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1.
J Am Acad Dermatol ; 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32246965

RESUMO

BACKGROUND: The literature surrounding survival of patients with multiple primary melanomas (MPM) yields variable and opposing findings, constrained by statistical challenges. OBJECTIVES: To critically examine the available literature regarding survival of patients with MPM compared with single primary melanomas (SPM) and detail statistical methods employed. METHODS: Electronic searches of Pubmed, Embase, Web of Science and Scopus, with cross-checking of references, for the period January 1956 - June 2019 were carried out. All studies published in English examining survival in patients with multiple melanoma were included. Case studies and small case series were excluded. RESULTS: Fourteen studies were eligible for inclusion. Conclusions on survival varied markedly depending on the statistical method used. Four studies that accounted for survival bias by partitioning the survival time were included in the quantitative review, with three of these reporting a survival disadvantage for MPM, while the fourth showed no difference in survival. Pooled HR was 1.39 (1.07-1.81) but with significant heterogeneity (I2= 96.8% Phet < 0.001). LIMITATIONS: Studies showed significant heterogeneity in methodology. CONCLUSIONS: When data was analysed with robust statistical methods, patients with MPM had a survival disadvantage compared with patients with SPM.

2.
Artigo em Inglês | MEDLINE | ID: mdl-32337759

RESUMO

BACKGROUND: Childhood liver cancers are relatively rare, hence inferences on incidence trends over time are limited by lack of precision in most studies. OBJECTIVE: To conduct a systematic review and meta-analysis of published contemporary trends on childhood liver cancer incidence rates worldwide. DATA SOURCES: PubMed, EMBASE, CINAHL, Web of Science. STUDY SELECTION AND DATA EXTRACTION: English-language peer-reviewed articles published from 1 January 2008 to 1 December 2019 that presented quantitative estimates of incidence trends for childhood liver cancer and diagnostic subgroups. Review was conducted per PRISMA guidelines. Two authors independently extracted data and critically assessed studies. SYNTHESIS: Random effects meta-analysis models were used to estimate pooled incidence trends by diagnostic subgroups. Heterogeneity was measured using the Q and I2 statistics and publication bias evaluated using Egger's test. RESULTS: Eighteen studies were included, all based on population-based cancer registries. Trends were reported on average for 18 years. Overall pooled estimates of the annual percentage change (APC) were 1.4 (95% confidence interval [CI] 0.5, 2.3) for childhood liver cancers, 2.8 (95% CI 1.8, 3.8) for hepatoblastoma and -3.0 (95% CI -11.0, 4.9) for hepatocellular carcinoma. Sub-group analysis by region indicated increasing trends for childhood liver cancers in North America/Europe/Australia (APC 1.7, 95% CI 0.7, 2.8) whereas corresponding trends were stable in Asia (APC 1.4, 95%CI -0.3, 2.7). Publication bias was not detected for any of these analyses. The I2 statistic indicated that the heterogeneity among included studies was low for combined liver cancers, moderate for hepatoblastoma and high for hepatocellular carcinoma. CONCLUSIONS: Incidence is increasing for childhood liver cancers and the most commonly diagnosed subgroup hepatoblastoma. Lack of knowledge of the etiology of childhood liver cancers limited the ability to understand the reasons for observed incidence trends. This review highlighted the need for ongoing monitoring of incidence trends and etiological studies.

3.
Artigo em Inglês | MEDLINE | ID: mdl-32068329

RESUMO

AIM: Neuroblastoma predominantly affects younger children and exhibits heterogeneous behaviour. This study describes incidence and outcomes for neuroblastoma using national population-based data from the Australian Childhood Cancer Registry. METHODS: Deidentified data for all children (0-14 years) diagnosed with neuroblastoma and ganglioneuroblastoma from 1983 to 2015 were extracted. Cause-specific (CSS) and event-free survival were estimated using the cohort method. Adjusted hazard ratios were calculated using a multivariable flexible parametric survival model. Other outcomes investigated included recurrence and second primary malignancies (SPMs). RESULTS: The study cohort comprised 1269 patients. Age-standardised incidence rates remained steady across the study period at approximately 9.5 per million children per year. The proportion of patients with metastatic disease at diagnosis decreased from 63% in 1983-1995 to 42% by 2006-2015 (P < 0.001). CSS and event-free survival both improved significantly over time and reached 75% (95% confidence interval (CI) = 71-79%) and 71% (95% CI = 66-75%) at 5 years post-diagnosis, respectively, for children diagnosed between 2004 and 2013. Of patients achieving full remission, 28% relapsed with subsequent 5-year CSS of only 20%. Although SPMs were rare, neuroblastoma survivors carried a fivefold increased risk compared to cancer rates in the general population (standardised incidence ratio = 5.18, 95% CI = 3.01-8.91), with 7 of the 13 patients (54%) who were diagnosed with an SPM dying within 5 years. CONCLUSIONS: CSS for childhood neuroblastoma has improved substantially over time in Australia, but still remains lower than for most other types of childhood cancer. SPMs are uncommon and carry a better prognosis than relapse of the primary tumour.

