Association between heated tobacco product use and airway obstruction: a single-centre observational study, Japan.

BACKGROUND: While heated tobacco products (HTPs) may affect pulmonary function, the evidence supporting the utility of screening for HTP use in clinical settings is insufficient. We examined the association between HTP use and airway obstruction after switching from cigarettes. METHOD: The study subjects were patients aged ≥20 years undergoing surgery from December 2021 to September 2022 who completed spirometry and reported tobacco (cigarette and HTP) use status during the preoperative assessment. Airway obstruction was defined as forced expiratory volume in 1 s to forced vital capacity ratio below the lower limit of normal. Current tobacco use was defined as past-30-day use. Multivariable Poisson regression analysis was performed to examine the associations between HTP use and airway obstruction by adjusting for demographic characteristics, lifetime cigarette smoking (pack-year) and duration of smoking cessation. RESULTS: Overall (N=2850, 55.4% women, mean age 62.4), 4.6% and 10.7% reported current HTP use and cigarette smoking, respectively. 16.8% had airway obstruction. Airway obstruction was more common among current HTP-only users (adjusted prevalence ratio (APR)=2.32), current cigarette-only smokers (APR=2.57) and current dual users (APR=2.82) than never-tobacco users. Among current tobacco users (N=398), the prevalence of airway obstruction was not significantly different between HTP-only users and cigarette-only smokers. Among former cigarette smokers (>30-day cigarette quitters) (N=1077), current HTP users had 1.42 times the increased prevalence of airway obstruction than never-HTP users after adjusting for cigarette pack-year; a stronger association was observed when the analysis was restricted to ≥5-year cigarette quitters (N=772) (APR=1.96, vs never HTP users). CONCLUSION: Current HTP use was associated with airway obstruction among patients with cancer who had completely switched from cigarettes even after quitting smoking for a long period. Patients should be routinely screened for HTP use and advised to quit any tobacco.

Alcohol consumption and 10-year mortality in oral and pharyngeal cancer.

BACKGROUND: Previous studies on the association of alcohol drinking with the prognosis of patients with oral and pharyngeal cancer are scarce and conflicting. Most previous studies are surveys from Europe, and examined up to 5 years of overall survival. We therefore evaluated the association between alcohol consumption and 10-year mortality among oral and pharyngeal cancer patients in Japan. METHODS: 2626 eligible cancer patients diagnosed between 1975 and 2010, identified through a hospital-based cancer registry in Japan, were followed up for up to 10 years. Alcohol consumption was used to divide subjects into five categories: non-drinker, ex-drinker, light (≤23 g/day of ethanol), moderate (23 < and ≤ 46 g/day of ethanol), and heavy drinker (> 46 g/day of ethanol), respectively. A Cox proportional hazards regression model was conducted to evaluate the association of alcohol consumption with 10-year all-cause mortality adjusting for sex, age, primary site, cancer stage, number of multiple cancers, surgery, radiotherapy, chemotherapy, smoking status and diagnosis year. RESULTS: Ex-drinker and heavy drinker cases had a significantly higher risk of death than non-drinkers (ex-drinker; HR=1.59; 95% CI,1.28-1.96, heavy drinker; HR=1.36; 95% CI,1.14-1.62). Heavy drinkers had a significantly higher risk of death than non-drinkers in both men and women (men; HR=1.35; 95% CI,1.10-1.65, women; HR=2.52; 95% CI,1.41-4.49). CONCLUSIONS: Among oral and pharyngeal cancer patients, an elevated risk of death was observed for heavy drinkers who consumed more than 46 g/day of ethanol compared with non-drinkers. In addition, this relationship was observed in both men and women.

Prognostic impact of coexisting cardiovascular disease in patients with cancer: A multicenter retrospective cohort study.

