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Guimarães Ribeiro A, Ferlay J, Vaccarella S, Dias de Oliveira Latorre MDR, Tavares Guerreiro Fregnani JH, Bray F. Ethnic disparities in cancer mortality in the capital and northeast of the State of São Paulo, Brazil 2001-17. Cancer Causes Control 2024; 35:523-529. [PMID: 37917366 DOI: 10.1007/s10552-023-01812-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/04/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE There is a paucity of studies investigating cancer disparities in groups defined by ethnicity in transitioning economies. We examined the influence of ethnicity on mortality for the leading cancer types in São Paulo, Brazil, comparing patterns in the capital and the northeast of the state. METHODS Cancer deaths were obtained from a Brazilian public government database for the Barretos region (2003-2017) and the municipality of São Paulo (2001-2015). Age-standardized rates (ASR) per 100,000 persons-years, by cancer type and sex, for five self-declared racial classifications (white, black, eastern origin (Asian), mixed ethnicity (pardo), and indigenous Brazilians), were calculated using the world standard population. RESULTS Black Brazilians had higher mortality rates for most common cancer types in Barretos, whereas in São Paulo, white Brazilians had higher rates of mortality from breast, colorectal, and lung cancer. In both regions, lung cancer was the leading cause of cancer death among white, black, and pardo Brazilians, with colorectal cancer deaths leading among Asian Brazilians. Black and pardo Brazilians had higher cervical cancer mortality rates than white Brazilians. CONCLUSION There are substantial disparities in mortality from different cancers in São Paulo according to ethnicity, pointing to inequities in access to health care services.
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Affiliation(s)
- Adeylson Guimarães Ribeiro
- Cancer Surveillance Branch, International Agency for Research On Cancer, 25 Avenue Tony Garnier, CS 90627, 69366, Lyon Cedex 07, France.
- Educational and Research Institute, Barretos Cancer Hospital, Barretos, Brazil.
| | - Jacques Ferlay
- Cancer Surveillance Branch, International Agency for Research On Cancer, 25 Avenue Tony Garnier, CS 90627, 69366, Lyon Cedex 07, France
| | - Salvatore Vaccarella
- Cancer Surveillance Branch, International Agency for Research On Cancer, 25 Avenue Tony Garnier, CS 90627, 69366, Lyon Cedex 07, France
| | | | | | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research On Cancer, 25 Avenue Tony Garnier, CS 90627, 69366, Lyon Cedex 07, France
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Drevinskaite M, Kaceniene A, Patasius A, Stukas R, Germanavicius A, Miseikyte E, Urbonas V, Smailyte G. Cancer mortality and morbidity among patients with schizophrenia: A hospital-based cohort study, 1992-2020. Acta Psychiatr Scand 2024; 149:234-243. [PMID: 38173088 DOI: 10.1111/acps.13651] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/27/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE Due to the inconsistency of the evidence about the cancer risk among patients with schizophrenia, the aim of this study was to analyse cancer mortality and morbidity in patients with schizophrenia treated in a single centre in Lithuania during the study period of 1992-2020. MATERIALS AND METHODS A retrospective cohort study was conducted in Vilnius Republican Psychiatric Hospital, the biggest specialised psychiatric hospital in Lithuania, with approximately 5000 hospital admissions annually. The patients' cohort was established by identifying all patients with the diagnosis of schizophrenia (ICD-10 code F20) in the hospital database from 1 January 1992 until 31 December 2017. The cancer cases and cancer deaths in the cohort were identified in the Lithuanian Cancer Register through linkage procedures. The analysis of risk was based on a comparison of observed and expected numbers of cancers and deaths. Expected number of cancer cases were calculated by multiplication of the exact person-years under observation in the cohort by sex, calendar year and a 5-year age-group-specific national incidence and mortality rate. All statistical analyses were carried out using STATA 15 statistical software. RESULTS During the follow-up, out of 8553 patients, 673 cases of cancer were diagnosed in both sexes. Statistically significantly lower risk for overall cancer incidence was observed in men (SIR 0.74, 95% CI 0.66-0.83), but not in women (SIR 1.07, 95% CI 0.97-1.18). Statistically significant lower overall cancer mortality risk was observed in men (SMR 0.82, 95% CI 0.70-0.96), while in the women's group, risk of cancer deaths was significantly higher compared to the general population (SMR 1.28, 95% CI 1.11-1.48). We observed lower risk for pancreatic cancer (SIR 0.36, 95% CI 0.14-0.96), non-melanoma skin cancer (SIR 0.54, 95% CI 0.33-0.88) and prostate cancer (SIR 0.69, 95% CI 0.55-0.87) in men and higher risk for malignant neoplasm of liver (SIR 2.58, 95% CI 1.53-4.36) and skin melanoma (SIR 2.03, 95% CI 1.12-3.66) in men and for breast cancer (SIR 1.38, 95% CI 1.14-1.66) and corpus uteri cancer (SIR 1.56, 95% CI 1.18-2.07) in women. CONCLUSIONS The current results of our study indicate lower risk of overall cancer incidence and mortality in male patients with schizophrenia, while female patients had a higher mortality risk, alongside variations in the risk of different cancer types. This information is important not only for patients, but for healthcare specialists to develop effective disease-specific preventive interventions and programmes.
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Affiliation(s)
- M Drevinskaite
- Laboratory of Cancer Epidemiology, National Cancer Institute, Vilnius, Lithuania
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - A Kaceniene
- Laboratory of Cancer Epidemiology, National Cancer Institute, Vilnius, Lithuania
| | - A Patasius
- Laboratory of Cancer Epidemiology, National Cancer Institute, Vilnius, Lithuania
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - R Stukas
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - A Germanavicius
- Clinic of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Psychiatry, Republican Vilnius Psychiatric Hospital, Vilnius, Lithuania
| | - E Miseikyte
- Department of Psychiatry, Republican Vilnius Psychiatric Hospital, Vilnius, Lithuania
| | - V Urbonas
- Laboratory of Clinical Oncology, National Cancer Institute, Vilnius, Lithuania
| | - G Smailyte
- Laboratory of Cancer Epidemiology, National Cancer Institute, Vilnius, Lithuania
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Boull C, Levy R, Huang JT. Survival of Childhood Cancer and Subsequent Clinical Care. JAMA 2024; 331:616-617. [PMID: 38497702 DOI: 10.1001/jama.2023.26987] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Affiliation(s)
- Christina Boull
- Department of Dermatology, University of Minnesota, Minneapolis
| | - Rebecca Levy
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer T Huang
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
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Bhatia S, Tonorezos ES, Landier W. Survival of Childhood Cancer and Subsequent Clinical Care-Reply. JAMA 2024; 331:617. [PMID: 38497699 DOI: 10.1001/jama.2023.26984] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Affiliation(s)
- Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
| | - Emily S Tonorezos
- Office of Cancer Survivorship, National Cancer Institute, Rockville, Maryland
| | - Wendy Landier
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
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Corredor C, Piñeros M, Wiesner C, de Vries E. Using administrative registries as a source for population-based cancer incidence and mortality. BMC Cancer 2024; 24:232. [PMID: 38373947 PMCID: PMC10875795 DOI: 10.1186/s12885-023-11754-w] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/12/2023] [Indexed: 02/21/2024] Open
Affiliation(s)
- C Corredor
- Cancer Surveillance Group, National Cancer Institute, Bogotá, D. C, Colombia.
| | - M Piñeros
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - C Wiesner
- General Direction, National Cancer Institute, Bogotá, D. C, Colombia
| | - E de Vries
- Department of Clinical Epidemiology and Biostatistics. Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, D. C, Colombia
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Liu C, Zhang Q, Liu C, Liu T, Song M, Zhang Q, Xie H, Lin S, Ren J, Chen Y, Zheng X, Shi J, Deng L, Shi H, Wu S. Age Differences in the Association of Sleep Duration Trajectory With Cancer Risk and Cancer-Specific Mortality: Prospective Cohort Study. JMIR Public Health Surveill 2024; 10:e50836. [PMID: 38324354 PMCID: PMC10882471 DOI: 10.2196/50836] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/21/2023] [Accepted: 12/13/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Baseline sleep duration is associated with cancer risk and cancer-specific mortality; however, the association between longitudinal patterns of sleep duration and these risks remains unknown. OBJECTIVE This study aimed to elucidate the association between sleep duration trajectory and cancer risk and cancer-specific mortality. METHODS The participants recruited in this study were from the Kailuan cohort, with all participants aged between 18 and 98 years and without cancer at baseline. The sleep duration of participants was continuously recorded in 2006, 2008, and 2010. Latent mixture modeling was used to identify shared sleep duration trajectories. Furthermore, the Cox proportional risk model was used to examine the association of sleep duration trajectory with cancer risk and cancer-specific mortality. RESULTS A total of 53,273 participants were included in the present study, of whom 40,909 (76.79%) were men and 12,364 (23.21%) were women. The average age of the participants was 49.03 (SD 11.76) years. During a median follow-up of 10.99 (IQR 10.27-11.15) years, 2705 participants developed cancers. Three sleep duration trajectories were identified: normal-stable (44,844/53,273, 84.18%), median-stable (5877/53,273, 11.03%), and decreasing low-stable (2552/53,273, 4.79%). Compared with the normal-stable group, the decreasing low-stable group had increased cancer risk (hazard ratio [HR] 1.39, 95% CI 1.16-1.65) and cancer-specific mortality (HR 1.54, 95% CI 1.18-2.06). Dividing the participants by an age cutoff of 45 years revealed an increase in cancer risk (HR 1.88, 95% CI 1.30-2.71) and cancer-specific mortality (HR 2.52, 95% CI 1.22-5.19) only in participants younger than 45 years, rather than middle-aged or older participants. Joint analysis revealed that compared with participants who had a stable sleep duration within the normal range and did not snore, those with a shortened sleep duration and snoring had the highest cancer risk (HR 2.62, 95% CI 1.46-4.70). CONCLUSIONS Sleep duration trajectories and quality are closely associated with cancer risk and cancer-specific mortality. However, these associations differ with age and are more pronounced in individuals aged <45 years. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR-TNRC-11001489; http://tinyurl.com/2u89hrhx.
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Affiliation(s)
- Chenan Liu
- Department of Gastrointestinal Surgery and Clinical Nutrition, Beijing Shijitan Hospital, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
- Key Laboratory of of Cancer Food for Special Medical Purposes for State Market Regulation, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Qingsong Zhang
- Department of General Surgery, Kailuan General Hospital, Tangshan, China
| | - Chenning Liu
- Department of Obstetrics and Gynecology, Dongguan Maternal and Child Health Care Hospital, Dongguan, China
| | - Tong Liu
- Department of Gastrointestinal Surgery and Clinical Nutrition, Beijing Shijitan Hospital, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
- Key Laboratory of of Cancer Food for Special Medical Purposes for State Market Regulation, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Mengmeng Song
- Cardiovascular Research Institute, University of California, San Francisco, CA, United States
| | - Qi Zhang
- Department of Genetics, Yale University School of Medicine, New Haven, CT, United States
| | - Hailun Xie
- Department of Gastrointestinal Surgery and Clinical Nutrition, Beijing Shijitan Hospital, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
- Key Laboratory of of Cancer Food for Special Medical Purposes for State Market Regulation, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Shiqi Lin
- Department of Gastrointestinal Surgery and Clinical Nutrition, Beijing Shijitan Hospital, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
- Key Laboratory of of Cancer Food for Special Medical Purposes for State Market Regulation, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Jiangshan Ren
- Department of Oncology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yue Chen
- Department of Gastrointestinal Surgery and Clinical Nutrition, Beijing Shijitan Hospital, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
- Key Laboratory of of Cancer Food for Special Medical Purposes for State Market Regulation, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Xin Zheng
- Department of Gastrointestinal Surgery and Clinical Nutrition, Beijing Shijitan Hospital, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
- Key Laboratory of of Cancer Food for Special Medical Purposes for State Market Regulation, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Jinyu Shi
- Department of Gastrointestinal Surgery and Clinical Nutrition, Beijing Shijitan Hospital, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
- Key Laboratory of of Cancer Food for Special Medical Purposes for State Market Regulation, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Li Deng
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
- Key Laboratory of of Cancer Food for Special Medical Purposes for State Market Regulation, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Hanping Shi
- Department of Gastrointestinal Surgery and Clinical Nutrition, Beijing Shijitan Hospital, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
- Key Laboratory of of Cancer Food for Special Medical Purposes for State Market Regulation, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
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Olson R, Abraham H, Leclerc C, Benny A, Baker S, Matthews Q, Chng N, Bergman A, Mou B, Dunne EM, Schellenberg D, Jiang W, Chan E, Atrchian S, Lefresne S, Carolan H, Valev B, Tyldesley S, Bang A, Berrang T, Clark H, Hsu F, Louie AV, Warner A, Palma DA, Howell D, Barry A, Dawson L, Grendarova P, Walker D, Sinha R, Tsai J, Bahig H, Thibault I, Koul R, Senthi S, Phillips I, Grose D, Kelly P, Armstrong J, McDermott R, Johnstone C, Vasan S, Aherne N, Harrow S, Liu M. Single vs. multiple fraction non-inferiority trial of stereotactic ablative radiotherapy for the comprehensive treatment of oligo-metastases/progression: SIMPLIFY-SABR-COMET. BMC Cancer 2024; 24:171. [PMID: 38310262 PMCID: PMC10838428 DOI: 10.1186/s12885-024-11905-7] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/21/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Radiotherapy delivery regimens can vary between a single fraction (SF) and multiple fractions (MF) given daily for up to several weeks depending on the location of the cancer or metastases. With limited evidence comparing fractionation regimens for oligometastases, there is support to explore toxicity levels to nearby organs at risk as a primary outcome while using SF and MF stereotactic ablative radiotherapy (SABR) as well as explore differences in patient-reported quality of life and experience. METHODS This study will randomize 598 patients in a 1:1 ratio between the standard arm (MF SABR) and the experimental arm (SF SABR). This trial is designed as two randomized controlled trials within one patient population for resource efficiency. The primary objective of the first randomization is to determine if SF SABR is non-inferior to MF SABR, with respect to healthcare provider (HCP)-reported grade 3-5 adverse events (AEs) that are related to SABR. Primary endpoint is toxicity while secondary endpoints include lesional control rate (LCR), and progression-free survival (PFS). The second randomization (BC Cancer sites only) will allocate participants to either complete quality of life (QoL) questionnaires only; or QoL questionnaires and a symptom-specific survey with symptom-guided HCP intervention. The primary objective of the second randomization is to determine if radiation-related symptom questionnaire-guided HCP intervention results in improved reported QoL as measured by the EuroQoL-5-dimensions-5levels (EQ-5D-5L) instrument. The primary endpoint is patient-reported QoL and secondary endpoints include: persistence/resolution of symptom reporting, QoL, intervention cost effectiveness, resource utilization, and overall survival. DISCUSSION This study will compare SF and MF SABR in the treatment of oligometastases and oligoprogression to determine if there is non-inferior toxicity for SF SABR in selected participants with 1-5 oligometastatic lesions. This study will also compare patient-reported QoL between participants who receive radiation-related symptom-guided HCP intervention and those who complete questionnaires alone. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT05784428. Date of Registration: 23 March 2023.
