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Matz M, Valkov M, Šekerija M, Luttman S, Caldarella A, Coleman MP, Allemani C. Worldwide trends in esophageal cancer survival, by sub-site, morphology, and sex: an analysis of 696,974 adults diagnosed in 60 countries during 2000-2014 (CONCORD-3). Cancer Commun (Lond) 2023; 43:963-980. [PMID: 37488785 PMCID: PMC10508138 DOI: 10.1002/cac2.12457] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 05/04/2023] [Accepted: 06/11/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Esophageal cancer survival is poor worldwide, though there is some variation. Differences in the distribution of anatomical sub-site and morphological sub-type may help explain international differences in survival for all esophageal cancers combined. We estimated survival by anatomic sub-site and morphological sub-type to understand further the impact of topography and morphology on international comparisons of esophageal cancer survival. METHODS We estimated age-standardized one-year and five-year net survival among adults (15-99 years) diagnosed with esophageal cancer in each of 60 participating countries to monitor survival trends by calendar period of diagnosis (2000-2004, 2005-2009, 2010-2014), sub-site, morphology, and sex. RESULTS For adults diagnosed during 2010-2014, tumors in the lower third of the esophagus were the most common, followed by tumors of overlapping sub-site and sub-site not otherwise specified. The proportion of squamous cell carcinomas diagnosed during 2010-2014 was generally higher in Asian countries (50%-90%), while adenocarcinomas were more common in Europe, North America and Oceania (50%-60%). From 2000-2004 to 2010-2014, the proportion of squamous cell carcinoma generally decreased, and the proportion of adenocarcinoma increased. Over time, there were few improvements in age-standardized five-year survival for each sub-site. Age-standardized one-year survival was highest in Japan for both squamous cell carcinoma (67.7%) and adenocarcinoma (69.0%), ranging between 20%-60% in most other countries. Age-standardized five-year survival from squamous cell carcinoma and adenocarcinoma was similar for most countries included, around 15%-20% for adults diagnosed during 2010-2014, though international variation was wider for squamous cell carcinoma. In most countries, survival for both squamous cell carcinoma and adenocarcinoma increased by less than 5% between 2000-2004 and 2010-2014. CONCLUSIONS Esophageal cancer survival remains poor in many countries. The distributions of sub-site and morphological sub-type vary between countries, but these differences do not fully explain international variation in esophageal cancer survival.
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Affiliation(s)
- Melissa Matz
- Cancer Survival GroupDepartment of Non‐Communicable Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondon WC1E 7HTGreater LondonUnited Kingdom
| | - Mikhail Valkov
- Department of RadiologyRadiotherapy and OncologyNorthern State Medical University, ArkhangelskArkhangelsk OblastRussia
| | - Mario Šekerija
- Croatian National Cancer RegistryCroatian Institute of Public Health, ZagrebZagreb CountyCroatia
| | | | - Adele Caldarella
- Tuscany Cancer RegistryIstituto per lo studio e la prevenzione oncologicaFlorenceTuscanyItaly
| | - Michel P Coleman
- Cancer Survival GroupDepartment of Non‐Communicable Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondon WC1E 7HTGreater LondonUnited Kingdom
- Cancer DivisionUniversity College London Hospitals NHS Foundation Trust, London NW1 2BUGreater LondonUnited Kingdom
| | - Claudia Allemani
- Cancer Survival GroupDepartment of Non‐Communicable Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondon WC1E 7HTGreater LondonUnited Kingdom
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Montel L, Coleman MP, Murphy T, Balabanova D, Ciula R, Evans DP, Lougarre C, Verhoeven D, Allemani C. Implementing and monitoring the right to health in breast cancer: selection of indicators using a Delphi process. Int J Equity Health 2023; 22:142. [PMID: 37507731 PMCID: PMC10386607 DOI: 10.1186/s12939-023-01964-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Women with breast cancer have different chances of surviving their disease, depending on where they live. Variations in survival may stem from unequal access to prompt diagnosis, treatment and care. Implementation of the right to health may help remedy such inequalities. The right to health is enshrined in international human rights law, notably Article 12 of the International Covenant on Economic, Social and Cultural Rights. A human rights-based approach to health requires a robust, just and efficient health system, with access to adequate health services and medicines on a non-discriminatory basis. However, it may prove challenging for health policymakers and cancer management specialists to implement and monitor this right in national health systems. METHOD This article presents the results of a Delphi study designed to select indicators of implementation of the right to health to inform breast cancer care and management. In a systematic process, 13 experts examined an initial list of 151 indicators. RESULTS After two rounds, 54 indicators were selected by consensus, three were rejected, three were added, and 97 remained open for debate. For breast cancer, right-to-health features selected as worth implementing and monitoring included the formal recognition of the right to health in breast cancer strategies; a population-based screening programme, prompt diagnosis, strong referral systems and limited waiting times; the provision of palliative, survivorship and end-of-life care; the availability, accessibility, acceptability and quality (AAAQ) of breast cancer services and medicines; the provision of a system of accountability; and the collection of anonymised individual data to target patterns of discrimination. CONCLUSION We propose a set of indicators as a guide for health policy experts seeking to design national cancer plans that are based on a human rights-based approach to health, and for cancer specialists aiming to implement principles of the right to health in their practice. The 54 indicators selected may be used in High-Income Countries, or member states of the OECD who also have signed the International Covenant on Economic, Social and Cultural Rights to monitor progress towards implementation of the right to health for women with breast cancer.
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Affiliation(s)
- Lisa Montel
- London School of Hygiene and Tropical Medicine, Cancer Survival Group, Faculty of Epidemiology and Population Health, Keppel Street, London, WC1E 7HT, UK.
| | - Michel P Coleman
- London School of Hygiene and Tropical Medicine, Cancer Survival Group, Faculty of Epidemiology and Population Health, Keppel Street, London, WC1E 7HT, UK
| | - Therese Murphy
- Queen's University Belfast, Belfast, UK
- Raoul Wallenberg Visiting Chair, Lund University, Lund, Sweden
| | - Dina Balabanova
- London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
| | | | - Dabney P Evans
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | | | | | - Claudia Allemani
- London School of Hygiene and Tropical Medicine, Cancer Survival Group, Faculty of Epidemiology and Population Health, Keppel Street, London, WC1E 7HT, UK
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Matz M, Rhodes S, Tongeren MV, Coleman MP, Allemani C, Nafilyan V, Pearce N. Excess mortality among essential workers in England and Wales during the COVID-19 pandemic: an updated analysis. J Epidemiol Community Health 2023:jech-2023-220391. [PMID: 37258216 DOI: 10.1136/jech-2023-220391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/16/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Excess mortality from all causes combined during the COVID-19 pandemic in England and Wales in 2020 was predominantly higher for essential workers. In 2021, the vaccination programme had begun, new SARS-CoV-2 variants were identified and different policy approaches were used. We have updated our previous analyses of excess mortality in England and Wales to include trends in excess mortality by occupation for 2021. METHODS We estimated excess mortality for working age adults living in England and Wales by occupational group for each month in 2021 and for the year as a whole. RESULTS During 2021, excess mortality remained higher for most groups of essential workers than for non-essential workers. It peaked in January 2021 when all-cause mortality was 44.6% higher than expected for all occupational groups combined. Excess mortality was highest for adults working in social care (86.9% higher than expected). CONCLUSION Previously, we reported excess mortality in 2020, with this paper providing an update to include 2021 data. Excess mortality was predominantly higher for essential workers during 2021. However, unlike the first year of the pandemic, when healthcare workers experienced the highest mortality, the highest excess mortality during 2021 was experienced by social care workers.
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Affiliation(s)
- Melissa Matz
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Sarah Rhodes
- Centre for Biostatistics, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Martie Van Tongeren
- Centre for Occupational and Environmental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Michel P Coleman
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Claudia Allemani
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Vahe Nafilyan
- Health Analysis Division, Office for National Statistics, Newport, UK
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Neil Pearce
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Girardi F, Matz M, Stiller C, You H, Marcos Gragera R, Valkov MY, Bulliard JL, De P, Morrison D, Wanner M, O'Brian DK, Saint-Jacques N, Coleman MP, Allemani C, Hamdi-Chérif M, Kara L, Meguenni K, Regagba D, Bayo S, Cheick Bougadari T, Manraj SS, Bendahhou K, Ladipo A, Ogunbiyi OJ, Somdyala NIM, Chaplin MA, Moreno F, Calabrano GH, Espinola SB, Carballo Quintero B, Fita R, Laspada WD, Ibañez SG, Lima CA, Da Costa AM, De Souza PCF, Chaves J, Laporte CA, Curado MP, de Oliveira JC, Veneziano CLA, Veneziano DB, Almeida ABM, Latorre MRDO, Rebelo MS, Santos MO, Azevedo e Silva G, Galaz JC, Aparicio Aravena M, Sanhueza Monsalve J, Herrmann DA, Vargas S, Herrera VM, Uribe CJ, Bravo LE, Garcia LS, Arias-Ortiz NE, Morantes D, Jurado DM, Yépez Chamorro MC, Delgado S, Ramirez M, Galán Alvarez YH, Torres P, Martínez-Reyes F, Jaramillo L, Quinto R, Castillo J, Mendoza M, Cueva P, Yépez JG, Bhakkan B, Deloumeaux J, Joachim C, Macni J, Carrillo R, Shalkow Klincovstein J, Rivera Gomez R, Perez P, Poquioma E, Tortolero-Luna G, Zavala D, Alonso R, Barrios E, Eckstrand A, Nikiforuk C, Woods RR, Noonan G, Turner D, Kumar E, Zhang B, Dowden JJ, Doyle GP, Saint-Jacques N, Walsh G, Anam A, De P, McClure CA, Vriends KA, Bertrand C, Ramanakumar AV, Davis L, Kozie S, Freeman T, George JT, Avila RM, O’Brien DK, Holt A, Almon L, Kwong S, Morris C, Rycroft R, Mueller L, Phillips CE, Brown H, Cromartie B, Ruterbusch J, Schwartz AG, Levin GM, Wohler B, Bayakly R, Ward KC, Gomez SL, McKinley M, Cress R, Davis J, Hernandez B, Johnson CJ, Morawski BM, Ruppert LP, Bentler S, Charlton ME, Huang B, Tucker TC, Deapen D, Liu L, Hsieh MC, Wu XC, Schwenn M, Stern K, Gershman ST, Knowlton RC, Alverson G, Weaver T, Desai J, Rogers DB, Jackson-Thompson J, Lemons D, Zimmerman HJ, Hood M, Roberts-Johnson J, Hammond W, Rees JR, Pawlish KS, Stroup A, Key C, Wiggins C, Kahn AR, Schymura MJ, Radhakrishnan S, Rao C, Giljahn LK, Slocumb RM, Dabbs C, Espinoza RE, Aird KG, Beran T, Rubertone JJ, Slack SJ, Oh J, Janes TA, Schwartz SM, Chiodini SC, Hurley DM, Whiteside MA, Rai S, Williams MA, Herget K, Sweeney C, Kachajian J, Keitheri Cheteri MB, Migliore Santiago P, Blankenship SE, Conaway JL, Borchers R, Malicki R, Espinoza J, Grandpre J, Weir HK, Wilson R, Edwards BK, Mariotto A, Rodriguez-Galindo C, Wang N, Yang L, Chen JS, Zhou Y, He YT, Song GH, Gu XP, Mei D, Mu HJ, Ge HM, Wu TH, Li YY, Zhao DL, Jin F, Zhang JH, Zhu FD, Junhua Q, Yang YL, Jiang CX, Biao W, Wang J, Li QL, Yi H, Zhou X, Dong J, Li W, Fu FX, Liu SZ, Chen JG, Zhu J, Li YH, Lu YQ, Fan M, Huang SQ, Guo GP, Zhaolai H, Wei K, Chen WQ, Wei W, Zeng H, Demetriou AV, Mang WK, Ngan KC, Kataki AC, Krishnatreya M, Jayalekshmi PA, Sebastian P, George PS, Mathew A, Nandakumar A, Malekzadeh R, Roshandel G, Keinan-Boker L, Silverman BG, Ito H, Koyanagi Y, Sato M, Tobori F, Nakata I, Teramoto N, Hattori M, Kaizaki Y, Moki F, Sugiyama H, Utada M, Nishimura M, Yoshida K, Kurosawa K, Nemoto Y, Narimatsu H, Sakaguchi M, Kanemura S, Naito M, Narisawa R, Miyashiro I, Nakata K, Mori D, Yoshitake M, Oki I, Fukushima N, Shibata A, Iwasa K, Ono C, Matsuda T, Nimri O, Jung KW, Won YJ, Alawadhi E, Elbasmi A, Ab Manan A, Adam F, Nansalmaa E, Tudev U, Ochir C, Al Khater AM, El Mistiri MM, Lim GH, Teo YY, Chiang CJ, Lee WC, Buasom R, Sangrajrang S, Suwanrungruang K, Vatanasapt P, Daoprasert K, Pongnikorn D, Leklob A, Sangkitipaiboon S, Geater SL, Sriplung H, Ceylan O, Kög I, Dirican O, Köse T, Gurbuz T, Karaşahin FE, Turhan D, Aktaş U, Halat Y, Eser S, Yakut CI, Altinisik M, Cavusoglu Y, Türkköylü A, Üçüncü N, Hackl M, Zborovskaya AA, Aleinikova OV, Henau K, Van Eycken L, Atanasov TY, Valerianova Z, Šekerija M, Dušek L, Zvolský M, Steinrud Mørch L, Storm H, Wessel Skovlund C, Innos K, Mägi M, Malila N, Seppä K, Jégu J, Velten M, Cornet E, Troussard X, Bouvier AM, Guizard AV, Bouvier V, Launoy G, Dabakuyo Yonli S, Poillot ML, Maynadié M, Mounier M, Vaconnet L, Woronoff AS, Daoulas M, Robaszkiewicz M, Clavel J, Poulalhon C, Desandes E, Lacour B, Baldi I, Amadeo B, Coureau G, Monnereau A, Orazio S, Audoin M, D’Almeida TC, Boyer S, Hammas K, Trétarre B, Colonna M, Delafosse P, Plouvier S, Cowppli-Bony A, Molinié F, Bara S, Ganry O, Lapôtre-Ledoux B, Daubisse-Marliac L, Bossard N, Uhry Z, Estève J, Stabenow R, Wilsdorf-Köhler H, Eberle A, Luttmann S, Löhden I, Nennecke AL, Kieschke J, Sirri E, Justenhoven C, Reinwald F, Holleczek B, Eisemann N, Katalinic A, Asquez RA, Kumar V, Petridou E, Ólafsdóttir EJ, Tryggvadóttir L, Murray DE, Walsh PM, Sundseth H, Harney M, Mazzoleni G, Vittadello F, Coviello E, Cuccaro F, Galasso R, Sampietro G, Giacomin A, Magoni M, Ardizzone A, D’Argenzio A, Di Prima AA, Ippolito A, Lavecchia AM, Sutera Sardo A, Gola G, Ballotari P, Giacomazzi E, Ferretti S, Dal Maso L, Serraino D, Celesia MV, Filiberti RA, Pannozzo F, Melcarne A, Quarta F, Andreano A, Russo AG, Carrozzi G, Cirilli C, Cavalieri d’Oro L, Rognoni M, Fusco M, Vitale MF, Usala M, Cusimano R, Mazzucco W, Michiara M, Sgargi P, Boschetti L, Marguati S, Chiaranda G, Seghini P, Maule MM, Merletti F, Spata E, Tumino R, Mancuso P, Cassetti T, Sassatelli R, Falcini F, Giorgetti S, Caiazzo AL, Cavallo R, Piras D, Bella F, Madeddu A, Fanetti AC, Maspero S, Carone S, Mincuzzi A, Candela G, Scuderi T, Gentilini MA, Rizzello R, Rosso S, Caldarella A, Intrieri T, Bianconi F, Contiero P, Tagliabue G, Rugge M, Zorzi M, Beggiato S, Brustolin A, Gatta G, De Angelis R, Vicentini M, Zanetti R, Stracci F, Maurina A, Oniščuka M, Mousavi M, Steponaviciene L, Vincerževskienė I, Azzopardi MJ, Calleja N, Siesling S, Visser O, Johannesen TB, Larønningen S, Trojanowski M, Macek P, Mierzwa T, Rachtan J, Rosińska A, Kępska K, Kościańska B, Barna K, Sulkowska U, Gebauer T, Łapińska JB, Wójcik-Tomaszewska J, Motnyk M, Patro A, Gos A, Sikorska K, Bielska-Lasota M, Didkowska JA, Wojciechowska U, Forjaz de Lacerda G, Rego RA, Carrito B, Pais A, Bento MJ, Rodrigues J, Lourenço A, Mayer-da-Silva A, Coza D, Todescu AI, Valkov MY, Gusenkova L, Lazarevich O, Prudnikova O, Vjushkov DM, Egorova A, Orlov A, Pikalova LV, Zhuikova LD, Adamcik J, Safaei Diba C, Zadnik V, Žagar T, De-La-Cruz M, Lopez-de-Munain A, Aleman A, Rojas D, Chillarón RJ, Navarro AIM, Marcos-Gragera R, Puigdemont M, Rodríguez-Barranco M, Sánchez Perez MJ, Franch Sureda P, Ramos Montserrat M, Chirlaque López MD, Sánchez Gil A, Ardanaz E, Guevara M, Cañete-Nieto A, Peris-Bonet R, Carulla M, Galceran J, Almela F, Sabater C, Khan S, Pettersson D, Dickman P, Staehelin K, Struchen B, Egger Hayoz C, Rapiti E, Schaffar R, Went P, Mousavi SM, Bulliard JL, Maspoli-Conconi M, Kuehni CE, Redmond SM, Bordoni A, Ortelli L, Chiolero A, Konzelmann I, Rohrmann S, Wanner M, Broggio J, Rashbass J, Stiller C, Fitzpatrick D, Gavin A, Morrison DS, Thomson CS, Greene G, Huws DW, Grayson M, Rawcliffe H, Allemani C, Coleman MP, Di Carlo V, Girardi F, Matz M, Minicozzi P, Sanz N, Ssenyonga N, James D, Stephens R, Chalker E, Smith M, Gugusheff J, You H, Qin Li S, Dugdale S, Moore J, Philpot S, Pfeiffer R, Thomas H, Silva Ragaini B, Venn AJ, Evans SM, Te Marvelde L, Savietto V, Trevithick R, Aitken J, Currow D, Fowler C, Lewis C. Global survival trends for brain tumors, by histology: analysis of individual records for 556,237 adults diagnosed in 59 countries during 2000-2014 (CONCORD-3). Neuro Oncol 2023; 25:580-592. [PMID: 36355361 PMCID: PMC10013649 DOI: 10.1093/neuonc/noac217] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Survival is a key metric of the effectiveness of a health system in managing cancer. We set out to provide a comprehensive examination of worldwide variation and trends in survival from brain tumors in adults, by histology. METHODS We analyzed individual data for adults (15-99 years) diagnosed with a brain tumor (ICD-O-3 topography code C71) during 2000-2014, regardless of tumor behavior. Data underwent a 3-phase quality control as part of CONCORD-3. We estimated net survival for 11 histology groups, using the unbiased nonparametric Pohar Perme estimator. RESULTS The study included 556,237 adults. In 2010-2014, the global range in age-standardized 5-year net survival for the most common sub-types was broad: in the range 20%-38% for diffuse and anaplastic astrocytoma, from 4% to 17% for glioblastoma, and between 32% and 69% for oligodendroglioma. For patients with glioblastoma, the largest gains in survival occurred between 2000-2004 and 2005-2009. These improvements were more noticeable among adults diagnosed aged 40-70 years than among younger adults. CONCLUSIONS To the best of our knowledge, this study provides the largest account to date of global trends in population-based survival for brain tumors by histology in adults. We have highlighted remarkable gains in 5-year survival from glioblastoma since 2005, providing large-scale empirical evidence on the uptake of chemoradiation at population level. Worldwide, survival improvements have been extensive, but some countries still lag behind. Our findings may help clinicians involved in national and international tumor pathway boards to promote initiatives aimed at more extensive implementation of clinical guidelines.