Background: The incidence of malignancy and cardiovascular disease (CVD) is increasing worldwide. However, it is not entirely clear how the coexistence of CVD at the time of cancer diagnosis affects the overall survival of patients with cancer. Methods and results: We used the cancer registries and administrative claims data of patients diagnosed with cancer at 36 designated cancer care hospitals in Osaka, Japan, from 2010 to 2015. The Cox proportional hazard model was used to examine how coexisting CVD (heart failure [HF], ischemic heart disease, peripheral arterial disease, cerebrovascular accidents, and atrial fibrillation) affected overall survival and the impact of HF severity, as documented by the New York Heart Association (NYHA) classification. Of the 131,701 patients with cancer, 9704 had coexisting CVD. The 3-year survival rates for patients with and without coexisting CVD were 62.9 % and 77.6 %, respectively. The adjusted hazard ratio (aHR) for all-cause mortality for coexisting CVD was 1.47 (95 % confidence interval, 1.41-1.52). Among the CVD subtype, patients with coexisting HF had the poorest prognosis. The aHRs in patients with HF by NYHA classification, using the patients without HF as a reference, were as follows: Class I: 1.33 (p = 0.217); II: 1.68 (p < 0.001); III: 1.54 (p = 0.011); IV: 2.47 (p < 0.001). Conclusion: Coexisting CVD and HF severity at cancer diagnosis is associated with survival in patients with cancer.

Faster surgery initiation in oral cancer patients during the COVID-19 pandemic in Osaka, Japan.

BACKGROUND: We investigated the impact of the COVID-19 pandemic on oral cancer (OC), comparing diagnosis and number of pre-operative days in the diagnosis of OC in 2019 (pre-COVID-19) and that in 2020 (during the COVID-19 pandemic). METHODS: Using data from a cancer registry-based study on the impact of COVID-19 on cancer care in Osaka (CanReCO), we collected details of sex, age, residential area, cancer site, date of diagnosis, clinical stage at first treatment and number of pre-operative days in OC patients. RESULTS: A total of 1470 OC cases were registered. Incidence of OC before and during COVID-19 was 814 and 656 cases, respectively. During the first wave of the pandemic (March to May 2020), incidence was about half that in the same period in 2019 (2019; n = 271, 2020; n = 145). Number of pre-operative days (median number of days between the first hospital visit and surgery date) was significantly shorter during the COVID-19 year (24.5 days) than in the pre-COVID-19 year (28 days, p = 0.0015). CONCLUSIONS: Incidence of OC during the COVID-19 pandemic was lower than in pre-COVID-19. Despite disruption in the healthcare system, the number of pre-operative days for OC cases was shorter during the pandemic.

Travel patterns of patients seeking cancer care during the COVID-19 pandemic: Multi-centre cohort study in Osaka, Japan.

BACKGROUND: In Japan, provision of equal access to cancer care is intended to be achieved via secondary medical areas (SMAs). However, the percentage of patients receiving care within the residential area varies by SMA in Osaka Prefecture. We aimed to assess the effect size of factors associated with patient mobility, and whether patient mobility was affected by the COVID-19 pandemic. METHODS: Records of patients diagnosed with stomach, colorectal, lung, breast, cervical, oesophageal, liver or pancreatic cancer during 2019-2020 were extracted from multi-centre hospital-based cancer registry data. Odds ratios of whether a patient received care within the SMA of residence were set as the outcome. A multivariable model was built using generalised estimating equations with multiple imputation for missing data. Change in patient mobility after the pandemic was examined by deriving age- and SMA-specific adjusted ORs (aORs). RESULTS: A total of 78,839 records were included. Older age, more advanced stage and palliative care had up to 1.69 times higher aORs of receiving care within their own area. Patients with oesophageal, liver or pancreatic cancer tended to travel outside their area with aORs ranging from 0.71 to 0.90. Patients aged ≤ 79 and living in the East and South SMAs tended to remain in their area with aORs ranging from 1.05 to 1.11 after the pandemic. CONCLUSION: Patient mobility decreased for higher age and stage. It also varied by SMA, cancer site and treatment type. POLICY SUMMARY: Our results need to be linked with resource inputs to help policymakers decide whether to intervene to address current efficiency or equity issues.