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Affiliation(s)
- Robert Olson
- University of British Columbia, Vancouver, Canada.
- University of Northern British Columbia, Prince George, Canada.
- BC Cancer - Prince George, 1215 Lethbridge Street, Prince George, BC, V2M7A9, Canada.
- Department of Radiation Oncology, BC Cancer - Centre for the North, 1215 Lethbridge Street, Prince George, British Columbia, V2M 7E9, Canada.
| | - Hadassah Abraham
- BC Cancer - Prince George, 1215 Lethbridge Street, Prince George, BC, V2M7A9, Canada
| | - Curtis Leclerc
- University of British Columbia, Vancouver, Canada
- BC Cancer - Prince George, 1215 Lethbridge Street, Prince George, BC, V2M7A9, Canada
| | | | - Sarah Baker
- BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - Quinn Matthews
- BC Cancer - Prince George, 1215 Lethbridge Street, Prince George, BC, V2M7A9, Canada
| | - Nick Chng
- BC Cancer - Prince George, 1215 Lethbridge Street, Prince George, BC, V2M7A9, Canada
| | - Alanah Bergman
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - Benjamin Mou
- BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - Emma M Dunne
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | | | - Will Jiang
- BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - Elisa Chan
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | | | - Shilo Lefresne
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - Hannah Carolan
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - Boris Valev
- BC Cancer- Victoria, Victoria, British Columbia, Canada
| | | | - Andrew Bang
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - Tanya Berrang
- BC Cancer- Victoria, Victoria, British Columbia, Canada
| | - Haley Clark
- BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - Fred Hsu
- BC Cancer- Abbotsford, Abbotsford, British Columbia, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andrew Warner
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - David A Palma
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Doris Howell
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Laura Dawson
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Debra Walker
- Patient partner, BC Cancer-Prince George, Prince George, BC, Canada
| | - Rishi Sinha
- Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Jillian Tsai
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Houda Bahig
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | | | - Rashmi Koul
- Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | | | - Iain Phillips
- Western General Hospital/Edinburgh Cancer Centre, Edinburgh, Scotland
| | - Derek Grose
- Beatson West of Scotland Cancer Centre, Glasgow, Scotland
| | - Paul Kelly
- Bon Secours Radiotherapy Cork (In Partnership with UPMC Hillman Cancer Centre), Cork, Ireland
| | | | | | - Candice Johnstone
- Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Srini Vasan
- Precision Cancer Center, Ashland, Kentucky, United States of America
| | - Noel Aherne
- Riverina Cancer Care Centre, Wagga Wagga, New South Wales, Australia
| | - Stephen Harrow
- Western General Hospital/Edinburgh Cancer Centre, Edinburgh, Scotland
| | - Mitchell Liu
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
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Curtis AR, Livingstone KM, Daly RM, Abbott G, Kiss N. Dietary patterns linked to lower odds of malnutrition are associated with all-cause and cancer mortality in adults with cancer. J Nutr Health Aging 2024; 28:100026. [PMID: 38388112 DOI: 10.1016/j.jnha.2023.100026] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/30/2023] [Indexed: 02/24/2024]
Abstract
OBJECTIVES Dietary patterns, characterised by protein, polyunsaturated fatty acids, and vitamin D, reduce the odds of malnutrition in cancer survivors. However, it is unclear whether these dietary patterns also improve prognosis. This study prospectively examined associations between dietary patterns linked to lower odds of malnutrition and the risk of all-cause and cancer mortality in adult cancer survivors from the UK Biobank cohort. DESIGN Prospective observational study. SETTING AND PARTICIPANTS Cancer survivors from the UK Biobank (mean ± SD, 7.1 ± 6.3 years since diagnosis) were included (n = 2415; 59.7 ± 7.1 years; 60.7% female). MEASUREMENTS Dietary intake was estimated using the Oxford WebQ 24-h dietary assessment. Dietary patterns ('high oily fish and nuts', and 'low oily fish') were derived using reduced rank regression (response variables: protein (g/kg/day), polyunsaturated fatty acids (g/day) and vitamin D (μg/day)). Cox proportional hazard models estimated hazard ratios (HR) and 95% confidence intervals (CI) for all-cause and cancer mortality. Nonlinear relationships were examined using restricted cubic splines. Models were adjusted for demographic and health characteristics. Sub-group analyses investigated relationships in sub-samples of adults with i) high nutritional risk (lung, gastrointestinal, haematological, or head and neck tumours) and ii) recent cancer diagnosis (cancer diagnosis within two years prior to assessment). RESULTS Deaths due to all-causes (n = 305) and cancer (n = 249) were identified during a median 10.4 (IQR: 10.2-10.8) years follow-up. There were no statistically significant linear associations between the dietary patterns and all-cause or cancer mortality. However, a U-shaped association between the 'high oily fish and nuts' pattern, characterised by higher intake of oily fish and nuts and seeds, and all-cause mortality (p-non-linearity = 0.004) was identified, as well as with all-cause (p-non-linearity = 0.006) and cancer mortality (p-non-linearity = 0.035) in adults with a high nutritional risk cancer diagnosis (lung, gastrointestinal, haematological, or head and neck tumours), indicating that both above and below mean intake was associated with increased risk. The 'low oily fish' pattern, characterised by lower oily fish but higher potato intake, also had a non-linear association with all-cause mortality (p-non-linearity = 0.046) where lower but not higher than mean intake increased mortality risk. No dietary patterns were significantly associated with mortality in adults with a recent cancer diagnosis. CONCLUSION 'High oily fish and nuts' or 'low oily fish' dietary patterns that were protective against malnutrition were associated with risk of all-cause and cancer mortality in adults with cancer. Future research should assess the efficacy of these dietary patterns in the acute treatment period when malnutrition is most prevalent.
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Affiliation(s)
- Annie R Curtis
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3220, Australia.
| | - Katherine M Livingstone
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3220, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3220, Australia
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3220, Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3220, Australia; Allied Health Research, Peter MacCallum Cancer Centre, Melbourne, Australia
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Mignozzi S, Santucci C, Medina HN, Negri E, La Vecchia C, Pinheiro PS. Cancer mortality in Germany-born Americans and Germans. Cancer Epidemiol 2024; 88:102519. [PMID: 38183748 DOI: 10.1016/j.canep.2023.102519] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION Comparing cancer mortality and associated risk factors among immigrant populations in a host country to those in their country of origin reveals disparities in cancer risk, access to care, diagnosis, and disease management. This study compares cancer mortality between the German resident population and Germany-born individuals who migrated to the US. METHODS Cancer mortality data from 2008-2018 were derived for Germans from the World Health Organization database and for Germany-born Americans resident in four states (California, Florida, Massachusetts, and New York) from respective Departments of Vital Statistics. We calculated age-standardized mortality rates (ASMRs) using the European standard population and standardized mortality ratios (SMR) compared to the German resident population along with 95% confidence intervals (CIs). RESULTS Germany-born American males had lower ASMRs (253.8 per 100,000) than German resident population (325.6 per 100,000). The difference in females was modest, with ASMRs of 200.7 and 203.7 per 100,000, respectively. For all cancers, Germany-born American males had an SMR of 0.72 (95% CI: 0.70-0.74) and females 0.98 (95% CI: 0.95-1.00). Male SMRs among Germany-born Americans were significantly below one for oral cavity, stomach, colorectal, liver, lung, prostate, and kidney cancer. Among females, SMRs were below one for oral cavity, stomach, colorectal, gallbladder, breast, cervix uteri, and kidney cancer. For both sexes, SMRs were over one for bladder cancer (1.14 for males, 1.21 for females). Mortality was higher for lung cancer (SMR: 1.68), non-Hodgkin's lymphoma (1.18) and uterine cancer (1.22) among Germany-born American females compared to the German resident population. CONCLUSION Germany-born American males but not females showed lower cancer mortality than German resident population. Disparities may stem from variations in risk factors (e.g., smoking and alcohol use) as well as differences in screening practices and participation, cancer treatment, besides some residual potential "healthy immigrant effect".
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Affiliation(s)
- Silvia Mignozzi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Claudia Santucci
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Heidy N Medina
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eva Negri
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paulo S Pinheiro
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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Velame KT, Antunes JLF. Cancer mortality in childhood and adolescence: analysis of trends and spatial distribution in the 133 intermediate Brazilian regions grouped by macroregions. Rev Bras Epidemiol 2024; 27:e240003. [PMID: 38294061 PMCID: PMC10824501 DOI: 10.1590/1980-549720240003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 10/26/2023] [Accepted: 11/01/2023] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVE To assess the magnitude, trend, and spatial patterns of childhood and adolescent cancer mortality between 1996 and 2017 in 133 Brazilian intermediate regions by using socioeconomic and healthcare services indicators. METHODS This is an ecological study for analyzing the trend of mortality from cancer in childhood and adolescence through time series. Data on deaths were extracted from the Brazilian Mortality Information System. Data on population were extracted from the 1991, 2000, and 2010 demographic censuses of the Brazilian Institute of Geography and Statistics, with interpolation for intercensal years. Time series were delineated for mortality by type of cancer in each intermediate region. Such regions were grouped by macroregions to present the results. The calculation and interpretation of mortality trends use the Prais-Winsten autoregression procedure. RESULTS Mortality rates for all neoplasms were higher in the Northern region (7.79 deaths per 100 thousand population), while for leukemias, they were higher in the Southern region (1.61 deaths per 100 thousand population). In both regions, mortality was higher in boys and in the 0-4 age group. The trend was decreasing (annual percent change [APC] - -2.11 [95%CI: -3.14; - 1.30]) for all neoplasms in the Brazilian regions and stationary (APC - -0.43 [95%CI: -1.61; 2.12]) for leukemias in the analyzed period. CONCLUSION The mortality rate for all neoplasms showed higher values in regions with smaller numbers of ICU beds in the public healthcare system.
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Feng Y, Su M, Liu Y, Peng J, Sun X. Health-related quality of life among cancer survivors: pre-existing chronic conditions are to be given priority. Support Care Cancer 2024; 32:124. [PMID: 38252273 DOI: 10.1007/s00520-024-08315-7] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024]
Abstract
PURPOSE This study aimed to describe the health-related quality of life (HRQoL) of cancer survivors in China by the five-level EuroQol-5-dimension (EQ-5D-5L) questionnaire and to explore the impact of the comorbidity of pre-existing chronic conditions on HRQoL in cancer survivors. METHODS Data on cancer survivors were obtained from two cross-sectional surveys conducted in Shandong Province, China. The data of the Chinese general population, the Chinese diabetes population, the Chinese hypertension population, and the Chinese urban population from the published studies were used as the controls. The χ2 test was conducted to compare the incidence of five-dimensional problems between the study and control populations. The non-parametric Mann-Whitney U test and Kruskal-Wallis test were performed to examine the differences in EQ-5D-5L utility scores. Besides, the Tobit regression model was used to examine the variables influencing the EQ-5D-5L utility score. RESULTS One thousand fifty-one adult cancer survivors were included. Cancer survivors had significantly lower EQ-5D-5L utility scores (Z = - 15.939, P < 0.001) and EQ-VAS scores (Z = - 11.156, P < 0.001) than the general adult population. The average EQ-5D-5L utility score of hypertensive cancer survivors was lower than that of the hypertensive population (Z = - 1.610, P = 0.107), but the difference was not statistically significant. CONCLUSION Compared to the general population, the HRQoL of cancer survivors was extremely poor in all dimensions of the EQ-5D-5L. Pre-existing chronic conditions had significant antecedent effects on the HRQoL of cancer survivors. Therefore, more attention should be paid to chronic diseases, and effective interventions should be adopted based on this.
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Affiliation(s)
- Yujia Feng
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Wenhuaxi Road 44#, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Mingzhu Su
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Wenhuaxi Road 44#, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Yanxiu Liu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Wenhuaxi Road 44#, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Jiaqi Peng
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Wenhuaxi Road 44#, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Xiaojie Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Wenhuaxi Road 44#, Jinan, China.
- National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China.
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12
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Gupta A, Akinyemiju T. Trends in Cancer Mortality Disparities Between Black and White Individuals in the US, 2000-2020. JAMA Health Forum 2024; 5:e234617. [PMID: 38214921 PMCID: PMC10787320 DOI: 10.1001/jamahealthforum.2023.4617] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/27/2023] [Indexed: 01/13/2024] Open
Abstract
This cross-sectional study compares trends in estimated age-adjusted cancer mortality rates between non-Hispanic Black and non-Hispanic White individuals in the US from 2000 to 2020.
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Affiliation(s)
- Anjali Gupta
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Stanford University School of Medicine, Stanford, California
| | - Tomi Akinyemiju
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
- Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina
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Woodford R, Zhou D, Kok PS, Lord SJ, Friedlander M, Marschner I, Simes RJ, Lee CK. Validity and Efficiency of Progression-Free Survival-2 as a Surrogate End Point for Overall Survival in Advanced Cancer Randomized Trials. JCO Precis Oncol 2024; 8:e2300296. [PMID: 38207226 DOI: 10.1200/po.23.00296] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 10/05/2023] [Accepted: 10/17/2023] [Indexed: 01/13/2024] Open
Abstract
PURPOSE Progression-free survival (PFS)-2, defined as the time from randomization to progression on second-line therapy, is potentially a more reliable surrogate than PFS for overall survival (OS), but will require longer follow-up and a larger sample size. We sought to compare the validity and efficiency, defined as proportional increase in follow-up time and sample size, of PFS-2 to PFS. METHODS We performed an electronic search to identify randomized trials of advanced solid tumors reporting PFS, PFS-2, and OS as prespecified end points. Only studies that had protocols that defined measurement of PFS-2 and follow-up for patients after first disease progression were included. We compared correlations in the relative treatment effect for OS with PFS and PFS-2. We reconstructed individual patient data from survival curves to estimate time to statistical significance (TSS) of the relative treatment effect. We further computed the sample size (person-year [PY] follow-up) required to reach statistical significance. RESULTS Across the 42 analysis units and 21,255 patients, the correlation of the relative treatment effect between OS and PFS-2, r, was 0.70 (95% CI, 0.41 to 0.80) and r = 0.46 (95% CI, 0.26 to 0.74) for OS and PFS. The median differences in TSS between OS with PFS, OS with PFS-2, and PFS with PFS-2 were 16.59 (95% CI, 4.48 to not reached [NR]), 10.0 (95% CI, 2.2 to NR), and 4.31 (95% CI, 2.92 to 13.13) months, respectively. The median difference in PYs required to reach statistical significance for PFS-2 over PFS was 156 (95% CI, 82 to 500) PYs, equivalent to an estimated median 12.7% increase in PYs. CONCLUSION PFS-2 offers improved correlation with OS than PFS with a modest increase in follow-up time and sample size. PFS-2 should be considered as a primary end point in future trials of advanced cancers.
