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Pierannunzio D, Maraschini A, Lopez T, Donati S, Amodio R, Bianconi F, Bruni R, Castaing M, Cirilli C, Fantaci G, Guarda L, Iacovacci S, Mangone L, Mazzoleni G, Mazzucco W, Melcarne A, Merlo E, Parazzini F, Peccatori FA, Rugge M, Sampietro G, Scambia G, Scarfone G, Sferrazza A, Stracci F, Torrisi A, Vitale MF, Francisci S. Cancer and Pregnancy: Estimates in Italy from Record-Linkage Procedures between Cancer Registries and the Hospital Discharge Database. Cancers (Basel) 2023; 15:4305. [PMID: 37686581 PMCID: PMC10486505 DOI: 10.3390/cancers15174305] [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: 06/15/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
The aim of this study is to describe the frequency and trend of pregnancy-associated cancer (PAC) in Italy, an increasingly relevant phenomenon due to postponing age at childbirth. To this purpose, a population-based retrospective longitudinal study design based on cohorts of women aged 15-49 diagnosed with cancer and concomitant pregnancy is proposed. The study uses 19 population-based Cancer Registries, covering about 22% of Italy, and linked at an individual level with Hospital Discharge Records. A total of 2,861,437 pregnancies and 3559 PAC are identified from 74,165 women of the cohort with a rate of 1.24 PAC per 1000 pregnancies. The most frequent cancer site is breast (24.3%), followed by thyroid (23.9%) and melanoma (14.3%). The most frequent outcome is delivery (53.1%), followed by voluntary termination of pregnancy and spontaneous abortion (both 12.0%). The trend of PAC increased from 2003 to 2015, especially when the outcome is delivery, thus confirming a new attitude of clinicians to manage cancer throughout pregnancy. This represents the first attempt in Italy to describe PAC from Cancer Registries data; the methodology is applicable to other areas with the same data availability. Evidence from this study is addressed to clinicians for improving clinical management of women with PAC.
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Affiliation(s)
- Daniela Pierannunzio
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, 00162 Rome, Italy
| | - Alice Maraschini
- Technical-Scientific Statistical Service, Italian National Institute of Health, 00162 Rome, Italy
| | - Tania Lopez
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, 00162 Rome, Italy
| | - Serena Donati
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, 00162 Rome, Italy
| | - Rosalba Amodio
- Clinical Epidemiology and Cancer Registry Unit, Azienda Ospedaliera Universitaria Policlinico (AOUP), 90127 Palermo, Italy
| | | | | | - Marine Castaing
- Siracusa Cancer Registry, Health Unit of Siracusa, 96100 Siracusa, Italy
| | - Claudia Cirilli
- Dipartimento di Epidemiologia e Comunicazione del Rischio, AUSL di Modena, 41126 Modena, Italy
| | | | - Linda Guarda
- SC Osservatorio Epidemiologico ATS Valpadana, 46100 Mantova, Italy
| | - Silvia Iacovacci
- RT LT, Dipartimento di Prevenzione ASL Latina, 04100 Latina, Italy
| | - Lucia Mangone
- European Epidemiology Unit, Gynecologic Oncology Department, AUSL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
| | | | - Walter Mazzucco
- Clinical Epidemiology and Cancer Registry Unit, Azienda Ospedaliera Universitaria Policlinico (AOUP), 90127 Palermo, Italy
| | | | - Elisabetta Merlo
- UOC Epidemiologia, Agenzia per la Tutela della Salute (ATS) della Brianza, 20900 Monza, Italy
| | - Fabio Parazzini
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, 20122 Milano, Italy
| | | | - Massimo Rugge
- Surgical Pathology & Cytopathology Unit, Department of Medicine (DIMED), University of Padova, 35128 Padova, Italy
- Veneto Tumor Registry (RTV), Veneto Regional Authority, 35132 Padova, Italy
| | | | - Giovanni Scambia
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica Roma, 00168 Roma, Italy
| | - Giovanna Scarfone
- Gynecologic Oncology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Ausilia Sferrazza
- ASP Ragusa-Dipartimento Medico di Prevenzione, UOSD Registro Tumori, 97100 Ragusa, Italy
| | - Fabrizio Stracci
- Associazione Nazionale dei Registri Tumori—AIRTUM—Public Health Section, Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy
| | - Antonina Torrisi
- Registro Tumori Integrato, Azienda Ospedaliero Universitaria Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy
| | | | - Silvia Francisci
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health, 00162 Rome, Italy
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McClean K, Cross M, Reed S. Evaluating the Effectiveness of a Clinical Practice Intervention in Increasing Obesity Data Recording at a Western Australian Country Health Service Hospital: A Quasi-Experimental Controlled Trial. J Multidiscip Healthc 2021; 14:2501-2512. [PMID: 34539181 PMCID: PMC8445102 DOI: 10.2147/jmdh.s325903] [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: 06/24/2021] [Accepted: 08/19/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Identification and mitigation of obesity-related risks to staff and healthcare organisations can occur using patient obesity data; however, a 2017/18 audit of obesity data accuracy was assessed to be poor. This study investigates the results of an intervention to improve obesity data recording and coding accuracy at an Australian hospital. Background Increasing population obesity rates result in increased organisational and financial risks to hospitals. Australian obesity prevalence has steadily increased since 1995, and 42% of the Australian population is predicted to be obese in 2035. To reduce risks to healthcare staff who care for obese patients, complete and accurate obesity recording is required. Methods Following a previous audit of obesity recording and coding accuracy of patients admitted to hospital with Type II diabetes, a 12-month intervention was undertaken, comprising staff education, introduction of tape measures and obesity decision-making tools, recording of patient volunteered height, regular reinforcement of obesity recording requirements and enhanced clinical coding of obesity. A re-audit was subsequently conducted to determine if the intervention impacted obesity recording and coding at the previously audited site. Results Improved recording of obesity-related measures and obesity data accuracy were observed, including increased patient BMI, impacted by increased patient height measurements and increased patient weight measurements. Obesity recording accuracy increased due to the intervention, including increased sensitivity, increased negative predictive values and reduced false negatives. Conclusion The obesity recording intervention was successful; however, as hospitals increasingly use electronic health records, improvement opportunities should be considered such as compulsory recording of patient weight and height, embedded BMI calculators and “check boxes” for recording impacts of obesity conditions on treatment. Immediate improvement of obesity recording in manual patient files can be achieved in the meantime by implementing targets of 100% weight, height and BMI recording, introducing education programs and auditing compliance.
