ABSTRACT
BACKGROUND: There is little evidence on variation in radiotherapy use in different countries, although it is a key treatment modality for some patients with cancer. Here we aimed to examine such variation. METHODS: This population-based study used data from Norway, the four UK nations (England, Northern Ireland, Scotland, and Wales), nine Canadian provinces (Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, Ontario, Prince Edward Island, and Saskatchewan), and two Australian states (New South Wales and Victoria). Patients aged 15-99 years diagnosed with cancer in eight different sites (oesophageal, stomach, colon, rectal, liver, pancreatic, lung, or ovarian cancer), with no other primary cancer diagnosis occurring within the 5 years before to 1 year after the index cancer diagnosis or during the study period were included in the study. We examined variation in radiotherapy use from 31 days before to 365 days after diagnosis and time to its initiation, alongside related variation in patient group differences. Information was obtained from cancer registry records linked to clinical or patient management system data, or hospital administration data. Random-effects meta-analyses quantified interjurisdictional variation using 95% prediction intervals (95% PIs). FINDINGS: Between Jan 1, 2012, and Dec 31, 2017, of 902â312 patients with a new diagnosis of one of the studied cancers, 115â357 (12·8%) did not meet inclusion criteria, and 786,955 were included in the analysis. There was large interjurisdictional variation in radiotherapy use, with wide 95% PIs: 17·8 to 82·4 (pooled estimate 50·2%) for oesophageal cancer, 35·5 to 55·2 (45·2%) for rectal cancer, 28·6 to 54·0 (40·6%) for lung cancer, and 4·6 to 53·6 (19·0%) for stomach cancer. For patients with stage 2-3 rectal cancer, interjurisdictional variation was greater than that for all patients with rectal cancer (95% PI 37·0 to 84·6; pooled estimate 64·2%). Radiotherapy use was infrequent but variable in patients with pancreatic (95% PI 1·7 to 16·5%), liver (1·8 to 11·2%), colon (1·6 to 5·0%), and ovarian (0·8 to 7·6%) cancer. Patients aged 85-99 years had three-times lower odds of radiotherapy use than those aged 65-74 years, with substantial interjurisdictional variation in this age difference (odds ratio [OR] 0·38; 95% PI 0·20-0·73). Women had slightly lower odds of radiotherapy use than men (OR 0·88, 95% PI 0·77-1·01). There was large variation in median time to first radiotherapy (from diagnosis date) by cancer site, with substantial interjurisdictional variation (eg, oesophageal 95% PI 11·3 days to 112·8 days; pooled estimate 62·0 days; rectal 95% PI 34·7 days to 77·3 days; pooled estimate 56·0 days). Older patients had shorter median time to radiotherapy with appreciable interjurisdictional variation (-9·5 days in patients aged 85-99 years vs 65-74 years, 95% PI -26·4 to 7·4). INTERPRETATION: Large interjurisdictional variation in both use and time to radiotherapy initiation were observed, alongside large and variable age differences. To guide efforts to improve patient outcomes, underlying reasons for these differences need to be established. FUNDING: International Cancer Benchmarking Partnership (funded by the Canadian Partnership Against Cancer, Cancer Council Victoria, Cancer Institute New South Wales, Cancer Research UK, Danish Cancer Society, National Cancer Registry Ireland, The Cancer Society of New Zealand, National Health Service England, Norwegian Cancer Society, Public Health Agency Northern Ireland on behalf of the Northern Ireland Cancer Registry, DG Health and Social Care Scottish Government, Western Australia Department of Health, and Public Health Wales NHS Trust).
Subject(s)
Ovarian Neoplasms , Rectal Neoplasms , Female , Humans , Male , Benchmarking , Colon , Liver , Lung , Ontario/epidemiology , State Medicine , Stomach , Victoria , Adolescent , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and overABSTRACT
The aim of the study is to provide a comprehensive assessment of incidence and survival trends of epithelial ovarian cancer (EOC) by histological subtype across seven high income countries (Australia, Canada, Denmark, Ireland, New Zealand, Norway and the United Kingdom). Data on invasive EOC diagnosed in women aged 15 to 99 years during 1995 to 2014 were obtained from 20 cancer registries. Age standardized incidence rates and average annual percentage change were calculated by subtype for all ages and age groups (15-64 and 65-99 years). Net survival (NS) was estimated by subtype, age group and 5-year period using Pohar-Perme estimator. Our findings showed marked increase in serous carcinoma incidence was observed between 1995 and 2014 among women aged 65 to 99 years with average annual increase ranging between 2.2% and 5.8%. We documented a marked decrease in the incidence of adenocarcinoma "not otherwise specified" with estimates ranging between 4.4% and 7.4% in women aged 15 to 64 years and between 2.0% and 3.7% among the older age group. Improved survival, combining all EOC subtypes, was observed for all ages combined over the 20-year study period in all countries with 5-year NS absolute percent change ranging between 5.0 in Canada and 12.6 in Denmark. Several factors such as changes in guidelines and advancement in diagnostic tools may potentially influence the observed shift in histological subtypes and temporal trends. Progress in clinical management and treatment over the past decades potentially plays a role in the observed improvements in EOC survival.
