomes in non-small-cell lung cancer (NSCLC). However, little is known about the impact of delay in time to diagnosis. We aimed to evaluate the impact of time from radiographic suspicion to histologic diagnosis on survival outcomes using the US SEER-Medicare population database. METHODS We identified patients from the SEER-Medicare data set diagnosed with any stage NSCLC between January 1, 2011, and December 31, 2015, who received stage-appropriate treatment and had a computed tomography scan within 1 year of diagnosis. Time to confirmation was determined as the interval between most recent computed tomography imaging and date of histologic diagnosis. Our primary outcome was overall survival (OS). RESULTS In total, 10,824 eligible patients were identified. The median time to confirmation was 20 (range 0-363) days. Using multivariate Cox regression models, longer time to confirmation was associated with improved OS in all comers driven by stage IV patients after adjustment for age, sex, diagnosis year, histology, and comorbidity index. In a separate landmark analysis excluding patients deceased within 6 months of diagnosis, the association between time to diagnosis and survival was no longer evident. CONCLUSION Time to confirmation of NSCLC was inversely associated with OS in this US SEER population study. This association was lost when patients deceased within 6 months of diagnosis were excluded, suggesting that retrospective registry-claims databases may not be the optimal data source to study time to diagnosis as a quality metric because of the unaccounted confounding effects of tumor behavior. Prospective evaluations of clinically enriched data sources may better serve this purpose.
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Affiliation(s)
- Perrin E Romine
- Division of Medical Oncology, University of Washington, Seattle, WA
| | - Qin Sun
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Catherine Fedorenko
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Li Li
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Mariel Tang
- Georgetown University Law Center/Johns Hopkins Bloomberg School of Public Health, Washington, DC
| | - Keith D Eaton
- Division of Medical Oncology, University of Washington, Seattle, WA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Renato G Martins
- Division of Medical Oncology, University of Washington, Seattle, WA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
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23
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Huber RM, Cavic M, Kerpel-Fronius A, Viola L, Field J, Jiang L, Kazerooni EA, Koegelenberg CF, Mohan A, Sales dos Santos R, Ventura L, Wynes M, Yang D, Zulueta J, Lee CT, Tammemägi MC, Henschke CI, Lam S. Lung Cancer Screening Considerations During Respiratory Infection Outbreaks, Epidemics or Pandemics: An International Association for the Study of Lung Cancer Early Detection and Screening Committee Report. J Thorac Oncol 2022; 17:228-238. [PMID: 34864164 PMCID: PMC8639478 DOI: 10.1016/j.jtho.2021.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 11/07/2021] [Accepted: 11/10/2021] [Indexed: 02/02/2023]
Abstract
After the results of two large, randomized trials, the global implementation of lung cancer screening is of utmost importance. However, coronavirus disease 2019 infections occurring at heightened levels during the current global pandemic and also other respiratory infections can influence scan interpretation and screening safety and uptake. Several respiratory infections can lead to lesions that mimic malignant nodules and other imaging changes suggesting malignancy, leading to an increased level of follow-up procedures or even invasive diagnostic procedures. In periods of increased rates of respiratory infections from severe acute respiratory syndrome coronavirus 2 and others, there is also a risk of transmission of these infections to the health care providers, the screenees, and patients. This became evident with the severe acute respiratory syndrome coronavirus 2 pandemic that led to a temporary global stoppage of lung cancer and other cancer screening programs. Data on the optimal management of these situations are not available. The pandemic is still ongoing and further periods of increased respiratory infections will come, in which practical guidance would be helpful. The aims of this report were: (1) to summarize the data available for possible false-positive results owing to respiratory infections; (2) to evaluate the safety concerns for screening during times of increased respiratory infections, especially during a regional outbreak or an epidemic or pandemic event; (3) to provide guidance on these situations; and (4) to stimulate research and discussions about these scenarios.