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Affiliation(s)
- Fabio Girardi
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK.,Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Melissa Matz
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Charles Stiller
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Hui You
- Cancer Information Analysis Unit, Cancer Institute NSW, St Leonards, New South Wales, Australia
| | - Rafael Marcos Gragera
- Epidemiology Unit and Girona Cancer Registry, Catalan Institute of Oncology, Girona, Spain
| | - Mikhail Y Valkov
- Department of Radiology, Radiotherapy and Oncology, Northern State Medical University, Arkhangelsk, Russia
| | - Jean-Luc Bulliard
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,Neuchâtel and Jura Tumour Registry, Neuchâtel, Switzerland
| | - Prithwish De
- Surveillance and Cancer Registry, and Research Office, Clinical Institutes and Quality Programs, Ontario Health, Toronto, Ontario, Canada
| | - David Morrison
- Scottish Cancer Registry, Public Health Scotland, Edinburgh, UK
| | - Miriam Wanner
- Cancer Registry Zürich, Zug, Schaffhausen and Schwyz, University Hospital Zürich, Zürich, Switzerland
| | - David K O'Brian
- Alaska Cancer Registry, Alaska Department of Health and Social Services, Anchorage, Alaska, USA
| | - Nathalie Saint-Jacques
- Department of Medicine and Community Health and Epidemiology, Centre for Clinical Research, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michel P Coleman
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK.,Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Claudia Allemani
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK
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Girardi F, Di Carlo V, Stiller C, Gatta G, Woods RR, Visser O, Lacour B, Tucker TC, Coleman MP, Allemani C. Global survival trends for brain tumors, by histology: Analysis of individual records for 67,776 children diagnosed in 61 countries during 2000-2014 (CONCORD-3). Neuro Oncol 2023; 25:593-606. [PMID: 36215122 PMCID: PMC10013647 DOI: 10.1093/neuonc/noac232] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Tumors of the central nervous system are among the leading causes of cancer-related death in children. Population-based cancer survival reflects the overall effectiveness of a health care system in managing cancer. Inequity in access to care world-wide may result in survival disparities. METHODS We considered children (0-14 years) diagnosed with a brain tumor during 2000-2014, regardless of tumor behavior. Data underwent a rigorous, three-phase quality control as part of CONCORD-3. We implemented a revised version of the International Classification of Childhood Cancer (third edition) to control for under-registration of non-malignant astrocytic tumors. We estimated net survival using the unbiased nonparametric Pohar Perme estimator. RESULTS The study included 67,776 children. We estimated survival for 12 histology groups, each based on relevant ICD-O-3 codes. Age-standardized 5-year net survival for low-grade astrocytoma ranged between 84% and 100% world-wide during 2000-2014. In most countries, 5-year survival was 90% or more during 2000-2004, 2005-2009, and 2010-2014. Global variation in survival for medulloblastoma was much wider, with age-standardized 5-year net survival between 47% and 86% for children diagnosed during 2010-2014. CONCLUSIONS To the best of our knowledge, this study provides the largest account to date of global trends in population-based survival for brain tumors in children, by histology. We devised an enhanced version of ICCC-3 to account for differences in cancer registration practices world-wide. Our findings may have public health implications, because low-grade glioma is 1 of the 6 index childhood cancers included by WHO in the Global Initiative for Childhood Cancer.
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Affiliation(s)
- Fabio Girardi
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK.,Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Veronica Di Carlo
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Charles Stiller
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Gemma Gatta
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Otto Visser
- Department of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Brigitte Lacour
- National Registry of Childhood Solid Tumors, Faculty of Medicine -Vandœuvre-lès-Nancy Cedex, France.,National Registry of Childhood Cancers, CRESS EQ7, UMR-S 1153, INSERM, Université de Paris, Paris, France
| | - Thomas C Tucker
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA.,Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Michel P Coleman
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK.,Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Claudia Allemani
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK
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6
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Lawler M, Davies L, Oberst S, Oliver K, Eggermont A, Schmutz A, La Vecchia C, Allemani C, Lievens Y, Naredi P, Cufer T, Aggarwal A, Aapro M, Apostolidis K, Baird AM, Cardoso F, Charalambous A, Coleman MP, Costa A, Crul M, Dégi CL, Di Nicolantonio F, Erdem S, Geanta M, Geissler J, Jassem J, Jagielska B, Jonsson B, Kelly D, Kelm O, Kolarova T, Kutluk T, Lewison G, Meunier F, Pelouchova J, Philip T, Price R, Rau B, Rubio IT, Selby P, Južnič Sotlar M, Spurrier-Bernard G, van Hoeve JC, Vrdoljak E, Westerhuis W, Wojciechowska U, Sullivan R. European Groundshot-addressing Europe's cancer research challenges: a Lancet Oncology Commission. Lancet Oncol 2023; 24:e11-e56. [PMID: 36400101 DOI: 10.1016/s1470-2045(22)00540-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022]
Abstract
Cancer research is a crucial pillar for countries to deliver more affordable, higher quality, and more equitable cancer care. Patients treated in research-active hospitals have better outcomes than patients who are not treated in these settings. However, cancer in Europe is at a crossroads. Cancer was already a leading cause of premature death before the COVID-19 pandemic, and the disastrous effects of the pandemic on early diagnosis and treatment will probably set back cancer outcomes in Europe by almost a decade. Recognising the pivotal importance of research not just to mitigate the pandemic today, but to build better European cancer services and systems for patients tomorrow, the Lancet Oncology European Groundshot Commission on cancer research brings together a wide range of experts, together with detailed new data on cancer research activity across Europe during the past 12 years. We have deployed this knowledge to help inform Europe's Beating Cancer Plan and the EU Cancer Mission, and to set out an evidence-driven, patient-centred cancer research roadmap for Europe. The high-resolution cancer research data we have generated show current activities, captured through different metrics, including by region, disease burden, research domain, and effect on outcomes. We have also included granular data on research collaboration, gender of researchers, and research funding. The inclusion of granular data has facilitated the identification of areas that are perhaps overemphasised in current cancer research in Europe, while also highlighting domains that are underserved. Our detailed data emphasise the need for more information-driven and data-driven cancer research strategies and planning going forward. A particular focus must be on central and eastern Europe, because our findings emphasise the widening gap in cancer research activity, and capacity and outcomes, compared with the rest of Europe. Citizens and patients, no matter where they are, must benefit from advances in cancer research. This Commission also highlights that the narrow focus on discovery science and biopharmaceutical research in Europe needs to be widened to include such areas as prevention and early diagnosis; treatment modalities such as radiotherapy and surgery; and a larger concentration on developing a research and innovation strategy for the 20 million Europeans living beyond a cancer diagnosis. Our data highlight the important role of comprehensive cancer centres in driving the European cancer research agenda. Crucial to a functioning cancer research strategy and its translation into patient benefit is the need for a greater emphasis on health policy and systems research, including implementation science, so that the innovative technological outputs from cancer research have a clear pathway to delivery. This European cancer research Commission has identified 12 key recommendations within a call to action to reimagine cancer research and its implementation in Europe. We hope this call to action will help to achieve our ambitious 70:35 target: 70% average 10-year survival for all European cancer patients by 2035.
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Affiliation(s)
- Mark Lawler
- Patrick G Johnston Centre for Cancer Research, Faculty of Medicine, Health and Life Sciences, Queen's University Belfast, Belfast, UK.
| | - Lynne Davies
- International Cancer Research Partnership, International House, Cardiff, UK
| | - Simon Oberst
- Organisation of European Cancer Institutes, Brussels, Belgium
| | - Kathy Oliver
- International Brain Tumour Alliance, Tadworth, UK; European Cancer Organisation Patient Advisory Committee, Brussels, Belgium
| | - Alexander Eggermont
- Faculty of Medicine, Utrecht University Medical Center, Utrecht, Netherlands; Princess Máxima Centrum, Utrecht, Netherlands
| | - Anna Schmutz
- International Agency for Cancer Research, Lyon, France
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Claudia Allemani
- Cancer Survival Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Peter Naredi
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tanja Cufer
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK; Institute of Cancer Policy, King's College London, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Matti Aapro
- Genolier Cancer Center, Genolier, Switzerland
| | - Kathi Apostolidis
- Hellenic Cancer Federation, Athens, Greece; European Cancer Patient Coalition, Brussels, Belgium
| | - Anne-Marie Baird
- Lung Cancer Europe, Bern, Switzerland; Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Fatima Cardoso
- Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Andreas Charalambous
- European Cancer Organisation Brussels, Brussels, Belgium; Department of Nursing, Cyprus University of Technology, Limassol, Cyprus; Department of Oncology, University of Turku, Turku, Finland
| | - Michel P Coleman
- Cancer Survival Group, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Csaba L Dégi
- Faculty of Sociology and Social Work, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Federica Di Nicolantonio
- Department of Oncology, University of Turin, Turin, Italy; Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Sema Erdem
- European Cancer Organisation Patient Advisory Committee, Europa Donna, Istanbul, Türkiye
| | - Marius Geanta
- Centre for Innovation in Medicine and Kol Medical Media, Bucharest, Romania
| | - Jan Geissler
- Patvocates and CML Advocates Network, Leukaemie-Online (LeukaNET), Munich, Germany
| | | | - Beata Jagielska
- Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Daniel Kelly
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Olaf Kelm
- International Agency for Research on Cancer, Lyon, France
| | | | - Tezer Kutluk
- Faculty of Medicine & Cancer Institute, Hacettepe University, Ankara, Türkiye
| | - Grant Lewison
- Institute of Cancer Policy, School of Cancer Sciences, Kings College London, London, UK
| | | | | | - Thierry Philip
- Organisation of European Cancer Institutes, Brussels, Belgium; Institut Curie, Paris, France
| | - Richard Price
- European Cancer Organisation Brussels, Brussels, Belgium
| | - Beate Rau
- Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Peter Selby
- School of Medicine, University of Leeds, Leeds, UK
| | | | | | - Jolanda C van Hoeve
- Organisation of European Cancer Institutes, Brussels, Belgium; Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | - Eduard Vrdoljak
- Department of Oncology, University Hospital Center Split, School of Medicine, University of Split, Split, Croatia
| | - Willien Westerhuis
- Organisation of European Cancer Institutes, Brussels, Belgium; Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | | | - Richard Sullivan
- Institute of Cancer Policy, School of Cancer Sciences, Kings College London, London, UK
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7
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Alkhalawi E, Allemani C, Al-Zahrani AS, Coleman MP. How does Linkage to the National Death Index Affect Population-Based Net Survival Estimates for Women with Cervical Cancer in Saudi Arabia? Gulf J Oncolog 2023; 1:17-22. [PMID: 36804155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 02/23/2023]
Abstract
BACKGROUND Population-based cancer survival is a key metric for the assessment of cancer control strategies. Accurate estimation of cancer survival requires complete follow-up data for all patients. AIM To explore the impact of linking national cancer registry data to the national death index on net survival estimates for women diagnosed with cervical cancer in Saudi Arabia during 2005-2016. METHODS We acquired data on 1,250 Saudi women diagnosed with invasive cervical cancer during the 12- year period 2005-2016 from the Saudi Cancer Registry. These included the woman's last known vital status and the date of last known vital status, but this was restricted to information from clinical records and death certificates that mention cancer as a cause of death ("registry follow-up"). We submitted available national ID numbers to the National Information Center (NIC) of the Ministry of Interior, to ascertain the date of death, from any cause of death, for women who had died up until 31 December 2018 ("NIC follow-up"). We estimated age-standardised 5-year net survival using the Pohar-Perme estimator under five different scenarios using the two sources of follow-up, and censoring at the date of last contact with the registry versus extending survival until the closing date if no information on death was obtained. RESULTS 1,219 women were eligible for survival analysis. Five-year net survival was lowest when using NIC followup only (56.8%; 95%CI 53.5 - 60.1%), and highest when registry follow-up only was used and survival time was extended until closure date for those with no information on death (81.8%; 95%CI 79.6 - 84%). CONCLUSION Reliance solely on information from deaths certified as due to cancer and clinical records leads to a high proportion of missing deaths in the national cancer registry. This is probably due to low quality of certification of the cause of death in Saudi Arabia. Linkage of the national cancer registry to the national death index at the NIC identifies virtually all deaths, providing more reliable survival estimates, and it eliminates the ambiguity in determining the underlying cause of death. Therefore, this should become the standard approach to estimating cancer survival in Saudi Arabia.
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Affiliation(s)
- Eman Alkhalawi
- Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.,Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Claudia Allemani
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Ali Saeed Al-Zahrani
- Gulf Centre for Cancer Control and Prevention, King Faisal Special Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Michel P Coleman
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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8
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Nemati S, Saeedi E, Lotfi F, Nahvijou A, Mohebbi E, Ravankhah Z, Rezaeianzadeh A, Yaghoobi-Ashrafi M, Pirnejad H, Golpazir A, Dolatkhah R, Alvand S, Ahmadi-Tabatabaei SV, Cheraghi M, Weiderpass E, Bray F, Coleman MP, Etemadi A, Khosravi A, Najafi F, Mohagheghi MA, Roshandel G, Malekzadeh R, Zendehdel K. National surveillance of cancer survival in Iran (IRANCANSURV): Analysis of data of 15 cancer sites from nine population-based cancer registries. Int J Cancer 2022; 151:2128-2135. [PMID: 35869869 DOI: 10.1002/ijc.34224] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 06/26/2022] [Accepted: 06/27/2022] [Indexed: 03/25/2024]
Abstract
Cancer survival is a key indicator for the national cancer control programs. However, survival data in the East Mediterranean region (EMR) are limited. We designed a national cancer survival study based on population-based cancer registries (PBCRs) from nine provinces in Iran. The current study reports 5-year net survival of 15 cancers in Iranian adults (15-99 years) during 2014 to 2015 in nine provinces of Iran. We used data linkages between the cancer registries and the causes of death registry and vital statistics and active follow-up approaches to ascertain the vital status of the patients. Five-year net survival was estimated through the relative survival analysis. We applied the international cancer survival standard weights for age standardization. Five-year survival was highest for prostate cancer (74.9%, 95% CI 73.0, 76.8), followed by breast (74.4%, 95% CI 72.50, 76.3), bladder (70.4%, 95% CI 69.0, 71.8) and cervix (65.2%, 95% CI 60.5, 69.6). Survival was below 25% for cancers of the pancreas, lung, liver, stomach and esophagus. Iranian cancer patients experience a relatively poor prognosis as compared to those in high-income countries. Implementation of early detection programs and improving the quality of care are required to improve the cancer survival among Iranian patients. Further studies are needed to monitor the outcomes of cancer patients in Iran and other EMR countries.
