From Policy to Practice: Assessing the Impact of Staging Policies for Recording Cancer Stage across Canada

Background and objectives: Krüppel-like transcription factor 10 (KLF10) plays a vital role in regulating cell proliferation, including the anti-proliferative process, activation of apoptosis, and differentiation control. KLF10 may also act as a protective factor against oral cancer. We studied the impact of KLF10 expression on the clinical outcomes of oral cancer patients to identify its role as a prognostic factor in oral cancer. Materials and Methods: KLF10 immunoreactivity was analyzed by immunohistochemical (IHC) stain analysis in 286 cancer specimens from primary oral cancer patients. The prognostic value of KLF10 on overall survival was determined by Kaplan–Meier analysis and the Cox proportional hazard model. Results: High KLF10 expression was significantly associated with male gender and betel quid chewing. The 5-year survival rate was greater for patients with high KLF10 expression than for those with low KLF10 expression (62.5% vs. 51.3%, respectively; p = 0.005), and multivariate analyses showed that high KLF10 expression was the only independent factor correlated with greater overall patient survival. The significant correlation between high KLF10 expression and a higher 5-year survival rate was observed in certain subgroups of clinical parameters, including female gender, non-smokers, cancer stage T1, and cancer stage N0. Conclusions: KLF10 expression, detected by IHC staining, could be an independent prognostic marker for oral cancer patients.

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Meeting Psychosocial Needs to Improve Health: A Prospective Cohort Study

10.21203/rs.2.17909/v1 ◽

2019 ◽

Author(s):

Austyn Snowden ◽

Jenny Young ◽

Jan Savinc

Keyword(s):

Quality Of Life ◽

Cohort Study ◽

Health Status ◽

Cancer Type ◽

Cancer Stage ◽

Health Related Quality ◽

Related Quality ◽

Health Related ◽

The Impact

Abstract Background Cancer impacts on patients and their families across a range of different domains. For that reason, optimal cancer care has moved away from a disease-centric focus to a more holistic approach in order to proactively support people with their individual needs and concerns. While international policy clearly advocates this agenda, implementation into routine care is limited. Therefore, relevant interventions that measurably improve patient outcomes are essential to understand if this ideal is to become routine multidisciplinary practice. The aim of this study was to analyse the impact of a proactive, holistic, community-based intervention on health-related quality of life in a cohort of people diagnosed with cancer. Secondary aim was to explore the relationship between changes in health status and: cancer type, cancer stage, number of concerns expressed and change in severity of concerns pre and post intervention. Method Prospective observational cohort study. A convenience sample of 437 individuals were referred to the service ‘Improving the Cancer Journey (ICJ) in the UK. Each completed the Euroqol EQ-5D-3L and visual analogue scale (VAS) and a Holistic Needs Assessment (HNA) during initial visit to the service and again at follow-up review, approximately 4 months later. Change between scores was tested with paired t-tests and relationships between variables with multiple regression models. Results Participants were White British with median age between 50-64 years. Cancer type and stage were varied. There was a statistically significant improvement in EQ-5D scores over time (t(330)=7.48, p<.001). The strongest predictor of change was a decrease in severity of concerns. Cancer stage ‘palliative care’ contributed to a reduction in health status. Conclusion This study is the first to show that a holistic community intervention dedicated to supporting the individual concerns of participants has a statistically and meaningful impact on participants’ health-related quality of life. The mean change in EQ-5D scores was more than the ‘minimally important clinical difference’ described in the literature. This is important because while quality of life has multiple determinants this study has reported that it is possible to capture a meaningful improvement as a function of reducing someone’s personally identified concerns.

