scholarly journals 553Stage at diagnosis for six major cancers in China with comparison to the United States

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Xianhui Ran ◽  
Hongmei Zeng ◽  
Siwei Zhang ◽  
Lan An ◽  
Rongshou Zheng ◽  
...  
Keyword(s):  
Cancer Patients ◽  
The United States ◽  
Stage I ◽  
Cancer Site ◽  
Cancer Stage ◽  
Stage At Diagnosis ◽  
Stage Distribution ◽  
The Us ◽  
Center Hospital ◽  
Clinical Records

Abstract Background To explore the distribution and factors associated with cancer stage at diagnosis, we conducted a multi-center hospital-based study in China. Methods 38 hospitals were selected to set up the Chinese cancer clinical database. Detailed stage information was collected from clinical records and focus on cancers of the lung, stomach, colon-rectum, liver, female breast, and esophagus diagnosed during 2016-2017. We compared the stage distribution with the US by data from Surveillance, Epidemiology, and End Results database during the same period. Results Overall 69632 first diagnosed cancer cases were analyzed. The proportion of cancer patients in stage I varies by cancer site, with highest in breast (28%) and lowest in liver (13%). The proportion of cancer cases at stage I was generally higher in women (OR:1.7,95%CI:1.6-1.8), in young (<65 years) (OR:1.2,1.1-1.2) and in subjects having Chinese Urban Insurances (OR:1.9,1. 8-2.0). Except for esophageal cancer, the other five major cancers in China had more advanced stage than in the US. Conclusions Socio-demographic inequalities exist in stage at diagnosis for major cancer cases in China. Early detection interventions are especially needed to be targeted on patients with higher risk of advance disease diagnosis. Key messages Multi-center hospital-based study on cancer stage distribution in China shows that women, young, and those with Chinese Urban Insurance were more likely to be diagnosed with early stage. Stage distribution in China was generally more advanced compared with cancer patients in the US.

Clinical and molecular evaluation of patients with esophageal adenocarcinoma from the United States and Japan

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4087-4087
Author(s):  
M. Gibson ◽  
H. Orita ◽  
M. Brock ◽  
L. Xu ◽  
S. Yang ◽  
...  
Keyword(s):  
Esophageal Adenocarcinoma ◽  
Median Survival ◽  
Stage Iv ◽  
The United States ◽  
Stage I ◽  
Stage Iii ◽  
Clinical Variables ◽  
Stage Distribution ◽  
Pathologic Stage ◽  
The Us

4087 Background: Esophageal adenocarcinoma (EAC) is more common than squamous cancer (ESC) in the US versus Japan (J); however, EAC in J is now more frequently recognized. We assessed features of EAC in J and US patients to determine if the cohort of EAC in Japan is similar to the US. Methods: Patients with EAC who underwent primary curative surgery were identified by reviewing all surgical cases from 1998 to the present at Johns Hopkins Hospital (n = 57) and Juntendo University Hospital (n = 20). Clinical variables included: gender, age, pathologic stage, date of surgery and of death. Methylation of APC, E-cadherin, MGMT, ER, p16, DAP-kinase and TIMP3 was determined with methylation specific-PCR for each J patient and compared to historical control US EAC patients. Logistic regression and survival analysis were used to evaluate the relationship between clinical variables and methylation status to outcome in these two patient groups. Results: Age and gender were similar in each cohort. Gender (50M/6F in US; 16M4F p = 0.29). Median age (65.5 in US; 64 in J). Path stage was lower in US patients but not significant compared to J patients. Stage distribution US: stage I (n = 30), IIA (n = 2), stage IIB (n = 6), stage III (n = 9) and stage IV (n = 4). Stage distribution in J: stage I (n = 6), IIA (n = 5), stage IIB (n = 5), stage III (n = 3) and stage IV (n = 3). Path stage unavailable in 5 US patients. Overall median survival was 4.2 years. Median survival for US was 2.9 years but not reached for J (note 15/20 J patients outcome not known). For the combined cohort, age and path stage (adjusted for clinical co-variates) correlated with worse survival. Age HR 1.05; 95% CI 1.01–1.09. Pathologic Stage HR 1.4; 95% CI 1.19–1.65. These were also predictive within each subgroup. The fraction of patients with methylation is available for three genes: APC (66% US; 70% J). p16 (39% US; 20% J). MGMT (63% US; 75% J). Conclusions: Clinical data are similar for US and J patients with EAC. Early stage in US patients may by due to induction chemoRT in the US. Predictors of survival (age and pathologic stage) are also similar. This suggests that EAC is similar in US and J patients, perhaps reflecting similar environmental and molecular causes. Methylation data for all 7 genes and their correlation with outcome will be presented at the meeting. No significant financial relationships to disclose.