4.
Pediatr Pulmonol ; 55(3): 719-722, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31909892

RESUMO

Lung cancers in children under the age of 15 are very uncommon, with a scarcity of literature describing patient characteristics and survival. This study assessed first primary malignant cancers occurring in the trachea, bronchus, or lung (International Classification of Diseases for Oncology, 3rd edition [ICD-O-3] codes C33-C34) for the period 1983-2015, using data from the population-based Australian Childhood Cancer Registry. Variables of interest included morphology, sex, age group, and metastatic status at diagnosis. Mode of treatment was also assessed where possible. The Kaplan-Meier method was used to calculate 5-year observed survival. Of the 53 in-scope patients, almost half (n = 23, 43%) were diagnosed with pleuropulmonary blastoma and a further 8 (15%) had a carcinoid tumor. Few of the patients with details available on stage at diagnosis (n = 7 of 43, 16%) presented with metastatic disease. Surgical excision was the most common treatment (30 of 37 children, 81%), with two-thirds (n = 28 of 43, 65%) receiving chemotherapy. Five-year observed survival was estimated to be 74% (95% CI = 61%-85%). Our results represent one of the largest and most complete population-based cohorts of children with primary malignant lung cancers available to date. Detection of childhood lung cancer can be difficult due to the rarity of this disease and symptoms that are typically nonspecific.

5.
J Paediatr Child Health ; 56(6): 908-916, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31943452

RESUMO

AIM: This paper describes the incidence and outcomes of childhood renal malignancies in Australia using national population-based data from the Australian Childhood Cancer Registry. METHODS: De-identified data for children (0-14 years) diagnosed with renal malignancies from 1983 to 2015 inclusive were extracted. Cause-specific (CSS) and event-free survival up to 20 years from diagnosis were estimated using the cohort method. Adjusted excess mortality hazard ratios were calculated using a multivariable flexible parametric survival model. Details relating to second primary malignancies (SPMs) were also examined. RESULTS: There were 1046 children diagnosed with renal malignancies in Australia between 1983 and 2015 (91% nephroblastoma), generating an annual age-standardised incidence rate of 8 per million children, which remained constant over the study period. CSS was 89% (95% confidence interval = 87-91%) and 88% (86-90%) at 5 and 20 years, respectively, and 5-year event-free survival was 82% (80-84%). Five-year CSS did not change over the study period and was highest for nephroblastoma (91%). Of the 94% of patients achieving remission, 15% relapsed and subsequent 5-year CSS was 49% (40%-58%). Eleven children were diagnosed with SPM (standardised incidence ratio = 2.9, 95% confidence interval = 1.6-5.3, P < 0.001), and five of them (45%) died within 5 years of the second diagnosis. CONCLUSIONS: Children treated for renal malignancies in Australia have excellent long-term survival, which is unchanged since 1983. SPMs are uncommon following treatment for childhood renal cancer but carry a poor prognosis. Relapse carries a similarly poor prognosis to SPM but is more common. These data are comparable to registry outcomes in similarly developed nations.