Subject(s)
Ovarian Neoplasms , Humans , Female , Aged , Carcinoma, Ovarian Epithelial/epidemiology , Incidence , Ovarian Neoplasms/pathology , United Kingdom/epidemiology , Norway/epidemiology , RegistriesABSTRACT
BACKGROUND: Administrative data offer unique opportunities for researching experiences which pose barriers to participation in primary research and household surveys. Experiencing multiple social disadvantages is associated with very poor health outcomes, but little is known about how often this occurs and what combinations are most common. We linked administrative data across public services to create a novel population cohort containing information on experiences of homelessness, justice involvement, opioid dependence and psychosis. METHODS: We securely linked administrative data from (i) a population register derived from general practitioner registrations; (ii) local authority homelessness applications; (iii) prison records; (iv) criminal justice social work reports; (v) community dispensing for opioid substitution therapy; and (vi) a psychosis clinical register, for people aged ≥18 years resident in Glasgow, Scotland between 01 April 2010 and 31 March 2014. We estimated period prevalence and compared demographic characteristics for different combinations. RESULTS: Of 536â653 individuals in the cohort, 28â112 (5.2%) had at least one of the experiences of interest during the study period and 5178 (1.0%) had more than one. Prevalence of individual experiences varied from 2.4% (homelessness) to 0.7% (psychosis). The proportion of people with multiple co-occurring experiences was highest for imprisonment (50%) and lowest for psychosis (14%). Most combinations showed a predominance of men living in the most deprived areas of Scotland. CONCLUSIONS: Cross-sectoral record linkage to study multiple forms of social disadvantage showed that co-occurrence of these experiences was relatively common. Following this demonstration of feasibility, these methods offer opportunities for evaluating the health impacts of policy and service change.
Subject(s)
Ill-Housed Persons , Opioid-Related Disorders , Psychotic Disorders , Male , Humans , Adolescent , Adult , Female , Psychotic Disorders/epidemiology , Social Work , Scotland/epidemiology , Opioid-Related Disorders/epidemiologyABSTRACT
The coronavirus pandemic has disrupted cancer screening programmes. Kregting and colleagues' microsimulation models indicate that attempting to quickly catch up with missed screens while simultaneously restarting the ongoing programme would achieve better outcomes but require substantial increases in normal screening capacity that may not be feasible.
Subject(s)
COVID-19/epidemiology , Early Detection of Cancer , Neoplasms/diagnosis , Pandemics , COVID-19/virology , Humans , SARS-CoV-2/isolation & purificationABSTRACT
BACKGROUND: There is limited information on cervical cancer incidence among different ethnic groups. This study used a name classification system to describe recent patterns of cervical cancer by ethnic group in Scotland. METHODS: Data on incident cases of cancer of the cervix and carcinoma in situ diagnosed in Scotland from 2008 to 2017 were extracted from the Scottish Cancer Registry. Onomap was applied to ascribe ethnicity to each patient. Ethnic groups were categorised as White, Black, South-Asian, Chinese and Other. Age-standardised rates (ASRs) were calculated for each year, as well as cumulatively for the 10-year time period. RESULTS: The Cumulative Age-standardised rate (CASR) of invasive cancer was 2.45 times higher in the White ethnic group (CASR 125.45 (95% CI 121.2-129.8) per 1,00,000) compared to the non-white ethnic groups combined (CASR 51.16 (95% CI 31.05-77.36) per 1,00,000). The highest age-specific rates within the White patients were in the 30-34 age group (18.34 per 1,00,000), whereas the highest age specific rates for the non-white patients were in the 60-64 age group (9.59 per 1,00,000). CONCLUSION: Ethnic minority populations in Scotland had lower incidence of cervical cancer compared to the White population between 2008 and 2017.
