Self-reported health, lifestyle and social circumstances of Australian adult cancer survivors: A propensity score weighted cross-sectional study.

BACKGROUND: With the prevalence of cancer survivors increasing, their unique needs must be better understood. We examined the health, lifestyles and social circumstances of adults with and without a history of cancer. METHODS: We performed a cross-sectional study, using exposure and outcome data from the baseline survey (2006-2009) of participants in the 45 and Up Study, a prospective cohort study in New South Wales, Australia. We compared 20,811 cancer registry-verified adult cancer survivors with 207,148 participants without a history of cancer using propensity score weighting and accounting for multiple testing. The propensity weighting included age, sociodemographic factors and number of self-reported co-morbidities. RESULTS: Cancer survivors were more likely to report poorer physical and psychological health and quality of life compared to those without a cancer history, with most deficits still evident more than 10 years after cancer diagnosis. Cancer survivors were more likely to have a higher body mass index, but were less likely to smoke. Cancer survivors had greater functional limitations, including sexual, and were less likely to work full time, volunteer and spend time outdoors. Their social connectedness was, however, similar. Those with haematological cancer, lung cancer, or distant metastases, and those diagnosed at an older age, had the greatest health deficits and functional limitations. CONCLUSIONS: A history of cancer is associated with poorer health and less paid and unpaid work. Our findings reinforce the importance of routine long-term, integrated multidisciplinary care for cancer survivors and indicate the subgroups with the greatest unmet needs.

Minimal excess risk of cancer and reduced risk of death from cancer in Australian Department of Veterans' Affairs clients: a record linkage study.

OBJECTIVE: To quantify the risk of incident cancer and cancer-related mortality in Australian Government Department of Veterans' Affairs (DVA) clients. METHODS: A population-based record linkage study of 75,482 adult clients residing in New South Wales (NSW) from 2000 to 2007; median age 75 years (interquartile range, 68-79); 57% male. Standardised incidence ratios (SIRs) and mortality ratios (SMRs) for any cancer and by cancer type were calculated, relative to the NSW population. RESULTS: The risk of any cancer was slightly increased for males (SIR 1.07, 95%CI 1.04-1.10) but not females (SIR 1.00, 95%CI 0.96-1.04). Males exhibited a significantly elevated risk of prostate cancer (SIR 1.08), cutaneous melanoma (SIR 1.19), head and neck cancer (SIR 1.27) and connective tissue cancer (SIR 1.52). Females did not exhibit excess risk for any cancer type. Risk of cancer death was significantly reduced for any cancer (male SMR 0.78, 95%CI 0.75-0.81; female SMR 0.80, 95%CI 0.76-0.85) and for a range of haematopoietic and solid neoplasms including prostate (SMR 0.57), breast (SMR 0.62) and colon cancer (male SMR 0.67; female SMR 0.71). CONCLUSION: Cancer incidence rates are largely similar, and mortality rates moderately lower, for DVA clients compared to the NSW general population. IMPLICATIONS: These risk patterns may reflect service-related history, a healthy-survivor effect, competing risk of death, and/or comprehensive health care entitlements with minimal to no co-payments. Our findings suggest DVA clients are probably accessing cancer screening services. Outcomes after cancer diagnosis are good, most probably due to comprehensive health care entitlements.

Oesophagectomy rates and post-resection outcomes in patients with cancer of the oesophagus and gastro-oesophageal junction: a population-based study using linked health administrative linked data.

