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Jalili F, Hajizadeh M, Mehrabani S, Ghoreishy SM, MacIsaac F. The association between neighborhood socioeconomic status and the risk of incidence and mortality of colorectal cancer: A systematic review and meta-analysis of 1,678,582 participants. Cancer Epidemiol 2024; 91:102598. [PMID: 38878681 DOI: 10.1016/j.canep.2024.102598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 06/01/2024] [Accepted: 06/05/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVES We conducted a systematic review and meta-analysis to evaluate the association between neighborhood socioeconomic status (n-SES) and the risk of incidence and mortality in colorectal cancer (CRC). SETTING A comprehensive literature search was performed using PubMed/MEDLINE, ISI Web of Science and Scopus without any limitation until October 11, 2023. Inclusion criteria consisted of observational studies in adult subjects (≥18 years) which provided data on the association between n-SES and CRC-related incidence and mortality. Relative risk (RR) and 95 % confidence interval (CI) were pooled by employing a random-effects model. We employed validated methods to assess study quality and publication bias, utilizing the Newcastle-Ottawa Scale for quality evaluation, subgroup analysis to find possible sources of heterogeneity, Egger's regression asymmetry and Begg's rank correlation tests for bias detection and sensitivity analysis. RESULTS Finally, 24 studies (21 cohorts and 3 cross-sectional studies) from seven different countries with 1678,582 participants were included. The analysis suggested that a significant association between lower n-SES and an increased incidence of CRC (RR=1.11; 95 % CI: 1.08, 1.14; I2=64.4 %; p<0.001; n=46). The analysis also indicated a significant association between lower n-SES and an increased risk of mortality of CRC (RR=1.21; 95 % CI: 1.16, 1.26; I2=76.4 %; p<0.001; n=23). Furthermore, subgroup analysis revealed that there was a significant association between lower n-SES and an increased risk of incidence of CRC in colon location (RR=1.06; 95 % CI: 1.02, 1.10; I2=0.0 %; p=0.001; n=8), but not rectal location. In addition, subgroup analysis for covariates adjustment suggested that body mass index, smoking, physical activity, alcohol intake, or sex adjustment may influence the relationship between n-SES and the risk of incidence and mortality in CRC. CONCLUSION Lower n-SES was found to be a contributing factor to increased incidence and mortality rates associated with CRC, highlighting the substantial negative impacts of lower n-SES on cancer susceptibility and health outcomes.
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Affiliation(s)
- Faramarz Jalili
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada.
| | - Mohammad Hajizadeh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Sanaz Mehrabani
- Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed Mojtaba Ghoreishy
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran; Student Research Committee, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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Gheybi K, Buckley E, Vitry A, Roder D. Associations of advanced age with comorbidity, stage and primary subsite as contributors to mortality from colorectal cancer. Front Public Health 2023; 11:1101771. [PMID: 37089488 PMCID: PMC10116414 DOI: 10.3389/fpubh.2023.1101771] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/16/2023] [Indexed: 04/09/2023] Open
Abstract
BackgroundAlthough survival from colorectal cancer (CRC) has improved substantially in recent decades, people with advanced age still have a high likelihood of mortality from this disease. Nonetheless, few studies have investigated how cancer stage, subsite and comorbidities contribute collectively to poor prognosis of older people with CRC. Here, we decided to explore the association of age with mortality measures and how other variables influenced this association.MethodsUsing linkage of several administrative datasets, we investigated the risk of death among CRC cases during 2003–2014. Different models were used to explore the association of age with mortality measures and how other variables influenced this association.ResultsOur results indicated that people diagnosed at a young age and with lower comorbidity had a lower likelihood of all-cause and CRC-specific mortality. Aging had a greater association with mortality in early-stage CRC, and in rectal cancer, compared that seen with advanced-stage CRC and right colon cancer, respectively. Meanwhile, people with different levels of comorbidity were not significantly different in terms of their increased likelihood of mortality with advanced age. We also found that while most comorbidities were associated with all-cause mortality, only dementia [SHR = 1.43 (1.24–1.64)], Peptic ulcer disease [SHR = 1.12 (1.02–1.24)], kidney disease [SHR = 1.11 (1.04–1.20)] and liver disease [SHR = 1.65 (1.38–1.98)] were risk factors for CRC-specific mortality.ConclusionThis study showed that the positive association of advanced age with mortality in CRC depended on stage and subsite of the disease. We also found only a limited number of comorbidities to be associated with CRC-specific mortality. These novel findings implicate the need for more attention on factors that cause poor prognosis in older people.
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Affiliation(s)
- Kazzem Gheybi
- University of South Australia Allied Health and Human Performance, Adelaide, SA, Australia
- University of South Australia, Cancer Epidemiology and Population Health, Adelaide, SA, Australia
- Charles Perkins Centre, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia
| | - Elizabeth Buckley
- University of South Australia Allied Health and Human Performance, Adelaide, SA, Australia
- University of South Australia, Cancer Epidemiology and Population Health, Adelaide, SA, Australia
| | - Agnes Vitry
- University of South Australia Clinical and Health Sciences, Adelaide, SA, Australia
| | - David Roder
- University of South Australia Allied Health and Human Performance, Adelaide, SA, Australia
- University of South Australia, Cancer Epidemiology and Population Health, Adelaide, SA, Australia
- *Correspondence: David Roder
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Long-term benefits for lower socioeconomic groups by improving bowel screening participation in South Australia: A modelling study. PLoS One 2022; 17:e0279177. [PMID: 36542644 PMCID: PMC9770333 DOI: 10.1371/journal.pone.0279177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 11/27/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The gap in bowel cancer screening participation rates between the lowest socioeconomic position (SEP) groups and the highest in Australia is widening. This study estimates the long-term health impacts and healthcare costs at current colorectal cancer (CRC) screening participation rates by SEP in South Australia (SA). METHODS A Markov microsimulation model for each socioeconomic quintile in SA estimated health outcomes over the lifetime of a population aged 50-74 years (total n = 513,000). The model simulated the development of CRC, considering participation rates in the National Bowel Cancer Screening Program and estimated numbers of cases of CRC, CRC deaths, adenomas detected, mean costs of screening and treatment, and quality adjusted life years. Screened status, stage of diagnosis and survival were obtained for patients diagnosed with CRC in 2006-2013 using data linked to the SA Cancer Registry. RESULTS We predict 10915 cases of CRC (95%CI: 8017─13812) in the lowest quintile (Q1), 17% more than the highest quintile (Q5) and 3265 CRC deaths (95%CI: 2120─4410) in Q1, 24% more than Q5. Average costs per person, were 29% higher in Q1 at $11997 ($8754─$15240) compared to Q5 $9281 ($6555─$12007). When substituting Q1 screening and diagnostic testing rates with Q5's, 17% more colonoscopies occur and adenomas and cancers detected increase by 102% in Q1. CONCLUSION Inequalities were evident in CRC cases and deaths, as well as adenomas and cancers that could be detected earlier. Implementing programs to increase screening uptake and follow-up tests for lower socioeconomic groups is critical to improve the health of these priority population groups.
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Tham NL, Skandarajah A, Hayes IP. Socioeconomic disadvantage and its impact on colorectal cancer in Australia: a scoping review. ANZ J Surg 2022; 92:2808-2815. [PMID: 36189982 PMCID: PMC9828090 DOI: 10.1111/ans.18081] [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: 07/13/2022] [Revised: 09/15/2022] [Accepted: 09/17/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Social disparities in cancer survival have been demonstrated in Australia despite a universal healthcare insurance system. Colorectal cancer is common, and reasons for survival disparities related to socioeconomic status need to be investigated and addressed. The aim is to evaluate the current Australian literature concerning the impact of socioeconomic status on colorectal cancer survival and stage at presentation. METHODS A systematic search of PUBMED, EMBASE, SCOPUS and Clarivate Web of Science databases from January 2010 to March 2022 was performed. Studies investigating the impact of socioeconomic status on colorectal stage at presentation or survival in Australia were included. Data were extracted on author, year of publication, state or territory of origin, patient population, other exposure variables, outcomes and findings and adjustments made. RESULTS Of the 14 articles included, the patient populations examined varied in size from 207 to 100 000+ cases. Evidence that socioeconomic disadvantage was associated with poorer survival was demonstrated in eight of 12 studies. Evidence of effect on late stage at presentation was demonstrated in two of seven studies. Area-level measures were commonly used to assess socioeconomic status, with varying indices utilized. CONCLUSION There is limited evidence that socioeconomic status is associated with late-stage at presentation. More studies provide evidence of an association between socioeconomic disadvantage and poorer survival, especially larger studies utilizing less clinically-detailed cancer registry data. Further investigation is required to analyse why socioeconomic disadvantage may be associated with poorer survival.
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Affiliation(s)
- Nicole Li Tham
- Colorectal Surgical UnitThe Royal Melbourne HospitalParkvilleVictoriaAustralia,Department of General Surgical SpecialtiesThe Royal Melbourne HospitalParkvilleVictoriaAustralia,Department of SurgeryThe University of MelbourneMelbourneVictoriaAustralia
| | - Anita Skandarajah
- Department of General Surgical SpecialtiesThe Royal Melbourne HospitalParkvilleVictoriaAustralia,Department of SurgeryThe University of MelbourneMelbourneVictoriaAustralia
| | - Ian Paul Hayes
- Colorectal Surgical UnitThe Royal Melbourne HospitalParkvilleVictoriaAustralia,Department of General Surgical SpecialtiesThe Royal Melbourne HospitalParkvilleVictoriaAustralia,Department of SurgeryThe University of MelbourneMelbourneVictoriaAustralia
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Hultstrand C, Hörnsten C, Lilja M, Coe A, Fjällström P, Hajdarevic S. The association between sociodemographic factors and time to diagnosis for colorectal cancer in northern Sweden. Eur J Cancer Care (Engl) 2022; 31:e13687. [PMID: 35970596 PMCID: PMC9787547 DOI: 10.1111/ecc.13687] [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: 07/11/2021] [Revised: 06/29/2022] [Accepted: 08/02/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES This study examined whether sociodemographic factors, including distance to hospital, were associated with differences in the diagnostic interval and the treatment interval for colorectal cancer in northern Sweden. METHODS Data were retrieved from the Swedish cancer register on patients (n = 446) diagnosed in three northern regions during 2017-2018, then linked to data from Statistics Sweden and medical records. Also, Google maps was used to map the distance between patients' place of residence and nearest hospital. The different time intervals were analysed using Mann-Whitney U-test and Cox regression. RESULTS Differences in time to diagnosis were found between groups for income and distance to hospital, favouring those with higher income and shorter distance. The unadjusted regression analysis showed higher income to be associated with more rapid diagnosis (HR 1.004, CI 1.001-1.007). This association remained in the fully adjusted model for income (HR 1.004, CI 1.000-1.008), but not for distance. No differences between sociodemographic groups were found in the treatment interval. CONCLUSION Higher income and shorter distance to hospital were in the unadjusted models associated with shorter time to diagnosis for patients with CRC in northern Sweden. The association remained for income when adjusting for other variables even though the difference was small.