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Affiliation(s)
- Saeed Nemati
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Elnaz Saeedi
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
- Biostatistics Research Group, Department of Health Science, University of Leicester, Leicester, UK
| | - Fereshte Lotfi
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Azin Nahvijou
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Mohebbi
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Ravankhah
- Esfahan Cancer Registry, Esfahan University of Medical Sciences, Esfahan, Iran
| | | | | | - Habbiballah Pirnejad
- Patient Safety Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Arash Golpazir
- Kermanshah Cancer Registry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Roya Dolatkhah
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saba Alvand
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maria Cheraghi
- Cancer Registry Section, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Elisabete Weiderpass
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Freddie Bray
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Michel P Coleman
- Cancer Survival Group, Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Arash Etemadi
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ardeshir Khosravi
- Deputy of Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Farid Najafi
- Department of Epidemiology and Biostatistics, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Ali Mohagheghi
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Roshandel
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Zendehdel
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
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9
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Nikšić M, Minicozzi P, Weir HK, Zimmerman H, Schymura MJ, Rees JR, Coleman MP, Allemani C. Pancreatic cancer survival trends in the US from 2001 to 2014: a CONCORD-3 study. Cancer Commun (Lond) 2022; 43:87-99. [PMID: 36353792 PMCID: PMC9859729 DOI: 10.1002/cac2.12375] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/01/2022] [Accepted: 10/11/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Survival from pancreatic cancer is low worldwide. In the US, the 5-year relative survival has been slightly higher for women, whites and younger patients than for their counterparts, and differences in age and stage at diagnosis [Corrections added Nov 16, 2022, after first online publication: a new affiliation is added to Maja Nikšić] may contribute to this pattern. We aimed to examine trends in survival by race, stage, age and sex for adults (15-99 years) diagnosed with pancreatic cancer in the US. METHODS This population-based study included 399,427 adults registered with pancreatic cancer in 41 US state cancer registries during 2001-2014, with follow-up to December 31, 2014. We estimated age-specific and age-standardized net survival at 1 and 5 years. RESULTS Overall, 12.3% of patients were blacks, and 84.2% were whites. About 9.5% of patients were diagnosed with localized disease, but 50.5% were diagnosed at an advanced stage; slightly more among blacks, mainly among men. No substantial changes were seen over time (2001-2003, 2004-2008, 2009-2014). In general, 1-year net survival was higher in whites than in blacks (26.1% vs. 22.1% during 2001-2003, 35.1% vs. 31.4% during 2009-2014). This difference was particularly evident among patients with localized disease (49.6% in whites vs. 44.6% in blacks during 2001-2003, 60.1% vs. 55.3% during 2009-2014). The survival gap between blacks and whites with localized disease was persistent at 5 years after diagnosis, and it widened over time (from 24.0% vs. 21.3% during 2001-2003 to 39.7% vs. 31.0% during 2009-2014). The survival gap was wider among men than among women. CONCLUSIONS Gaps in 1- and 5-year survival between blacks and whites were persistent throughout 2001-2014, especially for patients diagnosed with a localized tumor, for which surgery is currently the only treatment modality with the potential for cure.
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Affiliation(s)
- Maja Nikšić
- Cancer Survival GroupDepartment of Non‐Communicable Disease EpidemiologyLondon School of Hygiene & Tropical MedicineKeppel StreetLondonWC1E 7HTUK,Centre for Health Services StudiesUniversity of KentCanterburyCT2 7NFUK
| | - Pamela Minicozzi
- Cancer Survival GroupDepartment of Non‐Communicable Disease EpidemiologyLondon School of Hygiene & Tropical MedicineKeppel StreetLondonWC1E 7HTUK
| | - Hannah K Weir
- Division of Cancer Prevention and ControlCenters for Disease Control and PreventionAtlantaGA30333USA
| | - Heather Zimmerman
- Montana Central Tumor RegistryChronic Disease Prevention and Health Promotion BureauPO Box 202951, 1400 BroadwayHelenaMT59620‐2951USA
| | - Maria J Schymura
- Bureau of Cancer EpidemiologyNew York State Cancer RegistryNew York State Department of Health150 BroadwayAlbanyNY12204‐2719USA
| | - Judith R Rees
- New Hampshire State Cancer RegistryNorris Cotton Cancer Center, and Department of EpidemiologyGeisel School of MedicineDartmouth CollegeDartmouth‐Hitchcock Medical CenterOne Medical Center DriveLebanonNH03756USA
| | - Michel P Coleman
- Cancer Survival GroupDepartment of Non‐Communicable Disease EpidemiologyLondon School of Hygiene & Tropical MedicineKeppel StreetLondonWC1E 7HTUK,Cancer DivisionUniversity College London Hospitals NHS Foundation Trust250 Euston RoadLondonNW1 2PGUK
| | - Claudia Allemani
- Cancer Survival GroupDepartment of Non‐Communicable Disease EpidemiologyLondon School of Hygiene & Tropical MedicineKeppel StreetLondonWC1E 7HTUK
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10
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Montel L, Di Carlo V, Minicozzi P, Coleman MP, Allemani C. The people behind the numbers: women with breast cancer. Lancet Oncol 2022. [DOI: 10.1016/s1470-2045(22)00678-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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11
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Montel L, Ssenyonga N, Coleman MP, Allemani C. How should implementation of the human right to health be assessed? A scoping review of the public health literature from 2000 to 2021. Int J Equity Health 2022; 21:139. [PMID: 36138460 PMCID: PMC9502920 DOI: 10.1186/s12939-022-01742-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/28/2022] [Indexed: 11/12/2022] Open
Abstract
The human right to health is a critical legal tool to achieve health justice, and universal health coverage is included among the Sustainable Development Goals. However, the content and meaning of the right to health may not be used adequately in public health research. We conducted a scoping review of the literature to discover the extent to which the legal principles underlying the right to health are used in public health. We mapped the various attempts to assess implementation of this right since its legal content was clarified in 2000. The first studies emerged in 2006, with an increase and a wider variety of investigations since 2015. We observe that some key principles do form the basis of right-to-health assessments, but some concepts remain unfamiliar. Critically, public health academics may have limited access to human rights research on health, which creates a gap in knowledge between the two disciplines.
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Affiliation(s)
- Lisa Montel
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. .,Centre for Health, Law and Society, Faculty of Social Sciences and Law, University of Bristol, Bristol, UK.
| | - Naomi Ssenyonga
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Michel P Coleman
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Claudia Allemani
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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12
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Di Carlo V, Stiller CA, Eisemann N, Bordoni A, Matz M, Curado MP, Daubisse‐Marliac L, Valkov M, Bulliard J, Morrison D, Johnson C, Girardi F, Marcos‐Gragera R, Šekerija M, Larønningen S, Sirri E, Coleman MP, Allemani C. Does the morphology of cutaneous melanoma help to explain the international differences in survival? Results from 1 578 482 adults diagnosed during 2000-2014 in 59 countries (CONCORD-3). Br J Dermatol 2022; 187:364-380. [PMID: 35347700 PMCID: PMC9542891 DOI: 10.1111/bjd.21274] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/18/2022] [Accepted: 03/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND CONCORD-3 highlighted wide disparities in population-based 5-year net survival for cutaneous melanoma during 2000-2014. Clinical evidence suggests marked international differences in the proportion of lethal acral and nodular subtypes of cutaneous melanoma. OBJECTIVES We aimed to assess whether the differences in morphology may explain global variation in survival. METHODS Patients with melanoma were grouped into the following seven morphological categories: malignant melanoma, not otherwise specified (International Classification of Diseases for Oncology, third revision morphology code 8720), superficial spreading melanoma (8743), lentigo maligna melanoma (8742), nodular melanoma (8721), acral lentiginous melanoma (8744), desmoplastic melanoma (8745) and other morphologies (8722-8723, 8726-8727, 8730, 8740-8741, 8746, 8761, 8770-8774, 8780). We estimated net survival using the nonparametric Pohar Perme estimator, correcting for background mortality by single year of age, sex and calendar year in each country or region. All-ages survival estimates were standardized using the International Cancer Survival Standard weights. We fitted a flexible parametric model to estimate the effect of morphology on the hazard of death. RESULTS Worldwide, the proportion of nodular melanoma ranged between 7% and 13%. Acral lentiginous melanoma accounted for less than 2% of all registrations but was more common in Asia (6%) and Central and South America (7%). Overall, 36% of tumours were classified as superficial spreading melanoma. During 2010-2014, age-standardized 5-year net survival for superficial spreading melanoma was 95% or higher in Oceania, North America and most European countries, but was only 71% in Taiwan. Survival for acral lentiginous melanoma ranged between 66% and 95%. Nodular melanoma had the poorest prognosis in all countries. The multivariable analysis of data from registries with complete information on stage and morphology found that sex, age and stage at diagnosis only partially explain the higher risk of death for nodular and acral lentiginous subtypes. CONCLUSIONS This study provides the broadest picture of distribution and population-based survival trends for the main morphological subtypes of cutaneous melanoma in 59 countries. The poorer prognosis for nodular and acral lentiginous melanomas, more frequent in Asia and Latin America, suggests the need for health policies aimed at specific populations to improve awareness, early diagnosis and access to treatment. What is already known about this topic? The histopathological features of cutaneous melanoma vary markedly worldwide. The proportion of melanomas with the more aggressive acral lentiginous or nodular histological subtypes is higher in populations with predominantly dark skin than in populations with predominantly fair skin. What does this study add? We aimed to assess the extent to which these differences in morphology may explain international variation in survival when all histological subtypes are combined. This study provides, for the first time, international comparisons of population-based survival at 5 years for the main histological subtypes of melanoma for over 1.5 million adults diagnosed during 2000-2014. This study highlights the less favourable distribution of histological subtypes in Asia and Central and South America, and the poorer prognosis for nodular and acral lentiginous melanomas. We found that later stage at diagnosis does not fully explain the higher excess risk of death for nodular and acral lentiginous melanoma compared with superficial spreading melanoma.
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Affiliation(s)
- Veronica Di Carlo
- Cancer Survival GroupLondon School of Hygiene and Tropical MedicineKeppel StreetWC1E 7HTLondonUK
| | | | - Nora Eisemann
- Institute of Social Medicine and Epidemiology, University of LübeckRatzeburger Allee160 23538LübeckGermany
| | - Andrea Bordoni
- Ticino Cancer Registry, Dipartimento Sanità e SocialitàDivisione della Salute PubblicaVia Ciseri10 6600LocarnoSwitzerland
| | - Melissa Matz
- Cancer Survival GroupLondon School of Hygiene and Tropical MedicineKeppel StreetWC1E 7HTLondonUK
| | - Maria P. Curado
- Goiânia Cancer Registry, Group of Epidemiology and Statistics on CancerAC Camargo Cancer CenterRua Tamandaré 753 ‐ LiberdadeSP01525‐001São PauloBrazil
| | - Laetitia Daubisse‐Marliac
- Tarn Cancer RegistryInstitut Universitaire du Cancer Toulouse – Oncopole Institut C. Regaud1 Avenue Irène Joliot‐Curie31059ToulouseFrance
| | - Mikhail Valkov
- Northern State Medical UniversityProspekt Troitskiy51 163000ArkhangelskRussian Federation
| | - Jean‐Luc Bulliard
- Centre for Primary Care and Public Health (Unisanté)University of LausanneLausanneSwitzerland
- Neuchâtel and Jura Tumour RegistryNeuchâtelSwitzerland
| | - David Morrison
- Scottish Cancer RegistryGyle Square, 1 South Gyle CrescentEH12 9EBEdinburghUK
| | - Chris Johnson
- Cancer Data Registry of Idaho, 615 North 7th StreetID83701‐1278BoiseUSA
| | - Fabio Girardi
- Cancer Survival GroupLondon School of Hygiene and Tropical MedicineKeppel StreetWC1E 7HTLondonUK
- Cancer DivisionUniversity College London Hospitals NHS Foundation TrustEuston RoadWC1H 8NJLondonUK
- Division of Medical Oncology 2Veneto Institute of Oncology IOV‐IRCCSVia Gattamelata64 35128PadovaItaly
| | - Rafael Marcos‐Gragera
- Epidemiology Unit and Girona Cancer RegistryCatalan Institute of Oncology (ICO), IDIBGI, Oncology Coordination Plan, Department of Health Government of Catalonia17004GironaSpain
- University of Girona (UdG)17004GironaSpain
- CIBER of Epidemiology and Public Health (CIBERESP)MadridSpain
| | - Mario Šekerija
- Croatian National Cancer RegistryCroatian Institute of Public HealthRockefeller Street7 10000ZagrebCroatia
| | | | - Eunice Sirri
- Epidemiological Cancer Registry of Lower SaxonyOffis Caree GmbHIndustriestr92 6121OldenburgGermany
| | - Michel P. Coleman
- Cancer Survival GroupLondon School of Hygiene and Tropical MedicineKeppel StreetWC1E 7HTLondonUK
- Cancer DivisionUniversity College London Hospitals NHS Foundation TrustEuston RoadWC1H 8NJLondonUK
| | - Claudia Allemani
- Cancer Survival GroupLondon School of Hygiene and Tropical MedicineKeppel StreetWC1E 7HTLondonUK
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13
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Matz M, Gamkrelidze A, Mebonia N, Kereselidze M, Kazanjan K, Zhizhilashvili S, Atun R, Coleman MP, Allemani C. Survival from five common cancers in Georgia, 2015-2019 (CONCORD). Cancer Epidemiol 2022; 79:102190. [PMID: 35696766 DOI: 10.1016/j.canep.2022.102190] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Population-based cancer survival is a key metric of the effectiveness of health systems in managing cancer. Data from population-based cancer registries are essential for producing reliable and robust cancer survival estimates. Georgia established a national population-based cancer registry on 1 January 2015. This is the first analysis of population-based cancer survival from Georgia. METHODS Data were available from the national cancer registry for 16,359 adults who were diagnosed with a cancer of the stomach, colon, rectum, breast (women) or cervix during 2015-2019. We estimated age-specific and age-standardised net survival at one, two and three years after diagnosis for each cancer, by sex. RESULTS The data were of extremely high quality, with less than 2% of data excluded from each dataset. For the patients included in analyses, at least 80% of the tumours were microscopically verified. Age-standardised three-year survival from stomach cancer was 30.6%, similar in men and women. For colon cancer, three-year survival was 60.1%, with survival 4% higher for men than for women. Three-year survival from rectal cancer was similar for men and women, at 54.7%. For women diagnosed with breast cancer, three-year survival was 84.4%, but three-year survival from cervical cancer was only 67.2%. CONCLUSION Establishment of a national cancer registry with obligatory cancer registration has enabled the first examination of population-based cancer survival in Georgia. Maintenance of the registry will facilitate continued surveillance of both cancer incidence and survival in the country.
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Affiliation(s)
- Melissa Matz
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | - Amiran Gamkrelidze
- Chronic Disease Division, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Nana Mebonia
- Chronic Disease Division, National Center for Disease Control and Public Health, Tbilisi, Georgia; Department of Epidemiology and Biostatistics, Tbilisi State Medical University, Georgia
| | - Maia Kereselidze
- Medical Statistics Department, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Konstantin Kazanjan
- Medical Statistics Department, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Saba Zhizhilashvili
- Department of Epidemiology and Biostatistics, Tbilisi State Medical University, Georgia
| | - Rifat Atun
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Health Policy & Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston MA, USA
| | - Michel P Coleman
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Claudia Allemani
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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14
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Nikšić M, Matz M, Valkov M, Marcos-Gragera R, Stiller C, Rosso S, Coleman MP, Allemani C. World-wide trends in net survival from pancreatic cancer by morphological sub-type: An analysis of 1,258,329 adults diagnosed in 58 countries during 2000-2014 (CONCORD-3). Cancer Epidemiol 2022; 80:102196. [PMID: 35841761 DOI: 10.1016/j.canep.2022.102196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 05/17/2022] [Accepted: 06/01/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Ductal adenocarcinomas and neuroendocrine tumours are the two main morphological sub-types of pancreatic cancer. Using data from CONCORD-3, we examined whether the distribution of morphological sub-types could help explain international variations in pancreatic cancer survival for all morphologies combined. We also examined world-wide survival trends from pancreatic cancer, by morphological sub-type and country. METHODS We estimated age-standardised one- and five-year net survival by country, calendar period of diagnosis (2000-2004, 2005-2009, 2010-2014) and morphological sub-type, using data from 295 population-based cancer registries in 58 countries for 1,258,329 adults (aged 15-99 years) diagnosed with pancreatic cancer during 2000-2014 and followed up until 31 December 2014. RESULTS Carcinomas were by far the most common morphological sub-type, comprising 90% or more of all pancreatic tumours in all countries. Neuroendocrine tumours were rare, generally 0-10% of all tumours. During 2010-2014, age-standardised one-year net survival ranged from 10% to 30% for carcinomas, while it was much higher for neuroendocrine tumours (40% to 80%). Age-standardised five-year survival was generally poor (less than 10 %) for carcinomas, but it ranged from 20% to 50% for neuroendocrine tumours. CONCLUSIONS Survival from pancreatic carcinoma remains poor world-wide and trends showed little improvement during 2000-2014. Despite slight declines in the proportion of carcinomas, they continue to comprise the majority of pancreatic tumours. Increases in survival from neuroendocrine tumours were greater than those for carcinomas, indicating that enhancements in diagnostic techniques and treatments have helped improve survival over time.
