Lack of active follow-up of cancer patients in Chennai, India: implications for population-based survival estimates

An Ambispective Community-Based Survival Study of Common Cancers in Rural Jodhpur, Rajasthan, Western India

Background Cancer is the leading cause of death globally. Information on cancer patterns and survival is essential for the effective planning and implementation of cancer control interventions. Objective This study aimed to identify various factors associated with the survival estimates of common cancers. Methods A community-based ambispective study was conducted in a rural population. Data were collected from individuals diagnosed with cancer or relatives of individuals who died of cancer. The total population covered was 82,983. All cancer cases diagnosed since 2005 and followed until the year 2020 were included. Survival analysis and five-year survival rates were estimated. A Cox proportional hazard model was used. Results A total of 146 cancer patients were included in the study. Five-year survival estimates for breast cancer, head and neck cancer, and GI cancer were 72%, 28%, and 0%, respectively. The median survival time was lowest for GI cancers (1 year), and for head and neck and breast cancers, it was 3 and 6 years, respectively. Multivariate Cox regression was performed, adjusting for age, type of hospital, alcohol use, tobacco use, opium use, gender, treatment sought, GI cancer, frequency of changing hospitals, and frequency of follow-up. After adjustment, changing hospitals ≥3 times, being lost to follow-up, receiving no treatment, tobacco abuse, and the presence of GI cancers were significantly associated with survival estimates. Conclusions The five-year survival estimate for GI cancers was the lowest compared to other cancers. Study participants who were lost to follow-up or who took no treatment were significantly associated with lower survival estimates.

Survival of patients with cervical cancer in India - findings from 11 population based cancer registries under National Cancer Registry Programme

Background

Cancer survival data from Population Based Cancer Registries (PBCR) reflect the average outcome of patients in the population, which is critical for cancer control efforts. Despite decreasing incidence rates, cervical cancer is the second most common female cancer in India, accounting for 10% of all female cancers. The objective of the study is to estimate the five-year survival of patients with cervical cancer diagnosed between 2012 and 2015 from the PBCRs in India.

Methods

A single primary incidence of cervical cancer cases of 11 PBCRs (2012-2015) was followed till June 30, 2021 (n = 5591). Active follow-ups were conducted through hospital visits, telephone calls, home or field visits, and public databases. Five-year Observed Survival (OS) and Age Standardised Relative Survival (ASRS) was calculated. OS was measured by age and clinical extent of disease for cervical cancers.

Findings

The five-year ASRS (95% CI) of cervical cancer was 51.7% (50.2%-53.3%). Ahmedabad urban (61.5%; 57.4%-65.4%) had a higher survival followed by Thiruvananthapuram (58.8%; 53.1%-64.3%) and Kollam (56.1%; 50.7%-61.3%). Tripura had the lowest overall survival rate (31.6%; 27.2%-36.1%). The five-year OS% for pooled PBCRs was 65.9%, 53.5%, and 18.0% for localised, regional, and distant metastasis, respectively.

Interpretation

We observed a wide variation in cervical cancer survival within India. The findings of this study would help the policymakers to identify and address inequities in the health system. We re-emphasise the importance of awareness, early detection, and increase the improvement of the health care system.

Funding

The National Cancer Registry Programme is funded through intra-mural funding by Indian Council of Medical Research, Department of Health Research, India, Ministry of Health & Family Welfare.

Cancer Survival Trends in Southeastern China, 2011-2021: A Population-Based Study

Purpose

The 5-year cancer survival rate among Chinese patients is lower than that among patients in developed countries and varies widely across geographic regions. The aim of this study was to analyse the 5-year relative cancer survival rate in southeastern China, between 2011 and 2021.

Patients and Methods

We utilised population-based statistics from 12 cancer registries in Fujian, China. Study population data were up to date as of Dec 31, 2019, and survival outcome status was updated as of Dec 31, 2021. We used the ICD-10 and the ICD-O-3 to categorize all cancer cases. We analysed the 5-year relative survival for cancers combined and different cancer types stratified by sex, urban and rural areas, and age. Survival estimates were stratified according to calendar period (2011-13, 2014-15, 2016-18 and 2019-21).

Results

Ultimately, a total of 160,294 cancer patients were enrolled in the study. In 2011-13, 2014-15, 2016-18 and 2019-21, the age-standardised 5-year relative survival for cancers combined were 29.1% (95% CI: 28.6-29.7), 31.5% (95% CI: 31.0-32.0), 36.8% (95% CI: 36.4-37.3) and 39.1% (95% CI: 38.7-39.6), respectively. The age-standardised 5-year relative survival for lung, prostate, larynx, colon-rectum, kidney and bone cancers increased 4.3%, 4.0%, 3.8%, 3.4%, 3.4% and 2.70%, respectively. Cancers with high 5-year relative survival rates (>60%) in 2019-21 included thyroid, testis, breast, bladder, cervix, prostate and uterus cancers. The 5-year survival rates in 2019-2021 was higher for females than for males (47.8% vs 32.0%) and higher in urban areas than in rural areas (41.7% vs 37.1%). Relative survival rates decreased with increasing age.

