Sleep disorders in children with brain tumors: a pilot study based on a sleep disorder questionnaire.

PURPOSE: The aim of this study is to compare the prevalence of sleep disorders (SD) between children treated for brain tumors and healthy children, and to define the type of SD. METHODS: A case-control study was performed from October 2014 to April 2015. Inclusion criteria were patients between 2 and 16 years with "cases" defined as children affected by central nervous system tumors at least 3 months after the end of treatment (surgery and/or radiotherapy and/or chemotherapy) at the time of evaluation and "controls" as healthy children. Children's sleep quality was assessed with a questionnaire administered to parents (Child's Sleep Habits Questionnaire, CSHQ). A total score greater than 41 is suggestive for the presence of disturbed sleep. The risk of SD was estimated by the odds ratio (OR) and their 95% confidence intervals (95% CI) through logistic regression models. RESULTS: Twenty-nine cases and 87 controls (in a 1:3 model) were enrolled, for a total of 116 subjects. The prevalence of SD resulted of 82.8% among cases and 64.4% in controls. A statistically significant difference between the two groups (OR 2.65; 95% CI 0.92-7.65) was not reached. Analyzing singular disturbances, parasomnias and night awakenings showed a statistically significant difference between the two groups (OR 4.32; 95% CI 1.08-17.34). CONCLUSIONS: Our study revealed a trend toward SD in children with brain tumor when compared to healthy population. Hovewer, analyzing specific subtypes of SD some significant differences were obtained. A significant difference was obtained only for specific subtypes of SD. Further investigations could better define the real burden of SD.

Dietary inflammatory index and prostate cancer survival.

Systemic inflammatory status has been reported to impact survival of prostate cancer (PCa) patients; however, evidence is lacking on whether the inflammatory potential of diet can influence prognosis of PCa patients. To investigate the association between a dietary inflammatory index (DII) and PCa survival, we conducted a retrospective cohort study including 726 men with PCa originally enrolled, between 1995 and 2002, in an Italian case-control study. Information on diet and Gleason score was collected at PCa diagnosis. DII was derived from a food frequency questionnaire using a validated algorithm. Adjusted hazard ratios (HRs) of death with 95% confidence intervals (CIs) were estimated using a Fine-Gray model. DII scores were not significantly associated with all-cause mortality of PCa patients (HR highest vs. lowest DII tertile = 1.25; 95% CI: 0.86-1.83). However, considerable heterogeneity emerged according to Gleason score (p < 0.01): no associations emerged among men with Gleason score 2-6 PCa; whereas, among patients with Gleason score 7-10 PCa, DII was directly associated with both all-cause and PCa-specific mortality (HR highest vs. lowest DII tertile: 2.78; 95% CI: 1.41-5.48; and 4.01; 95% CI: 1.25-12.86; respectively). Among patients with Gleason score 7-10 PCa, ten-year all-cause survival probabilities were 58% (95% CI: 47-67%) for highest and 78% (95% CI: 67-86%) for lowest DII tertile. Study findings support the hypothesis that diet, through its inflammatory potential, may influence the prognosis of patients with more aggressive PCa. Dietary interventions aimed at decreasing inflammation may be considered to improve survival of men with PCa.

The negative impact of tobacco smoking on survival after prostate cancer diagnosis.

PURPOSE: Tobacco smoking has been found to increase prostate cancer (PCa) mortality in cohorts of healthy men, but its effects on prognosis of men with PCa are still unclear. This study investigated the role of smoking on long-term survival after PCa diagnosis. METHODS: A retrospective cohort including 780 men with incident PCa previously enrolled (between 1995 and 2002) as cases in an Italian case-control study. Information on vital status up to 2013 (median follow-up 13 years) and cause of death were retrieved through health archives. Hazard ratios (HRs) of all-cause and PCa-specific death, and corresponding 95 % confidence intervals (CIs), were calculated using Cox models, adjusting for Gleason score and major confounders. RESULTS: Out of 263 PCa deceased patients, 81 died because of PCa. Smokers at PCa diagnosis reported increased risks of all-cause (HR = 1.5, 95% CI 1.1-2.2) and PCa death (HR = 2.0, 95% CI 1.0-3.8), as compared to never smokers. Dose-response effects emerged according to smoking intensity (HRs for >15 cigarettes/day: 1.9, 95% CI 1.3-3.0, for all causes and 2.3, 95% CI 1.1-4.9, for PCa) and duration (HRs for >45 years: 1.7, 95% CI 1.1-2.6, for all causes and 2.6, 95% CI 1.2-5.5, for PCa). Conversely, former smokers at PCa diagnosis showed no statistically significant higher risks of PCa death. The effects of smoking were consistent in strata of Gleason score. CONCLUSIONS: Current smoking at PCa diagnosis negatively impacted PCa-specific, long-term survival, regardless of Gleason score. Our findings suggest that smoking could be a modifiable risk factor to improve prognosis of men diagnosed with PCa.