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Affiliation(s)
- Maja Nikšić
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Centre for Health Services Studies, University of Kent, Canterbury
| | - Melissa Matz
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - Mikhail Valkov
- Department of Radiology, Radiotherapy and Oncology, Northern State Medical University, Arkhangelsk, Russia
| | - Rafael Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry, Catalan Institute of Oncology (ICO), IDIBGI, Oncology Coordination Plan, Department of Health Government of Catalonia, 17004, Girona, Spain; University of Girona (UdG), Girona, 17004, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Charles Stiller
- National Disease Registration Service, NHS Digital, London, UK
| | - Stefano Rosso
- Piedmont Cancer Registry, A.O.U, Citta` della Salute e della Scienza di Torino, Turin, Italy
| | - Michel P Coleman
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Claudia Allemani
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Ssenyonga N, Stiller C, Nakata K, Shalkow J, Redmond S, Bulliard JL, Girardi F, Fowler C, Marcos-Gragera R, Bonaventure A, Saint-Jacques N, Minicozzi P, De P, Rodríguez-Barranco M, Larønningen S, Di Carlo V, Mägi M, Valkov M, Seppä K, Wyn Huws D, Coleman MP, Allemani C. Worldwide trends in population-based survival for children, adolescents, and young adults diagnosed with leukaemia, by subtype, during 2000-14 (CONCORD-3): analysis of individual data from 258 cancer registries in 61 countries. Lancet Child Adolesc Health 2022; 6:409-431. [PMID: 35468327 DOI: 10.1016/s2352-4642(22)00095-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/28/2022] [Accepted: 03/17/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Leukaemias comprise a heterogenous group of haematological malignancies. In CONCORD-3, we analysed data for children (aged 0-14 years) and adults (aged 15-99 years) diagnosed with a haematological malignancy during 2000-14 in 61 countries. Here, we aimed to examine worldwide trends in survival from leukaemia, by age and morphology, in young patients (aged 0-24 years). METHODS We analysed data from 258 population-based cancer registries in 61 countries participating in CONCORD-3 that submitted data on patients diagnosed with leukaemia. We grouped patients by age as children (0-14 years), adolescents (15-19 years), and young adults (20-24 years). We categorised leukaemia subtypes according to the International Classification of Childhood Cancer (ICCC-3), updated with International Classification of Diseases for Oncology, third edition (ICD-O-3) codes. We estimated 5-year net survival by age and morphology, with 95% CIs, using the non-parametric Pohar-Perme estimator. To control for background mortality, we used life tables by country or region, single year of age, single calendar year and sex, and, where possible, by race or ethnicity. All-age survival estimates were standardised to the marginal distribution of young people with leukaemia included in the analysis. FINDINGS 164 563 young people were included in this analysis: 121 328 (73·7%) children, 22 963 (14·0%) adolescents, and 20 272 (12·3%) young adults. In 2010-14, the most common subtypes were lymphoid leukaemia (28 205 [68·2%] patients) and acute myeloid leukaemia (7863 [19·0%] patients). Age-standardised 5-year net survival in children, adolescents, and young adults for all leukaemias combined during 2010-14 varied widely, ranging from 46% in Mexico to more than 85% in Canada, Cyprus, Belgium, Denmark, Finland, and Australia. Individuals with lymphoid leukaemia had better age-standardised survival (from 43% in Ecuador to ≥80% in parts of Europe, North America, Oceania, and Asia) than those with acute myeloid leukaemia (from 32% in Peru to ≥70% in most high-income countries in Europe, North America, and Oceania). Throughout 2000-14, survival from all leukaemias combined remained consistently higher for children than adolescents and young adults, and minimal improvement was seen for adolescents and young adults in most countries. INTERPRETATION This study offers the first worldwide picture of population-based survival from leukaemia in children, adolescents, and young adults. Adolescents and young adults diagnosed with leukaemia continue to have lower survival than children. Trends in survival from leukaemia for adolescents and young adults are important indicators of the quality of cancer management in this age group. FUNDING Children with Cancer UK, the Institut National du Cancer, La Ligue Contre le Cancer, Centers for Disease Control and Prevention, Swiss Re, Swiss Cancer Research foundation, Swiss Cancer League, Rossy Family Foundation, US National Cancer Institute, and the American Cancer Society.
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Affiliation(s)
- Naomi Ssenyonga
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
| | - Charles Stiller
- National Cancer Registration and Analysis Service, Public Health England, Wellington House, London, UK
| | - Kayo Nakata
- Cancer Control Center, Osaka International Cancer Institute 3-1-69, Otemae, Chuo-ku, Osaka City, Osaka, Japan
| | - Jaime Shalkow
- Instituto Nacional de Pediatría, Insurgentes Cuicuilco, Coyoacán, Ciudad de México, Mexico
| | - Sheilagh Redmond
- Institute of Social and Preventive Medicine, Bern University, Bern, Switzerland
| | - Jean-Luc Bulliard
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland; Neuchâtel and Jura Tumour Registry, Neuchâtel, Switzerland
| | - Fabio Girardi
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK; Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK; Division of Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Christine Fowler
- Classification and Terminology, Technology and Digital Services, Ministry of Health, Wellington, New Zealand
| | | | - Audrey Bonaventure
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK; CRESS, Université de Paris, INSERM, UMR 1153, Epidemiology of Childhood and Adolescent Cancers Team, Villejuif, France
| | - Nathalie Saint-Jacques
- Department of Medicine and Community Health and Epidemiology, Centre for Clinical Research, Dalhousie University, Halifax, NS, Canada
| | - Pamela Minicozzi
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Prithwish De
- Surveillance and Cancer Registry, and Research Office, Clinical Institutes and Quality Programs, Ontario Health, Toronto, ON, Canada
| | - Miguel Rodríguez-Barranco
- Granada Cancer Registry, Escuela Andaluza de Salud Pública (EASP), Cuesta del Observatorio 4, Granada, Spain
| | | | - Veronica Di Carlo
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Margit Mägi
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | | | - Karri Seppä
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Dyfed Wyn Huws
- Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales, Cardiff, UK
| | - Michel P Coleman
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK; Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Claudia Allemani
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
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16
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Matz M, Allemani C, van Tongeren M, Nafilyan V, Rhodes S, van Veldhoven K, Pembrey L, Coleman MP, Pearce N. Excess mortality among essential workers in England and Wales during the COVID-19 pandemic. J Epidemiol Community Health 2022; 76:660-666. [PMID: 35470261 DOI: 10.1136/jech-2022-218786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/26/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Exposure to SARS-CoV-2, subsequent development of COVID-19 and death from COVID-19 may vary by occupation, and the risks may be higher for those categorised as 'essential workers'. METHODS We estimated excess mortality by occupational group and sex separately for each month in 2020 and for the entire 12 months overall. RESULTS Mortality for all adults of working age was similar to the annual average over the previous 5 years. Monthly excess mortality peaked in April, when the number of deaths was 54.2% higher than expected and was lowest in December when deaths were 30.0% lower than expected.Essential workers had consistently higher excess mortality than other groups throughout 2020. There were also large differences in excess mortality between the categories of essential workers, with healthcare workers having the highest excess mortality and social care and education workers having the lowest. Excess mortality also varied widely between men and women, even within the same occupational group. Generally, excess mortality was higher in men. CONCLUSIONS In summary, excess mortality was consistently higher for essential workers throughout 2020, particularly for healthcare workers. Further research is needed to examine excess mortality by occupational group, while controlling for important confounders such as ethnicity and socioeconomic status. For non-essential workers, the lockdowns, encouragement to work from home and to maintain social distancing are likely to have prevented a number of deaths from COVID-19 and from other causes.
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Affiliation(s)
- Melissa Matz
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Claudia Allemani
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Martie van Tongeren
- Centre for Occupational and Environmental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Vahé Nafilyan
- Health Analysis and Life Events Division, Office for National Statistics, Newport, UK.,Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Rhodes
- Centre for Biostatistics, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Karin van Veldhoven
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Lucy Pembrey
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Michel P Coleman
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Neil Pearce
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Weir HK, Bryant H, Turner D, Coleman MP, Mariotto AB, Spika D, Matz M, Harewood R, Tucker TC, Allemani C. Population-Based Cancer Survival in Canada and the United States by Socioeconomic Status: Findings from the CONCORD-2 Study. J Registry Manag 2022; 49:23-33. [PMID: 37260622 PMCID: PMC10198415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Background Population-based cancer survival provides insight into the effectiveness of health systems to care for all residents with cancer, including those in marginalized groups. Methods Using CONCORD-2 data, we estimated 5-year net survival among patients diagnosed 2004-2009 with one of 10 common cancers, and children diagnosed with acute lymphoblastic leukemia (ALL), by socioeconomic status (SES) quintile, age (0-14, 15-64, ≥65 years), and country (Canada or United States). Results In the lowest SES quintile, survival was higher among younger Canadian adults diagnosed with liver (23% vs 15%) and cervical (78% vs 68%) cancers and with leukemia (62% vs 56%), including children diagnosed with ALL (92% vs 86%); and higher among older Americans diagnosed with colon (62% vs 56%), female breast (87% vs 80%), and prostate (97% vs 85%) cancers. In the highest SES quintile, survival was higher among younger Americans diagnosed with stomach cancer (33% vs 27%) and younger Canadians diagnosed with liver cancer (31% vs 23%); and higher among older Americans diagnosed with stomach (27% vs 22%) and prostate (99% vs 92%) cancers. Conclusions Among younger Canadian cancer patients in the lowest SES group, greater access to health care may have resulted in higher cancer survival, while higher screening prevalence and access to health insurance (Medicare) among older Americans during the period of this study may have resulted in higher survival for some screen-detected cancers. Higher survival in the highest SES group for stomach and liver may relate to treatment differences. Survival differences by age and SES between Canada and the United States may help inform cancer control strategies.
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Affiliation(s)
- Hannah K Weir
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Michel P Coleman
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Devon Spika
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Melissa Matz
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rhea Harewood
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Claudia Allemani
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
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18
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Matz M, Weir HK, Alkhalawi E, Coleman MP, Allemani C. Disparities in cervical cancer survival in the United States by race and stage at diagnosis: An analysis of 138,883 women diagnosed between 2001 and 2014 (CONCORD-3). Gynecol Oncol 2021; 163:305-311. [PMID: 34454725 PMCID: PMC11075792 DOI: 10.1016/j.ygyno.2021.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/04/2021] [Accepted: 08/17/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE During 2000-2014, age-standardized five-year net survival for cervical cancer was 63-64% in the United States. Using data from CONCORD-3, we analyzed cervical cancer survival trends by race, stage and period of diagnosis. METHODS Data from 41 state-wide population-based cancer registries on 138,883 women diagnosed with cervical cancer during 2001-2014 were available. Vital status was followed up until December 31, 2014. We estimated age-standardized five-year net survival, by race (Black or White), stage and calendar period of diagnosis (2001-2003, 2004-2008, 2009-2014) in each state, and for all participating states combined. RESULTS White women were most commonly diagnosed with localized tumors (45-50%). However, for Black women, localized tumors were the most common stage (43.0%) only during 2001-2003. A smaller proportion of Black women received cancer-directed surgery than White women. For all stages combined, five-year survival decreased between 2001-2003 and 2009-2014 for both White (64.7% to 63.0%) and Black (56.7% to 55.8%) women. For localized and regional tumors, survival increased over the same period for both White (by 2-3%) and Black women (by 5%). Survival did not change for Black women diagnosed with distant tumors but increased by around 2% for White women. CONCLUSIONS Despite similar screening coverage for both Black and White women and improvements in stage-specific survival, Black women still have poorer survival than White women. This may be partially explained by inequities in access to optimal treatment. The results from this study highlight the continuing need to address the disparity in cervical cancer survival between White and Black women in the United States.
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Affiliation(s)
- Melissa Matz
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - Hannah K Weir
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eman Alkhalawi
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Michel P Coleman
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Claudia Allemani
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Henderson RH, French D, Maughan T, Adams R, Allemani C, Minicozzi P, Coleman MP, McFerran E, Sullivan R, Lawler M. The economic burden of colorectal cancer across Europe: a population-based cost-of-illness study. Lancet Gastroenterol Hepatol 2021; 6:709-722. [PMID: 34329626 DOI: 10.1016/s2468-1253(21)00147-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Colorectal cancer is one of the leading causes of cancer morbidity and mortality in Europe. We aimed to ascertain the economic burden of colorectal cancer across Europe using a population-based cost-of-illness approach. METHODS In this population-based cost-of-illness study, we obtained 2015 activity and costing data for colorectal cancer in 33 European countries (EUR-33) from global and national sources. Country-specific aggregate data were acquired for health-care, mortality, morbidity, and informal care costs. We calculated primary, outpatient, emergency, and hospital care, and systemic anti-cancer therapy (SACT) costs, as well as the costs of premature death, temporary and permanent absence from work, and unpaid informal care due to colorectal cancer. Colorectal cancer health-care costs per case were compared with colorectal cancer survival and colorectal cancer personnel, equipment, and resources across EUR-33 using univariable and multivariable regression. We also compared hospital care and SACT costs against 2009 data for the 27 EU countries. FINDINGS The economic burden of colorectal cancer across Europe in 2015 was €19·1 billion. The total non-health-care cost of €11·6 billion (60·6% of total economic burden) consisted of loss of productivity due to disability (€6·3 billion [33·0%]), premature death (€3·0 billion [15·9%]), and opportunity costs for informal carers (€2·2 billion [11·6%]). The €7·5 billion (39·4% of total economic burden) of direct health-care costs consisted of hospital care (€3·3 billion [43·4%] of health-care costs), SACT (€1·9 billion [25·6%]), and outpatient care (€1·3 billion [17·7%]), primary care (€0·7 billion [9·3%]), and emergency care (€0·3 billion [3·9%]). The mean cost for managing a patient with colorectal cancer varied widely between countries (€259-36 295). Hospital-care costs as a proportion of health-care costs varied considerably (24·1-84·8%), with a decrease of 21·2% from 2009 to 2015 in the EU. Overall, hospital care was the largest proportion (43·4%) of health-care expenditure, but pharmaceutical expenditure was far higher than hospital-care expenditure in some countries. Countries with similar gross domestic product per capita had widely varying health-care costs. In the EU, overall expenditure on pharmaceuticals increased by 213·7% from 2009 to 2015. INTERPRETATION Although the data analysed include non-homogenous sources from some countries and should be interpreted with caution, this study is the most comprehensive analysis to date of the economic burden of colorectal cancer in Europe. Overall spend on health care in some countries did not seem to correspond with patient outcomes. Spending on improving outcomes must be appropriately matched to the challenges in each country, to ensure tangible benefits. Our results have major implications for guiding policy and improving outcomes for this common malignancy. FUNDING Department for Employment and Learning of Northern Ireland, Medical Research Council, Cancer Research UK, Health Data Research UK, and DATA-CAN.
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Affiliation(s)
- Raymond Hugo Henderson
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK; Queen's Management School, Queen's University Belfast, Belfast, UK; Diaceutics, Belfast, UK.
| | - Declan French
- Queen's Management School, Queen's University Belfast, Belfast, UK
| | - Timothy Maughan
- MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - Richard Adams
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Claudia Allemani
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Pamela Minicozzi
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Michel P Coleman
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Ethna McFerran
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Richard Sullivan
- Institute of Cancer Policy, King's College London & King's Health Partners Comprehensive Cancer Centre, UK
| | - Mark Lawler
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
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Woods LM, Rachet B, Morris M, Bhaskaran K, Coleman MP. Are socio-economic inequalities in breast cancer survival explained by peri-diagnostic factors? BMC Cancer 2021; 21:485. [PMID: 33933034 PMCID: PMC8088027 DOI: 10.1186/s12885-021-08087-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/23/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Patients living in more deprived localities have lower cancer survival in England, but the role of individual health status at diagnosis and the utilisation of primary health care in explaining these differentials has not been widely considered. We set out to evaluate whether pre-existing individual health status at diagnosis and primary care consultation history (peri-diagnostic factors) could explain socio-economic differentials in survival amongst women diagnosed with breast cancer. METHODS We conducted a retrospective cohort study of women aged 15-99 years diagnosed in England using linked routine data. Ecologically-derived measures of income deprivation were combined with individually-linked data from the English National Cancer Registry, Clinical Practice Research Datalink (CPRD) and Hospital Episodes Statistics (HES) databases. Smoking status, alcohol consumption, BMI, comorbidity, and consultation histories were derived for all patients. Time to breast surgery was derived for women diagnosed after 2005. We estimated net survival and modelled the excess hazard ratio of breast cancer death using flexible parametric models. We accounted for missing data using multiple imputation. RESULTS Net survival was lower amongst more deprived women, with a single unit increase in deprivation quintile inferring a 4.4% (95% CI 1.4-8.8) increase in excess mortality. Peri-diagnostic co-variables varied by deprivation but did not explain the differentials in multivariable analyses. CONCLUSIONS These data show that socio-economic inequalities in survival cannot be explained by consultation history or by pre-existing individual health status, as measured in primary care. Differentials in the effectiveness of treatment, beyond those measuring the inclusion of breast surgery and the timing of surgery, should be considered as part of the wider effort to reduce inequalities in premature mortality.