Subject(s)
Ethnicity , Uterine Cervical Neoplasms , Female , Humans , Incidence , Minority Groups , Scotland/epidemiology , Uterine Cervical Neoplasms/epidemiologyABSTRACT
OBJECTIVES: Because of the biologic effects of volatile anesthetics on the immune system and cancer cells, it has been hypothesized that their use during non-small cell lung cancer (NSCLC) surgery may negatively affect cancer outcomes compared with total intravenous anesthesia (TIVA) with propofol. The present study evaluated the relationship between anesthetic technique and dose and oncologic outcome in NSCLC surgery. DESIGN: Retrospective cohort study. SETTING: Surgical records collated from a single, tertiary care hospital and combined with the Scottish Cancer Registry and continuously recorded electronic anesthetic data. PARTICIPANTS: Patients undergoing elective lung resection for NSCLC between January 2010 and December 2014. INTERVENTIONS: The cohort was divided into patients receiving TIVA only and patients exposed to volatile anesthetics. MEASUREMENTS AND MAIN RESULTS: Final analysis included 746 patients (342 received TIVA and 404 volatile anesthetic). Kaplan-Meier survival curves with log-rank testing were drawn for cancer-specific and overall survival. No significant differences were demonstrated for either cancer-specific (pâ¯=â¯0.802) or overall survival (pâ¯=â¯0.736). Factors influencing survival were analyzed using Cox proportional hazards modeling. Anesthetic type was not a significant predictor for cancer-specific or overall survival in univariate or multivariate Cox analysis. Volatile anesthetic exposure was quantified using area under the end-tidal expired anesthetic agent versus time curves. This was not significantly associated with cancer-specific survival on univariate (pâ¯=â¯0.357) or multivariate (pâ¯=â¯0.673) modeling. CONCLUSIONS: No significant relationship was demonstrated between anesthetic technique and NSCLC survival. Whether a causal relationship exists between anesthetic technique during NSCLC surgery and oncologic outcome warrants definitive investigation in a prospective, randomized trial.
Subject(s)
Anesthetics , Carcinoma, Non-Small-Cell Lung , Lung Neoplasms , Anesthesia, Intravenous/adverse effects , Carcinoma, Non-Small-Cell Lung/surgery , Humans , Lung Neoplasms/surgery , Prospective Studies , Retrospective StudiesABSTRACT
BACKGROUND: Lung cancer is the most common cause of cancer related death worldwide and survival is poor. Patients with lung cancer may develop a critical illness, but it is unclear what features are associated with an Intensive Care Unit (ICU) admission. METHODS: This retrospective, observational, population-based study of linked cancer registration, ICU, hospital discharge and mortality data described the factors associated with ICU admission in patients with lung cancer. The cohort comprised all incident cases of adult lung cancer diagnosed between 1st January 2000 and 31st December 2009 in the West of Scotland, UK, who were subsequently admitted to an ICU within 2 years of cancer diagnosis. Multiple logistic regression was used to determine factors associated with admission. RESULTS: 26,731 incident cases of lung cancer were diagnosed with 398 (1.5%) patients admitted to an ICU. Patients were most commonly admitted with respiratory conditions and there was a high rate of invasive mechanical ventilation. ICU, in-hospital and six-month survival were 58.5, 42.0 and 31.2%, respectively. Surgical treatment of lung cancer increased the odds of ICU admission (OR 7.23 (5.14-10.2)). Odds of admission to ICU were reduced with older age (75-80 years OR 0.69 (0.49-0.94), > 80 years OR 0.21 (0.12-0.37)), female gender (OR 0.73 (0.59-0.90)) and radiotherapy (OR 0.54 (0.39-0.73)) or chemotherapy treatment (OR 0.52 (0.38-0.70)). CONCLUSION: 1.5% of patients diagnosed with lung cancer are admitted to an ICU but both short term and long term survival was poor. Factors associated with ICU admission included age < 75 years, male gender and surgical treatment of cancer.
Subject(s)
Hospitalization/trends , Intensive Care Units/statistics & numerical data , Lung Neoplasms/mortality , Lung Neoplasms/therapy , Aged , Aged, 80 and over , Female , Hospital Mortality/trends , Humans , Logistic Models , Male , Middle Aged , Neoplasm Staging , Respiration, Artificial/statistics & numerical data , Retrospective Studies , Risk Factors , Scotland/epidemiology , Severity of Illness Index , Surgical Procedures, Operative/statistics & numerical data , Time FactorsABSTRACT
BACKGROUND: Population-based cancer survival estimates provide valuable insights into the effectiveness of cancer services and can reflect the prospects of cure. As part of the second phase of the International Cancer Benchmarking Partnership (ICBP), the Cancer Survival in High-Income Countries (SURVMARK-2) project aims to provide a comprehensive overview of cancer survival across seven high-income countries and a comparative assessment of corresponding incidence and mortality trends. METHODS: In this longitudinal, population-based study, we collected patient-level data on 3·9 million patients with cancer from population-based cancer registries in 21 jurisdictions in seven countries (Australia, Canada, Denmark, Ireland, New Zealand, Norway, and the UK) for seven sites of cancer (oesophagus, stomach, colon, rectum, pancreas, lung, and ovary) diagnosed between 1995 and 2014, and followed up until Dec 31, 2015. We calculated age-standardised net survival at 1 year and 5 years after diagnosis by site, age group, and period of diagnosis. We mapped changes in incidence and mortality to changes in survival to assess progress in cancer control. FINDINGS: In 19 eligible jurisdictions, 3â764â543 cases of cancer were eligible for inclusion in the study. In the 19 included jurisdictions, over 1995-2014, 1-year and 5-year net survival increased in each country across almost all cancer types, with, for example, 5-year rectal cancer survival increasing more than 13 percentage points in Denmark, Ireland, and the UK. For 2010-14, survival was generally higher in Australia, Canada, and Norway than in New Zealand, Denmark, Ireland, and the UK. Over the study period, larger survival improvements were observed for patients younger than 75 years at diagnosis than those aged 75 years and older, and notably for cancers with a poor prognosis (ie, oesophagus, stomach, pancreas, and lung). Progress in cancer control (ie, increased survival, decreased mortality and incidence) over the study period was evident for stomach, colon, lung (in males), and ovarian cancer. INTERPRETATION: The joint evaluation of trends in incidence, mortality, and survival indicated progress in four of the seven studied cancers. Cancer survival continues to increase across high-income countries; however, international disparities persist. While truly valid comparisons require differences in registration practice, classification, and coding to be minimal, stage of disease at diagnosis, timely access to effective treatment, and the extent of comorbidity are likely the main determinants of patient outcomes. Future studies are needed to assess the impact of these factors to further our understanding of international disparities in cancer survival. FUNDING: Canadian Partnership Against Cancer; Cancer Council Victoria; Cancer Institute New South Wales; Cancer Research UK; Danish Cancer Society; National Cancer Registry Ireland; The Cancer Society of New Zealand; National Health Service England; Norwegian Cancer Society; Public Health Agency Northern Ireland, on behalf of the Northern Ireland Cancer Registry; The Scottish Government; Western Australia Department of Health; and Wales Cancer Network.
