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Mas L, Castelli C, Coffy A, Tretarre B, Piquemal D, Bachet JB. Nationwide trends over 10 years in epidemiology and management of pancreatic ductal adenocarcinoma: A real-world study from the French administrative database. Clin Res Hepatol Gastroenterol 2024; 48:102426. [PMID: 39043316 DOI: 10.1016/j.clinre.2024.102426] [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] [Received: 05/17/2024] [Revised: 07/04/2024] [Accepted: 07/20/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND & AIMS Significant progress has been made in the management of pancreatic ductal adenocarcinoma (PDAC) in recent years. In this population-based study, we aimed to compare incidence, therapeutic strategies, and survival outcomes of PDAC patients in France over a decade. METHODS This study was performed using a nationwide French database. All patients receiving care for PDAC during years 2009, 2014 and 2018 were included. Treatment modalities and survival outcomes were analyzed. RESULTS A total of 8143/8771/10494 patients were considered in 2009/2014/2018, respectively. Incidence increased mainly among patients aged >60 years. In localized PDAC, the proportion of patients receiving best supportive care (BSC) only decreased at 43.6/36.4/32.4 % and 27.8/29.1/34.3 % received chemo(radio)therapy alone. The rate of upfront surgery remained stable while 3/8/18 % of operated patients received neoadjuvant therapy. Median overall survival (OS) was 7.0/7.9/8.5 months in the overall population. Among treated patients, 1-year OS was 61.4/67.7/68.8 % and 30.3/36.3/38.8 % for localized and metastatic PDAC, respectively. CONCLUSIONS This study confirms the rising incidence of PDAC. Improved outcomes were seen in localized PDAC, with a wider use of chemotherapy and neoadjuvant strategies, and in treated metastatic patients. A modest survival gain was seen overall, hindered by the still high rate of patients receiving BSC only.
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Affiliation(s)
- Léo Mas
- AP-HP, Hépato-Gastroenterology et Digestive Oncology department, Pitié-Salpêtrière University Hospital, Sorbonne University, 47-83 Boulevard de l'Hôpital, Paris 75013, France.
| | - Christel Castelli
- AESIO SANTE Department Clinical Research team, Beau Soleil clinic, Montpellier 34070, France
| | - Amandine Coffy
- AESIO SANTE Department Clinical Research team, Beau Soleil clinic, Montpellier 34070, France
| | | | | | - Jean-Baptiste Bachet
- AP-HP, Hépato-Gastroenterology et Digestive Oncology department, Pitié-Salpêtrière University Hospital, Sorbonne University, 47-83 Boulevard de l'Hôpital, Paris 75013, France
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Lavoue V, Favier A, Franck S, Boutet G, Azuar AS, Brousse S, Golfier F, Uzan C, Vaysse C, Molière S, Boisserie-Lacroix M, Kermarrec E, Seror JY, Delpech Y, Luporsi É, Maugard CM, Taris N, Chabbert-Buffet N, Sabah J, Alghamdi K, Fritel X, Mathelin C. French college of gynecologists and obstetricians (CNGOF) recommendations for clinical practice: Place of breast self-examination in screening strategies. Breast 2024; 75:103619. [PMID: 38547580 PMCID: PMC10990735 DOI: 10.1016/j.breast.2023.103619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/26/2023] [Accepted: 11/29/2023] [Indexed: 04/07/2024] Open
Abstract
Breast cancer is the most common female cancer in the world. Numerous studies have shown that the risk of metastatic disease increases with tumor volume. In this context, it is useful to assess whether the regular practice of formal breast self-examination (BSE) as opposed to breast awareness has an impact on the number of cancers diagnosed, their stage, the treatments used and mortality. DESIGN The Commission of Senology (CS) of the Collège National de Gynécologie et Obstétrique Français (CNGOF) respected and followed the Grading of Recommendations Assessment, Development and Evaluation method to assess the quality of the evidence on which the recommendations were based. METHODS The CS studied 16 questions individualizing four groups of women (general population, women aged over 75, high-risk women, and women previously treated for breast cancer). For each situation, it was determined whether the practice of BSE versus abstention from this examination led to detection of more breast cancers and/or recurrences and/or reduced treatment and/or increased survival. RESULTS BSE should not be recommended for women in the general population, who otherwise benefit from clinical breast examination by practitioners from the age of 25, and from organized screening from 50 to 74 (strong recommendation). In the absence of data on the benefits of BSE in patients aged over 75, for those at high risk and those previously treated for breast cancer, the CS was unable to issue recommendations. Thus, if women in these categories wish to undergo BSE, information on the benefits and risks observed in the general population must be given, notably that BSE is associated with a higher number of referrals, biopsies, and a reduced quality of life.
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Affiliation(s)
- Vincent Lavoue
- CHU Service de Gynécologie, 16 Boulevard de Bulgarie, 35200, Rennes, France
| | - Amélia Favier
- Gynécologie-obstétrique et Médecine de La Reproduction, Maternité Hôpital Tenon, 4 Rue de La Chine, 75020, Paris, France
| | - Sophie Franck
- Institut Curie, 26 Rue D'Ulm, 75248, Paris Cedex 05, France
| | - Gérard Boutet
- AGREGA, Service de Chirurgie Gynécologique et Médecine de La Reproduction, Centre Aliénor D'Aquitaine, Centre Hospitalier Universitaire de Bordeaux, Groupe Hospitalier Pellegrin, Place Amélie-Raba-Léon, 33000, Bordeaux, France
| | - Anne-Sophie Azuar
- Centre Hospitalier Clavary, Chemin de Clavary, 06130, Grasse, France
| | - Susie Brousse
- Service D'oncologie Chirurgicale, Centre Eugène Marquis, Unicancer, Rennes, France
| | - François Golfier
- Service de Chirurgie Gynécologique et Cancérologique - Obstétrique, Hospices Civils de Lyon, CHU Lyon Sud, Lyon, France
| | - Catherine Uzan
- Hôpital Pitié Salpetrière, 47 Bld de L'Hôpital, 75013, Paris, France
| | - Charlotte Vaysse
- Service de Chirurgie Oncologique, CHU Toulouse, Institut Universitaire Du Cancer de Toulouse-Oncopole, 1 Avenue Irène Joliot Curie, 31059, Toulouse, France
| | | | | | - Edith Kermarrec
- Hôpital Tenon Service de Radiologie, 4 Rue de La Chine, 75020, Paris, France
| | - Jean-Yves Seror
- Imagerie Duroc, 9 Ter Boulevard Montparnasse 75006 Paris, France
| | - Yann Delpech
- Centre Antoine Lacassagne, 33 Avenue de Valombrose, 06189, Nice, France
| | - Élisabeth Luporsi
- Oncologie Médicale et Oncogénétique, CHR Metz-Thionville, Hôpital de Mercy, 1 Allée Du Château, 57085, Metz, France
| | - Christine M Maugard
- Service de Génétique Oncologique Clinique et Unité de Génétique Oncologique Moléculaire, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France
| | - Nicolas Taris
- Service de Génétique Oncologique, ICANS, 17 Rue Calmette, 67200, Strasbourg, France, France
| | | | - Jonathan Sabah
- CHRU Avenue Molière, 67200, Strasbourg et ICANS, 17 Rue Albert Calmette, 67033, Strasbourg,Cedex, France
| | - Khalid Alghamdi
- CHRU Avenue Molière, 67200, Strasbourg et ICANS, 17 Rue Albert Calmette, 67033, Strasbourg,Cedex, France
| | - Xavier Fritel
- Centre Hospitalo-universitaire de Poitiers, 2 Rue de La Milétrie, 86021, Poitiers, France
| | - Carole Mathelin
- CHRU Avenue Molière, 67200, Strasbourg et ICANS, 17 Rue Albert Calmette, 67033, Strasbourg,Cedex, France.
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Fu Y, Chen W, Liu Y. The association between ultra-processed food intake and age-related hearing loss: a cross-sectional study. BMC Geriatr 2024; 24:450. [PMID: 38783172 PMCID: PMC11118724 DOI: 10.1186/s12877-024-04935-0] [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: 09/09/2023] [Accepted: 03/29/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES This study aimed to explore the association between ultra-processed foods and age-related hearing loss. METHODS Cross-sectional analyses based on data from a nationally representative sample of 1075 adults aged over 50 in the US was performed. The odds ratios (ORs) and 95% confidence intervals (CIs) for hearing loss according to ultra-processed foods intake quartiles were calculated using a multiple adjusted logistic regression model. Restricted cubic spline model was used to flexibly model potential nonlinear relations between ultra-processed foods intake and possibility of hearing loss. We also explored statistical interactions and conducted subgroup analyses where they were found to be significant. RESULTS Ultra-processed foods intake was significantly correlated with high-frequency hearing loss. After controlling for all covariables, individuals in the fourth quartile of Ultra-processed foods consumption had a 2.8 times higher chance of developing high-frequency hearing loss than individuals in the first quartile of Ultra-processed foods consumption. We also found that the association was more significant in non-Hispanic whites. CONCLUSIONS This study discovered an association between Ultra-processed foods intake and the incidence of high-frequency hearing loss, which was more significant in non-Hispanic whites.
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Affiliation(s)
- Yanpeng Fu
- Department of Otorhinolaryngology Head and Neck Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wenyu Chen
- Interventional Cardiology Department, Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, China
| | - Yuehui Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, China.
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Plouvier SD, Marcq G, Vankemmel O, Colin P, Bonnal JL, Leroy X, Saint F, Pasquier D. Practice patterns and survival outcomes for muscle-invasive bladder cancer: real-life experience in a general population setting. Int J Qual Health Care 2024; 36:mzae040. [PMID: 38722033 DOI: 10.1093/intqhc/mzae040] [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: 10/24/2023] [Revised: 02/05/2024] [Accepted: 05/02/2024] [Indexed: 05/22/2024] Open
Abstract
Bladder cancer (BC) is a common malignancy in Europe and North America. Among BCs, muscle-invasive BCs (MIBCs) are distinguished, as they require aggressive treatment due to their spreading potential and poor prognosis. Despite its clinical relevance, little information on MIBC in a general population setting is available. This study aims to report practice patterns and survival outcomes for MIBC patients in a general population setting. MIBCs among BC incidence in 2011 and 2012 recorded in a French population-based cancer registry (810 000 inhabitants) were included in the study. Data were extracted from the medical files. Individual, tumour-related characteristics and initial management including diagnostic tools, multidisciplinary team meeting (MDT) assessment, and treatment delivered were described. Cystectomy, chemoradiation, radiotherapy, and chemotherapy were considered as specific treatments. Matching between MDT decision and the treatment provided was detailed. Management practices were discussed according to the guideline's recommendations. Overall survival (using the Kaplan-Meier method) and net survival (using the Pohar-Perme estimator) were calculated. Among 538 incident BC cases, 147 (27.3%) were MIBCs. Diagnostic practices displayed a relevant locoregional assessment of BC. Almost all cases (n = 136, 92.5%) were assessed during an uro-oncological MDT with a median time from diagnosis of 18 days (first quartile:12-third quartile:32). Discrepancies appeared between MDT decisions and treatments delivered: 71 out of 86 subjects received the recommended cystectomy or chemoradiation (with or without neoadjuvant chemotherapy); 6 out of 11 had the recommended radio- or chemotherapy; and 9 patients did not undergo any specific treatment despite the MDT decision. Cystectomy was the most common treatment performed; the time to surgery appeared consistent with the guideline's recommendations. Forty people only received supportive care. Still, the 5-year overall and net survival was poor, with 19% (13-26) and 22% (14-31), respectively. The 5-year net survival was 35% (23-48) for people who underwent curative-intent treatments. MIBC management remains challenging even for cases assessed during an MDT. Many people did not undergo any specific treatment. Prognosis was poor even when curative-intent therapies were delivered. Efforts to reduce exposure to risk factors such as tobacco smoking and occupational exposures must be maintained.
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Affiliation(s)
- Sandrine D Plouvier
- General Cancer Registry of Lille area, C2RC, Bld du Pr Jules Leclercq, Lille 59037, France
| | - Gautier Marcq
- Urology Department, Claude Huriez Hospital, CHU Lille, Rue Michel Polonowski, Lille F-59000, France
- University Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020-U1277-CANTHER-Cancer Heterogeneity Plasticity and Resistance to Therapies, Lille F-59000, France
| | - Olivier Vankemmel
- Cabinet urologie, Hôpital privé Le Bois, 85 av Marx Dormoy, Lille 59000, France
| | - Pierre Colin
- Service d'Urologie, Hôpital privé La Louvière, rue des Vicaires, Lille 59000, France
| | - Jean-Louis Bonnal
- Service d'Urologie, Groupement des hôpitaux de l'Institut Catholique de Lille, Université nord de France, Rue du Grand But, 59160
| | - Xavier Leroy
- Department of Pathology, CHU Lille, Université de Lille, Bld du Pr Jules Leclercq, Lille 59037, France
| | - Fabien Saint
- Service d'Urologie Transplantation CHU Amiens Picardie, Laboratoire EPROAD EA 4669 UPJV, 1 Rond-Point du Professeur Christian Cabrol, Amiens cedex 01 80054, France
| | - David Pasquier
- Academic Department of Radiation Oncology, Centre Oscar Lambret, 3 rue Combemale, CEDEX Lille F-59020, France
- University Lille & CNRS, Centrale Lille, UMR 9189-CRIStAL, Lille F-59000, France
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Albigès L, Bellera C, Branchoux S, Arnaud M, Gouverneur A, Néré S, Gaudin AF, Durand-Zaleski I, Négrier S. Real-World Treatment Patterns and Effectiveness of Patients With Advanced Renal Cell Carcinoma: A Nationwide Observational Study. Clin Genitourin Cancer 2024; 22:295-304.e6. [PMID: 38105152 DOI: 10.1016/j.clgc.2023.11.012] [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: 07/21/2023] [Revised: 11/16/2023] [Accepted: 11/19/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Treatment landscape for advanced renal cell carcinoma (aRCC) has evolved quickly and few data about the real-world treatment patterns are available. This study aimed at describing the real-world treatment patterns and effectiveness of all systemic treatments available for aRCC in first and second-line treatment. MATERIALS AND METHODS A cohort of patients initiating a first-line systemic treatment for aRCC in 2016 was extracted from the French nationwide healthcare insurance system database (SNDS). The first-line treatment initiation date constituted the index date and patients were followed until death, loss to follow-up, or December 31, 2019, whichever occurred first. aRCC was identified using hospital diagnosis, long-term disease, or renal biopsy before index date. All analyses were performed for first and second-line treatment. Overall survival (OS) and time-to-next treatment or death (TNT-D) were estimated using Kaplan-Meier approach. RESULTS In 2016, 1629 patients initiated a first-line treatment for aRCC. Most of them were male (75.9%) and the median age was 67 years. Most of patients (91.7%) had received a tyrosine kinase inhibitor as first-line treatment, mainly sunitinib (64.4%), and 53.5% received a second-line, among which 43.7% nivolumab. Median OS (95% confidence interval [CI]) was 20.7 (95% CI:18.2-22.4) months from first-line treatment initiation and 15.4 (13.9-17.5) months from second-line treatment initiation. Median TNT-D were respectively 9.3 (9.7-12.1) months and 6.9 (5.9-7.7) months. CONCLUSION This study highlights the limited survival of aRCC patients These results provide a valuable baseline and highlight the need for innovation, such as immune checkpoint inhibitor-based combinations that have recently became first-line standard of care.