BACKGROUND: Hospital performance is being benchmarked increasingly against surgical indicators such as 30-day mortality, length-of-stay, survival and post-surgery complication rates. The aim of this paper was to examine oesophagectomy rates and post-surgical outcomes in cancers of the oesophagus and gastro-oesophageal junction and to determine how the addition of gastro-oesophageal cancer to oesophageal cancer impacts on these outcomes. METHODS: Our study population consisted of patients with a primary invasive oesophageal or gastro-oesophageal cancer identified from the NSW Cancer Registry from July 2000-Dec 2007. Their records were linked to the hospital separation data for determination of resection rates and post-resection outcomes. We used multivariate logistic regression analyses to examine factors associated with oesophagectomy and post-resection outcomes. Cox-proportional hazard regression analysis was used to examine one-year cancer survival following oesophagectomy. RESULTS: We observed some changes in resection rates and surgical outcomes with the addition of gastro-oesophageal cancer patients to the oesophageal cancer cohort. 14.6% of oesophageal cancer patients and 26.4% of gastro-oesophageal cancer patients had an oesophagectomy; an overall oesophagectomy rate of 18.2% in the combined cohort. In the combined cohort, oesophagectomy was associated with younger age, being male and Australian-born, having non-metastatic disease or adenocarcinoma and being admitted in a co-located hospital. Rates of length-of-stay >28 days (20.9% vs 19.7%), 30-day mortality (3.8% vs 2.7%) and one-year survival post-surgery (24.5% vs 23.1%) were similar between oesophageal cancer alone and the combined cohort; whilst 30-day complication rates were 21.5% versus 17.0% respectively. Some factors statistically associated with post-resection complication in oesophageal cancer alone were not significant in the overall cohort. Poorer post-resection outcomes were associated with some patient (older age, birthplace) and hospital-related characteristics (fiscal sector, area health service). CONCLUSION: Outcomes following oesophagectomy in oesophageal and gastro-oesophageal cancer patients in NSW are within world benchmarks. Our study demonstrates that the inclusion of gastro-oesophageal cancer did alter some outcomes compared to analysis based solely on oesophageal cancer. As such, care must be taken with analyses based on administrative health data to capture all populations eligible for treatment and to understand the contribution of these subpopulations to overall outcomes.

Discontinuation of statin therapy in older people: does a cancer diagnosis make a difference? An observational cohort study using data linkage.

OBJECTIVE: The aim was to examine statin discontinuation rates in a cohort of elderly Australians with newly diagnosed cancer using population-based secondary health data. DESIGN: Observational cohort study. SETTING: New South Wales, the largest jurisdiction in Australia. The Pharmaceutical Benefits and Repatriation Pharmaceutical Benefits Schemes are national programmes subsidising prescription drugs to the Australian population and Australian Government Department of Veterans' Affairs clients. PARTICIPANTS: The cohort comprised 1731 cancer patients aged ≥65 years with evidence of statin use in the 90 days prior to diagnosis. They were matched to 3462 non-cancer patients prescribed statins in the same period. MAIN OUTCOME MEASURE: The authors compared statin discontinuation rates up to 4 years post-diagnosis and examined the factors associated with statin discontinuation. RESULTS: The proportion of cancer patients discontinuing statin therapy at 4 years (27%) was comparable to the comparison cohort; however, significantly higher proportions of the cancer cohort discontinued statins than the comparison cohort at 3, 6 and 12 months of follow-up (9.7% vs 7.4% at 12 months, respectively). More than 30% of cancer patients who died were dispensed statins within 30 days of death. Discontinuation of statin therapy in cancer patients was associated with regionalised and distant disease spread at diagnosis (p<0.001), older age (p=0.006), upper gastrointestinal organs and liver cancer (aHR 2.95, 95% CI 1.92 to 4.53) and cancer of the lung, bronchus and trachea (aHR 1.99, 95% CI 1.32 to 3.00) and poorer survival. CONCLUSIONS: Medications should be rationalised at the time of a cancer diagnosis, especially in the setting of a poor prognosis. At least for some patients in our cohort, statin therapy may be inappropriately continued which adds unnecessarily to therapeutic burden.

Epidemiology and trends for Caesarean section births in New South Wales, Australia: a population-based study.