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Affiliation(s)
- Laura M Woods
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK.
| | - Bernard Rachet
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Melanie Morris
- Department of Health Services Research and Policy, Faculty of Public Health and Policy London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Krishnan Bhaskaran
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Michel P Coleman
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
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21
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Girardi F, Rous B, Stiller CA, Gatta G, Fersht N, Storm HH, Rodrigues JR, Herrmann C, Marcos-Gragera R, Peris-Bonet R, Valkov M, Weir HK, Woods RR, You H, Cueva PA, De P, Di Carlo V, Johannesen TB, Lima CA, Lynch CF, Coleman MP, Allemani C. The histology of brain tumours for 67,331 children and 671,085 adults diagnosed in 60 countries during 2000-2014: a global, population-based study (CONCORD-3). Neuro Oncol 2021; 23:1765-1776. [PMID: 33738488 DOI: 10.1093/neuonc/noab067] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Global variations in survival for brain tumours are very wide when all histological types are considered together. Appraisal of international differences should be informed by the distribution of histology, but little is known beyond Europe and North America. PATIENTS AND METHODS The source for the analysis was the CONCORD data base, a programme of global surveillance of cancer survival trends, which includes the tumour records of individual patients from more than 300 population-based cancer registries. We considered all patients aged 0-99 years who were diagnosed with a primary brain tumour during 2000-2014, whether malignant or non-malignant. We presented the histology distribution of these tumours, for patients diagnosed during 2000-2004, 2005-2009, and 2010-2014. RESULTS Records were submitted from 60 countries on five continents, 67,331 for children and 671,085 for adults. After exclusion of irrelevant morphology codes, the final study population comprised 60,783 children and 602,112 adults. Only 59 of 60 countries covered in CONCORD-3 were included, because none of the Mexican records were eligible. We defined 12 histology groups for children, and 11 histology groups for adults. In children (0-14 years), the proportion of low-grade astrocytomas ranged between 6% and 50%. Medulloblastoma was the most common sub-type in countries where low-grade astrocytoma was less commonly reported. In adults (15-99 years), the proportion of glioblastomas varied between 9% and 69%. International comparisons were made difficult by wide differences in the proportion of tumours with unspecified histology, which accounted for up to 52% of diagnoses in children and up to 65% in adults. CONCLUSIONS To our knowledge, this is the first account of the global histology distribution of brain tumours, in children and adults. Our findings provide insights into the practices and the quality of cancer registration worldwide.
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Affiliation(s)
- Fabio Girardi
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Cancer Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom.,Division of Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Brian Rous
- National Cancer Registration and Analysis Service, Public Health England, London, United Kingdom
| | - Charles A Stiller
- National Cancer Registration and Analysis Service, Public Health England, London, United Kingdom
| | - Gemma Gatta
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Naomi Fersht
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | | | | | | | | | - Mikhail Valkov
- Arkhangelsk Regional Cancer Registry, Arkhangelsk, Russian Federation
| | - Hannah K Weir
- Centers for Disease Control and Prevention, Atlanta, United States
| | - Ryan R Woods
- British Columbia Cancer Registry, Vancouver, Canada
| | - Hui You
- New South Wales Cancer Registry, Alexandria, Australia
| | | | | | - Veronica Di Carlo
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Carlos A Lima
- Registro de Câncer de Base Populacional de Aracaju, Aracaju, Brazil
| | | | - Michel P Coleman
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Cancer Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Claudia Allemani
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
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22
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Di Carlo V, Estève J, Johnson C, Girardi F, Weir HK, Wilson RJ, Minicozzi P, Cress RD, Lynch CF, Pawlish KS, Rees JR, Coleman MP, Allemani C. Trends in short-term survival from distant-stage cutaneous melanoma in the United States, 2001-2013 (CONCORD-3). JNCI Cancer Spectr 2021; 4:pkaa078. [PMID: 33409455 PMCID: PMC7771008 DOI: 10.1093/jncics/pkaa078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 07/13/2020] [Accepted: 08/19/2020] [Indexed: 11/24/2022] Open
Abstract
Background Survival from metastatic cutaneous melanoma is substantially lower than for localized disease. Treatments for metastatic melanoma have been limited, but remarkable clinical improvements have been reported in clinical trials in the last decade. We described the characteristics of US patients diagnosed with cutaneous melanoma during 2001-2013 and assessed trends in short-term survival for distant-stage disease. Methods Trends in 1-year net survival were estimated using the Pohar Perme estimator, controlling for background mortality with life tables of all-cause mortality rates by county of residence, single year of age, sex, and race for each year 2001-2013. We fitted a flexible parametric survival model on the log-hazard scale to estimate the effect of race on the hazard of death because of melanoma and estimated 1-year net survival by race. Results Only 4.4% of the 425 915 melanomas were diagnosed at a distant stage, cases diagnosed at a distant stage are more commonly men, older patients, and African Americans. Age-standardized, 1-year net survival for distant-stage disease was stable at approximately 43% during 2001-2010. From 2010 onward, survival improved rapidly, reaching 58.9% (95% confidence interval = 56.6% to 61.2%) for patients diagnosed in 2013. Younger patients experienced the largest improvement. Survival for distant-stage disease increased in both Blacks and Whites but was consistently lower in Blacks. Conclusions One-year survival for distant-stage melanoma improved during 2001-2013, particularly in younger patients and those diagnosed since 2010. This improvement may be a consequence of the introduction of immune-checkpoint-inhibitors and other targeted treatments for metastatic and unresectable disease. Persistent survival inequalities exist between Blacks and Whites, suggesting differential access to treatment.
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Affiliation(s)
- Veronica Di Carlo
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Jacques Estève
- Université Claude Bernard, Hospices Civils de Lyon, Service de Biostatistique, Lyon Cedex 03, France
| | | | - Fabio Girardi
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Hannah K Weir
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Reda J Wilson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Pamela Minicozzi
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Rosemary D Cress
- Public Health Institute, Cancer Registry of Greater California, Sacramento, CA, USA
| | - Charles F Lynch
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | | | - Judith R Rees
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Michel P Coleman
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Claudia Allemani
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Montel L, Kapilashrami A, Coleman MP, Allemani C. The Right to Health in Times of Pandemic: What Can We Learn from the UK's Response to the COVID-19 Outbreak? Health Hum Rights 2020; 22:227-241. [PMID: 33390709 PMCID: PMC7762905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The UK's response to COVID-19 has been widely criticized by scientists and the public. According to EuroMOMO, a European mortality monitoring initiative, the excess mortality that may be attributable to COVID-19 in England is one of the highest in Europe, second only to Spain. While critiqued from a public health perspective, much less attention is given to the implications of the pandemic outbreak for the right to health as defined under international human rights law and ratified by member states. Using the UK as a case study, we examine critically the extent to which the government's response to COVID-19 complied with the legal framework of the right to health. We review further key states' obligations on the right to health and assess its suitability in times of pandemic. Finally, we offer some recommendations for an update of the right to health. This paper adds to the body of literature on the right to health and human rights based-approaches to health.
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Affiliation(s)
- Lisa Montel
- PhD candidate in the Cancer Survival Group, Department of Non-Communicable Disease Epidemiology at the London School of Hygiene and Tropical Medicine, and Research Associate in the Social Sciences and Law Faculty at the University of Bristol, UK
| | - Anuj Kapilashrami
- Professor in Global Health Policy and Equity in the School of Health and Social Care at the University of Essex, Colchester, UK
| | - Michel P. Coleman
- Professor of Epidemiology and Vital Statistics and Head of the Cancer Survival Group, Department of Non-Communicable Disease Epidemiology at the London School of Hygiene and Tropical Medicine, UK
| | - Claudia Allemani
- Associate Professor of Cancer Epidemiology in the Cancer Survival Group, Department of Non-Communicable Disease Epidemiology at the London School of Hygiene and Tropical Medicine, UK
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Abstract
Background Brain tumors represent an important cause of cancer-related death in adolescents and young adults. Most are diagnosed in low-income and middle-income countries. We aimed to conduct the first, to our knowledge, systematic review of time trends and geographical variation in survival in this age group. Methods We included observational studies describing population-based survival from astrocytic tumors in patients aged 15-39 years. We queried 6 electronic databases from database inception to December 31, 2019. This review is registered with PROSPERO, number CRD42018111981. Results Among 5640 retrieved records, 20 studies fulfilled the inclusion criteria. All but 1 study focused on high-income countries. Five-year survival from astrocytoma (broad morphology group) mostly varied between 48.0% and 71.0% (1973-2004) without clear trends or geographic differences. Adolescents with astrocytoma had better outcomes than young adults, but survival values were similar when nonmalignant tumors were excluded. During 2002-2007, 5-year survival for World Health Organization grade I-II tumors was in the range of 72.6%-89.1% in England, Germany, and the United States but lower in Southeastern Europe (59.0%). Five-year survival for anaplastic astrocytoma varied between 39.6% and 55.4% (2002-2007). Five-year survival from glioblastoma was in the range of 14.2%-23.1% (1991-2009). Conclusions Survival from astrocytic tumors remained somewhat steady over time, with little change between 1973 and 2009. Survival disparities were difficult to examine, because nearly all the studies were conducted in affluent countries. Studies often adopted the International Classification of Childhood Cancer, which, however, did not allow to accurately describe variation in survival. Larger studies are warranted, including underrepresented populations and providing more recent survival estimates.
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Affiliation(s)
- Fabio Girardi
- Cancer Survival Group, Non-Communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Claudia Allemani
- Cancer Survival Group, Non-Communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Michel P Coleman
- Cancer Survival Group, Non-Communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK
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Morris M, Alencar Y, Rachet B, Stephens R, Coleman MP. Fleshing out the data: when epidemiological researchers engage with patients and carers. Learning lessons from a patient involvement activity. BMJ Open 2020; 10:e036311. [PMID: 32998916 PMCID: PMC7528373 DOI: 10.1136/bmjopen-2019-036311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 08/11/2020] [Accepted: 08/26/2020] [Indexed: 11/03/2022] Open
Abstract
Patient and public involvement and engagement has become an essential element of health research, ensuring aims and outputs are worthwhile and relevant. However, research involving secondary data analyses does not present immediately obvious ways to involve patients and the public. Innovative approaches to ensure their involvement is meaningful and effective are required.The Cancer Survival Group cohosted a full-day meeting with the National Cancer Research Institute Consumer Forum-a group of patients and carers. This included the Forum's 'Dragons' Den': a small-group session in which their members provided insight, advice and ideas on current or planned research in the Cancer Survival Group.We investigated this activity as an example of effective patient involvement, with the aim of developing broad recommendations to improve epidemiological/quantitative research by involving patients and carers as directly as possible.In addition to quantitative data captured through evaluation forms completed after the event, we used semistructured interviews of a sample of participants to evaluate the effectiveness of the session and to learn lessons. The interviews were analysed to identify broad or recurrent themes and recommendations.Feedback was overwhelmingly positive, and some impacts on the research projects were identified. Interviewees commented on overall expectations and experiences, as well as specifics of room layout, timing of the session, composition of groups, effectiveness of the facilitation and content of discussions.We present a summary of our findings as a guide for other researchers, including recommendations for improvement gleaned from the interviews. The value to researchers of hosting and participating in such activities was clear. We developed recommendations that should help to improve future events for ourselves and for others who wish to conduct similar activities, which in turn may lead to more concrete benefits for research and patients.
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Affiliation(s)
- Melanie Morris
- Cancer Survival Group, NCDE, London School of Hygiene & Tropical Medicine, London, UK
| | - Yuki Alencar
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Bernard Rachet
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Michel P Coleman
- Cancer Survival Group, NCDE, London School of Hygiene & Tropical Medicine, London, UK
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26
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Atun R, Bhakta N, Denburg A, Frazier AL, Friedrich P, Gupta S, Lam CG, Ward ZJ, Yeh JM, Allemani C, Coleman MP, Di Carlo V, Loucaides E, Fitchett E, Girardi F, Horton SE, Bray F, Steliarova-Foucher E, Sullivan R, Aitken JF, Banavali S, Binagwaho A, Alcasabas P, Antillon F, Arora RS, Barr RD, Bouffet E, Challinor J, Fuentes-Alabi S, Gross T, Hagander L, Hoffman RI, Herrera C, Kutluk T, Marcus KJ, Moreira C, Pritchard-Jones K, Ramirez O, Renner L, Robison LL, Shalkow J, Sung L, Yeoh A, Rodriguez-Galindo C. Sustainable care for children with cancer: a Lancet Oncology Commission. Lancet Oncol 2020; 21:e185-e224. [PMID: 32240612 DOI: 10.1016/s1470-2045(20)30022-x] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/22/2019] [Accepted: 01/14/2020] [Indexed: 12/29/2022]
Abstract
We estimate that there will be 13·7 million new cases of childhood cancer globally between 2020 and 2050. At current levels of health system performance (including access and referral), 6·1 million (44·9%) of these children will be undiagnosed. Between 2020 and 2050, 11·1 million children will die from cancer if no additional investments are made to improve access to health-care services or childhood cancer treatment. Of this total, 9·3 million children (84·1%) will be in low-income and lower-middle-income countries. This burden could be vastly reduced with new funding to scale up cost-effective interventions. Simultaneous comprehensive scale-up of interventions could avert 6·2 million deaths in children with cancer in this period, more than half (56·1%) of the total number of deaths otherwise projected. Taking excess mortality risk into consideration, this reduction in the number of deaths is projected to produce a gain of 318 million life-years. In addition, the global lifetime productivity gains of US$2580 billion in 2020-50 would be four times greater than the cumulative treatment costs of $594 billion, producing a net benefit of $1986 billion on the global investment: a net return of $3 for every $1 invested. In sum, the burden of childhood cancer, which has been grossly underestimated in the past, can be effectively diminished to realise massive health and economic benefits and to avert millions of needless deaths.
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Affiliation(s)
- Rifat Atun
- Department of Global health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston MA, USA.
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Avram Denburg
- Division of Haematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - A Lindsay Frazier
- Dana-Farber and Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Paola Friedrich
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Sumit Gupta
- Division of Haematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Catherine G Lam
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Zachary J Ward
- Center for Health Decision Science, Harvard T H Chan School of Public Health, Harvard University, Boston MA, USA
| | - Jennifer M Yeh
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston MA, USA; Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Claudia Allemani
- Cancer Survival Group, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Michel P Coleman
- Cancer Survival Group, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Veronica Di Carlo
- Cancer Survival Group, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Elizabeth Fitchett
- University College London Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Fabio Girardi
- Cancer Survival Group, Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Susan E Horton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, WHO, Lyon, France
| | - Eva Steliarova-Foucher
- Section of Cancer Surveillance, International Agency for Research on Cancer, WHO, Lyon, France
| | - Richard Sullivan
- Institute of Cancer Policy, Conflict and Health Research Group, School of Cancer Sciences, King's College London, London, UK
| | - Joanne F Aitken
- Cancer Council Queensland, Brisbane, QLD, Australia; School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Shripad Banavali
- Department of Medical and Pediatric Oncology, Tata Memorial Center, Mumbai, India; Homi Bhabha National Institute, Mumbai, India
| | | | - Patricia Alcasabas
- Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Federico Antillon
- Unidad Nacional de Oncología Pediátrica and the School of Medicine, Universidad Francisco Marroquín, Guatemala City, Guatemala
| | - Ramandeep S Arora
- Department of Medical Oncology, Max Super-Specialty Hospital, New Delhi, India
| | - Ronald D Barr
- Departments of Pediatrics, Pathology and Medicine, Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Eric Bouffet
- Division of Haematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Julia Challinor
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | | | - Thomas Gross
- Center for Global Health, US National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lars Hagander
- Department of Clinical Sciences Lund, Pediatric Surgery, WHO Collaborating Centre for Surgery and Public Health, Lund University Faculty of Medicine, Lund, Sweden
| | - Ruth I Hoffman
- American Childhood Cancer Organization, Beltsville, MD, USA
| | - Cristian Herrera
- Health Division, Organization for Economic Cooperation and Development, Paris, France; Department of Public Health, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Tezer Kutluk
- Department of Pediatrics, Division of Pediatric Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey; Cancer Institute, Hacettepe University, Ankara, Turkey
| | - Karen J Marcus
- Department of Radiation Oncology, Harvard Medical School, Harvard University, Boston MA, USA; Division of Radiation Oncology, Boston Children's Hospital, Boston, MA, USA
| | - Claude Moreira
- Institut Jean Lemerle, African Paediatric Oncology Formation, Dakar, Senegal; Hôpital Aristide Le Dantec, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Kathy Pritchard-Jones
- University College London Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Oscar Ramirez
- Department of Pediatric Haematology and Oncology, Centro Médico Imbanaco de Cali, Cali, Colombia; Cali Cancer Population-based Registry, Universidad del Valle, Cali, Colombia
| | - Lorna Renner
- Department of Child Health, University of Ghana Medical School Accra, Ghana; Paediatric Oncology Unit, Korle Bu Teaching Hospital, Accra, Ghana
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Jaime Shalkow
- Department of Pediatric Surgical Oncology, National Institute of Pediatrics, Mexico City, Mexico; School of Medicine, Anahuac University, Mexico City, Mexico
| | - Lillian Sung
- Division of Haematology and Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Allen Yeoh
- Division of Paediatric Haematology and Oncology, National University Cancer Institute, Singapore National University Health System, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Carlos Rodriguez-Galindo
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA.