6.
Med J Aust ; 212(3): 121-125, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31743457

RESUMO

OBJECTIVE: To investigate the incidence of second primary cancers in people diagnosed with cancer during childhood. DESIGN, SETTING: Retrospective, population-based study; analysis of Australian Childhood Cancer Registry data. PARTICIPANTS: People alive at least two months after being diagnosed before the age of 15 years with a primary cancer, 1983-2013, followed until 31 December 2015 (2-33 years' follow-up). MAIN OUTCOME MEASURES: Risks of second primary cancer compared with the general population, expressed as standardised incidence ratios (SIRs). RESULTS: Among 18 230 people diagnosed with cancer during childhood, 388 (2%) were later diagnosed with second primary cancers; the estimated 30-year cumulative incidence of second cancers was 4.4% (95% CI, 3.8-5.0%). The risk of a new primary cancer was five times as high as for the general population (SIR, 5.13; 95% CI, 4.65-5.67). Relative risk of a second primary cancer was greatest for people who had childhood rhabdomyosarcoma (SIR, 19.9; 95% CI, 14.4-27.6). Relative risk was particularly high for children who had undergone both chemotherapy and radiotherapy (SIR, 9.80; 95% CI, 8.35-11.5). Relative risk peaked during the 5 years following the first diagnosis (2 to less than 5 years: SIR, 10.3; 95% CI, 8.20-13.0), but was still significant at 20-33 years (SIR, 2.58; 95% CI, 2.02-3.30). The most frequent second primary cancers were thyroid carcinomas (65 of 388, 17%) and acute myeloid leukaemias (57, 15%). CONCLUSIONS: Survivors of childhood cancer remain at increased risk of a second primary cancer well into adulthood. As the late effects of cancer treatment probably contribute to this risk, treatments need to be refined and their toxicity reduced, without reducing their benefit for survival.


Assuntos
Sobreviventes de Câncer , Segunda Neoplasia Primária/epidemiologia , Adolescente , Adulto , Austrália/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
7.
Med J Aust ; 212(3): 113-120, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31876953

RESUMO

OBJECTIVES: To describe changes in childhood cancer incidence in Australia, 1983-2015, and to estimate projected incidence to 2035. DESIGN, SETTING: Population-based study; analysis of Australian Childhood Cancer Registry data for the 20 547 children under 15 years of age diagnosed with cancer in Australia between 1983 and 2015. MAIN OUTCOME MEASURES: Incidence rate changes during 1983-2015 were assessed by joinpoint regression, with rates age-standardised to the 2001 Australian standard population. Incidence projections to 2035 were estimated by age-period-cohort modelling. RESULTS: The overall age-standardised incidence rate of childhood cancer increased by 34% between 1983 and 2015, increasing by 1.2% (95% CI, +0.5% to +1.9%) per annum between 2005 and 2015. During 2011-2015, the mean annual number of children diagnosed with cancer in Australia was 770, an incidence rate of 174 cases (95% CI, 169-180 cases) per million children per year. The incidence of hepatoblastoma (annual percentage change [APC], +2.3%; 95% CI, +0.8% to +3.8%), Burkitt lymphoma (APC, +1.6%; 95% CI, +0.4% to +2.8%), osteosarcoma (APC, +1.1%; 95%, +0.0% to +2.3%), intracranial and intraspinal embryonal tumours (APC, +0.9%; 95% CI, +0.4% to +1.5%), and lymphoid leukaemia (APC, +0.5%; 95% CI, +0.2% to +0.8%) increased significantly across the period 1983-2015. The incidence rate of childhood melanoma fell sharply between 1996 and 2015 (APC, -7.7%; 95% CI, -10% to -4.8%). The overall annual cancer incidence rate is conservatively projected to rise to about 186 cases (95% CI, 175-197 cases) per million children by 2035 (1060 cases per year). CONCLUSIONS: The incidence rates of several childhood cancer types steadily increased during 1983-2015. Although the reasons for these rises are largely unknown, our findings provide a foundation for health service planning for meeting the needs of children who will be diagnosed with cancer until 2035.


Assuntos
Neoplasias/epidemiologia , Adolescente , Austrália/epidemiologia , Linfoma de Burkitt/epidemiologia , Criança , Pré-Escolar , Feminino , Previsões , Hepatoblastoma/epidemiologia , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Melanoma/epidemiologia , Sistema de Registros
8.
Artigo em Inglês | MEDLINE | ID: mdl-31765264

