scholarly journals Improvements in esophageal and gastric cancer care in Sweden-population-based results 2007–2016 from a national quality register

2019 ◽  
Vol 33 (3) ◽  
Author(s):  
M Jeremiasen ◽  
G Linder ◽  
J Hedberg ◽  
L Lundell ◽  
O Björ ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cancer Care ◽  
Gastroesophageal Junction ◽  
Population Based ◽  
National Register ◽  
Clinical Registry ◽  
Oncological Treatment ◽  
Gastric Cancers ◽  
Quality Register ◽  
National Quality

SUMMARY The Swedish National Register for Esophageal and Gastric cancer was launched in 2006 and contains data with adequate national coverage and of high internal validity on patients diagnosed with these tumors. The aim of this study was to describe the evolution of esophageal and gastric cancer care as reflected in a population-based clinical registry. The study population was 12,242 patients (6,926 with esophageal and gastroesophageal junction (GEJ) cancers and 5,316 with gastric cancers) diagnosed between 2007 and 2016. Treatment strategies, short- and long-term mortality, gender aspects, and centralization were investigated. Neoadjuvant oncological treatment became increasingly prevalent during the study period. Resection rates for both esophageal/GEJ and gastric cancers decreased from 29.4% to 26.0% (P = 0.022) and from 38.8% to 33.3% (P = 0.002), respectively. A marked reduction in the number of hospitals performing esophageal and gastric cancer surgery was noted. In gastric cancer patients, an improvement in 30-day mortality from 4.2% to 1.6% (P = 0.005) was evident. Overall 5-year survival after esophageal resection was 38.9%, being higher among women compared to men (47.5 vs. 36.6%; P < 0.001), whereas no gender difference was seen in gastric cancer. During the recent decade, the analyses based on the Swedish National Register for Esophageal and Gastric cancer database demonstrated significant improvements in several important quality indicators of care for patients with esophagogastric cancers. The Swedish National Register for Esophageal and Gastric cancer offers an instrument not only for the control and endorsement of quality of care but also a unique tool for population-based clinical research.

scholarly journals Variability in Breast Cancer Biomarker Assessment and the Effect on Oncological Treatment Decisions: A Nationwide 5-Year Population-Based Study

Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1166
Author(s):  
Balazs Acs ◽  
Irma Fredriksson ◽  
Caroline Rönnlund ◽  
Catharina Hagerling ◽  
Anna Ehinger ◽  
...  
Keyword(s):  
Breast Cancer ◽  
New Technologies ◽  
Growth Factor Receptor ◽  
Patient Characteristics ◽  
Population Based ◽  
Breast Cancer Patients ◽  
Oncological Treatment ◽  
Quality Register ◽  
National Quality ◽  
Her2 Positivity

We compared estrogen receptor (ER), progesterone receptor (PR), human epidermal growth-factor receptor 2 (HER2), Ki67, and grade scores among the pathology departments in Sweden. We investigated how ER and HER2 positivity rates affect the distribution of endocrine and HER2-targeted treatments among oncology departments. All breast cancer patients diagnosed between 2013 and 2018 in Sweden were identified in the National Quality Register for Breast Cancer. Cases with data on ER, PR, HER2, Ki67, grade, and treatment were selected (43,261 cases from 29 departments following the guidelines for biomarker testing). The ER positivity rates ranged from 84.2% to 97.6% with 6/29 labs out of the overall confidence intervals (CIs), while PR rates varied between 64.8% and 86.6% with 7/29 labs out of the CIs. HER2 positivity rates ranged from 9.4% to 16.3%, with 3/29 labs out of the overall CIs. Median Ki67 varied between 15% and 30%, where 19/29 labs showed significant intra-laboratory variability. The proportion of grade-II cases varied between 42.9% and 57.1%, and 13/29 labs were outside of the CI. Adjusting for patient characteristics, the proportion of endocrine and anti-HER2 treatments followed the rate of ER and HER2 positivity, illustrating the clinical effect of inter- and intra-laboratory variability. There was limited variability among departments in ER, PR, and HER2 testing. However, even a few outlier pathology labs affected endocrine and HER2-targeted treatment rates in a clinically relevant proportion, suggesting the need for improvement. High variability was found in grading and Ki67 assessment, illustrating the need for the adoption of new technologies in practice.

