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Toussi N, Daida K, Moser M, Le D, Hagel K, Kanthan R, Shaw J, Zaidi A, Chalchal H, Ahmed S. Prognostic Factors in Patients Diagnosed with Gallbladder Cancer over a Period of 20 Years: A Cohort Study. Cancers (Basel) 2024; 16:2932. [PMID: 39272789 PMCID: PMC11394600 DOI: 10.3390/cancers16172932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 08/19/2024] [Accepted: 08/22/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Gallbladder cancer (GBC) is an uncommon cancer. This study aimed to determine the outcomes of GBC in relation to geographic, demographic, and clinical factors in a Canadian province from 2000 to 2019. METHODS This population-based retrospective cohort study included all patients diagnosed with gallbladder cancer (GBC) in Saskatchewan, Canada, from 2000 to 2019. Cox proportional multivariate regression analysis was conducted to identify factors associated with poorer outcomes. RESULTS In total, 331 patients with a median age of 74 years and male-female ratio of 1:2 were identified. Of these patients, 305 (92%) had a pathological diagnosis of GBC. Among patients with documented staging data, 64% had stage IV disease. A total of 217 (66%) patients were rural residents, and 149 (45%) were referred to a cancer center. The multivariate analysis for patients with stage I-III GBC showed that stage III disease [hazard ratio (HR), 2.63; 95% confidence interval (CI), 1.09-6.34)] and urban residence (HR, 2.20; 95% CI, 1.1-4.39) were correlated with inferior disease-free survival. For all patients, stage IV disease (HR, 3.02; 95% CI, 1.85-4.94), no referral to a cancer center (HR, 2.64; 95% CI, 1.51-4.62), lack of surgery (HR, 1.63; 95% CI, 1.03-2.57), a neutrophil-lymphocyte ratio of >3.2 (HR, 1.57; 1.05-2.36), and age of ≥70 years (HR, 1.51; 95% CI, 1.04-2.19) were correlated with inferior overall survival. CONCLUSIONS In this real-world context, the majority of patients with GBC were diagnosed at a late stage and were not referred to a cancer center. For those with early-stage GBC, living in an urban area and having stage III disease were linked to worse outcomes. Across all stages of GBC, stage IV disease, older age, absence of surgery, lack of referral to a cancer center, and a high neutrophil-to-lymphocyte ratio were associated with poorer survival.
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Affiliation(s)
- Nima Toussi
- College of Medicine, University of Saskatchewan, Saskatoon, SK S7N4H4, Canada
| | - Krishna Daida
- College of Medicine, University of Saskatchewan, Saskatoon, SK S7N4H4, Canada
| | - Michael Moser
- College of Medicine, University of Saskatchewan, Saskatoon, SK S7N4H4, Canada
- Department of Surgery, University of Saskatchewan, Saskatoon, SK S7N0W8, Canada
| | - Duc Le
- College of Medicine, University of Saskatchewan, Saskatoon, SK S7N4H4, Canada
- Department of Oncology, University of Saskatchewan, Saskatoon, SK S7N4H4, Canada
- Saskatoon Cancer Center, Saskatoon, SK S7N4H4, Canada
| | - Kimberly Hagel
- College of Medicine, University of Saskatchewan, Saskatoon, SK S7N4H4, Canada
- Department of Oncology, University of Saskatchewan, Saskatoon, SK S7N4H4, Canada
- Allan Blair Cancer Center, Regina, SK S4T7T1, Canada
| | - Rani Kanthan
- College of Medicine, University of Saskatchewan, Saskatoon, SK S7N4H4, Canada
- Canada Department of Pathology, University of Saskatchewan, Saskatoon, SK S7N0W8, Canada
| | - John Shaw
- College of Medicine, University of Saskatchewan, Saskatoon, SK S7N4H4, Canada
- Department of Surgery, University of Saskatchewan, Saskatoon, SK S7N0W8, Canada
| | - Adnan Zaidi
- College of Medicine, University of Saskatchewan, Saskatoon, SK S7N4H4, Canada
- Department of Oncology, University of Saskatchewan, Saskatoon, SK S7N4H4, Canada
- Saskatoon Cancer Center, Saskatoon, SK S7N4H4, Canada
| | - Haji Chalchal
- College of Medicine, University of Saskatchewan, Saskatoon, SK S7N4H4, Canada
- Department of Oncology, University of Saskatchewan, Saskatoon, SK S7N4H4, Canada
- Allan Blair Cancer Center, Regina, SK S4T7T1, Canada
| | - Shahid Ahmed
- College of Medicine, University of Saskatchewan, Saskatoon, SK S7N4H4, Canada
- Department of Oncology, University of Saskatchewan, Saskatoon, SK S7N4H4, Canada
- Saskatoon Cancer Center, Saskatoon, SK S7N4H4, Canada