Does remaining teeth and dental prosthesis associate with social isolation? A six-year longitudinal study from the Japan Gerontological Evaluation Study (JAGES).

OBJECTIVES: Social isolation was associated with increased mortality and numerous adverse health outcomes. However, the longitudinal association between oral health and social isolation has not been studied. In this longitudinal prospective cohort study, the association between the number of remaining teeth and dental prosthesis use with social isolation after 6-years follow-up was examined. METHODS: Functionally independent adults aged 65 years or older, who were not socially isolated in 2010, were followed up until 2016 in the Japan Gerontological Evaluation Study. Data from 26 417 participants were analysed after random forest imputation to address missing data. Logistic regression models were used to calculate the odds ratio (OR) for incident social isolation in 2016 after adjusting for age, sex, educational attainment, income, activities of daily living, living area and having depressive symptoms. RESULTS: The mean age of the participants at baseline was 72.3 (SD = 5.0). A total of 1,127 (4.3%) participants were socially isolated at follow-up. Of these, 338 (3.2%) had ≥20 teeth (with or without using dental prosthesis), 171 (3.9%) had 10-19 teeth and used dental prosthesis, 112 (4.2%) had 10-19 teeth and did not use the dental prosthesis, 338 (5.1%) had 0-9 teeth and used dental prosthesis, and 168 (7.6%) had 0-9 teeth and did not use the dental prosthesis. Fully adjusted logistic regression models showed that the OR of incident social isolation was higher for those with fewer teeth; OR = 1.13 (95%CI = 0.96-1.33) for those with 10-19 teeth and OR = 1.36 (95%CI = 1.17-1.58) for those with 0-9 teeth, compared to those with ≥20 teeth. The OR of incident social isolation was lower for those who used a dental prosthesis [OR = 0.90, 95%CI = 0.80-1.02)] compared to those who did not use a dental prosthesis. The interaction between the number of teeth and dental prosthesis use demonstrated that the latter mitigated the incidence of social isolation for participants with tooth loss. Compared to those with ≥20 teeth (with or without prosthesis use), participants with 0-9 teeth that did not use a dental prosthesis were 79% [OR = 1.79, 95%CI = 1.49-2.19] more likely to be socially isolated, whereas participants with 0-9 teeth that used a dental prosthesis were only 23% [OR = 1.23, 95%CI = 1.05-1.45] more likely to be socially isolated. CONCLUSION: Tooth loss was the main predictor for social isolation at follow-up, while no dental prostheses use was an additional risk factor. Dental prosthesis use may reduce the risk of social isolation especially in those with severe tooth loss.

Minimum surgical volume to ensure 5-year survival probability for six cancer sites in Japan.

BACKGROUND: In Japan, the government designates hospitals specialized in cancer care, requiring them to perform 400 surgeries annually without requiring surgical volume per cancer site. This study aimed to estimate the site-specific minimum surgical volume per year based on its associations with 5-year survival probability. METHODS: The data of 64,402 patients who had undergone surgery for six types of cancers (including esophageal, stomach, colorectal, pancreatic, lung, and breast cancers) at designated cancer care hospitals in Osaka between 2007 and 2011 were analyzed. The hospitals were categorized by the average annual surgical volume per cancer type (e.g., 0-4, 5-9, 10-14…). We estimated the adjusted 5-year survival probability per surgical volume category using multivariable Cox proportional hazard regression. Furthermore, we identified inflection points for the trend of adjusted survival probability per increase of five surgical volumes using the joinpoint regression model and considered them as the suggested minimum surgical volume. RESULTS: The estimated minimum surgical volumes were 35-39, 20-25, 25-29, 10-14, 10-14, and 25-29 for esophageal, stomach, colorectal, pancreatic, lung, and breast cancers, respectively. The percentage change in the adjusted 5-year survival probability per increase of five surgical volumes before and after the suggested surgical volume were +2.23 and +0.39 for the esophagus, +9.68 and +0.34 for the stomach, +8.11 and +0.05 for the colorectum, +3.82 and +0.87 for the pancreas, +9.46 and +0.23 for the lung, and +1.27 and +0.03 for the breast. CONCLUSIONS: The suggested surgical volume based on the association with survival probability varies with cancer sites, some of which are close to the existing surgical volume standards used in Japan. These evidence-based minimum surgical volumes may help improve the quality of cancer surgeries.