40 INTRODUCING AN INTERACTIVE ONLINE-REPORT FROM THE SWEDISH NATIONAL QUALITY REGISTER FOR ESOPHAGEAL AND GASTRIC CANCER—OPEN NREV

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
G Linder ◽  
M Lindblad ◽  
J Johansson ◽  
F Lindberg ◽  
U Smedh ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Quality Indicators ◽  
Hospital Staff ◽  
Population Based ◽  
Decision Makers ◽  
Quality Registry ◽  
Quality Register ◽  
National Quality ◽  
Time Changes ◽  
National Quality Register

Abstract   The Swedish National Quality Register for Esophageal and Gastric Cancer (NREV) was introduced in 2007 and is the sole quality registry in Sweden for patients with esophageal and gastric cancer. Previously, selected variables from the registry was made available to both caregivers and the public through a downloadable annual report. We aimed to make quality indicators readily available to all interested parties; caregivers, patient groups, hospital staff, researchers, administrators and health-political decision-makers. Methods A database was compiled with registry data presented for all years since 2007 and updated every six months. Several graphical and numeric presentations were implemented. Both medical expertise and a patient representative were involved in choosing relevant quality indicator variables as well as designing the web interface. Results Registry Coverage, Quality indicators/lead times, Treatment and Outcomes were the four main focus areas. All areas contained selectable sub-variables and the user was given the choice to present data on a national or regional level. Alterations in chosen variables or selection-base resulted in real time changes in the online report. Thus, a variable national or regional report could be tailored to the users’ needs. All data could be presented as comparative diagrams, crude tables or as time-trend analysis, as exemplified by figure 1. Conclusion An interactive online platform to display population based results and time-trends for important quality indicators in the diagnosis and treatment of esophageal and gastric cancer is now available for all. The main purpose, to make anonymized data available, was achieved by OPEN-NREV. We propose that presenting data in this manner is of interest to patients, caregivers, scientists and decision makers.

scholarly journals Study protocol for an observational register-based study on health and risk factors in patients with hip and knee osteoarthritis

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e022812 ◽  
Author(s):  
Kristin Gustafsson ◽  
Ola Rolfson ◽  
Marit Eriksson ◽  
Leif Dahlberg ◽  
Joanna Kvist
Keyword(s):  
Knee Osteoarthritis ◽  
Population Based ◽  
Good Prognosis ◽  
Ethical Review ◽  
Swedish Population ◽  
Arthroplasty Register ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Quality Register ◽  
National Quality

IntroductionHip and knee osteoarthritis is a leading cause of disability worldwide. Currently, the course of deterioration in pain and physical functioning in individuals with osteoarthritis is difficult to predict. Factors such as socioeconomic status and comorbidity contribute to progression of osteoarthritis, but clear associations have not been established. There is a need for early identification of individuals with slow disease development and a good prognosis, and those that should be recommended for future joint replacement surgery.Methods and analysisThis nationwide register-based study will use data for approximately 75 000 patients who sought and received core treatment for osteoarthritis in primary healthcare, and were registered in the Swedish population-based National Quality Register for Better Management of Patients with Osteoarthritis. These data will be merged with data for replacement surgery, socioeconomic factors, healthcare consumption and comorbidity from the Swedish Hip Arthroplasty Register, the Swedish Knee Arthroplasty Register, Statistics Sweden and the National Board of Health and Welfare, Sweden. The linkage will be performed using personal identity numbers that are unique to all citizens in Sweden.Ethics and disseminationThe study was approved by the Regional Ethical Review Board in Gothenburg, Sweden (dnr 1059–16). The results from this study will be submitted to peer-reviewed journals and reported at suitable national and international meetings.Trial registration numberNCT03438630.

scholarly journals Abatacept in rheumatoid arthritis: survival on drug, clinical outcomes, and their predictors—data from a large national quality register

2020 ◽  
Vol 22 (1) ◽  
Author(s):  
Giovanni Cagnotto ◽  
Minna Willim ◽  
Jan-Åke Nilsson ◽  
Michele Compagno ◽  
Lennart T. H. Jacobsson ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Response ◽  
Cox Regression ◽  
Population Based ◽  
Drug Survival ◽  
Quality Register ◽  
High Pain Score ◽  
Selection Of Variables ◽  
National Quality ◽  
Significant Difference