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Affiliation(s)
- Kim McClean
- Occupational Safety and Health Department, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Martyn Cross
- Occupational Safety and Health Department, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Sue Reed
- Occupational Safety and Health Department, Edith Cowan University, Joondalup, Western Australia, Australia
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Frequency of Pregnancy-Associated Cancer: A Systematic Review of Population-Based Studies. Cancers (Basel) 2020; 12:cancers12061356. [PMID: 32466494 PMCID: PMC7352408 DOI: 10.3390/cancers12061356] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 12/20/2022] Open
Abstract
Despite numerous available resources of evidence, the results about the frequency of pregnancy-associated cancer (PAC) still show poor comparability due to dissimilarities in the study design and methodology, inclusion criteria, incoherent duration of follow-up and a heterogeneous reference population. We conducted a systematic review of population-based studies on PAC published up to December 2019, to provide updated research on this topic, highlighting strengths and limitations. Of the 24 papers included, 11 considered all types of tumors and 13 dealt with specific types of cancer. Differences in the procedures for estimating the frequency of PAC emerged even among population studies. However, we found consistent results for overall frequency of PAC— around 1/1000 pregnancies. Our review suggests that about 25% of PAC cases are diagnosed during pregnancy, confirming the hypothesis of an excess of diagnosis in the postpregnancy period. Sparse and inconsistent results were found regarding a potential increase in the frequency of PAC over calendar years. Alignments in the strategy to identify PAC are needed to overcome methodological weaknesses.
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Tew M, Dalziel KM, Petrie DJ, Clarke PM. Growth of linked hospital data use in Australia: a systematic review. AUST HEALTH REV 2019; 41:394-400. [PMID: 27444270 DOI: 10.1071/ah16034] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 06/05/2016] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to quantify and understand the utilisation of linked hospital data for research purposes across Australia over the past two decades. Methods A systematic review was undertaken guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 checklist. Medline OVID, PsycINFO, Embase, EconLit and Scopus were searched to identify articles published from 1946 to December 2014. Information on publication year, state(s) involved, type of data linkage, disease area and purpose was extracted. Results The search identified 3314 articles, of which 606 were included; these generated 629 records of hospital data linkage use across all Australian states and territories. The major contributions were from Western Australia (WA; 51%) and New South Wales (NSW; 32%) with the remaining states and territories having significantly fewer publications (total contribution only 17%). WA's contribution resulted from a steady increase from the late 1990s, whereas NSW's contribution is mostly from a rapid increase from 2010. Current data linkage is primarily used in epidemiological research (73%). Conclusion More than 80% of publications were from WA and NSW, whereas other states significantly lag behind. The observable growth in these two states clearly demonstrates the underutilised opportunities for data linkage to add value in health services research in the other states. What is known about the topic? Linking administrative hospital data to other data has the potential to be a cost-effective method to significantly improve health policy. Over the past two decades, Australia has made significant investments in improving its data linkage capabilities. However, several articles have highlighted the many barriers involved in using linked hospital data. What does this paper add? This paper quantitatively evaluates the performance across all Australian states in terms of the use of their administrative hospital data for research purposes. The performance of states varies considerably, with WA and NSW the clear stand-out performers and limited outputs currently seen for the other Australian states and territories. What are the implications for practitioners? Given the significant investments made into data linkage, it is important to continue to evaluate and monitor the performance of the states in terms of translating this investment into outputs. Where the outputs do not match the investment, it is important to identify and overcome those barriers limiting the gains from this investment. More generally, there is a need to think about how we improve the effective and efficient use of data linkage investments in Australia.