Subject(s)
Developed Countries/economics , Healthcare Disparities/trends , Income , Neoplasms/epidemiology , Neoplasms/therapy , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Australia/epidemiology , Canada/epidemiology , Cancer Survivors , Europe/epidemiology , Female , Humans , Incidence , Longitudinal Studies , Male , Middle Aged , Neoplasms/diagnosis , Neoplasms/mortality , New Zealand/epidemiology , Registries , Risk Factors , Sex Factors , Time Factors , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: Cancers of Unknown Primary (CUP) are the 3-4th most common causes of cancer death and recent clinical guidelines recommend that patients should be directed to a team dedicated to their care. Our aim was to inform the care of patients diagnosed with CUP during hospital admission. METHODS: Descriptive study using hospital admissions (Scottish Morbidity Record 01) linked to cancer registrations (ICD-10 C77-80) and death records from 1998 to 2011 in West of Scotland, UK (population 2.4 m). Cox proportional hazards models were used to assess effects of baseline variables on survival. RESULTS: Seven thousand five hundred ninety nine patients were diagnosed with CUP over the study period, 54.4% female, 67.4% aged ≥ 70 years, 36.7% from the most deprived socio-economic quintile. 71% of all diagnoses were made during a hospital admission, among which 88.6% were emergency presentations and the majority (56.3%) were admitted to general medicine. Median length of stay was 15 days and median survival after admission 33 days. Non-specific morphology, emergency admission, age over 60 years, male sex and admission to geriatric medicine were all associated with poorer survival in adjusted analysis. CONCLUSIONS: Patients with a diagnosis of CUP are usually diagnosed during unplanned hospital admissions and have very poor survival. To ensure that patients with CUP are quickly identified and directed to optimal care, increased surveillance and rapid referral pathways will be required.
Subject(s)
Neoplasms/diagnosis , Aged , Aged, 80 and over , Female , Hospitalization , Humans , International Classification of Diseases , Length of Stay , Male , Middle Aged , Proportional Hazards Models , Registries , ScotlandABSTRACT
BACKGROUND: There is evidence that cancer survivors are at increased risk of second primary cancers. Changes in the prevalence of risk factors and diagnostic techniques may have affected more recent risks. METHODS: We examined the incidence of second primary cancer among adults in the West of Scotland, UK, diagnosed with cancer between 2000 and 2004 (n = 57,393). We used National Cancer Institute Surveillance Epidemiology and End Results and International Agency for Research on Cancer definitions of multiple primary cancers and estimated indirectly standardised incidence ratios (SIR) with 95% confidence intervals (CI). RESULTS: There was a high incidence of cancer during the first 60 days following diagnosis (SIR = 2.36, 95% CI = 2.12 to 2.63). When this period was excluded the risk was not raised, but it was high for some patient groups; in particular women aged <50 years with breast cancer (SIR = 2.13, 95% CI = 1.58 to 2.78), patients with bladder (SIR = 1.41, 95% CI = 1.19 to 1.67) and head & neck (SIR = 1.93, 95% CI = 1.67 to 2.21) cancer. Head & neck cancer patients had increased risks of lung cancer (SIR = 3.75, 95% CI = 3.01 to 4.62), oesophageal (SIR = 4.62, 95% CI = 2.73 to 7.29) and other head & neck tumours (SIR = 6.10, 95% CI = 4.17 to 8.61). Patients with bladder cancer had raised risks of lung (SIR = 2.18, 95% CI = 1.62 to 2.88) and prostate (SIR = 2.41, 95% CI = 1.72 to 3.30) cancer. CONCLUSIONS: Relative risks of second primary cancers may be smaller than previously reported. Premenopausal women with breast cancer and patients with malignant melanomas, bladder and head & neck cancers may benefit from increased surveillance and advice to avoid known risk factors.
