Detection of spatial aggregation of cases of cancer from data on patients and health centres contained in the Minimum Basic Data Set

The feasibility of the Minimum Basic Data Set (MBDS) as a tool in cancer research was explored monitoring its incidence through the detection of spatial clusters. Case-control studies based on MBDS and marked point process were carried out with the focus on the residence of patients from the Prince of Asturias University Hospital in Alcalá de Henares (Madrid, Spain). Patients older than 39 years with diagnoses of stomach, colorectal, lung, breast, prostate, bladder and kidney cancer, melanoma and haematological tumours were selected. Geocoding of the residence address of the cases was done by locating them in the continuous population roll provided by the Madrid Statistical Institute and extracting the coordinates. The geocoded control group was a random sample of 10 controls per case matched by frequency of age and sex. To assess case clusters, differences in Ripley K functions between cases and controls were calculated. The spatial location of clusters was explored by investigating spatial intensity and its ratio between cases and controls. Results suggest the existence of an aggregation of cancers with a common risk factor such as tobacco smoking (lung, bladder and kidney cancers). These clusters were located in an urban area with high socioeconomic deprivation. The feasibility of designing and carrying out case-control studies from the MBDS is shown and we conclude that MBDS can be a useful epidemiological tool for cancer surveillance and identification of risk factors through case-control spatial point process studies.

[Description of postauthorisation observational prospective studies with drugs in the valencian region between 2010 and 2015. Factors associated with their authorisation.]

OBJECTIVE

Postauthorisation observational studies are crucial source of information on drug effectiveness and safety. The objectives of this work were to describe the characteristics of the postauthorisation observational prospective studies (EPA-SP) for which authorisation was requested in the Valencian region, as well as to explore which factors influenced the aforementioned authorisation.

METHODS

We performed a retrospective analytical study comprising all the EPA-SP for which authorisation was requested in the Valencian region between 2010 and 2015.The variables associated to the studies (e.g., objectives, studied drug, target disease) as well as those concerning the authorisation process itself (e.g., authorisation status, reason for authorisation refusal, current status of the study) were obtained from relevant databases. The analysis was divided into descriptive and analytical stages.

RESULTS

We included a total of 249 studies, out of which 192 (77, 1%) aimed at estimating effectiveness or quality of life. The most frequent types of drugs involved in the studies were the antineoplastic and immunomodulating agents (42%). Only 57% of the studies were granted authorisation, with prescription induction and unusual practice being the most common causes for refusal (40.1% and 39.3%, respectively). The authorisation was linked to the diagnosis (circulatory system OR 10,7, IC95% 2,3 to 49,1), ATC L group (OR 4,2, IC95% 1,9 to 49,1) as well as to whether it had been advocated by the industry (OR 0,5, IC95% 0,3 to 0,9).

CONCLUSIONS

Given the importance of having information on effectiveness and safety in usual practice, it is a priority for EPA-SP to be directed towards these aims and to promote independent research.

Incidence Patterns and Trends of non-Central Nervous System Solid Tumours in Children and Adolescents. A Collaborative Study of the Spanish Population Based Cancer Registries

Objective: To describe incidence patterns and trends in children (0-14 years) and adolescents (15-19 age-range) with solid tumours, except those of central nervous system (CNS), in Spain.

Methods: Cases were drawn from eleven Spanish population-based cancer registries. Incidence was estimated for the period 1983-2007 and trends were evaluated using Joinpoint regression analysis.

Results: The studied tumour groups accounted for 36% of total childhood cancers and 47.6% of those diagnosed in adolescence with annual rates per million of 53.5 and 89.3 respectively. In children 0 to 14 years of age, Neuroblastoma (NB) was the commonest (7.8%) followed by Soft-tissue sarcomas (STS) (6.3%), bone tumours (BT) (6.2%) and renal tumours (RT) (4.5%). NB was the most frequently diagnosed tumour before the 5th birthday, while STS and BT were the commonest at 5-9 years of age, and BT and Carcinoma and other epithelial tumours (COET) at 10-14. COET presented the highest incidence in adolescents, followed by germ-cell tumours (GCT), BT and STS. These four diagnostic groups accounted for 94% of total non-CNS solid tumours, in adolescents. Overall incidence rates increased significantly in children up to 1996 with an annual percentage change (APC) of 2.6% (95%CI: 1.7; 3.6). NB and COET showed significant time trend (APCs: 1.4% and 3.8% respectively) while other tumour groups such as RT, STS, BT or GCT had no significant changes over time. A significant increase was present in NB under the age of 5 and in BT and STS in children aged 10-14 years. In adolescents there were significant increases for all tumours combined (APC=2.7; 95%CI: 1.8-3.6) and for STS, GCT and COET (APCs: 3.2%, 4.4% and 3.5% respectively), while other tumour groups such as hepatic tumours, BT or thyroid carcinomas showed a decreasing trend or no increase.

Conclusions: Overall, the incidence of the studied cancers in children increased along the period 1983-1996 with no posterior significant rise, while the incidence in adolescents increased significantly over the whole period 1983-2007. Several specific tumour groups showed significant rises or decrements in childhood or adolescence, although the small number of cases precludes showing significant trends or inflexion points.