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Affiliation(s)
- Cecilia Hultstrand
- Department of NursingUmeå UniversityUmeåSweden,Department of Public Health and Clinical Medicine, Family MedicineUmeå UniversityUmeåSweden
| | | | - Mikael Lilja
- Department of Public Health and Clinical Medicine, Unit of Research, Education, and DevelopmentÖstersund Hospital, Umeå UniversityUmeåSweden
| | | | | | - Senada Hajdarevic
- Department of NursingUmeå UniversityUmeåSweden,Department of Public Health and Clinical Medicine, Family MedicineUmeå UniversityUmeåSweden
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Lal A, McCaffrey N, Gold L, Roder D, Buckley E. Variations in utilisation of colorectal cancer services in South Australia indicated by MBS/PBS benefits: a benefit incidence analysis. Aust N Z J Public Health 2022; 46:237-242. [PMID: 35174927 DOI: 10.1111/1753-6405.13197] [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: 05/01/2021] [Revised: 10/01/2021] [Accepted: 11/01/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This study investigated variations in healthcare expenditure for colorectal cancer (CRC) patients in South Australia by socioeconomic position (SEP) and remoteness area. METHODS Benefits incidence analysis (BIA) was used to examine healthcare expenditure and utilisation in relation to CRC patients by SEP and remoteness areas. Utilisation data was obtained for patients diagnosed with CRC in 2003-2013 from a dataset linked to a population-based cancer registry, Medicare Benefits Scheme (MBS), Pharmaceutical Benefits Scheme (PBS), hospital and death data. Concentration indices estimated the distribution of health expenditure on MBS, MBS palliative care, PBS and general practitioners. Costs of claims data and length of stay in hospital were used as indicators of healthcare utilisation. RESULTS The results indicated that MBS palliative healthcare services utilisation favoured the more advantaged groups for both SEP and remoteness area (Concentration index (CI)= 0.1681, t-value=54.42 (SEP) and CI=0.1546, t-value=41.64). MBS expenditure was also favourable to the more advantaged groups (CI: 0.0785 and 0.0493).PBS and MBS general practitioner expenditure were equal (-0.0093 to 0.0250). CONCLUSION Overall MBS and PBS healthcare expenditure for CRC patients was close to equality, however utilisation of MBS-funded palliative healthcare services was less concentrated in low SEP and more remote areas. Implications for public health: Whether the differences in palliative healthcare utilisation supplied by private providers are offset by other services requires investigation to determine if there is a need for initiatives to improve equality and give greater support to those who choose to die at home.
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Affiliation(s)
- Anita Lal
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Victoria
| | - Nikki McCaffrey
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Victoria
| | - Lisa Gold
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Victoria
| | - David Roder
- Cancer Epidemiology and Population Health Research Group, Allied Health and Human Performance Academic Unit, University of South Australia, Adelaide, South Australia
| | - Elizabeth Buckley
- Cancer Epidemiology and Population Health Research Group, Allied Health and Human Performance Academic Unit, University of South Australia, Adelaide, South Australia
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Lung Cancer and Self-Management Interventions: A Systematic Review of Randomised Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010536. [PMID: 35010796 PMCID: PMC8744740 DOI: 10.3390/ijerph19010536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 02/01/2023]
Abstract
Background: Lung cancer is the most common cancer worldwide. Evidence suggests self-management (SM) interventions benefit cancer patients. This review aims to determine the effectiveness of SM interventions for lung cancer patients. Method: Searches occurred in PubMed, Cinahl, ProQuest, Psych Info, Scopus, and Medline, using predefined criteria, assessing randomised controlled trials (RCTs). Results: Five hundred and eighty-seven studies were yielded, 10 RCTs met criteria. Of the total patient pool, 1001 of 1089 had Non-Small Cell Lung Cancer (NSCLC). Six studies tested home-based SM exercise, two studies SM education, and one each for diary utilisation and symptom reporting. Fatigue was the most targeted function. Other functions targeted included exercise capacity, anxiety, depression, quality of life (QoL), sleep quality, and symptom burden. Six studies met their primary endpoints (five SM exercise, one SM education). Positive outcomes are described for fatigue, anxiety/depression, sleep quality, self-efficacy, and exercise capacity. With exception to fatigue, early-stage NSCLC, younger age, female, never smokers, partnered patients experienced increased treatment effect. Conclusions: SM interventions improve outcomes among some lung cancer patients. Interventions targeting fatigue yield benefit despite histology, stage or gender and could encourage broader cohort engagement. Consideration of patient characteristics may predict SM effect. Effectiveness of home-based SM exercise by NSCLC stage and SM tailored to sociodemographic variables requires further research.
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Yu XQ, Goldsbury D, Feletto E, Koh CE, Canfell K, O'Connell DL. Socioeconomic disparities in colorectal cancer survival: contributions of prognostic factors in a large Australian cohort. J Cancer Res Clin Oncol 2021; 148:2971-2984. [PMID: 34822016 PMCID: PMC8614213 DOI: 10.1007/s00432-021-03856-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/10/2021] [Indexed: 12/24/2022]
Abstract
Purpose We quantified the contributions of prognostic factors to socioeconomic disparities in colorectal cancer survival in a large Australian cohort. Methods The sample comprised 45 and Up Study participants (recruited 2006–2009) who were subsequently diagnosed with colorectal cancer. Both individual (education attained) and neighbourhood socioeconomic measures were used. Questionnaire responses were linked with cancer registrations (to December 2013), records for hospital inpatient stays, emergency department presentations, death information (to December 2015), and Medicare and Pharmaceutical Benefits claims for subsidised procedures and medicines. Proportions of socioeconomic survival differences explained by prognostic factors were quantified using multiple Cox proportional hazards regression. Results 1720 eligible participants were diagnosed with colorectal cancer after recruitment: 1174 colon and 546 rectal cancers. Significant colon cancer survival differences were only observed for neighbourhood socioeconomic measure (p = 0.033): HR = 1.55; 95% CI 1.09–2.19 for lowest versus highest quartile, and disease-related factors explained 95% of this difference. For rectal cancer, patient- and disease-related factors were the main drivers of neighbourhood survival differences (28–36%), while these factors and treatment-related factors explained 24–41% of individual socioeconomic differences. However, differences remained significant for rectal cancer after adjusting for all these factors. Conclusion In this large contemporary Australian cohort, we identified several drivers of socioeconomic disparities in colorectal cancer survival. Understanding of the role these contributors play remains incomplete, but these findings suggest that improving access to optimal care may significantly reduce these survival disparities.
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Affiliation(s)
- Xue Qin Yu
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Kings Cross, P O Box 572, Sydney, NSW, 1340, Australia.
| | - David Goldsbury
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Kings Cross, P O Box 572, Sydney, NSW, 1340, Australia
| | - Eleonora Feletto
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Kings Cross, P O Box 572, Sydney, NSW, 1340, Australia
| | - Cherry E Koh
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Discipline of Surgery, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Karen Canfell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Kings Cross, P O Box 572, Sydney, NSW, 1340, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Dianne L O'Connell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Kings Cross, P O Box 572, Sydney, NSW, 1340, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
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Impact of Socioeconomic Status on Cancer Incidence Risk, Cancer Staging, and Survival of Patients with Colorectal Cancer under Universal Health Insurance Coverage in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212164. [PMID: 34831918 PMCID: PMC8625901 DOI: 10.3390/ijerph182212164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 12/14/2022]
Abstract
This study examined the impact of socioeconomic status on colorectal cancer risk, staging, and survival under the National Health Insurance (NHI) system in Taiwan. Monthly salary and education level were used as measures of socioeconomic status to observe the risk of colorectal cancer among individuals aged 40 years or above in 2006-2015 and survival outcomes of patients with colorectal cancer until the end of 2016. Data from 286,792 individuals were used in this study. Individuals with a monthly salary ≤Q1 were at a significantly lower incidence risk of colorectal cancer than those with a monthly salary >Q3 (HR = 0.80, 95% CI = 0.74-0.85), while those with elementary or lower education were at a significantly higher risk than those with junior college, university, or higher education (HR = 1.18, 95% CI = 1.06-1.31). The results show that socioeconomic status had no significant impact on colorectal cancer stage at diagnosis. Although salary was not associated with their risk of mortality, patients with colorectal cancer who had elementary or lower education incurred a significantly higher risk of mortality than those who had junior college, university, or higher education (HR = 1.39, 95% CI = 1.07-1.77). Education level is a significant determinant of the incidence risk and survival in patients with colorectal cancer, but only income significantly impacts incidence risk.