Subject(s)
Neoplasms, Second Primary/epidemiology , Survivors/statistics & numerical data , Female , Humans , Male , Neoplasms, Second Primary/pathology , Risk Factors , Scotland/epidemiologyABSTRACT
PURPOSE: The ratio of positive lymph nodes to total retrieved lymph nodes (lymph node ratio, LNR) has been proposed to be the superior prognostic score in colon cancer. This study aimed to validate LNR in a large, multi-centred population, focusing on patients that have undergone adjuvant chemotherapy. METHODS: Analysis of a prospectively collected database (The West of Scotland Colorectal Cancer Managed Clinical Network) with 1,514 patients with colonic cancer identified that had undergone elective curative surgical resection in the 12 hospitals in the West of Scotland from 2000-2004. Variables recorded were as follows: demographics, adjuvant chemotherapy, number of lymph nodes retrieved, lymph node retrieval ≥12, number of positive lymph nodes and LNR. Follow up continued until June 2009. Univariate and multivariate analyses were performed to determine the influence of LNR on overall survival. RESULTS: In 673 patients (44.5%), ≥12 lymph nodes were retrieved. Patients had a poorer long-term prognosis with increasing age, T stage and N stage. Retrieval of <12 lymph nodes and increasing LNR were both found to be significantly associated with poorer long-term survival, but on multivariable analysis, LNR was the only independently significant variable. In patients that had received adjuvant chemotherapy, only patients staged in the second lowest LNR group (0.05-0.19) had a significant improvement in long-term survival. CONCLUSION: Lymph node ratio is the optimal method of assessing lymph node status and highlights the heterogeneity of patients with node positive disease, altering patient stratification with implications for adjuvant chemotherapy.
Subject(s)
Colonic Neoplasms/drug therapy , Colonic Neoplasms/pathology , Lymph Nodes/pathology , Neoplasm Staging/methods , Adult , Age Factors , Aged , Aged, 80 and over , Chemotherapy, Adjuvant , Colonic Neoplasms/surgery , Female , Humans , Lymphatic Metastasis , Male , Middle Aged , Prospective Studies , Survival AnalysisABSTRACT
PURPOSE: Reorganisation of cancer services in the UK and across Europe has led to elective surgery for colon cancer being increasingly, but not exclusively, delivered by specialist colorectal surgeons. This study examines survival after elective colon cancer surgery performed by specialist compared to non-specialist surgeons. METHOD: Patients undergoing elective surgery for colon cancer in 16 hospitals between 2001 and 2004 were identified from a prospectively maintained regional audit database. Post-operative mortality (<30 days) and 5-year relative survival in those receiving surgery under the care of a specialist or non-specialist surgeon were compared. RESULTS: A total of 1,856 patients were included, of which, 1,367 (73.7%) were treated by a specialist and 489 (26.4%) by a non-specialist surgeon. Those treated by a specialist were more likely to be deprived, undergo surgery in a high volume unit and have higher lymph node yields than those treated by a non-specialist. Post-operative mortality was lower (4.5 versus 7.0%; P = 0.032) and 5-year relative survival was higher (72.2 versus 65.6%; P = 0.012) among those treated by a specialist surgeon. In multivariate analysis, surgery by non-specialists was independently associated with increased post-operative mortality (adjusted odds ratio (OR) 1.69; P < 0.001) and poorer 5-year relative survival (adjusted relative excess risk (RER) 1.17; P = 0.045). After exclusion of post-operative deaths, there was no difference in long-term survival (adjusted RER 1.08; P = 0.505). CONCLUSION: Five-year relative survival after elective colon cancer surgery was higher among those treated by specialist colorectal surgeons due to increased post-operative mortality among those treated by non-specialists.
Subject(s)
Clinical Competence , Colonic Neoplasms/mortality , Colonic Neoplasms/surgery , Colorectal Surgery , Elective Surgical Procedures , Adult , Aged , Aged, 80 and over , Colonic Neoplasms/pathology , Female , Humans , Lymphatic Metastasis , Male , Middle Aged , Scotland/epidemiology , Socioeconomic Factors , Survival Rate , Treatment Outcome , Young AdultABSTRACT
PURPOSE: The majority of patients with node-negative colorectal cancer have excellent 5-year survival prospects, but up to a third relapse. Strategies to identify patients at higher risk of adverse outcomes are desirable to enable optimal treatment and follow-up. The aim of this study was to examine postoperative mortality and longer-term survival by mode of presentation for patients with node-negative colorectal cancer undergoing surgery with curative intent. METHODS: Patients from 16 hospitals in the west of Scotland between 2001 and 2004 were identified from a prospectively maintained regional clinical audit database. Postoperative mortality and 5-year relative survival by mode of presentation were recorded. RESULTS: Of 1,877 patients with node-negative disease, 251 (13.4%) presented as an emergency. Those presenting as an emergency were more likely to be older (P = 0.023), have colon rather than rectal cancer (P < 0.001), have pT4 stage disease (P < 0.001), have extramural vascular invasion (P = 0.001), and receive surgery under the care of a nonspecialist surgeon (P < 0.001) compared to those presenting electively. The postoperative mortality rate was 3.3% after elective and 12.8% after emergency presentation (P < 0.001). Five-year relative survival was 91.8% after elective and 66.8% after emergency presentation (P < 0.001). The adjusted relative excess risk ratio for 5-year relative survival after emergency relative to elective presentation was 2.59 (95% CI 1.67-4.01; P < 0.001) and 1.90 (95% CI 1.00-3.62; P = 0.049) after exclusion of postoperative deaths. CONCLUSIONS: Emergency presentation of node-negative colorectal cancer treated with curative intent was independently associated with higher postoperative mortality and poorer 5-year relative survival compared to elective presentation.