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Affiliation(s)
- Rudolf M. Huber
- Division of Respiratory Medicine and Thoracic Oncology, Department of Medicine V, Ludwig-Maximilian-University of Munich, Thoracic Oncology Centre Munich, German Centre for Lung Research (DZL CPC-M), Munich, Germany,Corresponding author. Address for correspondence: Rudolf M. Huber, MD, PhD, Division of Respiratory Medicine and Thoracic Oncology, Department of Medicine V, Ludwig-Maximilians-University of Munich, Thoracic Oncology Centre Munich, German Centre for Lung Research (DZL CPC-M), Ziemssenstrasse 1, Munich, Bavaria D-80336 Germany
| | - Milena Cavic
- Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Anna Kerpel-Fronius
- Department of Radiology, National Korányi Institute for Pulmonology, Budapest, Hungary
| | - Lucia Viola
- Thoracic Oncology Unit, Fundación Neumológica Colombiana, Bogotá, Colombia
| | - John Field
- Roy Castle Lung Cancer Research Programme, The University of Liverpool, Department of Molecular and Clinical Cancer Medicine, Liverpool, United Kingdom
| | - Long Jiang
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, People’s Republic of China
| | - Ella A. Kazerooni
- Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan Medical School/Michigan Medicine, Ann Arbor, Michigan,Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School/Michigan Medicine, Ann Arbor, Michigan
| | - Coenraad F.N. Koegelenberg
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Anant Mohan
- Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Luigi Ventura
- Thoracic Surgery, Department of Medicine and Surgery, University Hospital of Parma, Italy
| | - Murry Wynes
- The International Association for the Study of Lung Cancer, Denver, Colorado
| | - Dawei Yang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Javier Zulueta
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine, New York, New York
| | - Choon-Taek Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seoul, South Korea
| | - Martin C. Tammemägi
- Prevention and Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada,Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Claudia I. Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stephen Lam
- Department of Integrative Oncology, BC Cancer and Department of Medicine, University of British Columbia, Vancouver, Canada
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Marshall T, Kalanjeri S, Almeida FA. Lung cancer staging, the established role of bronchoscopy. Curr Opin Pulm Med 2022; 28:17-30. [PMID: 34720099 DOI: 10.1097/mcp.0000000000000843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Lung cancer is the leading cause of cancer-related deaths worldwide. In the absence of distant metastases, accurate mediastinal nodal staging determines treatment approaches to achieve most favourable outcomes for patients. Mediastinal staging differentiates N0/N1 disease from N2/N3 in surgical candidates. Likewise, presence of nodal involvement in nonsurgical candidates who are being considered for stereotactic body radiation therapy is also critical. This review article seeks to discuss the current options available for mediastinal staging in nonsmall cell lung cancer (NSCLC), particularly the role of bronchoscopy. RECENT FINDINGS Although several techniques are available to stage the mediastinum, bronchoscopy with EBUS-TBNA with or without EUS-FNA appears to be superior in most clinical situations based on its ability to concomitantly diagnose and stage at once, safety, accessibility to the widest array of lymph node stations, cost and low risk of complications. However, training and experience are required to achieve consistent diagnostic accuracy with EBUS-TBNA. SUMMARY EBUS-TBNA with or without EUS-FNA is considered the modality of choice in the diagnosis and staging of NSCLC in both surgical and nonsurgical candidates.
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Affiliation(s)
- Tanya Marshall
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, Ohio
| | - Satish Kalanjeri
- Pulmonary and Critical Care Medicine, Harry S. Truman Memorial Veterans Hospital
- Pulmonary and Critical Care Medicine, University of Missouri School of Medicine, Columbia, Missouri
| | - Francisco Aecio Almeida
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Impact of the first surge of the coronavirus disease pandemic on general thoracic surgery practices in Kanagawa: a questionnaire survey by the Kanagawa General Thoracic Surgical Study Group. Gen Thorac Cardiovasc Surg 2021; 70:265-272. [PMID: 34714471 PMCID: PMC8554187 DOI: 10.1007/s11748-021-01724-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/19/2021] [Indexed: 12/01/2022]
Abstract
Objectives The first surge in severe acute respiratory syndrome coronavirus 2 infection had a significant impact on health care institutions. Understanding how the pandemic affected general thoracic surgery would provide valuable data for establishing a health care protocol for upcoming surges. Methods A questionnaire survey on coronavirus disease-related patient statistics and health care was conducted between February 2020 and June 2020 across 14 facilities affiliated with the Kanagawa General Thoracic Surgery Study Group. Results The average number of newly referred patients from February to June 2020 was 65% of that during the same period in 2019. Six facilities placed restrictions on medical care services, among which four restricted surgeries. At all institutions and those placed on surgical restriction, the total number of surgeries under general anesthesia was 92% and 78%, the total number of primary lung cancers was 94% and 86%, and the total number of surgeries for pneumothorax was 71% and 77% of that in the preceding year, respectively. Infection control and insufficient resources of the medical material were the most influential factors impacting the medical institutions’ decision to restrict the services provided. Conclusions Restrictions on surgery had a significant impact on the care provided by general thoracic surgery departments. To avoid patient inconvenience, establishing a collaborative system that refers patients to operational medical institutions in case of medical treatment restrictions may be useful. Supplementary Information The online version contains supplementary material available at 10.1007/s11748-021-01724-z.