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Affiliation(s)
- Rachel Woodford
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Deborah Zhou
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Peey-Sei Kok
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Sally J Lord
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Michael Friedlander
- Prince of Wales Clinical School University of New South Wales, Sydney, Australia
- Prince of Wales Hospital, Sydney, NSW, Australia
| | - Ian Marschner
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - R John Simes
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Chee Khoon Lee
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
- St George Hospital, Sydney, NSW, Australia
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14
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Lebakula V, Cosby AG. Geographic disparities of cardiovascular and cancer mortality in the USA: 1981-2019. J Public Health (Oxf) 2023; 45:799-803. [PMID: 37395175 PMCID: PMC10687862 DOI: 10.1093/pubmed/fdad089] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 11/18/2022] [Revised: 04/19/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Cardiovascular and cancer mortality are the two leading causes of death in the developed world including the USA. However, mortality trends for these diseases are highly dynamic, and the geographic landscape is in transition. We analyze patterns of mortality improvement at county level during recent decades focusing on mortality decline and geographic diversity. METHODS We grouped age-adjusted mortality rates of cardiovascular and cancer diseases from CDC WONDER for 2959 US counties into 3-year time periods to improve reliability. We calculated percent mortality decrease between 1981-83 and 2016-19 for both causes to quantify mortality improvements for counties. RESULTS Using standard deviation as an index of disparities, place-based cancer mortalities were 68% larger than cardiovascular disparities. Significantly, 566 US counties had same or higher rates of cancer mortality in 2019 as in 1981. The geographic distribution of mortality improvement in either cause tends to favor largely populated areas along coasts. Less-populated, rural places in the interior and southeastern regions were experiencing less improvement. CONCLUSIONS At the county level, large place-based disparities exist for both causes of death with the magnitude of disparities being substantially larger for the reduction in cancer deaths. Put differently, place matters, more for cancer than cardiovascular mortality.
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Affiliation(s)
- V Lebakula
- Geospatial Science and Human Security Division, Oak Ridge National Laboratory, 37831-6017 Oak Ridge, TN USA
| | - A G Cosby
- Social Science Research Center, Mississippi State University, 39762, Starkville, MS, USA
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15
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Pizzato M, di Maso M, Collatuzzo G, Pelucchi C, Turati F, Negri E, La Vecchia C, Boffetta P, Alicandro G. Cancer mortality associated with low education in Italy. J Public Health (Oxf) 2023; 45:822-828. [PMID: 37681283 DOI: 10.1093/pubmed/fdad164] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/25/2023] [Accepted: 08/15/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND This study provides a nationwide representative quantification of the impact of educational inequalities on cancer mortality in Italy. METHODS The study is based on prevalence data and mortality rate ratios according to levels of education obtained from the Italian 2011 census cohort, including >35 million individuals aged 30-74. We estimated the population attributable fraction (PAF) and the number of cancer deaths associated with low education (below university degree) in Italy by sex. RESULTS PAFs for low levels of education were 29.1% among men and 13.3% among women, corresponding to 22,271 cancer deaths associated with low education in men and 7456 in women in 2019. PAFs by cancer site in men were: 53.0% for upper aerodigestive tract (UADT), 44.6% for liver, 41.3% for stomach, 41.3% for lung, 37.0% for bladder, 18.5% for colorectal, 9.8% for prostate and 9.1% for pancreatic cancers. PAFs in women were: 44.5% for cervical, 36.1% for UADT, 34.9% for stomach and 13.9% for colorectal cancers. The cancer sites with the highest number of deaths associated with low education were lung among men (7902/22,271, 35.5%) and colorectum among women (780/7456, 10.5%). CONCLUSIONS About a quarter of cancer deaths in 2019 in Italy may be prevented by reducing the socioeconomic determinants that contribute to educational disparities in cancer mortality.
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Affiliation(s)
- Margherita Pizzato
- Department of Clinical Sciences and Community Health, University of Milan, 20133 Milano, Italy
| | - Matteo di Maso
- Department of Clinical Sciences and Community Health, University of Milan, 20133 Milano, Italy
| | - Giulia Collatuzzo
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Claudio Pelucchi
- Department of Clinical Sciences and Community Health, University of Milan, 20133 Milano, Italy
| | - Federica Turati
- Department of Clinical Sciences and Community Health, University of Milan, 20133 Milano, Italy
| | - Eva Negri
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, 20133 Milano, Italy
| | - Paolo Boffetta
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
- Stony Brook Cancer Center, Stony Brook University, 11794 Stony Brook, NY, USA
| | - Gianfranco Alicandro
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milano, Italy
- Cystic Fibrosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
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Jayasekera J, El Kefi S, Fernandez JR, Wojcik KM, Woo JMP, Ezeani A, Ish JL, Bhattacharya M, Ogunsina K, Chang CJ, Cohen CM, Ponce S, Kamil D, Zhang J, Le R, Ramanathan AL, Butera G, Chapman C, Grant SJ, Lewis-Thames MW, Dash C, Bethea TN, Forde AT. Opportunities, challenges, and future directions for simulation modeling the effects of structural racism on cancer mortality in the United States: a scoping review. J Natl Cancer Inst Monogr 2023; 2023:231-245. [PMID: 37947336 PMCID: PMC10637025 DOI: 10.1093/jncimonographs/lgad020] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/23/2023] [Accepted: 07/03/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE Structural racism could contribute to racial and ethnic disparities in cancer mortality via its broad effects on housing, economic opportunities, and health care. However, there has been limited focus on incorporating structural racism into simulation models designed to identify practice and policy strategies to support health equity. We reviewed studies evaluating structural racism and cancer mortality disparities to highlight opportunities, challenges, and future directions to capture this broad concept in simulation modeling research. METHODS We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review Extension guidelines. Articles published between 2018 and 2023 were searched including terms related to race, ethnicity, cancer-specific and all-cause mortality, and structural racism. We included studies evaluating the effects of structural racism on racial and ethnic disparities in cancer mortality in the United States. RESULTS A total of 8345 articles were identified, and 183 articles were included. Studies used different measures, data sources, and methods. For example, in 20 studies, racial residential segregation, one component of structural racism, was measured by indices of dissimilarity, concentration at the extremes, redlining, or isolation. Data sources included cancer registries, claims, or institutional data linked to area-level metrics from the US census or historical mortgage data. Segregation was associated with worse survival. Nine studies were location specific, and the segregation measures were developed for Black, Hispanic, and White residents. CONCLUSIONS A range of measures and data sources are available to capture the effects of structural racism. We provide a set of recommendations for best practices for modelers to consider when incorporating the effects of structural racism into simulation models.
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Affiliation(s)
- Jinani Jayasekera
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Safa El Kefi
- NYU Langone Health, New York University, New York, NY, USA
| | - Jessica R Fernandez
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Kaitlyn M Wojcik
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer M P Woo
- Epidemiology Branch at the National Institute of Environmental Health Sciences at the National Institutes of Health, Bethesda, MD, USA
| | - Adaora Ezeani
- Health Behaviors Research Branch of the Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Jennifer L Ish
- Epidemiology Branch at the National Institute of Environmental Health Sciences at the National Institutes of Health, Bethesda, MD, USA
| | - Manami Bhattacharya
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, and the Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Kemi Ogunsina
- Epidemiology Branch at the National Institute of Environmental Health Sciences at the National Institutes of Health, Bethesda, MD, USA
| | - Che-Jung Chang
- Epidemiology Branch at the National Institute of Environmental Health Sciences at the National Institutes of Health, Bethesda, MD, USA
| | - Camryn M Cohen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Stephanie Ponce
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Dalya Kamil
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Julia Zhang
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
- Sophomore at Williams College, Williamstown, MA, USA
| | - Randy Le
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Amrita L Ramanathan
- Diabetes, Endocrinology, & Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Gisela Butera
- Office of Research Services, National Institutes of Health Library, Bethesda, MD, USA
| | - Christina Chapman
- Department of Radiation Oncology, Baylor College of Medicine, and the Center for Innovations in Quality, Effectiveness, and Safety in the Department of Medicine, Baylor College of Medicine and the Houston Veterans Affairs, Houston, TX, USA
| | - Shakira J Grant
- Department of Medicine, Division of Hematology, University of North Carolina, Chapel Hill, NC, USA
| | - Marquita W Lewis-Thames
- Department of Medical Social Science, Center for Community Health at Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Chiranjeev Dash
- Office of Minority Health and Health Disparities Research at the Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Traci N Bethea
- Office of Minority Health and Health Disparities Research at the Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Allana T Forde
- Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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Harris E. Many Older People Disagree With Life Expectancy-Based Cancer Screening. JAMA 2023; 330:1612. [PMID: 37851483 DOI: 10.1001/jama.2023.19803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
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18
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Curtin SC, Anderson RN. Declines in Cancer Death Rates Among Youth: United States, 2001-2021. NCHS Data Brief 2023:1-8. [PMID: 38051196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Since the mid-1970s, cancer death rates for youth in the United States have declined significantly despite a slow increase in incidence for some of the major types (1-3). A previous report with trends from 1999 through 2014 showed declines for all 5-year age groups of youth (0-4, 5-9, 10-14, 15-19) (4). This Data Brief updates that report by presenting trends in cancer death rates through 2021. Rates from 2001 to 2021 are presented in total and for females and males. Rates for 2001, 2011, and 2021 are presented by 5-year age groups and for White, Black, and Hispanic youth. Trends are shown for the three most common types of cancer in youth.
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Silverstein J, Van Loon K. Risk of Death Due to Pregnancy-Associated Cancers-More Questions Than Answers. JAMA Oncol 2023; 9:1588-1589. [PMID: 37733335 DOI: 10.1001/jamaoncol.2023.3648] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Affiliation(s)
- Jordyn Silverstein
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco
| | - Katherine Van Loon
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco
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Warkentin MT, Ruan Y, Ellison LF, Billette JM, Demers AA, Liu FF, Brenner DR. Progress in cancer control leads to a substantial number of cancer deaths avoided in Canada. JNCI Cancer Spectr 2023; 7:pkad105. [PMID: 38085245 PMCID: PMC10750808 DOI: 10.1093/jncics/pkad105] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/26/2023] [Accepted: 12/04/2023] [Indexed: 12/27/2023] Open
Abstract
It is currently not known how many more cancer deaths would have occurred among Canadians if cancer mortality rates were unchanged following various modern human interventions. The objective of this study was to estimate the number of cancer deaths that have been avoided in Canada since the age-standardized overall cancer mortality rate peaked in 1988. We applied the age-specific overall cancer mortality rates from 1988 to the Canadian population for all subsequent years to estimate the number of expected deaths. Avoided cancer deaths were estimated as the difference between the observed and expected number of cancer deaths for each year. Since 1988, there have been 372 584 (standardized mortality ratio = 0.77) and 120 045 (standardized mortality ratio = 0.90) avoided cancer deaths in males and females, respectively (492 629 total). Nearly half a million cancer deaths have been avoided in Canada since the overall cancer mortality rate peaked, which demonstrates the exceptional progress made in modern cancer control in Canada.
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Affiliation(s)
- Matthew T Warkentin
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Yibing Ruan
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Larry F Ellison
- Centre for Population Health Data, Statistics Canada, Ottawa, ON, Canada
| | | | - Alain A Demers
- Adult Chronic Diseases and Conditions Division, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Fei-Fei Liu
- Institute of Cancer Research, Canadian Institutes of Health Research, Ottawa, ON, Canada
| | - Darren R Brenner
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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21
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Nierengarten MB. Certain cancer types show global variation in mortality rates. Cancer 2023; 129:3191-3192. [PMID: 37732412 DOI: 10.1002/cncr.35017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
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22
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Robb C, Carr PR, Ball J, Owen A, Beilin LJ, Newman AB, Nelson MR, Reid CM, Orchard SG, Neumann JT, Tonkin AM, Wolfe R, McNeil JJ. Association of a healthy lifestyle with mortality in older people. BMC Geriatr 2023; 23:646. [PMID: 37821846 PMCID: PMC10568769 DOI: 10.1186/s12877-023-04247-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/20/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Unhealthy lifestyle behaviours such as smoking, high alcohol consumption, poor diet or low physical activity are associated with morbidity and mortality. Public health guidelines provide recommendations for adherence to these four factors, however, their relationship to the health of older people is less certain. METHODS The study involved 11,340 Australian participants (median age 7.39 [Interquartile Range (IQR) 71.7, 77.3]) from the ASPirin in Reducing Events in the Elderly study, followed for a median of 6.8 years (IQR: 5.7, 7.9). We investigated whether a point-based lifestyle score based on adherence to guidelines for a healthy diet, physical activity, non-smoking and moderate alcohol consumption was associated with subsequent all-cause and cause-specific mortality. RESULTS In multivariable adjusted models, compared to those in the unfavourable lifestyle group, individuals in the moderate lifestyle group (Hazard Ratio (HR) 0.73 [95% CI 0.61, 0.88]) and favourable lifestyle group (HR 0.68 [95% CI 0.56, 0.83]) had lower risk of all-cause mortality. A similar pattern was observed for cardiovascular related mortality and non-cancer/non-cardiovascular related mortality. There was no association of lifestyle with cancer-related mortality. CONCLUSIONS In a large cohort of initially healthy older people, reported adherence to a healthy lifestyle is associated with reduced risk of all-cause and cause-specific mortality. Adherence to all four lifestyle factors resulted in the strongest protection.