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Affiliation(s)
| | - Carine Bellera
- Department of Clinical Epidemiology and Clinical Research, Institut Bergonié, Bordeaux, France
| | - Sébastien Branchoux
- Department of Health Economics & Outcomes Research, Bristol Myers Squibb, Rueil-Malmaison, France
| | | | | | - Sonia Néré
- Department of Medical Affairs, Bristol Myers Squibb, Rueil-Malmaison, France
| | - Anne-Françoise Gaudin
- Department of Health Economics & Outcomes Research, Bristol Myers Squibb, Rueil-Malmaison, France
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Quillet A, Le Stang N, Meriau N, Isambert N, Defossez G. Socio-demographic inequalities in stage at diagnosis of lung cancer: A French population-based study. Cancer Epidemiol 2024; 89:102522. [PMID: 38237387 DOI: 10.1016/j.canep.2024.102522] [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: 11/15/2023] [Revised: 12/26/2023] [Accepted: 01/01/2024] [Indexed: 03/16/2024]
Abstract
BACKGROUND Diagnosing patients at a non-advanced stage has become a mainstay of lung cancer prevention and control strategies. Understanding socio-demographic inequalities in stage at diagnosis may improve the targeting of interventions on patients at higher risk. This study aimed to identify these socio-demographic determinants in a large-scale French population-based cancer registry. METHODS All incident lung cancers diagnosed between 2008 and 2019 identified from the Poitou-Charentes Cancer Registry (south-west France) were included. Stage at diagnosis was categorised as advanced/non-advanced (TNM III/IV vs I/II) according to the 8th TNM edition, the objective being to ensure a consistent level of prognosis over time. Socio-demographic variables included age, sex, the French European Deprivation Index (EDI) and patient's place of residence. Their impact on stage at diagnosis was quantified by multivariate logistic regression models with subgroup analyses by histological subtype. RESULTS Out of the 15,487 included patients, 75% were diagnosed at an advanced stage (66% to 95% depending on the histological subtype), 17% at a non-advanced stage and 10% at a non-specified stage. Multivariate analysis showed different patterns according to histological subtypes. In patients with adenocarcinoma, a higher risk of advanced stage was found for younger and older patients (u-shape), those most deprived, and those living in rural areas. The same effect of age was reported for squamous cell carcinomas, while no association was found for small-cell lung carcinomas. CONCLUSIONS This study highlighted substantial socio-demographic inequalities in stage at diagnosis, specifically for adenocarcinoma patients. Diagnosis strategies could be refined and strengthened in the non-smoker population, in which adenocarcinomas are mainly reported.
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Affiliation(s)
- Alexandre Quillet
- CHU de Poitiers, Service D'Information Médicale, F-86000 Poitiers, France; Université de Poitiers, CIC-INSERM, Axe SCALE-EPI, F-86000 Poitiers, France; CHU de Poitiers, Registre Général des Cancers de Poitou-Charentes, F-86000 Poitiers, France.
| | - Nolwenn Le Stang
- Université de Poitiers, CIC-INSERM, Axe SCALE-EPI, F-86000 Poitiers, France; CHU de Poitiers, Registre Général des Cancers de Poitou-Charentes, F-86000 Poitiers, France
| | - Nicolas Meriau
- CHU de Poitiers, Registre Général des Cancers de Poitou-Charentes, F-86000 Poitiers, France
| | - Nicolas Isambert
- CHU de Poitiers, Service D'Oncologie Médicale, F-86000 Poitiers, France; Université de Poitiers, CIC-INSERM, Axe THOR, F-86000 Poitiers, France
| | - Gautier Defossez
- Université de Poitiers, CIC-INSERM, Axe SCALE-EPI, F-86000 Poitiers, France; CHU de Poitiers, Registre Général des Cancers de Poitou-Charentes, F-86000 Poitiers, France
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Read SH, Quignot N, Kapso-Kapnang R, Comerford E, Zheng Y, Gainford C, Sasane M, Vataire AL, Delzongle L, Bidard FC. Treatment patterns of patients with HR+/HER2- metastatic breast cancer receiving CDK4/6 inhibitor-based regimens: a cohort study in the French nationwide healthcare database. Breast Cancer Res Treat 2024; 204:579-588. [PMID: 38206533 PMCID: PMC10959771 DOI: 10.1007/s10549-023-07201-w] [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: 09/13/2023] [Accepted: 11/26/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE To assess real-world treatment patterns in patients diagnosed with hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) metastatic breast cancer (mBC) who received cyclin-dependent kinase 4/6 (CDK4/6) inhibitors in combination with an aromatase inhibitor (AI) or fulvestrant at first line. METHODS Patient characteristics, treatment history, and outcomes data were extracted from the French 'Système National des Données de Santé' (SNDS) database for patients diagnosed with HR+/HER2- mBC between January 2014 and June 2019 and who received combination therapy with a CDK4/6 inhibitor and endocrine therapy. Kaplan-Meier methodology was used to assess time to next treatment (TTNT) and time to treatment discontinuation (TTTD). RESULTS The cohort comprised 6061 patients including 4032 patients who received CDK4/6 inhibitors + AIs and 2029 patients who received CDK4/6 inhibitors + fulvestrant. Median follow-up was 13.5 months (IQR 9.5-18.1). The median TTTD of first line treatment with CDK4/6 inhibitors + AIs and CDK4/6 inhibitors + fulvestrant was 17.3 months (95% CI 16.8-17.9) and 9.7 months (95% CI 9.0-10.2), respectively. Chemotherapy was the most common second line therapy. Median TTTD of subsequent treatment lines was progressively shorter following first line treatment with CDK4/6 inhibitors + AIs (2nd line: 4.6 months (95% CI 4.4-4.9) and with CDK4/6 inhibitors + fulvestrant (2nd line: 4.7 months (95% CI 4.3-5.1). TTNT was longer than TTTD across lines of therapy. CONCLUSION This real-world analysis confirms the effectiveness of CDK4/6 inhibitor-based regimens in French patients and highlights the frequent use of chemotherapy as second line therapy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Francois-Clement Bidard
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
- Université Versailles Saint-Quentin, Université Paris-Saclay, Saint-Cloud, France
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Mathelin C, Brousse S, Schmitt M, Taris N, Uzan C, Molière S, Vaysse C. [Updated surgical indications and quality and safety indicators in the management of infiltrative breast carcinoma]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:125-131. [PMID: 38122844 DOI: 10.1016/j.gofs.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Breast surgery is the cornerstone of breast cancer treatment. Its indications and procedures are constantly evolving. To update best practices, four questions were submitted to the Senology Commission (SC) of the Collège national des gynécologues et obstétriciens français (CNGOF), covering the indications and modalities of tumor surgery: (1) initially, (2) following neoadjuvant systemic treatment, (3) in case of local recurrence, and (4) the quality and safety of care indicators applicable to this surgery. METHODS The CNGOF SC essentially based its responses on the clinical practice recommendations and guidelines of the French Cancer Institute concerning invasive carcinomas of the breast. Exclusion criteria were carcinoma in situ, sarcoma and axillary surgery. RESULTS To define the type of breast surgery, knowledge of four parameters is essential: the patient's level of risk, the presence of metastases, the size of the breast tumor and its focality (assessed by the clinical/mammography/ultrasound tripod). (1) In the case of initial management, the 6 indications for mastectomy are patient choice (particularly in case of high risk), contraindication to radiotherapy, inflammatory cancer (T4d), surgery with positive margins (after several surgical intervention), surgery that cannot be performed as a monobloc in the case of tumors with multiple foci, and poor expected aesthetic results. All other situations should be treated conservatively. (2) The same criteria apply after neoadjuvant systemic treatment, with conservative treatment still possible whatever the size (excluding carcinomatous mastitis) and focality of the initial tumor. (3) In case of local recurrence, total mastectomy is the reference treatment, with a second conservative treatment reserved for patients with no risk factors for a second recurrence, and no poor prognostic factors, after validation in a multidisciplinary meeting. (4) Four quality and safety indicators apply to breast surgery: it must be performed after obtaining a histological diagnosis, within less than 6 weeks of mammography, in a single surgery in over 80% of cases, and followed by local radiotherapy in the case of conservative treatment. CONCLUSION The indications and modalities of breast surgery are evolving rapidly. To improve aesthetic results, oncoplastic techniques, immediate breast reconstruction, and preservation of the skin or nipple-areolar complex need to be further developed and evaluated in the long-term. These developments must necessarily be accompanied in France by a training policy for breast surgeons.
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Affiliation(s)
- Carole Mathelin
- Service de chirurgie, ICANS, avenue Albert-Calmette, 67200 Strasbourg, France; CHRU, avenue Molière, 67200 Strasbourg, France.
| | - Susie Brousse
- Service de chirurgie, centre Eugène-Marquis, avenue de la Bataille Flandres-Dunkerque, 35042 Rennes cedex, France.
| | - Martin Schmitt
- Service de radiothérapie, CHR Metz-Thionville, hôpital de Mercy, 1, allée du Château, 57085 Metz cedex, France.
| | - Nicolas Taris
- Service d'onco-génétique, ICANS, avenue Albert-Calmette, 67200 Strasbourg, France.
| | - Catherine Uzan
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpital Pitié-Salpêtrière, Sorbonne université, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - Sébastien Molière
- Service d'imagerie de la femme, ICANS, avenue Albert-Calmette, 67200 Strasbourg, France; Service de radiologie B, CHU de Strasbourg, avenue Molière, 67200 Strasbourg, France.
| | - Charlotte Vaysse
- Service de chirurgie gynécologique oncologique, IUCT-Oncopole, CHU de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France.
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Kemoun G, Weiss E, El Houari L, Bonny V, Goury A, Caliez O, Picard B, Rudler M, Rhaiem R, Rebours V, Mayaux J, Bachet JB, Belin L, Demoule A, Decavèle M. Clinical features and outcomes of patients with pancreatic cancer requiring unplanned medical ICU admission: A retrospective multicenter study. Dig Liver Dis 2024; 56:514-521. [PMID: 37718226 DOI: 10.1016/j.dld.2023.08.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/27/2023] [Accepted: 08/17/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND We sought to describe the reasons for intensive care unit (ICU) admission and outcomes of patients with pancreatic cancer requiring unplanned medical ICU admission. PATIENTS AND METHODS Retrospective cohort study in five ICUs from 2009 to 2020. All patients with pancreatic cancer admitted to the ICU were included. Patients having undergone recent surgery were excluded (< 4 weeks). RESULTS 269 patients were included. Tumors were mainly adenocarcinoma (90%). Main reason for admission was sepsis/septic shock (32%) with a biliary tract infection in 44 (51%) patients. Second reason for admission was gastrointestinal bleeding (28%). ICU and 3-month mortality rates were 26% and 59% respectively. Performance status 3-4 (odds ratio OR 3.58), disease status (responsive/stable -ref-, newly diagnosed OR 3.25, progressive OR 5.99), mechanical ventilation (OR 8.03), vasopressors (OR 4.19), SAPS 2 (OR 1.69) and pH (OR 0.02) were independently associated with ICU mortality. Performance status 3-4 (Hazard ratio HR 1.96) and disease status (responsive/stable -ref-, newly diagnosed HR 2.67, progressive HR 4.14) were associated with 3-month mortality. CONCLUSION Reasons for ICU admissions of pancreatic cancer patients differ from those observed in other solid cancer. Short- and medium-term mortality are strongly influenced by performance status and disease status at ICU admission.
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Affiliation(s)
- G Kemoun
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation (Département R3S), Paris, France.
| | - E Weiss
- AP-HP Nord, Université de Paris, Hôpital Beaujon, Département d'anesthésie-réanimation, Clichy, France; Université de Paris, UMRS1149, Centre de recherche sur l'inflammation, Liver Intensive Care Group of Europe (LICAGE), France
| | - L El Houari
- AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Santé Publique, F-75013, Paris, France
| | - V Bonny
- AP-HP Sorbonne Université, site Saint-Antoine, Service de Médecine Intensive - Réanimation, Paris, France
| | - A Goury
- Unité de médecine intensive et réanimation polyvalente, Hôpital Robert Debré, CHU de Reims, France
| | - O Caliez
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service d'hépato-gastro-entérologie, Paris, France
| | - B Picard
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation (Département R3S), Paris, France
| | - M Rudler
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service d'hépato-gastro-entérologie, Paris, France; Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - R Rhaiem
- Service de chirurgie hépatobiliaire, pancréatique et oncologique digestive, Hôpital Robert Debré, CHU de Reims, France
| | - V Rebours
- AP-HP Nord, Université de Paris, Hôpital Beaujon, Service de Pancréatologie, Clichy, France; Université de Paris, INSERM, UMR 1149, pancreatic rare diseases (PaRaDis), centre de référence de maladies rares, Clichy, France
| | - J Mayaux
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation (Département R3S), Paris, France
| | - J B Bachet
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service d'hépato-gastro-entérologie, Paris, France
| | - L Belin
- Sorbonne-Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Santé Publique, F-75013, Paris, France
| | - A Demoule
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation (Département R3S), Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - M Decavèle
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation (Département R3S), Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
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10
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Dantony E, Uhry Z, Fauvernier M, Coureau G, Mounier M, Trétarre B, Molinié F, Roche L, Remontet L. Multidimensional penalized splines for survival models: illustration for net survival trend analyses. Int J Epidemiol 2024; 53:dyae033. [PMID: 38499394 DOI: 10.1093/ije/dyae033] [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: 06/08/2023] [Accepted: 02/13/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND In descriptive epidemiology, there are strong similarities between incidence and survival analyses. Because of the success of multidimensional penalized splines (MPSs) in incidence analysis, we propose in this pedagogical paper to show that MPSs are also very suitable for survival or net survival studies. METHODS The use of MPSs is illustrated in cancer epidemiology in the context of survival trends studies that require specific statistical modelling. We focus on two examples (cervical and colon cancers) using survival data from the French cancer registries (cases 1990-2015). The dynamic of the excess mortality hazard according to time since diagnosis was modelled using an MPS of time since diagnosis, age at diagnosis and year of diagnosis. Multidimensional splines bring the flexibility necessary to capture any trend patterns while penalization ensures selecting only the complexities necessary to describe the data. RESULTS For cervical cancer, the dynamic of the excess mortality hazard changed with the year of diagnosis in opposite ways according to age: this led to a net survival that improved in young women and worsened in older women. For colon cancer, regardless of age, excess mortality decreases with the year of diagnosis but this only concerns mortality at the start of follow-up. CONCLUSIONS MPSs make it possible to describe the dynamic of the mortality hazard and how this dynamic changes with the year of diagnosis, or more generally with any covariates of interest: this gives essential epidemiological insights for interpreting results. We use the R package survPen to do this type of analysis.