BACKGROUND: Caesarean section (CS) rates around the world have been increasing and in Australia have reached 30% of all births. Robson's Ten-Group Classification System (10-group classification) provides a clinically relevant classification of CS rates that provides a useful basis for international comparisons and trend analyses. This study aimed to investigate trends in CS rates in New South Wales (NSW), including trends in the components of the 10-group classification. METHODS: We undertook a cross-sectional study using data from the Midwives Data Collection, a state-wide surveillance system that monitors patterns of pregnancy care, services and pregnancy outcomes in New South Wales, Australia. The study population included all women giving birth between 1st January 1998 and 31st December 2008. Descriptive statistics are presented including age-standardised CS rates, annual percentage change as well as regression analyses. RESULTS: From 1998 to 2008 the CS rate in NSW increased from 19.1 to 29.5 per 100 births. There was a significant average annual increase in primary 4.3% (95%CI 3.0-5.7%) and repeat 4.8% (95% CI 3.9-5.7%) CS rates from 1998 to 2008. After adjusting for maternal and pregnancy factors, the increase in CS delivery over time was maintained. When examining CS rates classified according to the 10-group classification, the greatest contributors to the overall CS rate and the largest annual increases occurred among nulliparae at term having elective CS and multipara having elective repeat CS. CONCLUSIONS: Given that the increased CS rate cannot be explained by known and collected maternal or pregnancy characteristics, the increase may be related to differences in clinical decision making or maternal request. Future efforts to reduce the overall CS rate should be focussed on reducing the primary CS rate.

Adenocarcinoma of the oesophagus: incidence and survival rates in New South Wales, 1972-2005.

OBJECTIVE: To investigate trends in the incidence of adenocarcinoma (AC) of the oesophagus in New South Wales, factors associated with a diagnosis of AC, and factors associated with survival of patients with AC. DESIGN AND SETTING: We examined all cases of invasive oesophageal cancer recorded in the NSW Central Cancer Registry from 1972 to 2005. The Accessibility/Remoteness Index of Australia was used to assess geographical remoteness and the Index of Relative Socio-Economic Disadvantage to assess socioeconomic status. MAIN OUTCOME MEASURES: Incidence of AC; factors associated with diagnosis of AC and survival of patients with AC. RESULTS: The overall incidence of oesophageal AC in NSW increased in both males and females (annual percentage change, 4.2% [95% CL, 2.7%, 5.8%] in males [1988-2005] and 4.3% [95% CL, 1.8%, 7.0%] in females [1983-2005]). A diagnosis of AC was significantly associated with being male (adjusted odds ratio [AOR], 4.37 [95% CL, 3.84, 4.98]; P < 0.001); a younger age at diagnosis (P trend < 0.001); having distant rather than localised disease spread (AOR, 2.12 [95% CL, 1.82, 2.48]; P < 0.001); higher socioeconomic status (P trend < 0.001); and living in an inner regional area (AOR, 1.26 [95% CL, 1.11, 1.43]; P < 0.001) or outer regional area (AOR, 1.19 [95% CL, 1.00, 1.41]; P = 0.05) compared with a major city. Early diagnosis of AC was associated with substantial improvement in survival outcomes: patients with metastatic disease at diagnosis had a three times greater risk of dying than those with localised AC at diagnosis. CONCLUSION: The incidence of AC is increasing in NSW. Possible contributing factors include increasing obesity, which is associated with increased incidence of gastro-oesophageal reflux disease. Survival may be improved by diagnosis at an earlier stage and changes in modifiable risk factors (eg, smoking, diet, exercise).

Maternal smoking during pregnancy and childhood cancer in New South Wales: a record linkage investigation.

Following linkage between the NSW Central Cancer Registry (CCR) and the NSW Midwives Data Collection, an investigation of the association between maternal smoking during pregnancy and the risk of childhood cancer in their offspring was undertaken. Children born in NSW between 1994 and 2005, inclusive of 1,045,966 babies, were matched to 948 cancer cases in the CCR. After adjustment for maternal age, gestational age, baby's gender, birth weight, remoteness index, socioeconomic disadvantage and maternal health factors, no association (OR = 0.96, 95% CI 0.81-1.15, p = 0.68) was found with childhood cancer between mothers who smoked (81/100,000) and those who did not smoke during pregnancy (99/100,000). Maternal smoking was, however, significantly associated with retinoblastoma (OR = 2.20, 95% CI 1.19-4.09, p = 0.01). Association between maternal smoking and preterm birth and low birth weight was significant. Maternal smoking during pregnancy is significantly associated with retinoblastoma and adverse birth outcomes. These results should be highlighted to expectant mothers through antitobacco-smoking campaigns.