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Affiliation(s)
- Catherine Robb
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia.
| | - Prudence R Carr
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
| | - Jocasta Ball
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
| | - Lawrence J Beilin
- School of Medicine, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Anne B Newman
- Department of Epidemiology, Centre for Aging and Population Health, University of Pittsburgh, Pittsburgh, USA
| | - Mark R Nelson
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
| | - Johannes T Neumann
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
- German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
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De Camargo Cancela M, Monteiro Dos Santos JE, Lopes de Souza LB, Martins LFL, Bezerra de Souza DL, Barchuk A, Hanly P, Sharp L, Soerjomataram I, Pearce A. The economic impact of cancer mortality among working-age individuals in Brazil from 2001 to 2030. Cancer Epidemiol 2023; 86:102438. [PMID: 37579673 PMCID: PMC10577440 DOI: 10.1016/j.canep.2023.102438] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND About half of cancer deaths in Brazil occur among individuals of working-age (under 65 years for men, under 60 for women), resulting in a substantial economic impact for the country. We aimed to estimate the years of potential productive life lost (YPPLL) and value the productivity lost due to premature deaths from cancer between 2001 and 2015 and the projected to 2030. METHODS We used the Human Capital Approach to estimate the productivity losses corresponding to YPPLL for cancer deaths in working age people (15-64 years). Mortality data were obtained from the Mortality Information System from 2001 to 2015 and projected between 2016 and 2030. Economic data were obtained from the Continuous National Household Sample Survey and forecasted to 2030. Productivity lost was calculated as the monetary value arising from YPPLL in Int$(2016). RESULTS Between 2001 and 2030, a total of 2.3 million premature deaths from all cancers combined were observed and forecasted in Brazil (57% men, 43% women), corresponding to 32 million YPPLL and Int$141.3 billion in productivity losses (men: Int$102.5 billion, women: Int$38.8 billion). Between 2001 and 2030, among men, lung (Int$ 12.6 billion), stomach (Int$ 10.6 billion) and colorectal (Int$ 9.4 billion) cancers were expected to contribute to the greatest productivity losses; and among women, it will be for breast (Int$ 10.0 billion), cervical (Int$ 6.4 billion) and colorectal (Int$ 3.2 billion) cancers. CONCLUSIONS Many preventable cancers result in high lost productivity, suggesting measure to reduce smoking prevalence, alcohol consumption, physical inactivity and inadequate diet, improving screening programs and increasing vaccination coverage for human papillomavirus and hepatitis B would have a positive impact on the economy, as well as reducing morbidity and mortality from cancer.
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Affiliation(s)
- Marianna De Camargo Cancela
- Division of Surveillance and Data Analysis, Coordination of Prevention and Surveillance, Brazilian National Cancer Institute, Ministry of Health, Rio de Janeiro, Brazil.
| | - Jonas Eduardo Monteiro Dos Santos
- Division of Surveillance and Data Analysis, Coordination of Prevention and Surveillance, Brazilian National Cancer Institute, Ministry of Health, Rio de Janeiro, Brazil
| | - Leonardo Borges Lopes de Souza
- Division of Surveillance and Data Analysis, Coordination of Prevention and Surveillance, Brazilian National Cancer Institute, Ministry of Health, Rio de Janeiro, Brazil
| | - Luís Felipe Leite Martins
- Division of Surveillance and Data Analysis, Coordination of Prevention and Surveillance, Brazilian National Cancer Institute, Ministry of Health, Rio de Janeiro, Brazil
| | | | - Anton Barchuk
- Faculty of Social Sciences, Health Sciences, Tampere University, Finland
| | - Paul Hanly
- School of Business, National College of Ireland, Dublin, Ireland
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, University of Newcastle, Newcastle Upon Tyne, United Kingdom
| | | | - Alison Pearce
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Barnes JM, Johnston KJ, Johnson KJ, Chino F, Osazuwa-Peters N. State Public Assistance Spending and Survival Among Adults With Cancer. JAMA Netw Open 2023; 6:e2332353. [PMID: 37669050 PMCID: PMC10481229 DOI: 10.1001/jamanetworkopen.2023.32353] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 07/29/2023] [Indexed: 09/06/2023] Open
Abstract
Importance Social determinants of health contribute to disparities in cancer outcomes. State public assistance spending, including Medicaid and cash assistance programs for socioeconomically disadvantaged individuals, may improve access to care; address barriers, such as food and housing insecurity; and lead to improved cancer outcomes for marginalized populations. Objective To determine whether state-level public assistance spending is associated with overall survival (OS) among individuals with cancer, overall and by race and ethnicity. Design, Setting, and Participants This cohort study included US adults aged at least 18 years with a new cancer diagnosis from 2007 to 2013, with follow-up through 2019. Data were obtained from the Surveillance, Epidemiology, and End Results program. Data were analyzed from November 18, 2021, to July 6, 2023. Exposure Differential state-level public assistance spending. Main Outcome and Measure The main outcome was 6-year OS. Analyses were adjusted for age, race, ethnicity, sex, metropolitan residence, county-level income, state fixed effects, state-level percentages of residents living in poverty and aged 65 years or older, cancer type, and cancer stage. Results A total 2 035 977 individuals with cancer were identified and included in analysis, with 1 005 702 individuals (49.4%) aged 65 years or older and 1 026 309 (50.4%) male. By tertile of public assistance spending, 6-year OS was 55.9% for the lowest tertile, 55.9% for the middle tertile, and 56.6% for the highest tertile. In adjusted analyses, public assistance spending at the state-level was significantly associated with higher 6-year OS (0.09% [95% CI, 0.04%-0.13%] per $100 per capita; P < .001), particularly for non-Hispanic Black individuals (0.29% [95% CI, 0.07%-0.52%] per $100 per capita; P = .01) and non-Hispanic White individuals (0.12% [95% CI, 0.08%-0.16%] per $100 per capita; P < .001). In sensitivity analyses examining the roles of Medicaid spending and Medicaid expansion including additional years of data, non-Medicaid spending was associated with higher 3-year OS among non-Hispanic Black individuals (0.49% [95% CI, 0.26%-0.72%] per $100 per capita when accounting for Medicaid spending; 0.17% [95% CI, 0.02%-0.31%] per $100 per capita Medicaid expansion effects). Conclusions and Relevance This cohort study found that state public assistance expenditures, including cash assistance programs and Medicaid, were associated with improved survival for individuals with cancer. State investment in public assistance programs may represent an important avenue to improve cancer outcomes through addressing social determinants of health and should be a topic of further investigation.
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Affiliation(s)
- Justin M. Barnes
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Kenton J. Johnston
- General Medical Sciences Division, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | | | - Fumiko Chino
- Department of Radiation Oncology, Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina
- Duke Cancer Institute, Duke University, Durham, North Carolina
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Nordling L. African scientists call for research equity as a cancer crisis looms. Nature 2023; 621:S16-S17. [PMID: 37674000 DOI: 10.1038/d41586-023-02610-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
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26
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Zhu J, Oh JH, Simhal AK, Elkin R, Norton L, Deasy JO, Tannenbaum A. Geometric graph neural networks on multi-omics data to predict cancer survival outcomes. Comput Biol Med 2023; 163:107117. [PMID: 37329617 PMCID: PMC10638676 DOI: 10.1016/j.compbiomed.2023.107117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/23/2023] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/19/2023]
Abstract
The advance of sequencing technologies has enabled a thorough molecular characterization of the genome in human cancers. To improve patient prognosis predictions and subsequent treatment strategies, it is imperative to develop advanced computational methods to analyze large-scale, high-dimensional genomic data. However, traditional machine learning methods face a challenge in handling the high-dimensional, low-sample size problem that is shown in most genomic data sets. To address this, our group has developed geometric network analysis techniques on multi-omics data in connection with prior biological knowledge derived from protein-protein interactions (PPIs) or pathways. Geometric features obtained from the genomic network, such as Ollivier-Ricci curvature and the invariant measure of the associated Markov chain, have been shown to be predictive of survival outcomes in various cancers. In this study, we propose a novel supervised deep learning method called geometric graph neural network (GGNN) that incorporates such geometric features into deep learning for enhanced predictive power and interpretability. More specifically, we utilize a state-of-the-art graph neural network with sparse connections between the hidden layers based on known biology of the PPI network and pathway information. Geometric features along with multi-omics data are then incorporated into the corresponding layers. The proposed approach utilizes a local-global principle in such a manner that highly predictive features are selected at the front layers and fed directly to the last layer for multivariable Cox proportional-hazards regression modeling. The method was applied to multi-omics data from the CoMMpass study of multiple myeloma and ten major cancers in The Cancer Genome Atlas (TCGA). In most experiments, our method showed superior predictive performance compared to other alternative methods.
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Affiliation(s)
- Jiening Zhu
- Department of Applied Mathematics & Statistics, Stony Brook University, NY, USA.
| | - Jung Hun Oh
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, NY, USA.
| | - Anish K Simhal
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, NY, USA.
| | - Rena Elkin
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, NY, USA.
| | - Larry Norton
- Department of Medicine, Memorial Sloan Kettering Cancer Center, NY, USA.
| | - Joseph O Deasy
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, NY, USA.
| | - Allen Tannenbaum
- Department of Applied Mathematics & Statistics, Stony Brook University, NY, USA; Department of Computer Science, Stony Brook University, NY, USA.
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Hudson MF, Oostdyk AM, Simmons VM, Martin JC. Considering context in area-level socioeconomic status, cancer treatment initiation, and survival. JNCI Cancer Spectr 2023; 7:pkad078. [PMID: 37850333 PMCID: PMC10582689 DOI: 10.1093/jncics/pkad078] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/19/2023] Open
Affiliation(s)
- Matthew F Hudson
- Department of Medicine, Prisma Health Cancer Institute, Greenville, SC, USA
| | - Alicia M Oostdyk
- Department of Medicine, Prisma Health Cancer Institute, Greenville, SC, USA
| | - Virginia M Simmons
- Department of Medicine, Prisma Health Cancer Institute, Greenville, SC, USA
| | - Julie C Martin
- Department of Medicine, Prisma Health Cancer Institute, Greenville, SC, USA
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Li C, Andrzejak SE, Jones SR, Williams BM, Moore JX. Investigating the association between educational attainment and allostatic load with risk of cancer mortality among African American women. BMC Womens Health 2023; 23:448. [PMID: 37620873 PMCID: PMC10463695 DOI: 10.1186/s12905-023-02529-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/05/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND African American (AA) women navigate the world with multiple intersecting marginalized identities. Accordingly, AA women have higher cumulative stress burden or allostatic load (AL) compared to other women. Studies suggest that AA women with a college degree or higher have lower AL than AA women with less than a high school diploma. We examined the joint effect of educational attainment and AL status with long-term risk of cancer mortality, and whether education moderated the association between AL and cancer mortality. METHODS We performed a retrospective analysis among 4,677 AA women within the National Health and Nutrition Examination Survey (NHANES) from 1988 to 2010 with follow-up data through December 31, 2019. We fit weighted Cox proportional hazards models to estimate adjusted hazard ratios (aHRs) of cancer death between educational attainment/AL (adjusted for age, income, and smoking status). RESULTS AA women with less than a high school diploma living with high AL had nearly a 3-fold increased risk (unadjusted HR: 2.98; 95%C CI: 1.24-7.15) of cancer death compared to AA college graduates living with low AL. However, after adjusting for age, this effect attenuated (age-adjusted HR: 1.11; 95% CI: 0.45-2.74). AA women with high AL had 2.3-fold increased risk of cancer death (fully adjusted HR: 2.26; 95% CI: 1.10-4.57) when compared to AA with low AL, specifically among women with high school diploma or equivalent and without history of cancer. CONCLUSIONS Our findings suggest that high allostatic load is associated with a higher risk of cancer mortality among AA women with lower educational attainment, while no such association was observed among AA women with higher educational attainment. Thus, educational attainment plays a modifying role in the relationship between allostatic load and the risk of cancer death for AA women. Higher education can bring several benefits, including improved access to medical care and enhanced medical literacy, which in turn may help mitigate the adverse impact of AL and the heightened risk of cancer mortality among AA women.
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Affiliation(s)
- Cynthia Li
- Georgia Cancer Center, Augusta University, 1410 Laney Walker Blvd, 30912, Augusta, GA, USA
| | | | - Samantha R Jones
- Department of Family and Community Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | | | - Justin Xavier Moore
- Center for Health Equity Transformation, Department of Behavioral Science, University of Kentucky, Lexington, KY, USA.
- Community Impact Office, Markey Cancer Center, University of Kentucky, Lexington, KY, USA.
- Department of Internal Medicine, University of Kentucky, Lexington, KY, USA.
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29
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Lee J, Yang AWJ, Chung LIY, Yu J, Lee Y, Kim HS, Shin HJ, Choi YG, Bharat A, Chae YK. A Comprehensive Landscape of De Novo Malignancy After Double Lung Transplantation. Transpl Int 2023; 36:11552. [PMID: 37663524 PMCID: PMC10468575 DOI: 10.3389/ti.2023.11552] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023]
Abstract
Although the association between post-transplant malignancy (PTM) and immunosuppressive therapy after organ transplantation has been studied, an integrated review of PTM after lung transplantation is lacking. We investigated the incidence and types of de novo PTM and its impact on survival following double lung transplantation (DLT). The incidence and type of PTM as well as the annual and cumulative risks of each malignancy after DLT were analyzed. The overall survival (OS) of recipients with or without PTM was compared by the Kaplan-Meier survival method and landmark analysis. There were 5,629 cases (23.52%) with 27 types of PTMs and incidences and OS varied according to the types of PTMs. The recipients with PTM showed a significantly longer OS than those without PTM (p < 0.001). However, while the recipients with PTM showed significantly better OS at 3, and 5 years (p < 0.001, p = 0.007), it was worse at the 10-year landmark time (p = 0.013). And the single PTM group showed a worse OS rate than the multiple PTM group (p < 0.001). This comprehensive report on PTM following DLT can help understand the risks and timing of PTM to improve the implementation of screening and treatment.