Impact of coexisting diabetes on survival and risk of developing second primary cancer in diabetes patients receiving drug therapy: A multicenter retrospective cohort study of patients with cancer in Japan.

AIMS/INTRODUCTION: We investigated the association between coexisting diabetes at the time of cancer diagnosis, and the overall survival and incidence of second primary cancer in patients with cancer and receiving drug therapy for diabetes. MATERIALS AND METHODS: We used cancer registry and administrative data of patients diagnosed with cancer at designated cancer care hospitals in Osaka Prefecture between 2010 and 2015. The presence of diabetes was identified from the prescription records of antidiabetic drugs in Diagnosis Procedure Combination System data. After adjusting for patient characteristics, we compared overall survival between patients with cancer with coexisting diabetes and those without coexisting diabetes using the Cox proportional hazards model. In addition, the impact of coexisting diabetes on the risk of developing second primary cancer was evaluated using a competing risk analysis. RESULTS: Of the 131,701 patients with cancer included in the analysis, 6,135 (4.7%) had coexisting diabetes. The 5-year survival rates for patients with and without coexisting diabetes were 56.2% (95% confidence interval 54.8-57.6) and 72.7% (95% confidence interval 72.4-73.0), respectively. Coexisting diabetes was associated with a higher risk of developing second primary cancer (subdistribution hazard ratio 1.23; 95% confidence interval 1.08-1.41). In site-specific analysis, coexisting diabetes was associated with an increased risk for the development of second primary cancer of multiple myeloma, and cancer of the uterus, pancreas and liver. CONCLUSIONS: Coexisting diabetes was associated with a higher mortality and risk of developing second primary cancer in Japanese patients with cancer and on drug therapy for diabetes.

Association Between Toothbrushing Habits and COVID-19 Symptoms.

OBJECTIVES: The association between toothbrushing and coronavirus disease 2019 (COVID-19) infections is unknown. The aim of this study was to test the hypothesis that the change in time and frequency of toothbrushing is associated with having COVID-19 symptoms. METHODS: In this 8-month retrospective cohort study, we used the data from the Japan COVID-19 and Society Internet Survey (JACSIS; N = 22,366), which was conducted between August and September 2020. The logistic regression analyses were used to calculate the odds ratios (ORs) of having the 3 main COVID-19 symptoms (high fever, cough, and taste and smell disorder). Confounders were age, sex, educational attainment, equivalised income level, self-rated health, health literacy, and living area. RESULTS: The mean age of the participants was 49 years (SD = ±17.3), and 49.2% were male. Overall 2704 (12.1%) participants changed (increased or decreased) the time and frequency of toothbrushing, whilst 19,662 (87.9%) did not change. Only 60 participants (0.3%) had the 3 main COVID-19 symptoms. All logistic regression models showed that those who had a change in time and frequency of toothbrushing had higher odds of having the 3 main COVID-19 symptoms compared to those who had unchanged time and frequency of toothbrushing. The ORs ranged from 6.00 (95% confidence interval [CI], 3.60-9.99) in the crude model to 4.08 (95% CI, 2.38-6.98) in the fully adjusted model. CONCLUSIONS: The change in time and frequency of toothbrushing from before to after the COVID-19 pandemic was associated with having the 3 main COVID-19 symptoms.

Attitudes toward COVID-19 vaccination during the state of emergency in Osaka, Japan.