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Afshar N, Dashti SG, Te Marvelde L, Blakely T, Haydon A, White VM, Emery JD, Bergin RJ, Whitfield K, Thomas RJS, Giles GG, Milne RL, English DR. Factors Explaining Socio-Economic Inequalities in Survival from Colon Cancer: A Causal Mediation Analysis. Cancer Epidemiol Biomarkers Prev 2021; 30:1807-1815. [PMID: 34272266 DOI: 10.1158/1055-9965.epi-21-0222] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/09/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Socio-economic inequalities in colon cancer survival exist in high-income countries, but the reasons are unclear. We assessed the mediating effects of stage at diagnosis, comorbidities, and treatment (surgery and intravenous chemotherapy) on survival from colon cancer. METHODS We identified 2,203 people aged 15 to 79 years with first primary colon cancer diagnosed in Victoria, Australia, between 2008 and 2011. Colon cancer cases were identified through the Victorian Cancer Registry (VCR), and clinical information was obtained from hospital records. Deaths till December 31, 2016 (n = 807), were identified from Victorian and national death registries. Socio-economic disadvantage was based on residential address at diagnosis. For stage III disease, we decomposed its total effect into direct and indirect effects using interventional mediation analysis. RESULTS Socio-economic inequalities in colon cancer survival were not explained by stage and were greater for men than women. For men with stage III disease, there were 161 [95% confidence interval (CI), 67-256] additional deaths per 1,000 cases in the 5 years following diagnosis for the most disadvantaged compared with the least disadvantaged. The indirect effects through comorbidities and intravenous chemotherapy explained 6 (95% CI, -10-21) and 15 (95% CI, -14-44) per 1,000 of these additional deaths, respectively. Surgery did not explain the observed gap in survival. CONCLUSIONS Disadvantaged men have lower survival from stage III colon cancer that is only modestly explained by having comorbidities or not receiving chemotherapy after surgery. IMPACT Future studies should investigate the potential mediating role of factors occurring beyond the first year following diagnosis, such as compliance with surveillance for recurrence and supportive care services.
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Affiliation(s)
- Nina Afshar
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.
- Cancer Health Services Research Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - S Ghazaleh Dashti
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Luc Te Marvelde
- Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Tony Blakely
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Haydon
- Department of Medical Oncology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Victoria M White
- School of Psychology, Deakin University, Burwood, Victoria, Australia
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Jon D Emery
- Cancer in Primary Care Research Group, Department of General Practice, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Rebecca J Bergin
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Cancer in Primary Care Research Group, Department of General Practice, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Kathryn Whitfield
- Cancer Strategy and Development, Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Robert J S Thomas
- Cancer Strategy and Development, Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Graham G Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Dallas R English
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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MacDermid E, Pasch J, Fok KY, Pasch L, Premaratne C, Kotecha K, Barto W, El Khoury T. The effect of socioeconomic deprivation on presentation stage and long-term outcomes in patients undergoing colorectal cancer resection in Western Sydney. ANZ J Surg 2021; 91:1563-1568. [PMID: 34224200 DOI: 10.1111/ans.17048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/05/2021] [Accepted: 06/12/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND While socioeconomic deprivation has been shown to affect survival in colorectal cancer, other factors such as global region of birth and ethnicity also exert an effect. We wished to ascertain the influence of socioeconomic deprivation on stage of presentation and cancer survival in an ethnically diverse Australian population. METHODS Cases from a database of resections in Western Sydney (n = 1596) were stratified into cohorts of socioeconomic quintiles. Univariate analysis was used to compare demographics, AJCC stage and histopathological details between the least and most socioeconomically deprived groups. Kaplan-Meier analysis and log-rank testing were used to compare cancer-specific and all-cause 5-year survival between the most deprived quintile and all others, after case-control matching for age and overseas birth. RESULTS A total of 322 (20.2%) patients from the most socioeconomically deprived centile, and 275 (17.2%) from the least were compared. The most deprived were significantly more likely to be aged under 70 (54.1% vs. 44.4%, p = 0.019), born overseas (54.3% vs. 38.6%, p = 0.003), present with stage III disease (37.4% vs. 26.7%, p = 0.005), perforated (12.5% vs. 5.3%, p = 0.005) or circumferential tumours (37% vs. 24.3%, p = 0.043). There was no significant difference in proportions presenting with metastatic disease, or 5-year survival between the most deprived quintile and all others after correction for age and foreign birth. CONCLUSIONS Socioeconomic deprivation is associated with unfavourable colorectal cancer presentation stage but not poorer 5-year survival in our Western Sydney population. The reasons for this are unclear and demand further attention.
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Affiliation(s)
- Ewan MacDermid
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Surgery, Nepean Hospital, Penrith, New South Wales, Australia
| | - James Pasch
- Department of Surgery, Northern Beaches Hospital, Sydney, New South Wales, Australia
| | - Kar Yin Fok
- Department of Surgery, Nepean Hospital, Penrith, New South Wales, Australia
| | - Lachlan Pasch
- School of Midwifery and Nursing, University of Western Sydney, Sydney, New South Wales, Australia
| | - Chatika Premaratne
- Department of Surgery, John Hunter Hospital, Sydney, New South Wales, Australia
| | - Krishna Kotecha
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Walid Barto
- Department of Surgery, Nepean Hospital, Penrith, New South Wales, Australia
| | - Toufic El Khoury
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
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Afshar N, English DR, Milne RL. Factors Explaining Socio-Economic Inequalities in Cancer Survival: A Systematic Review. Cancer Control 2021; 28:10732748211011956. [PMID: 33929888 PMCID: PMC8204531 DOI: 10.1177/10732748211011956] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND There is strong and well-documented evidence that socio-economic inequality in cancer survival exists within and between countries, but the underlying causes of these differences are not well understood. METHODS We systematically searched the Ovid Medline, EMBASE, and CINAHL databases up to 31 May 2020. Observational studies exploring pathways by which socio-economic position (SEP) might causally influence cancer survival were included. RESULTS We found 74 eligible articles published between 2005 and 2020. Cancer stage, other tumor characteristics, health-related lifestyle behaviors, co-morbidities and treatment were reported as key contributing factors, although the potential mediating effect of these factors varied across cancer sites. For common cancers such as breast and prostate cancer, stage of disease was generally cited as the primary explanatory factor, while co-morbid conditions and treatment were also reported to contribute to lower survival for more disadvantaged cases. In contrast, for colorectal cancer, most studies found that stage did not explain the observed differences in survival by SEP. For lung cancer, inequalities in survival appear to be partly explained by receipt of treatment and co-morbidities. CONCLUSIONS Most studies compared regression models with and without adjusting for potential mediators; this method has several limitations in the presence of multiple mediators that could result in biased estimates of mediating effects and invalid conclusions. It is therefore essential that future studies apply modern methods of causal mediation analysis to accurately estimate the contribution of potential explanatory factors for these inequalities, which may translate into effective interventions to improve survival for disadvantaged cancer patients.
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Affiliation(s)
- Nina Afshar
- Cancer Epidemiology Division, 56367Cancer Council Victoria, Melbourne, Victoria, Australia.,Cancer Health Services Research Unit, Centre for Health Policy, 50066School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dallas R English
- Cancer Epidemiology Division, 56367Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, 50066School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Roger L Milne
- Cancer Epidemiology Division, 56367Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, 50066School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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Wu MH, Yueh TC, Chang WS, Tsai CW, Fu CK, Yang MD, Yu CC, Bau DAT. Contribution of Matrix Metalloproteinase-1 Genotypes to Colorectal Cancer in Taiwan. Cancer Genomics Proteomics 2021; 18:245-251. [PMID: 33893077 DOI: 10.21873/cgp.20255] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/04/2021] [Accepted: 02/15/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND/AIM Matrix metalloproteinase-1 is responsible for extracellular matrix regulation, and its genetic role in colorectal cancer (CRC) is unclear. The aim of the study was to investigate the contribution of Matrix metalloproteinase-1 genotypes to CRC risk in Taiwan. MATERIALS AND METHODS A total of 362 cases and 362 controls were included and their MMP-1 -1607 (rs1799705) genotypes were examined. The environmental factors and clinical-pathological records were also analyzed. RESULTS The genotypic frequency of MMP-1 rs1799750 were different between the CRC and control groups (p for trend=0.0083). 1G/2G and 1G/1G were associated with lower risk (p=0.0438 and 0.0030, adjusted OR=0.73 and 0.54, 95%CI=0.54-0.90 and 0.37-0.83). Among non-smokers, those with 1G/2G and 1G/1G genotypes were at 0.70- and 0.48-fold odds of having CRC. Among non-alcohol drinkers, people with 1G/2G and 1G/1G genotypes were at 0.71- and 0.54-fold odds. The 1G/1G genotype were statistically lower among CRC patients with lymph node metastasis (7.2%) than those without (19.0%). CONCLUSION The genotypes at MMP-1 rs1799705 play a role in determining susceptibility to CRC risk in Taiwan.
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Affiliation(s)
- Ming-Hsien Wu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan, R.O.C.,Division of Colon and Rectal Surgery, Taichung Armed Forces General Hospital, Taichung, Taiwan, R.O.C.,National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Te-Cheng Yueh
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan, R.O.C.,Division of Colon and Rectal Surgery, Taichung Armed Forces General Hospital, Taichung, Taiwan, R.O.C.,National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Wen-Shin Chang
- Terry Fox Cancer Research Laboratory, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, R.O.C
| | - Chia-Wen Tsai
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan, R.O.C.,Terry Fox Cancer Research Laboratory, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, R.O.C
| | - Chun-Kai Fu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan, R.O.C.,National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Mei-Due Yang
- Terry Fox Cancer Research Laboratory, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, R.O.C
| | - Chien-Chih Yu
- School of Pharmacy, China Medical University, Taichung, Taiwan, R.O.C
| | - DA-Tian Bau
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan, R.O.C.; .,Terry Fox Cancer Research Laboratory, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, R.O.C.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan, R.O.C
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14
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Rosskamp M, Verbeeck J, Sass V, Gadeyne S, Verdoodt F, De Schutter H. Social Inequalities in Cancer Survival in Belgium: A Population-Based Cohort Study. Cancer Epidemiol Biomarkers Prev 2020; 30:45-52. [PMID: 33082205 DOI: 10.1158/1055-9965.epi-20-0721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/28/2020] [Accepted: 10/09/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Socioeconomic status (SES) is an important factor in cancer survival; however, results are heterogeneous and linked to characteristics of the study population and health care system. This population-based cohort study evaluates the association between individual-level socioeconomic and demographic factors and cancer survival for the first time in Belgium. METHODS From the Belgian Cancer Registry, we identified 109,591 patients diagnosed between 2006 and 2013 with one of eight common cancer types. Information on treatment, socioeconomic parameters, and vital status were retrieved from multiple data sources and linked using a unique personal identification number. The outcome was 5-year observed survival. Associations between survival and socioeconomic and demographic factors were assessed using multivariable Cox proportional-hazard regression models. RESULTS Lower income, unemployment, and living alone were all associated with worse cancer survival. These associations were most pronounced for certain lifestyle-related cancer types (e.g., head and neck cancers) and those with good to moderate prognosis (e.g., colorectal and female breast cancer). CONCLUSIONS These results indicate that, despite a comprehensive and nationwide health insurance program in which equity in rights and access to health care are pursued, SES is associated with disparities in cancer survival in Belgium. IMPACT This population-based study with individual-level socioeconomic information of more than 100,000 patients with cancer identifies patient groups that may be at highest risk for socioeconomic disparities in cancer survival. Reasons behind the observed disparities are multiple and complex and should be further examined. Health policy interventions should consider the observed deprivation gap to plan targeted actions.