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Affiliation(s)
- Jeeyeon Lee
- Department of Surgery, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, Daegu, Republic of Korea
- Department of Internal Medicine, Northwestern Memorial Hospital, Chicago, IL, United States
| | - Andrew Won Jun Yang
- Department of Internal Medicine, Northwestern Memorial Hospital, Chicago, IL, United States
| | - Liam Il-Young Chung
- Department of Internal Medicine, Northwestern Memorial Hospital, Chicago, IL, United States
| | - Jisang Yu
- Department of Internal Medicine, Northwestern Memorial Hospital, Chicago, IL, United States
| | - Yunjoo Lee
- Department of Internal Medicine, Northwestern Memorial Hospital, Chicago, IL, United States
| | - Hye Sung Kim
- Department of Internal Medicine, Northwestern Memorial Hospital, Chicago, IL, United States
| | - Hyun Joon Shin
- Division of Cardiology, Department of Medicine, Lemuel Shattuck Hospital, Massachusetts Department of Public Health, Jamaica Plain, MA, United States
| | - Young-Geun Choi
- Department of Mathematics Education, Sungkyunkwan University, Seoul, Republic of Korea
| | - Ankit Bharat
- Department of Internal Medicine, Northwestern Memorial Hospital, Chicago, IL, United States
| | - Young Kwang Chae
- Department of Internal Medicine, Northwestern Memorial Hospital, Chicago, IL, United States
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Sakr RA, Nasr AA, Zineldin EI, Gouda MA. Long-Term Survival in Patients with Cancers: Surveillance, epidemiology and end results-based analysis. Sultan Qaboos Univ Med J 2023; 23:344-350. [PMID: 37655083 PMCID: PMC10467541 DOI: 10.18295/squmj.1.2023.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 11/24/2022] [Accepted: 12/15/2022] [Indexed: 01/19/2023] Open
Abstract
Objectives This study aimed to explore real-world data on the long-term survival of cancer patients using historical records from the Surveillance, Epidemiology, and End Results (SEER) Programme. Long-term survival is an important endpoint in the management of different malignancies. It is rarely assessed due to the unfeasibility of follow-up for a long duration of time. Besides reporting the five-year relative survival, the 10- and 20-year survival rates for different types of cancers were analysed. Additionally, survival trends as a function of time, age and tumour type were reviewed and reported. Methods The study used SEER*Stat (Version 8.3.6.1) for data acquisition from the SEER 9 Regs (November 2019) database. Data from patients diagnosed with cancer between 1975 and 2014 were retrieved and included in the analysis. Results For patients diagnosed with any malignant disease (N = 4,412,024), there was a significant increase in median overall survival over time (P <0.001). The 20-, 10-, and 5-year survival rates were higher in solid tumours compared to haematological malignancies (50.8% versus 38%; 57% versus 47.4%; and 62.2% versus 57.4%, respectively). The highest 20-year relative survival rates were observed in thyroid cancer (95.2%), germ cell and trophoblastic neoplasms (90.3%), melanoma (86.8%), Wilms' tumour (86.2%) and prostate cancer (83.5%). Conclusion Long-term follow-up data were suggestive of high 20-year relative survival rates for most tumour types. Relative survival showed an improving trend over time, especially in solid tumours.
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Affiliation(s)
- Rokia A. Sakr
- Department of Pathology, Menoufia University, Menoufia, Egypt
| | - Abdelrahman A. Nasr
- Department of Hepatobiliary Surgery, National Liver Institute, Menoufia University, Menoufia, Egypt
| | | | - Mohamed A. Gouda
- Department of Clinical Oncology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
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Konishi T, Sasabuchi Y, Matsui H, Tanabe M, Seto Y, Yasunaga H. Long-Term Risk of Being Bedridden in Elderly Patients Who Underwent Oncologic Surgery: A Retrospective Study Using a Japanese Claims Database. Ann Surg Oncol 2023; 30:4604-4612. [PMID: 37149549 PMCID: PMC10319666 DOI: 10.1245/s10434-023-13566-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/23/2023] [Accepted: 04/10/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Although functional outcomes are important in surgery for elderly patients, the long-term functional prognosis following oncologic surgery is unclear. We retrospectively investigated the long-term, functional and survival prognosis following major oncologic surgery according to age among elderly patients. METHODS We used a Japanese administrative database to identify 11,896 patients aged ≥ 65 years who underwent major oncological surgery between June 2014 and February 2019. We investigated the association between age at surgery and the postoperative incidence of bedridden status and mortality. Using the Fine-Gray model and restricted cubic spline functions, we conducted a multivariable, survival analysis with adjustments for patient background characteristics and treatment courses to estimate hazard ratios for the outcomes. RESULTS During a median follow-up of 588 (interquartile range, 267-997) days, 657 patients (5.5%) became bedridden and 1540 (13%) died. Patients aged ≥ 70 years had a significantly higher incidence of being bedridden than those aged 65-69 years; the subdistribution hazard ratios of the age groups of 70-74, 75-79, 80-84, and ≥ 85 years were 3.20 (95% confidence interval [CI], 1.53-6.71), 3.86 (95% CI 1.89-7.89), 6.26 (95% CI 3.06-12.8), and 8.60 (95% CI 4.19-17.7), respectively. Restricted cubic spline analysis demonstrated an increase in the incidence of bedridden status in patients aged ≥ 65 years, whereas mortality increased in patients aged ≥ 75 years. CONCLUSIONS This large-scale, observational study revealed that older age at oncological surgery was associated with poorer functional outcomes and higher mortality among patients aged ≥ 65 years.
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Affiliation(s)
- Takaaki Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Yusuke Sasabuchi
- Data Science Center, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Masahiko Tanabe
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuyuki Seto
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Chung GE, Yu SJ, Yoo J, Cho Y, Lee K, Shin DW, Kim YJ, Yoon J, Han K, Cho EJ. Differential risk of 23 site-specific incident cancers and cancer-related mortality among patients with metabolic dysfunction-associated fatty liver disease: a population-based cohort study with 9.7 million Korean subjects. Cancer Commun (Lond) 2023; 43:863-876. [PMID: 37337385 PMCID: PMC10397567 DOI: 10.1002/cac2.12454] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/30/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023] Open
Abstract
INTRODUCTION Although an association between metabolic dysfunction-associated fatty liver disease (MAFLD) and cardiovascular disease or overall mortality has been reported, it is unclear whether there is an association between MAFLD and cancer incidence or mortality. We aimed to investigate the differential risk of all- and site-specific cancer incidence and mortality according to MAFLD subgroups categorized by additional etiologies of liver disease. METHODS Using the Korean National Health Insurance Service database, we stratified the participants into three groups: (1) single-etiology MAFLD (S-MAFLD) or MAFLD of pure metabolic origin; (2) mixed-etiology MAFLD (M-MAFLD) or MAFLD with additional etiological factor(s) (i.e., concomitant liver diseases and/or heavy alcohol consumption); and (3) non-MAFLD. Hepatic steatosis and fibrosis were defined using the fatty liver index and the BARD score, respectively. Cox proportional hazards regression was performed to estimate the risk of cancer events. RESULTS Among the 9,718,182 participants, the prevalence of S-MAFLD and M-MAFLD was 29.2% and 6.7%, respectively. During the median 8.3 years of follow-up, 510,330 (5.3%) individuals were newly diagnosed with cancer, and 122,774 (1.3%) cancer-related deaths occurred among the entire cohort. Compared with the non-MAFLD group, the risk of all-cancer incidence and mortality was slightly higher among patients in the S-MAFLD group (incidence, adjusted hazard ratio [aHR] = 1.03; 95% confidence interval [CI]: 1.02-1.04; mortality, aHR = 1.06; 95% CI: 1.04-1.08) and highest among patients with M-MAFLD group (incidence, aHR = 1.31; 95% CI: 1.29-1.32; mortality, aHR = 1.45; 95% CI: 1.42-1.48, respectively). The M-MAFLD with fibrosis group (BARD score ≥ 2) showed the highest relative risk of all-cancer incidence (aHR = 1.38, 95% CI = 1.36-1.39), followed by the M-MAFLD without fibrosis group (aHR = 1.09, 95% CI = 1.06-1.11). Similar trends were observed for cancer-related mortality. CONCLUSIONS MAFLD classification, by applying additional etiologies other than pure metabolic origin, can be used to identify a subgroup of patients with poor cancer-related outcomes.
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Affiliation(s)
- Goh Eun Chung
- Department of Internal Medicine and Healthcare Research InstituteSeoul National University Hospital Healthcare System Gangnam CenterSeoulRepublic of Korea
| | - Su Jong Yu
- Department of Internal Medicine and Liver Research InstituteSeoul National University College of MedicineSeoulRepublic of Korea
| | - Jeong‐Ju Yoo
- Department of Gastroenterology and HepatologySoonchunhyang University Bucheon HospitalBucheonGyeonggi‐doRepublic of Korea
| | - Yuri Cho
- Center for Liver and Pancreatobiliary CancerNational Cancer CenterGoyangGyeonggi‐doRepublic of Korea
| | - Kyu‐na Lee
- Department of Biomedicine & Health ScienceCatholic University of KoreaSeoulRepublic of Korea
| | - Dong Wook Shin
- Department of Family Medicine/ Supportive care centerSamsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
- Department of Clinical Research Design and Evaluation/Department of Digital HealthSamsung Advanced Institute for Health ScienceSeoulRepublic of Korea
| | - Yoon Jun Kim
- Department of Internal Medicine and Liver Research InstituteSeoul National University College of MedicineSeoulRepublic of Korea
| | - Jung‐Hwan Yoon
- Department of Internal Medicine and Liver Research InstituteSeoul National University College of MedicineSeoulRepublic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial ScienceSoongsil UniversitySeoulRepublic of Korea
| | - Eun Ju Cho
- Department of Internal Medicine and Liver Research InstituteSeoul National University College of MedicineSeoulRepublic of Korea
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Kyrönlahti A, Erdmann F, Feychting M, Frederiksen LE, Hirvonen E, Korhonen LM, Krøyer A, Mader L, Malila N, Mogensen H, Pedersen C, Talbäck M, Taskinen M, Winther JF, Madanat‐Harjuoja L, Pitkäniemi J. Income disparities between adult childhood cancer survivors and their peers-A register-based cohort study from the SALiCCS research programme. Cancer Med 2023; 12:16455-16468. [PMID: 37305982 PMCID: PMC10469706 DOI: 10.1002/cam4.6218] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/20/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Childhood cancer survivors face various adverse consequences. This Nordic register-based cohort study aimed to assess whether survivors of childhood cancer are more likely to have low income than their peers. METHODS We identified 17,392 childhood cancer survivors diagnosed at ages 0 to 19 between 1971 and 2009 with 83,221 age-, sex-, and country-matched population comparisons. Annual disposable income at ages 20 to 50 years was retrieved from statistical offices (for 1990-2017) and categorized into low income and middle/high income. The number of transitions between income categories were assessed using binomial regression analyses. RESULTS The prevalence of annual low income among childhood cancer survivors was 18.1% and 15.6% among population comparisons (risk ratio [RR] 1.17; 95% confidence interval [CI] 1.16-1.18). Compared to population comparisons, childhood cancer survivors were 10% (95% CI 8%-11%) less likely to transition from low to middle/high income and 12% (10%-15%) more likely to transition from middle/high to low income during follow-up. Among those initially in the low income category, survivors were 7% (95% CI 3%-11%) more likely to remain in the low income category. If the initial category was middle/high income, childhood cancer survivors were 10% (95% CI 8%-11%) less likely to remain in the middle/high income and 45% (37%-53%) more likely to transition to the low income category permanently. CONCLUSIONS Childhood cancer survivors are at higher risk for low income in adulthood than their peers. These disparities might be reduced by continued career counseling along with support in managing within the social security system.
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Affiliation(s)
- Anniina Kyrönlahti
- Finnish Cancer RegistryHelsinkiFinland
- Children and AdolescentsHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Friederike Erdmann
- Childhood Cancer Research GroupDanish Cancer Society Research CenterCopenhagenDenmark
- Division of Childhood Cancer EpidemiologyInstitute of Medical Biostatistics, Epidemiology, and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University MainzGermany
- Department of Prevention and EvaluationLeibniz Institute for Prevention Research and Epidemiology – BIPSBremenGermany
| | - Maria Feychting
- Unit of EpidemiologyInstitute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | | | | | - Liisa Maria Korhonen
- Finnish Cancer RegistryHelsinkiFinland
- Children and AdolescentsHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Anja Krøyer
- Childhood Cancer Research GroupDanish Cancer Society Research CenterCopenhagenDenmark
| | - Luzius Mader
- Childhood Cancer Research GroupDanish Cancer Society Research CenterCopenhagenDenmark
- Childhood Cancer Research GroupInstitute of Social and Preventive Medicine, University of BernBernSwitzerland
- Cancer Registry Bern‐SolothurnUniversity of BernBernSwitzerland
| | | | - Hanna Mogensen
- Unit of EpidemiologyInstitute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Camilla Pedersen
- Childhood Cancer Research GroupDanish Cancer Society Research CenterCopenhagenDenmark
| | - Mats Talbäck
- Unit of EpidemiologyInstitute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Mervi Taskinen
- Children and AdolescentsHelsinki University Hospital and University of HelsinkiHelsinkiFinland
- Division of Pediatric Hematology, Oncology, and Stem Cell TransplantationHelsinki University HospitalHelsinkiFinland
| | | | - Laura Madanat‐Harjuoja
- Finnish Cancer RegistryHelsinkiFinland
- Dana Farber/Boston Children's Cancer and Blood Disorders ClinicBostonMassachusettsUSA
| | - Janne Pitkäniemi
- Finnish Cancer RegistryHelsinkiFinland
- Health Sciences Unit, Faculty of Social SciencesTampere UniversityTampereFinland
- Department of Public Health, Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
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Fine JR, Ransdell JM, Pinheiro PS, Kwon D, Reis IM, Barredo JC, Isrow DM. The Effect of Health Insurance on Pediatric Cancer Survival: An Analysis of Children Evaluated for Radiation Therapy in Diverse Multicenter Health Systems. J Pediatr Hematol Oncol 2023; 45:e662-e670. [PMID: 37278568 DOI: 10.1097/mph.0000000000002678] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/21/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Understanding the role of health insurance in cancer survival in a diverse population of pediatric radiation oncology patients could help to identify patients at risk of adverse outcomes. MATERIALS AND METHODS Data were collected from cancer patients evaluated for radiation therapy, age < 19, diagnosed from January 1990 to August 2019. Predictors of recurrence-free survival (RFS) and overall survival (OS) were analyzed by univariable and multivariable Cox regression. Variables included health insurance, diagnosis type, sex, race/ethnicity, and socioeconomic status deprivation index. RESULTS The study included 459 patients with a median diagnosis age of 9 years. Demographic breakdown was 49.5% Hispanic, 27.2% non-Hispanic White, and 20.7% non-Hispanic Black. There were 203 recurrences and 86 deaths observed over a median follow-up of 2.4 years. Five-year RFS was 59.8% (95% CI, 51.6, 67.0) versus 36.5% (95% CI, 26.6, 46.6), and 5-year OS was 87.5% (95% CI, 80.9, 91.9) versus 71.0% (95% CI, 60.3, 79.3) in private pay insurance versus Medicaid/Medicare, respectively. Multivariable showed Medicaid/Medicare patients experienced a 54% higher risk of recurrence (hazard ratio: 1.54, 95% CI, 1.08, 2.20) and 79% higher risk of death (hazard ratio: 1.79, 95% CI, 1.02, 3.14) than privately insured patients. CONCLUSIONS Significant disadvantages in RFS and OS were identified in radiation oncology patients with Medicaid/Medicare insurance, even after adjusting for clinical and demographic variables.