Conclusion

The 5-year cancer survival in Fujian Province increased between 2011 and 2021 but remained at a low level. Building a strong primary public health system may be a key step in reducing the cancer burden in Fujian Province.

Survival differences between the USA and an urban population from China for all cancer types and 20 individual cancers: a population-based study

Background

The systematic comparison of cancer survival between China and the USA is rare. Here we aimed to assess the magnitude of survival disparities and disentangle the impact of the stage at diagnosis between a Chinese metropolitan city and the USA on cancer survival.

Methods

We included 11,046 newly diagnosed cancer patients in Dalian Cancer Registry, China, 2015, with the follow-up data for vital status until December 2020. We estimated age-standardised 5-year relative survival and quantified the excess hazard ratio (EHR) of death using generalised linear models for all cancers and 20 individual cancers. We compared these estimates with 17 cancer registries' data from the USA, using the Surveillance, Epidemiology, and End Results database. We further estimated the stage-specific survival for five major cancers by region.

Findings

Age-standardised 5-year relative survival for all patients in Dalian was lower than that in the USA (49.9% vs 67.9%). By cancer types, twelve cancers with poorer prognosis were observed in Dalian compared to the USA, with the largest gap seen in prostate cancer (Dalian: 55.8% vs USA: 96.0%). However, Dalian had a better survival for lung cancer, cervical cancer, and bladder cancer. Dalian patients had a lower percentage of stage Ⅰ colorectal cancer (Dalian: 17.9% vs USA: 24.2%) and female breast cancer (Dalian: 40.9% vs USA: 48.9%). However, we observed better stage-specific survival among stage Ⅰ-Ⅱ lung cancer patients in Dalian than in the USA.

Interpretation

This study suggests that although the overall prognosis for patients was better in the USA than in Dalian, China, survival deficits existed in both countries. Improvement in cancer early detection and cancer care are needed in both countries.

Funding

National Key R&D Program (2021YFC2501900, 2022YFC3600805), Major State Basic Innovation Program of the Chinese Academy of Medical Sciences (2021-I2M-1-010, 2021-I2M-1-046), and Talent Incentive Program of Cancer Hospital of Chinese Academy of Medical Sciences.

Conditional survival in patients treated for gastric cancer with a curative intent

BACKGROUND AND OBJECTIVES

Conditional survival (CS) provides the probability that a patient who has already survived a certain number of years after treatment will survive an additional number of years. We aim to study the CS of patients with gastric cancer.

METHODS

Patients who underwent curative intent treatment for gastric cancer in a single institution between 2007 and 2018 were included in the analysis. The probability (CS) that a patient who has already survived x years will survive an additional y year, was calculated as CS (y/x) = S(x + y)/S(x).

RESULTS

The probability of surviving an additional 3 years if a patient had already survived 1, 2, 3, 4, and 5 years after treatment were 64.2%, 74.5%, 81.6%, 83.2%, and 88.2%, respectively whereas the 4-, 5-, 6-, 7-, and 8-year actuarial OS were only 47.2%, 43.2%, 41%, 39.4%, and 38.2%, respectively. The independent prognostic factors associated with poor survival were age >60 years, T stage ≥T3, N stage ≥N2, proximal tumor location, and lymph node ratio > 0.18. Patients with these high-risk features showed the greatest increase in CS3 over time.

CONCLUSION

CS estimates provided a more dynamic prognostic information over time for patients treated for gastric cancer with curative intent.

Outcomes of non-metastatic triple negative breast cancers: Real-world data from a large Indian cohort

Background

Triple negative Breast tumor (TNBC) is an aggressive tumor with sparse data worldwide.

Methods

We analyzed non-metastatic TNBC from 2013 to 2019 for demographics, practice patterns, and survival by the Kaplan Meir method. Prognostic factors for OS and DFS were evaluated using Cox Proportional Hazard model estimator for univariate and multivariable analysis after checking for collinearity among the variables.

Results

There were 1297 patients with median age of 38 years; 41 (33.3%) among 123 tested were BRCA-positives. Among these 593 (45.7%) had stage III disease, 1279 (98.6%) were grade III, 165 (13.0%) had peri-nodal extension (PNE), 212 (16.0%) lympho-vascular invasion (LVI), and 21 (1.6%) were metaplastic; 1256 (96.8%) received chemotherapy including 820 (63.2%) neoadjuvant with 306 (40.0%) pCR. Grade ≥3 toxicities occurred in 155 (12.4%) including two deaths and 3 s-primaries. 1234 (95.2%) underwent surgery [722 (55.7%) breast conservations] and 1034 (79.7%) received radiotherapy.

At a median follow-up of 54 months, median disease-free (DFS) was 92.2 months and overall survival (OS) was not reached. 5-year estimated DFS and OS was 65.9% and 80.3%. There were 259 (20.0%) failures; predominantly distant (204, 15.7%) - lung (51%), liver (31.8%).

In multivariate analysis presence of LVI (HR-2.00, p-0.003), PNE (HR-2.09 p-0.003), older age (HR-1.03, p-0.002) and stage III disease (HR-4.89, p-0.027), were associated with poor OS.