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Affiliation(s)
- Emmanuelle Dantony
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
- Equipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France
- Université de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Zoé Uhry
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
- Direction des Maladies Non Transmissibles et des Traumatismes, Santé Publique France, Saint-Maurice, France
| | - Mathieu Fauvernier
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
- Equipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France
- Université de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Gaëlle Coureau
- French Network of Cancer Registries (Francim), Toulouse, France
- Gironde General Cancer Registry, Univ Bordeaux, Bordeaux, France
- Service d'information Médicale, CHU de Bordeaux, Bordeaux, France
| | - Morgane Mounier
- French Network of Cancer Registries (Francim), Toulouse, France
- Registre des Hémopathies Malignes de la Côte-d'Or, CHU de Dijon Bourgogne, Dijon, France
- UMR INSERM 1231, Université Bourgogne Franche-Comté, Dijon, France
| | - Brigitte Trétarre
- French Network of Cancer Registries (Francim), Toulouse, France
- Hérault Cancer Registry, Montpellier, France
- CERPOP, UMR 1295, Université de Toulouse III, Toulouse, France
| | - Florence Molinié
- French Network of Cancer Registries (Francim), Toulouse, France
- CERPOP, UMR 1295, Université de Toulouse III, Toulouse, France
- Loire-Atlantique/Vendée Cancer Registry, SIRIC-ILIAD, Nantes, France
| | - Laurent Roche
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
- Equipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France
- Université de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Laurent Remontet
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
- Equipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France
- Université de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
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11
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Goro S, Challine A, Lefèvre JH, Epaud S, Lazzati A. Impact of interhospital competition on mortality of patients operated on for colorectal cancer faced to hospital volume and rurality: A cross-sectional study. PLoS One 2024; 19:e0291672. [PMID: 38271446 PMCID: PMC10810549 DOI: 10.1371/journal.pone.0291672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 09/03/2023] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Contradictions remain on the impact of interhospital competition on the quality of care, mainly the mortality. The aim of the study is to evaluate the impact of interhospital competition on postoperative mortality after surgery for colorectal cancer in France. METHODS We conducted a retrospective cross-sectional study from 2015 to 2019. Data were collected from a National Health Database. Patients operated on for colorectal cancer in a hospital in mainland France were included. Competition was measured using number of competitors by distance-based approach. A mixed-effect model was carried out to test the link between competition and mortality. RESULTS Ninety-five percent (n = 152,235) of the 160,909 people operated on for colorectal cancer were included in our study. The mean age of patients was 70.4 ±12.2 years old, and female were more represented (55%). A total of 726 hospitals met the criteria for inclusion in our study. Mortality at 30 days was 3.6% and we found that the mortality decreases with increasing of the hospital activity. Using the number of competitors per distance method, our study showed that a "highly competitive" and "moderately competitive" markets decreased mortality by 31% [OR: 0.69 (0.59, 0.80); p<0.001] and by 12% respectively [OR: 0.88 (0.79, 0.99); p<0.03], compared to the "non-competitive" market. High hospital volume (100> per year) was also associated to lower mortality rate [OR: 0.74 (0.63, 0.86); p<0.001]. CONCLUSIONS The results of our studies show that increasing hospital competition independently decreases the 30-day mortality rate after colorectal cancer surgery. Hospital caseload, patients' characteristics and age also impact the post-operative mortality.
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Affiliation(s)
- Seydou Goro
- Université Paris Cité, Paris, France
- HeKA, Inria, Paris, France
- Service de chirurgie digestive, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Alexandre Challine
- Université Paris Cité, Paris, France
- HeKA, Inria, Paris, France
- Service de chirurgie digestive, AP-HP, Hôpital Saint Antoine, Paris, France
- Sorbonne Université, Paris, France
| | - Jérémie H. Lefèvre
- Service de chirurgie digestive, AP-HP, Hôpital Saint Antoine, Paris, France
- Sorbonne Université, Paris, France
| | | | - Andrea Lazzati
- Service de chirurgie digestive, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Université Paris Est Créteil, Créteil, France
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12
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Houvenaeghel G, Cohen M, Gonçalves A, Berthelot A, Chauvet MP, Faure C, Classe JM, Jouve E, Sabiani L, Bannier M, Tassy L, Martino M, Tallet A, de Nonneville A. Triple-negative and Her2-positive breast cancer in women aged 70 and over: prognostic impact of age according to treatment. Front Oncol 2023; 13:1287253. [PMID: 38162480 PMCID: PMC10757327 DOI: 10.3389/fonc.2023.1287253] [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: 09/01/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Background Elderly breast cancer (BC) patients have been underrepresented in clinical trials whereas ~60% of deaths from BC occur in women aged 70 years and older. Only limited data are available on the prognostic impact of age according to treatment, especially in the triple-negative (TN) and Her2-positive because of the lower frequency of these subtypes in elderly patients. We report herein the results of a multicenter retrospective study analyzing the prognostic impact of age according to treatment delivered in TN and Her2-positive BC patients of 70 years or older, including comparison by age groups. Methods The medical records of 31,473 patients treated from January 1991 to December 2018 were retrieved from 13 French cancer centers for retrospective analysis. Our study population included all ≥70 patients with TN or Her2-positive BC treated by upfront surgery. Three age categories were determined: 70-74, 75-80, and > 80 years. Results Of 528 patients included, 243 patients were 70-74 years old (46%), 172 were 75-80 years (32.6%) and 113 were >80 years (21.4%). Half the population (51.9%, 274 patients) were TN, 30.1% (159) Her2-positive/hormone receptors (HR)-positive, and, 18% (95) Her2-positive/endocrine receptors (ER)-negative BC. Advanced tumor stage was associated with older age but no other prognostic factors (tumor subtype, tumor grade, LVI). Adjuvant chemotherapy delivery was inversely proportional to age. With 49 months median follow-up, all patient outcomes (overall survival (OS), disease-free survival (DFS), breast cancer-specific survival (BCSS), and recurrence-free survival (RFS)) significantly decreased as age increased. In multivariate analysis, age >80, pT2-3 sizes, axillary macrometastases, lymphovascular involvement, and HR-negativity tumor negatively affected DFS and OS. Comparison between age >80 and <=80 years old showed worse RFS in patients aged > 80 (HR=1.771, p=0.031). Conclusion TN and Her2-positive subtypes occur at similar frequency in elderly patients. Older age is associated with more advanced tumor stage presentation. Chemotherapy use decreases with older age without worse other pejorative prognostic factors. Age >80, but not ≤80, independently affected DFS and OS.
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Affiliation(s)
- Gilles Houvenaeghel
- Department of Surgical Oncology, Cancer Research Center of Marseille (CRCM), Institut Paoli−Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Monique Cohen
- Department of Surgical Oncology, Cancer Research Center of Marseille (CRCM), Institut Paoli−Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Anthony Gonçalves
- Department of Medical Oncology, Cancer Research Center of Marseille (CRCM), Institut Paoli−Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Axel Berthelot
- Department of Medical Oncology, Cancer Research Center of Marseille (CRCM), Institut Paoli−Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | | | | | - Jean Marc Classe
- Institut René Gauducheau, Site hospitalier Nord, St Herblain, France
| | - Eva Jouve
- Surgical Oncology Department, Centre Claudius Regaud, Toulouse, France
| | - Laura Sabiani
- Department of Surgical Oncology, Cancer Research Center of Marseille (CRCM), Institut Paoli−Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Marie Bannier
- Department of Surgical Oncology, Cancer Research Center of Marseille (CRCM), Institut Paoli−Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Louis Tassy
- Department of Medical Oncology, Cancer Research Center of Marseille (CRCM), Institut Paoli−Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Marc Martino
- Department of Surgical Oncology, Cancer Research Center of Marseille (CRCM), Institut Paoli−Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Agnès Tallet
- Department of Radiotherapy, Cancer Research Center of Marseille (CRCM), Institut Paoli−Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - Alexandre de Nonneville
- Department of Medical Oncology, Cancer Research Center of Marseille (CRCM), Institut Paoli−Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
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13
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Roura P, Puigoriol E, Altimiras J, Batiste-Alentorn E, Dégano IR. Trend and Joinpoint Analysis of Cancer Incidence and 1-Year Mortality in North-East Spain 2005-2020. Cancers (Basel) 2023; 15:5527. [PMID: 38067232 PMCID: PMC10705763 DOI: 10.3390/cancers15235527] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/03/2023] [Accepted: 11/17/2023] [Indexed: 07/03/2024] Open
Abstract
Cancer is the second leading cause of death. It is thus essential to examine cancer trends in all regions. In addition, trend data after 2019 and on cancer 1-year mortality are scarce. Our aim was to analyze incidence and 1-year mortality cancer trends in northeastern Spain during 2005-2020. We used the Osona Tumor Registry, which registers cancer incidence and mortality in Osona. The mortality information came from the Spanish Death Index. We analyzed age-standardized incidence rates and 1-year mortality by sex in the population aged > 17 years during 2005-2020. Trends were examined with negative binomial and joinpoint regression. Incidence rates of colorectal, lung and bronchus, and urinary bladder cancer increased annually in females by 2.86%, 4.20%, and 4.56%, respectively. In males, the incidence of stomach and prostate cancer decreased annually by 3.66% and 2.05%, respectively. One-year mortality trends decreased annually for endometrium cancer (-9.0%) and for colorectal cancer in males (-3.1%). From 2019 to 2020, the incidence of cancer decreased, while 1-year mortality increased in both sexes. In a North-Eastern Spanish county, 1-year mortality decreased for endometrium cancer in females and for colorectal cancer in males. Our results suggest a trend of decreasing cancer incidence and increasing cancer mortality as a result of the COVID-19 pandemic.
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Affiliation(s)
- Pere Roura
- Clinical Epidemiology and Research Unit, Vic Hospital Consortium, 08500 Vic, Spain; (P.R.); (E.P.); (J.A.)
- Faculty of Medicine, University of Vic—Central University of Catalonia, 08500 Vic, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), 08500 Vic, Spain
| | - Emma Puigoriol
- Clinical Epidemiology and Research Unit, Vic Hospital Consortium, 08500 Vic, Spain; (P.R.); (E.P.); (J.A.)
| | - Jacint Altimiras
- Clinical Epidemiology and Research Unit, Vic Hospital Consortium, 08500 Vic, Spain; (P.R.); (E.P.); (J.A.)
| | | | - Irene R. Dégano
- Faculty of Medicine, University of Vic—Central University of Catalonia, 08500 Vic, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), 08500 Vic, Spain
- Centro de Investigación Biomédica en Red of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Registre Gironí del Cor (REGICOR) Study Group, Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
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14
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Assié JB, Grumberg V, Reynaud D, Gaudin AF, Batisse A, Jolivel R, Jouaneton B, Cotté FE, Chouaïd C. Characteristics, management, and healthcare resources of patients with advanced non-small-cell lung cancer surviving 5 years after nivolumab treatment initiation: A national database analysis. Respir Med Res 2023; 84:101051. [PMID: 37897879 DOI: 10.1016/j.resmer.2023.101051] [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: 07/04/2023] [Revised: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Data on long-term survivors with advanced non-small-cell lung cancer (NSCLC) treated with nivolumab are available from randomized trials. Characteristics, management, and healthcare resources of those patients need to be confirmed with real-world data. METHODS The UNIVOC retrospective observational study included all patients with advanced NSCLC recorded in the French national hospital database starting nivolumab in 2015 and followed them until December 2020. The Kaplan-Meier method estimated the overall survival (OS). A machine learning approach identified patients with similar treatment sequences. RESULTS Within the 3,050 patients who had nivolumab initiation,5-year OS rate was 14.6 % (95 %CI 13.3 %-16.2 %). In total, data covering at least 5 years of follow-up were retrieved for 231 surviving patients. Survivors were younger, often female and had fewer comorbidities than non-survivors. Three clusters of patients with different nivolumab treatment durations were identified: 1/ Continuous nivolumab treatment; 2/ Long period of nivolumab treatment followed by chemotherapy or no treatment; 3/ Short period of nivolumab treatment then chemotherapy or no treatment. At 5 years, 61.0 % of survivors were no longer receiving systemic therapy, 26.4 % were treated with nivolumab, 8.7 % chemotherapy, and 3.9 % other immunotherapies. Among 5-y survivor patients, the average number of hospitalisations per patient decreased from 23.4 to 12.8 between the 1st and the 5th year. In the 5th year, 46 % of patients had no more hospitalization for lung cancer. CONCLUSIONS This large nationwide study confirms the long-term benefit of nivolumab treatment for advanced NSCLC patients in the real-world setting, with a 5-year survival rate similar to that reported in clinical trials.