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Affiliation(s)
| | | | - Victoria Sass
- Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Sociology, University of Washington, Seattle, Washington
| | - Sylvie Gadeyne
- Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels, Belgium
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15
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Quezada-Gutiérrez C, Álvarez-Bañuelos MT, Morales-Romero J, Sampieri CL, Guzmán-García RE, Montes-Villaseñor E. Factors associated with the survival of colorectal cancer in Mexico. Intest Res 2020; 18:315-324. [PMID: 32418415 PMCID: PMC7385577 DOI: 10.5217/ir.2019.09179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND/AIMS Colorectal cancer (CRC) is a public health problem. In Mexico, there have been no recent studies conducted on survival in terms of this pathology or on the influence of prognostic factors. The study aims to determine the probability of survival in patients with CRC presence of low levels of schooling and a rural population, adjusted for clinical stage and type of treatment. METHODS A retrospective study was conducted in a cohort of 305 patients with CRC treated at State Cancer Center, located in Veracruz-Mexico; the follow-up period of 60 months (2012-2016). The survival probability was calculated using the Kaplan-Meier estimator and the log-rank test with 95% confidence intervals (CIs). Prognostic factors were determined using hazard ratio (HR) multivariate Cox regression analysis. RESULTS Overall survival was 40% at 60 months. Subjects in the age group ≥ 65 years had a low survival rate of 28% (P= 0.026) and an advanced clinical stage of 22% (P< 0.001). Of the patients with bone metastasis, none survived longer than 5 years (P= 0.008). With respect to the unfavorable prognostic factors identified in the multivariate analysis, a decreased level of schooling was associated with an HR of 7.6 (95% CI, 1.1-54.7), advanced clinical stage was associated with an HR of 2.1 (95% CI, 1.2-4.0), and the presence of metastasis had an HR of 1.8 (95% CI, 1.1-2.9). CONCLUSIONS Poor prognostic factors include an advanced clinical stage, the presence of metastasis and a low level of schooling. These findings confirm the importance of screening for early diagnosis, diminishing the barriers to accessing treatment and prospectively monitoring the population.
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16
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Social determinants of colorectal cancer risk, stage, and survival: a systematic review. Int J Colorectal Dis 2020; 35:985-995. [PMID: 32314192 DOI: 10.1007/s00384-020-03585-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Several social determinants of health have been examined in relation to colorectal cancer incidence, stage at diagnosis, and survival including income, education, neighborhood disadvantage, immigration status, social support, and social network. Colorectal cancer incidence rates are positively associated with income and other measures of socioeconomic status. In contrast, low socioeconomic status tends to be associated with poorer survival. METHODS The present review is based upon bibliographic searches in PubMed and CINAHL and relevant search terms. Articles published in English from 1970 through April 1, 2019 were identified using the following MeSH search terms and Boolean algebra commands: colorectal cancer AND (incidence OR stage OR mortality) AND (social determinants OR neighborhood disadvantage OR racial discrimination OR immigration OR social support). RESULTS This review indicates that poverty, lack of education, immigration status, lack of social support, and social isolation play important roles in colorectal cancer stage at diagnosis and survival. CONCLUSIONS To address social determinants of colorectal cancer, effective interventions are needed that account for the social contexts in which patients live.
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17
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Afshar N, English DR, Chamberlain JA, Blakely T, Thursfield V, Farrugia H, Giles GG, Milne RL. Differences in cancer survival by remoteness of residence: an analysis of data from a population-based cancer registry. Cancer Causes Control 2020; 31:617-629. [PMID: 32356140 DOI: 10.1007/s10552-020-01303-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 04/15/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Cancer survival is generally lower for rural compared with urban residents, but findings have been inconsistent. We aimed to assess inequalities in cancer survival by remoteness of residence in Victoria, Australia. METHODS Incident cancer cases diagnosed in 2001-2015 with 30 cancer types (n = 331,302) were identified through the Victorian Cancer Registry and followed to the end of 2015 through death registries. Five-year net survival was estimated using the Pohar-Perme method and differences assessed by excess mortality rate ratios (EMRRs) using Poisson regression, adjusting for sex, age and year of diagnosis. EMRRs adjusted for socio-economic disadvantage were also estimated. RESULTS People living outside major cities had lower survival for 11 cancers: esophagus, stomach, colorectum, liver, gallbladder/biliary tract, pancreas, lung, connective/soft tissue, ovary, prostate, kidney. No differences in survival were found for cancers of uterus, small intestine and mesothelioma. After adjusting for socio-economic disadvantage, the observed differences in survival decreased for most cancers and disappeared for colorectal cancer, but they remained largely unchanged for cancers of esophagus, stomach, liver, pancreas, lung, connective/soft tissue, ovary and kidney. CONCLUSION People with cancer residing outside major cities had lower survival from some cancers, which is partly due to the greater socio-economic disadvantage of rural residents.
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Affiliation(s)
- Nina Afshar
- Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia.
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3010, Australia.
| | - Dallas R English
- Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3010, Australia
| | - James A Chamberlain
- Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Tony Blakely
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3010, Australia
| | - Vicky Thursfield
- Victorian Cancer Registry, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Helen Farrugia
- Victorian Cancer Registry, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Graham G Giles
- Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3010, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3010, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia
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18
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Goodwin BC, Rowe AK, Crawford-Williams F, Baade P, Chambers SK, Ralph N, Aitken JF. Geographical Disparities in Screening and Cancer-Related Health Behaviour. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041246. [PMID: 32075173 PMCID: PMC7068477 DOI: 10.3390/ijerph17041246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/10/2020] [Accepted: 02/10/2020] [Indexed: 01/11/2023]
Abstract
This study aimed to identify whether cancer-related health behaviours including participation in cancer screening vary by geographic location in Australia. Data were obtained from the 2014-2015 Australian National Health Survey, a computer-assisted telephone interview that measured a range of health-related issues in a sample of randomly selected households. Chi-square tests and adjusted odds ratios from logistic regression models were computed to assess the association between residential location and cancer-related health behaviours including cancer screening participation, alcohol consumption, smoking, exercise, and fruit and vegetable intake, controlling for age, socio-economic status (SES), education, and place of birth. The findings show insufficient exercise, risky alcohol intake, meeting vegetable intake guidelines, and participation in cervical screening are more likely for those living in inner regional areas and in outer regional/remote areas compared with those living in major cities. Daily smoking and participation in prostate cancer screening were significantly higher for those living in outer regional/remote areas. While participation in cancer screening in Australia does not appear to be negatively impacted by regional or remote living, lifestyle behaviours associated with cancer incidence and mortality are poorer in regional and remote areas. Population-based interventions targeting health behaviour change may be an appropriate target for reducing geographical disparities in cancer outcomes.
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Affiliation(s)
- Belinda C. Goodwin
- Cancer Council Queensland, 553 Gregory Terrace, Fortitude Valley QLD 4006, Australia; (P.B.); (N.R.); (J.F.A.)
- Institute for Resilient Regions, University of Southern Queensland, Springfield QLD 4300, Australia; (A.K.R.); (F.C.-W.); (S.K.C.)
- Correspondence:
| | - Arlen K. Rowe
- Institute for Resilient Regions, University of Southern Queensland, Springfield QLD 4300, Australia; (A.K.R.); (F.C.-W.); (S.K.C.)
- School of Psychology, University of Southern Queensland, Springfield QLD 4300, Australia
| | - Fiona Crawford-Williams
- Institute for Resilient Regions, University of Southern Queensland, Springfield QLD 4300, Australia; (A.K.R.); (F.C.-W.); (S.K.C.)
| | - Peter Baade
- Cancer Council Queensland, 553 Gregory Terrace, Fortitude Valley QLD 4006, Australia; (P.B.); (N.R.); (J.F.A.)
- Menzies Institute of Health Queensland, Griffith University, Gold Coast QLD 4215, Australia
- School of Mathematical Sciences, Queensland University of Technology, Brisbane QLD 4000, Australia
| | - Suzanne K. Chambers
- Institute for Resilient Regions, University of Southern Queensland, Springfield QLD 4300, Australia; (A.K.R.); (F.C.-W.); (S.K.C.)
- Menzies Institute of Health Queensland, Griffith University, Gold Coast QLD 4215, Australia
- Faculty of Health, University of Technology Sydney, Ultimo NSW 2007, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup WA 6027, Australia
| | - Nicholas Ralph
- Cancer Council Queensland, 553 Gregory Terrace, Fortitude Valley QLD 4006, Australia; (P.B.); (N.R.); (J.F.A.)
- Institute for Resilient Regions, University of Southern Queensland, Springfield QLD 4300, Australia; (A.K.R.); (F.C.-W.); (S.K.C.)
- Faculty of Health, University of Technology Sydney, Ultimo NSW 2007, Australia
- School of Nursing & Midwifery, University of Southern Queensland, Toowoomba QLD 4370, Australia
| | - Joanne F. Aitken
- Cancer Council Queensland, 553 Gregory Terrace, Fortitude Valley QLD 4006, Australia; (P.B.); (N.R.); (J.F.A.)
- Institute for Resilient Regions, University of Southern Queensland, Springfield QLD 4300, Australia; (A.K.R.); (F.C.-W.); (S.K.C.)