Conclusion

Relatively large contemporary data of non-metastatic TNBC confirms aggressive biology and predominant advanced stage presentation which adversely affects outcomes. The data strongly indicate the unmet need for early detection to optimize care.

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TNBC affects young women and majority are locally advanced at presentation.

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Multimodal management achieves favorable survival with limited resources.

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Most relapses are at distant visceral sites, outcomes dismal after relapse.

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Challenges in implementing resource intensive interventions.

Population-based cancer survival in the Golestan province in the northeastern part of Iran 2007-2012

OBJECTIVE

We studied 5-year relative survival (RS) for 14 leading cancer sites in the population-based cancer registry (PBCR) of Golestan province in the northeastern part of Iran.

METHODOLOGY

We followed patients diagnosed in 2007-2012 through data linkage with different databases, including the national causes of death registry and vital statistics office. We also followed the remaining patients through active contact. We used relative survival (RS) analysis to estimate 5-year age-standardized net survival for each cancer site. Multiple Imputation (MI) method was performed to obtain vital status for loss to follow-up (LTFU) cases.

RESULTS

We followed 6910 cancer patients from Golestan PBCR. However, 2162 patients were loss to follow-up. We found a higher RS in women (29.5%, 95% CI, 27.5, 31.7) than men (21.0%, 95% CI, 19.5, 22.5). The highest RS was observed for breast cancer in women (RS=49.8%, 95% CI, 42.2, 56.9) and colon cancer in men (RS=37.9%, 95% CI, 31.2, 44.6). Pancreatic cancer had the lowest RS both in men (RS= 8.7%, 95% CI, 4.1, 13.5) and women (RS= 7.9%, 95% CI, 5.0, 10.8) CONCLUSION: Although the 5-year cancer survival rates were relatively low in the Golestan province, there were distinct variations by cancer site. Further studies are required to evaluate the survival trends in Golestan province over time and compare them with the rates in the neighboring provinces and other countries in the region.

Cervical cancer treatment in Rwanda: Resource-driven adaptations, quality indicators, and patient outcomes

OBJECTIVE

Most cervical cancer cases and deaths occur in low- and middle-income countries, yet clinical research from these contexts is significantly underrepresented. We aimed to describe the treatment quality, resource-driven adaptations, and outcomes of cervical cancer patients in Rwanda.

METHODS

A retrospective cohort study was conducted of all patients with newly diagnosed cervical cancer enrolled between April 2016 and June 2018. Data were abstracted from medical records and analyzed using descriptive statistics, Kaplan Meier methods, and Cox proportional hazards regression.

RESULTS

A total of 379 patients were included; median age 54 years, 21% HIV-infected. A majority (55%) had stage III or IV disease. Thirty-four early-stage patients underwent radical hysterectomy. Of 254 patients added to a waiting list for chemoradiation, 114 ultimately received chemoradiation. Of these, 30 (26%) received upfront chemoradiation after median 126 days from diagnosis, and 83 (73%) received carboplatin/paclitaxel while waiting, with a median 56 days from diagnosis to chemotherapy and 207 days to chemoradiation. There was no survival difference between the upfront chemoradiation and prior chemotherapy subgroups. Most chemotherapy recipients (77%) reported improvement in symptoms. Three-year event-free survival was 90% with radical hysterectomy (95% CI 72-97%), 66% with chemoradiation (95% CI 55-75%), and 12% with chemotherapy only (95% CI 6-20%).

CONCLUSIONS

Multi-modality treatment of cervical cancer is effective in low resource settings through coordinated care and pragmatic approaches. Our data support a role for temporizing chemotherapy if delays to chemoradiation are anticipated. Sustainable access to gynecologic oncology surgery and expanded access to radiotherapy are urgently needed.

Loss to Follow-up: A Deceptive Enigma

Loss to follow-up indicates both patients not reporting and inability to trace them during the required follow-up period or study period. Significant loss to follow-up can affect the validity of a study and thereby the impact of that study. The importance of loss to follow-up has been very scarcely and meagerly highlighted in literature. More than one-fifth loss to follow-up can lead to significant selection bias. Loss to follow-up affects delivery of appropriate patient care. In the cohort studies, follow-up rates of 50 to 80% are accepted by authors, due to lack of any recommendations. The causes of loss to follow-up may vary from patient’s age, occupation, chronicity of the disease, etc. Loss to follow-up needs to be reported in all prospective studies, and intention to treat analysis should be applied. This will improve the validity of study, provide reliable results, and reflect the true effect of the intervention used in the study. It also helps to determine the actual survival rates in fatal diseases. The course of a disease can also be monitored, and appropriate intervention can be done at an appropriate point of time to prevent morbidity and mortality. Its overall benefits are better patient care and improved outcomes of the treatment method.

Triaging and adaptations of surveillance of cancer services in the COVID pandemic

Introduction:

Coronavirus disease (COVID-19) has significantly challenged the access to cancer care and follow-up for a patient with cancer.

Methods:

Based on published literature and our experiences, it is reasonable to presume that clinical examination and follow-up visits have been significantly curtailed worldwide in order to adhere to the new norms during the pandemic. Although telephonic and telemedicine consultations may help bridge a few gaps, completely dispensing with in-person consultation has its challenges, especially in low middle-income countries. Telephonic consultations could facilitate triaging of ambulatory cancer patients and allocation of face-to-face consultations for high priority patients.