BACKGROUND: COVID-19 vaccination for general population started on April 12, 2021, in Osaka, Japan. We investigated public attitudes toward vaccination and associated factors of vaccine hesitancy during the third state of emergency. METHODS: An internet-based, self-reported, cross-sectional survey was conducted in June 2021, using the smartphone health app for residents of Osaka aged ≥18 years. Respondents were asked about their attitudes toward COVID-19 vaccine. Responses "Don't want to receive vaccines" or "Don't know" were defined as vaccine hesitancy (vs. "Received [1st dose]", "Received [2nd dose]", or "Want to receive vaccines"). Multivariable Poisson regression analysis was conducted to examine the associations between hesitancy and population characteristics. RESULTS: 23,214 individuals (8,482 men & 14,732 women) were included in the analysis. Proportions that answered "Received (1st dose)", "Received (2nd dose)", "Want to receive vaccines", "Don't want to receive vaccines", "Don't know", and "Don't want to answer" were 14.6%, 3.8%, 70.6%, 4.3%, 6.1%, and 0.5% among men; and 11.3%, 6.0%, 64.9%, 6.2%, 11.0%, and 0.6% among women. Factors associated with vaccine hesitancy included being a woman (aPR = 1.33; 95%CI = 1.23-1.44), age 18-39 (aPR = 7.00; 95%CI = 6.01-8.17) and 40-64 years (aPR = 4.25; 95%CI = 3.71-4.88 vs. 65+ years), living alone (aPR = 1.19; 95%CI = 1.08-1.30 vs. living with 3+ members), non-full-time employment and unemployment (aPRs ranged 1.12 to 1.49 vs. full-time employment), cardiovascular diseases/hypertension (aPR = 0.72; 95%CI = 0.65-0.81), and pregnancy (women of reproductive age only) (aPR = 1.35; 95%CI = 1.03-1.76). CONCLUSIONS: Most respondents expressed favorable attitudes toward COVID-19 vaccination while hesitancy was disproportionately high in certain populations. Efforts are needed to ensure accessible vaccine information resources and healthcare services.

Diagnosis and treatment of digestive cancers during COVID-19 in Japan: A Cancer Registry-based Study on the Impact of COVID-19 on Cancer Care in Osaka (CanReCO).

BACKGROUND: The coronavirus disease 2019 (COVID-19) affected cancer care in Japan, but the detailed impact on cancer diagnosis and treatment is not well-understood. We aimed to assess the impact of COVID-19 on digestive cancer care in Osaka Prefecture, which has a population of 8.8 million. METHODS: We conducted a multi-center cohort study, using hospital-based cancer registry (HBCR) data linked to administrative data from 66 designated cancer care hospitals in Osaka. Records of patients diagnosed with cancer of the stomach, colorectum, esophagus, liver, gallbladder or pancreas were extracted from the HBCR data. Baseline characteristics, such as the number of diagnoses, routes to diagnosis and clinical stage, were compared between patients diagnosed in 2019 and those in 2020. We also compared treatment patterns such as the number of treatments (operations, endoscopic surgeries, chemotherapies, radiotherapies), pathological stage and time to treatment for each digestive cancer. RESULTS: In total, 62,609 eligible records were identified. The number of diagnoses decreased in 2020, ranging from -1.9% for pancreatic cancer to -12.7% for stomach cancer. Screen-detected cases decreased in stomach and colorectal cancer. The percentage of clinical stage III slightly increased across different cancers, although it was only significant for colorectal cancer. Among 52,741 records analyzed for treatment patterns, the relative decrease in radiotherapy was larger than for other treatments. The median time from diagnosis to operation was shortened by 2-5 days, which coincided with the decrease in operations. CONCLUSION: The impact of COVID-19 on cancer care in 2020 was relatively mild compared with other countries but was apparent in Osaka. Further investigation is needed to determine the most affected populations.

Between-hospital variations in 3-year survival among patients with newly diagnosed gastric, colorectal, and lung cancer.