Reflexive optokinetic nystagmus in younger and older observers under photopic and mesopic viewing conditions.

PURPOSE: To investigate the effect of age on optokinetic nystagmus (OKN) in response to stimuli designed to preferentially stimulate the M-pathway. METHOD: OKN was recorded in 10 younger (32.3 +/- 5.98 years) and 10 older (65.6 +/- 6.53) subjects with normal vision. Vertical gratings of 0.43 or 1.08 cpd drifting at 5 degrees /s or 20 degrees /s and presented at either 8% or 80% contrast were displayed on a large screen as full-field stimulation, central stimulation within a central Gaussian-blurred window of 15 degrees diameter, or peripheral stimulation outside this window. All conditions apart from the high-contrast condition were presented in a random order at two light levels, mesopic (1.8 cdm(-2)) and photopic (71.5 cdm(-2)). RESULTS: Partial-field data indicated that central stimulation, mesopic light levels, and lower temporal frequency each significantly increased slow-phase velocity (SPV). Although there was no overall difference between groups for partial-field stimulation, full-field stimulation, or low-contrast stimulation, a change in illumination revealed a significant interaction with age: there was a larger decrease in SPV going from photopic to mesopic conditions for the older group than the younger group, especially for higher temporal frequency stimulation. CONCLUSIONS: OKN becomes reflexive in conditions conducive to M-pathway stimulation, and this rOKN response is significantly diminished in older healthy adults than in younger healthy adults, indicative of decreased M-pathway sensitivity.

Central visual field changes using flicker perimetry in type 2 diabetes mellitus.

PURPOSE: To evaluate the efficacy of flicker perimetry compared with that of static perimetry in determining central visual field losses in participants with type 2 diabetes mellitus. METHODS: Flicker and static perimetry were performed using the Medmont field analyser on 20 participants with type 2 diabetes mellitus and 24 age-matched control participants. RESULTS: Flicker, but not static, perimetry demonstrated significant reductions in thresholds in those participants who had a recent diagnosis of diabetes or who had no or only minimal diabetic retinopathy compared to the control group at eccentricities close to fixation. CONCLUSION: Flicker perimetry is recommended for the evaluation of visual field losses in participants with recent onset of diabetes and minimal diabetic retinopathy.

Letter contrast sensitivity changes in early diabetic retinopathy.

PURPOSE: To investigate the discriminative ability of letter contrast sensitivity (CS) and visual acuity (VA) in detecting functional losses in participants with type 2 diabetes. METHODS: LogMAR VA and letter CS were measured on 20 type 2 diabetic and 24 age-matched control participants. The diabetic participants were sub-grouped according to the level of retinopathy present. RESULTS: Letter CS was able to distinguish those participants with and without macular oedema and those with no or minimal diabetic retinopathy from the control group, whereas VA was not. CONCLUSION: Letter CS may be used as an effective screening tool to assess damage to the visual pathway of diabetic participants both with and without clinically detectable signs.

Visual fields in glaucoma: a clinical overview.

Static automated visual field testing is now an integral part of the detection and monitoring of primary open angle glaucoma. However, although many aspects of testing are automated, interpretation of the large amounts of data produced by these instruments is not. Two major challenges facing the practitioner are differentiating between the visual fields of a patient with early glaucoma and those of a normal patient, and identifying whether small reductions in sensitivity are due to a true defect or a product of other factors. This paper presents a clinical overview of how to systematically review visual field plots and how to recognise defects arising from patient factors, as well as some of the alternative testing techniques available for the assessment of the glaucoma patient.