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Exarchakou A, Papacleovoulou G, Rous B, Magadi W, Rachet B, Neoptolemos JP, Coleman MP. Pancreatic cancer incidence and survival and the role of specialist centres in resection rates in England, 2000 to 2014: A population-based study. Pancreatology 2020; 20:454-461. [PMID: 32014435 DOI: 10.1016/j.pan.2020.01.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 01/09/2020] [Accepted: 01/18/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The aim was to compare population-based survival for exocrine pancreatic cancer in England in the 23 regions covered by specialist centres. The centres were initiated in 2001, covering populations of 2-4 million. METHODS We examined incidence for adults diagnosed with a pancreatic exocrine cancer during 1995-2014 and age-standardised net survival up to five years after diagnosis for patients diagnosed during 2000-2013. We examined variation in regional resection rates and survival for patients diagnosed during 2010-2013. The data were extracted from the National Cancer Registration and Analysis Service. RESULTS Age-standardised annual incidence rates of exocrine pancreatic cancer increased from 17.1 per 100,000 during 1995-1999 to 18.7 during 2010-2014. Age-standardised one-year and five-year net survival increased from 17.9% and 3.6%, respectively, for 2000-2009, to 21.6% and 4.2% during 2010-2013. There were 2086 (8.9%) resections among 23,415 patients diagnosed with an exocrine tumour in 2010-2013. The proportion ranged from 5.1% to 19.6% between centres. Among resected patients, survival was 73.0% at one year and 20.2% at five years. Of the total 2118 resected patients, 18 (0.9%) were at stage 1; 34 (1.6%) at stage 2; 791 (37.3%) at stage 3 and 140 (6.6%) at stage 4, although 53.6% of stage information was missing. Five-year survival was 2.1% for those who were not resected. The number of resections performed in each centre was not correlated with one-year survival. CONCLUSIONS Despite improvements in the management of pancreatic cancer in England with the introduction of specialist centres, resection rates remain relatively low, and survival remains lower than in comparably wealthy countries.
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Affiliation(s)
- Aimilia Exarchakou
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | | | - Brian Rous
- National Cancer Registration and Analysis Service, Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Winnie Magadi
- UK Renal Registry, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Bernard Rachet
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - John P Neoptolemos
- Department of General Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany
| | - Michel P Coleman
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Exarchakou A, Donaldson LJ, Girardi F, Coleman MP. Colorectal cancer incidence among young adults in England: Trends by anatomical sub-site and deprivation. PLoS One 2019; 14:e0225547. [PMID: 31805076 PMCID: PMC6894790 DOI: 10.1371/journal.pone.0225547] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/06/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Colorectal cancer incidence in the UK and other high-income countries has been increasing rapidly among young adults. This is the first analysis of colorectal cancer incidence trends by sub-site and socioeconomic deprivation in young adults in a European country. METHODS We examined age-specific national trends in colorectal cancer incidence among all adults (20-99 years) diagnosed during 1971-2014, using Joinpoint regression to analyse data from the population-based cancer registry for England. We fitted a generalised linear model to the incidence rates, with a maximum of two knots. We present the annual percentage change in incidence rates in up to three successive calendar periods, by sex, age, deprivation and anatomical sub-site. RESULTS Annual incidence rates among the youngest adults (20-39 years) fell slightly between 1971 and the early 1990s, but increased rapidly from then onwards. Incidence Rates (IR) among adults 20-29 years rose from 0.8 per 100,000 in 1993 to 2.8 per 100,000 in 2014, an average annual increase of 8%. An annual increase of 8.1% was observed for adults aged 30-39 years during 2005-2014. Among the two youngest age groups (20-39 years), the average annual increase for the right colon was 5.2% between 1991 and 2010, rising to 19.4% per year between 2010 (IR = 1.2) and 2014 (IR = 2.5). The large increase in incidence rates for cancers of the right colon since 2010 were more marked among the most affluent young adults. Smaller but substantial increases were observed for cancers of the left colon and rectum. Incidence rates in those aged 50 years and older remained stable or decreased over the same periods. CONCLUSIONS Despite the overall stabilising trend of colorectal cancer incidence in England, incidence rates have increased rapidly among young adults (aged 20-39 years). Changes in the prevalence of obesity and other risk factors may have affected the young population but more research is needed on the cause of the observed birth cohort effect. Extension of mass screening may not be justifiable due to the low number of newly diagnosed cases but clinicians should be alert to this trend.
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Affiliation(s)
- Aimilia Exarchakou
- Cancer Survival Group, Non-Communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Liam J. Donaldson
- Non-Communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Fabio Girardi
- Cancer Survival Group, Non-Communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michel P. Coleman
- Cancer Survival Group, Non-Communicable Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Abstract
PURPOSE The histology of brain tumors determines treatment and predicts outcome. Population-based survival reflects the effectiveness of a health care system in managing cancer. No systematic review of worldwide variation and time trends in survival from brain tumors in children is currently available. PATIENTS AND METHODS We considered longitudinal, observational studies comprising children diagnosed with intracranial astrocytic or embryonal tumors. We searched six electronic databases from database inception to September 30, 2018, using complex search strategies. The outcome measure was 5-year survival, estimated through a time-to-event analysis. This study is registered with PROSPERO, number CRD42018111981. RESULTS Among 5,244 studies, we identified 47 eligible articles that provided 228 survival estimates. Only five studies were entirely or partially conducted in low-income or middle-income countries. Five-year survival from embryonal tumors increased from 37% in 1980 to approximately 60% in 2009. Although survival for medulloblastoma improved substantially (from 29% to 73% during 1959-2009), survival for primitive neuroectodermal tumors wavered over time (1973-2009) and between countries. Five-year survival from astrocytoma changed very little over the 27 years between 1982 and 2009 (from 78% to 89%). Interpretation of the literature was made difficult by the heterogeneity of study designs. CONCLUSION Survival has improved for embryonal tumors, but little change has been observed for astrocytic tumors. We found a striking gap in knowledge about survival from childhood brain tumor subtypes in middle-income and low-income countries, where half of these tumors are diagnosed. Larger studies are needed, including in under-represented countries and based on standardized data collection, to provide up-to-date survival estimates.
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Affiliation(s)
- Fabio Girardi
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Claudia Allemani
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michel P. Coleman
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Abstract
PURPOSE The ratio of cancer mortality and cancer incidence rates in a population has conventionally been used as an indicator of the completeness of cancer registration. More recently, the complement of the mortality-to-incidence ratio (1-M/I) has increasingly been presented as a surrogate for cancer survival. We discuss why this is mistaken in principle and misleading in practice. METHODS We provide an empirical assessment of the extent to which trends in the 1-M/I ratio reflect trends in cancer survival. We used national cancer incidence, mortality and survival data in England to compare trends in both the 1-M/I ratio and net survival at 1, 5, and 10 years for 19 cancers in men and 20 cancers in women over the 29-year period from 1981 to 2009. RESULTS The absolute difference between the 1-M/I ratio and 5-year net survival for 2009 was less than 5% for only 12 of the 39 cancer/sex combinations examined. For an additional 12, the 1-M/I ratio differed from 5-year net survival by at least 15%. The comparison is also unstable over time; thus, even when differences were small for 2009, the difference between 5-year net survival and the 1-M/I ratio had changed dramatically for most cancers between 1981 and 2009. CONCLUSION The 1-M/I ratio lacks any theoretical basis as a proxy for cancer survival. It is not a valid proxy for cancer survival in practice, either, whether at 5 years or at any other time interval since diagnosis. It has none of the useful properties of a population-based survival estimate. It should not be used as a surrogate for cancer survival.
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Affiliation(s)
- Libby Ellis
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Aurélien Belot
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bernard Rachet
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michel P. Coleman
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Alawadhi E, Al-Awadi A, Elbasmi A, Coleman MP, Allemani C. A Novel Approach to Obtain Follow-up Data on the Vital Status of Registered Cancer Patients: The Kuwait Cancer Registry Experience. Gulf J Oncolog 2019; 1:31-38. [PMID: 30956194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE We present an approach to obtain accurate and complete data on the last known vital status, and the date of last known vital status of all Kuwaiti cancer patients. These data are essential for robust estimation of population-based cancer survival. METHODS Government-issued Civil ID numbers (IDs) of patients registered during 2000-2013 were obtained from the Kuwait Cancer Registry. Missing IDs were traced using the Ministry of Health's Information System or the patient's medical records. IDs were manually entered in the Public Authority of Civil Information (PACI) database to ascertain vital status for patients whose vital status was not known in the registry. To obtain the date of death for deceased patients, IDs were then manually entered and searched in the electronic archive of "Death Announcements" at the Ministry of Health's Central Records Department of Births and Deaths. Patients not found in the "Death Announcements" archive were considered alive as on 31 December 2015. RESULTS The traditional method to obtain data on cancer patients' vital status, restricted to patients whose death was certified as due to cancer, had captured only 62% of all patients' deaths. This new approach resolved the vital status for 98.3% of patients for whom it was previously unknown. The impact was substantial: the proportion of patients known to be dead rose from 27.9% to 45.0%, while the proportion presumed alive dropped from 72.1% to 53.7%. Only 1.3% of the patients remained lost to follow-up. CONCLUSION This approach substantially improved the quality and completeness of follow-up data for all Kuwaiti cancer patients. We recommend that this approach should be performed routinely in Kuwait to enable accurate estimation and monitoring of population-based survival trends.
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Affiliation(s)
- Eiman Alawadhi
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Ahmed Al-Awadi
- Kuwait Cancer Control Center, Ministry of Health, State of Kuwait
| | - Amani Elbasmi
- Kuwait Cancer Control Center, Ministry of Health, State of Kuwait
| | - Michel P Coleman
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Claudia Allemani
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK
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Benitez Majano S, Di Girolamo C, Rachet B, Maringe C, Guren MG, Glimelius B, Iversen LH, Schnell EA, Lundqvist K, Christensen J, Morris M, Coleman MP, Walters S. Surgical treatment and survival from colorectal cancer in Denmark, England, Norway, and Sweden: a population-based study. Lancet Oncol 2019; 20:74-87. [PMID: 30545752 PMCID: PMC6318222 DOI: 10.1016/s1470-2045(18)30646-6] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/10/2018] [Accepted: 08/20/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Survival from colorectal cancer has been shown to be lower in Denmark and England than in comparable high-income countries. We used data from national colorectal cancer registries to assess whether differences in the proportion of patients receiving resectional surgery could contribute to international differences in colorectal cancer survival. METHODS In this population-based study, we collected data from all patients aged 18-99 years diagnosed with primary, invasive, colorectal adenocarcinoma from Jan 1, 2010, to Dec 31, 2012, in Denmark, England, Norway, and Sweden, from national colorectal cancer registries. We estimated age-standardised net survival using multivariable modelling, and we compared the proportion of patients receiving resectional surgery by stage and age. We used logistic regression to predict the resectional surgery status patients would have had if they had been treated as in the best performing country, given their individual characteristics. FINDINGS We extracted registry data for 139 457 adult patients with invasive colorectal adenocarcinoma: 12 958 patients in Denmark, 97 466 in England, 11 450 in Norway, and 17 583 in Sweden. 3-year colon cancer survival was lower in England (63·9%, 95% CI 63·5-64·3) and Denmark (65·7%, 64·7-66·8) than in Norway (69·5%, 68·4-70·5) and Sweden (72·1%, 71·2-73·0). Rectal cancer survival was lower in England (69·7%, 69·1-70·3) than in the other three countries (Denmark 72·5%, 71·1-74·0; Sweden 74·1%, 72·7-75·4; and Norway 75·0%, 73·1-76·8). We found no significant differences in survival for patients with stage I disease in any of the four countries. 3-year survival after stage II or III rectal cancer and stage IV colon cancer was consistently lower in England (stage II rectal cancer 86·4%, 95% CI 85·0-87·6; stage III rectal cancer 75·5%, 74·2-76·7; and stage IV colon cancer 20·5%, 19·9-21·1) than in Norway (94·1%, 91·5-96·0; 83·4%, 80·1-86·1; and 33·0%, 31·0-35·1) and Sweden (92·9%, 90·8-94·6; 80·6%, 78·2-82·7; and 23·7%, 22·0-25·3). 3-year survival after stage II rectal cancer and stage IV colon cancer was also lower in England than in Denmark (stage II rectal cancer 91·2%, 88·8-93·1; and stage IV colon cancer 23·5%, 21·9-25·1). The total proportion of patients treated with resectional surgery ranged from 47 803 (68·4%) of 69 867 patients in England to 9582 (81·3%) of 11 786 in Sweden for colon cancer, and from 16 544 (59·9%) of 27 599 in England to 4106 (70·8%) of 5797 in Sweden for rectal cancer. This range was widest for patients older than 75 years (colon cancer 19 078 [59·7%] of 31 946 patients in England to 4429 [80·9%] of 5474 in Sweden; rectal cancer 4663 [45·7%] of 10 195 in England to 1342 [61·9%] of 2169 in Sweden), and the proportion of patients treated with resectional surgery was consistently lowest in England. The age gradient of the decline in the proportion of patients treated with resectional surgery was steeper in England than in the other three countries in all stage categories. In the hypothetical scenario where all patients were treated as in Sweden, given their age, sex, and disease stage, the largest increase in resectional surgery would be for patients with stage III rectal cancer in England (increasing from 70·3% to 88·2%). INTERPRETATION Survival from colon cancer and rectal cancer in England and colon cancer in Denmark was lower than in Norway and Sweden. Survival paralleled the relative provision of resectional surgery in these countries. Differences in patient selection for surgery, especially in patients older than 75 years or individuals with advanced disease, might partly explain these differences in international colorectal cancer survival. FUNDING Early Diagnosis Policy Research Grant from Cancer Research UK (C7923/A18348).
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Affiliation(s)
- Sara Benitez Majano
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Chiara Di Girolamo
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Bernard Rachet
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Camille Maringe
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Marianne Grønlie Guren
- Department of Oncology and KG Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, Oslo, Norwa
| | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Lene Hjerrild Iversen
- Department of Surgery, Aarhus University Hospital, and Danish Colorectal Cancer Group, Aarhus, Denmark
| | | | - Kristina Lundqvist
- Department of Radiation Sciences, Oncology, Umeå University, and Regionalt Cancercentrum Norr, Umeå, Sweden
| | - Jane Christensen
- Cancer Control, Documentation and Quality, Danish Cancer Society, Copenhagen, Denmark
| | - Melanie Morris
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Michel P Coleman
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Walters
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Alawadhi E, Al-Awadi A, Elbasmi A, Coleman MP, Allemani C. Cancer survival trends in Kuwait, 2000-2013: A population-based study. Gulf J Oncolog 2019; 1:39-52. [PMID: 30956195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To examine population-based cancer survival trends in Kuwait; to facilitate public assessment of cancer control. METHODS Data were obtained from the Kuwait Cancer Registry for Kuwaiti adults (15-99 years) and children (0-14 years) diagnosed with one of 18 common cancers during 2000-2013 and followed up to 31 December 2014. Net survival was estimated at 1, 3, and 5 years by sex. To control for background mortality, life tables of all-cause mortality in the general population were constructed by single year of age, sex, and calendar year of death ("complete" life tables). Net survival estimates were age-standardised using the International Cancer Survival Standard weights. RESULTS Cancers with the highest net survival throughout the 14-year period were prostate, breast (women) and rectum in adults, and lymphoma in children. Survival was lowest for liver, pancreas and lung cancer in adults, and brain tumours in children. During 2010-2013, one year survival was over 80% for cancers of the prostate, breast, rectum, cervix and colon. Five-year survival was above 80% only for prostate cancer. For children, one and five-year survival was above 80% only for acute lymphoblastic leukaemia (ALL) and lymphoma. Survival was generally higher for women than men, and declined faster in women than men between 1 and 3 years after diagnosis. Differences between boys and girls were small. CONCLUSION Cancer survival improved for most Kuwaiti adults and children over the 14-year period, with women generally having a more favourable prognosis than men. Continuous surveillance is required to monitor cancers for which survival did not improve, and to dissect the underlying causes for the differences in survival between Kuwait and other countries.
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Affiliation(s)
- Eiman Alawadhi
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Ahmed Al-Awadi
- Kuwait Cancer Control Center, Ministry of Health, State of Kuwait
| | - Amani Elbasmi
- Kuwait Cancer Control Center, Ministry of Health, State of Kuwait
| | - Michel P Coleman
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Claudia Allemani
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, UK
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Bhakta N, Force LM, Allemani C, Atun R, Bray F, Coleman MP, Steliarova-Foucher E, Frazier AL, Robison LL, Rodriguez-Galindo C, Fitzmaurice C. Childhood cancer burden: a review of global estimates. Lancet Oncol 2019; 20:e42-e53. [PMID: 30614477 DOI: 10.1016/s1470-2045(18)30761-7] [Citation(s) in RCA: 195] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/04/2018] [Accepted: 10/08/2018] [Indexed: 12/18/2022]
Abstract
5-year net survival of children and adolescents diagnosed with cancer is approximately 80% in many high-income countries. This estimate is encouraging as it shows the substantial progress that has been made in the diagnosis and treatment of childhood cancer. Unfortunately, scarce data are available for low-income and middle-income countries (LMICs), where nearly 90% of children with cancer reside, suggesting that global survival estimates are substantially worse in these regions. As LMICs are undergoing a rapid epidemiological transition, with a shifting burden from infectious diseases to non-communicable diseases, cancer care for all ages has become a global focus. To improve outcomes for children and adolescents diagnosed with cancer worldwide, an accurate appraisal of the global burden of childhood cancer is a necessary first step. In this Review, we analyse four studies of the global cancer burden that included data for children and adolescents. Each study used various overlapping and non-overlapping statistical approaches and outcome metrics. Moreover, to provide guidance on improving future estimates of the childhood global cancer burden, we propose several recommendations to strengthen data collection and standardise analyses. Ultimately, these data could help stakeholders to develop plans for national and institutional cancer programmes, with the overall aim of helping to reduce the global burden of cancer in children and adolescents.