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Affiliation(s)
| | | | - Paulo S Pinheiro
- Sylvester Comprehensive Cancer Center
- Department of Public Health Science, University of Miami Miller School of Medicine
| | - Deukwoo Kwon
- Division of Biostatistics, Department of Public Health Sciences, Miller School of Medicine, University of Miami
- Biostatistics and Bioinformatics Core Resource, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami
| | - Isildinha M Reis
- Division of Biostatistics, Department of Public Health Sciences, Miller School of Medicine, University of Miami
- Biostatistics and Bioinformatics Core Resource, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami
| | | | - Derek M Isrow
- Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
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Guan H, Liu K, Fan X, Yu H, Qin Y, Yang J, Zhu Z, Shen C, Pan E, Lu Y, Zhou J, Su J, Wu M. Association of gamma-glutamyl transferase concentrations with all-cause and cause-specific mortality in Chinese adults with type 2 diabetes. J Diabetes 2023; 15:674-684. [PMID: 37161588 PMCID: PMC10415869 DOI: 10.1111/1753-0407.13399] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/06/2023] [Accepted: 04/15/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Evidence links gamma-glutamyl transferase (GGT) to mortality in the general population. However, the relationship of GGT with all-cause and cause-specific mortality risk has been little explored in type 2 diabetes mellitus (T2DM) patients. METHODS We recruited 20 340 community-dwelling T2DM patients between 2013 and 2014 in Jiangsu, China. Cox regression models were used to assess associations of GGT with all-cause and specific-cause mortality. Restricted cubic splines were used to analyze dose-response relationships between GGT and mortality. Stratified analysis was conducted to examine potential interaction effects by age, sex, smoking status, body mass index (BMI), diabetes duration, and dyslipidemia. RESULTS During a median follow-up period of 7.04 years (interquartile range: 6.98-7.08), 2728 deaths occurred, including 902 (33.09%) due to cardiovascular disease (CVD), and 754 (27.58%) due to cancer. GGT concentrations were positively associated with all-cause, CVD, and cancer mortality. Multivariable hazard ratios (HRs) for the highest (Q5) vs. the lowest quintile (Q1) were 1.63 (95% confidence intervals [CI]: 1.44-1.84) for all-cause mortality, 1.87 (95% CI: 1.49-2.35) for CVD mortality, and 1.43 (95% CI: 1.13-1.81) for cancer mortality. Effect modification by BMI and dyslipidemia was observed for all-cause mortality (both p for interaction <.05), and HRs were stronger in the BMI <25 kg/m2 group and those without dyslipidemia. CONCLUSIONS Our findings suggest that, in Chinese T2DM patients, elevated serum GGT concentrations were associated with mortality for all-cause, CVD, and cancer, and further research is needed to elucidate the role of obesity, nonalcoholic fatty liver disease, and lipids in this association.
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Affiliation(s)
- Haoyu Guan
- Department of Epidemiology, School of Public HealthNanjing Medical UniversityNanjingChina
| | - Ke Liu
- Department of Epidemiology and Health Statistics, School of Public HealthSoutheast UniversityNanjingChina
| | - Xikang Fan
- Department of Non‐communicable Chronic Disease ControlProvincial Center for Disease Control and PreventionNanjingChina
| | - Hao Yu
- Department of Non‐communicable Chronic Disease ControlProvincial Center for Disease Control and PreventionNanjingChina
| | - Yu Qin
- Department of Non‐communicable Chronic Disease ControlProvincial Center for Disease Control and PreventionNanjingChina
| | - Jie Yang
- Department of Non‐communicable Chronic Disease ControlProvincial Center for Disease Control and PreventionNanjingChina
| | - Zheng Zhu
- Department of Non‐communicable Chronic Disease ControlProvincial Center for Disease Control and PreventionNanjingChina
| | - Chong Shen
- Department of Epidemiology, School of Public HealthNanjing Medical UniversityNanjingChina
| | - Enchun Pan
- Department of Chronic Disease Prevention and ControlHuai'an City Center for Disease Control and PreventionHuai'anChina
| | - Yan Lu
- Department of Chronic Disease Prevention and ControlSuzhou City Center for Disease Control and PreventionSuzhouChina
| | - Jinyi Zhou
- Department of Non‐communicable Chronic Disease ControlProvincial Center for Disease Control and PreventionNanjingChina
| | - Jian Su
- Department of Non‐communicable Chronic Disease ControlProvincial Center for Disease Control and PreventionNanjingChina
| | - Ming Wu
- Department of Epidemiology, School of Public HealthNanjing Medical UniversityNanjingChina
- Department of Non‐communicable Chronic Disease ControlProvincial Center for Disease Control and PreventionNanjingChina
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Munir MM, Woldesenbet S, Endo Y, Moazzam Z, Lima HA, Azap L, Katayama E, Alaimo L, Shaikh C, Dillhoff M, Cloyd J, Ejaz A, Pawlik TM. Disparities in Socioeconomic Factors Mediate the Impact of Racial Segregation Among Patients With Hepatopancreaticobiliary Cancer. Ann Surg Oncol 2023; 30:4826-4835. [PMID: 37095390 DOI: 10.1245/s10434-023-13449-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/21/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Structural racism within the U.S. health care system contributes to disparities in oncologic care. This study sought to examine the socioeconomic factors that underlie the impact of racial segregation on hepatopancreaticobiliary (HPB) cancer inequities. METHODS Both Black and White patients who presented with HPB cancer were identified from the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database (2005-2015) and 2010 Census data. The Index of Dissimilarity (IoD), a validated measure of segregation, was examined relative to cancer stage at diagnosis, surgical resection, and overall mortality. Principal component analysis and structural equation modeling were used to determine the mediating effect of socioeconomic factors. RESULTS Among 39,063 patients, 86.4 % (n = 33,749) were White and 13.6 % (n = 5314) were Black. Black patients were more likely to reside in segregated areas than White patients (IoD, 0.62 vs. 0.52; p < 0.05). Black patients in highly segregated areas were less likely to present with early-stage disease (relative risk [RR], 0.89; 95 % confidence interval [CI] 0.82-0.95) or undergo surgery for localized disease (RR, 0.81; 95% CI 0.70-0.91), and had greater mortality hazards (hazard ratio 1.12, 95% CI 1.06-1.17) than White patients in low segregation areas (all p < 0.05). Mediation analysis identified poverty, lack of insurance, education level, crowded living conditions, commute time, and supportive income as contributing to 25 % of the disparities in early-stage presentation. Average income, house price, and income mobility explained 17 % of the disparities in surgical resection. Notably, average income, house price, and income mobility mediated 59 % of the effect that racial segregation had on long-term survival. CONCLUSION Racial segregation, mediated through underlying socioeconomic factors, accounted for marked disparities in access to surgical care and outcomes for patients with HPB cancer.
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Affiliation(s)
- Muhammad Musaab Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Zorays Moazzam
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Henrique A Lima
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Lovette Azap
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Erryk Katayama
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Laura Alaimo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Chanza Shaikh
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Mary Dillhoff
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Jordan Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
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Pompa IR, Ghosh A, Bhat S, Ragala S, Nwiloh A, Rasheed N, Chino F, Willers H, Goldberg S, Kamran SC. US Cancer Mortality Trends Among Hispanic Populations From 1999 to 2020. JAMA Oncol 2023; 9:1090-1098. [PMID: 37382965 PMCID: PMC10311425 DOI: 10.1001/jamaoncol.2023.1993] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/23/2023] [Indexed: 06/30/2023]
Abstract
Importance Advances in cancer research and treatment access have led to decreasing cancer mortality in the US; however, cancer remains the leading cause of death among Hispanic individuals. Objective To evaluate longitudinal cancer mortality trends from 1999 to 2020 among Hispanic individuals by demographic characteristics and to compare age-adjusted cancer death rates between the Hispanic population and other racial and ethnic populations during 2000, 2010, and 2020. Design, Setting, and Participants This cross-sectional study obtained age-adjusted cancer death rates among Hispanic individuals of all ages between January 1999 and December 2020, using the Centers for Disease Control and Prevention WONDER database. Cancer death rates in other racial and ethnic populations were extracted for 2000, 2010, and 2020. Data were analyzed from October 2021 to December 2022. Exposures Age, gender, race, ethnicity, cancer type, and US census region. Main Outcomes and Measures Trends and average annual percent changes (AAPCs) in age-adjusted cancer-specific mortality (CSM) rates among Hispanic individuals were estimated by cancer type, age, gender, and region. Results From 1999 to 2020, 12 644 869 patients died of cancer in the US, of whom 690 677 (5.5%) were Hispanic; 58 783 (0.5%) were non-Hispanic American Indian or Alaska Native; 305 386 (2.4%), non-Hispanic Asian or Pacific Islander; 1 439 259 (11.4%), non-Hispanic Black or African American; and 10 124 361 (80.1%), non-Hispanic White. For 26 403 patients (0.2%), no ethnicity was stated. The overall CSM rate among Hispanic individuals decreased by 1.3% (95% CI, 1.2%-1.3%) annually. Overall CSM rate decreased more for Hispanic men (AAPC, -1.6%; 95% CI, -1.7% to -1.5%) compared with women (AAPC, -1.0%; 95% CI, -1.0% to -0.9%). While death rates among Hispanic individuals decreased for most cancer types, mortality rates for liver cancer (AAPC, 1.0%; 95% CI, 0.6%-1.4%) increased among Hispanic men, and rates of liver (AAPC, 1.0%; 95% CI, 0.8%-1.3%), pancreas (AAPC, 0.2%; 95% CI, 0.1%-0.4%), and uterine (AAPC, 1.6%; 95% CI, 1.0%-2.3%) cancers increased among Hispanic women. Overall CSM rates increased for Hispanic men aged 25 to 34 years (AAPC, 0.7%; 95% CI, 0.3%-1.1%). By US region, liver cancer mortality rates increased significantly in the West for both Hispanic men (AAPC, 1.6%; 95% CI, 0.9%-2.2%) and Hispanic women (AAPC, 1.5%; 95% CI, 1.1%-1.9%). There were differential findings in mortality rates when comparing Hispanic individuals with individuals belonging to other racial and ethnic populations. Conclusions and Relevance In this cross-sectional study, despite overall CSM decreasing over 2 decades among Hispanic individuals, disaggregation of data demonstrated that rates of liver cancer deaths among Hispanic men and women and pancreas and uterine cancer deaths among Hispanic women increased from 1999 to 2020. There were also disparities in CSM rates among age groups and US regions. The findings suggest that sustainable solutions need to be implemented to reverse these trends among Hispanic populations.
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Affiliation(s)
- Isabella R. Pompa
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anushka Ghosh
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shamik Bhat
- Yale School of Medicine, New Haven, Connecticut
| | - Siri Ragala
- University of Missouri–Kansas City School of Medicine, Kansas City
| | | | - Nabeel Rasheed
- University of Missouri–Kansas City School of Medicine, Kansas City
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Henning Willers
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Saveli Goldberg
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sophia C. Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Sedeta E, Sung H, Laversanne M, Bray F, Jemal A. Recent Mortality Patterns and Time Trends for the Major Cancers in 47 Countries Worldwide. Cancer Epidemiol Biomarkers Prev 2023; 32:894-905. [PMID: 37195435 DOI: 10.1158/1055-9965.epi-22-1133] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/22/2023] [Accepted: 04/25/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Most prior studies have reported cancer mortality trends across countries for specific cancer types. Herein, we examine recent patterns and trends in cancer mortality rates for the eight common forms of cancer in 47 countries across five continents (except Africa) based on the World Health Organization mortality database. METHODS Rates were age-standardized to the 1966 Segi-Doll world population, and trends in the age-standardized rates for the most recent 10 years of data were examined using Joinpoint regression. RESULTS Cancer-specific mortality rates vary substantially across countries, with rates of infection-related (cervix and stomach) and tobacco-related cancers (lung and esophagus) varying by 10-fold. Recent mortality rates for all major cancers decreased in most of the studied countries except lung cancer in females and liver cancer in males, where increasing rates were observed in most countries. Rates decreased or stabilized in all countries for lung cancer in men and stomach cancer in both sexes. CONCLUSIONS The findings reinforce the importance of implementing and strengthening resource-stratified and targeted cancer prevention and control programs in all parts of the world to further reduce or halt the rising cancer burden. IMPACT The results may inform cancer prevention and treatment strategies and in so doing, reduce the marked global cancer disparities observed today.
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Affiliation(s)
- Ephrem Sedeta
- Brookdale University Hospital Medical Center, Brooklyn, New York
| | - Hyuna Sung
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Mathieu Laversanne
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Ahmedin Jemal
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia
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Guven DC, Yekeduz E, Erul E, Yazgan SC, Sahin TK, Karatas G, Aksoy S, Erman M, Yalcin S, Urun Y, Kilickap S. The benefit of treatment beyond progression with immune checkpoint inhibitors: a multi-center retrospective cohort study. J Cancer Res Clin Oncol 2023; 149:3599-3606. [PMID: 35960374 DOI: 10.1007/s00432-022-04268-8] [Citation(s) in RCA: 1] [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: 07/17/2022] [Accepted: 08/04/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE Treatment beyond progression (TBP) with immune checkpoint inhibitors (ICIs) is an evolving field due to the limitations of conventional imaging in response evaluation. However, real-life data on the benefit of TBP is scarce, especially from the limited resource settings and patients treated in the later lines. Therefore, we aimed to investigate the survival benefit of TBP with ICIs in patients with advanced tumors from a limited resource setting. METHODS For this multi-center retrospective cohort study, we included 282 patients treated with ICIs and had radiological progression according to RECIST 1.1 criteria. We evaluated post-progression survival according to the use of TBP (TBP and non-TBP groups) with univariate and multivariate analyses. RESULTS The cohort's median age was 61, and 84.4% were treated in the second or later lines. 82 (29.1%) of 282 patients continued on ICIs following the initial progression. In multivariate analyses, patients in the TBP group had improved post-progression survival compared to non-TBP (13.18 vs. 4.63 months, HR: 0.500, 95% CI: 0.349-0.717, p < 0.001). The benefit of the TBP was independent of the tumor type, treatment line, and age. Furthermore, TBP with ICIs remained associated with improved post-progression survival (HR: 0.600, 95% CI: 0.380-0.947, p = 0.028) after excluding the patients with no further treatment after progression in the non-TBP arm. CONCLUSIONS In this study, we observed that patients receiving ICIs beyond progression had considerably longer survival. Continuation of ICIs after progression should be considered a reasonable management option for patients with advanced cancer, specifically for patients with limited alternative options.