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26
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Zuniga PVS, Ost DE. Impact of Delays in Lung Cancer Treatment on Survival. Chest 2021; 160:1934-1958. [PMID: 34425080 DOI: 10.1016/j.chest.2021.08.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/08/2021] [Accepted: 08/10/2021] [Indexed: 12/25/2022] Open
Abstract
Timely care is an important dimension of health care quality, but the impact of delays in care on lung cancer outcomes is unclear. Quantifying the impact of delays in cancer treatment on survival is necessary to inform resource allocation, quality improvement initiatives, and lung cancer guidelines. Review of the available literature demonstrated significant heterogeneity between studies in terms of the impact of delay. Frequently paradoxical results were reported, with delay being associated with improved survival in patients with advanced disease. However, significant methodologic flaws were identified in many studies, which probably is the reason for the paradoxical results. The most significant methodologic limitations identified were incorrectly controlling for final pathologic stage (a mediator in the causal chain from delay to survival), failure to control for confounding by acuity of cancer presentation, and failure to consider effect measure modification. The effect of delay on survival probably varies by stage. The impact of delays is lowest for subcentimeter nodules, probably highest in stage II disease, and low in patients who are only eligible for palliative care. Precise quantification of the impact of delay is not currently possible. Given the available evidence, quality metrics for the timeliness of lung cancer care should focus on local barriers to care. These metrics should be carefully designed to take into account clinical-radiographic stage at initial presentation.
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Affiliation(s)
- Paula Valeria Sainz Zuniga
- The University of Texas MD Anderson Cancer Center, Houston, TX; Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, Mexico
| | - David E Ost
- The University of Texas MD Anderson Cancer Center, Houston, TX.
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Yang MS, Park M, Back JH, Lee GH, Shin JH, Kim K, Seo HJ, Kim YA. Validation of Cancer Diagnosis Based on the National Health Insurance Service Database versus the National Cancer Registry Database in Korea. Cancer Res Treat 2021; 54:352-361. [PMID: 34353000 PMCID: PMC9016317 DOI: 10.4143/crt.2021.044] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 07/23/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose This study aimed to assess the feasibility of operational definitions of cancer patients in conducting cancer-related studies using the claims data from the National Health Insurance Service (NHIS). Materials and Methods Cancer incidence data were obtained from The Korean Central Cancer Registry (KCCR), NHIS primary diagnosis, and from the rare and intractable disease (RID) registration program. Results The operational definition with higher sensitivity for cancer patient verification was different by cancer type. Using primary diagnosis, the lowest sensitivity was found in colorectal cancer (91.5%; 95% confidence interval [CI], 91.7 to 92.0) and the highest sensitivity was found in breast cancer (97.9%; 95% CI, 97.8 to 98.0). With RID, sensitivity was the lowest in liver cancer (91.9%; 95% CI, 91.7 to 92.0) and highest in breast cancer (98.1%; 95% CI, 98.0 to 98.2). In terms of the difference in the date of diagnosis in the cancer registration data, > 80% of the patients showed a < 31-day difference from the RID definition. Conclusion Based on the health claims data, the operational definition of cancer incidence is more accurate when using the RID registration program claims compared to using the primary diagnosis despite the relatively less concordance by cancer type requires additional definitions such as treatment.
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Affiliation(s)
- Min Soo Yang
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Minae Park
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Joung Hwan Back
- Health Insurance Policy Research Institute, National Health Insurance Service, Wonju, Korea
| | - Gyeong Hyeon Lee
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Ji Hye Shin
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Kyuwoong Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Hwa Jeong Seo
- Medical Informatics and health Technology (MIT), Department of Health Care Management, Gachon University, Seongnam, Korea
| | - Young Ae Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
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Brade A, Jao K, Yu S, Cheema P, Doucette S, Christofides A, Schellenberg D. A Canadian Perspective on the Challenges for Delivery of Curative-Intent Therapy in Stage III Unresectable Non-Small Cell Lung Cancer. ACTA ACUST UNITED AC 2021; 28:1618-1629. [PMID: 33923355 PMCID: PMC8161772 DOI: 10.3390/curroncol28030151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 11/16/2022]
Abstract
Stage III non-small cell lung cancer (NSCLC) comprises a highly heterogenous group of patients with regards to patient fitness and tumour size and distribution, resulting in a wide range of treatment goals and therapy options. Curative-intent multimodality treatment should be considered in all patients with stage III NSCLC. For patients with unresectable disease who are fit, have adequate lung function, and have a disease that can be encompassed within a radical radiation volume, concurrent chemoradiation therapy (cCRT) is the standard of care and can produce cure rates of 20–30%. Recently, consolidation immunotherapy with durvalumab has been recognized as the standard of care following cCRT based on significant improvement rates in overall survival at 4 years. The large heterogeneity of the stage III NSCLC population, along with the need for extensive staging procedures, multidisciplinary care, intensive cCRT, and now consolidation therapy makes the delivery of timely and optimal treatment for these patients complex. Several logistical, communication, and education factors hinder the delivery of guideline-recommended care to patients with stage III unresectable NSCLC. This commentary discusses the potential challenges patients may encounter at different points along their care pathway that can interfere with delivery of curative-intent therapy and suggests strategies for improving care delivery.