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Affiliation(s)
- Nickhill Bhakta
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA.
| | - Lisa M Force
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Claudia Allemani
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rifat Atun
- Harvard T H Chan School of Public Health and Harvard Medical School, Harvard University, Boston, MA, USA
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Michel P Coleman
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Eva Steliarova-Foucher
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - A Lindsay Frazier
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Carlos Rodriguez-Galindo
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Christina Fitzmaurice
- Division of Hematology, Department of Medicine, University of Washington, Seattle, WA, USA; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Affiliation(s)
- MP Coleman
- London School of Hygiene and Tropical Medicine, London, UK
| | - C Allemani
- London School of Hygiene and Tropical Medicine, London, UK
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Bailey C, Richardson LC, Allemani C, Bonaventure A, Harewood R, Moore AR, Stewart SL, Weir HK, Coleman MP. Adult leukemia survival trends in the United States by subtype: A population-based registry study of 370,994 patients diagnosed during 1995-2009. Cancer 2018; 124:3856-3867. [PMID: 30343495 PMCID: PMC6392057 DOI: 10.1002/cncr.31674] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/15/2018] [Accepted: 06/14/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND The lifetime risk of developing leukemia in the United States is 1.5%. There are challenges in the estimation of population-based survival using registry data because treatments and prognosis vary greatly by subtype. The objective of the current study was to determine leukemia survival estimates in the United States from 1995 to 2009 according to subtype, sex, geographical area, and race. METHODS Five-year net survival was estimated using data for 370,994 patients from 43 registries in 37 states and in 6 metropolitan areas, covering approximately 81% of the adult (15-99 years) US population. Leukemia was categorized according to principal subtype (chronic lymphocytic leukemia, acute myeloid leukemia, and acute lymphocytic leukemia), and subcategorized in accordance with the HAEMACARE protocol. We analyzed age-standardized 5-year net survival by calendar period (1995-1999, 2000-2004, and 2005-2009), leukemia subtype, sex, race, and US state. RESULTS The age-standardized 5-year net survival estimates increased from 45.0% for patients diagnosed during 1995-1999 to 49.0% for those diagnosed during 2000-2004 and 52.0% for those diagnosed during 2005-2009. For patients diagnosed during 2005-2009, 5-year survival was 18.2% (95% confidence interval [95% CI], 17.8%-18.6%) for acute myeloid leukemia, 44.0% (95% CI, 43.2%-44.8%) for acute lymphocytic leukemia, and 77.3% (95% CI, 76.9%-77.7%) for chronic lymphocytic leukemia. For nearly all leukemia subtypes, survival declined in successive age groups above 45 to 54 years. Men were found to have slightly lower survival than women; however, this discrepancy was noted to have fallen in successive calendar periods. Net survival was substantially higher in white than black patients in all calendar periods. There were large differences in survival noted between states and metropolitan areas. CONCLUSIONS Survival from leukemia in US adults improved during 1995-2009. Some geographical differences in survival may be related to access to care. We found disparities in survival by sex and between black and white patients.
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MESH Headings
- Adolescent
- Adult
- Age of Onset
- Aged
- Aged, 80 and over
- Female
- Humans
- Leukemia/classification
- Leukemia/diagnosis
- Leukemia/epidemiology
- Leukemia/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/mortality
- Male
- Middle Aged
- Mortality/trends
- Neoplasm Staging
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/mortality
- Prognosis
- Registries/statistics & numerical data
- SEER Program
- Survival Analysis
- United States/epidemiology
- Young Adult
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Affiliation(s)
- Chris Bailey
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lisa C. Richardson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Claudia Allemani
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Audrey Bonaventure
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rhea Harewood
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Angela R. Moore
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sherri L. Stewart
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hannah K. Weir
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michel P. Coleman
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Muller P, Walters S, Coleman MP, Woods L. Which indicators of early cancer diagnosis from population-based data sources are associated with short-term mortality and survival? Cancer Epidemiol 2018; 56:161-170. [PMID: 30056051 PMCID: PMC6189520 DOI: 10.1016/j.canep.2018.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/20/2018] [Accepted: 07/16/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND A key component of recent English cancer policy is the monitoring of trends in early diagnosis of cancer. Early diagnosis can be defined by the disease stage at diagnosis or by other indicators derived from electronic health records. We evaluate the association between different early diagnosis indicators and survival, and discuss the implementation of the indicators in surveillance of early diagnosis. METHODS We searched the PubMed database and grey literature to identify early diagnosis indicators and evaluate their association with survival. We analysed cancer registrations for 355,502 cancer patients diagnosed in England during the period 2009-2013, and quantified the association between each early diagnosis indicator and 30-day mortality and five-year net survival. RESULTS Each incremental difference in stage (I-IV) predicts lower 5-year survival, so prognostic information is lost in comparisons which use binary stage indicators. Patients without a recorded stage have high risk of death shortly following diagnosis and lower 5-year survival. Emergency presentation is independently associated with lower five-year survival. Shorter intervals between first symptoms and diagnosis are not consistently associated with improved survival, potentially due to confounding from tumour characteristics. INTERPRETATION Contrary to current practice, we recommend that all the stage information should be used in surveillance. Patients missing stage should also be included to minimise bias. Combined data on stage and emergency presentation could be used to create summary prognostic measures. More work is needed to create statistics based on the diagnostic interval that will be useful for surveillance.
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Affiliation(s)
- Patrick Muller
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | - Sarah Walters
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Michel P Coleman
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Laura Woods
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Chu TPC, Shah A, Walker D, Coleman MP. How Do Biological Characteristics of Primary Intracranial Tumors Affect Their Clinical Presentation in Children and Young Adults? J Child Neurol 2018; 33:503-511. [PMID: 29724124 DOI: 10.1177/0883073818767562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We demonstrated the pattern in presentation of primary intracranial tumors in a population-based cohort of patients aged 0-24 years identified from the National Cancer Registry for England, using linked medical records from primary care and hospitals. We used generalized additive models to estimate temporal changes in presentation rates. Borderline and malignant tumors presented at a similar rate in primary care (6.4 and 6.6 consultations per 100 patients each month) and in hospital (3.4 and 3.6). Benign tumors presented earlier but less frequently (rate = 4.4 and rate ratio = 0.75, 95% CI = 0.60-0.93, in primary care; rate = 2.6 and rate ratio = 0.83, 95% CI = 0.77-0.89, in hospital). Many tumors began presenting shortly before their diagnosis, but less aggressive tumors were likely to present earlier in primary care. Earlier detection of less aggressive tumors in primary care may reduce the risk of complications and morbidity among survivors.
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Affiliation(s)
- Thomas P C Chu
- 1 Cancer Survival Group, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Anjali Shah
- 2 Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - David Walker
- 3 Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - Michel P Coleman
- 1 Cancer Survival Group, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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White A, Rim SH, Joseph D, Johnson CJ, Coleman MP, Allemani C. Reply to Colon cancer survival in the US Department of Veterans Affairs by race and stage: 2001 through 2009. Cancer 2018; 124:2859-2860. [PMID: 29710371 PMCID: PMC6368182 DOI: 10.1002/cncr.31523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Arica White
- Division of Cancer Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sun Hee Rim
- Division of Cancer Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Djenaba Joseph
- Division of Cancer Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Michel P. Coleman
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Claudia Allemani
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Di Girolamo C, Walters S, Benitez Majano S, Rachet B, Coleman MP, Njagi EN, Morris M. Characteristics of patients with missing information on stage: a population-based study of patients diagnosed with colon, lung or breast cancer in England in 2013. BMC Cancer 2018; 18:492. [PMID: 29716543 PMCID: PMC5930770 DOI: 10.1186/s12885-018-4417-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 04/20/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Stage is a key predictor of cancer survival. Complete cancer staging is vital for understanding outcomes at population level and monitoring the efficacy of early diagnosis initiatives. Cancer registries usually collect details of the disease extent but staging information may be missing because a stage was never assigned to a patient or because it was not included in cancer registration records. Missing stage information introduce methodological difficulties for analysis and interpretation of results. We describe the associations between missing stage and socio-demographic and clinical characteristics of patients diagnosed with colon, lung or breast cancer in England in 2013. We assess how these associations change when completeness is high, and administrative issues are assumed to be minimal. We estimate the amount of avoidable missing stage data if high levels of completeness reached by some Clinical Commissioning Groups (CCGs), were achieved nationally. METHODS Individual cancer records were retrieved from the National Cancer Registration and linked to the Routes to Diagnosis and Hospital Episode Statistics datasets to obtain additional clinical information. We used multivariable beta binomial regression models to estimate the strength of the association between socio-demographic and clinical characteristics of patients and missing stage and to derive the amount of avoidable missing stage. RESULTS Multivariable modelling showed that old age was associated with missing stage irrespective of the cancer site and independent of comorbidity score, short-term mortality and patient characteristics. This remained true for patients in the CCGs with high completeness. Applying the results from these CCGs to the whole cohort showed that approximately 70% of missing stage information was potentially avoidable. CONCLUSIONS Missing stage was more frequent in older patients, including those residing in CCGs with high completeness. This disadvantage for older patients was not explained fully by the presence of comorbidity. A substantial gain in completeness could have been achieved if administrative practices were improved to the level of the highest performing areas. Reasons for missing stage information should be carefully assessed before any study, and potential distortions introduced by how missing stage is handled should be considered in order to draw the most correct inference from available statistics.
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Affiliation(s)
- Chiara Di Girolamo
- Cancer Survival Group, Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
- Department of Medical and Surgical Sciences, Alma Mater Studiorum – University of Bologna, Via Zamboni, 33 40126 Bologna, Italy
| | - Sarah Walters
- Cancer Survival Group, Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Sara Benitez Majano
- Cancer Survival Group, Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Bernard Rachet
- Cancer Survival Group, Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Michel P. Coleman
- Cancer Survival Group, Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Edmund Njeru Njagi
- Cancer Survival Group, Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
| | - Melanie Morris
- Cancer Survival Group, Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
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Allemani C, Matsuda T, Di Carlo V, Harewood R, Matz M, Nikšić M, Bonaventure A, Valkov M, Johnson CJ, Estève J, Ogunbiyi OJ, Azevedo E Silva G, Chen WQ, Eser S, Engholm G, Stiller CA, Monnereau A, Woods RR, Visser O, Lim GH, Aitken J, Weir HK, Coleman MP. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet 2018; 391:1023-1075. [PMID: 29395269 PMCID: PMC5879496 DOI: 10.1016/s0140-6736(17)33326-3] [Citation(s) in RCA: 2730] [Impact Index Per Article: 455.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/05/2017] [Accepted: 12/07/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND In 2015, the second cycle of the CONCORD programme established global surveillance of cancer survival as a metric of the effectiveness of health systems and to inform global policy on cancer control. CONCORD-3 updates the worldwide surveillance of cancer survival to 2014. METHODS CONCORD-3 includes individual records for 37·5 million patients diagnosed with cancer during the 15-year period 2000-14. Data were provided by 322 population-based cancer registries in 71 countries and territories, 47 of which provided data with 100% population coverage. The study includes 18 cancers or groups of cancers: oesophagus, stomach, colon, rectum, liver, pancreas, lung, breast (women), cervix, ovary, prostate, and melanoma of the skin in adults, and brain tumours, leukaemias, and lymphomas in both adults and children. Standardised quality control procedures were applied; errors were rectified by the registry concerned. We estimated 5-year net survival. Estimates were age-standardised with the International Cancer Survival Standard weights. FINDINGS For most cancers, 5-year net survival remains among the highest in the world in the USA and Canada, in Australia and New Zealand, and in Finland, Iceland, Norway, and Sweden. For many cancers, Denmark is closing the survival gap with the other Nordic countries. Survival trends are generally increasing, even for some of the more lethal cancers: in some countries, survival has increased by up to 5% for cancers of the liver, pancreas, and lung. For women diagnosed during 2010-14, 5-year survival for breast cancer is now 89·5% in Australia and 90·2% in the USA, but international differences remain very wide, with levels as low as 66·1% in India. For gastrointestinal cancers, the highest levels of 5-year survival are seen in southeast Asia: in South Korea for cancers of the stomach (68·9%), colon (71·8%), and rectum (71·1%); in Japan for oesophageal cancer (36·0%); and in Taiwan for liver cancer (27·9%). By contrast, in the same world region, survival is generally lower than elsewhere for melanoma of the skin (59·9% in South Korea, 52·1% in Taiwan, and 49·6% in China), and for both lymphoid malignancies (52·5%, 50·5%, and 38·3%) and myeloid malignancies (45·9%, 33·4%, and 24·8%). For children diagnosed during 2010-14, 5-year survival for acute lymphoblastic leukaemia ranged from 49·8% in Ecuador to 95·2% in Finland. 5-year survival from brain tumours in children is higher than for adults but the global range is very wide (from 28·9% in Brazil to nearly 80% in Sweden and Denmark). INTERPRETATION The CONCORD programme enables timely comparisons of the overall effectiveness of health systems in providing care for 18 cancers that collectively represent 75% of all cancers diagnosed worldwide every year. It contributes to the evidence base for global policy on cancer control. Since 2017, the Organisation for Economic Co-operation and Development has used findings from the CONCORD programme as the official benchmark of cancer survival, among their indicators of the quality of health care in 48 countries worldwide. Governments must recognise population-based cancer registries as key policy tools that can be used to evaluate both the impact of cancer prevention strategies and the effectiveness of health systems for all patients diagnosed with cancer. FUNDING American Cancer Society; Centers for Disease Control and Prevention; Swiss Re; Swiss Cancer Research foundation; Swiss Cancer League; Institut National du Cancer; La Ligue Contre le Cancer; Rossy Family Foundation; US National Cancer Institute; and the Susan G Komen Foundation.
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Affiliation(s)
- Claudia Allemani
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Tomohiro Matsuda
- Population-based Cancer Registry Section, Division of Surveillance, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Veronica Di Carlo
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rhea Harewood
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Melissa Matz
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Maja Nikšić
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Audrey Bonaventure
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Mikhail Valkov
- Department of Radiology, Radiotherapy and Oncology, Northern State Medical University, Arkhangelsk, Russia
| | | | - Jacques Estève
- Department of Biostatistics, Université Claude Bernard, Lyon, France
| | - Olufemi J Ogunbiyi
- Ibadan Cancer Registry, University City College Hospital, Ibadan, Dyo State, Nigeria
| | - Gulnar Azevedo E Silva
- Department of Epidemiology, Universidade do Estado do Rio de Janeiro, Maracanã, Rio de Janeiro, Brazil
| | - Wan-Qing Chen
- National Office for Cancer Prevention and Control and National Central Cancer Registry, National Cancer Center, Beijing, China
| | - Sultan Eser
- Department of Public Health, Balıkesir University, Balıkesir, Turkey
| | - Gerda Engholm
- Department of Documentation and Quality, Danish Cancer Society, Copenhagen, Denmark
| | - Charles A Stiller
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Alain Monnereau
- Registre des hémopathies malignes de la Gironde, Institut Bergonié, Bordeaux, France; French Network of Cancer Registries, Toulouse, France
| | - Ryan R Woods
- British Columbia Cancer Registry, BC Cancer Agency, Vancouver, BC, Canada
| | - Otto Visser
- Netherlands Cancer Registry Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands
| | - Gek Hsiang Lim
- National Registry of Diseases Office, Health Promotion Board, Singapore
| | - Joanne Aitken
- Cancer Council Queensland, Fortitude Valley, QLD, Australia
| | - Hannah K Weir
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michel P Coleman
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Exarchakou A, Rachet B, Belot A, Maringe C, Coleman MP. Impact of national cancer policies on cancer survival trends and socioeconomic inequalities in England, 1996-2013: population based study. BMJ 2018; 360:k764. [PMID: 29540358 PMCID: PMC5850596 DOI: 10.1136/bmj.k764] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the effectiveness of the NHS Cancer Plan (2000) and subsequent national cancer policy initiatives in improving cancer survival and reducing socioeconomic inequalities in survival in England. DESIGN Population based cohort study. SETTING England. POPULATION More than 3.5 million registered patients aged 15-99 with a diagnosis of one of the 24 most common primary, malignant, invasive neoplasms between 1996 and 2013. MAIN OUTCOME MEASURES Age standardised net survival estimates by cancer, sex, year, and deprivation group. These estimates were modelled using regression model with splines to explore changes in the cancer survival trends and in the socioeconomic inequalities in survival. RESULTS One year net survival improved steadily from 1996 for 26 of 41 sex-cancer combinations studied, and only from 2001 or 2006 for four cancers. Trends in survival accelerated after 2006 for five cancers. The deprivation gap observed for all 41 sex-cancer combinations among patients with a diagnosis in 1996 persisted until 2013. However, the gap slightly decreased for six cancers among men for which one year survival was more than 65% in 1996, and for cervical and uterine cancers, for which survival was more than 75% in 1996. The deprivation gap widened notably for brain tumours in men and for lung cancer in women. CONCLUSIONS Little evidence was found of a direct impact of national cancer strategies on one year survival, and no evidence for a reduction in socioeconomic inequalities in cancer survival. These findings emphasise that socioeconomic inequalities in survival remain a major public health problem for a healthcare system founded on equity.