Conclusions:

We propose a telephonic consultation-based triaging approach for ambulatory cancer patients in order to identify those needing in-hospital consultations.

Conventional radiotherapy planning of cervical cancer in resource-constrained set-up: Utilizing soldering lead wire to delineate radiotherapy portal

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Cervical cancer is the commonest malignancy among women in developing countries.

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Radiotherapy is mainstay of management and simulator for RT planning may be sparse.

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Our study has demonstrated the utility of locally available resources for simulation.

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Using soldering wire for conventional RT field delineation appears to be feasible.

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Future studies are needed to validate the RT portals delineated by this technique.

Simulator for radiotherapy planning may not be available in resource-constrained set-up. Surface anatomy based planning has its own limitation in terms of adequately covering target due to variation of anatomy and tumor growth and spread pattern. Hence, improvisation of radiotherapy planning of cervical cancer, commonest malignancy among women in this set-up, utilizing locally available resource may improve treatment quality.

Soldering lead wire, plumber’s measuring tape, diagnostic x-ray and transpore adhesive tape were utilized to delineate radiotherapy portals for management of cervical cancer. Delineation of radiotherapy portals for irradiation of different regions in selected patients of carcinoma cervix is feasible in resource-constrained set-up. Radiotherapy delivery by conventional 2-D technique through the portal designed by utilizing soldering lead wire and diagnostic x-ray was achievable. Radiotherapy portal so delineated need to be validated in future clinical studies.

Nano Drug Delivery in Treatment of Oral Cancer, A Review of the Literature

Oral Cancer (OC) is a serious and growing problem which constitutes a huge burden on people in more and less economically developed countries alike. The scenario is clearly depicted from the increase in the expected number of new cases in the US diagnosed with OC from 49,670 people in 2016, to 49,750 cases in 2017. The situation is even more alarming in India, with 75,000 to 80,000 new cases being reported every year, thus making it the OC capital of the world. Leukoplakia, erythroplakia, oral lichen planus, oral submucous fibrosis, discoid lupus erythmatosus, hereditary disorders such as dyskeratosis congenital and epidermolisys bullosa are highlighted by WHO expert working group as the predisposing factors increasing the risk of OC. Consumption of tobacco and alcohol, genetic factors, and human papilloma virus are assigned as the factors contributing to the aetiology of OC. On the other hand, pathogenesis of OC involves not only apoptosis but also pain, inflammation and oxidative stress. Inspite of current treatment options (surgery, radiotherapy, and chemotherapy), OC is often associated with recurrence and formation of secondary primary tumours resulting in poor overall survival rates (∼50%). The intervention of nano technology-based drug delivery systems as therapeutics for cancers is often viewed as a cutting edge for technologists. Though ample literature on the usefulness of nano-coutured cancer therapeutics, rarely any product is in pipeline. Yet, despite all the hype about nanotechnology, there are few ongoing trials. This review discusses the current and future trends of nano-based drug delivery for the treatment of OC.

A multi-institutional real world data study from India of 3453 non-metastatic breast cancer patients undergoing upfront surgery

The present analysis reports the clinical, pathological, treatment profile and overall survival (OS) and disease-free survival (DFS) outcomes of consecutive breast cancer patients from three Indian centres, who underwent curative surgery as their first treatment. Among the 3453 patients, stage I, II, and III cases were 11.75%, 66.79%, and 21.64%, respectively while hormone receptor positive/HER2 negative, triple negative (TNBC) and hormone receptor any/HER2 positive cases were 55.2%, 24.2% and 20.6%, respectively. The five-year OS in the entire cohort, node-negative and node-positive patients were 94.1% (93.25–94.98), 96.17% (95.2–97.15) and 91.83% (90.36–93.31), respectively, and the corresponding DFS were 88.1% (86.96–89.31), 92.0% (90.64–93.39) and 83.93% (82.03–85.89), respectively. The five-year OS in hormone receptor positive/HER2 negative, TNBC and HER2 subgroups were 96.11% (95.12–97.1), 92.74% (90.73–94.8) and 90.62% (88.17–93.15), respectively, and the corresponding DFS were 91.59% (90.19–93.02), 85.46% (82.79–88.22) and 81.29% (78.11–84.61), respectively. This is the largest dataset of early breast cancer patients from India with survival outcome analysis and can therefore serve as a benchmark for future studies.

Impact of loss-to-follow-up on cancer survival estimates for small populations: a simulation study using Hospital-Based Cancer Registries in Japan

OBJECTIVES

The accuracy of the ascertainment of vital status impacts the validity of cancer survival. This study assesses the potential impact of loss-to-follow-up on survival in Japan, both nationally and in the samples seen at individual hospitals.

DESIGN

Simulation study SETTING AND PARTICIPANTS: Data of patients diagnosed in 2007, provided by the Hospital-Based Cancer Registries of 177 hospitals throughout Japan.