Subject(s)
Colonic Neoplasms/mortality , Colonic Neoplasms/surgery , Rectal Neoplasms/mortality , Rectal Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Colonic Neoplasms/pathology , Emergencies , Female , Humans , Lymph Nodes/pathology , Male , Middle Aged , Neoplasm Invasiveness , Neoplasm Staging , Prognosis , Rectal Neoplasms/pathology , Socioeconomic Factors , Survival Analysis , Young AdultABSTRACT
OBJECTIVE: To estimate the potential to reduce childhood obesity through targeted interventions of overweight households. DESIGN: Cross-sectional nationally representative samples of the Scottish population. SETTING: Households in Scotland during 2008 and 2009. PARTICIPANTS: A total of 1651 households with parents and children aged 2-15 years. MAIN OUTCOME MEASURES: The WHO cut-off points for adult body mass index (BMI): overweight (25 to <30 kg/m2) and obese (≥30 kg/m2). Overweight and obesity in childhood respectively defined as a BMI 85th to <95th percentile and ≥95th percentile based on 1990 reference centiles. RESULTS: Thirty-two percent (600/1849) of children and 75% (966/1290) of adults were overweight or obese. Seventy-five percent (1606/2128) of all children lived with a parent who was overweight or obese. Among obese children, 58% (185/318) lived with an obese parent. The population attributable risk percentage of child obesity associated with parental obesity was 32.5%. Targeting obese households would require substantial falls in adult weight and need to reach 38% of all children; it might achieve a reduction in the prevalence of childhood obesity of 14% in these households (from 26% to 12%). Targeting parents with BMI ≥ 40 might reduce the overall prevalence of child obesity by 9%. Such an intervention would require large weight loss, consistent with approaches used for morbidly obese adults; it would involve 4% of all children and lead to a reduction in the prevalence of obesity in these households from 57% to 16%. CONCLUSIONS: Family-based interventions for obesity would be most efficiently targeted at obese children whose parents are morbidly obese.
Subject(s)
Parents , Pediatric Obesity/prevention & control , Adolescent , Adult , Body Mass Index , Child , Child, Preschool , Cross-Sectional Studies , Female , Health Surveys , Humans , Infant , Obesity/epidemiology , Obesity/prevention & control , Overweight/epidemiology , Overweight/prevention & control , Pediatric Obesity/epidemiology , Prevalence , Risk , Scotland/epidemiologyABSTRACT
BACKGROUND: Survival from lung cancer remains poor in Scotland, UK. Although the presence of comorbidities is known to influence outcomes, detailed quantification of comorbidities is not available in routinely collected audit or cancer registry data. The aim of the present study was to assess the prevalence and severity of comorbidities in patients with newly diagnosed lung cancer across four centres throughout Scotland using validated criteria. METHODS: Between 2005 and 2008, all patients with newly diagnosed lung cancer coming through the multidisciplinary teams in four Scottish centres were included in the study. Patient demographics, WHO/Eastern Cooperative Oncology Group performance status, clinicopathological features and primary treatment modality were recorded. RESULTS: Details of 882 patients were collected prospectively. The majority of patients (87.3%) had at least one comorbidity, the most common being weight loss (53%), chronic obstructive pulmonary disease (43%), renal impairment (28%) and ischaemic heart disease (27%). A composite score was produced that included both number and severity of comorbidities. One in seven patients (15.3%) had severe comorbidity scores. There were statistically significant variations in comorbidity scores between treatment centres and between non-small cell lung carcinoma treatment groups. Disease stage was not associated with comorbidity score. CONCLUSIONS: There is a high prevalence of multiple, severe comorbidities in Scottish patients with lung cancer, and these vary by site and treatment group. Further research is needed to determine the relationship between comorbidity scores and survival in these patients.