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Affiliation(s)
- Aimilia Exarchakou
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Bernard Rachet
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Aurélien Belot
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Camille Maringe
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Michel P Coleman
- Cancer Survival Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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Di Girolamo C, Walters S, Gildea C, Benitez Majano S, Coleman MP, Rachet B, Morris M. Which patients are not included in the English Cancer Waiting Times monitoring dataset, 2009-2013? Implications for use of the data in research. Br J Cancer 2018; 118:733-737. [PMID: 29348489 PMCID: PMC5846064 DOI: 10.1038/bjc.2017.452] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/16/2017] [Accepted: 11/16/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cancer waiting time targets are routinely monitored in England, but the Cancer Waiting Times monitoring dataset (CWT) does not include all eligible patients, introducing scope for bias. METHODS Data from adults diagnosed in England (2009-2013) with colorectal, lung, or ovarian cancer were linked from CWT to cancer registry, mortality, and Hospital Episode Statistics data. We present demographic characteristics and net survival for patients who were and were not included in CWT. RESULTS A CWT record was found for 82% of colorectal, 76% of lung, and 77% of ovarian cancer patients. Patients not recorded in CWT were more likely to be in the youngest or oldest age groups, have more comorbidities, have been diagnosed through emergency presentation, have late or missing stage, and have much poorer survival. CONCLUSIONS Researchers and policy-makers should be aware of the limitations in the completeness and representativeness of CWT, and draw conclusions with appropriate caution.
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Affiliation(s)
- C Di Girolamo
- Cancer Survival Group, Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Zamboni, 33, 40126 Bologna, Italy
| | - S Walters
- Cancer Survival Group, Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - C Gildea
- National Cancer Registration and Analysis Service, Public Health England, Vulcan House Steel, 6 Millsands, Sheffield S3 8NU, UK
| | - S Benitez Majano
- Cancer Survival Group, Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - M P Coleman
- Cancer Survival Group, Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - B Rachet
- Cancer Survival Group, Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - M Morris
- Cancer Survival Group, Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Micheli A, Sanz N, Mwangi-Powell F, Coleman MP, Neal C, Ullrich A, Travado L, Santini LA, Grassi L, De Lorenzo F, Costa A, Dangou JM, Bisanti L, Costantini AS, Abu-Rmeileh N, Kamal M, Federico M, Saracci R, Rennert G, Stefanini A, Cavalli F, Cazap E, Redmond K, O?Reilly S, Muti P, Casali P, Gatta G, Ferrari A, Koifman S, Bah E, Pastore G, Barr R, Lombardo C, Frazzingaro C, Ciampichini R, Baili P. International collaborations in cancer control and the Third International Cancer Control Congress. Tumori 2018; 95:579-96. [DOI: 10.1177/030089160909500502] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Over the past few decades, there has been growing support for the idea that cancer needs an interdisciplinary approach. Therefore, the international cancer community has developed several strategies as outlined in the WHO non-communicable diseases Action Plan (which includes cancer control) as the World Health Assembly and the UICC World Cancer Declaration, which both include primary prevention, early diagnosis, treatment, and palliative care. This paper highlights experiences/ideas in cancer control for international collaborations between low, middle, and high income countries, including collaborations between the European Union (EU) and African Union (AU) Member States, the Latin-American and Caribbean countries, and the Eastern Mediterranean countries. These proposals are presented within the context of the global vision on cancer control set forth by WHO in partnership with the International Union Against Cancer (UICC), in addition to issues that should be considered for collaborations at the global level: cancer survival (similar to the project CONCORD), cancer control for youth and adaptation of Clinical Practice Guidelines. Since cancer control is given lower priority on the health agenda of low and middle income countries and is less represented in global health efforts in those countries, EU and AU cancer stakeholders are working to put cancer control on the agenda of the EU-AU treaty for collaborations, and are proposing to consider palliative care, population-based cancer registration, and training and education focusing on primary prevention as core tools. A Community of Practice, such as the Third International Cancer Control Congress (ICCC-3), is an ideal place to share new proposals, learn from other experiences, and formulate new ideas. The aim of the ICCC-3 is to foster new international collaborations to promote cancer control actions in low and middle income countries. The development of supranational collaborations has been hindered by the fact that cancer control is not part of the objectives of the Millennium Development Goals (MGGs). As a consequence, less resources of development aids are allocated to control NCDs including cancer.
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Affiliation(s)
- Andrea Micheli
- Descriptive studies and health planning unit, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | - Natalia Sanz
- Descriptive studies and health planning unit, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | | | - Michel P Coleman
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Andreas Ullrich
- Diseases and Health Promotion, World Health Organization (WHO), Geneva, Switzerland
| | - Luzia Travado
- National Coordination for Oncology Diseases, High Commission for Health, Lisbon, Portugal
| | | | - Luigi Grassi
- Section of Psychiatry, University of Ferrara, Italy
| | | | | | | | - Luigi Bisanti
- Epidemiology Unit, Local Health Authority of Milan, Milan, Italy
| | - Adele Seniori Costantini
- Occupational and Environmental Epidemiology Unit, ISPO Cancer Prevention and Research Institute, Florence, Italy
| | - Niveen Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University West Bank, Palestinian Authority
| | - Mostafa Kamal
- Egyptian Smoking Prevention Research Institute, Cairo, Egypt
| | | | | | - Gad Rennert
- National Israeli Breast and Colorectal Cancer Detection Programs Ministry of Health and Israel Cancer Association, Department of Community Medicine and Epidemiology Carmel Medical Center and B. Rappaport Faculty of Medicine, Technion, Israel
| | - Angelo Stefanini
- Office of Development Cooperation, Consulate General of Italy, Jerusalem (on leave from the University of Bologna, Italy), Jerusalem, Israel
| | - Franco Cavalli
- International Union Against Cancer (UICC), Geneva, Switzerland
| | - Eduardo Cazap
- Latino American and Caribbean Society of Medical Oncology (SLACOM), Buenos Aires, Argentina
| | - Kathy Redmond
- Cancer World Magazine and Media Program, European School of Oncology, Milan, Italy
| | - Susan O?Reilly
- British Columbia Cancer Agency, Division of Medical Oncology Department of Medicine at the University of British Columbia, Vancouver, Canada
| | - Paola Muti
- Italian National Cancer Institute “Regina Elena”, Rome, Italy
| | - Paolo Casali
- Oncology Medicine Unit, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | - Gemma Gatta
- Evaluation Epidemiology Unit, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | - Andrea Ferrari
- Paedriatic Oncology Unit, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | | | - Ebrima Bah
- International Agency for Cancer Research (IARC), Banjul, Gambia
| | | | | | - Claudio Lombardo
- National Institute for Cancer Research of Genoa, Genoa, and Alleanza Contro il Cancro, Rome
| | - Cristina Frazzingaro
- Descriptive studies and health planning unit, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | - Roberta Ciampichini
- Descriptive studies and health planning unit, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
| | - Paolo Baili
- Descriptive studies and health planning unit, Fondazione IRCCS “Istituto Nazionale dei Tumori”, Milan, Italy
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Abstract
Cancer is a growing global health issue, and many countries are ill-prepared to deal with their current cancer burden let alone the increased burden looming on the horizon. Growing and aging populations are projected to result in dramatic increases in cancer cases and cancer deaths particularly in low- and middle-income countries. It is imperative that planning begin now to deal not only with those cancers already occurring but also with the larger numbers expected in the future. Unfortunately, such planning is hampered, because the magnitude of the burden of cancer in many countries is poorly understood owing to lack of surveillance and monitoring systems for cancer risk factors and for the documentation of cancer incidence, survival and mortality. Moreover, the human resources needed to fight cancer effectively are often limited or lacking. Cancer diagnosis and cancer care services are also inadequate in low-and middle-income countries. Late-stage presentation of cancers is very common in these settings resulting in less potential for cure and more need for symptom management. Palliative care services are grossly inadequate in low- and middle-income countries, and many cancer patients die unnecessarily painful deaths. Many of the challenges faced by low- and middle-income countries have been at least partially addressed by higher income countries. Experiences from around the world are reviewed to highlight the issues and showcase some possible solutions.
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Affiliation(s)
| | | | | | - Paul Ndom
- Oncology Service, General Hospital of Yaounde, Yaounde, Camaroon
| | | | - Michel P Coleman
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Baili P, Micheli A, De Angelis R, Weir HK, Francisci S, Santaquilani M, Hakulinen T, Quaresma M, Coleman MP. Life Tables for World-Wide Comparison of Relative Survival for Cancer (CONCORD Study). Tumori 2018; 94:658-68. [DOI: 10.1177/030089160809400503] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The CONCORD study compares population-based relative survival from cancer using data from cancer registries in five continents. To estimate relative survival, general mortality life tables are required. Available statistics are incomplete, so various approaches are used to construct complete life tables. This article outlines how the life tables were constructed for CONCORD; it compares life expectancy at birth between 101 populations covered by cancer registries in 31 countries and compares the impact of two approaches to the deployment of life tables in relative survival analysis. Methods The CONCORD approach, using specific mathematical methods, produced complete (single-year-of-age) life tables by sex, cancer registry area, calendar year (1990–1999) and race (only in the USA). In order to study the impact of different approaches, we compared relative survival in the USA using the US national life table, centered on the relevant census years, and the CONCORD approach. We estimated relative survival in each American participating cancer registry for patients diagnosed with breast (women), colorectal or prostate cancer during 1990–1994 and followed up to 1999. Results Average life expectancy at birth during 1990–1999 varied in CONCORD cancer registry areas from 64 to 78 years in males and from 71 to 84 years in females. It increased during the 1990s more in men than in women. In the USA, it was lower in blacks than in whites. Relative survival in American populations was lower with the CONCORD approach, which incorporates trends and geographic variation in background mortality, than with the USA census life tables. Conclusions International variation in background mortality by geographic area, calendar time, race, age and sex is wide. We suggest that in international comparisons of cancer relative survival, complete life tables that are specific for cancer registry area, calendar year and race should be used.
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Affiliation(s)
- Paolo Baili
- Descriptive Epidemiology and Health Planning Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Micheli
- Descriptive Epidemiology and Health Planning Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberta De Angelis
- Istituto Superiore di Sanità, National Center of Epidemiology, Surveillance and Health Promotion, Cancer Epidemiology Unit, Rome, Italy
| | - Hannah K Weir
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Silvia Francisci
- Istituto Superiore di Sanità, National Center of Epidemiology, Surveillance and Health Promotion, Cancer Epidemiology Unit, Rome, Italy
| | - Mariano Santaquilani
- Istituto Superiore di Sanità, National Center of Epidemiology, Surveillance and Health Promotion, Cancer Epidemiology Unit, Rome, Italy
| | | | - Manuela Quaresma
- Cancer Research UK Cancer Survival Group, Non-Communicable Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, UK
| | - Michel P Coleman
- Cancer Research UK Cancer Survival Group, Non-Communicable Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, UK
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Forgacs I, Ashton R, Allum W, Bowley T, Brown H, Coleman MP, Fitzgerald R, Glynn M, Hiom S, Jones R, Machesney M, Maher J, Pereira SP, Steele R, Veitch A, Wyatt S. Conference report: improving outcomes for gastrointestinal cancer in the UK. Frontline Gastroenterol 2018; 9:49-61. [PMID: 29484161 PMCID: PMC5824771 DOI: 10.1136/flgastro-2016-100713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 05/10/2016] [Indexed: 02/04/2023] Open
Affiliation(s)
| | | | | | | | - Hilary Brown
- College of Social Sciences, University of Birmingham, Birmingham, UK
| | | | | | - Michael Glynn
- Royal London Hospital—Barts Health NHS Trust, London, UK
| | | | - Roger Jones
- Royal College of General Practitioners, London, UK
| | | | | | | | - Robert Steele
- University of Dundee and Clinical Direction of Scottish Bowel Screening Programme
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Tai EW, Ward KC, Bonaventure A, Siegel DA, Coleman MP. Survival among children diagnosed with acute lymphoblastic leukemia in the United States, by race and age, 2001 to 2009: Findings from the CONCORD-2 study. Cancer 2017; 123 Suppl 24:5178-5189. [PMID: 29205314 PMCID: PMC6075705 DOI: 10.1002/cncr.30899] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 06/14/2017] [Accepted: 07/05/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy. This report describes the survival of children with ALL in the United States using the most comprehensive and up-to-date cancer registry data. METHODS Data from 37 state cancer registries that cover approximately 80% of the US population were used. Age-standardized survival up to 5 years was estimated for children aged 0-14 years who were diagnosed with ALL during 2 periods (2001-2003 and 2004-2009). RESULTS In total, 17,500 children with ALL were included. The pooled age-standardized net survival estimates for all US registries combined were 95% at 1 year, 90% at 3 years, and 86% at 5 years for children diagnosed during 2001-2003, and 96%, 91%, and 88%, respectively, for those diagnosed during 2004-2009. Black children who were diagnosed during 2001-2003 had lower 5-year survival (84%) than white children (87%) and had less improvement in survival by 2004-2009. For those diagnosed during 2004-2009, the 1-year and 5-year survival estimates were 96% and 89%, respectively, for white children and 96% and 84%, respectively, for black children. During 2004-2009, survival was highest among children aged 1 to 4 years (95%) and lowest among children aged <1 year (60%). CONCLUSIONS The current results indicate that overall net survival from childhood ALL in the United States is high, but disparities by race still exist, especially beyond the first year after diagnosis. Clinical and public health strategies are needed to improve health care access, clinical trial enrollment, treatment, and survivorship care for children with ALL. Cancer 2017;123:5178-89. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- Eric W. Tai
- Division of Cancer Prevention and Control, Centers for
Disease Control and Prevention, Atlanta, Georgia
| | - Kevin C. Ward
- Georgia Center for Cancer Statistics, Emory University,
Atlanta, Georgia
| | - Audrey Bonaventure
- Cancer Survival Group, Department of Epidemiology and
Population Health, London School of Hygiene and Tropical Medicine, London, United
Kingdom
| | - David A. Siegel
- Aflac Cancer and Blood Disorders Center of
Children’s Healthcare of Atlanta, Emory University School of Medicine,
Atlanta, Georgia
| | - Michel P. Coleman
- Cancer Survival Group, Department of Epidemiology and
Population Health, London School of Hygiene and Tropical Medicine, London, United
Kingdom
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49
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Joseph DA, Johnson CJ, White A, Wu M, Coleman MP. Rectal cancer survival in the United States by race and stage, 2001 to 2009: Findings from the CONCORD-2 study. Cancer 2017; 123 Suppl 24:5037-5058. [PMID: 29205308 PMCID: PMC6191027 DOI: 10.1002/cncr.30882] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/22/2017] [Accepted: 06/14/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND In the first CONCORD study, 5-year survival for patients with diagnosed with rectal cancer between 1990 and 1994 was <60%, with large racial disparities noted in the majority of participating states. We have updated these findings to 2009 by examining population-based survival by stage of disease at the time of diagnosis, race, and calendar period. METHODS Data from the CONCORD-2 study were used to compare survival among individuals aged 15 to 99 years who were diagnosed in 37 states encompassing up to 80% of the US population. We estimated net survival up to 5 years after diagnosis correcting for background mortality with state-specific and race-specific life table. Survival estimates were age-standardized with the International Cancer Survival Standard weights. We present survival estimates by race (all, black, and white) for 2001 through 2003 and 2004 through 2009 to account for changes in collecting the data for Surveillance, Epidemiology, and End Results Summary Stage 2000. RESULTS There was a small increase in 1-year, 3-year, and 5-year net survival between 2001-2003 (84.6%, 70.7%, and 63.2%, respectively), and 2004-2009 (85.1%, 71.5%, and 64.1%, respectively). Black individuals were found to have lower 1-year, 3-year, and 5-year survival than white individuals in both periods; the absolute difference in survival between black and white individuals declined only for 5-year survival. Black patients had lower 5-year survival than whites at each stage at the time of diagnosis in both time periods. CONCLUSIONS There was little improvement noted in net survival for patients with rectal cancer, with persistent disparities noted between black and white individuals. Additional investigation is needed to identify and implement effective interventions to ensure the consistent and equitable use of high-quality screening, diagnosis, and treatment to improve survival for patients with rectal cancer. Cancer 2017;123:5037-58. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- Djenaba A. Joseph
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Chris J. Johnson
- Cancer Data Registry of Idaho, Idaho Hospital Association, Boise, ID
| | - Arica White
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Manxia Wu
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Michel P. Coleman
- Cancer Survival Group, Non-Communicable Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, UK
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50
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Allemani C, Coleman MP. Public health surveillance of cancer survival in the United States and worldwide: The contribution of the CONCORD programme. Cancer 2017; 123 Suppl 24:4977-4981. [PMID: 29205301 PMCID: PMC6191026 DOI: 10.1002/cncr.30854] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/16/2017] [Accepted: 06/05/2017] [Indexed: 11/11/2022]
Abstract
CONCORD is a programme for the global surveillance of cancer survival. In 2015, the second cycle of the program (CONCORD-2) established long-term surveillance of cancer survival worldwide, for the first time, in the largest cancer survival study published to date. CONCORD-2 provided cancer survival trends for 25,676,887 patients diagnosed during the 15-year period between 1995 and 2009 with 1 of 10 common cancers that collectively represented 63% of the global cancer burden in 2009. Herein, the authors summarize the past, describe the present, and outline the future of the CONCORD programme. They discuss the difference between population-based studies and clinical trials, and review the importance of international comparisons of population-based cancer survival. This study will focus on the United States. The authors explain why population-based survival estimates are crucial for driving effective cancer control strategies to reduce the wide and persistent disparities in cancer survival between white and black patients, which are likely to be attributable to differences in access to early diagnosis and optimal treatment. Cancer 2017;123:4977-81. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- Claudia Allemani
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michel P Coleman
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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