Time trends of cancer incidence in Setif, Algeria, 1986-2010: an observational study.

BACKGROUND: Incidence rates of various cancers are increasing in Arab countries and are expected to reach those of industrialized ones in few decades. This paper aimed to describe the incidence rates of most common cancers--and/or of those cancer preventable through modifiable behaviors--recorded in the province of Setif, Algeria from 1986 through 2010. METHODS: Cancer diagnoses for the 1986-2010 period were provided by the population-based Cancer Registry of Setif, disentangled by site, morphology, age (quinquennia), sex, and calendar period. The corresponding population was obtained from the Algerian Institute of Statistics. Age-standardized rates (world population) (ASR-WR) were computed by calendar period (five quinquennias from 1986-1990 to 2006-2010), while annual percent changes (APCs) were computed for the period 1996-2010. RESULTS: During the 2006-2010 period, ASR-WR for all cancer sites were 106.4/100,000 in men and 110.3 in women. The four leading cancers were: lung (18.0%); colon-rectum (9.6%); bladder (9.1%); and prostate (6.5%) in men; breast (36.4%); colon-rectum (8.5%); cervix uteri (6.0%); and thyroid (6.0%) in women. Between 1996-2010, overall cancer incidence increased statistically significantly (p < 0.05) in both men (APC = +2.5%) and women (APC = +3.7%). Statistically significant decreasing trends were observed for nasopharyngeal carcinoma (APC = -3.4%) in men, and for cervical (APC = -4.2%) and gallbladder (APC = -3.2%) cancers in women. Statistically significant increasing trends were observed for most common cancers both in men (lung:+1.8%, colon-rectum:+5.4%, prostate:+4.3%, liver:+8.9%, and bladder:+5.9%) and women (breast:+8.2%, colon-rectum:+4.5%, lung:+10.0%, liver:+5.4%, thyroid:+5.3%, and larynx:+13.8%). CONCLUSIONS: International recommendations against cancer must be strongly promoted in Setif after taking into account epidemiological transition, lifestyle, and environmental changes.

Direct health-care cost of head and neck cancers: a population-based study in north-eastern Italy.

Improvements in prognosis of head-and-neck squamous cell carcinoma (HNSCC) have paralleled with an increase in health-care costs, so that an economic evaluation is of growing importance. Presently, most of the evidence is from insurance-based studies in the USA. Between 2007 and 2010, 879 HNSCC patients were identified through the population-based cancer registry of the Friuli Venezia Giulia region, including 266 oral, 187 oropharyngeal, 136 hypopharyngeal, and 290 laryngeal cancers. Health-care costs from diagnosis to treatment initiation and in the following 2 years were retrieved through a record linkage with the regional health data warehouse. This database collected comprehensive health information on all resident citizens. Generalized linear models with a gamma distribution and log-link function were applied to model costs. The average health-care cost from diagnosis up to 2 years after treatment initiation was €20,184 (95% confidence interval: €19,634 - 20,733). Heterogeneity emerged according to cancer site, elective treatment, and retreatment for cancer persistence/recurrence (no: €13,896; yes: €24,599; p < 0.001). An advanced stage was associated with increased costs stage (I: €12,969; II: €18,276; III: €26,229; IV: €25,574; p < 0.001) as the result of treatment complexity and elevated frequency of patients retreatment due to recurrence. These findings further support strategies to diagnose patients at an earlier cancer stage and the accurate definition of diagnostic and treatment pathways, to start treating patients when radical unimodal approach is still feasible. Besides the advantage in prognosis due to timely curative treatments, this would reduce the economic burden of cancer treatment.

Fruit and vegetables consumption is directly associated to survival after prostate cancer.