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Affiliation(s)
- Deniz Can Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Sihhiye, 06100, Ankara, Turkey.
| | - Emre Yekeduz
- Department of Medical Oncology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Enes Erul
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sati Coskun Yazgan
- Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Taha Koray Sahin
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gokturk Karatas
- Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Hacettepe University Cancer Institute, Sihhiye, 06100, Ankara, Turkey
| | - Mustafa Erman
- Department of Medical Oncology, Hacettepe University Cancer Institute, Sihhiye, 06100, Ankara, Turkey
| | - Suayib Yalcin
- Department of Medical Oncology, Hacettepe University Cancer Institute, Sihhiye, 06100, Ankara, Turkey
| | - Yuksel Urun
- Department of Medical Oncology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Saadettin Kilickap
- Faculty of Medicine, Istinye University, Istanbul, Turkey
- Medical Oncology Unit, Liv Hospital Ankara, Ankara, Turkey
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Hedman C, Strang P, Lundström S, Martinsson L. Symptom Management and Support in Dying Patients with Cancer and Coronavirus Disease-19-A Register-Based Study. J Palliat Care 2023; 38:261-267. [PMID: 36793233 PMCID: PMC10350711 DOI: 10.1177/08258597231157622] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVE Little is known to what extent access to specialist palliative care (SPC) for cancer patients dying with coronavirus disease-2019 (COVID-19) affects the occurrence of breakthrough symptoms, symptom relief, and overall care, compared to hospital deaths. Our aim was to include patients with both COVID-19 and cancer and compare those dying in hospitals with those dying in SPC with reference to the quality of end-of-life care. METHODS Patients with both cancer and COVID-19 who died in hospitals (n = 430) and within SPC (n = 384) were identified from the Swedish Register of Palliative Care. The hospital and SPC groups were compared regarding the quality of end-of-life care, including the occurrence of 6 breakthrough symptoms during the last week in life, symptom relief, end-of-life care decisions, information, support, and human presence at death. RESULTS Breakthrough of breathlessness was more common in the hospital patients compared to the SPC patients (61% and 39%, respectively; p < .001), while pain was less common (65% and 78%, respectively; p < .001). Breakthrough of nausea, anxiety, respiratory secretions, or confusion did not differ. All 6 symptoms, except for confusion, were more often completely relieved in SPC (p = .014 to p < .001 in different comparisons). In SPC, a documented decision about the goal being end-of-life care and information about this were more common than in hospitals (p < .001). Also, to have family members present at the time of death and for family members to be offered a follow-up talk afterward was more common in SPC (p < .001). CONCLUSION More systematic palliative care routines may be an important factor for better symptom control and higher quality of end-of-life care in hospitals.
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Affiliation(s)
- Christel Hedman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- R&D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Peter Strang
- R&D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden
- Department of Oncology–Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Staffan Lundström
- R&D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden
- Department of Oncology–Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Lisa Martinsson
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
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Eide D, Skurtveit S, Clausen T, Hesse M, Mravčík V, Nechanská B, Rolová G, Thylstrup B, Tjagvad C, Seid AK, Odsbu I, Gabrhelík R. Cause-Specific Mortality among Patients in Treatment for Opioid Use Disorder in Multiple Settings: A Prospective Comparative Cohort Study. Eur Addict Res 2023; 29:272-284. [PMID: 37385232 PMCID: PMC10614278 DOI: 10.1159/000530822] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 04/18/2023] [Indexed: 07/01/2023]
Abstract
INTRODUCTION Among people receiving current or previous opioid maintenance treatment (OMT), the leading cause of premature death is an opioid overdose. However, other causes of mortality remain high in this group. An understanding of causes of deaths across multiple settings can be useful in informing more comprehensive prevention responses. The aim of this study was to describe all non-overdose causes of death in three national cohorts (Czechia, Denmark, and Norway) among OMT patients and to explore associations of non-overdose mortality with age and gender. METHODS This prospective comparative cohort study used national mortality registry databases for OMT patients from Czechia (2000-2019), Denmark (2000-2018), and Norway (2010-2019). Crude mortality rates and age-standardized mortality rates (ASMRs) were calculated as deaths per 1,000 person years for cause-specific mortality. RESULTS In total, 29,486 patients were included, with 5,322 deaths recorded (18%). We found variations in causes of death among the cohorts and within gender and age groups. The leading non-overdose causes of death were accidents in Czechia and Denmark, and neoplasms in Norway. Cardiovascular deaths were highest in Czechia, particularly for women in OMT (ASMR 3.59 vs. 1.24 in Norway and 1.87 in Denmark). CONCLUSION This study found high rates of preventable death among both genders and all age groups. Different demographic structures, variations in risk exposure, as well as variations in coding practices can explain the differences. The findings support increased efforts towards screening and preventative health initiatives among OMT patients specific to the demographic characteristics in different settings.
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Affiliation(s)
- Desiree Eide
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Svetlana Skurtveit
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
- Norwegian Institute of Public Health, Oslo, Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Morten Hesse
- Centre for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark
| | - Viktor Mravčík
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Addictology, General University Hospital in Prague, Prague, Czech Republic
| | - Blanka Nechanská
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Addictology, General University Hospital in Prague, Prague, Czech Republic
| | - Gabriela Rolová
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Addictology, General University Hospital in Prague, Prague, Czech Republic
| | - Birgitte Thylstrup
- Centre for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark
| | - Christian Tjagvad
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Abdu Kedir Seid
- Centre for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark
| | - Ingvild Odsbu
- Norwegian Institute of Public Health, Oslo, Norway
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Roman Gabrhelík
- Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Addictology, General University Hospital in Prague, Prague, Czech Republic
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Biazus TB, Beraldi GH, Tokeshi L, Rotenberg LDS, Dragioti E, Carvalho AF, Solmi M, Lafer B. All-cause and cause-specific mortality among people with bipolar disorder: a large-scale systematic review and meta-analysis. Mol Psychiatry 2023; 28:2508-2524. [PMID: 37491460 PMCID: PMC10611575 DOI: 10.1038/s41380-023-02109-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE Bipolar disorder (BD) is associated with premature mortality. All-cause and specific mortality risks in this population remain unclear, and more studies are still needed to further understand this issue and guide individual and public strategies to prevent mortality in bipolar disorder Thus, a systematic review and meta-analysis of studies assessing mortality risk in people with BD versus the general population was conducted. The primary outcome was all-cause mortality, whilst secondary outcomes were mortality due to suicide, natural, unnatural, and specific-causes mortality. RESULTS Fifty-seven studies were included (BD; n = 678,353). All-cause mortality was increased in people with BD (RR = 2.02, 95% CI: 1.89-2.16, k = 39). Specific-cause mortality was highest for suicide (RR = 11.69, 95% CI: 9.22-14.81, k = 25). Risk of death due to unnatural causes (RR = 7.29, 95% CI: 6.41-8.28, k = 17) and natural causes (RR = 1.90, 95% CI: 1.75-2.06, k = 17) were also increased. Among specific natural causes analyzed, infectious causes had the higher RR (RR = 4,38, 95%CI: 1.5-12.69, k = 3), but the analysis was limited by the inclusion of few studies. Mortality risk due to respiratory (RR = 3.18, 95% CI: 2.55-3.96, k = 6), cardiovascular (RR = 1.76, 95% CI: 1.53-2.01, k = 27), and cerebrovascular (RR = 1.57, 95% CI: 1.34-1.84, k = 13) causes were increased as well. No difference was identified in mortality by cancer (RR = 0.99, 95% CI: 0.88-1.11, k = 16). Subgroup analyses and meta-regression did not affect the findings. CONCLUSION Results presented in this meta-analysis show that risk of premature death in BD is not only due to suicide and unnatural causes, but somatic comorbidities are also implicated. Not only the prevention of suicide, but also the promotion of physical health and the prevention of physical conditions in individuals with BD may mitigate the premature mortality in this population. Notwithstanding this is to our knowledge the largest synthesis of evidence on BD-related mortality, further well-designed studies are still warranted to inform this field.
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Affiliation(s)
- Taís Boeira Biazus
- Bipolar Disorder Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
| | - Gabriel Henrique Beraldi
- Bipolar Disorder Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Schizophrenia Research Program (Projesq), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Lucas Tokeshi
- Consultation Liaison, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Luísa de Siqueira Rotenberg
- Bipolar Disorder Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Elena Dragioti
- Research Laboratory Psychology of Patients, Families & Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, SE 58185, Linköping, Sweden
| | - André F Carvalho
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Beny Lafer
- Bipolar Disorder Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
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Shiels MS, Lipkowitz S, Campos NG, Schiffman M, Schiller JT, Freedman ND, Berrington de González A. Opportunities for Achieving the Cancer Moonshot Goal of a 50% Reduction in Cancer Mortality by 2047. Cancer Discov 2023; 13:1084-1099. [PMID: 37067240 PMCID: PMC10164123 DOI: 10.1158/2159-8290.cd-23-0208] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 02/17/2023] [Revised: 03/14/2023] [Accepted: 03/14/2023] [Indexed: 04/18/2023]
Abstract
On February 2, 2022, President Biden and First Lady Dr. Biden reignited the Cancer Moonshot, setting a new goal to reduce age-standardized cancer mortality rates by at least 50% over the next 25 years in the United States. We estimated trends in U.S. cancer mortality during 2000 to 2019 for all cancers and the six leading types (lung, colorectum, pancreas, breast, prostate, liver). Cancer death rates overall declined by 1.4% per year from 2000 to 2015, accelerating to 2.3% per year during 2016 to 2019, driven by strong declines in lung cancer mortality (-4.7%/year, 2014 to 2019). Recent declines in colorectal (-2.0%/year, 2010-2019) and breast cancer death rates (-1.2%/year, 2013-2019) also contributed. However, trends for other cancer types were less promising. To achieve the Moonshot goal, progress against lung, colorectal, and breast cancer deaths needs to be maintained and/or accelerated, and new strategies for prostate, liver, pancreatic, and other cancers are needed. We reviewed opportunities to prevent, detect, and treat these common cancers that could further reduce population-level cancer death rates and also reduce disparities. SIGNIFICANCE We reviewed opportunities to prevent, detect, and treat common cancers, and show that to achieve the Moonshot goal, progress against lung, colorectal, and breast cancer deaths needs to be maintained and/or accelerated, and new strategies for prostate, liver, pancreatic, and other cancers are needed. See related commentary by Bertagnolli et al., p. 1049. This article is highlighted in the In This Issue feature, p. 1027.
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Affiliation(s)
- Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Stanley Lipkowitz
- Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Nicole G Campos
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - John T Schiller
- Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Amy Berrington de González
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
- The Institute of Cancer Research, London, United Kingdom
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Wu W, Wang J, Liao XZ, Xu K, Zou Y, Shi Z, Hu Y, Xiao H, Li C, Cao S, Wang S, Guo J, Luo Z, Liu M, Xu M, Jin D, Chen M, Fu Z, Yan S. Projection of Premature Cancer Mortality in Hunan, China, Through 2030: Modeling Study. JMIR Public Health Surveill 2023; 9:e43967. [PMID: 36877566 PMCID: PMC10028508 DOI: 10.2196/43967] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/21/2023] [Accepted: 01/30/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The United Nations Sustainable Development Goals for 2030 include reducing premature mortality from noncommunicable diseases by one-third. Although previous modeling studies have predicted premature mortality from noncommunicable diseases, the predictions for cancer and its subcategories are less well understood in China. OBJECTIVE The aim of this study was to project premature cancer mortality of 10 leading cancers in Hunan Province, China, based on various scenarios of risk factor control so as to establish the priority for future interventions. METHODS We used data collected between 2009 and 2017 from the Hunan cancer registry annual report as empirical data for projections. The population-attributable fraction was used to disaggregate cancer deaths into parts attributable and unattributable to 10 risk factors: smoking, alcohol use, high BMI, diabetes, physical inactivity, low vegetable and fruit intake, high red meat intake, high salt intake, and high ambient fine particulate matter (PM2.5) levels. The unattributable deaths and the risk factors in the baseline scenario were projected using the proportional change model, assuming constant annual change rates through 2030. The comparative risk assessment theory was used in simulated scenarios to reflect how premature mortality would be affected if the targets for risk factor control were achieved by 2030. RESULTS The cancer burden in Hunan significantly increased during 2009-2017. If current trends for each risk factor continued to 2030, the total premature deaths from cancers in 2030 would increase to 97,787 in Hunan Province, and the premature mortality (9.74%) would be 44.47% higher than that in 2013 (6.74%). In the combined scenario where all risk factor control targets were achieved, 14.41% of premature cancer mortality among those aged 30-70 years would be avoided compared with the business-as-usual scenario in 2030. Reductions in the prevalence of diabetes, high BMI, ambient PM2.5 levels, and insufficient fruit intake played relatively important roles in decreasing cancer premature mortality. However, the one-third reduction goal would not be achieved for most cancers except gastric cancer. CONCLUSIONS Existing targets on cancer-related risk factors may have important roles in cancer prevention and control. However, they are not sufficient to achieve the one-third reduction goal in premature cancer mortality in Hunan Province. More aggressive risk control targets should be adopted based on local conditions.