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Affiliation(s)
- Anthony Brade
- Department of Radiation Oncology, Peel Regional Cancer Centre, Mississauga, ON L5M 2N1, Canada
- Correspondence:
| | - Kevin Jao
- Department of Hematology and Oncology, Hôpital du Sacré-Coeur de Montréal, Montreal, QC H4J 1C5, Canada;
| | - Simon Yu
- Department of Medicine, Burnaby Hospital Cancer Centre, Burnaby, BC V5G 2X6, Canada;
| | - Parneet Cheema
- Department of Medicine, Division of Medical Oncology, University of Toronto, Toronto, ON M5S 3H2, Canada;
- William Osler Health System, Brampton, ON L6R 3J7, Canada
| | - Sarah Doucette
- Senior Medical Writer, IMPACT Medicom Inc., Toronto, ON M6S 3K2, Canada; (S.D.); (A.C.)
| | - Anna Christofides
- Senior Medical Writer, IMPACT Medicom Inc., Toronto, ON M6S 3K2, Canada; (S.D.); (A.C.)
| | - Devin Schellenberg
- Department of Radiation Oncology, BC Cancer Agency, Surrey, BC V2V 1Z2, Canada;
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Does Delaying Time in Cancer Treatment Affect Mortality? A Retrospective Cohort Study of Korean Lung and Gastric Cancer Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073462. [PMID: 33810467 PMCID: PMC8036321 DOI: 10.3390/ijerph18073462] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 12/16/2022]
Abstract
The aim of this study is to investigate the association between delays in surgical treatment and five- and one- year mortality in patients with lung or gastric cancer. The National Health Insurance claims data from 2006 to 2015 were used. The association between time to surgical treatment, in which the cut-off value was set at average time (30 or 50 days), and five year mortality was analyzed using the Cox proportional hazard model. Subgroup analysis was performed based on treatment type and location of medical institution. A total of 810 lung and 2659 gastric cancer patients were included, in which 74.8% of lung and 71.2% of gastric cancer patients received surgery within average. Compared to lung cancer patients who received treatment within 50 days, the five-year (HR 1.826, 95% CI 1.437–2.321) mortality of those who received treatment afterwards was higher. The findings were not significant for gastric cancer based on the after 30 days standard (HR: 1.003, 95% CI: 0.822–1.225). In lung cancer patients, time-to-treatment and mortality risk were significantly different depending on region. Delays in surgical treatment were associated with mortality in lung cancer patients. The findings imply the importance of monitoring and assuring timely treatment in lung cancer patients.
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van de Ven M, Koffijberg H, Retèl V, Monkhorst K, Smit E, van Harten W, IJzerman M. Real-World Utilization of Biomarker Testing for Patients with Advanced Non-Small Cell Lung Cancer in a Tertiary Referral Center and Referring Hospitals. J Mol Diagn 2021; 23:484-494. [PMID: 33493663 DOI: 10.1016/j.jmoldx.2021.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 12/21/2020] [Accepted: 01/12/2021] [Indexed: 12/26/2022] Open
Abstract
The continued introduction of biomarkers and innovative testing methods makes already complex diagnosis in patients with stage IV non-small-cell lung cancer (NSCLC) even more complex. This study primarily analyzed variations in biomarker testing in clinical practice in patients referred to a comprehensive cancer center in the Netherlands. The secondary aim was to compare the cost of biomarker testing with the cost of whole-genome sequencing. The cohort included 102 stage IV NSCLC patients who received biomarker testing in 2017 or 2018 at the comprehensive cancer center. The complete biomarker testing history of the cohort was identified using linked data from the comprehensive cancer center and the nationwide network and registry of histopathology and cytopathology in the Netherlands. Unique biomarker-test combinations, costs, turnaround times, and test utilization were examined. The results indicate substantial variation in test utilization and sequences. The mean cost per patient of biomarker testing was 2259.92 ± 1217.10 USD, or 1881.23 ± 1013.15 EUR. Targeted gene panels were most frequently conducted, followed by IHC analysis for programmed cell death protein ligand 1. Typically, the most common biomarkers were assessed within the first tests, and emerging biomarkers were tested further down the test sequence. At the cost of current biomarker testing, replacing current testing with whole-genome sequencing would have led to cost-savings in only two patients (2%).