Abstract Background There are limited data regarding efficacy of abatacept treatment for rheumatoid arthritis (RA) outside clinical trials. Quality registers have been useful for observational studies on tumor necrosis factor inhibition in clinical practice. The aim of this study was to investigate clinical efficacy and tolerability of abatacept in RA, using a national register. Methods RA patients that started abatacept between 2006 and 2017 and were included in the Swedish Rheumatology Quality register (N = 2716) were investigated. Survival on drug was estimated using Kaplan-Meier analysis. The European League Against Rheumatism (EULAR) good response and Health Assessment Questionnaire (HAQ) response (improvement of ≥ 0.3) rates (LUNDEX corrected for drug survival) at 6 and at 12 months were assessed. Predictors of discontinuation were investigated by Cox regression analyses, and predictors of clinical response by logistic regression. Significance-based backward stepwise selection of variables was used for the final multivariate models. Results There was a significant difference in drug survival by previous biologic disease-modifying antirheumatic drug (bDMARD) exposure (p < 0.001), with longer survival in bionaïve patients. Men (hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.74–0.98) and methotrexate users (HR 0.85, 95% CI 0.76–0.95) were less likely to discontinue abatacept, whereas a high pain score predicted discontinuation (HR 1.14 per standard deviation, 95% CI 1.07–1.20). The absence of previous bDMARD exposure, male sex, and a low HAQ score were independently associated with LUNDEX-corrected EULAR good response. The absence of previous bDMARD exposure also predicted LUNDEX-corrected HAQ response. Conclusions In this population-based study of RA, bDMARD naïve patients and male patients were more likely to remain on abatacept with a major clinical response.

scholarly journals Lithium for suicide and readmission prevention after electroconvulsive therapy for unipolar depression: population-based register study

BJPsych Open ◽  
2019 ◽  
Vol 5 (3) ◽  
Author(s):  
Ole Brus ◽  
Yang Cao ◽  
Åsa Hammar ◽  
Mikael Landén ◽  
Johan Lundberg ◽  
...  
Keyword(s):  
Electroconvulsive Therapy ◽  
Suicide Attempts ◽  
Cox Regression ◽  
Lithium Treatment ◽  
Unipolar Depression ◽  
Population Based ◽  
Register Study ◽  
Quality Register ◽  
National Quality ◽  
History Of

Background Electroconvulsive therapy (ECT) is effective for unipolar depression but relapse and suicide are significant challenges. Lithium could potentially lower these risks, but is used only in a minority of patients. Aims This study quantifies the effect of lithium on risk of suicide and readmission and identifies factors that are associate with readmission and suicide. Method This population-based register study used data from the Swedish National Quality Register for ECT and other Swedish national registers. Patients who have received ECT for unipolar depression as in-patients between 2011 and 2016 were followed until death, readmission to hospital or the termination of the study at the end of 2016. Cox regression was used to estimate hazard ratios (HR) of readmission and suicide in adjusted models. Results Out of 7350 patients, 56 died by suicide and 4203 were readmitted. Lithium was prescribed to 638 (9%) patients. Mean follow-up was 1.4 years. Lithium was significantly associated with lower risk of suicide (P = 0.014) and readmission (HR 0.84 95% CI 0.75–0.93). The number needed to be treated with lithium to prevent one readmission was 16. In addition, the following factors were statistically associated with suicide: male gender, being a widow, substance use disorder and a history of suicide attempts. Readmission was associated with young age, being divorced or unemployed, comorbid anxiety disorder, nonpsychotic depression, more severe symptoms before ECT, no improvement with ECT, not receiving continuation ECT or antidepressants, usage of antipsychotics, anxiolytics or benzodiazepines, severity of medication resistance and number of previous admissions. Conclusions More patients could benefit from lithium treatment. Declaration of interest None.

Long-Term Survivors of Gastric Cancer: A California Population-Based Study

2012 ◽  
Vol 30 (28) ◽  
pp. 3507-3515 ◽  
Author(s):  
Pamela L. Kunz ◽  
Matthew Gubens ◽  
George A. Fisher ◽  
James M. Ford ◽  
Daphne Y. Lichtensztajn ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Gastroesophageal Junction ◽  
The United States ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Intestinal Histology ◽  
Hospital Size

Purpose In the United States, gastric cancer is rapidly fatal with a 25% 5-year survival. Of the few patients who survive, little is known about their demographic, clinical, and tumor characteristics. Patients and Methods Data regarding all cases of gastric and gastroesophageal junction (GEJ) adenocarcinoma diagnosed in California between 1988 and 2005 were obtained from the California Cancer Registry, a member of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. A Cox proportional hazards model was constructed to understand the independent relationships of patient demographic, disease, and treatment factors with survival. Results We identified 47,647 patients diagnosed with gastric or GEJ cancer. Of those, only 9,325 (20%) survived at least 3 years. Variables associated with longer survival were localized stage (hazard ratio [HR], 0.20), surgery with diagnosis in 2002 or later (HR, 0.34), surgery with diagnosis in 2001 or before (0.37), regional stage (HR, 0.53), chemotherapy (HR, 0.56), intestinal histology (HR, 0.74), well- or moderately differentiated tumors (HR, 0.76), radiation (HR, 0.80), Asian/Pacific Islander race (HR, 0.81), treatment at an academic hospital (HR, 0.85), fundus/body/antrum location (HR, 0.90), highest socioeconomic status quintile (HR, 0.91), female sex (HR, 0.92), Hispanic race (HR, 0.92), and hospital size more than 150 beds (HR, 0.94). Kaplan-Meier curves showed longer median disease-specific survival (DSS) in patients with tumors originating in the fundus/body/antrum compared with esophagus/cardia (13.4 v 10.8 months). Intestinal histology had significantly longer median DSS (28.9 months) compared with other (11.0 months) or diffuse (10.1 months) histology. Conclusion Patients who survive gastric and GEJ cancer more than 3 years after diagnosis have demographic and pathologic characteristics distinct from those who do not survive.