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The Outcome of Unscreened Population in Colorectal Cancer: The Impact of Sex and Other Determinants on Cancer Stage

Cancer Management and Research ◽

10.2147/cmar.s268823 ◽

2020 ◽

Vol Volume 12 ◽

pp. 12319-12327

Author(s):

Mesnad Alyabsi ◽

Fouad Sabatin ◽

Abdul Rahman Jazieh

Keyword(s):

Colorectal Cancer ◽

Cancer Stage ◽

The Impact

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The impact of initial cancer stage on the incidence of venous thromboembolism: the Scandinavian Thrombosis and Cancer (STAC) Cohort

Journal of Thrombosis and Haemostasis ◽

10.1111/jth.13752 ◽

2017 ◽

Vol 15 (8) ◽

pp. 1567-1575 ◽

Cited By ~ 15

Author(s):

I. L. Gade ◽

S. K. Braekkan ◽

I. A. Naess ◽

J.-B. Hansen ◽

S. C. Cannegieter ◽

...

Keyword(s):

Venous Thromboembolism ◽

Cancer Stage ◽

The Impact

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Breast Cancer Stage at Presentation in Ohio: The Effect of Medicaid Expansion and the Affordable Care Act

The American Surgeon ◽

10.1177/000313482008600327 ◽

2020 ◽

Vol 86 (3) ◽

pp. 195-199

Author(s):

Dan Kirkpatrick ◽

Margaret Dunn ◽

Rebecca Tuttle

Keyword(s):

Breast Cancer ◽

Affordable Care Act ◽

Advanced Disease ◽

Disease Stage ◽

Cancer Stage ◽

Medicaid Expansion ◽

Cancer Data ◽

Before And After ◽

The Affordable Care Act ◽

The Impact

Patients presenting with localized breast cancer have a five-year survival of 99 per cent, whereas survival falls to 27 per cent in advanced disease. This obviates the importance of early diagnosis and treatment. Our study evaluates the impact of Ohio's Medicaid expansion and the passage of the Affordable Care Act (ACA) on the stage at which Ohioans were diagnosed with breast cancer. Data were collected for 3056 patients presenting with breast cancer between 2006 and 2016 in the Dayton area. Patients were divided into groups based on cancer stage. The percentage of patients presenting with advanced disease (stage 3 or 4) was compared both before and after ACA implementation and Ohio Medicaid expansion. These results were also compared with statewide data maintained by the Ohio Department of Health. Compared with pre-ACA, the number of uninsured patients post-ACA was noted to fall 83 per cent, the number of patients presenting with Medicaid increased by five times, and the proportion of patients younger than 65 years presenting with breast cancer increased by approximately 7 per cent. These changes notwithstanding, no difference was identified in the percentage of patients presenting with advanced breast cancer before and after ACA implementation or Ohio Medicaid expansion ( P = 0.56). Statewide data similarly demonstrated no change ( P = 0.88). Improved insurance access had a smaller-than-anticipated impact on the stage at which Ohioans presented with breast cancer. As significant morbidity and mortality can be avoided by earlier presentation, additional research is appropriate to identify factors affecting patients’ decision to seek breast cancer screening and care.

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The impact of travel time on colorectal cancer stage at diagnosis in a privately insured population

BMC Health Services Research ◽

10.1186/s12913-019-4004-6 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 4

Author(s):

Mesnad Alyabsi ◽

Mary Charlton ◽

Jane Meza ◽

K. M. Monirul Islam ◽

Amr Soliman ◽

...

Keyword(s):

Colorectal Cancer ◽

Travel Time ◽

Cancer Stage ◽

Stage At Diagnosis ◽

The Impact ◽

Privately Insured

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Impact of bladder cancer stage on work impairment and financial toxicity.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.6_suppl.460 ◽

2020 ◽

Vol 38 (6_suppl) ◽

pp. 460-460

Author(s):

Pauline Filippou ◽

Sean McCabe ◽

Hannah McCloskey ◽

Kathryn Gessner ◽

Judy Hamad ◽

...