RESUMO

Purpose: Breast cancer is the most common cancer diagnosed among adolescent and young adult (AYA) females worldwide, but epidemiological patterns unique to this group are often obscured when results are combined with older patients. This study investigates breast cancer incidence and survival among AYA females, including differences by broad stage at diagnosis. Methods: A retrospective, population-based cohort study was conducted using de-identified data for females in Queensland, Australia, aged 15-39 diagnosed with a first primary breast cancer between 1997 and 2014 with follow-up to December 31, 2016. Incidence rate trends were examined with Joinpoint analysis. Cause-specific survival was calculated for key characteristics, and 5-year adjusted hazard ratios (HRs) were estimated from a multivariable flexible parametric model. Results: The study cohort comprised 2337 patients, of whom two-thirds (n = 1565, 67%) were diagnosed with advanced disease (tumor diameter >20 mm, lymph node involvement or presence of distant metastases at diagnosis). Incidence rates of localized tumors decreased by 1.9% per year (95% confidence interval [CI] -3.5% to -0.4%) over the study period, whereas the trend for advanced breast cancers remained stable. Five-year cause-specific survival increased from 85% to 92% for 2011-2014 compared to 1997-2001 (adjusted HR = 0.43, 95% CI = 0.29-0.65). Patients who were Indigenous from disadvantaged areas or diagnosed with advanced stage experienced significantly worse survival. Conclusion: The high proportion of younger females diagnosed with advanced breast cancer should be the focus of future campaigns to improve awareness and earlier detection. While survival has increased over time, further work is required to ensure that this progress is experienced equitably by all patients.

9.
Cancer Epidemiol ; 59: 208-214, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30831553

RESUMO

BACKGROUND: Stage of cancer at diagnosis is one of the strongest predictors of survival and is essential for population cancer surveillance, comparison of cancer outcomes and to guide national cancer control strategies. Our aim was to describe, for the first time, the distribution of cases by stage at diagnosis and differences in stage-specific survival on a population basis for a range of childhood solid cancers in Australia. METHODS: The study cohort was drawn from the population-based Australian Childhood Cancer Registry and comprised children (<15 years) diagnosed with one of 12 solid malignancies between 2006 and 2014. Stage at diagnosis was assigned according to the Toronto Paediatric Cancer Stage Guidelines. Observed (all cause) survival was calculated using the Kaplan-Meier method, with follow-up on mortality available to 31 December 2015. RESULTS: Almost three-quarters (1256 of 1760 cases, 71%) of children in the study had localised or regional disease at diagnosis, varying from 43% for neuroblastoma to 99% for retinoblastoma. Differences in 5-year observed survival by stage were greatest for osteosarcoma (localised 85% (95% CI = 72%-93%) versus metastatic 37% (15%-59%)), neuroblastoma (localised 98% (91%-99%) versus metastatic 60% (52%-67%)), rhabdomyosarcoma (localised 85% (71%-93%) versus metastatic 53% (34%-69%)), and medulloblastoma (localised 69% (61%-75%) versus metastases to spine 42% (27%-57%)). CONCLUSION: The stage-specific information presented here provides a basis for comparison with other international population cancer registries. Understanding variations in survival by stage at diagnosis will help with the targeted formation of initiatives to improve outcomes for children with cancer.


Assuntos
Neoplasias/epidemiologia , Neoplasias/patologia , Austrália/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Estadiamento de Neoplasias/estatística & dados numéricos , Neoplasias/mortalidade , Vigilância da População , Sistema de Registros
10.
Pediatr Blood Cancer ; 66(6): e27683, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30803139

RESUMO

BACKGROUND: Information on stage at diagnosis for childhood blood cancers is essential for surveillance but is not available on a population basis in most countries. Our aim was to apply the internationally endorsed Toronto Paediatric Cancer Stage Guidelines to children (<15 years) with acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), Hodgkin lymphoma (HL), or non-Hodgkin lymphoma (NHL) and to assess differences in survival by stage at diagnosis. PROCEDURE: Stage was defined by extent of involvement of the central nervous system (CNS) for ALL and AML and using the Ann Arbor and St Jude-Murphy systems for HL and NHL, respectively. The study cohort was drawn from the population-based Australian Childhood Cancer Registry, consisting of children diagnosed with one of these four blood cancers between 2006 and 2014 with follow-up to 2015. Five-year observed survival was estimated from the Kaplan-Meier method. RESULTS: Stage was assigned to 2201 of 2351 eligible patients (94%), ranging from 85% for AML to 95% for ALL, HL, and NHL. Survival following ALL varied from 94% (95% CI = 93%-95%) for CNS1 disease to 89% (95% CI = 79%-94%) for CNS2 (P = 0.07), whereas for AML there was essentially no difference in survival between CNS- (77%) and CNS+ disease (78%; P = 0.94). Nearly all children with HL survived for five years. There was a trend (P = 0.04) toward worsening survival with higher stage for NHL. CONCLUSIONS: These results provide the first population-wide picture of the distribution and outcomes for childhood blood cancers in Australia by extent of disease at diagnosis and provide a baseline for future comparisons.