- School of Public Health, The University of Queensland, St Lucia, QLD 4702, Australia
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Afshar N, English DR, Blakely T, Thursfield V, Farrugia H, Giles GG, Milne RL. Differences in cancer survival by area-level socio-economic disadvantage: A population-based study using cancer registry data. PLoS One 2020; 15:e0228551. [PMID: 31999795 PMCID: PMC6992207 DOI: 10.1371/journal.pone.0228551] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/19/2020] [Indexed: 11/23/2022] Open
Abstract
Despite overall improvements in cancer survival due to earlier diagnosis and better treatment, socio-economically disadvantaged people have lower cancer survival than more advantaged people. We aimed to examine differences in cancer survival by area-level socio-economic disadvantage in Victoria, Australia and assess whether these inequalities varied by year of diagnosis, age at diagnosis, time since diagnosis and sex. Cases diagnosed with a first primary cancer in 2001–2015 were identified using the Victorian Cancer Registry and followed to the end of 2016. Five-year net survival and the excess risk of death due to a cancer diagnosis were estimated. People living in more disadvantaged areas had lower five-year survival than residents of less disadvantaged regions for 21 of 29 cancer types: head and neck, oesophagus, stomach, colorectum, anus/anal canal, liver, gallbladder/biliary tract, pancreas, lung, melanoma, connective/soft tissue, female breast, ovary, prostate, kidney, bladder, brain and central nervous system, unknown primary, non-Hodgkin lymphoma, multiple myeloma and leukemia. The observed lower survival in more deprived regions persisted over time, except head and neck cancer, for which the gap in survival has widened. Socio-economic inequalities in survival decreased with increasing age at diagnosis for cancers of connective/soft tissue, bladder and unknown primary. For colorectal cancer, the observed survival disadvantage in lower socio-economic regions was greater for men than for women, while for brain and central nervous system tumours, it was larger for women. Cancer survival is generally lower for residents of more socio-economically disadvantaged areas. Identifying the underlying reasons for these inequalities is important and may help to identify effective interventions to increase survival for underprivileged cancer patients.
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Affiliation(s)
- Nina Afshar
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- * E-mail:
| | - Dallas R. English
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tony Blakely
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Vicky Thursfield
- Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Helen Farrugia
- Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Graham G. Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Roger L. Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
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Lee CH, Tseng PL, Tung HY, Cheng SC, Ching CY, Chang SC, Wu SF. Comparison of risk factors between colon cancer and rectum cancer in a single medical center hospital, Taiwan. Arch Med Sci 2020; 16:102-111. [PMID: 32051712 PMCID: PMC6963157 DOI: 10.5114/aoms.2019.89407] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 09/12/2017] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Colorectal cancer (CRC) is rapidly increasing in developed countries. In Taiwan, the incidence rate of CRC has increased during the past decade, but the 5-year survival has remained at approximately 63%. In this study, we sought to determine the 5-year survival rate of patients diagnosed with colon and rectum cancer and to determine factors affecting survival. MATERIAL AND METHODS All patients from the Taiwan Cancer Database of the medical center hospital in North Taiwan between 2007 and 2013 were identified. Survival analysis was performed using Kaplan-Meier curves, and differences between the curves were analyzed using the log-rank test. Cox proportional hazards regression models were used to analyze survival by each variable. RESULTS A total of 869 patients were included: 554 (63.8%) patients had colon cancer and 315 (36.2%) had rectum cancer. The mean survival time was 71.27 ±1.27 months (colon group: 71.90 ±1.58 months; rectum group: 67.88 ±1.95 months). There was no significant difference (p = 0.493) between patients who had colon or rectum cancer. The forward stepwise Cox regression analysis results indicated that perineural invasion, distant metastasis, age, pathological differentiation grade, and obstruction were statistically significant for patients who had CRC, colon cancer or rectum cancer. CONCLUSIONS The long-term survival from CRC, colon cancer and rectum cancer remains promising, as 68.66%, 69.11% and 67.90% of patients are alive 5 years after being diagnosed, respectively. Perineural invasion was found to be an important factor related to the survival of patients who have CRC. Thus, early detection of CRC may help improve survival.
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Affiliation(s)
- Chao-Hsien Lee
- Department of Health Business Administration, Meiho University, Pingtung, Taiwan
| | - Peng-Lin Tseng
- Department of Nursing, Pingtung Christian Hospital, Pingtung, Taiwan
- Department of Nursing, Meiho University, Pingtung, Taiwan
| | - Hong-Yi Tung
- Department of Health Business Administration, Meiho University, Pingtung, Taiwan
- Department of General Surgery, Yuan’s General Hospital, Kaohsiung, Taiwan
| | - Shu-Chen Cheng
- Department of Cancer Registry Division, Cathay General Hospital, Taipei, Taiwan
| | - Ching-Yun Ching
- Department of Nursing, Yuan’s General Hospital, Kaohsiung, Taiwan
| | - Shih-Chang Chang
- Department of Colorectal Surgery, Division of Surgery, Cathay General Hospital, Taipei, Taiwan
| | - Shu-Fen Wu
- Department of Nursing, Yuan’s General Hospital, Kaohsiung, Taiwan
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21
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Woo HT, Sim JA, Mo J, Yun YH, Shin A. Regional Differences in Colorectal Cancer Mortality Between 2000 and 2013 in Republic of Korea. J Epidemiol 2019; 29:399-405. [PMID: 30298861 PMCID: PMC6737187 DOI: 10.2188/jea.je20170331] [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: 01/04/2018] [Accepted: 09/13/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Colorectal cancer (CRC) is the fourth most common site for cancer death in the Republic of Korea. The aim of this study was to describe the trends of colorectal cancer mortality by region. METHODS CRC mortality trends in Republic of Korea were described by region using a Joinpoint regression model in both sexes. The annual percent changes (APCs) were calculated for each segment. Visualization of the changes in mortality rate of colorectal cancer death rates by 16 geographic areas in both sexes between 2000-2004 and 2009-2013 were also conducted. RESULTS CRC mortality rates of men showed decreasing trend after increase in Daegu, Gyeongsangnam-do, and Chungcheongbuk-do between 2000 and 2013 based on the joinpoint model, while Gwangju, Jeollabuk-do, Jeollanam-do, and Gyeongsangbuk-do showed increase in CRC mortality during the same period. For women, CRC mortality of Seoul, Incheon, Daejeon, and Gyeongsangnam-do started to decrease in 2005, 2003, 2007, and 2006, respectively. The mortality rate for CRC in the eastern regions, which had relatively low rates of CRC among men in 2000 through 2004, reached a level similar to that in the northwestern regions of 2009 through 2013, while the highest CRC mortality rates in women was observed in Chungcheongbuk-do. CONCLUSIONS Reduction in CRC mortality varied across 16 metropolitan cities and provinces in men, and the visualization pattern showed that the east side of South Korea had the least progress in mortality reduction.
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Affiliation(s)
- Hyeong Taek Woo
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Ah Sim
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Jonghoon Mo
- Department of Psychology, Seoul National University College of Social Science, Seoul, Republic of Korea
| | - Young Ho Yun
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Republic of Korea
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Aesun Shin
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
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22
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Li M, Olver I, Keefe D, Holden C, Worthley D, Price T, Karapetis C, Miller C, Powell K, Buranyi-Trevarton D, Fusco K, Roder D. Pre-diagnostic colonoscopies reduce cancer mortality - results from linked population-based data in South Australia. BMC Cancer 2019; 19:856. [PMID: 31464597 PMCID: PMC6716808 DOI: 10.1186/s12885-019-6092-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/26/2019] [Indexed: 01/08/2023] Open
Abstract
Background To investigate the association between pre-diagnostic colonoscopy and colorectal cancer mortality in South Australia. Methods Colonoscopy histories were obtained for colorectal cancer patients diagnosed in 2003–2013 using linked Medical Benefits Schedule (MBS) claims, hospital-inpatient and cancer-registry data. Colonoscopy histories included the year of colonoscopy, numbers of examinations, and the time from first colonoscopy to diagnosis. Histories of multiple exposures to colonoscopies, and exposures of greater than a year from initial colonoscopy to diagnosis, were regarded as indicators of screening or surveillance activity. Colonoscopies occurring within one year of diagnosis were regarded as more likely to be a response to cancer symptoms than those occurring > 1 year before diagnosis. Associations between colonoscopy history and post-diagnostic survival were analysed using sub-hazard ratios (SHRs) from competing risk regression adjusted for socio-demographic and cancer characteristics. Results Having pre-diagnostic colonoscopy was associated with an unadjusted reduction in risk of colorectal cancer death of 17% (SHR: 0.83, 95% CI 0.78–0.89). After adjusting for time period and sociodemographic characteristics, the risk of colorectal cancer death reduced by 17% for one pre-diagnostic colonoscopy examination; 27% for two pre-diagnostic colonoscopy examinations; and 45% for three or more pre-diagnostic colonoscopy examinations. Those with a time of over one year from first colonoscopy in the study window to diagnosis, when compared with less than one year, had a 17% lower risk of colorectal cancer death in this adjusted analysis. These reductions were substantially reduced or eliminated when also adjusting for less advanced stage. Conclusions Pre-diagnostic colonoscopy, and more so, multiple colonoscopies and first colonoscopy occurring over one year from initial colonoscopy to diagnosis, were associated with longer survival post diagnosis. This was largely explained by less advanced cancer stage at the time of diagnosis. Electronic supplementary material The online version of this article (10.1186/s12885-019-6092-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ming Li
- Cancer Research Institute, University of South Australia, Adelaide, Australia.