SCOPE: Since the evidence on the role of diet on prostate cancer (PCa) prognosis is still controversial, we evaluated the long-term effects of fruit and vegetables consumption on survival after PCa. METHODS AND RESULTS: A retrospective cohort study included 777 men with PCa diagnosed between 1995 and 2002 in north-eastern Italy and followed up to 2013. A validated food frequency questionnaire assessed the usual diet in the 2 years before PCa diagnosis, including detailed fruit and vegetables consumption. Adjusted hazard ratios (HRs) of death with 95% confidence intervals (CIs) were estimated using Fine-Gray models. PCa patients with a consumption of both fruit and vegetables above the median showed a higher 15-year overall survival probability than those with lower intakes (71% versus 58%, p = 0.04; HR = 0.66, 95% CI: 0.47-0.93). Consumption of foods rich in fiber (HR = 0.59, 95% CI: 0.41-0.86) and proanthocyanidins (HR = 0.58, 95% CI: 0.40-0.82) were inversely associated with overall mortality. Interestingly, proanthocyanidins (HR = 0.52; 95% CI: 0.27-0.98) and flavonols (HR = 0.40; 95% CI: 0.19-0.84) were inversely associated also with PCa-specific mortality. CONCLUSION: High consumption of fruit and vegetables offers an advantage in survival among the rising number of men living after a PCa diagnosis, possibly through the epigenetic effect of some nutrients.

The impact of time to treatment initiation on survival from head and neck cancer in north-eastern Italy.

OBJECTIVES: To evaluate the impact of time to treatment initiation (TTI) on overall survival in patients with head-and-neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS: In the period 2003-2009, 1616 HNSCC patients were diagnosed in Friuli Venezia Giulia Region, Northeastern Italy, including 462 oral, 346 oropharyngeal, 212 hypopharyngeal, and 596 laryngeal cancers. Clinical information, including date and type of first treatment, and follow-up were retrieved from the regional Cancer Registry and a population-based health database collecting comprehensive health information on people living in the Region. Multivariate hazard ratio (HR) and confidence intervals (CI) were calculated through Cox model. RESULTS: Overall, the median TTI was 28days, (Q1-Q3: 13-45days), but significant variations emerged according to anatomical site, cancer stage, treatment approach, and care transition to specialized centers. Five-year overall survival decreased with increasing treatment delay from 62% for TTI<30days to 39% for TTI≥90days (p<0.01). HR of death was 1.13 (95% CI: 0.92-1.39) for TTI between 45-89days, and 1.47 (1.05-2.05) for TTI≥90days. The association between TTI and poor prognosis was stronger for laryngeal cancers and early-stage HNSCCs. Further, care transition from community hospitals to specialized centers was associated to a better prognosis (HR=0.73; 95% CI: 0.60-0.88). CONCLUSION: Our study findings suggest that HNSCC patients treated within 45days from diagnosis have increased survival probabilities and that early-stage patients suffered the most from treatment delay. Furthermore, care transition to specialized centers -though competitive to timely treatment- improves survival by providing the most innovative technologies and treatment approaches.

Residential Proximity to Major Roadways and Lung Cancer Mortality. Italy, 1990-2010: An Observational Study.

BACKGROUND: Air pollution from road traffic has been associated to an increased risk of lung cancer. Herein, we investigated the association between lung cancer mortality and residence near Italian highways or national major roads. METHODS: Information on deaths for lung cancer registered from 1990 to 2010 and stratified by age, gender, and urban or rural municipality of residence at death were obtained from the National Institute of Statistics. Distance between the centroid of the municipality of residence and closest major roadways was considered as a proxy of pollution exposure. Relative Risks (RR) and 95% confidence intervals (CI) were computed using Poisson log-linear models adjusted for age, calendar period, deprivation index, North/South gradient, and urban/rural status. RESULTS: A gradient in risk for lung cancer mortality was seen for residents within 50 meters (m) of national major roads. In particular, in rural municipalities a statistically significant increased risk for lung cancer death was observed in both sexes (RR = 1.27 for distance <25 m vs. 500-1999 m, 95% CI 1.17-1.42, in men; RR = 1.97, 95% CI 1.64-2.39, in women). In urban municipalities, weak risks of borderline significance were documented in both sexes (RR = 1.06, 95% CI 0.99-1.15 in men; and RR = 1.09, 95% CI 0.97-1.22 in women). No statistically significant association emerged between residence within 100 to 500 m from highways and RRs of death for lung cancer. CONCLUSIONS: In Italy, residing near national major roads, in particular in rural municipalities, was related to elevated risks of death for lung cancer.