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Affiliation(s)
- Jean-Baptiste Assié
- Functional Genomics of Solid Tumors Laboratory, Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France; Centre Hospitalier Intercommunal Créteil, Créteil, France
| | - Valentine Grumberg
- Bristol Myers Squibb France, 3 rue Joseph Monier, Rueil-Malmaison 92500, France; Oncostat - U1018, INSERM, Paris Saclay University, "Ligue Contre le Cancer" Labeled Team, Villejuif, France.
| | - Dorothée Reynaud
- Bristol Myers Squibb France, 3 rue Joseph Monier, Rueil-Malmaison 92500, France
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15
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Perenic E, Grember E, Bassard S, Koutlidis N. Impact of virtual reality on pain management in transrectal MRI-guided prostate biopsy. FRONTIERS IN PAIN RESEARCH 2023; 4:1156463. [PMID: 37854306 PMCID: PMC10580802 DOI: 10.3389/fpain.2023.1156463] [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: 02/01/2023] [Accepted: 07/25/2023] [Indexed: 10/20/2023] Open
Abstract
Background The beneficial effect of virtual reality (VR) on pain management in the context of transrectal MRI-guided prostate biopsy is not well established. However, it remains unclear whether an adjunctive of VR also improves pain management. This study aimed to evaluate the impact of VR as adjunctive in pain management in transrectal MRI-guided prostate biopsy (PB). Methods We retrospectively evaluated the pain intensity incidence in the 153 patients with PB indication (of which 102 were naïve of PB) who were admitted to our hospital since the acquisition of the Healthy Mind virtual reality headset on 19 January 2021. Results Baseline characteristics of patients who received local anesthesia with 1% lidocaine periprostatic nerve block (PPNB) (Group SOC, N = 78) and patients who received VR associated with PPNB (Group VR, N = 75) were largely similar. One PB with general anesthesia was excluded. The mean pain score at day zero was respectively 3.4 (±2.5) and 2.9 (±2.3) for SOC and VR (p = 0.203). However, the mean pain score at day zero was significantly lower in naïve PB patients with VR [2.7 (±2.0)] than in naïve PB patients with SOC [3.8 (±2.5), p = 0.012] when patients were stratified in PB status. Similar results were found on day 3 for the analysis including naïve-PB patients with SOC vs. with VR [0.4 (±2.5) vs. 0.2 (±2.0); p = 0.023)]. Conclusions The pain intensity was significantly lower in naïve PB patients with VR than in naïve PB patients with SOC. There were no side effects from VR and tolerability was excellent.
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Affiliation(s)
- Emma Perenic
- Department of Urology, Chalon-sur-Saone Hospital, Chalon-sur-Saone, France
| | - Emilie Grember
- Department of Urology, Dijon University Hospital, Dijon, France
| | - Sébastien Bassard
- Department of Urology, Chalon-sur-Saone Hospital, Chalon-sur-Saone, France
| | - Nicolas Koutlidis
- Department of Urology, Chalon-sur-Saone Hospital, Chalon-sur-Saone, France
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16
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Sow M, Saadoun D, Cacoub P, Le Joncour A. Screening for Lung Cancer by Chest Computed Tomography During Thromboangiitis Obliterans. Angiology 2023:33197231203575. [PMID: 37729868 DOI: 10.1177/00033197231203575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Buerger's disease or thromboangiitis obliterans (TAO) is a non-atherosclerotic inflammatory arteritis strongly associated with smoking exposure. This tobacco use would expose patients to lung cancer. The French-speaking thoracic cancer intergroup recommends screening for lung cancer with a chest computed tomography (CT). Our study aims to evaluate lung cancer screening using chest CT during TAO. Ninety-seven TAO patients were included. The mean age of onset of TAO symptoms was 36.5 ± 10 years, and 73 (75%) were male. The mean follow-up was 8.5 ± 14 years. Overall, at least one chest CT was performed during follow-up in 32 (33%) patients. Twenty-three of the thirty-four (68%) patients who were over 50 at follow-up did not have a CT. An abnormality was found in 15 of the 32 (47%) patients who had a CT: lung nodules 6/15, lung mass 1/15, emphysema 6/15, and others 2. Two cases of lung adenocarcinoma were diagnosed. None died during 2 years follow-up. In conclusion, two-third of the TAO patients over 50 years of age did not receive the routine screening recommended in the general smoking population. Two cases of lung cancer have been diagnosed. Improving screening practices for lung cancer in this high-risk population is crucial.
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Affiliation(s)
- Maïmouna Sow
- Sorbonne Universités, Hôpital Pitié-Salpêtrière, Paris, France
- Département de Médecine interne et d'Immunologie Clinique, Paris, France
- AP-HP. Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris, France
| | - David Saadoun
- Sorbonne Universités, Hôpital Pitié-Salpêtrière, Paris, France
- Département de Médecine interne et d'Immunologie Clinique, Paris, France
- AP-HP. Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris, France
| | - Patrice Cacoub
- Sorbonne Universités, Hôpital Pitié-Salpêtrière, Paris, France
- Département de Médecine interne et d'Immunologie Clinique, Paris, France
- AP-HP. Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris, France
| | - Alexandre Le Joncour
- Sorbonne Universités, Hôpital Pitié-Salpêtrière, Paris, France
- Département de Médecine interne et d'Immunologie Clinique, Paris, France
- AP-HP. Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris, France
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17
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Kiss Z, Kocsis J, Nikolényi A, Horváth Z, Knollmajer K, Benedek A, Várnai M, Polányi Z, Kovács KA, Berta A, Köveskuti I, Karamousouli E, Szabó TG, Rokszin G, Fábián I, Bartókné Tamás R, Surján O, Fürtős D, Surján G, Kenessey I, Weber A, Barcza Z, Berki T, Vokó Z, Dózsa C, Dank M, Boér K. Opposite trends in incidence of breast cancer in young and old female cohorts in Hungary and the impact of the Covid-19 pandemic: a nationwide study between 2011-2020. Front Oncol 2023; 13:1182170. [PMID: 37795445 PMCID: PMC10545848 DOI: 10.3389/fonc.2023.1182170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/19/2023] [Indexed: 10/06/2023] Open
Abstract
Background This nationwide study examined breast cancer (BC) incidence and mortality rates in Hungary between 2011-2019, and the impact of the Covid-19 pandemic on the incidence and mortality rates in 2020 using the databases of the National Health Insurance Fund (NHIF) and Central Statistical Office (CSO) of Hungary. Methods Our nationwide, retrospective study included patients who were newly diagnosed with breast cancer (International Codes of Diseases ICD)-10 C50) between Jan 1, 2011 and Dec 31, 2020. Age-standardized incidence and mortality rates (ASRs) were calculated using European Standard Populations (ESP). Results 7,729 to 8,233 new breast cancer cases were recorded in the NHIF database annually, and 3,550 to 4,909 all-cause deaths occurred within BC population per year during 2011-2019 period, while 2,096 to 2,223 breast cancer cause-specific death was recorded (CSO). Age-standardized incidence rates varied between 116.73 and 106.16/100,000 PYs, showing a mean annual change of -0.7% (95% CI: -1.21%-0.16%) and a total change of -5.41% (95% CI: -9.24 to -1.32). Age-standardized mortality rates varied between 26.65-24.97/100,000 PYs (mean annual change: -0.58%; 95% CI: -1.31-0.27%; p=0.101; total change: -5.98%; 95% CI: -13.36-2.66). Age-specific incidence rates significantly decreased between 2011 and 2019 in women aged 50-59, 60-69, 80-89, and ≥90 years (-8.22%, -14.28%, -9.14%, and -36.22%, respectively), while it increased in young females by 30.02% (95%CI 17,01%- 51,97%) during the same period. From 2019 to 2020 (in first COVID-19 pandemic year), breast cancer incidence nominally decreased by 12% (incidence rate ratio [RR]: 0.88; 95% CI: 0.69-1.13; 2020 vs. 2019), all-cause mortality nominally increased by 6% (RR: 1.06; 95% CI: 0.79-1.43) among breast cancer patients, and cause-specific mortality did not change (RR: 1.00; 95%CI: 0.86-1.15). Conclusion The incidence of breast cancer significantly decreased in older age groups (≥50 years), oppositely increased among young females between 2011 and 2019, while cause-specific mortality in breast cancer patients showed a non-significant decrease. In 2020, the Covid-19 pandemic resulted in a nominal, but not statistically significant, 12% decrease in breast cancer incidence, with no significant increase in cause-specific breast cancer mortality observed during 2020.
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Affiliation(s)
| | - Judit Kocsis
- Department of Oncology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Alíz Nikolényi
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Zsolt Horváth
- Department of Oncology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | | | | | | | | | | | | | | | | | | | | | - Ibolya Fábián
- RxTarget Ltd., Szolnok, Hungary
- University of Veterinary Medicine Budapest, Department of Biostatistics, Budapest, Hungary
| | - Renáta Bartókné Tamás
- Department of Deputy Chief Medical Officer II., National Public Health Center, Budapest, Hungary
| | - Orsolya Surján
- Department of Deputy Chief Medical Officer II., National Public Health Center, Budapest, Hungary
| | - Diána Fürtős
- Department of Deputy Chief Medical Officer II., National Public Health Center, Budapest, Hungary
| | - György Surján
- Department of Deputy Chief Medical Officer II., National Public Health Center, Budapest, Hungary
- Institute of Digital Health Sciences, Semmelweis University, Budapest, Hungary
| | - István Kenessey
- National Institute of Oncology, National Tumorbiology Laboratory project (NLP-17), Budapest, Hungary
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | - András Weber
- National Institute of Oncology, National Tumorbiology Laboratory project (NLP-17), Budapest, Hungary
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Zsófia Barcza
- Syntesia Medical Communications Ltd, Budapest, Hungary
| | - Tamás Berki
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Zoltán Vokó
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Csaba Dózsa
- Department of Theoretical Health Sciences, University of Miskolc Faculty of Health Sciences, Miskolc, Hungary
| | - Magdolna Dank
- Cancer Center, Semmelweis University, Budapest, Hungary
| | - Katalin Boér
- Department of Clinical Oncology, St. Margaret Hospital, Budapest, Hungary
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18
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Rousseau F, Ranchon F, Bardin C, Bakrin N, Lavoué V, Bengrine-Lefevre L, Falandry C. Ovarian cancer in the older patient: where are we now? What to do next? Ther Adv Med Oncol 2023; 15:17588359231192397. [PMID: 37724138 PMCID: PMC10505350 DOI: 10.1177/17588359231192397] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 07/19/2023] [Indexed: 09/20/2023] Open
Abstract
In recent years, major advances have been made toward the individualization of epithelial ovarian cancer care, leading to an overall improvement of patient outcomes. However, real-life data indicate that the oldest populations do not benefit from this, due to aspects related to cancer (more aggressive histopathological features), treatment (i.e. frequently suboptimal), and the host (increased toxicities in patients with lower physiological reserve). A specific risk-benefit perspective should therefore be taken when considering surgery, chemotherapy, and maintenance treatments: the decision for cytoreductive surgery should include geriatric vulnerability and surgical complexity, neo-adjuvant chemotherapy being an option when primary surgery appears at high risk; carboplatin paclitaxel association remains the standard even in vulnerable older patients; and bevacizumab and poly(ADP-ribose) polymerase inhibitors maintenance are interesting options provided they are prescribed according to their indications with a close monitoring of their toxicities. Future studies should aim to individualize care without limiting access of older patients to innovation. A specific focus is needed on age-specific translational analyses (focusing on tumor mutational burden and impaired biological pathways), a better patient stratification according to geriatric parameters, an adaptation of both oncological treatment and geriatric interventions, and treatment adaptations not a priori but according to formal pharmacokinetic data.
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Affiliation(s)
- Frédérique Rousseau
- Institut Paoli Calmettes Institute, Marseille, France
- Société Francophone d'OncoGériatrie (SOFOG)
- Groupe d’Investigateurs Nationaux pour l’Étude des Cancers de l’Ovaire et du sein (GINECO)
| | - Florence Ranchon
- Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Hospices Civils de Lyon, Pierre-Bénite, France
- CICLY Centre pour l’Innovation en Cancérologie de Lyon, Oullins, France
- Société Française de Pharmacie Oncologique (SFPO)
| | - Christophe Bardin
- Service de Pharmacie Clinique, Hôpital Cochin AP-HP Centre Université Paris Cité, Paris, France
- Société Française de Pharmacie Oncologique (SFPO)
| | - Naoual Bakrin
- Hospices Civils de Lyon, Service de Chirurgie Digestive, CHU Hôpital Lyon-Sud, Pierre-Bénite Cedex, France
- Groupe d’Investigateurs Nationaux pour l’Étude des Cancers de l’Ovaire et du sein (GINECO)
| | - Vincent Lavoué
- Service de Gynécologie, CHU de Rennes, Hôpital Sud, Rennes, France
- UMR S1085, IRSET-INSERM, Université de Rennes, Rennes, France
- Groupe Français de chirurgie Oncologique et Gynécologique (FRANCOGYN)
| | - Leila Bengrine-Lefevre
- Département d’Oncologie Médicale, Centre Georges-Francois Leclerc, Dijon, France
- Société Francophone d'OncoGériatrie (SOFOG)
- Groupe d’Investigateurs Nationaux pour l’Étude des Cancers de l’Ovaire et du sein (GINECO)
| | - Claire Falandry
- Hospices Civils de Lyon, Unité de Gériatrie, Centre Hospitalier de la Croix Rousse, 103, Grande Rue de la Croix-Rousse, Lyon 69004, France
- Université de Lyon, CarMeN Laboratory, INSERM U.1060/Université Lyon 1/INRA U1397/INSA Lyon/Hospices Civils Lyon Bâtiment CENS-ELI 2D; Hôpital Lyon Sud Secteur 2; Pierre-Bénite 69310, France
- Université Claude Bernard Lyon 1, Pierre-Bénite 69310, France Société Francophone d'OncoGériatrie (SOFOG)
- Groupe d’Investigateurs Nationaux pour l’Étude des Cancers de l’Ovaire et du sein (GINECO)
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19
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Wang Y, Ronckers CM, van Leeuwen FE, Moskowitz CS, Leisenring W, Armstrong GT, de Vathaire F, Hudson MM, Kuehni CE, Arnold MA, Demoor-Goldschmidt C, Green DM, Henderson TO, Howell RM, Ehrhardt MJ, Neglia JP, Oeffinger KC, van der Pal HJH, Robison LL, Schaapveld M, Turcotte LM, Waespe N, Kremer LCM, Teepen JC. Subsequent female breast cancer risk associated with anthracycline chemotherapy for childhood cancer. Nat Med 2023; 29:2268-2277. [PMID: 37696934 PMCID: PMC10504074 DOI: 10.1038/s41591-023-02514-1] [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: 01/11/2023] [Accepted: 07/26/2023] [Indexed: 09/13/2023]
Abstract
Anthracycline-based chemotherapy is associated with increased subsequent breast cancer (SBC) risk in female childhood cancer survivors, but the current evidence is insufficient to support early breast cancer screening recommendations for survivors treated with anthracyclines. In this study, we pooled individual patient data of 17,903 survivors from six well-established studies, of whom 782 (4.4%) developed a SBC, and analyzed dose-dependent effects of individual anthracycline agents on developing SBC and interactions with chest radiotherapy. A dose-dependent increased SBC risk was seen for doxorubicin (hazard ratio (HR) per 100 mg m-2: 1.24, 95% confidence interval (CI): 1.18-1.31), with more than twofold increased risk for survivors treated with ≥200 mg m-2 cumulative doxorubicin dose versus no doxorubicin (HR: 2.50 for 200-299 mg m-2, HR: 2.33 for 300-399 mg m-2 and HR: 2.78 for ≥400 mg m-2). For daunorubicin, the associations were not statistically significant. Epirubicin was associated with increased SBC risk (yes/no, HR: 3.25, 95% CI: 1.59-6.63). For patients treated with or without chest irradiation, HRs per 100 mg m-2 of doxorubicin were 1.11 (95% CI: 1.02-1.21) and 1.26 (95% CI: 1.17-1.36), respectively. Our findings support that early initiation of SBC surveillance may be reasonable for survivors who received ≥200 mg m-2 cumulative doxorubicin dose and should be considered in SBC surveillance guidelines for survivors and future treatment protocols.