Assuntos
Doença de Hodgkin/patologia , Leucemia Mieloide Aguda/patologia , Linfoma não Hodgkin/patologia , Estadiamento de Neoplasias/normas , Guias de Prática Clínica como Assunto/normas , Leucemia-Linfoma Linfoblástico de Células Precursoras/patologia , Sistema de Registros/estatística & dados numéricos , Adolescente , Austrália/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Seguimentos , Doença de Hodgkin/epidemiologia , Humanos , Lactente , Leucemia Mieloide Aguda/epidemiologia , Linfoma não Hodgkin/epidemiologia , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia
11.
Int J Cancer ; 145(11): 2944-2953, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30748013

RESUMO

The International Agency for Research on Cancer first concluded that alcohol causes cancer in humans in 1988. The World Cancer Research Fund has declared that alcohol causes cancer of the oral cavity, pharynx, larynx, oesophagus (squamous cell carcinoma), female breast, colon, rectum, stomach and liver. It recommended that alcohol be avoided altogether to prevent cancer. We aimed to quantify the impact of reducing alcohol consumption on future cancer incidence in Australia. We used PREVENT 3.01 simulation modelling software to estimate the proportion of cancers that could potentially be prevented over a 25-year period under two hypothetical intervention scenarios and two latency periods (20 and 30 years). Under a scenario where alcohol consumption abruptly ceases, we estimated up to 4% of alcohol-related cancers could be avoided over a 25-year period (~49,500 cancers, depending on assumed latency). If the maximum consumption of all Australian adults was ≤20 g/day (~two Australian standard drinks), up to 2% of alcohol-related cancers could be avoided (~29,600 cancers). The maximum proportions were higher for men (6% for no alcohol consumption; 5% for ≤20 g/day) than women (3%; 1%). The proportion avoidable was highest for oesophageal squamous cell carcinoma (17% no alcohol consumption; 9% ≤20 g/day), followed by cancers of the oral cavity (12%; 5%) and pharynx (11%; 5%). The cancer sites with the highest numbers of potentially avoidable cases were colon in men (11,500; 9,900) and breast in women (14,400; 4,100). Successful interventions to reduce alcohol intake could lead to significant reductions in cancer incidence.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Neoplasias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/epidemiologia , Austrália/epidemiologia , Feminino , Guias como Assunto , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Medição de Risco , Sociedades Médicas/organização & administração , Adulto Jovem
12.
Int J Cancer ; 144(9): 2088-2098, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30357816

RESUMO

Globally, 39% of the world's adult population is overweight or obese and 23% is insufficiently active. These percentages are even larger in high-income countries with 58% overweight/obese and 33% insufficiently active. Fourteen cancer types have been declared by the World Cancer Research Fund to be causally associated with being overweight or obese: oesophageal adenocarcinoma, stomach cardia, colon, rectum, liver, gallbladder, pancreas, breast, endometrium, ovary, advanced/fatal prostate, kidney, thyroid and multiple myeloma. Colon, postmenopausal breast and endometrial cancers have also been judged causally associated with physical inactivity. We aimed to quantify the proportion of cancer cases that would be potentially avoidable in Australia if the prevalence of overweight/obesity and physical inactivity in the population could be reduced. We used the simulation modelling software PREVENT 3.01 to calculate the proportion of avoidable cancers over a 25-year period under different theoretical intervention scenarios that change the prevalence of overweight/obesity and physical inactivity in the population. Between 2013 and 2037, 10-13% of overweight/obesity-related cancers in men and 7-11% in women could be avoided if overweight and obesity were eliminated in the Australian population. If everyone in the population met the Australian physical activity guidelines for cancer prevention (i.e. engaged in at least 300 min of moderate-intensity physical activity per week), an estimated 2-3% of physical inactivity-related cancers could be prevented in men (colon cancer) and 1-2% in women (colon, breast and endometrial cancers). This would translate to the prevention of up to 190,500 overweight/obesity-related cancers and 19,200 inactivity-related cancers over 25 years.