PRIMARY AND SECONDARY OUTCOME MEASURES

We performed simulations for each cancer site, for sample sizes of 100, 1000 and 8000 patients, and for loss-to-follow-up ranging from 1% to 5%. We estimated the average bias and the variation in bias in survival due to loss-to-follow-up.

RESULTS

The expected bias was not associated with the sample size (with 5% loss-to-follow-up, about 2.1% for the cohort including all cancers), but a smaller sample size led to more variable bias. Sample sizes of around 100 patients, as may be seen at individual hospitals, had very variable bias: with 5% loss-to-follow-up for all cancers, 25% of samples had a bias of <1.02% and 25% of samples had a bias of > 3.06%.

CONCLUSION

Survival should be interpreted with caution when loss-to-follow-up is a concern, especially for poor-prognosis cancers and for small-area estimates.

The Adolescent Idiopathic Scoliosis International Disease Severity Study: Do Operative Curve Magnitude and Complications Vary by Country?

BACKGROUND

The prevalence of adolescent idiopathic scoliosis (AIS) in diverse regions of the world has been studied. Access to care varies widely, and differences in disease severity and operative treatment outcomes are not well understood. This study aimed to determine variation in disease presentation and operative complications for AIS patients from an international cohort.

METHODS

This is a retrospective study carried out at seven surgical centers in the United States (Manhattan and Miami), Ghana, Pakistan, Spain, Egypt, and China. A total of 541 consecutive patients with AIS were evaluated. Preoperative major curve magnitude, operative parameters, and complications were compared among sites using analysis of variance with post hoc tests and Pearson correlation coefficients. Univariate and multivariate forward stepwise binary logistic regressions determined the variables most predictive of complications.

RESULTS

Countries with lowest-access to care (Ghana, Egypt, and Pakistan) displayed larger curves, more levels fused, longer operative time (OT), and greater estimated blood loss (EBL) than the other countries (p ≤ .001). Increasing curve magnitude was correlated with greater levels fused, longer OT, and greater EBL in all groups (p = .01). In the univariate regression analysis, Cobb magnitude, levels fused, EBL, and OT were associated with complication occurrence. Only OT remained significantly associated with complication occurrence after adjusting for Cobb magnitude, levels fused, and site (odds ratio [OR] = 1.005, 95% confidence interval 1.001-1.007, p = .003). Complications were greatest in Pakistan and Ghana (21.7% and 13.5%, respectively) and lowest in Miami (6.5%).

CONCLUSIONS

Larger curve magnitudes in the least-access countries correlated with more levels fused, longer OT, and greater EBL, indicating that increased curve magnitude at surgery could explain the difference in operative morbidity between low- and high-access countries. With OT as the prevailing predictive factor of complications, we suggest that increased curve magnitude leads to longer OTs and more complications. A lack of access to orthopedic care may be the largest contributor to the postponement of treatment.

LEVEL OF EVIDENCE

Level II.

Importancia del acceso de los registros de cáncer de base poblacional a las estadísticas vitales: barreras identificadas en Colombia

Los registros de cáncer de base poblacional (RCBP) son los responsables del reporte de incidencia, mortalidad y supervivencia de los pacientes con cáncer para sus respectivas poblaciones. Los RCBP del país son definidos por la legislación colombiana como fuentes de información de los registros nacionales de cáncer para adultos y niños, pero carecen de un soporte jurídico que permita el acceso a las fuentes oficiales de información nacional y enfrentan restricciones dadas por la ley para el tratamiento de datos personales que impide la transferencia de información de los registros nacionales de cáncer y todas sus fuentes hacia los RCBP. Se analizarán los problemas de acceso a la información de estadísticas vitales del país, así como las consecuencias de estas barreras de acceso para los RCBP, y se presentarán argumentos que sustenten la necesidad de que los RCBP puedan acceder a la información necesaria para poder cumplir su objetivo.

Measuring cancer in indigenous populations

It is estimated that there are 370 million indigenous peoples in 90 countries globally. Indigenous peoples generally face substantial disadvantage and poorer health status compared with nonindigenous peoples. Population-level cancer surveillance provides data to set priorities, inform policies, and monitor progress over time. Measuring the cancer burden of vulnerable subpopulations, particularly indigenous peoples, is problematic. There are a number of practical and methodological issues potentially resulting in substantial underestimation of cancer incidence and mortality rates, and biased survival rates, among indigenous peoples. This, in turn, may result in a deprioritization of cancer-related programs and policies among these populations. This commentary describes key issues relating to cancer surveillance among indigenous populations including 1) suboptimal identification of indigenous populations, 2) numerator-denominator bias, 3) problems with data linkage in survival analysis, and 4) statistical analytic considerations. We suggest solutions that can be implemented to strengthen the visibility of indigenous peoples around the world. These include acknowledgment of the central importance of full engagement of indigenous peoples with all data-related processes, encouraging the use of indigenous identifiers in national and regional data sets and mitigation and/or careful assessment of biases inherent in cancer surveillance methods for indigenous peoples.

Critical Points for Interpreting Patients' Survival Rate Using Cancer Registries: A Literature Review

Background

Survival rate is used to develop cancer control plans. However, there are limitations and biases when interpreting patient survival rate data. This study aimed to identify and account for potential biases and/or limitations on estimating survival rate to enable more effective control of cancer.