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Affiliation(s)
- Michiel van de Ven
- Health Technology and Services Research, TechMed Center, University of Twente, Enschede, the Netherlands
| | - Hendrik Koffijberg
- Health Technology and Services Research, TechMed Center, University of Twente, Enschede, the Netherlands
| | - Valesca Retèl
- Health Technology and Services Research, TechMed Center, University of Twente, Enschede, the Netherlands; Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Kim Monkhorst
- Department of Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Egbert Smit
- Department of Thoracic Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Wim van Harten
- Health Technology and Services Research, TechMed Center, University of Twente, Enschede, the Netherlands; Rijnstate General Hospital, Arnhem, the Netherlands
| | - Maarten IJzerman
- Health Technology and Services Research, TechMed Center, University of Twente, Enschede, the Netherlands; Centre for Cancer Research and Centre for Health Policy, University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia.
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Hanna TP, King WD, Thibodeau S, Jalink M, Paulin GA, Harvey-Jones E, O'Sullivan DE, Booth CM, Sullivan R, Aggarwal A. Mortality due to cancer treatment delay: systematic review and meta-analysis. BMJ 2020; 371:m4087. [PMID: 33148535 PMCID: PMC7610021 DOI: 10.1136/bmj.m4087] [Citation(s) in RCA: 545] [Impact Index Per Article: 136.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To quantify the association of cancer treatment delay and mortality for each four week increase in delay to inform cancer treatment pathways. DESIGN Systematic review and meta-analysis. DATA SOURCES Published studies in Medline from 1 January 2000 to 10 April 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Curative, neoadjuvant, and adjuvant indications for surgery, systemic treatment, or radiotherapy for cancers of the bladder, breast, colon, rectum, lung, cervix, and head and neck were included. The main outcome measure was the hazard ratio for overall survival for each four week delay for each indication. Delay was measured from diagnosis to first treatment, or from the completion of one treatment to the start of the next. The primary analysis only included high validity studies controlling for major prognostic factors. Hazard ratios were assumed to be log linear in relation to overall survival and were converted to an effect for each four week delay. Pooled effects were estimated using DerSimonian and Laird random effect models. RESULTS The review included 34 studies for 17 indications (n=1 272 681 patients). No high validity data were found for five of the radiotherapy indications or for cervical cancer surgery. The association between delay and increased mortality was significant (P<0.05) for 13 of 17 indications. Surgery findings were consistent, with a mortality risk for each four week delay of 1.06-1.08 (eg, colectomy 1.06, 95% confidence interval 1.01 to 1.12; breast surgery 1.08, 1.03 to 1.13). Estimates for systemic treatment varied (hazard ratio range 1.01-1.28). Radiotherapy estimates were for radical radiotherapy for head and neck cancer (hazard ratio 1.09, 95% confidence interval 1.05 to 1.14), adjuvant radiotherapy after breast conserving surgery (0.98, 0.88 to 1.09), and cervix cancer adjuvant radiotherapy (1.23, 1.00 to 1.50). A sensitivity analysis of studies that had been excluded because of lack of information on comorbidities or functional status did not change the findings. CONCLUSIONS Cancer treatment delay is a problem in health systems worldwide. The impact of delay on mortality can now be quantified for prioritisation and modelling. Even a four week delay of cancer treatment is associated with increased mortality across surgical, systemic treatment, and radiotherapy indications for seven cancers. Policies focused on minimising system level delays to cancer treatment initiation could improve population level survival outcomes.
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Affiliation(s)
- Timothy P Hanna
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, 10 Stuart Street, 2nd Level, Kingston, ON K7L3N6, Canada
- Department of Oncology, Queen's University, Kingston, ON, Canada
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Will D King
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | | | - Matthew Jalink
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, 10 Stuart Street, 2nd Level, Kingston, ON K7L3N6, Canada
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Gregory A Paulin
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | | | - Dylan E O'Sullivan
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Christopher M Booth
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, 10 Stuart Street, 2nd Level, Kingston, ON K7L3N6, Canada
- Department of Oncology, Queen's University, Kingston, ON, Canada
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | | | - Ajay Aggarwal
- Department of Clinical Oncology, Guy's & St Thomas' NHS Trust, London, UK
- Institute of Cancer Policy, King's College London, London, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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