Assuntos
Exercício Físico , Neoplasias/epidemiologia , Neoplasias/prevenção & controle , Obesidade/epidemiologia , Prevenção Primária/métodos , Comportamento Sedentário , Austrália/epidemiologia , Índice de Massa Corporal , Intervenção Médica Precoce/métodos , Intervenção Médica Precoce/estatística & dados numéricos , Humanos , Incidência
13.
J Invest Dermatol ; 139(4): 842-847, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30423330

RESUMO

Survivors of invasive melanoma have an increased risk of developing second primary cancers; however, similar risks associated with in situ melanoma have not been established. We evaluated 39,872 survivors of first primary in situ melanoma diagnosed from 1982 through 2012 in Queensland, Australia. Relative risk of second nonmelanoma primary cancers was estimated from standardized incidence ratios with 95% confidence intervals. A total of 4,823 (12%) in situ melanoma survivors developed a second primary cancer. A small increased risk (6%) compared with the general population was found. In those younger than 50 years, risk was increased by 14% for all cancers combined. In situ melanoma survivors had significantly increased risks of developing lip, thyroid, pancreatic, and brain cancers and decreased risks of head and neck, and lung cancers. Male in situ melanoma survivors had a significantly increased risk of prostate cancer; female survivors had an increased risk of thyroid cancer and lymphoid leukemia. Findings indicate that in situ melanoma may predict the diagnosis of certain second primary cancers. This altered risk may be due to biological, behavioral, or genetic factors or increased medical surveillance, and it requires further investigation, particularly among people younger than 50 years.


Assuntos
Sobreviventes de Câncer/estatística & dados numéricos , Melanoma/epidemiologia , Segunda Neoplasia Primária/epidemiologia , Sistema de Registros , Medição de Risco/métodos , Programa de SEER , Neoplasias Cutâneas/epidemiologia , Idoso , Feminino , Humanos , Incidência , Masculino , Melanoma/diagnóstico , Pessoa de Meia-Idade , Segunda Neoplasia Primária/diagnóstico , Queensland/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Neoplasias Cutâneas/diagnóstico
14.
Lancet Child Adolesc Health ; 2(3): 173-179, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-30169253

RESUMO

BACKGROUND: Cancer stage at diagnosis is crucial for assessing global efforts to increase awareness of childhood cancer and improve outcomes. However, consistent information on childhood cancer stage is absent from population cancer registries worldwide. The Toronto Childhood Cancer Stage Guidelines, compiled through an international consensus process, were designed to provide a standard framework for collection of information on stage at diagnosis of childhood cancers. We aimed to assess the feasibility of implementing the Toronto Guidelines within a national population cancer registry. METHODS: We did a population-based registry study using data from the Australian Childhood Cancer Registry and included data from children aged 0-14 years diagnosed between Jan 1, 2006, and Dec 31, 2010 with one of 16 childhood cancers listed in the Toronto Guidelines (acute lymphoblastic leukaemia, acute myeloid leukaemia, Hodgkin's lymphoma, non-Hodgkin lymphoma, neuroblastoma, Wilms' tumour, rhabdomyosarcoma, non-rhabdomyosarcoma soft tissue sarcoma, osteosarcoma, Ewing's sarcoma, retinoblastoma, hepatoblastoma, testicular cancer, ovarian cancer, medulloblastoma, and ependymoma). We extracted data from medical records, and assigned stage according to the Tier 1 criteria (basic) and Tier 2 criteria (more detailed, requiring data from cytology, imaging, and other diagnostic tests, where available) using computer algorithms derived from the Toronto Guidelines. Additionally, expert reviewers independently assigned Tier 2 stage to a random subsample of 160 cases (ten per malignancy type). Feasibility of the guidelines was assessed on the percentage of cases that could be staged, agreement between stage assigned by the algorithms and the expert reviewers, and the mean time (min) taken to collect the required data. FINDINGS: We obtained data for 1412 eligible children. Stage could be assigned according to Tier 2 criteria for 1318 (93%) cases, ranging from 48 (84%) of 57 cases of non-rhabdomyosarcoma soft tissue sarcoma to 46 (100%) cases of hepatoblastoma. According to Tier 1 criteria, stage could be assigned for 1329 (94%) cases, ranging from 131 (87%) of 151 cases of acute myeloid leukaemia to 46 (100%) cases of hepatoblastoma. By contrast, stage at diagnosis was recorded by the treating physician for 555 (39%) of the 1412 cases. The computer algorithm assigned the same stage as did one or more independent expert reviewers in 155 (97%) of the 160 cases assessed. The mean time taken to review medical records and extract the required data was 18·0 min (SD 9·5 per case). INTERPRETATION: The Toronto Guidelines provide a highly functional framework that can be used to assign cancer stage at diagnosis using data routinely available in medical records for most childhood cancers. Data on staging have the potential to inform interventions targeting improved diagnosis and survival. FUNDING: Cancer Australia.