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Welsh C, Albani V, Matthews F, Bambra C. Inequalities in the evolution of the COVID-19 pandemic: an ecological study of inequalities in mortality in the first wave and the effects of the first national lockdown in England. BMJ Open 2022; 12:e058658. [PMID: 35948380 PMCID: PMC9378950 DOI: 10.1136/bmjopen-2021-058658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 07/19/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To examine how ecological inequalities in COVID-19 mortality rates evolved in England, and whether the first national lockdown impacted them. This analysis aimed to provide evidence for important lessons to inform public health planning to reduce inequalities in any future pandemics. DESIGN Longitudinal ecological study. SETTING 307 lower-tier local authorities in England. PRIMARY OUTCOME MEASURE Age-standardised COVID-19 mortality rates by local authority, regressed on Index of Multiple Deprivation (IMD) and relevant epidemic dynamics. RESULTS Local authorities that started recording COVID-19 deaths earlier were more deprived, and more deprived authorities saw faster increases in their death rates. By 6 April 2020 (week 15, the earliest time that the 23 March lockdown could have begun affecting death rates) the cumulative death rate in local authorities in the two most deprived deciles of IMD was 54% higher than the rate in the two least deprived deciles. By 4 July 2020 (week 27), this gap had narrowed to 29%. Thus, inequalities in mortality rates by decile of deprivation persisted throughout the first wave, but reduced during the lockdown. CONCLUSIONS This study found significant differences in the dynamics of COVID-19 mortality at the local authority level, resulting in inequalities in cumulative mortality rates during the first wave of the pandemic. The first lockdown in England was fairly strict-and the study found that it particularly benefited those living in more deprived local authorities. Care should be taken to implement lockdowns early enough, in the right places-and at a sufficiently strict level-to maximally benefit all communities, and reduce inequalities.
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Affiliation(s)
- Claire Welsh
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Viviana Albani
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona Matthews
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Clare Bambra
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Wiering B, Lyratzopoulos G, Hamilton W, Campbell J, Abel G. Concordance with urgent referral guidelines in patients presenting with any of six 'alarm' features of possible cancer: a retrospective cohort study using linked primary care records. BMJ Qual Saf 2022; 31:579-589. [PMID: 34607914 PMCID: PMC9304100 DOI: 10.1136/bmjqs-2021-013425] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/02/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Clinical guidelines advise GPs in England which patients warrant an urgent referral for suspected cancer. This study assessed how often GPs follow the guidelines, whether certain patients are less likely to be referred, and how many patients were diagnosed with cancer within 1 year of non-referral. METHODS We used linked primary care (Clinical Practice Research Datalink), secondary care (Hospital Episode Statistics) and cancer registration data. Patients presenting with haematuria, breast lump, dysphagia, iron-deficiency anaemia, post-menopausal or rectal bleeding for the first time during 2014-2015 were included (for ages where guidelines recommend urgent referral). Logistic regression was used to investigate whether receiving a referral was associated with feature type and patient characteristics. Cancer incidence (based on recorded diagnoses in cancer registry data within 1 year of presentation) was compared between those receiving and those not receiving referrals. RESULTS 48 715 patients were included, of which 40% (n=19 670) received an urgent referral within 14 days of presentation, varying by feature from 17% (dysphagia) to 68% (breast lump). Young patients (18-24 vs 55-64 years; adjusted OR 0.20, 95% CI 0.10 to 0.42, p<0.001) and those with comorbidities (4 vs 0 comorbidities; adjusted OR 0.87, 95% CI 0.80 to 0.94, p<0.001) were less likely to receive a referral. Associations between patient characteristics and referrals differed across features: among patients presenting with anaemia, breast lump or haematuria, those with multi-morbidity, and additionally for breast lump, more deprived patients were less likely to receive a referral. Of 29 045 patients not receiving a referral, 3.6% (1047) were diagnosed with cancer within 1 year, ranging from 2.8% for rectal bleeding to 9.5% for anaemia. CONCLUSIONS Guideline recommendations for action are not followed for the majority of patients presenting with common possible cancer features. A significant number of these patients developed cancer within 1 year of their consultation, indicating scope for improvement in the diagnostic process.