Illness understanding of oncology patients in a community-based cancer institute.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21605-e21605
Author(s):  
Shanthi Sivendran ◽  
Sarah Jenkins ◽  
Sarah Svetec ◽  
Michael Horst ◽  
Kristina Braine Newport ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Advanced Cancer ◽  
Stage I ◽  
Cancer Stage ◽  
Stage At Diagnosis ◽  
Advanced Cancer Patients ◽  
Community Based ◽  
Oncology Patients ◽  
Remission Status ◽  
Number Of Patients

e21605 Background: Several studies have demonstrated patients have a poor understanding of prognosis, survival and effectiveness of chemotherapy, particularly in the setting of advanced cancer. This study examines oncology patients’ understanding of their illness based on accurate reporting of stage at diagnosis as well as knowledge of remission status. Methods: 208 cancer patients previously treated at our large community based cancer institute participated in The Consumer-Based Cancer Care Value Index (CCCVI) Field Survey. Electronic medical record (EMR) documentation of stage at diagnosis and remission status were compared to patients’ self-reported responses. Concordance of responses and variables influencing discordance were evaluated. Results: 51.0% of patients’ self-reported cancer stage matched the abstracted stage with the highest concordance in the advanced cancer patients (72%) versus stage I-III patients (36.4%-61.5%). Unexpectedly, discordance was lower among advanced cancer patients as compared to stage I-III patients (p = 0.0528) Those who were concordant for cancer stage at diagnosis were significantly more likely to be female (p = 0.001), under the age of 65 (p = 0.01), have an income greater than $60,000 (p = 0.03), and have more education (p = 0.02). 64.4% of patients’ self-reported remission status matched the abstracted status. Nearly 30% of patients were not sure about their status even when they were in remission. Conclusions: Our findings confirm that more than one quarter of patients with advanced cancer have poor illness understanding, as well as highlights that an even greater number of patients with early stage I-III cancers have poor illness understanding. These observations highlight the need to improve illness understanding for patients across the entire cancer continuum.

Towards reducing cancer burden within the Medicaid program: Impact of Medicaid expansion on cancer stage at diagnosis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1572-1572
Author(s):  
Siran M. Koroukian ◽  
Jennifer Tsui ◽  
Weichuan Dong ◽  
Xiaoyu Yan ◽  
Uriel Kim ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Cancer Registry ◽  
Late Stage ◽  
Registry Data ◽  
Cancer Site ◽  
Cancer Stage ◽  
Medicaid Expansion ◽  
Stage At Diagnosis ◽  
Cancer Registry Data ◽  
Late Stage Diagnosis