Assuntos
Neoplasias/patologia , Guias de Prática Clínica como Assunto , Adolescente , Austrália , Criança , Pré-Escolar , Estudos de Viabilidade , Feminino , Humanos , Lactente , Masculino , Estadiamento de Neoplasias/normas , Sistema de Registros , Reprodutibilidade dos Testes
15.
Pediatr Blood Cancer ; 65(12): e27410, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30183136

RESUMO

BACKGROUND: Therapy-related acute myeloid leukemia (t-AML) is defined as AML that develops after exposure to cytotoxic chemotherapy and/or radiation therapy. There is a paucity of available literature, particularly in regard to t-AML following childhood cancer. Our aim was to describe the risk of t-AML among children treated for other cancers and their subsequent survival. PROCEDURE: We utilized data from the population-based Australian Childhood Cancer Registry to examine all childhood patients (<15 years at diagnosis) treated with chemotherapy and/or radiotherapy for cancers other than AML who received a subsequent diagnosis of AML between 1983 and 2014. Standardized incidence ratios (SIRs) were calculated to approximate the relative risk of being diagnosed with AML compared to the general population. Estimates of 5-year observed survival were obtained using the Kaplan-Meier method, with differences determined by the log-rank test. RESULTS: Fifty-eight of 11,753 patients in the study cohort (0.5%) were diagnosed with t-AML, an almost 50-fold higher risk than expected (SIR = 45.6, 95% confidence interval [CI] = 35.3-59.0). Five-year observed survival from the date of t-AML diagnosis was 31.2% (95% CI = 19.6-43.5%). A significant survival advantage was found for patients who underwent hematopoietic stem cell transplantation (HSCT) following diagnosis of t-AML, with a 5-year survival of 52.4% (29.7-70.9%) compared to 5.7% (0.4-22.6%) for those who did not have HSCT (P < 0.001). CONCLUSIONS: Although rare, t-AML is an important potential late effect of childhood cancer therapy. Prognosis is generally poor, with HSCT offering some survival benefit.


Assuntos
Leucemia Mieloide Aguda/epidemiologia , Leucemia Mieloide Aguda/etiologia , Segunda Neoplasia Primária/epidemiologia , Adolescente , Antineoplásicos/efeitos adversos , Austrália/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Humanos , Incidência , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Neoplasias/terapia , Radioterapia/efeitos adversos , Sistema de Registros
16.
BMJ Open ; 8(4): e019050, 2018 04 29.
Artigo em Inglês | MEDLINE | ID: mdl-29706597

RESUMO

OBJECTIVES: To systematically assess the evidence for variations in outcomes at each step along the breast cancer continuum of care for Australian women by residential location. DESIGN: Systematic review. METHODS: Systematic searches of peer-reviewed articles in English published from 1 January 1990 to 24 November 2017 using PubMed, EMBASE, CINAHL and Informit databases. Inclusion criteria were: population was adult female patients with breast cancer; Australian setting; outcome measure was survival, patient or tumour characteristics, screening rates or frequencies, clinical management, patterns of initial care or post-treatment follow-up with analysis by residential location or studies involving non-metropolitan women only. Included studies were critically appraised using a modified Newcastle-Ottawa Scale. RESULTS: Seventy-four quantitative studies met the inclusion criteria. Around 59% were considered high quality, 34% moderate and 7% low. No eligible studies examining treatment choices or post-treatment follow-up were identified. Non-metropolitan women consistently had poorer survival, with most of this differential being attributed to more advanced disease at diagnosis, treatment-related factors and socioeconomic disadvantage. Compared with metropolitan women, non-metropolitan women were more likely to live in disadvantaged areas and had differing clinical management and patterns of care. However, findings regarding geographical variations in tumour characteristics or diagnostic outcomes were inconsistent. CONCLUSIONS: A general pattern of poorer survival and variations in clinical management for Australian female patients with breast cancer from non-metropolitan areas was evident. However, the wide variability in data sources, measures, study quality, time periods and geographical classification made direct comparisons across studies challenging. The review highlighted the need to promote standardisation of geographical classifications and increased comparability of data systems. It also identified key gaps in the existing literature including a lack of studies on advanced breast cancer, geographical variations in treatment choices from the perspective of patients and post-treatment follow-up.