Keyword(s):

Bladder Cancer ◽

Cancer Patients ◽

Metastatic Cancer ◽

Multivariable Analysis ◽

Cancer Stage ◽

Financial Toxicity ◽

Work Time ◽

Activity Impairment ◽

Work Impairment ◽

The Impact

460 Background: Bladder cancer has been linked to financial toxicity with conflicting results regarding the impact of stage. Our objective was to evaluate financial toxicity and work impairment among bladder cancer patients in a large cross-sectional bladder cancer cohort. Methods: We surveyed bladder cancer patients in the Bladder Cancer Advocacy Network Patient Survey Network and Inspire platforms to determine financial toxicity and work impairment. We measured financial toxicity with the COST measure and Work Productivity and Activity Impairment General Health questionnaires. Patients were also queried regarding demographic, socioeconomic and clinical characteristics with specific attention to insurance status, income, and education. Results: 972 respondents self-identified as patients with bladder cancer. Among respondents, 41% were female and 97% were white. The mean age was 67.6 years, ranging from 29 to 93 years. Respondents were highly educated (67% completed college). Most patients identified as having non-invasive bladder cancer (NMIBC, n=578 [63%]); 30% (n=270) had MIBC, 7% (n=63) had metastatic cancer. Although patients with metastatic cancer had higher average COST scores (worse financial toxicity, Table below), stage was not significantly associated with COST on bivariable (p=0.07) or multivariable analysis (p=0.14). Patients with metastatic disease were more likely to report more work time missed and activity impairment due to health on bivariable analysis; only activity impairment was statistically associated with stage on multivariable analysis (p<0.001) when controlling for age, gender, race, comorbidity, insurance, and education. Conclusions: Bladder cancer stage significantly impacts activity impairment but not percentage work time missed due to health nor financial toxicity. [Table: see text]

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Impact of primary care providers on patient screening mammography and initial presentation in an underserved clinical setting.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.28_suppl.8 ◽

2015 ◽

Vol 33 (28_suppl) ◽

pp. 8-8

Author(s):

Ajaratu Keshinro ◽

Ioannis Hatzaras ◽

Shubhada Dhage ◽

Kenneth Rifkind ◽

Kathie-Ann P. Joseph

Keyword(s):

Breast Cancer ◽

Primary Care ◽

Primary Care Providers ◽

Screening Mammography ◽

Stage I ◽

Cancer Stage ◽

Care Providers ◽

Palpable Mass ◽

Stage Iv Breast Cancer ◽

The Impact

8 Background: Screening mammography (SM) is a routinely used modality for earlier detection of breast cancer and is effective in reducing breast cancer-related morbidity and mortality. A better understanding of the impact of access to primary care physician (PCP), on the screening protocols and stage presentation, is needed to address the issue of breast cancer stage disparity amongst underserved women. Methods: A retrospective chart review of the electronic medical record, for breast cancer patients newly diagnosed from 2012-2013, was performed using the tumor registry at Bellevue Hospital Center, the largest public hospital in New York City. Patients with recurrent breast cancer, stage IV breast cancer, and those that weren’t managed surgically at our institution, were excluded from the study. Data including patient demographics, established relationship with PCP, and screening mammogram and palpable mass at presentation, were obtained and analyzed using SPSS Statistics Software. Results: 173 patients were included in the study of which 5 presented with bilateral breast cancer (n = 178). The majority of the patients seen at our institution were from minority groups, primarily Hispanic (34%) and Chinese (23%). 129 patients (72%) had a PCP at the time of diagnosis versus 49 patients (28%) without a PCP. Patients without a PCP were more likely to have a palpable breast mass at presentation, compared to patients with a PCP (73% vs. 42% respectively, p < 0.05). Furthermore, only 32 % of patients without a PCP had a SM at time of presentation, compared to 61% of patients with a PCP (p = 0.003). Overall, in the group of patients with a PCP, the majority presented with stage I breast cancer (43%), followed by 29% with stage 0. In comparison, the majority of patient without a PCP presented with stage II (41%), followed by 29% with stage I (p = 0.019). Conclusions: There is a benefit for patients with access to a PCP, as it leads to a higher likelihood of breast cancer detection via SM, as opposed to a symptomatic presentation, such as a palpable mass. Therefore, these patients are more likely to be diagnosed with an earlier stage of breast cancer, which improves their mortality.