The impact of diabetes and other metabolic disorders on prostate cancer prognosis.

AIMS: To investigate the impact of diabetes mellitus (DM) and other metabolic disorders on the survival of men with prostate cancer (PCa). METHODS: We conducted a retrospective cohort-study based on 715 men with PCa, originally enrolled in an Italian case-control study between 1995 and 2002. Anthropometric measures, self-reported medical conditions, and Gleason score were assessed at enrollment. Adjusted hazard ratios (HRs) of death, with 95% confidence intervals (95% CIs), were estimated using Fine and Gray's regression model. RESULTS: After a median follow-up of 11.6years, 244 (34.1%) deaths occurred, 77 (31.6%) due to PCa. Excess mortality from all causes was reported in PCa patients with DM (HR=1.56, 95% CI: 1.03-2.36), which increased to 1.76 (95% CI: 0.99-3.13) when at least two out of three metabolic disorders (i.e., waist circumference ≥102cm, drug-treated hypertension, and hypercholesterolemia) were additionally present. The impact of metabolic disorders was stronger on non-PCa-specific mortality with HRs equal to 2.21 (95% CI: 1.38-3.54) for DM, 1.45 (95% CI: 0.97-2.19) for waist circumference ≥102cm, and 1.63 (95% CI: 1.19-2.22) for drug-treated hypertension. CONCLUSIONS: DM and other metabolic disorders unfavorably affected the survival of PCa patients, mainly impacting on the risk of death from causes other than PCa.

Residence in Proximity of an Iron Foundry and Risk of Lung Cancer in the Municipality of Trieste, Italy, 1995-2009.

We assessed the risk of lung cancer in people living near the iron foundry located within the city of Trieste, Northeastern Italy. Between 1995 and 2009, all incident cases of lung cancer and corresponding population were considered. A deposition model of the foundry-specific emissions of SO2 defined: "nearby", "urban", and "outlying" areas. Rate ratios (RRs) and annual percent changes (APCs) were computed. Among nearby residents, significantly increased risks of lung cancer were noted in men below age 75 years (RR = 1.35 vs. urban area; 95% CI: 1.03-1.77). In women, and in men aged 75 years or older, no significant RRs were observed. Conversely, people living in the outlying area appeared to be at lower risk than residents in the urban area- in all age groups, in men (RR = 0.87; 95% CI: 0.78-0.98) and in women (RR = 0.74; 95% CI: 0.62-0.88). Negative statistically significant APC was recorded in men living in urban areas (-2.6%), whereas in women APC significantly increased among those living in the urban area (+2.3%). Multiple interpretations for this observation are plausible, since several factors might have modified and/or confounded the risk of lung cancer, including air pollution from other sources and road traffic, occupational and smoking patterns.

Cancer estimates up to 2015 in Friuli Venezia Giulia.

AIMS AND BACKGROUND: This analysis intended to estimate the incidence, mortality and prevalence time trends for the major cancer sites up to 2015 in the Friuli Venezia Giulia region, northeastern Italy, where a population-based cancer registry has been covering the whole area since 1995. METHODS: The MIAMOD method, a statistical back-calculation approach, was applied to estimate incidence, mortality and prevalence figures, in the period 1970-2015, using mortality data from the Italian National Institute of Statistics and relative survival data from Italian cancer registries. RESULTS: We estimated that the cancer sites with the highest incidence rates in the forthcoming years will be breast in women (with an age-standardized incidence rate of 130 per 100,000 in 2015), prostate in men (97 per 100,000) and colon-rectum in both sexes (85 and 42 per 100,000 in men and women, respectively). The incidence rates for lung cancer will continue to decrease only in men (down to 43 per 100,000 in 2015). Although the decline in the mortality rates of lung, breast and colorectal cancers is likely to persist, these tumors will remain the big killers in the near future. The number of people living in Friuli Venezia Giulia after a cancer diagnosis is expected to continue to rise in particular for breast cancer (with a crude prevalence of 3,000 per 100,000 women in 2015), prostate cancer (1,700 per 100,000 men) and colorectal cancer (1,100 and 800 per 100,000 in men and women, respectively). CONCLUSION: These estimates confirmed the epidemiological patterns in time trends of major cancer sites recorded in Friuli Venezia Giulia. They highlighted in particular the increasing number of people living after a cancer diagnosis as a result of population aging, earlier diagnosis and better prognosis, which warrants adequate public health policies.