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Affiliation(s)
- Bianca Wiering
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare and Outcomes Group, Department of Behavioral Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Willie Hamilton
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - John Campbell
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Gary Abel
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
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Ip A, Black G, Vindrola-Padros C, Taylor C, Otter S, Hewish M, Bhuiya A, Callin J, Wong A, Machesney M, Fulop NJ, Taylor C, Whitaker KL. Socioeconomic differences in help seeking for colorectal cancer symptoms during COVID-19: a UK-wide qualitative interview study. Br J Gen Pract 2022; 72:e472-e482. [PMID: 35636968 PMCID: PMC9256043 DOI: 10.3399/bjgp.2021.0644] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/24/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND COVID-19 has led to rapid changes in healthcare delivery, raising concern that these changes may exacerbate existing inequalities in patient outcomes. AIM To understand how patients' help-seeking experiences in primary care for colorectal cancer symptoms during COVID-19 were affected by their socioeconomic status (SES). DESIGN AND SETTING Qualitative semi-structured interviews with males and females across the UK, recruited using purposive sampling by SES. METHOD Interviews were carried out with 39 participants (20 higher SES; 19 lower SES) who contacted primary care about possible symptoms of colorectal cancer during COVID-19. Data were analysed using framework analysis followed by comparative thematic analysis to explore differences between groups. RESULTS Three themes were identified with differences between SES groups: 1) how people decided to seek medical help through appraisal of symptoms; 2) how people navigated services; and 3) impact of COVID-19 on how patients interacted with healthcare professionals. The lower SES group expressed uncertainty appraising symptoms and navigating services (in terms of new processes resulting from COVID-19 and worries about infection). There was also potential for increased disparity in diagnosis and management, with other methods of getting in touch (for example, email or 111) taken up more readily by higher SES patients. CONCLUSION The findings suggest that COVID-19 exacerbated disparities between higher and lower SES participants. This study raises awareness around challenges in help seeking in the context of the pandemic, which are likely to persist (post-COVID-19) as healthcare systems settle on new models of care (for example, digital). Recommendations are provided to reduce inequalities of care.
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Affiliation(s)
- Athena Ip
- School of Health Sciences, University of Surrey, Guildford
| | - Georgia Black
- Department of Applied Health Research, University College London, London
| | | | - Claire Taylor
- London North West University Healthcare NHS Trust, London
| | - Sophie Otter
- Royal Surrey County Hospital NHS Foundation Trust, Guildford
| | | | - Afsana Bhuiya
- University College London Hospitals NHS Foundation Trust, London
| | - Julie Callin
- Bart's Health NHS Trust, The Royal Hospital, London
| | - Angela Wong
- Bart's Health NHS Trust, The Royal Hospital, London
| | | | - Naomi J Fulop
- Department of Applied Health Research, University College London, London
| | - Cath Taylor
- School of Health Sciences, University of Surrey, Guildford
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Dandona R, Gupta A, George S, Kishan S, Kumar GA. Administrative data deficiencies plague understanding of the magnitude of rape-related crimes in Indian women and girls. BMC Public Health 2022; 22:788. [PMID: 35440076 PMCID: PMC9020006 DOI: 10.1186/s12889-022-13182-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 04/05/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This paper investigates trends in rape-related crimes against women and girls reported in the Indian administrative data from 2001 to 2018 to assess the burden of crime, describe sub-national variations, and highlight data gaps to address sexual violence effectively in India. METHODS Data on five rape-related crimes were extracted from the annual reports of National Crimes Record Bureau (NCRB), and included assault with the intent to outrage modesty of woman, rape, insult to the modesty of women, attempt to commit rape, and murder with rape/gang-rape. Rates for all categories combined, and for each crime were estimated for women and girls for India and its states. Trends for type of offender for rape, mean number of people arrested, and legal status of the cases was also assessed. RESULTS The rate of all rape-related crime increased from 11.6 in 2001 to 19.8 in 2018 per 100,000 women and girls. Most of the 70.7% increase in rate between 2001 and 2018 was post 2012 following a gang-rape and murder case in India's capital. The largest proportion of crimes was recorded as assault with the intent to outrage modesty of the woman, followed by rape. The cited offender in rape cases was for the majority a close known person (44·3%) or other known person (43·1%). By the end of 2018, only 9·6% of the cases had completed trials, with acquittals in 73% cases. CONCLUSIONS The wide variations in the yearly crime rates at state-level highlighted significant issues in data quality including under-reporting, non-comparability, possible bias in data reporting in NCRB, definition of rape-related crime in India, and access in reporting of crimes. Addressing barriers to reporting, improving quality and scope of administrative data recorded on sexual violence is urgently needed for India to meet SDG targets of eliminating all forms of violence against women and girls.