Due to increases in cancer survivability, quality assessments of cancer care must include long-term outcomes. This multicenter retrospective cohort study evaluated between-hospital variations in the 3-year survival rates of patients with gastric, colorectal, and lung cancer irrespective of treatment modality. We linked cancer registry data and administrative data from patients aged 18-99 years who were diagnosed with gastric, colorectal, or lung cancer between 2013 and 2015 in Osaka Prefecture, Japan. The 3-year survival rates were adjusted for potential prognostic factors using multilevel logistic regression models. Between-hospital variations were visually evaluated using funnel plots. We analyzed 10,296 gastric cancer patients from 30 hospitals, 9276 colorectal cancer patients from 30 hospitals, and 7978 lung cancer patients from 28 hospitals. The 3-year survival rate was 70.2%, 75.2%, and 45.0% for gastric, colorectal, and lung cancer, respectively. In the funnel plots, the adjusted survival rates of gastric and colorectal cancer for all hospitals lay between the lower and upper control limits of two standard deviations of the average survival rates. However, the adjusted survival rates of lung cancer for four hospitals lay below the lower limit while that for two hospitals lay above the upper limit. Older age, men, advanced cancer stage, comorbidities, functional disability, emergency admission, current/ex-smokers, and underweight were independently associated with poorer survival. In conclusion, there were between-hospital variations in 3-year survival for lung cancer even after adjusting for case mix. Quality improvement initiatives may be needed to raise the consistency of care.

E-Cigarettes Use Behaviors in Japan: An Online Survey.

Electronic cigarette (e-cigarette) use has become increasingly widespread throughout the world, including in Japan. However, little is known about how e-cigarettes are used in Japan, a country with heavy restrictions on nicotine-containing e-liquids and/or vaping products. This study examined e-cigarette use (e-cigarette use duration, frequency of use, device type, electrical resistance, nicotine use, favorite e-liquid flavors) among users in Japan, through an online survey using a web-based self-reported questionnaire which included questions about sex, age, combustible cigarette and heated tobacco product (HTP) use behaviors. Of 4689 e-cigarettes users analyzed, 93.5% were men and 52.9% had been using e-cigarettes for 1-3 years. Over 80% used e-cigarettes every day; 62.3% used nicotine liquid, and half of the nicotine liquid users used nicotine salt. The most popular liquid flavor was fruit (prevalence: 68.1%), followed by tobacco (prevalence: 48.4%). While 50.9% were e-cigarette single users, 35.2% were dual users (e-cigarettes and cigarettes or HTPs) and 13.8% were triple user (e-cigarettes, cigarettes and HTPs). This is the first comprehensive survey of Japanese e-cigarette users and our finding suggest more than half use nicotine liquid, although e-cigarettes containing nicotine liquid have been prohibited by the Pharmaceutical Affairs Act since 2010 in Japan. The study also showed 49.1% of participants used cigarettes and/or HTPs concurrently (dual or triple users).

Surgical volume threshold to improve 3-year survival in designated cancer care hospitals in 2004-2012 in Japan.

In Japan, cancer care hospitals designated by the national government have a surgical volume requirement of 400 annually, which is not necessarily defined based on patient outcomes. This study aimed to estimate surgical volume thresholds that ensure optimal 3-year survival for three periods. In total, 186 965 patients who had undergone surgery for solid cancers in 66 designated cancer care hospitals in Osaka between 2004 and 2012 were examined using data from a population-based cancer registry. These hospitals were categorized by the annual surgical volume of each 50 surgeries (eg, 0-49, 50-99, and so on). Using multivariable Cox proportional hazard regression, we estimated the adjusted 3-year survival probability per surgical volume category for 2004-2006, 2007-2009, and 2010-2012. Using the joinpoint regression model that computes inflection points in a linear relationship, we estimated the points at which the trend of the association between surgical volume and survival probability changes, defining them as surgical volume thresholds. The adjusted 3-year survival ranges were 71.7%-90.0%, 68.2%-90.0%, and 79.2%-90.3% in 2004-2006, 2007-2009, and 2010-2012, respectively. The surgical volume thresholds were identified at 100-149 in 2004-2006 and 2007-2009 and 200-249 in 2010-2012. The extents of change in the adjusted 3-year survival probability per increase of 50 surgical volumes were +4.00%, +6.88%, and +1.79% points until the threshold and +0.41%, +0.30%, and +0.11% points after the threshold in 2004-2006, 2007-2009, and 2010-2012, respectively. The existing surgical volume requirements met our estimated thresholds. Surgical volume thresholds based on the association with patient survival may be used as a reference to validate the surgical volume requirement.