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Affiliation(s)
- Michelle Tew
- The University of Melbourne, Centre for Health Policy, Melbourne School of Population and Global Health, Level 4, 207 Bouverie Street, Carlton, Vic. 3053, Australia.
| | - Kim M Dalziel
- The University of Melbourne, Centre for Health Policy, Melbourne School of Population and Global Health, Level 4, 207 Bouverie Street, Carlton, Vic. 3053, Australia.
| | - Dennis J Petrie
- The University of Melbourne, Centre for Health Policy, Melbourne School of Population and Global Health, Level 4, 207 Bouverie Street, Carlton, Vic. 3053, Australia.
| | - Philip M Clarke
- The University of Melbourne, Centre for Health Policy, Melbourne School of Population and Global Health, Level 4, 207 Bouverie Street, Carlton, Vic. 3053, Australia.
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Håheim LL, Helgeland J. Agreement between referral information and discharge diagnoses according to Norwegian elective treatment guidelines - a cross-sectional study. BMC Health Serv Res 2014; 14:493. [PMID: 25359085 PMCID: PMC4219032 DOI: 10.1186/s12913-014-0493-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 10/06/2014] [Indexed: 01/29/2023] Open
Abstract
Background Norway introduced 32 priority guidelines for elective health treatment in the specialist health service in the period 2008–9. The guidelines were intended to reduce large differences in waiting times among hospitals, streamline referrals and ensure that patients accessed the necessary healthcare to which they were entitled for certain conditions. Referral information guided the priorities. As the referral information was key to future evaluation of the guidelines, this study validates the referral information in hospital patient records against discharge diagnoses, because only the discharge diagnosis is recorded in the Norwegian Patient Register (NPR) database, which is used in the main evaluation. Methods Of the specific conditions from 10 priority guidelines, 20 were selected for review for the period 2008–9 at 4 hospitals in Norway. The ICD-10 diagnoses per disease or condition were given in retrospect by clinicians who participated in the expert groups developing the priority guidelines. Reasons for deviations between referral information and discharge diagnoses were coded into four categories, according to the degree of precision of the former compared with the latter. Results In all, 1854 medical records were available for review. The diagnostic precision of the referrals differed significantly between hospitals, and across the 2 years 2008 and 2009. The overall sensitivity was 0.93 (95% confidence interval 0.92–0.94). For the separate conditions, sensitivity was in the range 0.60–1.00. Experience showed that it was necessary to pay careful attention to the selection of ICD-10 diagnoses for identifying patients. The medical records of psychiatry patients were unavailable in some cases and for certain conditions some were unavailable after use of our record extraction algorithm. Conclusion The sensitivity of the referral information on diagnosis or condition was high compared with the discharge diagnosis for the 20 selected conditions from the 10 priority guidelines. Although the review assessed a limited number of the total, we consider the results sufficiently representative and, hence, they will allow use of the NPR data for analyses of the introduction and follow-up of the 32 priority guidelines.
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Bannister-Tyrrell M, Roberts CL, Hasovits C, Nippita T, Ford JB. Incidence and outcomes of pregnancy-associated melanoma in New South Wales 1994-2008. Aust N Z J Obstet Gynaecol 2014; 55:116-22. [PMID: 25349945 DOI: 10.1111/ajo.12279] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 09/20/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is controversy about the interaction between melanoma and pregnancy. There is a lack of Australian data on pregnancy outcomes associated with melanoma in pregnancy, despite Australia having the highest incidence of melanoma in the world. AIMS Describe trends, maternal characteristics and pregnancy outcomes associated with pregnancy-associated melanoma in New South Wales. MATERIALS AND METHODS Population-based cohort study of all births (n = 1 309 501) of at least 20-week gestation or 400 g birthweight in New South Wales, 1994-2008. Logistic regression was used to analyse the association between melanoma in pregnancy and adverse birth outcomes. RESULTS 577 pregnancy-associated melanomas were identified, including 195 diagnosed during pregnancy and 382 diagnosed within 12 months postpartum. The crude incidence of pregnancy-associated melanoma increased from 37.1 per 100 000 maternities in 1994 to 51.84 per 100 000 maternities in 2008. Adjusting for maternal age accounted for the trend in pregnancy-associated melanoma. Melanomas diagnosed in pregnancy were thicker (median = 0.75 mm) than melanomas diagnosed postpartum (median = 0.60 mm) (P = 0.002). Pregnancy-associated melanoma was associated with the increased risk of large-for-gestational-age infant but not preterm birth, planned birth, caesarean section or stillbirth. Parity was inversely associated with pregnancy-associated melanoma, as women with three or more previous pregnancies had 0.59 times the odds of pregnancy-associated melanoma compared to nulliparous women (95% CI 0.42-0.84, P = 0.003). CONCLUSIONS The incidence of pregnancy-associated melanoma has increased with increasing maternal age. The observation of thicker melanomas in pregnancy and increased risk of large-for-gestational-age infants may suggest a role for growth-related pregnancy factors in pregnancy-associated melanoma.
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Affiliation(s)
- Melanie Bannister-Tyrrell
- Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
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