Methods

The authors searched PubMed from December 2010 to December 2015 for articles that investigated or described biases in estimating patient survival using cancer registries. Articles that only described the tendency of survival rate and investigated relationships between patient characteristics, treatment, and survival rate were excluded.

Results

In total, 50 articles met the inclusion criteria. The identified potential biases were categorized into three areas, as follows: 1) the quality of registry data (eg, the completeness of cancer patients, accuracy of data, and follow-up rates); 2) limitations related to estimated methods of survival rates (eg, misclassification of cause of death for cause-specific survival rate or a lack of comparability of background mortality for relative survival rate); and 3) the comparability of survival rates among different groups (eg, age-adjustment or patients with multiple cancers).

Conclusion

We concluded that survival rate can be suitable for answering questions related to health policy and research. Several factors should be considered when interpreting survival rates estimated using cancer registries.

Survival of Cancer Patients in Northeast China: Analysis of Sampled Cancers from Population-Based Cancer Registries

PURPOSE

The cancer survival was characterized by following up sampled subgroups of cancer cases from three population-based cancer registries in Northeast China.

MATERIALS AND METHODS

Survival analysis was used to analyze 6,871 patients, who had one of the 21 most common cancers based on sampling from the population-based cancer registries of three cities in Liaoning Province. All patients were diagnosed between 2000 and 2002 and were followed up to the end of 2007 by active and passive methods. The 5-year age standardized relative survival rates (ASRS) were estimated for all cancers combined and each of the 21 individual cancers.

RESULTS

The survival status was traced for 80.8% of 8,506 sampled cancer cases. The 5-year ASRS for all 21 cancers combined was 41.5% (95% confidence interval, 40.3 to 42.7), the highest ASRS was observed for thyroid cancer (85.2%), breast cancer (78.9%), uterine corpus cancer (75.9%), and urinary bladder cancer (70.2%); the lowest 5-year ASRS was noted in pancreatic cancer (8.8%), liver cancer (11.0%), esophageal cancer (18.8), and lung cancer (19.6%). The cancer survival rates in Liaoning cities were similar to those of urban areas in mainland China, but significantly lower than those in Hong Kong, Korea, and Japan.

CONCLUSION

The strikingly poor cancer survival rates in three cities of Liaoning Province and in other places in China highlight the need for urgent investment in cancer prevention, early detection, and standardized and centralized treatment.

Quantifying bias in survival estimates resulting from loss to follow-up among children with lymphoma in Malawi

Pediatric lymphoma is common in sub-Saharan Africa, where survival estimates are often based on limited follow-up with incomplete retention, introducing potential for bias. We compared follow-up and overall survival (OS) between passive and active tracing within a prospective cohort of children with lymphoma in Malawi. Median follow-up times were 4.4 months (interquartile range [IQR] 2.0-9.4) and 10.8 months (IQR 6.2-20.6) in passive and active follow-up, respectively. Twelve-month overall survival (OS) was 69% (95% confidence interval [CI] 54-80) in passive and 44% (95% CI 34-54) in active follow-up. Passive follow-up significantly overestimated the OS and underestimated the mortality. Efforts to improve retention in regional studies are needed.

Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2)

BACKGROUND

Worldwide data for cancer survival are scarce. We aimed to initiate worldwide surveillance of cancer survival by central analysis of population-based registry data, as a metric of the effectiveness of health systems, and to inform global policy on cancer control.

METHODS

Individual tumour records were submitted by 279 population-based cancer registries in 67 countries for 25·7 million adults (age 15-99 years) and 75,000 children (age 0-14 years) diagnosed with cancer during 1995-2009 and followed up to Dec 31, 2009, or later. We looked at cancers of the stomach, colon, rectum, liver, lung, breast (women), cervix, ovary, and prostate in adults, and adult and childhood leukaemia. Standardised quality control procedures were applied; errors were corrected by the registry concerned. We estimated 5-year net survival, adjusted for background mortality in every country or region by age (single year), sex, and calendar year, and by race or ethnic origin in some countries. Estimates were age-standardised with the International Cancer Survival Standard weights.

FINDINGS

5-year survival from colon, rectal, and breast cancers has increased steadily in most developed countries. For patients diagnosed during 2005-09, survival for colon and rectal cancer reached 60% or more in 22 countries around the world; for breast cancer, 5-year survival rose to 85% or higher in 17 countries worldwide. Liver and lung cancer remain lethal in all nations: for both cancers, 5-year survival is below 20% everywhere in Europe, in the range 15-19% in North America, and as low as 7-9% in Mongolia and Thailand. Striking rises in 5-year survival from prostate cancer have occurred in many countries: survival rose by 10-20% between 1995-99 and 2005-09 in 22 countries in South America, Asia, and Europe, but survival still varies widely around the world, from less than 60% in Bulgaria and Thailand to 95% or more in Brazil, Puerto Rico, and the USA. For cervical cancer, national estimates of 5-year survival range from less than 50% to more than 70%; regional variations are much wider, and improvements between 1995-99 and 2005-09 have generally been slight. For women diagnosed with ovarian cancer in 2005-09, 5-year survival was 40% or higher only in Ecuador, the USA, and 17 countries in Asia and Europe. 5-year survival for stomach cancer in 2005-09 was high (54-58%) in Japan and South Korea, compared with less than 40% in other countries. By contrast, 5-year survival from adult leukaemia in Japan and South Korea (18-23%) is lower than in most other countries. 5-year survival from childhood acute lymphoblastic leukaemia is less than 60% in several countries, but as high as 90% in Canada and four European countries, which suggests major deficiencies in the management of a largely curable disease.