1572 Background: Studies to date have shown post-Medicaid expansion (M-exp) decreases in the percentage of cancer patients who are uninsured and improvements in cancer stage at diagnosis in states that expanded Medicaid as part of the Affordable Care Act. However, most studies have examined impact of M-exp on stage outcomes at the population level, or among Medicaid and uninsured, rather than solely in the Medicaid population. Using cancer registry data from a non M-exp state (Georgia (GA)) and two M-exp states (Ohio (OH) and New Jersey (NJ)), we compared changes in cancer stage in patients on Medicaid, accounting for individual- and contextual-level characteristics at the Zip Code Tabulation Area (ZCTA) level. Methods: We used GA, OH, and NJ cancer registry data for individuals 20-64 years of age and diagnosed with incident invasive female breast (BC), cervical (CC), and colorectal cancer (CRC). Data spanned from 2010-2017 for GA and OH, and from 2011-2016 for NJ (for BC and CRC only), with 2014 marking the year in which Medicaid was expanded in OH and NJ. We retrieved demographic data (age, race/ethnicity, sex for CRC, insurance status, and cancer stage from the cancer registries), and obtained ZCTA-level data from the American Community Survey (e.g., income, education, and female-headed households). We defined late-stage diagnosis as regional- or distant- stage. We conducted multivariable logistic regression models by state and cancer site to examine changes in late-stage cancer diagnosis pre- and post-M-exp, accounting for individual- and ZCTA-level covariates. Results: The number of patients with incident cancer who were on Medicaid increased by 41.7% (n = 1757 to 2490), 59.6% (327 to 522), and 76.4% (953 to 1681) for BC, CC, and CRC cancers, respectively, in Ohio; by 92.4% (433 to 833) for BC and by over 100% for CRC (232 to 496) in NJ; but by 12.7% (662 to 746) among CRC patients in GA, where the number of BC and CC patients on Medicaid remained relatively stable. Adjusting for individual and contextual-level factors, the adjusted risk ratio (ARR and (95% Confidence Interval)) for late-stage disease was lowest for BC patients in OH (0.93 (0.87, 0.99)) and for CRC patients in GA (0.94 (0.89, 0.99)). The ARR for BC and CRC in NJ were not statistically significant, though they trended towards improvement. Similarly, changes in late-stage for CC were not statistically significant in OH or in GA. Conclusions: The increased number of cancer patients in Medicaid and the reductions in late-stage diagnosis observed may potentially translate into reduced, or at least stabilized, cancer-related morbidity and mortality burden among Medicaid beneficiaries over time. However, reductions in late-stage diagnosis were not consistent across cancer sites or states, possibly due to differences in population demographics, health behaviors, healthcare seeking patterns, and state-level cancer prevention efforts.

Accuracy and completeness of diagnosis codes for cancer metastasis on Medicare claims.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6521-6521 ◽  
Author(s):  
Neetu Chawla ◽  
K. Robin Yabroff ◽  
Angela Mariotto ◽  
Timothy S. McNeel ◽  
Deborah Schrag ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Metastatic Disease ◽  
Cancer Site ◽  
Administrative Claims ◽  
Stage At Diagnosis ◽  
Distant Disease ◽  
Medicare Claims ◽  
Diagnosis Codes ◽  
Seer Data ◽  
Sensitivity Specificity

6521 Background: Researchers are increasingly using diagnosis codes from administrative claims for cancer patients to identify metastatic disease at initial diagnosis or recurrence. However, the validity of metastasis codes on claims has not been established. We used the linked SEER -Medicare data to assess the completeness and validity of metastasis codes from Medicare claims for three common U.S. cancers. Methods: The study included 80,052 breast, lung, and colorectal cancer patients diagnosed with localized, regional, or distant disease in the SEER data between January 1, 2005 and December 31, 2007. From Medicare claims, patients were classified as having regional or distant disease at diagnosis if they had one hospital claim or two physician claims with metastasis codes within 3 months of diagnosis. Patients without claims with metastases codes were classified as having local disease. Using SEER data as the gold standard, we calculated sensitivity, specificity, positive and negative predictive values of metastasis codes on Medicare claims. We conducted multivariate logistic regression analysis to evaluate patient factors associated with stage misclassification for each cancer site. Results: For patients with distant disease per SEER data, the sensitivity and PPV of the claims to identify distant disease was: breast (50.6%, 67.3%), colorectal (72.2%, 68.8%) and lung cancer (42.1%, 88.6%). None of the measures for stage simultaneously exceeded 80% for sensitivity, specificity, and PPV for any of the cancer sites. In adjusted analysis, older, lower-income, and African American patients were more likely to have stage at diagnosis misclassified from Medicare claims. Conclusions: Use of diagnosis codes alone in Medicare claims will misclassify stage at diagnosis for cancer patients, particularly for patients with metastatic disease. Our findings also suggest that using diagnosis codes for metastasis to define recurrence in Medicare claims will be limited.