Incidence and relative risk of metachronous second primary cancers for 16 cancer sites, Osaka, Japan, 2000-2015: Population-based analysis.

BACKGROUND: An increasing number of cancer survivors have developed multiple primaries. This study aims to describe the incidence and risk patterns of metachronous second primary cancers (SPCs) in Osaka, Japan. METHODS: Data were obtained from the Osaka Cancer Registry, a population-based database of all cancers diagnosed in Osaka. The study subjects were individuals who were first diagnosed with invasive cancers in 16 major cancer sites during 2000-2014, aged 15-79 years, survived at least 3 months, and were followed up for 10 years. We measured incidence rates, cumulative risks, and standardized incidence ratios (SIRs: with the Osaka general population as the referent) of developing SPCs during 3 months to 10 years after the first diagnosis. RESULTS: During 2000-2015, among 418,791 cancer survivors, 24,368 (5.8%) developed SPCs within 10 years of first diagnosis. Males had higher incidence rates than females except among young-onset survivors (aged 15-39 years). 10-year cumulative risks among survivors aged 70-79 years (the most dominant age group) were 24.0% (male) and 11.8% (female). 10-year SIRs were 1.38 (95% CI, 1.36-1.40; male) and 1.44 (95% CI, 1.41-1.48; female) with higher estimates among younger survivors in both sexes. Strong bidirectional associations were observed between oral/pharyngeal, esophageal, and laryngeal cancers. Survivors of any smoking-related cancers had elevated SIRs of developing smoking-related SPCs. Similar results were observed for alcohol-related cancers. CONCLUSIONS: Cancer survivors are at excess risk of developing SPCs compared to the general population. Continued surveillance is warranted to inform survivorship care through risk-based long-term care planning and lifestyle-changing efforts to prevent new cancers.

Prolonged sedentary time under the state of emergency during the first wave of coronavirus disease 2019: Assessing the impact of work environment in Japan.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) outbreak and the resulting state of emergency have restricted work environments, which may contribute to increased duration of sedentary behaviors. This study investigated the self-reported sedentary time of Japanese workers during and after the first state of emergency (April 7 to May 25, 2020) and examined differences in sedentary time after starting work from home and according to job type. METHODS: We used cross-sectional data from the Japan COVID-19 and Society Internet Survey, a web-based questionnaire survey conducted from August to September 2020 (n = 11,623; age range 15-79 years; 63.6% male). Prolonged sedentary time was calculated by subtracting the sedentary time after the state of emergency (defined as the normal sedentary time) from that during the emergency, with adjustments using inverse probability weighting for being a respondent in an internet survey. RESULTS: An increase in sedentary time of at least 2 hours was reported by 12.8% of respondents who started working from home during the state of emergency, including 9.7% of salespersons and 7.7% of desk workers. After adjusting for potential confounders, the multivariate-adjusted odds ratios (ORs) for a prolonged sedentary time ≥2 hours was significantly higher in respondents who started to work from home (OR: 2.14, 95% confidence interval: 1.78-2.57), and certain job types (desk workers; OR: 1.56, 95% CI: 1.27-1.91, salespersons; OR: 2.03, 95% CI: 1.64-2.51). CONCLUSIONS: Working from home and non-physical work environments might be important predictors of prolonged sedentary time.