INTERPRETATION

International comparison of survival trends reveals very wide differences that are likely to be attributable to differences in access to early diagnosis and optimum treatment. Continuous worldwide surveillance of cancer survival should become an indispensable source of information for cancer patients and researchers and a stimulus for politicians to improve health policy and health-care systems.

FUNDING

Canadian Partnership Against Cancer (Toronto, Canada), Cancer Focus Northern Ireland (Belfast, UK), Cancer Institute New South Wales (Sydney, Australia), Cancer Research UK (London, UK), Centers for Disease Control and Prevention (Atlanta, GA, USA), Swiss Re (London, UK), Swiss Cancer Research foundation (Bern, Switzerland), Swiss Cancer League (Bern, Switzerland), and University of Kentucky (Lexington, KY, USA).

Is there a subgroup of long-term evolution among patients with advanced lung cancer?: hints from the analysis of survival curves from cancer registry data

BACKGROUND

Recently, with the access of low toxicity biological and targeted therapies, evidence of the existence of a long-term survival subpopulation of cancer patients is appearing. We have studied an unselected population with advanced lung cancer to look for evidence of multimodality in survival distribution, and estimate the proportion of long-term survivors.

METHODS

We used survival data of 4944 patients with non-small-cell lung cancer (NSCLC) stages IIIb-IV at diagnostic, registered in the National Cancer Registry of Cuba (NCRC) between January 1998 and December 2006. We fitted one-component survival model and two-component mixture models to identify short- and long- term survivors. Bayesian information criterion was used for model selection.

RESULTS

For all of the selected parametric distributions the two components model presented the best fit. The population with short-term survival (almost 4 months median survival) represented 64% of patients. The population of long-term survival included 35% of patients, and showed a median survival around 12 months. None of the patients of short-term survival was still alive at month 24, while 10% of the patients of long-term survival died afterwards.

CONCLUSIONS

There is a subgroup showing long-term evolution among patients with advanced lung cancer. As survival rates continue to improve with the new generation of therapies, prognostic models considering short- and long-term survival subpopulations should be considered in clinical research.

[Determinants of "lost to follow-up" status among patients treated for cancer in Morocco: situation before the Cancer Plan]

Introduction

Méthodes

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Conclusion

Cancer notification in India

In many developed countries, notification of cancer cases is compulsory. Developing countries including India accounts for more than half of new cancer cases in the world, however notification of cancer is not yet mandatory. The primary purpose of notification is to effect prevention and control and better utilization of resources. It is also a valuable source for incidence, prevalence, mortality and morbidity of the disease. Notification of cancer will lead to improved awareness of common etiologic agents, better understanding of common preventable causes and better utilization of health resources with better monitoring and evaluation of the effectiveness of health programs such as cancer screening and cancer treatment programs, which ultimately might improve survival. Notification of cancer can be done by the doctor or the hospital. Akin to the integrated disease surveillance project where more than 90% of the districts report weekly data through E-mail/portal, notification of cancer can be implemented if it is incorporated into the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke scheme. The need of the hour is cancer notification in India.

Trends of lip, oral cavity and oropharyngeal cancers in Australia 1982-2008: overall good news but with rising rates in the oropharynx

BACKGROUND

Considerable global variation in the incidence of lip, of oral cavity and of pharyngeal cancers exists. Whilst this reflects regional or population differences in risk, interpretation is uncertain due to heterogeneity of definitions of sites and of sub-sites within this anatomically diverse region. For Australia, limited data on sub-sites have been published. This study examines age-standardised incidence trends and demography from 1982 to 2008, the latest data available.

METHODS

Numbers of cases within ICD10:C00-C14 were obtained from the Australian Institute of Health and Welfare, recorded by sex, age, and sub-site. Raw data were re-analysed to calculate crude, age-specific and age-standardised incidence using Segi's world-standard population. Time-trends were analysed using Joinpoint regression.

RESULTS

Lip, Oral Cavity and Pharyngeal (excluding nasopharynx) cancers, considered together, show a biphasic trend: in men rising 0.9% pa from 1982 to 1992, and declining 1.6% pa between 1992 and 2008. For females: rises of 2.0% pa 1982-1997; declines of 2.8% pa 1997-2008. Lip cancer is declining especially significantly. When the Oropharynx is considered separately, steadily increasing trends of 1.2% pa for men and 0.8% pa for women were observed from 1982 to 2008.

CONCLUSIONS

Although overall rates of lip/oral/oropharyngeal cancer are declining in Australia, these are still high. This study revealed steady increases in cancers of the oropharynx, beginning in the late 1990s. Continued efforts to reduce the burden of these cancers are needed, focused on reduction of the traditional risk factors of alcohol and tobacco, and with special emphasis on the possible role of human papillomavirus and sexual hygiene for cancers of the oropharynx.