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Affiliation(s)
- Yuehan Wang
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
| | - Cécile M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
- Division of Childhood Cancer Epidemiology (EpiKiK), Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | | | | | | | - Florent de Vathaire
- Radiation Epidemiology Team, INSERM U1018, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | | | - Claudia E Kuehni
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Pediatric Hematology and Oncology, University Children's Hospital Bern, University of Bern, Bern, Switzerland
| | - Michael A Arnold
- Department of Pathology and Laboratory Medicine, Children's Hospital Colorado, Aurora, CO, USA
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Charlotte Demoor-Goldschmidt
- Radiation Epidemiology Team, INSERM U1018, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Department of Pediatric Hematology and Oncology, University-Hospital of Angers, Angers, France
- Radiotherapy Department, Francois Baclesse Center, Caen, France
| | | | - Tara O Henderson
- University of Chicago Medicine Comer Children's Hospital, Chicago, IL, USA
| | - Rebecca M Howell
- University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | | | - Joseph P Neglia
- University of Minnesota Masonic Cancer Center, Minneapolis, MN, USA
| | | | | | | | | | - Lucie M Turcotte
- University of Minnesota Masonic Cancer Center, Minneapolis, MN, USA
| | - Nicolas Waespe
- Childhood Cancer Research Group, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Pediatric Hematology and Oncology, University Children's Hospital Bern, University of Bern, Bern, Switzerland
- CANSEARCH research platform in pediatric oncology and hematology of the University of Geneva, Geneva, Switzerland
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Jop C Teepen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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20
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Viennet M, Tapia S, Cottenet J, Bernard A, Ortega-Deballon P, Quantin C. Increased risk of colon cancer after acute appendicitis: a nationwide, population-based study. EClinicalMedicine 2023; 63:102196. [PMID: 37680941 PMCID: PMC10480545 DOI: 10.1016/j.eclinm.2023.102196] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 09/09/2023] Open
Abstract
Background Acute appendicitis is the most common digestive disease requiring emergency surgery. Colorectal cancer is the third most common cancer in France. An increased risk of colorectal cancer after acute appendicitis has been suggested. We aimed to assess the frequency of hospitalization for colon cancer after appendicitis in a nationwide analysis. Methods Using the French Hospital Discharge Database (PMSI), we included all patients aged 18-59 years presenting with acute appendicitis between 2010 and 2015. Univariate and multivariate analyses were performed to compare colon cancer occurrence in these patients vs a control-matched population with a hospital stay for trauma in the same period. Patients presenting strong risk factors for colorectal cancer were excluded. Findings A total of 230,349 patients with acute appendicitis (exposed group) were included. We used a propensity score to match each exposed patient with two unexposed patients (controls) to ensure the comparability of the groups, resulting in a control group of 460,698 patients. Univariate analysis found significantly more colon cancer in the appendicitis group, especially during the first year after appendicitis (5 per 10,000 vs 1 per 10,000, p < 0.000, this corresponds to 111 patients in the appendicitis group), namely within the first 6 months. Survival analysis confirmed patients treated for appendicitis present a 4 times higher risk of being diagnosed with colon cancer than control patients during the first year of follow-up (sHR = 4.67 (95% CI: 3.51-6.21), and 8 times higher during the first 6 months (sHR = 8.39; 95% CI: 5.41-12.99). The association was even more marked for right-sided colon cancer (sHR = 8.25; 95% CI: 5.03-13.54 during the 1st year). While the risk of diagnosis of colon cancer was also significant for patients over 40 years, it was even greater in patients under 40 years, who had between a 6-fold and 12-fold increase in risk. Interpretation In this population-based study, we found that acute appendicitis seems to be a warning sign for colon cancer (reverse causality) in both middle-aged and younger adults. The risk of presenting with cancer colon was higher during the first six months after acute appendicitis. This raises the issue of routine diagnostic work-up in adults presenting with acute appendicitis. Funding Regional Council of Burgundy.
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Affiliation(s)
- Manon Viennet
- Department of Digestive Surgical Oncology, Dijon University Hospital, Dijon, France
| | - Solène Tapia
- Department Medical Information, Dijon University Hospital, Dijon, France
| | - Jonathan Cottenet
- Department Medical Information, Dijon University Hospital, Dijon, France
| | - Alain Bernard
- Department Medical Information, Dijon University Hospital, Dijon, France
| | - Pablo Ortega-Deballon
- Department of Digestive Surgical Oncology, Dijon University Hospital, Dijon, France
- Inserm CIC 1432 Clinical Investigation Unit, Dijon University Hospital, Dijon, France
- Inserm Unit 1231, Locoregional Therapy in Surgical Oncology, Dijon, France
| | - Catherine Quantin
- Department Medical Information, Dijon University Hospital, Dijon, France
- Inserm CIC 1432 Clinical Investigation Unit, Dijon University Hospital, Dijon, France
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21
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Satgé D, Nishi M, Trétarre B. Assessing cancer in people with profound and multiple disabilities. BMC Cancer 2023; 23:798. [PMID: 37626285 PMCID: PMC10463777 DOI: 10.1186/s12885-023-11313-3] [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: 11/15/2022] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Cancers are as common in individuals with intellectual disabilities as in the general population (GP). For the subgroup of people with profound and multiple disabilities (PMD) who present with both severe intellectual disability and major motor disorders, the frequency and distribution of cancers are currently not known, preventing proper cancer surveillance. METHODS We carried out a systematic and synthetic review of the medical literature, including a focused search of Japanese data. RESULTS The total risk of cancer in individuals with PMD is thought to be lower than in the GP, possibly due to a shorter life expectancy. They have reduced exposure to cancer risk factors, such as alcohol, tobacco, sunlight, human papillomavirus infection, occupational toxins, and being overweight. On the other hand, individuals with PMD present a greater frequency of gastroesophageal reflux disease, Helicobacter pylori gastritis, chronic cystitis, and cryptorchidism, which increase the risk for cancer of the esophagus, stomach, urinary bladder, and testes. In addition, certain genetic disorders underlying compromised motor and cognitive functions are associated with higher risk of childhood cancers. An analysis of 135 cancers in persons with PMD in Japan suggested that they present a particular tumor profile, with certain cancers rarer than in the GP, whereas cancers of the digestive tract are frequent. Cancers of the digestive tract occurred significantly earlier than in the GP (colon: average age 48.3 years vs. 71.3 years in the GP, esophagus: 39 years vs. 72 years in the GP). An increasing number of therapeutic successes in children and adults with PMD have been reported in different countries when cancers are discovered early. CONCLUSION Individuals with PMD must be appropriately monitored for cancer. Screenings for breast and colon cancer, as well as regular monitoring of the esophagus, stomach, urinary bladder, and testicles, are necessary. Population-based epidemiological studies are needed to better understand risk factors, frequency, and distribution of cancers in the PMD population.
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Affiliation(s)
- Daniel Satgé
- Oncodéfi, 209 Avenue des Apothicaires, Parc Euromédecine, Montpellier, 34090, France.
- UMR 1302 Institute Desbrest of Epidemiology and Public Health, INSERM, Univ Montpellier, Montpellier, France.
| | - Motoi Nishi
- Department of Fundamental Health Sciences, Health Sciences University of Hokkaido, Tobetsu, Japan
| | - Brigitte Trétarre
- Oncodéfi, 209 Avenue des Apothicaires, Parc Euromédecine, Montpellier, 34090, France
- Registre des Cancers de l'Hérault, 208 Avenue des Apothicaires, Montpellier, 34090, France
- Center for Epidemiology and Research in Population Health (CERPOP), Toulouse, France
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22
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Rollet Q, Exarchakou A, Launoy G, Merville O, Rubio FJ, Belot A. Functional forms of socio-territorial inequities in breast cancer screening - A French cross-sectional study using hierarchical generalised additive models. Prev Med 2023; 173:107587. [PMID: 37355102 DOI: 10.1016/j.ypmed.2023.107587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/15/2023] [Accepted: 06/21/2023] [Indexed: 06/26/2023]
Abstract
To reduce the breast cancer burden, the French National Organised Breast Cancer Screening Programme (FNOBCSP) was implemented in 2004. The recommended participation rate has never been achieved and socio-territorial inequities in participation have been reported on several occasions. We investigated the functional forms and consistency of the relationships between neighbourhood deprivation, travel time to the nearest accredited radiology centre and screening uptake. We used two-level hierarchical generalised additive models in 8 types of territories classified by socio-demographic and economic factors. The first level was 368,201 women aged 50-72 invited to the 2013-2014 screening campaign in metropolitan France. They were nested in 41 départements, the level of organisation of the FNOBCSP. The effect of travel time showed two main patterns: it was either linear (with participation decreasing as travel time increased) or participation first increased with increasing travel time to a peak around 5-15 min and decreased afterward. In nearly all types and départements, the probability of participation decreased linearly with increasing deprivation. Territorial inequities in participation were more context-dependent and complex than social inequities. Inequities in participation represent a loss of opportunity for individuals who already have the worst cancer outcomes. Evidence-based public health policies are needed to increase the effectiveness and equity of breast cancer screening.
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Affiliation(s)
- Quentin Rollet
- Inequalities in Cancer Outcomes Network (ICON), Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; U1086 "ANTICIPE" INSERM, University of Caen Normandie, Centre François Baclesse, 3, Avenue du Général Harris, Caen 14000, France.
| | - Aimilia Exarchakou
- Inequalities in Cancer Outcomes Network (ICON), Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Guy Launoy
- U1086 "ANTICIPE" INSERM, University of Caen Normandie, Centre François Baclesse, 3, Avenue du Général Harris, Caen 14000, France
| | - Ophélie Merville
- U1086 "ANTICIPE" INSERM, University of Caen Normandie, Centre François Baclesse, 3, Avenue du Général Harris, Caen 14000, France
| | - Francisco J Rubio
- Department of Statistical Science, University College London, Gower St, London WC1E 6BT, UK
| | - Aurélien Belot
- Inequalities in Cancer Outcomes Network (ICON), Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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23
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Neale RE, Lucas RM, Byrne SN, Hollestein L, Rhodes LE, Yazar S, Young AR, Berwick M, Ireland RA, Olsen CM. The effects of exposure to solar radiation on human health. Photochem Photobiol Sci 2023:10.1007/s43630-023-00375-8. [PMID: 36856971 PMCID: PMC9976694 DOI: 10.1007/s43630-023-00375-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/13/2023] [Indexed: 03/02/2023]
Abstract
This assessment by the Environmental Effects Assessment Panel (EEAP) of the Montreal Protocol under the United Nations Environment Programme (UNEP) evaluates the effects of ultraviolet (UV) radiation on human health within the context of the Montreal Protocol and its Amendments. We assess work published since our last comprehensive assessment in 2018. Over the last four years gains have been made in knowledge of the links between sun exposure and health outcomes, mechanisms, and estimates of disease burden, including economic impacts. Of particular note, there is new information about the way in which exposure to UV radiation modulates the immune system, causing both harms and benefits for health. The burden of skin cancer remains high, with many lives lost to melanoma and many more people treated for keratinocyte cancer, but it has been estimated that the Montreal Protocol will prevent 11 million cases of melanoma and 432 million cases of keratinocyte cancer that would otherwise have occurred in the United States in people born between 1890 and 2100. While the incidence of skin cancer continues to rise, rates have stabilised in younger populations in some countries. Mortality has also plateaued, partly due to the use of systemic therapies for advanced disease. However, these therapies are very expensive, contributing to the extremely high economic burden of skin cancer, and emphasising the importance and comparative cost-effectiveness of prevention. Photodermatoses, inflammatory skin conditions induced by exposure to UV radiation, can have a marked detrimental impact on the quality of life of sufferers. More information is emerging about their potential link with commonly used drugs, particularly anti-hypertensives. The eyes are also harmed by over-exposure to UV radiation. The incidence of cataract and pterygium is continuing to rise, and there is now evidence of a link between intraocular melanoma and sun exposure. It has been estimated that the Montreal Protocol will prevent 63 million cases of cataract that would otherwise have occurred in the United States in people born between 1890 and 2100. Despite the clearly established harms, exposure to UV radiation also has benefits for human health. While the best recognised benefit is production of vitamin D, beneficial effects mediated by factors other than vitamin D are emerging. For both sun exposure and vitamin D, there is increasingly convincing evidence of a positive role in diseases related to immune function, including both autoimmune diseases and infection. With its influence on the intensity of UV radiation and global warming, the Montreal Protocol has, and will have, both direct and indirect effects on human health, potentially changing the balance of the risks and benefits of spending time outdoors.