Hospital volume and 5-year survival in head and neck cancer patients in Osaka, Japan.

BACKGROUND: Few previous studies have examined the relationship between hospital volume and hazard of death for head and neck cancer patients. The purpose of this study was to examine the association between hospital volume and 5-year survival from diagnosis among head and neck cancer patients. METHODS: Using data from the population-based Osaka Cancer Registry, hospital volume was divided into three volume groups according to the number of head and neck cancer treatments identified between 2009 and 2011. We analysed the association between hospital volume and 5-year survival among 3069 patients aged 0-79 using Cox proportional hazard models, adjusting for characteristics of patients. RESULTS: Compared with head and neck cancer patients in high-hospital volume, patients treated in middle- and low-hospital volume were found to have a higher risk of death (middle-hospital volume: hazard ratio = 1.26; 95% confidence interval, 1.09-1.46, low-hospital volume: hazard ratio = 1.24; 95% confidence interval, 1.06-1.46). CONCLUSIONS: We found a significantly higher risk of hazard of death in middle- and low-hospital volume than in high-hospital volume for head and neck cancer.

Hospital volume and postoperative survival for three urological cancers: Prostate, kidney, and bladder.

OBJECTIVE: To examine the association between hospital volume and postoperative 5-year survival for patients with prostate, kidney, and bladder cancer. METHOD: Using Osaka Cancer Registry data, we identified 9285 patients who were diagnosed as having prostate, kidney, or bladder cancer and who underwent surgery between 2007 and 2011 in Osaka, Japan. The surgical hospital volume of each hospital was calculated and then divided into quartiles (high, medium, low, very low). We estimated the hazard ratios of hospital volume (quartiles) for 5-year survival using Cox proportional hazard models. RESULTS: For all three cancer sites, the mortality hazard of hospitals with the lowest hospital volume was significantly higher than that of hospitals with the highest volume. The difference in adjusted 5-year survival rates between hospitals with the highest and lowest hospital volume was 3.6% for prostate cancer, 6.6% for kidney cancer, and 13.3% for bladder cancer. CONCLUSION: Hospital surgical volume seems to affect 5-year survival for patients with urological cancers, especially kidney and bladder cancer.

Examining the associations between oral health and social isolation: A cross-national comparative study between Japan and England.

In Western countries, the most important part of the face in communication is the mouth, whereas it is the eyes in Asian countries; thus oral health could be more important in social interactions in Western countries. Our aim was to examine differences in the association between oral health status and social isolation among older people by comparing Japan and England. We used cross-sectional information obtained from adults aged 65+ in two ongoing prospective cohort studies: The Japan Gerontological Evaluation Study (JAGES, N = 120,195) and the English Longitudinal Study of Ageing (ELSA, N = 3,958). The dependent variable, social isolation score (SIS) was calculated from five factors (marital status, social support from children, social support from family, social support from friends, and social participation). The independent variables were self-reported number of remaining teeth (0, 1-9, 10-19, ≥20) and denture use (≥20 teeth, 10-19 teeth with denture, 10-19 teeth without denture, 0-9 teeth with denture, 0-9 teeth without denture), while the covariates in the model were: sex, age, educational attainment, self-rated health, number of comorbidities, household annual equivalized income, mental health status, daily living activities, and smoking status. We examined associations between oral health status and SIS by applying an ordered logit model by country. Compared to England, more Japanese participants were socially isolated (1.4% vs. 5.8%), but fewer were edentulous (13.1% vs. 7.7%). In both countries, poorer oral health further increased the odds of being socially isolated. Pooled analysis of the ordered logit model with an interaction term showed that the association of number of remaining teeth with SIS was stronger in edentulous participants and in England (odds ratio = 1.50, 95% Confidence interval:1.26-1.80). In both countries, oral health was associated with social isolation; this association could be stronger in England than in Japan.