Subject(s)
Carcinoma, Non-Small-Cell Lung/epidemiology , Lung Neoplasms/epidemiology , Myocardial Ischemia/epidemiology , Pulmonary Disease, Chronic Obstructive/epidemiology , Renal Insufficiency, Chronic/epidemiology , Weight Loss , Adult , Aged , Aged, 80 and over , Carcinoma, Non-Small-Cell Lung/physiopathology , Comorbidity , Female , Humans , Lung Neoplasms/physiopathology , Male , Middle Aged , Needs Assessment , Prevalence , Prognosis , Prospective Studies , Scotland/epidemiology , Severity of Illness Index , Social Class , Survival AnalysisABSTRACT
BACKGROUND: The modified Glasgow Prognostic Score (mGPS), an inflammation-based prognostic score that uses thresholds of C-reactive protein (> 10 mg/L) and albumin (< 35 g/L), has been found to be independently prognostic of survival in patients with cancer. The objective of the current study was to establish whether the addition of a differential leukocyte count and a high-sensitivity C-reactive protein measurement enhanced the prognostic value of the mGPS. METHODS: A total of 12,119 patients who had an incidental blood sample taken between 2000 and 2007 for C-reactive protein, albumin, and a differential leukocyte count as well as a diagnosis of cancer made within 2 years were identified. This group was studied for the prognostic value of neutrophil, lymphocyte, and platelet counts. In addition 2742 patients whose blood was sampled after the introduction of high-sensitivity C-reactive protein measurements were studied for the prognostic value of different thresholds. RESULTS: Using cancer-specific survival as an endpoint, the prognostic value of the mGPS (hazard ratio [HR], 2.61; P < .001 [area under the receiver operating characteristic curve (AUC), 0.695]) was found to be improved by the addition of neutrophil and platelet counts (HR, 4.86; P < .001 [AUC, 0.734]) and a high-sensitivity C-reactive protein measurement (> 3 mg/L) (HR, 5.77; P < .001 [AUC, 0.734]). CONCLUSIONS: The results of the current study demonstrate that the addition of neutrophil and platelet counts, as well as a high-sensitivity C-reactive protein measurement, enhanced the prognostic value of the mGPS.
Subject(s)
C-Reactive Protein/analysis , Inflammation/mortality , Inflammation/physiopathology , Leukocyte Count , Neoplasms/diagnosis , Platelet Count , Aged , Area Under Curve , Cohort Studies , Female , Humans , Inflammation/blood , Male , Middle Aged , Neoplasms/mortality , Neoplasms/physiopathology , Neutrophils , Predictive Value of Tests , Prognosis , Scotland , Serum Albumin/analysisABSTRACT
BACKGROUND: Deprivation is associated with poorer survival after surgery for colorectal cancer, but determinants of this socioeconomic inequality are poorly understood. METHODS: A total of 4,296 patients undergoing surgery for colorectal cancer in 16 hospitals in the West of Scotland between 2001 and 2004 were identified from a prospectively maintained regional audit database. Postoperative mortality (<30 days) and 5-year relative survival by socioeconomic circumstances, measured by the area-based Scottish Index of Multiple Deprivation 2006, were examined. RESULTS: There was no difference in age, gender, or tumor characteristics between socioeconomic groups. Compared with the most affluent group, patients from the most deprived group were more likely to present as an emergency (23.5 vs 19.5 %; p = .033), undergo palliative surgery (20.0 vs 14.5 %; p < .001), have higher levels of comorbidity (p = .03), have <12 lymph nodes examined (56.7 vs 53.1 %; p = .016) but were more likely to receive surgery under the care of a specialist surgeon (76.3 vs 72.0 %; p = .001). In multivariate analysis, deprivation was independently associated with increased postoperative mortality [adjusted odds ratio 2.26 (95 % CI, 1.45-3.53; p < .001)], and poorer 5-year relative survival [adjusted relative excess risk (RER) 1.25 (95 % CI, 1.03-1.51; p = .024)] but not after exclusion of postoperative deaths [adjusted RER 1.08 (95 %, CI .87-1.34; p = .472)]. CONCLUSIONS: The observed socioeconomic gradient in long-term survival after surgery for colorectal cancer was due to higher early postoperative mortality among more deprived groups.