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Affiliation(s)
- R. E. Neale
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD Australia ,School of Public Health, University of Queensland, Brisbane, QLD Australia
| | - R. M. Lucas
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT Australia
| | - S. N. Byrne
- School of Medical Science, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - L. Hollestein
- Erasmus MC Cancer Institute, Rotterdam, The Netherlands ,Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - L. E. Rhodes
- Dermatology Research Centre, School of Biological Sciences, University of Manchester, Salford Royal Hospital, Northern Care Alliance NHS Trust, Manchester, UK
| | - S. Yazar
- Garvan Medical Research Institute, Sydney, NSW Australia
| | | | - M. Berwick
- University of New Mexico Comprehensive Cancer Center, Albuquerque, USA
| | - R. A. Ireland
- School of Medical Science, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - C. M. Olsen
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD Australia ,Frazer Institute, University of Queensland, Brisbane, QLD Australia
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Luo G, Zhang Y, Etxeberria J, Arnold M, Cai X, Hao Y, Zou H. Projections of Lung Cancer Incidence by 2035 in 40 Countries Worldwide: Population-Based Study. JMIR Public Health Surveill 2023; 9:e43651. [PMID: 36800235 PMCID: PMC9984998 DOI: 10.2196/43651] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/16/2022] [Accepted: 01/11/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND The global burden of lung cancer (LC) is increasing. Quantitative projections of the future LC burden in different world regions could help optimize the allocation of resources and provide a benchmark for evaluating LC prevention and control interventions. OBJECTIVE We aimed to predict the future incidence of LC in 40 countries by 2035, with an emphasis on country- and sex-specific disparities. METHODS Data on LC incidence from 1978 to 2012 were extracted from 126 cancer registries of 40 countries in Cancer Incidence in Five Continents Volumes V-XI and used for the projection. Age-standardized incidence rates (ASRs) per 100,000 person-years and the number of incident cases were predicted through 2035, using the NORDPRED age-period-cohort model. RESULTS Global ASRs of the 40 studied countries were predicted to decrease by 23% (8.2/35.8) among males, from 35.8 per 100,000 person-years in 2010 to 27.6 in 2035, and increase by 2% (0.3/16.8) among females, from 16.8 in 2010 to 17.1 in 2035. The ASRs of LC among females are projected to continue increasing dramatically in most countries by 2035, with peaks after the 2020s in most European, Eastern Asian, and Oceanian countries, whereas the ASRs among males will continue to decline in almost all countries. The ASRs among females are predicted to almost reach those among males in Ireland, Norway, the United Kingdom, the Netherlands, Canada, the United States, and New Zealand in 2025 and in Slovenia in 2035 and even surpass those among males in Denmark in 2020 and in Brazil and Colombia in 2025. In 2035, the highest ASRs are projected to occur among males in Belarus (49.3) and among females in Denmark (36.8). The number of new cases in 40 countries is predicted to increase by 65.32% (858,000/1,314,000), from 1.31 million in 2010 to 2.17 million in 2035. China will have the largest number of new cases. CONCLUSIONS LC incidence is expected to continue to increase through 2035 in most countries, making LC a major public health challenge worldwide. The ongoing transition in the epidemiology of LC highlights the need for resource redistribution and improved LC control measures to reduce future LC burden worldwide.
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Affiliation(s)
- Ganfeng Luo
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yanting Zhang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Jaione Etxeberria
- Department of Statistics, Computer Science and Mathematics, Public University of Navarre, Navarre, Spain
- Institute for Advanced Materials and Mathematics (INAMAT2), Public University of Navarre, Navarre, Spain
| | - Melina Arnold
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Xiuyu Cai
- Department of VIP Inpatient, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yuantao Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
- Kirby Institute, University of New South Wales, Sydney, Australia
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Assié JB, Chouaïd C, Nunes H, Reynaud D, Gaudin AF, Grumberg V, Jolivel R, Jouaneton B, Cotté FE, Duchemann B. Outcome following nivolumab treatment in patients with advanced non-small cell lung cancer and comorbid interstitial lung disease in a real-world setting. Ther Adv Med Oncol 2023; 15:17588359231152847. [PMID: 36743523 PMCID: PMC9893351 DOI: 10.1177/17588359231152847] [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: 09/27/2022] [Accepted: 01/05/2023] [Indexed: 02/01/2023] Open
Abstract
Background Up to 10% of patients with advanced non-small cell lung cancer (aNSCLC) have pre-existing interstitial lung disease (ILD). These patients are usually excluded from immunotherapy clinical trials. Consequently, knowledge on outcomes following nivolumab treatment in these patients remains limited. The primary objective of this study was to evaluate survival outcome following nivolumab treatment in ILD patients with pre-treated aNSCLC in the real-world setting. Patients and methods The study included all patients with aNSCLC recorded in the French hospital database, starting nivolumab in 2015-2016. Patients were stratified by pre-existing ILD and three subgroups were studied [auto-immune or granulomatous (AI/G) ILD, other known causes ILD and idiopathic ILD]. Time to discontinuation of nivolumab treatment [time to treatment duration (TTD)] and overall survival (OS) were estimated using Kaplan-Meier survival analysis. Results Of 10,452 aNSCLC patients initiating nivolumab, 148 (1.4%) had pre-existing ILD. Mean age at nivolumab initiation was 64.6 ± 9.4 years in ILD and 63.8 ± 9.6 years in non-ILD. Compared to non-ILD, patients in the ILD group were more frequently men (p < 0.05) and had more comorbidities (p < 0.001). There was no significant difference between ILD and non-ILD groups for median TTD (2.5 versus 2.8 months; p = 0.6) or median OS (9.6 versus 11.9 months; p = 0.1). Median OS in AI/G ILD (n = 14), other known causes ILD (n = 75), and idiopathic ILD (n = 59) were 8.6, 10.7, and 9.6 months, respectively. Conclusion In this large cohort of aNSCLC patients with ILD, outcomes are similar to those obtained in the non-ILD population. Immunotherapy could be beneficial for these patients.
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Affiliation(s)
- Jean-Baptiste Assié
- Functional Genomics of Solid Tumors Laboratory, Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France,Centre Hospitalier Intercommunal Créteil, Créteil, France
| | | | - Hilario Nunes
- Department of Respiratory Medicine, Centre de Référence des Maladies Pulmonaires Rares, Avicenne Hospital, Université Sorbonne Paris Nord, Paris, France
| | | | | | | | | | | | | | - Boris Duchemann
- Department of Thoracic and Medical Oncology, Avicenne Hospital, Université Sorbonne Paris Nord, Paris, France,Laboratoire d’Immunomonitoring en Oncologie, INSERM US23, CNRS UMS 3655, Institut Gustave Roussy, Villejuif, France
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Le Bihan-Benjamin C, Rocchi M, Putton M, Méric JB, Bousquet PJ. Estimation of Oncologic Surgery Case Volume Before and After the COVID-19 Pandemic in France. JAMA Netw Open 2023; 6:e2253204. [PMID: 36701152 PMCID: PMC9880797 DOI: 10.1001/jamanetworkopen.2022.53204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
IMPORTANCE COVID-19 has had a major effect on health care activities, especially surgery. At first, comparisons were proposed using 2019 activities as the highest standard. However, while such an approach might have been suitable during the first months of the pandemic, this might no longer be the case for a longer period. OBJECTIVE To examine approaches that may better assess the use of cancer surgeries. DESIGN, SETTING, AND PARTICIPANTS In a cross-sectional design, the nationwide French hospital facility data (Medicalised Information System Program) were used to assess cancer surgery for 6 cancer site categories in adults from January 1, 2010, to December 31, 2021. EXPOSURE Estimated cancer surgery activity during the COVID-19 pandemic. MAIN OUTCOMES AND MEASURES Three models were proposed to assess the expected number of surgical procedures between 2020 and 2021 and make a comparison with those observed in earlier years. RESULTS In France, cancer removal surgeries account for approximately 7000 hospitalizations per year for liver cancer; 4000 for pancreatic cancer; 7700 for ovarian cancer; 1300 for esophagus cancer; 23 000 for ear, nose, and throat (ENT) cancer; 78 000 for breast cancer; and 16 600 for thoracic cancers. For most cancer sites, the number of surgical procedures increased from 2010 to 2019: liver, 14%; pancreas, 38%; ovary, 14%; esophagus, 18%; breast, 8%; and thoracic, 29%. Assuming stability, these values underestimate the gap in activity observed in 2020-2021. For other procedures, a decrease was observed: stomach, -10%, and ENT, -6%. Assuming stability, these values overestimate the gap in activity observed in 2020-2021. At the end of 2021, according to the model, the gap in activity observed in 2020-2021 was estimated at between -1.4% and 1.7% for breast, -6.6% and -7.3% for thoracic, -3.1% and -2.5% for ovarian, -4.2% and -1.7% for pancreas, -6.7% and 5.9% for stomach, and -13.0% and -13.9% for esophageal cancers. For ENT, liver, and urologic cancers, because the trend was different before and after 2015, it was necessary to opt for modeling using only the most recent period. The cumulative gap in activity observed in 2020-2021 was estimated at -1.0% for ENT cancers, -5.3% for liver cancers, and -2.9% for urologic cancers. CONCLUSIONS AND RELEVANCE The findings of this study suggest that short- and medium-term trends must be considered to estimate COVID-19 cancer surgery activities. Breast cancer is the site for which the activity showed the smallest decrease during the pandemic, with almost full recovery in 2021.
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Affiliation(s)
- Christine Le Bihan-Benjamin
- Health Data and Assessment Department, Survey Data Science and Assessment Division, National Cancer Institute, Boulogne-Billancourt, France
| | - Mathieu Rocchi
- Health Data and Assessment Department, Survey Data Science and Assessment Division, National Cancer Institute, Boulogne-Billancourt, France
| | - Maxime Putton
- Care Paths Organization Department, Public Health Division, National Cancer Institute, Boulogne-Billancourt, France
| | - Jean-Baptiste Méric
- Public Health Division, National Cancer Institute, Boulogne-Billancourt, France
| | - Philippe Jean Bousquet
- Survey Data Science and Assessment Division, National Cancer Institute, Boulogne-Billancourt, France
- Aix Marseille University, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France
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Gagnat G, Hobeika C, Modzelewski R, Collet CS, Di Fiore F, Druesne L, Tuech JJ, Schwarz L. Evaluation of sarcopenia biomarkers in older patients undergoing major surgery for digestive cancer. SAXO prospective cohort study. Eur J Surg Oncol 2023; 49:285-292. [PMID: 36167704 DOI: 10.1016/j.ejso.2022.08.038] [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: 03/14/2022] [Revised: 08/12/2022] [Accepted: 08/31/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The aim of the study was to prospectively evaluate different biomarkers to identify the most reliable for anticipating complications after major abdominal surgery for digestive cancer in older patients and compare their performance to the existing definition and screening algorithm of sarcopenia from EWGSOP. METHODS Ninety-five consecutive patients aged over 65 years who underwent elective surgery for digestive cancer were prospectively included in the SAXO study. Sarcopenia was defined according to EWGSOP criteria (four level from no sarcopenia to severe sarcopenia). Strength and physical performance were evaluated with the handgrip test (HGT) and gait speed test (GST), respectively. CT scan analysis was used to calculate the skeletal muscle index (SMI), intermuscular adipose tissue (IMAT), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT). Measures were adjusted to body mass index (BMI). Complication grading was performed using the Clavien‒Dindo classification. A doubly robust estimator with multivariable regression was used to limit bias. RESULTS Sixteen patients presented with sarcopenia. Adjusted to BMI, sarcopenic patients had an increased IMATBMI (0.35 vs. 0.22; p = 0.003) and increased VATBMI (7.85 vs. 6.13; p = 0.048). In multivariable analysis, IMAT was an independent risk factor for minor and severe complications (OR = 1.298; 95% CI [1.031: 1.635] p = 0.027), while an increased SAT area was a protective factor (OR = 0.982; 95% CI [0.969: 0.995] p = 0.007). Twenty-two patients were obese (BMI ≥30 kg/m2). While no association was observed between obesity and sarcopenia (according to EWGSOP definition), obese patients had increased IMATBMI (0.31 vs. 0.23; p = 0.010) and VATBMI (8.40 vs. 6.49; p = 0.019). The combination of SAT, VAT and IMAT performed well to anticipate severe complication (AUC = 0.759) while AUC of EWGSOP 2010 and 2019 algorithm were 0.660 and 0.519, respectively. DISCUSSION Non-invasive and imaging related measures of IMAT, SAT and VAT seems to be valuable tools to refine risk-assessment of older patients in surgery and specially to detect myosteatosis in obese ones.
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Affiliation(s)
- Guillaume Gagnat
- Normandie Univ, UNIROUEN, Department of Digestive Surgery, Rouen University Hospital, Rouen, France
| | - Christian Hobeika
- Department of Hepatobiliary and Liver Transplantation Surgery, AP-HP, Hôpital Pitié Salpêtrière, CRSA, Sorbonne Université, Paris, France
| | | | - Celine Savoye Collet
- Normandie Univ, UNIROUEN, Quantif-LITIS EA, 4108, Rouen Cedex, France; Normandie Univ, UNIROUEN, Department of Radiology, Rouen University Hospital, Rouen, France
| | - Frederic Di Fiore
- Normandie Univ, UNIROUEN, Department of Digestive Oncology, Rouen University Hospital, Rouen, France; Normandie Univ, UNIROUEN, Inserm, 1245, IRON Group, Rouen Cedex, France
| | - Laurent Druesne
- Normandie Univ, UNIROUEN, Department of Geriatrics, Rouen University Hospital, Rouen, France
| | - Jean Jacques Tuech
- Normandie Univ, UNIROUEN, Department of Digestive Surgery, Rouen University Hospital, Rouen, France; Normandie Univ, UNIROUEN, Inserm, 1245, IRON Group, Rouen Cedex, France
| | - Lilian Schwarz
- Normandie Univ, UNIROUEN, Department of Digestive Surgery, Rouen University Hospital, Rouen, France; Normandie Univ, UNIROUEN, Inserm, 1245, IRON Group, Rouen Cedex, France.
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Ingrand I, Palierne N, Sarrazin P, Desbordes Y, Blanchard C, Ingrand P. Familial colonoscopic screening: how do French general practitioners deal with patients and their high-risk relatives. A qualitative study. Eur J Gen Pract 2022; 28:182-190. [PMID: 35796607 PMCID: PMC9272923 DOI: 10.1080/13814788.2022.2089353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Screening of colorectal cancer (CRC) can reduce incidence and mortality. First-degree relatives (FDRs) of patients with CRC or advanced adenoma before the age of 65 (index patients) are at increased risk of CRC; however, the guidelines for screening of FDRs by colonoscopy are poorly followed. Objectives The present study, conducted in the context of the COLOR3 interventional study project, aimed to explore the positioning of general practitioners (GPs) in familial CRC screening in France. Methods From February 2020 to April 2021, 35 semi-structured interviews with GPs of index patients and/or their FDRs were conducted by telephone. The full-data transcribed corpus was subjected to horizontal thematic analysis. Results Knowledge and compliance with the guidelines vary greatly between GPs. Although initiating the diagnostic process, GPs do not consider themselves as actors in the flow of information concerning familial risk. Their accompaniment of index patients in this role varies. GPs should overcome barriers to implementing colonoscopic screening for FDRs. They underline the importance of exploring family history, but they lack the time and doubt the reliability of the information given by FDRs. Conclusion Challenges include circumventing gaps in knowledge, adherence to guidelines and improving family history updates. The GPs interviewed suggested personalised guidelines in specialists' reports to initiate information campaigns raising awareness of familial risk, and to enhance coordination between organised screening and familial screening.