Preclinical activity of MM-111, a bispecific ErbB2/ErbB3 antibody in previously treated ErbB2-positive gastric and gastroesophageal junction cancer.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 48-48 ◽  
Author(s):  
Johanna Lahdenranta ◽  
Violette Paragas ◽  
Arthur J. Kudla ◽  
Ryan Overland ◽  
Victor M. Moyo ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Gastroesophageal Junction ◽  
Resistance Mechanism ◽  
Predictive Biomarkers ◽  
Her2 Overexpression ◽  
Multiple Time ◽  
Gastric Cancers ◽  
Treatment Regimens ◽  
Gastroesophageal Junction Cancer ◽  
Erbb3 Signaling

48 Background: ErbB2 (HER2) overexpression has been reported in 7-34% of gastric cancers. ErbB3 (HER3) is the preferred dimerization partner of ErbB2, and ErbB2/ErbB3 heterodimer activation is implicated in the progression and metastasis of ErbB2+ tumors. Activation of ErbB3 signaling is a postulated resistance mechanism to current ErbB2-directed therapies and select chemotherapies. In line with this research, ErbB3 levels are associated with poor prognosis in gastric cancers. MM-111 is a bi-specific antibody that docks to ErbB2 and inhibits ErbB3 signaling in cells that overexpress ErbB2. In this study, MM-111 was evaluated in ErbB2+ gastric cancer by testing the activity of MM-111 in ErbB2+ pre-clinical models of gastric cancer, and by assessing the prevalence of potentially predictive biomarkers in a panel of archived gastric and gastroesophageal junction (GEJ) tumors. Methods: MM-111 was tested in ErbB2+ gastric cancer xenografts that were either untreated or after tumors ceased to respond to trastuzumab/5-FU. Xenografts were analyzed at multiple time points for the expression of ErbB-receptor family members and their downstream signaling by Luminex -assays. Preclinical data indicate that ErbB2, ErbB3, and heregulin are predictive biomarkers for MM-111. In order to determine the prevalence of our potentially predictive biomarkers in gastric and GEJ cancers, we obtained commercially archived tumor tissue and assayed the tissue for ErbB2 and ErbB3 expression levels using quantitative IHC, and measured heregulin transcript levels by RT-PCR. Results: MM-111 synergizes with various treatment regimens in the 2nd line treatment setting in ErbB2+ gastric cancer xenografts. In our models, the combination of MM-111, trastuzumab, and paclitaxel is particularly effective after tumors progressed on trastuzumab/5-FU. MM-111 inhibits the activity of the ErbB –signaling axis in these models. In addition, 23% of GEJ tumor samples and 20% of gastric samples were positive for potentially predictive biomarkers. Conclusions: ErbB2+xenograft tumors that stop responding to trastuzumab-based therapies benefit from MM-111–based regimens.

P71 NUTRITIONAL JEJUNOSTOMY IN ESOPHAGECTOMY FOR CANCER, A NATIONAL REGISTER-BASED COHORT STUDY OF ASSOCIATIONS WITH POSTOPERATIVE OUTCOMES AND SURVIVAL

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Holmén Anders ◽  
Hayami Masaru ◽  
Szabo Eva ◽  
Rouvelas Ioannis ◽  
Ágústsson Thorhallur ◽  
...  
Keyword(s):  
Cohort Study ◽  
Performance Status ◽  
Gastroesophageal Junction ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Length Of Hospital Stay ◽  
Tumor Location ◽  
Population Based ◽  
Invasive Technique ◽  
National Register