Oral cancer in India continues in epidemic proportions: evidence base and policy initiatives

OBJECTIVES

India has the highest number of cases of oral cancer in the world and this is increasing. This burden is not fully appreciated even within India, despite the high incidence and poor survival associated with this disease. Because the aetiology of oral cancer is predominantly tobacco-related, the immense public health challenge can be ameliorated through habit intervention.

METHODS

We reviewed current rates of incidence, mortality and survival, and investigated the determinants of disease and current prevention strategies.

RESULTS

In addition to tobacco smoking and the myriad other forms of tobacco use prevalent in India, risk factors include areca nut consumption, alcohol consumption, human papillomavirus, increasing age, male gender and socioeconomic factors. Although India has world-leading cancer treatment centres, access to these is limited. Further, the focus of health care services remains clinical and is either curative or palliative.

CONCLUSIONS

Although the efforts of agencies such as the Ministry of Health and Family Welfare and the Indian Dental Association are laudable, enhanced strategies should be based on common risk factors, focusing on primary prevention, health education, early detection and the earliest possible therapeutic intervention. A multi-agency approach is required.

Survival from digestive cancer in emerging countries in Asia and Africa

The incidence of digestive cancer, including cancer of the esophagus, stomach, colon, and liver, is analyzed in developing and less developed countries in Africa, Asia, the Caribbean, and Latin America. The analysis is based on cancer registries for observed values, on a recent monograph published at International Agency for Research on Cancer and on the GLOBOCAN 2008 database for estimations. For all tumor sites analyzed, the incidence is lower in these countries than in developed countries of Europe, North America, and Japan. The 5-year relative survival from digestive cancer is also lower. In developing countries, there is room for prevention of cancer burden through lifestyle interventions and through improved early detection of cancer.

Cancer survival in Africa, Asia, and Central America: a population-based study

BACKGROUND

Population-based cancer survival data, a key indicator for monitoring progress against cancer, are not widely available from countries in Africa, Asia, and Central America. The aim of this study is to describe and discuss cancer survival in these regions.

METHODS

Survival analysis was done for 341 658 patients diagnosed with various cancers from 1990 to 2001 and followed up to 2003, from 25 population-based cancer registries in 12 countries in sub-Saharan Africa (The Gambia, Uganda), Central America (Costa Rica), and Asia (China, India, Pakistan, Philippines, Saudi Arabia, Singapore, South Korea, Thailand, Turkey). 5-year age-standardised relative survival (ASRS) and observed survival by clinical extent of disease were determined.

FINDINGS

For cancers in which prognosis depends on stage at diagnosis, survival was highest in China, South Korea, Singapore, and Turkey and lowest in Uganda and The Gambia. 5-year ASRS ranged from 76-82% for breast cancer, 63-79% for cervical cancer, 71-78% for bladder cancer, and 44-60% for large-bowel cancers in China, Singapore, South Korea, and Turkey. Survival did not exceed 22% for any cancer site in The Gambia; in Uganda, survival did not exceed 13% for any cancer site except breast (46%). Variations in survival correlated with early detection initiatives and level of development of health services.

INTERPRETATION

The wide variation in cancer survival between regions emphasises the need for urgent investments in improving awareness, population-based cancer registration, early detection programmes, health-services infrastructure, and human resources.

FUNDING

Association for International Cancer Research (AICR; St Andrews, UK), Association pour la Recherche sur le Cancer (ARC, Villejuif, France), and the Bill & Melinda Gates Foundation (Seattle, USA).

Cancer pattern and survival in a rural district in South India

BACKGROUND

Cancer pattern data are rare and survival data are none from rural districts of India.

METHODS

The Dindigul Ambilikkai Cancer Registry (DACR) covering rural population of 2 millions in Dindigul district, Tamil Nadu state, South India, registered 4516 incident cancers during 2003-2006 by active case finding from 102 data sources for studying incidence pattern, of which, 1045 incident cancers registered in 2003 were followed up for estimating survival. House visits were undertaken annually for each registered case for data completion. Cancer pattern was described using average annual incidence rates and survival experience was expressed by computing observed survival by actuarial method and age-standardized relative survival (ASRS).

RESULTS

The average annual age-standardized rate per 100,000 of all cancers together was higher among women (62.6) than men (51.9) in DACR. The most common cancers among men were stomach (5.6), mouth (4.2) and esophagus (3.7). Cervical cancer (22.1) was ranked at the top among women followed by breast (10.9) and ovary (3.3). DACR incidence rates were lesser by at least two folds and 5-year survival were on par or lower than Chennai metropolitan registry for most cancers. Five-year age-standardized relative survival (%) in DACR was as follows: all cancers (29%), larynx (48), mouth (42), breast/tongue (38) and cervix (37).

CONCLUSION

Cancer incidence was significantly lower, cancer patterns were markedly different and population-based cancer survival was lower in rural areas than urban areas thus providing valuable leads in estimating realistic cancer burden and instituting cancer control programs in India.