| | - Ian Olver
- Cancer Research Institute, University of South Australia, Adelaide, Australia
| | - Dorothy Keefe
- SA Cancer Service, South Australian Department for Health and Wellbeing, Adelaide, Australia
| | - Carol Holden
- South Australia Health and Medical Research Institute, Adelaide, Australia
| | - Dan Worthley
- South Australia Health and Medical Research Institute, Adelaide, Australia
| | - Timothy Price
- Clinical Oncology Research Unit, The Queen Elizabeth Hospital, Woodville, Australia
| | | | - Caroline Miller
- South Australia Health and Medical Research Institute, Adelaide, Australia
| | - Kate Powell
- South Australia Health and Medical Research Institute, Adelaide, Australia
| | | | - Kellie Fusco
- Cancer Research Institute, University of South Australia, Adelaide, Australia
| | - David Roder
- Cancer Research Institute, University of South Australia, Adelaide, Australia
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23
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Yu XQ, Goldsbury D, Yap S, Yap ML, O'Connell DL. Contributions of prognostic factors to socioeconomic disparities in cancer survival: protocol for analysis of a cohort with linked data. BMJ Open 2019; 9:e030248. [PMID: 31427338 PMCID: PMC6825410 DOI: 10.1136/bmjopen-2019-030248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Socioeconomic disparities in cancer survival have been reported in many developed countries, including Australia. Although some international studies have investigated the determinants of these socioeconomic disparities, most previous Australian studies have been descriptive, as only limited relevant data are generally available. Here, we describe a protocol for a study to use data from a large-scale Australian cohort linked with several other health-related databases to investigate several groups of factors associated with socioeconomic disparities in cancer survival in New South Wales (NSW), Australia, and quantify their contributions to the survival disparities. METHODS AND ANALYSIS The Sax Institute's 45 and Up Study participants completed a baseline questionnaire during 2006-2009. Those who were subsequently diagnosed with cancer of the colon, rectum, lung or female breast will be included. This study sample will be identified by linkage with NSW Cancer Registry data for 2006-2013, and their vital status will be determined by linking with cause of death records up to 31 December 2015. The study cohort will be divided into four groups based on each of the individual education level and an area-based socioeconomic measure. The treatment received will be obtained through linking with hospital records and Medicare and pharmaceutical claims data. Cox proportional hazards models will be fitted sequentially to estimate the percentage contributions to overall socioeconomic survival disparities of patient factors, tumour and diagnosis factors, and treatment variables. ETHICS AND DISSEMINATION This research is covered by ethical approval from the NSW Population and Health Services Research Ethics Committee. Results of the study will be disseminated to different interest groups and organisations through scientific conferences, social media and peer-reviewed articles.
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Affiliation(s)
- Xue Qin Yu
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - David Goldsbury
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
| | - Sarsha Yap
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
| | - Mei Ling Yap
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
- Liverpool and Macarthur Cancer Therapy Centres, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Dianne L O'Connell
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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24
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Pule ML, Buckley E, Niyonsenga T, Roder D. The effects of comorbidity on colorectal cancer mortality in an Australian cancer population. Sci Rep 2019; 9:8580. [PMID: 31189947 PMCID: PMC6561932 DOI: 10.1038/s41598-019-44969-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 05/29/2019] [Indexed: 01/18/2023] Open
Abstract
This study estimated the absolute risk of colorectal cancer (CRC) specific and other-cause mortality using data from the population-based South Australian Cancer Registry. The impact of competing risks on the absolute and relative risks of mortality in cases with and without comorbidity was also investigated. The study included 7115 staged, primary CRC cases diagnosed between 2003 and 2012 with at least one year of follow-up. Comorbidities were classified according to Charlson, Elixhauser and C3 comorbidity indices, using hospital inpatient diagnoses occurring five years before CRC diagnosis. To estimate the differences in measures of association, the subdistribution hazard ratios (sHR) for the effect of comorbidity on mortality from the Fine and Gray model were compared to the cause-specific hazards (HR) from Cox regression model. CRC was most commonly diagnosed in people aged ≧ 70 years. In cases without comorbidity, the 10-year cumulative probability of CRC and other cause mortality were 37.1% and 17.2% respectively. In cases with Charlson comorbidity scores ≥2, the 10-year cumulative probability of CRC-specific and other cause mortality was 45.5% and 32.2%, respectively. Comorbidity was associated with increased CRC-specific and other cause mortality and the effect differed only marginally based on comorbidity index used.
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Affiliation(s)
- Maleshwane Lettie Pule
- Cancer Epidemiology and Population Health Group, University of South Australia Cancer Research Institute, Adelaide, SA, 5001, Australia.
| | - Elizabeth Buckley
- Cancer Epidemiology and Population Health Group, University of South Australia Cancer Research Institute, Adelaide, SA, 5001, Australia
| | - Theophile Niyonsenga
- Cancer Epidemiology and Population Health Group, University of South Australia Cancer Research Institute, Adelaide, SA, 5001, Australia
- Centre for Research and Action in Public Health, University of Canberra, University Drive, Bruce, ACT, 2617, Australia
| | - David Roder
- Cancer Epidemiology and Population Health Group, University of South Australia Cancer Research Institute, Adelaide, SA, 5001, Australia
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25
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Crawford-Williams F, March S, Goodwin BC, Ireland MJ, Chambers SK, Aitken JF, Dunn J. Geographic variations in stage at diagnosis and survival for colorectal cancer in Australia: A systematic review. Eur J Cancer Care (Engl) 2019; 28:e13072. [PMID: 31056787 DOI: 10.1111/ecc.13072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/12/2019] [Accepted: 04/08/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Australia has one of the highest incidence rates of colorectal cancer (CRC) in the world. Residents in rural areas of Australia experience disadvantage in health care and outcomes. This review investigates whether patients with CRC in rural areas demonstrate poorer survival and more advanced stages of disease at diagnosis. METHODS Systematic review of peer-reviewed articles and grey literature. Studies were included if they provided data on survival or stage of disease at diagnosis across multiple geographical locations; focused on CRC patients; and were conducted in Australia. RESULTS Twenty-six articles met inclusion criteria. Twenty-three studies examined survival, while five studies investigated stage at diagnosis. The evidence suggests that non-metropolitan patients are less likely to survive CRC for five years compared to patients living in metropolitan areas, yet there was limited evidence to suggest geographical disparity in stage of diagnosis. CONCLUSIONS While five-year survival disparities are apparent, these patterns appear to vary as a function of specific region and health jurisdiction, cancer type and year/s of data collection. Future research should examine current data using consistent and robust methods of reporting survival and classifying geographical location. The impact of population-level screening programmes on survival and stage at diagnosis also needs to be thoroughly explored.
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Affiliation(s)
- Fiona Crawford-Williams
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia
| | - Sonja March
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia.,School of Psychology, University of Southern Queensland, Springfield Central, Queensland, Australia
| | - Belinda C Goodwin
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia
| | - Michael J Ireland
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia.,School of Psychology, University of Southern Queensland, Springfield Central, Queensland, Australia
| | - Suzanne K Chambers
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia.,Health and Wellness Institute, Edith Cowan University, Joondalup, Western Australia, Australia.,Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Joanne F Aitken
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jeff Dunn
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia.,Health and Wellness Institute, Edith Cowan University, Joondalup, Western Australia, Australia.,Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.,School of Social Science, The University of Queensland, Brisbane, Queensland, Australia
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26
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Afshar N, English DR, Milne RL. Rural-urban residence and cancer survival in high-income countries: A systematic review. Cancer 2019; 125:2172-2184. [PMID: 30933318 DOI: 10.1002/cncr.32073] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 02/06/2019] [Accepted: 02/24/2019] [Indexed: 12/21/2022]
Abstract
There is some evidence that place of residence is associated with cancer survival, but the findings are inconsistent, and the underlying mechanisms by which residential location might affect survival are not well understood. We conducted a systematic review of observational studies investigating the association of rural versus urban residence with cancer survival in high-income countries. We searched the Ovid Medline, EMBASE, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases up to May 31, 2016. Forty-five studies published between 1984 and 2016 were included. We extracted unadjusted and adjusted relative risk estimates with the corresponding 95% confidence intervals. Most studies reported worse survival for cancer patients living in rural areas than those in urban regions. The most consistent evidence, observed across several studies, was for colorectal, lung, and prostate cancer. Of the included studies, 18 did not account for socio-economic position. Lower survival for more disadvantaged patients is well documented; therefore, it could be beneficial for future research to take socio-economic factors into consideration when assessing rural/urban differences in cancer survival. Some studies cited differential stage at diagnosis and treatment modalities as major contributing factors to regional inequalities in cancer survival. Further research is needed to disentangle the mediating effects of these factors, which may help to establish effective interventions to improve survival for patients living outside major cities.
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Affiliation(s)
- Nina Afshar
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dallas R English
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Roger L Milne
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
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27
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Goodwin BC, March S, Ireland MJ, Crawford-Williams F, Ng SK, Baade PD, Chambers SK, Aitken JF, Dunn J. Geographic Disparities in Previously Diagnosed Health Conditions in Colorectal Cancer Patients Are Largely Explained by Age and Area Level Disadvantage. Front Oncol 2018; 8:372. [PMID: 30254984 PMCID: PMC6141831 DOI: 10.3389/fonc.2018.00372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/21/2018] [Indexed: 12/19/2022] Open
Abstract
Background: Geographical disparity in colorectal cancer (CRC) survival rates may be partly due to aging populations and disadvantage in more remote locations; factors that also impact the incidence and outcomes of other chronic health conditions. The current study investigates whether geographic disparity exists amongst previously diagnosed health conditions in CRC patients above and beyond age and area-level disadvantage and whether this disparity is linked to geographic disparity in CRC survival. Methods: Data regarding previously diagnosed health conditions were collected via computer-assisted telephone interviews with a cross-sectional sample of n = 1,966 Australian CRC patients between 2003 and 2004. Ten-year survival outcomes were acquired in December 2014 from cancer registry data. Multivariate logistic regressions were applied to test associations between previously diagnosed health conditions and survival rates in rural, regional, and metropolitan areas. Results: Results suggest that only few geographical disparities exist in previously diagnosed health conditions for CRC patients and these were largely explained by socio-economic status and age. Living in an inner regional area was associated with cardio-vascular conditions, one or more respiratory diseases, and multiple respiratory diagnoses. Higher occurrences of these conditions did not explain lower CRC-specific 10 years survival rates in inner regional Australia. Conclusion: It is unlikely that health disparities in terms of previously diagnosed conditions account for poorer CRC survival in regional and remote areas. Interventions to improve the health of regional CRC patients may need to target issues unique to socio-economic disadvantage and older age.