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The impact of prostate cancer on overall cancer stage migration over time.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.2_suppl.35 ◽

2016 ◽

Vol 34 (2_suppl) ◽

pp. 35-35

Author(s):

Jay P. Ciezki ◽

Chandana A. Reddy ◽

Eric A. Klein

Keyword(s):

Stage Iv ◽

Stage I ◽

Stage Migration ◽

Cancer Stage ◽

Subsequent Increase ◽

Female Breast ◽

Stage Iv Disease ◽

Changes Over Time ◽

The Impact ◽

Over Time

35 Background: To define cancer stage migration according to year of diagnosis and type of cancer diagnosis. Methods: Cancer stage, site, and year of diagnosis information were retrieved from an academic radiation oncology center's database. The Jonckheere-Terpstra test was used to assess changes over time. Results: From 2005 to 2014, 12,807 newly diagnosed patients (pts) were seen. The distribution of pts by stage was 2% stage 0, 17% stage I, 33% stage II, 16% stage III, and 32% stage IV. The pattern of stage distribution significantly changed over time as seen in the table (p = 0.0016). For 4 of the 5 most commonly seen cancers, (female breast, lung, esophagus, head and neck, and prostate (CaP)) over time fewer late stage cancers were diagnosed or had no change in stage. The only exception was CaP, the largest number of pts (26.5% of total). In 2005, 10.76% of new CaP cases presented with stage IV disease, dipped to 4.6% in 2011, and rose to 8.47% in 2014 (p < 0.0001). The changes in stage I definition accounted for the increase seen in stage I disease, but could not account for the dip and subsequent increase in stage IV disease. Conclusions: The presentation of cancer by stage has changed over time, and it was predominately driven by CaP. The changes seen in stage IV CaP incidence in which it fell and then rose over the study period suggests that global practice changes may be present. An increased preference for active surveillance, recommendations against PSA screening, and increasing insurance deductibles may have favored a delay in treating/diagnosing CaP pts in the recent past. [Table: see text]

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Implementation of insurance marketplaces and changes in diagnosis stage in low-income cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.1576 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 1576-1576

Author(s):

Uriel Kim ◽

Siran M. Koroukian ◽

Kurt C Stange ◽

James Spilsbury ◽

Johnie Rose

Keyword(s):

Cancer Patients ◽

Low Income ◽

Private Insurance ◽

Insurance Coverage ◽

Control Analysis ◽

Cancer Stage ◽

Stage At Diagnosis ◽

Poverty Level ◽

Patients Âgés ◽

The Impact

1576 Background: Millions of low-income Americans gained insurance coverage through Medicaid expansion and the “Marketplaces” of the Affordable Care Act (ACA). How Marketplaces have specifically improved cancer outcomes among these individuals is unclear. Thus, we examined changes in insurance status and diagnosis stage following the ACA among low-income (139-250% of the Federal Poverty Level [FPL]), non-elderly patients (ages 30-64). Methods: In Ohio’s cancer registry, we identified patients diagnosed with one of the top 16 cancers before (2011-2013, “Pre-ACA”) and after (Q3 of 2014-2016, “Post-ACA”) the implementation of the ACA’s insurance Marketplaces and either had private insurance or no insurance. Low-income patients were isolated using a novel, geographically-driven approach called probability weighting. Results: The uninsured percentage dropped from 12.9% to 4.9% between the Pre- and Post-ACA periods in the study sample (N = 10,747). An estimated 11.1% of individuals had Marketplace insurance Post-ACA. A significant but modest Post-ACA (versus Pre-ACA) shift toward non-metastatic disease was identified (Adjusted Odds Ratio [AOR]: 0.95, 95%CI: 0.90-0.99). The largest site-specific shifts were observed for thyroid (AOR: 0.50, 95%CI: 0.30-0.83) and ovarian (AOR: 0.74, 95%CI: 0.58-0.93) cancers. In a control analysis of wealthier (400%+ FPL), privately insured individuals, no significant shifts were identified (AOR: 0.97, 95%CI: 0.92-1.02). Conclusions: This is the first study to show an effect in cancer stage at diagnosis from the Affordable Care Act’s Insurance Marketplaces. We found that the Marketplaces greatly reduced the number of low-income, uninsured cancer patients, translating to significant improvements in cancer stage at diagnosis. As policy makers contemplate modifications to the ACA, they should carefully consider the impact of those changes on the highly vulnerable population of low-income cancer patients.

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