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Affiliation(s)
- Isabelle Ingrand
- INSERM CIC 1402, University Hospital of Poitiers, University of Poitiers, Poitiers, France
| | - Nicolas Palierne
- GRESCO (EA 3815), University Hospital of Poitiers, University of Poitiers, Poitiers, France
| | - Pauline Sarrazin
- Department of General Medicine, University of Poitiers, Poitiers, France
| | - Yvan Desbordes
- Department of General Medicine, University of Poitiers, Poitiers, France
| | - Clara Blanchard
- Department of General Medicine, University of Poitiers, Poitiers, France
| | - Pierre Ingrand
- INSERM CIC 1402, University Hospital of Poitiers, University of Poitiers, Poitiers, France
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Lemoine L, Adam V, Galus X, Siles P, Coulon A, Grenier-Desforges J, Orabona J, Kergastel I, Wagner P, Salleron J, Tosti P, Huin-Schohn C, Merlin JL, Etienne R, Henrot P. Conversational hypnosis versus standard of care to reduce anxiety in patients undergoing marker placement under radiographic control prior to breast cancer surgery: A randomized, multicenter trial. Front Psychol 2022; 13:971232. [PMID: 36483698 PMCID: PMC9724617 DOI: 10.3389/fpsyg.2022.971232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 11/03/2022] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Surgery is a cornerstone of breast cancer management. Prior to surgery, a wire marker is placed at the site of the tumor, to enable the surgeon to accurately localize the lesion during later surgery. This procedure can generate considerable anxiety for many patients. We investigated the value of conversational hypnosis (CH) in reducing anxiety in patients undergoing preoperative wire placement under radiographic control. METHODS Randomized, multicentre study in 7 centers in France. Inclusion criteria were patients aged >18 years with an Eastern Cooperative Oncology Group performance status ≤2, scheduled to undergo preoperative wire placement in one or several breast lesions. Patients were randomized in a 1:1 ratio, stratified by center to undergo preoperative wire placement with or without the use of CH by a radiological technician trained in the CH technique. The primary endpoint was the percentage of patients with an anxiety score ≥ 6 on a visual analog scale ranging from 0 (absence of anxiety) to 10 (maximal anxiety). Secondary endpoints were pain score, perceived duration reported by the patient, technician satisfaction with their relationship with the patient, and ease of marker insertion reported by the radiologist. Semi-structured interviews were performed with patients to assess their perception of the marker placement procedure. RESULTS The trial was prematurely interrupted for futility after a planned interim analysis after accrual of 167 patients, i.e., half the planned sample size. Prior to marker placement, 29.3% (n = 24) of patients in the control group had an anxiety score ≥ 6, versus 42.3% (n = 33) in the CH group (p = 0.08). After marker placement, the change of anxiety score was not significantly different between groups (11.0% (n = 9) versus 14.3% (n = 11), p = 0.615). There was no significant difference in any of the secondary endpoints. In the interviews, patients from both groups frequently spoke of a feeling of trust. CONCLUSION This study failed to show a benefit of conversational hypnosis on anxiety in patients undergoing marker placement prior to surgery for breast cancer. The fact that some caregivers had learned this personalized therapeutic communication technique may have had a positive impact on the whole caregiving team. TRIAL REGISTRATION The study was registered with ClinicalTrials.gov (NCT02867644).
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Affiliation(s)
- Lydie Lemoine
- Department of Radiology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Virginie Adam
- Department of Supportive Care in Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Xavier Galus
- Department of Radiology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Pascale Siles
- Department of Radiology, Centre Hospitalier Universitaire la Timone, Marseille, France
| | - Agnès Coulon
- Department of Radiology, Centre Léon Bérard, Lyon, France
| | | | - Joseph Orabona
- Department of Radiology, Centre Hospitalier de Bastia, Institut du Sein, Bastia, France
| | - Isabelle Kergastel
- Department of Radiology, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Pierre Wagner
- Department of Radiology, Centre Paul Strauss, Strasbourg, France
| | - Julia Salleron
- Departement of Biostatistics, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Priscillia Tosti
- Departement of Clinical Research, Institut de Cancérologie de Lorraine, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Cécile Huin-Schohn
- Departement of Clinical Research, Institut de Cancérologie de Lorraine, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Jean-Louis Merlin
- Departement of Clinical Research, Institut de Cancérologie de Lorraine, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Rémi Etienne
- Department of Supportive Care in Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Philippe Henrot
- Department of Radiology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France
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Debieuvre D, Molinier O, Falchero L, Locher C, Templement-Grangerat D, Meyer N, Morel H, Duval Y, Asselain B, Letierce A, Trédaniel J, Auliac JB, Bylicki O, Moreau L, Fore M, Corre R, Couraud S, Cortot A. Lung cancer trends and tumor characteristic changes over 20 years (2000–2020): Results of three French consecutive nationwide prospective cohorts’ studies. Lancet Reg Health Eur 2022; 22:100492. [PMID: 36108315 PMCID: PMC9445429 DOI: 10.1016/j.lanepe.2022.100492] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Long-term changes in lung cancer (LC) patients are difficult to evaluate. We report results from the French KBP-2020 real-life cohort. Methods KBP-2020 was a prospective cohort that included all patients diagnosed with LC in 2020, in nonacademic public hospital in France. Patient and tumour characteristics were described and compared with similarly designed cohorts in 2000 and 2010. Findings In 2020, 82 centers included 8,999 patients diagnosed with LC. The proportion of women increased: 34·6% (3114/8999) compared to, 24·3% (1711/7051) and 16·0% (904/5667) in 2010 and 2000 (p<0·0001). The proportion of non-smokers was higher in 2020 (12·6%, 1129/8983) than in previous cohorts (10·9% (762/7008) in 2010; 7·2% (402/5586) in 2000, p<0·0001). In 2020, at diagnosis, 57·6% (4405/7648) of patients had a metastatic/disseminated stage non-small-cell lung cancer (NSCLC) (58·3% (3522/6046) in 2010; 42·6% (1879/4411) in 2000, p<0·0001). Compared with 2000 and 2010 data, early survival improved slightly. In 2020, 3-month mortality of NSCLC varied from 3·0% [2·2 – 3·8] for localized to 9·6% [8·1 – 11·0] for locally advanced to 29·2% [27·8 – 30·6] for metastatic and was 24·8% [22·3 – 27·3] for SCLC. Interpretation To our knowledge KBP cohorts have been the largest, prospective, real-world cohort studies involving LC patients conducted in worldwide. The trend found in our study shows an increase in LC in women and still a large proportion of patients diagnosed at metastatic or disseminated stage. Funding The study was promoted by the French College of General Hospital Pulmonologists with financial support of industrials laboratories.
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Affiliation(s)
- Didier Debieuvre
- Respiratory Medicine Department, Groupe Hospitalier de la Région Mulhouse Sud-Alsace, Hôpital Emile Muller, Mulhouse, France
- Corresponding author at: Service de Pneumologie, GHRMSA, Hôpital Emile Muller, 20 rue du Dr Laënnec, BP 1370, 68070 Mulhouse CEDEX, France.
| | - Olivier Molinier
- Respiratory Medicine Department, Centre Hospitalier Le Mans, Le Mans, France
| | - Lionel Falchero
- Respiratory Medicine Department, L'Hôpital Nord-Ouest, Villefranche-Sur-Saône, France
| | - Chrystèle Locher
- Respiratory Medicine Department, Grand Hôpital de l'Est Francilien (GHEF), Meaux, France
| | | | - Nicolas Meyer
- Biostatistician, Public Health Department, CHU de Strasbourg, GMRC, Strasbourg, France
| | - Hugues Morel
- Respiratory Medicine Department, Centre Hospitalier Régional D'Orléans Hôpital de La Source, Orléans, France
| | - Yannick Duval
- Respiratory Medicine Department, Hôpital de Cannes Simone Veil, Cannes, France
| | - Bernard Asselain
- Methodologist, Groupe Statistique, ARCAGY - GINECO, Paris, France
| | | | - Jean Trédaniel
- Department of Thoracic Oncology, Groupe hospitalier Paris-Saint Joseph, Paris, France
| | - Jean-Bernard Auliac
- Respiratory Medicine Department, Centre Hospitalier Intercommunal Créteil, Créteil, France
| | - Olivier Bylicki
- Respiratory Medicine Department, Hôpital d'Instruction des Armées Sainte-Anne, Toulon, France
| | - Lionel Moreau
- Respiratory Medicine Department, Centre Hospitalier de Colmar, Colmar, France
| | - Mathieu Fore
- Respiratory Medicine Department, Groupe Hospitalier de la Région Mulhouse Sud-Alsace, Hôpital Emile Muller, Mulhouse, France
| | - Romain Corre
- Respiratory Medicine Department, Centre Hospitalier de Cornouaille, Quimper, France
| | - Sébastien Couraud
- Respiratory Medicine Department, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Alexis Cortot
- Department of Thoracic Oncology, CHU de Lille, CNRS, Inserm, Institut Pasteur de Lille, UMR9020-U1277-CANTHER, Lille, France
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Predictors of Survival in Elderly Patients with Metastatic Colon Cancer: A Population-Based Cohort Study. Cancers (Basel) 2022; 14:cancers14215208. [PMID: 36358628 PMCID: PMC9654615 DOI: 10.3390/cancers14215208] [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: 10/01/2022] [Revised: 10/16/2022] [Accepted: 10/20/2022] [Indexed: 11/17/2022] Open
Abstract
Oncological strategies in the elderly population are debated. The objective of this study was to determine the predictive factors of survival in patients aged 80 years and older with metastatic colon cancer. Data from four digestive tumour registry databases were used in this analysis. This population-based retrospective study included 1115 patients aged 80 years and older with stage IV colon adenocarcinoma diagnosed between 2007 and 2016. Cox regression was used to assess the impact of different prognostic factors. Age was significantly correlated with the surgical treatment (p < 0.001) but not with overall survival. Patients with a low comorbidity burden had better survival than patients with higher comorbidities scores (9.4 (0−123) versus 7.9 (0−115) months) (p = 0.03). Surgery was more common for proximal colon cancer (p < 0.001), but the location of the primary lesion was not correlated with improved survival (p = 0.07). Patients with lung metastases had a better prognosis than those with liver metastases (HR 0.56 95% CI 0.40, 0.77 p < 0.001); multiple organ involvement had the worst survival (HR 1.32 95% CI 1.15, 1.51 p < 0.001). Chemotherapy was associated with improved survival for both operated (HR 0.45 95% CI 0.35, 0.58 p < 0.001) and non-operated patients (HR 0.41 95% CI 0.34, 0.50 p < 0.001). The majority of patients receiving adjuvant treatment had a low comorbidity burden. In our study, the location of metastases but not the primary tumor location had an impact on overall survival. Low comorbidity burden, curative surgery, and chemotherapy had a significant advantage for elderly patients with metastatic colon cancer.
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Reboux N, Jooste V, Goungounga J, Robaszkiewicz M, Nousbaum JB, Bouvier AM. Incidence and Survival in Synchronous and Metachronous Liver Metastases From Colorectal Cancer. JAMA Netw Open 2022; 5:e2236666. [PMID: 36239935 PMCID: PMC9568798 DOI: 10.1001/jamanetworkopen.2022.36666] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Although treatment and prognosis of synchronous liver metastases from colorectal cancer are relatively well known, a comparative description of the incidence, epidemiological features, and outcomes of synchronous and metachronous liver metastases is lacking. The difference in prognosis between patients with synchronous and metachronous liver metastases is controversial. OBJECTIVE To investigate temporal patterns in the incidence and outcomes of synchronous vs metachronous liver metastases from colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used information from a French regional digestive cancer registry accounting for 1 082 000 inhabitants. A total of 26 813 patients with a diagnosis of incident colorectal adenocarcinoma diagnosed between January 1, 1976, and December 31, 2018, were included. Data were analyzed from February 7 to May 20, 2022. MAIN OUTCOMES AND MEASURES Age-standardized incidence was calculated. Univariate and multivariate net survival analyses were performed. RESULTS Of 26 813 patients with colorectal cancer (15 032 men [56.1%]; median [IQR] age, 73 [64-81] years), 4546 (17.0%) presented with synchronous liver metastases. The incidence rate of synchronous liver metastases was 6.9 per 100 000 inhabitants in men and 3.4 per 100 000 inhabitants in women, with no significant variation since 2000. The 5-year cumulative incidence of metachronous liver metastases decreased from 18.6% (95% CI, 14.9%-22.2%) during the 1976 to 1980 period to 10.0% (95% CI, 8.8%-11.2%) during the 2006 to 2011 period. Cancer stage at diagnosis was the strongest risk factor for liver metastases; compared with patients diagnosed with stage II cancer, patients with stage III cancer had a 2-fold increase in risk (subdistribution hazard ratio, 2.42; 95% CI, 2.08-2.82) for up to 5 years. Net survival at 1 year was 41.8% for synchronous liver metastases and 49.9% for metachronous metastases, and net survival at 5 years was 6.2% for synchronous liver metastases and 13.2% for metachronous metastases. Between the first (1976-1980) and last (2011-2016) periods, the adjusted ratio of death after synchronous and metachronous metastases was divided by 2.5 for patients with synchronous status and 3.7 for patients with metachronous status. CONCLUSIONS AND RELEVANCE In this study, the incidence of colorectal cancer with synchronous liver metastases changed little over time, whereas there was a 2-fold decrease in the probability of developing metachronous liver metastases. Survival improved substantially for patients with metachronous liver metastases, whereas improvement was more modest for those with synchronous metastases. The differences observed in the epidemiological features of synchronous and metachronous liver metastases from colorectal cancer may be useful for the design of future clinical trials.
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Affiliation(s)
- Noémi Reboux
- Department of Hepato-Gastroenterology, University Hospital La Cavale Blanche, Brest, France
| | - Valérie Jooste
- Digestive Cancer Registry of Burgundy, Dijon, France
- INSERM UMR 1231, Lipides Nutrition Cancer, EPICAD Team, Dijon, France
- Department of clinical research, Dijon University Hospital, Dijon, France
- Medical School, University of Burgundy, Dijon, France
| | - Juste Goungounga
- Digestive Cancer Registry of Burgundy, Dijon, France
- INSERM UMR 1231, Lipides Nutrition Cancer, EPICAD Team, Dijon, France
- Department of clinical research, Dijon University Hospital, Dijon, France
- Medical School, University of Burgundy, Dijon, France
| | - Michel Robaszkiewicz
- Department of Hepato-Gastroenterology, University Hospital La Cavale Blanche, Brest, France
- Digestive Cancer Registry of Finistère, Equipe d’Accueil 7479, SPURBO, Brest, France
| | - Jean-Baptiste Nousbaum
- Department of Hepato-Gastroenterology, University Hospital La Cavale Blanche, Brest, France
- Digestive Cancer Registry of Finistère, Equipe d’Accueil 7479, SPURBO, Brest, France
| | - Anne-Marie Bouvier
- Digestive Cancer Registry of Burgundy, Dijon, France
- INSERM UMR 1231, Lipides Nutrition Cancer, EPICAD Team, Dijon, France
- Department of clinical research, Dijon University Hospital, Dijon, France
- Medical School, University of Burgundy, Dijon, France
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Ilic I, Ilic M. International patterns in incidence and mortality trends of pancreatic cancer in the last three decades: A joinpoint regression analysis. World J Gastroenterol 2022; 28:4698-4715. [PMID: 36157927 PMCID: PMC9476884 DOI: 10.3748/wjg.v28.i32.4698] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/05/2022] [Accepted: 06/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pancreatic cancer, as the one of most fatal malignancies, remains a critical issue in the global burden of disease.