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Affiliation(s)
- Belinda C Goodwin
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Toowoomba, QLD, Australia
| | - Sonja March
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Toowoomba, QLD, Australia.,School of Psychology and Counseling, University of Southern Queensland, Springfield Central, Toowoomba, QLD, Australia
| | - Michael J Ireland
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Toowoomba, QLD, Australia.,School of Psychology and Counseling, University of Southern Queensland, Springfield Central, Toowoomba, QLD, Australia
| | - Fiona Crawford-Williams
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Toowoomba, QLD, Australia
| | - Shu-Kay Ng
- Menzies Health Institute, Griffith University, Southport, QLD, Australia
| | - Peter D Baade
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia
| | - Suzanne K Chambers
- Menzies Health Institute, Griffith University, Southport, QLD, Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia.,Prostate Cancer Foundation of Australia, St Leonards, NSW, Australia.,Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia
| | - Joanne F Aitken
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia.,School of Public Health Fand Social Work, Queensland University of Technology, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Jeff Dunn
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Toowoomba, QLD, Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia.,School of Medicine, Griffith University, Brisbane, QLD, Australia
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28
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Crawford-Williams F, March S, Ireland MJ, Rowe A, Goodwin B, Hyde MK, Chambers SK, Aitken JF, Dunn J. Geographical Variations in the Clinical Management of Colorectal Cancer in Australia: A Systematic Review. Front Oncol 2018; 8:116. [PMID: 29868464 PMCID: PMC5965390 DOI: 10.3389/fonc.2018.00116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 03/29/2018] [Indexed: 12/17/2022] Open
Abstract
Background In Australia, cancer survival is significantly lower in non-metropolitan compared to metropolitan areas. Our objective was to evaluate the evidence on geographical variations in the clinical management and treatment of colorectal cancer (CRC). Methods A systematic review of published and gray literature was conducted. Five databases (CINAHL, PubMed, Embase, ProQuest, and Informit) were searched for articles published in English from 1990 to 2018. Studies were included if they assessed differences in clinical management according to geographical location; focused on CRC patients; and were conducted in Australia. Included studies were critically appraised using a modified Newcastle–Ottawa Scale. PRISMA systematic review reporting methods were applied. Results 17 articles met inclusion criteria. All were of high (53%) or moderate (47%) quality. The evidence available may suggest that patients in non-metropolitan areas are more likely to experience delays in surgery and are less likely to receive chemotherapy for stage III colon cancer and adjuvant radiotherapy for rectal cancer. Conclusion The present review found limited information on clinical management across geographic regions in Australia and the synthesis highlights significant issues both for data collection and reporting at the population level, and for future research in the area of geographic variation. Where geographical disparities exist, these may be due to a combination of patient and system factors reflective of location. It is recommended that population-level data regarding clinical management of CRC be routinely collected to better understand geographical variations and inform future guidelines and policy.
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Affiliation(s)
- Fiona Crawford-Williams
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Sonja March
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Michael J Ireland
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Arlen Rowe
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Belinda Goodwin
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,School of Psychology and Counselling, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Melissa K Hyde
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - Suzanne K Chambers
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,Prostate Cancer Foundation of Australia, St Leonards, NSW, Australia.,Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia
| | - Joanne F Aitken
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jeff Dunn
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, QLD, Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia.,School of Social Science, University of Queensland, Brisbane, QLD, Australia.,School of Medicine, Griffith University, Brisbane, QLD, Australia
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29
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Leach MJ, Jones M, Gillam M, May E. Regional South Australia Health (RESONATE) survey: study protocol. BMJ Open 2018; 8:e019784. [PMID: 29654014 PMCID: PMC5905783 DOI: 10.1136/bmjopen-2017-019784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 02/02/2018] [Accepted: 02/26/2018] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Access to quality healthcare services is considered a moral right. However, for people living in regional locations, timely access to the services that they need may not always be possible because of structural and attitudinal barriers. This suggests that people living in regional areas may have unmet healthcare needs. The aim of this research will be to examine the healthcare needs, expectations and experiences of regional South Australians. METHODS AND ANALYSIS The Regional South Australia Health (RESONATE) survey is a cross-sectional study of adult health consumers living in any private or non-private dwelling, in any regional, rural, remote or very remote area of South Australia and with an understanding of written English. Data will be collected using a 45-item, multidimensional, self-administered instrument, designed to measure healthcare need, barriers to healthcare access and health service utilisation, attitudes, experiences and satisfaction. The instrument has demonstrated acceptable psychometric properties, including good content validity and internal reliability, good test-retest reliability and a high level of acceptability. The survey will be administered online and in hard-copy, with at least 1832 survey participants to be recruited over a 12-month period, using a comprehensive, multimodal recruitment campaign. ETHICS AND DISSEMINATION The study has been reviewed and approved by the Human Research Ethics Committee of the University of South Australia. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media, broadcast media, print media, the internet and various community/stakeholder engagement activities.
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Affiliation(s)
- Matthew J Leach
- Department of Rural Health, University of South Australia, Adelaide, South Australia, Australia
| | - Martin Jones
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
| | - Marianne Gillam
- Department of Rural Health, University of South Australia, Adelaide, South Australia, Australia
| | - Esther May
- Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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30
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LEE CH, CHENG SC, TUNG HY, CHANG SC, CHING CY, WU SF. The Risk Factors Affecting Survival in Colorectal Cancer in Taiwan. IRANIAN JOURNAL OF PUBLIC HEALTH 2018; 47:519-530. [PMID: 29900136 PMCID: PMC5996318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Colorectal cancer is one of the most common malignancies in developed countries. The incidence of colorectal cancer (CRC) in Taiwan is rising. We aimed to determine the five-yr survival rate of patients diagnosed with CRC and determine factors affecting survival. METHODS All patients were identified from the Taiwan Cancer Data Base of the Medical Center Hospital in North Taiwan from 2007 to 2013. Data were collected using medical records and the cancer database. In all, 869 patients with CRC were included. Survival analysis was performed using Kaplan-Meier curves, and differences between the curves were analyzed using the log-rank test. Cox proportional hazards regression models were used to analyze survival by each variable. RESULTS The five-yr survival rate and the mean survival time after cancer diagnosis were 68.7% and 71.27±1.27 months. Perineural nerve invasion, distant metastasis, age, pathological differentiation grade, obstruction and regional lymph node metastasis were found to be independent predictors of the survival and prognosis of patients with CRC. CONCLUSION Perineural nerve invasion was an important factor related to the survival of CRC patients. Thus, the earlier detection of CRC might help improve survival.
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Affiliation(s)
- Chao-Hsien LEE
- Dept. of Health Business Administration, Meiho University, Pingtung, Taiwan
| | - Shu-Chen CHENG
- Dept. of Cancer Registry Division, Cathay General Hospital, Taipei, Taiwan
| | - Hong-Yi TUNG
- Dept. of Health Business Administration, Meiho University, Pingtung, Taiwan, Dept. of General Surgery, Yuan’s General Hospital, Kaohsiung, Kaohsiung, Taiwan
| | - Shih-Chang CHANG
- Dept. of Colorectal Surgery, Division of Surgery, Cathay General Hospital, Taipei, Taiwan
| | - Ching-Yun CHING
- Dept. of Nursing, Yuan’s General Hospital, Kaohsiung, Taiwan
| | - Shu-Fen WU
- Dept. of Health Business Administration, Meiho University, Pingtung, Taiwan, Dept. of Nursing, Yuan’s General Hospital, Kaohsiung, Taiwan, Dept. of Nursing, College of Medicine, I-Shou University, Kaohsiung, Taiwan,Corresponding Author:
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31
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Feller A, Schmidlin K, Bordoni A, Bouchardy C, Bulliard J, Camey B, Konzelmann I, Maspoli M, Wanner M, Zwahlen M, Clough‐Gorr KM. Socioeconomic and demographic inequalities in stage at diagnosis and survival among colorectal cancer patients: evidence from a Swiss population-based study. Cancer Med 2018; 7:1498-1510. [PMID: 29479854 PMCID: PMC5911574 DOI: 10.1002/cam4.1385] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 01/16/2018] [Accepted: 01/16/2018] [Indexed: 12/30/2022] Open
Abstract
Socioeconomic inequalities in cancer stage at diagnosis and survival are important public health issues. This study investigates the association between socioeconomic position (SEP) and colorectal cancer (CRC) stage at diagnosis and survival in Switzerland, a European country with highest level of medical facilities and life expectancy. We used population-based CRC data from seven Swiss cantonal cancer registries 2001-2008 (N = 10,088) linked to the Swiss National Cohort (SNC). Follow-up information was available until the end of 2013. SEP was estimated based on education. The association between cancer stage and SEP was assessed using logistic regression models including cancer localization (colon/rectum), sex, age, civil status, urbanity of residence, language region, and nationality (Swiss/non-Swiss). Survival was analyzed using competing risk regressions reporting subhazard ratios (SHRs) for the risk of dying due to CRC. We observed a social gradient for later stage CRC with adjusted odds ratios (ORs) of 1.11 (95% CI: 0.97-1.19) and 1.28 (95% CI: 1.08-1.50) for middle and low SEP compared to high SEP. Further, single compared to married people had elevated odds of being diagnosed at later stages. Survival was lower in patients with CRC with low SEP in the unadjusted model (SHR: 1.18, 95% CI: 1.07-1.30). After adjustment for stage at diagnosis and further sociodemographic characteristics, significant survival inequalities by SEP disappeared but remained for non-Swiss compared to Swiss citizens and for patients living in nonurban areas compared to their urban counterparts. Swiss public health strategies should facilitate equal access to CRC screening and optimal CRC care for all social groups and in all regions of Switzerland.