Emergency department visits for prescription and synthetic opioid overdoses among patients with cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6579-6579
Author(s):  
Vikram Jairam ◽  
Daniel X. Yang ◽  
James B. Yu ◽  
Henry S. Park
Keyword(s):  
Cervical Cancer ◽  
Emergency Department ◽  
Cancer Patients ◽  
The United States ◽  
Emergency Department Visits ◽  
Cancer Site ◽  
Opioid Overdose ◽  
Patients With Cancer ◽  
Rate Of Increase ◽  
Ed Visits

6579 Background: Patients with cancer may be at high risk of opioid dependence due to physical and psychosocial factors, although little data exists to inform providers and policymakers. Our aim is to examine overdoses from prescription and synthetic opiates leading to emergency department (ED) visits among patients with cancer in the United States. Methods: The Healthcare Cost and Utilization Project Nationwide Emergency Department Sample (HCUP-NEDS) was queried for all patient visits with a primary diagnosis of prescription or synthetic opioid overdose between 2006 and 2015. Baseline differences between patients with and without cancer were assessed using chi-square and ANOVA testing. Overdose rates by primary cancer site were normalized using prevalence data from the Surveillance, Epidemiology, and End Results (SEER) Program. Weighted frequencies were used to create national estimates for all data analyses. Results: There were 682,820 weighted ED visits for synthetic opioid overdose, among which 34,547 (5.1%) visits were also associated with a diagnosis of cancer. During this timeframe, ED visits for opioid overdose among patients with cancer increased 2.5-fold, compared to 1.7-fold among those without cancer. 16.5% of patients with cancer had metastatic disease. Patients with cancer presenting for opioid overdose had higher risk of hospital admission (74.8% vs 49.6%), respiratory intubation (13.2% vs 12.2%), mortality (2.1% vs 1.1%), and cost-of-hospital-stay ($32,665 vs $31,824) compared to their non-cancer counterparts (all P < 0.05). Primary cancers with the highest normalized overdose rates (ED visits per 10,000 patients) were esophagus (134), liver & intrahepatic bile duct (124), and cervical cancer (124). Other common cancers had the following normalized overdose rates: lung (105), head and neck (70), and breast (26). Conclusions: Approximately 5% of all ED visits due to prescription and synthetic opioid overdose are among patients with cancer. The rate of increase in ED visits due to opioid overdose from cancer patients was nearly 50% higher than that from non-cancer patients over the 10-year study period. Patients with esophageal, liver, and cervical cancer may be at highest risk.

Venous thromboembolism related hospitalizations among patients with genitourinary malignancy in the United States: A nationwide analysis.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e16126-e16126
Author(s):  
Sara Albagoush ◽  
Kamelah Abushalha ◽  
Sarah J Aurit ◽  
Janani Baskaran ◽  
Maryam Gbadamosi-Akindele
Keyword(s):  
Bladder Cancer ◽  
Venous Thromboembolism ◽  
African Americans ◽  
Cancer Patients ◽  
The United States ◽  
Primary Diagnosis ◽  
Teaching Hospitals ◽  
Cancer Site ◽  
Urban Teaching ◽  
Biological Sex