Abstract Aim The aim was to increase the knowledge about nutritional jejunostomies in curative intended treatment of esophageal and gastroesophageal junction cancer. Background and Methods The insertion of a jejunostomy in conjunction with esophagectomy is performed to decrease the risk for malnutrition and improve recovery. These possible benefits have, however, not been scientifically proven. All patients in Sweden, treated with esophagectomy due to cancer 2006-2017 in the Swedish National Register for Esophageal and Gastric Cancer, were included in this retrospective population-based cohort study. The indication for jejunostomy was not defined in the register. The patients were stratified into two groups: esophagectomy with jejunostomy, and esophagectomy alone. Results A total of 1024 patients (54.73%) had a jejunostomy inserted in conjunction with esophagectomy, while 847 patients (45.27%) were treated without jejunostomy. The median age was 66 years, and 79% of the patients were male. The groups were similar in regard to age, performance status, baseline dysphagia and weight, ASA-score, tumor location, neoadjuvant treatment, and use of minimally invasive technique. The patients in the jejunostomy group had more squamous cell carcinoma (20.3% vs. 17.8%, P=0.005), and more locally advanced tumors. There were no significant differences in length of hospital stay, postoperative surgical complications, Clavien-Dindo score, or 90-day mortality rate. The risk of pneumonia was increased in the jejunostomy group (11.8% vs. 7.2%, P=0.001). For patients with postoperative anastomotic leaks the risk for postoperative Clavien-Dindo score of IIIb or more was reduced (79.7% vs. 94.7%, P=0.037, adjusted odds ratio 0.20, 95% CI 0.04-0.97). Conclusions Jejunostomy is a safe method to ensure postoperative nutrition after esophagectomy, and might reduce the risk for severe outcomes in patients who suffer an anastomotic leak.

HER2 Expression in Gastric Cancer and Gastroesophageal Junction Cancer

2020 ◽  
Vol 22 (2) ◽  
pp. 79-82
Author(s):  
Md Azizur Rahman ◽  
Abdullah Md Abu Ayub Ansari ◽  
Kazi Mazharul Islam ◽  
Md Aminur Rahman ◽  
ABM Abdul Matin ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Gastric Carcinoma ◽  
Social Impact ◽  
Gastroesophageal Junction ◽  
Treatment Protocol ◽  
Armed Forces ◽  
Her2 Expression ◽  
Her2 Positive ◽  
Cancer Data ◽  
Her2 Positivity

Background: Carcinoma of the stomach is a major cause of cancer mortality worldwide. Due to social impact of gastric carcinoma (GC), there is a need to stratify patients into appropriate screening, surveillance and treatment programs. Although histopathology remains the most reliable and less expensive method, numerous efforts have been made to identify and validate novel biomarkers to accomplish the goals. In recent years, several molecules have been identified and tested for their clinical relevace in GC management. Among the biomarkers with the exception of HER2, none of the biomarkers is currently used in clinical practice, and some of them were described in single studies. Materials and Methods: This prospective type of observational study was performed in the Department of Surgery, Dhaka Medical College Hospital, Dhaka, 6 months from approval of protocol. Total 45 consecutive patients aged 18 years and above without consideration of gender were selected purposefully. Every patient was evaluated by clinical examination, appropriate investigations and after a confirm diagnosis of the tissue from the cancer. All patients have undergone operative intervention and Gastrectomy specimens were subtotal (including cardiac and pylorus), subtotal (including the pylorus), total radical gastrectomy and oesophago-gastrectomy sample. All specimens obtained were immersed in 10% formalin. Samples of whom were sent to the department of pathology, DMCH for histopathology examination. Portion of representative tissue/block was sent to AFIP (Armed Forces Institute of Pathology, Dhaka) for immunohistochemistry to find out the HER2 expression in gastric cancer and gastro-oesophageal cancer. Data was collected in a pre-designed questionnaire by face to face interview. Result and observation: In this study when 45 cases were categorized according to WHO grading system it was observed that majority (30) patients were found in grade II, among them 3(10%) were HER2 positive. But with grade III tumour the HER2 positivity were found more i,e; 37.5% (3/8). Grade- I tumor show HER2 neu expression 28.57% (2/7) and according to location most of the cases with HER2 positive expression was located in the gastro-esophageal junction which is 27.27% (3/11) than gastric carcinoma which is 14.70% (5/34). Conclusion: Most of the patients of gastric and gastrooesophageal junction adenocarcinoma are diagnosed at a very late stage, so they require special attention in treatment protocol, including chemotherapy and immunotherapy for increasing their survivability. The study showed with poorly differentiated (high grade) tumour, the HER2 positivity were found more. Journal of Surgical Sciences (2018) Vol. 22 (2) : 79-82

Sign in / Sign up

Export Citation Format

Share Document