AIM To estimate trends in pancreatic cancer incidence and mortality worldwide in the last three decades.
METHODS A descriptive epidemiological study was done. Pancreatic cancer incidence and mortality data were obtained from the database of the World Health Organization. Analysis of pancreatic cancer incidence and mortality during 2020 was performed. The age-standardized rates (ASRs, expressed per 100000) were presented. To estimate trends of incidence and mortality of pancreatic cancer, joinpoint regression analysis was used: the average annual percent change (AAPC) with the corresponding 95% confidence interval (95%CI) was calculated. Additionally, analysis was performed by sex and age. In this paper, the trend analysis included only countries with high and medium data quality.
RESULTS A total of 495773 (262865 male and 232908 female) new cases and 466003 (246840 male and 219163 female) deaths from pancreatic cancer were reported worldwide in 2020. In both sexes, most of the new cases (191348; 38.6% of the total) and deaths (182074; 39.1% of the total) occurred in the Western Pacific Region. In both sexes, the highest ASRs were found in the European Region, while the lowest rates were reported in the South-East Asia Region. The general pattern of rising pancreatic cancer incidence and mortality was seen across countries worldwide in observed period. Out of all countries with an increase in pancreatic cancer incidence, females in France and India showed the most marked rise in incidence rates (AAPC = +3.9% and AAPC = +3.7%, respectively). Decreasing incidence trends for pancreatic cancer were observed in some countries, but without significance. Out of all countries with an increase in pancreatic cancer mortality rates, Turkmenistan showed the most marked rise both in males (AAPC = +10.0%, 95%CI: 7.4–12.5) and females (AAPC = +6.4%, 95%CI: 3.5–9.5). The mortality trends of pancreatic cancer were decreasing in both sexes only in Canada and Mexico.
CONCLUSION Further research is needed to explain the cause of large international differences in incidence and mortality trends of pancreatic cancer in last three decades.
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Affiliation(s)
- Irena Ilic
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Milena Ilic
- Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac 34000, Serbia
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Colonna M, Grosclaude P, Bouvier AM, Goungounga J, Jooste V. Health status of prevalent cancer cases as measured by mortality dynamics (cancer vs. noncancer): Application to five major cancers sites. Cancer 2022; 128:3663-3673. [PMID: 35972380 DOI: 10.1002/cncr.34413] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/03/2022] [Accepted: 06/23/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Cancer prevalence is heterogeneous because it includes individuals who are undergoing initial treatment and those who are in remission, experiencing relapse, or cured. The proposed statistical approach describes the health status of this group by estimating the probabilities of death among prevalent cases. The application concerns colorectal, lung, breast, and prostate cancers and melanoma in France in 2017. METHODS Excess mortality was used to estimate the probabilities of death from cancer and other causes. RESULTS For the studied cancers, most deaths from cancer occurred during the first 5 years after diagnosis. The probability of death from cancer decreased with increasing time since diagnosis except for breast cancer, for which it remained relatively stable. The time beyond which the probability of death from cancer became lower than that from other causes depended on age and cancer site: for colorectal cancer, it was 6 years after diagnosis for women (7 years for men) aged 75-84 and 20 years for women (18 years for men) aged 45-54 years, whereas cancer was the major cause of death for women younger than 75 years whatever the time since diagnosis for breast and for all patients younger than 75 years for lung cancer. In contrast, deaths from other causes were more frequent in all the patients older than 75 years. Apart from breast cancer in women younger than 55 years and lung cancer in women older than 55 years and men older than 65 years, the probability of death from cancer among prevalent cases fell below 1%, with varying times since diagnosis. CONCLUSIONS The authors' approach can be used to better describe the burden of cancer by estimating outcomes in prevalent cases.
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Affiliation(s)
- Marc Colonna
- Isere Cancer Registry, University Hospital of Grenoble, Grenoble, France.,French Network of Cancer Registries (FRANCIM), Toulouse, France
| | - Pascale Grosclaude
- French Network of Cancer Registries (FRANCIM), Toulouse, France.,Tarn Cancer Registry, Claudius Regaud Institute, Toulouse, France
| | - Anne Marie Bouvier
- French Network of Cancer Registries (FRANCIM), Toulouse, France.,Digestive Cancer Registry of Burgundy, Dijon University Hospital, Dijon, France.,Unit 1231 Epidemiology and Clinical Research in Digestive Cancers, National Institute of Health and Medical Research, University of Burgundy-Franche Comte, Dijon, France
| | - Juste Goungounga
- Digestive Cancer Registry of Burgundy, Dijon University Hospital, Dijon, France.,Unit 1231 Epidemiology and Clinical Research in Digestive Cancers, National Institute of Health and Medical Research, University of Burgundy-Franche Comte, Dijon, France
| | - Valérie Jooste
- French Network of Cancer Registries (FRANCIM), Toulouse, France.,Digestive Cancer Registry of Burgundy, Dijon University Hospital, Dijon, France.,Unit 1231 Epidemiology and Clinical Research in Digestive Cancers, National Institute of Health and Medical Research, University of Burgundy-Franche Comte, Dijon, France
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Dahel Y, Cottet V, Boisson C, Manfredi S, Degand T. Compliance with follow-up guidelines after high-risk colorectal polyp removal: a population-based study. Gastrointest Endosc 2022; 96:351-358. [PMID: 35339474 DOI: 10.1016/j.gie.2022.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/17/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS After high-risk colorectal adenoma removal, colorectal cancer risk remains higher than that in the general population. Depending on polyp characteristics, a 3-month or 3-year follow-up colonoscopy is recommended, and clear follow-up instructions must be given to the patient. Our primary aim was to evaluate compliance with French follow-up recommendations. Second, we evaluated the impact of how the information was given and if patients actually underwent their control colonoscopy according to the instructions given. METHODS We collected data from the Burgundy polyp population-based registry and medical records from the endoscopy centers of the area. Between June 30, 2014 and July 1, 2015, 405 patients were included in this study. RESULTS Written follow-up instructions were provided to 345 patients (85.2%), and 184 of them (53.3%) complied with guidelines. For 29.9% the interval to follow-up colonoscopy was longer than recommended, and for 6.4% the interval was shorter. Among the 303 patients who had clear follow-up instructions, 42.2% had their control colonoscopy and 83.6% respected the stipulated interval. Follow-up instructions were found in the colonoscopy report in at least 49% of cases. CONCLUSIONS Compliance with follow-up guidelines was poor: Inappropriate intervals were often longer than recommended. Patients with written follow-up instructions and those who underwent follow-up colonoscopy mostly followed these instructions. Ensuring compliance with guidelines and giving written instructions to patients should be primary goals to achieve effective follow-up. Gastroenterologist training should be improved in this way.
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Affiliation(s)
- Yanis Dahel
- Department of Hepato-Gastroenterology, University Hospital of Dijon, Dijon, France
| | - Vanessa Cottet
- INSERM UMR 1231, CIC-EC 1432, University of Burgundy, Dijon, France
| | - Cyril Boisson
- INSERM UMR 1231, CIC-EC 1432, University of Burgundy, Dijon, France
| | - Sylvain Manfredi
- Department of Hepato-Gastroenterology, University Hospital of Dijon, Dijon, France; INSERM UMR 1231, CIC-EC 1432, University of Burgundy, Dijon, France
| | - Thibault Degand
- Department of Hepato-Gastroenterology, University Hospital of Dijon, Dijon, France
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Abstract
Dramatically increasing trends in consumption of ultra-processed foods have been reported across the globe. Public concern about the health consequences of ultra-processed foods is high. This manuscript provides a comprehensive review of trends in global consumption of ultra-processed foods, dietary nutrient profile of ultra-processed foods, demographic, socioeconomic, psychological, and behavioral characteristics of ultra-processed food consumers, current evidence from longitudinal studies at the population level on the association between ultra-processed foods consumption and major health outcomes (including all-cause and cause-specific mortality, cardiovascular disease, overweight and obesity, body composition and fat deposition, diabetes, cancer, and gastrointestinal and other diseases), potential mechanisms linking ultra-processed foods with these outcomes (nutrient displacement, factors that influence adiposity, and processing), and challenges and future research directions. The global trends in consumption of ultra-processed foods, the generally unfavorable nutrient profile of ultra-processed foods, the characteristics of ultra-processed food consumers, the accumulating longitudinal studies associating ultra-processed foods with major health outcomes, and the uncertainties and complexities in putative mechanisms all highlight the need for future high-quality epidemiologic and mechanistic investigations on this topic. It is critical to interpret findings in the light of the totality of evidence.
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Affiliation(s)
- Yin Zhang
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Edward L Giovannucci
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
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Multi-Disciplinary Care Planning of Ovarian Cancer in Older Patients: General Statement-A Position Paper from SOFOG-GINECO-FRANCOGYN-SFPO. Cancers (Basel) 2022; 14:cancers14051295. [PMID: 35267603 PMCID: PMC8909025 DOI: 10.3390/cancers14051295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary This position paper aims to provide practitioners a proposal for multidisciplinary care planning for older patients with ovarian cancer from the time of suspected diagnosis. The first-line treatment of advanced ovarian cancer involves several interdependent sequences: cytoreductive surgery, (neo)adjuvant chemotherapy and maintenance targeted treatments. In older patients, care planning must be adapted to their geriatric parameters and consider the geriatric impact of each treatment sequence to allow treatment completion. Care planning should be centered on patient motivation and imply multidisciplinarity. Each step of treatment plan should be reconsidered in light of a geriatric assessment and follow-up. Studies are needed to prospectively evaluate the impact of geriatric vulnerability parameters at each step of the treatment agenda and the impact of geriatric interventions on patient outcomes. Abstract In this position paper the Société Francophone d’OncoGériatrie (SOFOG; French-speaking oncogeriatric society), the Société Française de Pharmacie Oncologique (SFPO, French society for oncology pharmacy), the Groupe d’Investigateurs Nationaux pour l’Étude des Cancers de l’Ovaire et du sein (GINECO, National Investigators’ Group for Studies in Ovarian and Breast Cancer) and the Groupe Français de chirurgie Oncologique et Gynécologique (FRANCOGYN) propose a multi-disciplinary care planning of ovarian cancer in older patients. The treatment pathway is based on four successive decisional nodes (diagnosis, resectability assessment, operability assessment, adjuvant, and maintenance treatment decision) implying multidisciplinarity and adaptation of the treatment plan according to the patient’s geriatric covariates and her motivation towards treatment. Specific attention must be paid to geriatric intervention, supportive care and pharmaceutical conciliation. Studies are needed to prospectively evaluate the impact of geriatric vulnerability parameters at each step of the treatment agenda and the impact of geriatric interventions on patient outcomes.
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Gautier P, Guillet B, Sigaud M, Claeyssens S, Volot FG, Chamouni P, Lienahrt A, Frotscher B, Fournel A, Castet S, Poumayou C, Gay V, Thuret R, Wibaut B, Biron-Andreani C. Prostate biopsy and prostate cancer management in patients with haemophilia: The experience of French Haemophilia Treatment Centres. Haemophilia 2022; 28:437-444. [PMID: 35201650 DOI: 10.1111/hae.14507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/18/2022] [Accepted: 01/26/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Data are limited on prostate cancer (PC) management in patients with haemophilia (PWH). AIM To describe PC screening and diagnosis, treatment modalities and bleeding complications in a group of unselected PWH followed at French Haemophilia Treatment Centres (HTCs) PATIENTS AND METHODS: PC screening, management and bleeding complications were retrospectively investigated at 14 French HTCs between 2003 and 2018. RESULTS Among> 1549 > 50-year-old PWHs, 73 (4.7%) underwent PC screening (median age 71.1 years; 67/6 HA/HB, 17/56 severe-moderate/mild). At diagnosis, haematuria was infrequent. Prophylaxis was administered during 76/86 (88%) prostate biopsies (PB) (n = 67 clotting factor concentrates, CFC; n = 9 desmopressin; n = 17 associated with tranexamic acid, TA). Bleeding (11/86, 12.8%) occurred mainly post-prophylaxis (median delay: 7 days): haematuria (9/11, 81.8%), and rectal bleeding (2/11, 18.2%) including one major (1.2%). PC was confirmed in 50/86 PB and in two prostatectomy specimens (total n = 50 patients, n = 6 with only active surveillance). Surgery (n = 28/44 patients) was managed with CFC. Fifteen patients had radiotherapy/brachytherapy, 10 had hormone therapy; CFC-based prophylaxis was only prescribed for brachytherapy (n = 2). Major bleedings occurred in 3/28 (10.7%) and 2/15 (13.3%) patients who underwent surgery and radio/brachytherapy, respectively. No bleeding risk factor was found. CONCLUSION Our data indicate that PB requires prophylaxis for atleast 7 days, using CFC, desmopressin or TA in function of haemophilia severity. PC surgery should be considered at high bleeding risk. Long-term post-procedural CFC or oral TA could be discussed. Radiotherapy/brachytherapy also should be managed with prophylaxis (CFC or TA).
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Affiliation(s)
- Philippe Gautier
- Haemophilia Treatment Centre, Associated National Reference Willebrand Centre, University hospital, Caen, France
| | - Benoit Guillet
- Haemophilia Treatment Centre, University hospital, Rennes, France
| | - Marianne Sigaud
- Associated National Reference Haemophilia Treatment Centre, University hospital, Nantes, France
| | | | | | - Pierre Chamouni
- Haemophilia Treatment Centre, University hospital, Rouen, France
| | - Anne Lienahrt
- Reference Haemophilia Treatment Centre, University hospital, Lyon, France
| | - Birgit Frotscher
- Haemophilia Treatment Centre, University hospital, Nancy, France
| | | | - Sabine Castet
- Haemophilia Treatment Centre, University hospital, Bordeaux, France
| | - Catherine Poumayou
- Haemophilia Treatment Centre, La Timone Hospital APHM, Aix Marseille University, Marseille, France
| | - Valérie Gay
- hospital, Haemophilia Treatment Centre, Chambery, France
| | - Rodolphe Thuret
- Department of urologic surgery, University hospital, Montpellier, France
| | - Bénédicte Wibaut
- Haemophilia Treatment Centre, National Reference Willebrand Centre, University hospital, Lille, France
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