Assuntos
Neoplasias da Mama/epidemiologia , Características de Residência , Austrália/epidemiologia , Continuidade da Assistência ao Paciente , Feminino , Humanos , Avaliação de Resultados em Cuidados de Saúde , Pesquisa Qualitativa , Fatores Socioeconômicos , Resultado do Tratamento
18.
Int J Cancer ; 142(8): 1528-1535, 2018 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-29105744

RESUMO

Public campaigns encouraging sun protection for skin cancer prevention began in Queensland, Australia, in the early 1980s. We examined recent trends to assess whether earlier evidence of stabilizing melanoma incidence in young people has persisted. Anonymized incidence and mortality data for in situ and invasive melanoma for the 20 years 1995-2014 were obtained from the Queensland Cancer Registry. Time trends were analyzed using JoinPoint regression. Birth cohort patterns were assessed using age-period-cohort models. Melanoma incidence in Queensland remains the highest recorded in the world (age-standardized incidence of invasive melanoma (2010-2014) = 72/100,000/annum). Over the 20-year period, incidence of in situ melanoma increased in all age groups. Incidence of both thin (≤1 mm) and thick (>1 mm) invasive melanoma was either stable or decreased in people under 60, while it increased in those aged 60 and above, particularly in men. Age-period-cohort analysis revealed decreasing age-specific incidence of invasive melanoma under 40 years of age, beginning with the birth cohort born around the mid-1960s, with steepest falls for those born around 1980 and later. Age-specific incidence was stable between 40 and 59 years of age from the 1945 birth cohort onwards. Melanoma mortality over the period was stable or decreased in all groups except in men aged 60 or over. These findings are evidence of real advances in the prevention and early detection of invasive melanoma in this very high-risk population. They make a compelling case for continued public health efforts to reduce the burden of melanoma in susceptible populations.


Assuntos
Melanoma/epidemiologia , Melanoma/mortalidade , Adolescente , Adulto , Distribuição por Idade , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Queensland/epidemiologia , Sistema de Registros , Fatores de Risco , Adulto Jovem
19.
BMC Cancer ; 17(1): 816, 2017 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-29202718

RESUMO

BACKGROUND: Recent advances in methodologies utilizing "big data" have allowed researchers to investigate the use of common internet search engines as a real time tool to track disease. Little is known about its utility with tracking cancer incidence. This study aims to investigate the potential correlates of monthly internet search volume indexes (SVIs) and observed monthly age standardised incidence rates (ASRs) for breast cancer, colorectal cancer, melanoma and prostate cancer. METHODS: The monthly ASRs for the four cancers in Queensland were calculated using data from the Queensland Cancer Registry between January 2006 and December 2012. The monthly SVIs of the respective cancer search terms in Queensland were accessed from Google Trends for the same period. A time series seasonal decomposition method was performed to detect the seasonal patterns of SVIs and ASRs. Pearson's correlation coefficient and time series cross-correlation analysis were used to assess the associations between SVIs and ASRs. Linear regression models were used to examine the power of SVIs to predict monthly in ASRs. RESULTS: Increases in the monthly ASRs of the four cancers were significantly correlated with increases in the monthly SVIs of the respective cancers except for colorectal cancer. The predictive power of the SVIs to explain variances in the corresponding ASRs varied by cancer type, with the percent explained ranging from 5.6% for breast cancer to 17.9% for skin cancer (SVI) with melanoma (ASR). Some improvement in the variation explained was obtained by including more search terms or lagged SVIs for the respective cancers in the linear regression models. The seasonal analysis indicated that the SVIs peaked periodically at around their respective cancer awareness months. CONCLUSIONS: Using SVIs from a popular internet search engine was only able to explain a small portion of changes in the respective ASRs. While an expanded regression model explained a higher proportion of variability, the interpretation of this was difficult. Further development and refinement of this approach will be needed before search-based cancer surveillance can provide useful information regarding resource deployment to guide cancer control and track the impact of cancer awareness and education programmes.


Assuntos
Monitoramento Epidemiológico , Neoplasias da Mama/epidemiologia , Neoplasias Colorretais/epidemiologia , Feminino , Humanos , Incidência , Internet , Masculino , Melanoma/epidemiologia , Neoplasias da Próstata/epidemiologia , Queensland/epidemiologia , Sistema de Registros , Ferramenta de Busca , Estações do Ano , Neoplasias Cutâneas/epidemiologia
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