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Affiliation(s)
- Rakhi Dandona
- Public Health Foundation of India, Gurugram, India.
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA.
| | | | - Sibin George
- Public Health Foundation of India, Gurugram, India
| | - Somy Kishan
- Public Health Foundation of India, Gurugram, India
| | - G Anil Kumar
- Public Health Foundation of India, Gurugram, India
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Norris RP, Dew R, Sharp L, Greystoke A, Rice S, Johnell K, Todd A. Are there socio-economic inequalities in utilization of predictive biomarker tests and biological and precision therapies for cancer? A systematic review and meta-analysis. BMC Med 2020; 18:282. [PMID: 33092592 PMCID: PMC7583194 DOI: 10.1186/s12916-020-01753-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/19/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Novel biological and precision therapies and their associated predictive biomarker tests offer opportunities for increased tumor response, reduced adverse effects, and improved survival. This systematic review determined if there are socio-economic inequalities in utilization of predictive biomarker tests and/or biological and precision cancer therapies. METHODS MEDLINE, Embase, Scopus, CINAHL, Web of Science, PubMed, and PsycINFO were searched for peer-reviewed studies, published in English between January 1998 and December 2019. Observational studies reporting utilization data for predictive biomarker tests and/or cancer biological and precision therapies by a measure of socio-economic status (SES) were eligible. Data was extracted from eligible studies. A modified ISPOR checklist for retrospective database studies was used to assess study quality. Meta-analyses were undertaken using a random-effects model, with sub-group analyses by cancer site and drug class. Unadjusted odds ratios (ORs) and 95% confidence intervals (CIs) were computed for each study. Pooled utilization ORs for low versus high socio-economic groups were calculated for test and therapy receipt. RESULTS Among 10,722 citations screened, 62 papers (58 studies; 8 test utilization studies, 37 therapy utilization studies, 3 studies on testing and therapy, 10 studies without denominator populations or which only reported mean socio-economic status) met the inclusion criteria. Studies reported on 7 cancers, 5 predictive biomarkers tests, and 11 biological and precision therapies. Thirty-eight studies (including 1,036,125 patients) were eligible for inclusion in meta-analyses. Low socio-economic status was associated with modestly lower predictive biomarker test utilization (OR 0.86, 95% CI 0.71-1.05; 10 studies) and significantly lower biological and precision therapy utilization (OR 0.83, 95% CI 0.75-0.91; 30 studies). Associations with therapy utilization were stronger in lung cancer (OR 0.71, 95% CI 0.51-1.00; 6 studies), than breast cancer (OR 0.93, 95% CI 0.78-1.10; 8 studies). The mean study quality score was 6.9/10. CONCLUSIONS These novel results indicate that there are socio-economic inequalities in predictive biomarker tests and biological and precision therapy utilization. This requires further investigation to prevent differences in outcomes due to inequalities in treatment with biological and precision therapies.
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Affiliation(s)
- Ruth P. Norris
- School of Pharmacy, Newcastle University, King George VI Building, King’s Road, Newcastle-upon-Tyne, NE1 7RU UK
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle-upon-Tyne, UK
| | - Rosie Dew
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle-upon-Tyne, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle-upon-Tyne, UK
| | | | - Stephen Rice
- Health Economics Group and Evidence Synthesis Team, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Adam Todd
- School of Pharmacy, Newcastle University, King George VI Building, King’s Road, Newcastle-upon-Tyne, NE1 7RU UK
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle-upon-Tyne, UK
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