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Affiliation(s)
- Wenqiong Wu
- Department of Radiotherapy, Hunan Cancer Hospital, Changsha, China
| | - Jing Wang
- Chengdu Center for Disease Control and Prevention, Chengdu, China
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xian-Zhen Liao
- Department of Cancer Prevention and Control, Hunan Cancer Hospital, Changsha, China
| | - Kekui Xu
- Department of Cancer Prevention and Control, Hunan Cancer Hospital, Changsha, China
| | - Yanhua Zou
- Department of Cancer Prevention and Control, Hunan Cancer Hospital, Changsha, China
| | - Zhaohui Shi
- Department of Cancer Prevention and Control, Hunan Cancer Hospital, Changsha, China
| | - Yingyun Hu
- Department of Cancer Prevention and Control, Hunan Cancer Hospital, Changsha, China
| | - Haifan Xiao
- Department of Cancer Prevention and Control, Hunan Cancer Hospital, Changsha, China
| | - Can Li
- Department of Cancer Prevention and Control, Hunan Cancer Hospital, Changsha, China
| | - Shiyu Cao
- Department of Cancer Prevention and Control, Hunan Cancer Hospital, Changsha, China
| | - Shiyu Wang
- Department of Cancer Prevention and Control, Hunan Cancer Hospital, Changsha, China
| | - Jia Guo
- Department of Cancer Prevention and Control, Hunan Cancer Hospital, Changsha, China
| | - Zhicheng Luo
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Mengjiao Liu
- Department of Cancer Prevention and Control, Hunan Cancer Hospital, Changsha, China
| | - Mengyao Xu
- Department of Cancer Prevention and Control, Hunan Cancer Hospital, Changsha, China
| | - Donghui Jin
- Hunan Provincial Center for Disease Control and Prevention, Changsha, China
| | - Mengshi Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Zhongxi Fu
- Hunan Provincial Center for Disease Control and Prevention, Changsha, China
| | - Shipeng Yan
- Department of Cancer Prevention and Control, Hunan Cancer Hospital, Changsha, China
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Nash SH, Wahlen MM, Meisner ALW, Morawski BM. Choice of Survival Metric and Its Impacts on Cancer Survival Estimates for American Indian and Alaska Native People. Cancer Epidemiol Biomarkers Prev 2023; 32:398-405. [PMID: 36723409 PMCID: PMC9992150 DOI: 10.1158/1055-9965.epi-22-1059] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/08/2022] [Accepted: 01/09/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Different survival metrics have different applicability to clinical practice and research. We evaluated how choice of survival metric influences assessment of cancer survival among American Indian and Alaska Native (AIAN) people relative to non-Hispanic Whites (NHW). A secondary objective was to present variations in survival among AIAN people by age, sex, stage, and Indian Health Service (IHS) region. METHODS Five-year survival was calculated using the North American Association of Central Cancer Registries Cancer in North America dataset. We calculated survival among AIAN people, compared with NHW using four approaches: (i) observed (crude) survival, (ii) cause-specific survival, (iii) relative survival using age- and sex-adjusted lifetables, and (iv) relative survival using lifetables additionally adjusted for race, geography, and socioeconomic status. For AIAN people, we evaluated how survival varied by age, stage at diagnosis, and IHS region. RESULTS Observed survival methods produced the lowest estimates, and-excepting prostate cancer-cause-specific methods produced the highest survival estimates. Survival was lower among AIAN people than NHW for all methods. Among AIAN people, survival was higher among those 20-64 years, females, and tumors diagnosed at local stage. Survival varied by IHS region and cancer sites. CONCLUSIONS These results support the assertion that using the same methodology to compare survival estimates between racial and ethnic groups is of paramount importance, but that the choice of metric requires careful consideration of study objectives. IMPACT These findings have the potential to impact choice of survival metric to explore disparities among AIAN people.
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Affiliation(s)
- Sarah H Nash
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
- State Health Registry of Iowa, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Madison M Wahlen
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Angela L W Meisner
- New Mexico Tumor Registry, University of New Mexico Comprehensive Cancer Center, University of New Mexico, Albuquerque, New Mexico
| | - Bożena M Morawski
- Cancer Data Registry of Idaho, Idaho Hospital Association, Boise, Idaho
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Snider NG, Hastert TA, Nair M, Madhav K, Ruterbusch JJ, Schwartz AG, Peters ES, Stoffel EM, Rozek LS, Purrington KS. Area-level Socioeconomic Disadvantage and Cancer Survival in Metropolitan Detroit. Cancer Epidemiol Biomarkers Prev 2023; 32:387-397. [PMID: 36723416 PMCID: PMC10071652 DOI: 10.1158/1055-9965.epi-22-0738] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/27/2022] [Accepted: 01/09/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Racial segregation is linked to poorer neighborhood quality and adverse health conditions among minorities, including worse cancer outcomes. We evaluated relationships between race, neighborhood social disadvantage, and cancer survival. METHODS We calculated overall and cancer-specific survival for 11,367 non-Hispanic Black (NHB) and 29,481 non-Hispanic White (NHW) individuals with breast, colorectal, lung, or prostate cancer using data from the Metropolitan Detroit Cancer Surveillance System. The area deprivation index (ADI) was used to measure social disadvantage at the census block group level, where higher ADI is associated with poorer neighborhood factors. Associations between ADI and survival were estimated using Cox proportional hazards mixed-effects models accounting for geographic grouping and adjusting for demographic and clinical factors. RESULTS Increasing ADI quintile was associated with increased overall mortality for all four cancer sites in multivariable-adjusted models. Stratified by race, these associations remained among breast (NHW: HR = 1.16, P < 0.0001; NHB: HR = 1.20, P < 0.0001), colorectal (NHW: HR = 1.11, P < 0.0001; NHB: HR = 1.09, P = 0.00378), prostate (NHW: HR = 1.18, P < 0.0001; NHB: HR = 1.18, P < 0.0001), and lung cancers (NHW: HR = 1.06, P < 0.0001; NHB: HR = 1.07, P = 0.00177). Cancer-specific mortality estimates were similar to overall mortality. Adjustment for ADI substantially attenuated the effects of race on mortality for breast [overall proportion attenuated (OPA) = 47%, P < 0.0001; cancer-specific proportion attenuated (CSPA) = 37%, P < 0.0001] prostate cancer (OPA = 51%, P < 0.0001; CSPA = 56%, P < 0.0001), and colorectal cancer (OPA = 69%, P = 0.032; CSPA = 36%, P = 0.018). CONCLUSIONS Area-level socioeconomic disadvantage is related to cancer mortality in a racially diverse population, impacting racial differences in cancer mortality. IMPACT Understanding the role of neighborhood quality in cancer survivorship could improve community-based intervention practices.
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Affiliation(s)
- Natalie G. Snider
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
| | - Theresa A. Hastert
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan
| | - Mrudula Nair
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
| | - K.C. Madhav
- Department of Internal Medicine, Yale School of Medicine, Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, Connecticut
| | - Julie J. Ruterbusch
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan
| | - Ann G. Schwartz
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan
| | - Edward S. Peters
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Elena M. Stoffel
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - Laura S. Rozek
- Department of Oncology, Georgetown University School of Medicine, Washington, DC
| | - Kristen S. Purrington
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan
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Hovén E, Ljungman L, Sveen J, Skoglund C, Ljungman G, Ljung R, Wikman A. Losing a child to adolescent cancer: A register-based cohort study of psychotropic medication use in bereaved parents. Cancer Med 2023; 12:6148-6160. [PMID: 36218005 PMCID: PMC10028064 DOI: 10.1002/cam4.5347] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/09/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To investigate the short- and long-term risk of psychotropic medication use in parents who lose a child to cancer diagnosed in adolescence. METHODS This is a Swedish nationwide register-based study including 184 bereaved mothers and 184 bereaved fathers of 184 children diagnosed with cancer in adolescence. Logistic regression analyses, adjusted for sociodemographic characteristics and history of mental health problems, were performed to estimate risk of a prescription of psychotropic medication (anxiolytics, hypnotics/sedatives, antidepressants) in cancer-bereaved parents from 1 year before to 5 years after the child's death, with a general population sample of non-bereaved parents (n = 3291) as referents. RESULTS At the year of the child's death, 28%-36% of mothers and 11%-20% of fathers had a prescription of anxiolytics, hypnotics/sedatives or antidepressants. The corresponding percentages for non-bereaved mothers and fathers were 7%-12% and 4%-7%, respectively. Compared to non-bereaved mothers, bereaved mothers showed higher odds of prescriptions from 1 year before up to four (anxiolytics) and 5 years (hypnotics/sedatives and antidepressants) after the child's death. Bereaved fathers showed higher odds than non-bereaved fathers of prescriptions from 1 year before up to the year of (anxiolytics and hypnotics/sedatives) and 1 year after (antidepressants) the child's death. No differences in odds between bereaved and non-bereaved fathers were found at 2 years after the child's death. Being unmarried, born outside Sweden, and having a history of mental health problems were associated with higher odds of prescribed medications. CONCLUSIONS Indicative of mental health problems of clinical importance, cancer-bereaved parents had a higher prevalence of use of psychotropic medication. A decrease in medication use was evident with time, but still at 5 years after the child's death mothers displayed a higher use while fathers showed no difference to non-bereaved fathers after 2 years.
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Affiliation(s)
- Emma Hovén
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
- Childhood Cancer Research Unit, Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - Lisa Ljungman
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | - Josefin Sveen
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
- Center for Crisis PsychologyUniversity of BergenBergenNorway
| | | | - Gustaf Ljungman
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
- Pediatric OncologyUppsala University HospitalUppsalaSweden
| | - Rickard Ljung
- Unit of EpidemiologyInstitute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Anna Wikman
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
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van Halteren HK, Bennouna J, Brasiuniene B, Tomas AJC, Trinidad AMG, Indini A, Liposits G, Pellegrino B, Popovic L, Tan A, Vidra R, Strijbos M. Twelve ESMO Congress 2022 breakthroughs: practicing oncologists' perceptions and potential application on presented data. ESMO Open 2023; 8:100773. [PMID: 36634532 PMCID: PMC9843205 DOI: 10.1016/j.esmoop.2022.100773] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND During the European Society for Medical Oncology (ESMO) Congress 2022, outcome data of a great number of clinical trials were presented. For the attending medical oncologist, it is important to structure these data in a way that facilitates a trade-off between treatment burden and benefit. MATERIALS AND METHODS To illustrate this, we carried out a narrative non-systematic review of 12 selected oral presentations with potential impact on future daily practice, focusing on trial methodology, possible study flaws, reported clinical benefit and implementability. RESULTS The selected presentations encompassed 10 phase III trials, 1 randomized phase II trial and 1 phase II trial. In 7 out of 12 trials, quality of life and/or patient-reported outcomes had been evaluated. None of the trials, which reported progression-free survival (PFS) data, provided information, which could exclude informative censoring bias. In none of the trials reporting overall survival (OS) data, potential flaws due to undesirable crossover and imbalance between study groups regarding post-progression treatments were addressed. For the 11 reviewed randomized trials, the ESMO-Magnitude of Clinical Benefit Scale (MCBS) grade achieved with the new intervention was calculated based on the presented data. The MCBS grade varied from 1 to 5. CONCLUSIONS Our review confirms the high-quality standard of current cancer research and the clinical relevance of the research questions answered. However, during presentation of PFS and/or OS data, factors known to affect PFS and OS analysis should be structurally addressed. In order to keep cancer care affordable and sustainable, it could be considered to include an ESMO-MCBS threshold in the drug appraisal process of regulatory authorities.
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Affiliation(s)
- H K van Halteren
- Department of Medical Oncology, Adrz Hospital, Goes, The Netherlands.
| | - J Bennouna
- Department of Medical Oncology, Hospital Foch, Suresnes, France
| | - B Brasiuniene
- Department of Medical Oncology, National Cancer Institute of Lithuania, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - A J Cunquero Tomas
- Department of Medical Oncology, General University Hospital of Valencia, Valencia, Spain; Medical Oncology Unit, General Hospital of Requena, Valencia, Spain
| | - A M Garcia Trinidad
- Section of Medical Oncology, Dagupan Doctors Villaflor Memorial Hospital, Dagupan City, The Philippines
| | - A Indini
- Unit of Medical Oncology, Department of Oncology, Ospedale di Circolo e Fondazione Macchi, ASST Settelaghi, Varese, Italy
| | - G Liposits
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - B Pellegrino
- Medical Oncology and Breast Unit, University Hospital of Parma, Parma; Department of Medical Oncology, University of Parma, Parma, Italy
| | - L Popovic
- Oncology Institute of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - A Tan
- Department of Medical Oncology, Waikato Hospital, Hamilton, New Zealand
| | - R Vidra
- Department of Medical Oncology, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor", Cluj-Napoca, Romania; UBBMed, Babes-Bolyai University, Cluj-Napoca, Romania
| | - M Strijbos
- Department of Medical Oncology, GZA Hospitals, Wilrijk, Belgium
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49
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Parikh RB, Zhang Y, Kolla L, Chivers C, Courtright KR, Zhu J, Navathe AS, Chen J. Performance drift in a mortality prediction algorithm among patients with cancer during the SARS-CoV-2 pandemic. J Am Med Inform Assoc 2023; 30:348-354. [PMID: 36409991 PMCID: PMC9846686 DOI: 10.1093/jamia/ocac221] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 10/28/2022] [Accepted: 11/03/2022] [Indexed: 11/22/2022] Open
Abstract
Sudden changes in health care utilization during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic may have impacted the performance of clinical predictive models that were trained prior to the pandemic. In this study, we evaluated the performance over time of a machine learning, electronic health record-based mortality prediction algorithm currently used in clinical practice to identify patients with cancer who may benefit from early advance care planning conversations. We show that during the pandemic period, algorithm identification of high-risk patients had a substantial and sustained decline. Decreases in laboratory utilization during the peak of the pandemic may have contributed to drift. Calibration and overall discrimination did not markedly decline during the pandemic. This argues for careful attention to the performance and retraining of predictive algorithms that use inputs from the pandemic period.
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Affiliation(s)
- Ravi B Parikh
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Yichen Zhang
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Likhitha Kolla
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Corey Chivers
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Katherine R Courtright
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jingsan Zhu
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Amol S Navathe
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Jinbo Chen
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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50
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Milovac T. Parachutes, randomized controlled trials, and all-cause mortality. Hist Philos Life Sci 2022; 44:68. [PMID: 36434291 DOI: 10.1007/s40656-022-00551-6] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 11/10/2022] [Indexed: 06/16/2023]
Abstract
In 2003 and 2018 researchers discussed the perils of blind reliance on randomized controlled trials that have been substituted for medical experience and clinical acumen. Although these past articles do well to shed light on this issue, they neglect to discuss the topic of all-cause mortality in controlled trials. The current essay seeks to fill this void and expand the thought put into the appropriateness of all-cause mortality, especially when trials extend excessively far into the future. To do this effectively the current essay leans on trial data from statin research and evidence from cancer screening-where researchers have explicitly called for all-cause mortality to be used in lieu of cancer or cardiovascular specific mortality. The issue with such an endpoint is that it obfuscates the issue at hand, namely that a specific intervention is intended to have a specific effect, not that a specific intervention is supposed to have any kind of effect. The effect(s) of medical interventions ought to be relevant to their intended mechanism of action and not simply any positive effect that can be pulled from trial data.
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Affiliation(s)
- Thomas Milovac
- Department of Philosophy, University of Waterloo, 200 University Ave W, Waterloo, Canada.
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