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Affiliation(s)
- Anita Feller
- Institute of Social and Preventive Medicine (ISPM)University of BernFinkenhubelweg 11CH‐3012BernSwitzerland
- National Institute for Cancer Epidemiology and Registration (NICER)Hirschengraben 828001ZürichSwitzerland
| | - Kurt Schmidlin
- Institute of Social and Preventive Medicine (ISPM)University of BernFinkenhubelweg 11CH‐3012BernSwitzerland
| | - Andrea Bordoni
- Ticino Cancer RegistryInstituto cantonale di patologiaVia in Selva 246601Locarno 1Switzerland
| | - Christine Bouchardy
- Geneva Cancer RegistryInstitute of Global HealthUniversity of GenevaBd de la Cluse 551205GenevaSwitzerland
| | - Jean‐Luc Bulliard
- Vaud Cancer RegistryUniversity Institute of Social and Preventive Medicine (IUMSP)Route de la Corniche 10, Bâtiment Biopôle 21010LausanneSwitzerland
| | - Bertrand Camey
- Fribourg Cancer RegistrySt. Nicolas de Flüe 21705FribourgSwitzerland
| | - Isabelle Konzelmann
- Health Observatory ValaisValais Cancer RegistryAvenue Grand‐Champsec 641950SionSwitzerland
| | - Manuela Maspoli
- Neuchâtel and Jura Cancer RegistryRue du Plan 302000NeuchâtelSwitzerland
| | - Miriam Wanner
- Cancer Registry Zurich and ZugBiostatistics and Prevention InstituteUniversity ZurichVogelsangstrasse 108091ZurichSwitzerland
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine (ISPM)University of BernFinkenhubelweg 11CH‐3012BernSwitzerland
| | - Kerri M. Clough‐Gorr
- Institute of Social and Preventive Medicine (ISPM)University of BernFinkenhubelweg 11CH‐3012BernSwitzerland
- National Cancer Registry IrelandAirport Business Park6800CorkIreland
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Abstract
Disparities in cancer control exist in low- and middle-income countries (LMICs). Many countries do not have cancer registries to record incidence, mortality and prevalence and are reliant on Globocan estimates of their cancer burden. Poorer cancer control within and between countries occurs in those living remotely from urban centres, those in a low socioeconomic group and some ethnic groups who have lifestyle and belief systems which impact on cancer control. High-income countries generally have population screening programmes for cervix, breast and bowel cancer. However, simpler forms of screening for cancer of the cervix like visual inspection with acetic acid have been shown to be feasible in developing nations. The widespread use of vaccines to prevent cancer has been achieved with the Hepatitis B vaccine but the human papilloma virus vaccine to prevent cancer of the cervix is largely only available in high-income countries. Access to and training of oncological surgeons in LMICs is limited, while 70% of patients in these countries cannot access radiotherapy. The World Health Organization has developed a list of essential medicines although access remains poor in LMICs. The United Nations has set targets for the control of non-communicable diseases to improve global cancer control.
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Affiliation(s)
- I Olver
- Sansom Institute for Health Research, University of South Australia, Adelaide, SA, 5001, Australia
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Beckmann K, Moore J, Wattchow D, Young G, Roder D. Short-term outcomes after surgical resection for colorectal cancer in South Australia. J Eval Clin Pract 2017; 23:316-324. [PMID: 27480799 DOI: 10.1111/jep.12612] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/30/2016] [Accepted: 06/30/2016] [Indexed: 12/24/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVE Short-term outcomes (unplanned readmission, post-surgical complication rates, 30-day and 90-day post-surgical mortality) are often used as indicators of quality of surgical care for colorectal cancer (CRC). Differences in these immediate outcomes can highlight disparities in care across patient subpopulations. This study aimed to document short-term outcomes following major surgery for CRC and to identify whether there were any sociodemographic differences across South Australia (SA). METHODS This population-based study included all CRC resections among SA residents diagnosed with CRC aged 50-79 years in 2003-2008 (n = 3940). Clinical, treatment, comorbidity and outcomes data were compiled through linkage of administrative and surveillance datasets across SA. A retrospective cohort design was used to examine short-term outcomes including post-operative complications, 28-day emergency readmission and 30-day and 90-day mortality. We used multivariable logistic regression to identify factors associated with each outcome. RESULTS Post-operative complications occurred in 28% of cases. Thirty-day and ninety-day mortality were 1.3% and 3%, respectively. Later stage, older age, multiple comorbidities and emergency admissions were associated with poorer short-term outcomes. Risk of complications was lower among patients from higher socio-economic areas (OR = 0.77, 95%CI 0.62-0.98). Risk of 30-day mortality was higher among non-metropolitan patients (OR = 2.33, 95%CI 1.22-4.46). Post-operative complications increased the risk of emergency readmission and short-term mortality. CONCLUSIONS Short-term outcomes following CRC surgery may be improved through strategies to increase earlier detection and reduce emergency admissions. Socioeconomic and regional disparities require further examination of health system factors.
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Affiliation(s)
- Kerri Beckmann
- Centre for Population Health, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - James Moore
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - David Wattchow
- Department of General and Digestive Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Graeme Young
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, South Australia, Australia
| | - David Roder
- Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Ireland MJ, March S, Crawford-Williams F, Cassimatis M, Aitken JF, Hyde MK, Chambers SK, Sun J, Dunn J. A systematic review of geographical differences in management and outcomes for colorectal cancer in Australia. BMC Cancer 2017; 17:95. [PMID: 28152983 PMCID: PMC5290650 DOI: 10.1186/s12885-017-3067-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/18/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Australia and New Zealand have the highest incidence of colorectal cancer (CRC) in the world, presenting considerable health, economic, and societal burden. Over a third of the Australian population live in regional areas and research has shown they experience a range of health disadvantages that result in a higher disease burden and lower life expectancy. The extent to which geographical disparities exist in CRC management and outcomes has not been systematically explored. The present review aims to identify the nature of geographical disparities in CRC survival, clinical management, and psychosocial outcomes. METHODS The review followed PRISMA guidelines and searches were undertaken using seven databases covering articles between 1 January 1990 and 20 April 2016 in an Australian setting. Inclusion criteria stipulated studies had to be peer-reviewed, in English, reporting data from Australia on CRC patients and relevant to one of fourteen questions examining geographical variations in a) survival outcomes, b) patient and cancer characteristics, c) diagnostic and treatment characteristics and d) psychosocial and quality of life outcomes. RESULTS Thirty-eight quantitative, two qualitative, and three mixed-methods studies met review criteria. Twenty-seven studies were of high quality, sixteen studies were of moderate quality, and no studies were found to be low quality. Individuals with CRC living in regional, rural, and remote areas of Australia showed poorer survival and experienced less optimal clinical management. However, this effect is likely moderated by a range of other factors (e.g., SES, age, gender) and did appear to vary linearly with increasing distance from metropolitan centres. No studies examined differences in use of stoma, or support with stomas, by geographic location. CONCLUSIONS Overall, despite evidence of disparity in CRC survival and clinical management across geographic locations, the evidence was limited and at times inconsistent. Further, access to treatment and services may not be the main driver of disparities, with individual patient characteristics and type of region also playing an important role. A better understanding of factors driving ongoing and significant geographical disparities in cancer related outcomes is required to inform the development of effective interventions to improve the health and welfare of regional Australians.
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Affiliation(s)
- Michael J. Ireland
- Institute of Resilient Regions, University of Southern Queensland, Springfield Central, Australia
- School of Psychology and Counselling, University of Southern Queensland, Springfield Central, Australia
| | - Sonja March
- Institute of Resilient Regions, University of Southern Queensland, Springfield Central, Australia
- School of Psychology and Counselling, University of Southern Queensland, Springfield Central, Australia
| | - Fiona Crawford-Williams
- Institute of Resilient Regions, University of Southern Queensland, Springfield Central, Australia
- School of Psychology and Counselling, University of Southern Queensland, Springfield Central, Australia
| | - Mandy Cassimatis
- Non-communicable Disease Control Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC Australia
| | - Joanne F. Aitken
- Institute of Resilient Regions, University of Southern Queensland, Springfield Central, Australia
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, 4006 QLD Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, QLD Australia
| | - Melissa K. Hyde
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, 4006 QLD Australia
- Menzies Health Institute Queensland, Griffith University, Southport, QLD Australia
| | - Suzanne K. Chambers
- Institute of Resilient Regions, University of Southern Queensland, Springfield Central, Australia
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, 4006 QLD Australia
- Menzies Health Institute Queensland, Griffith University, Southport, QLD Australia
- Prostate Cancer Foundation of Australia, St Leonards, NSW Australia
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA Australia
| | - Jiandong Sun
- Institute of Resilient Regions, University of Southern Queensland, Springfield Central, Australia
| | - Jeff Dunn
- Institute of Resilient Regions, University of Southern Queensland, Springfield Central, Australia
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, 4006 QLD Australia
- School of Social Science, University of Queensland, Brisbane, Australia
- School of Medicine, Griffith University, Brisbane, QLD Australia
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Cadet T, Davis C, Elks J, Wilson P. A Holistic Model of Care to Support Those Living with and beyond Cancer. Healthcare (Basel) 2016; 4:E88. [PMID: 27869728 PMCID: PMC5198130 DOI: 10.3390/healthcare4040088] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/14/2016] [Accepted: 11/11/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Globally, the burden of cancer continues to increase and it is well-documented that while not a homogeneous population, cancer patients and cancer survivors face many physical, psychological, social, spiritual, and financial issues. Cancer care is shifting from a disease-focused to a patient-centered approach resulting in an increased need to address these concerns. METHODS Utilizing a quality improvement approach, this paper describes an integrated cancer care model at Bloomhill Cancer Center (BCC) in Queensland, Australia that demonstrates the ability to meet the holistic needs of patients living with and beyond cancer and to identify opportunities for better practice and service provision. RESULTS Survey results indicate that 67% and 77% of respondents were very satisfied and 27% and 17% were satisfied with their first contact and very satisfied with their first meeting with a nurse at BCC. Clients also reported being very satisfied (46%) or satisfied (30%) with the emotional support they received at BCC and over 90% were very satisfied or satisfied with the touch therapies that the received. CONCLUSION Due to the early success of the interventions provided by BCC, the model potentially offers other states and countries a framework for supportive cancer care provision for people living with and beyond cancer.
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Affiliation(s)
- Tamara Cadet
- School of Social Work, Simmons College, 300 The Fenway, Boston, MA 02115, USA.
- Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA 02115, USA.
| | - Cindy Davis
- Faculty of Arts, Business & Law, University of the Sunshine Coast, Sunshine Coast, QLD 4556, Australia.
| | - Jacinta Elks
- School of Nursing, University of the Sunshine Coast, Sunshine Coast, QLD 4556, Australia.
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Affiliation(s)
- Graham A Colditz
- Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO 63110, USA.
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