Subject(s)
Colorectal Neoplasms/mortality , Colorectal Neoplasms/surgery , Poverty , Adult , Age Factors , Aged , Aged, 80 and over , Colorectal Neoplasms/pathology , Comorbidity , Confidence Intervals , Emergencies , Female , Healthcare Disparities , Hospitalization/statistics & numerical data , Humans , Lymph Nodes/pathology , Male , Middle Aged , Multivariate Analysis , Neoplasm Grading , Neoplasm Staging , Odds Ratio , Palliative Care/statistics & numerical data , Scotland/epidemiology , Socioeconomic Factors , Survival Analysis , Time Factors , Young AdultABSTRACT
BACKGROUND: As the incidence of prostate cancer continues to rise steeply, there is an increasing need to identify more accurate prognostic markers for the disease. There is some evidence that a higher modified Glasgow Prognostic Score (mGPS) may be associated with poorer survival in patients with prostate cancer but it is not known whether this is independent of other established prognostic factors. Therefore the aim of this study was to describe the relationship between mGPS and survival in patients with prostate cancer after adjustment for other prognostic factors. METHODS: Retrospective clinical series on patients in Glasgow, Scotland, for whom data from the Scottish Cancer Registry, including Gleason score, Prostate Specific Antigen (PSA), C-reactive protein (CRP) and albumin, six months prior to or following the diagnosis, were included in this study. RESULTS: Seven hundred and forty four prostate cancer patients were identified; of these, 497 (66.8%) died during a maximum follow up of 11.9 years. Patients with mGPS of 2 had poorest 5-year and 10-year relative survival, of 32.6% and 18.8%, respectively. Raised mGPS also had a significant association with excess risk of death at five years (mGPS 2: Relative Excess Risk = 3.57, 95% CI 2.31-5.52) and ten years (mGPS 2: Relative Excess Risk = 3.42, 95% CI 2.25-5.21) after adjusting for age, socioeconomic circumstances, Gleason score, PSA and previous in-patient bed days. CONCLUSIONS: The mGPS is an independent and objective prognostic indicator for survival of patients with prostate cancer. It may be useful in determining the clinical management of patients with prostate cancer in addition to established prognostic markers.
Subject(s)
Prostatic Neoplasms/mortality , Prostatic Neoplasms/pathology , Aged , Combined Modality Therapy , Follow-Up Studies , Humans , Male , Neoplasm Grading , Neoplasm Staging , Prognosis , Prostatic Neoplasms/therapy , Retrospective Studies , Survival RateABSTRACT
INTRODUCTION: The COVID-19 epidemic interrupted normal cancer diagnosis procedures. Population-based cancer registries report incidence at least 18 months after it happens. Our goal was to make more timely estimates by using pathologically confirmed cancers (PDC) as a proxy for incidence. We compared the 2020 and 2021 PDC with the 2019 pre-pandemic baseline in Scotland, Wales, and Northern Ireland (NI). METHODS: Numbers of female breast (ICD-10 C50), lung (C33-34), colorectal (C18-20), gynaecological (C51-58), prostate (C61), head and neck (C00-C14, C30-32), upper gastro-intestinal (C15-16), urological (C64-68), malignant melanoma (C43), and non-melanoma skin (NMSC) (C44) cancers were counted. Multiple pairwise comparisons generated incidence rate ratios (IRR). RESULTS: Data were accessible within 5 months of the pathological diagnosis date. Between 2019 and 2020, the number of pathologically confirmed malignancies (excluding NMSC) decreased by 7315 (14.1 %). Scotland experienced early monthly declines of up to 64 % (colorectal cancers, April 2020 versus April 2019). Wales experienced the greatest overall change in 2020, but Northern Ireland experienced the quickest recovery. The pandemic's effects varied by cancer type, with no significant change in lung cancer diagnoses in Wales in 2020 (IRR 0.97 (95 % CI 0.90-1.05)), followed by an increase in 2021 (IRR 1.11 (1.03-1.20). CONCLUSION: PDC are useful in reporting cancer incidence quicker than cancer registrations. Temporal and geographical differences between participating countries mirrored differences in responses to the COVID-19 pandemic, indicating face validity and the potential for quick cancer diagnosis assessment. To verify their sensitivity and specificity against the gold standard of cancer registrations, however, additional research is required.
Subject(s)
COVID-19 , Melanoma , Male , Humans , Female , Incidence , Wales/epidemiology , Northern Ireland/epidemiology , SARS-CoV-2 , Pandemics , COVID-19/epidemiology , Scotland/epidemiology , Melanoma/epidemiology , Melanoma, Cutaneous MalignantABSTRACT
BACKGROUND: High cholesterol may be a modifiable risk factor for prostate cancer but results have been inconsistent and subject to potential "reverse causality" where undetected disease modifies cholesterol prior to diagnosis. METHODS: We conducted a prospective cohort study of 12,926 men who were enrolled in the Midspan studies between 1970 and 1976 and followed up to 31st December 2007. We used Cox-Proportional Hazards Models to evaluate the association between baseline plasma cholesterol and Gleason grade-specific prostate cancer incidence. We excluded cancers detected within at least 5 years of cholesterol assay. RESULTS: 650 men developed prostate cancer in up to 37 years' follow-up. Baseline plasma cholesterol was positively associated with hazard of high grade (Gleason score≥8) prostate cancer incidence (n = 119). The association was greatest among men in the 2nd highest quintile for cholesterol, 6.1 to < 6.69 mmol/l, Hazard Ratio 2.28, 95% CI 1.27 to 4.10, compared with the baseline of < 5.05 mmol/l. This association remained significant after adjustment for body mass index, smoking and socioeconomic status. CONCLUSIONS: Men with higher cholesterol are at greater risk of developing high-grade prostate cancer but not overall risk of prostate cancer. Interventions to minimise metabolic risk factors may have a role in reducing incidence of aggressive prostate cancer.