e16126 Background: Cancer Patients are at high risk of developing venous thromboembolism (VTE), pulmonary embolism (PE), and deep venous thrombosis (DVT). In this study, we aim to get an estimate of the incidence of VTE as a primary admission diagnosis among patients with genitourinary malignancies. Methods: We utilized ICD-9-CM and ICD-10-CM codes to identify patients with malignant neoplasms of the prostate, bladder, kidney, and testis who are older than 18 years and admitted with a primary diagnosis of DVT, PE within the NIS database during 2007-2016. Unadjusted incidence of DVT and PE was analyzed for each cancer site with the Rao-Scott chi-square test; multivariable logistic regression was employed to adjust for age, biological sex ( not for prostate/ testicular cancer), race, insurance, year of admission, and use of chemotherapy to further examine incidence. Results: We identified 3,339,985 admissions affiliated with genitourinary malignancies of whom 0.59% experienced DVT and 0.13% experienced PE with bladder cancer patients have the highest risk of hospitalization for VTE ( 79/1000). Within bladder cancer population; insurance ( p < 0.001) and hospital location and teaching status ( p < 0.001) were associated with DVT incidence; and biological sex ( p = 0.040) and race and ethnicity ( p = 0.026) with PE incidence. For all sites combined and after adjusting for all else, it was found that every year increase in age was associated with 1.2% increased odds of DVT or PE incidence (OR 95% CI: 1.01-1.02; p < 0.001). Further, rural vs. urban teaching hospitals had 41.2% increased odds (95% CI: 1.26-1.58; p < 0.001), and urban non teaching vs. urban teaching hospitals had 35.1% increased odds (95% CI: 1.26-1.45) of DVT or PE incidence. African Americans vs. whites had 46.8% increased odds of DVT or PE incidence (95% CI: 1.35-1.60; p < 0.001). Conclusions: Within the population of genitourinary malignancies who admitted with a primary diagnosis of VTE; the incidence was higher with older age, African Americans, uninsured population, in rural and urban non teaching facilities, bladder cancer population.

Marital status and suicide as a competing cause of mortality among cancer survivors.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19113-e19113
Author(s):  
Nosayaba Osazuwa-Peters ◽  
Matthew C Simpson ◽  
Eric Y Du ◽  
Scott A Hong ◽  
Aleksandr R Bukatko ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Marital Status ◽  
Head And Neck ◽  
Cancer Patients ◽  
Cancer Mortality ◽  
The United States ◽  
Mortality Rates ◽  
Suicide Mortality ◽  
Cancer Site ◽  
Mortality Risks

e19113 Background: The risk of suicide among cancer survivors more than double that of the general population, highlighting the need to mitigating risk factors for suicide. While several studies have described marital status, a surrogate for social support, as associated with cancer mortality, it is inconclusive whether marital status impacts suicide as a competing cause of cancer mortality. We tested this hypothesis by describing the association of marital status and suicide among survivors of four cancer sites with the highest suicide mortality rates in the United States. Methods: Adult cancer patients were identified from the Surveillance, Epidemiology and End Results database from 2004 to 2016 for four index cancer sites previously identified with highest suicide mortality rates: pancreas, head and neck, lung/bronchus and stomach ( n = 800,798). Cumulative incidence curves stratified by marital status (divorced/separated, widowed, never unmarried, and married/partnered) estimated unadjusted probability of suicide (outcome of interest). A multivariable competing risk proportional hazards model yielded sub-distribution hazard ratios (sdHRs) and 95% confidence intervals (CI) to estimate the association of marital status with suicide for each cancer site, while controlling for clinical and nonclinical factors. Results: Half (50.7%) of the cohort were married/partnered, males (56.8%), and non-Hispanic whites (71.0%). Mean age at diagnosis was 67.3 years. Most patients (60.9%) had cancer in the lung/bronchus, 17.9% head and neck, 13.8% pancreas, and 8.3% stomach. Unadjusted probability of suicide was highest among head and neck cancer survivors (0.3%). In the fully adjusted model, mortality by suicide was more likely among divorced/separated patients vs. married/partnered patients across cancer sites (sdHRhead and neck = 1.81; 95% CI 1.38, 2.37; sdHRlung/bronchus = 1.68; 95% CI 1.28, 2.19; sdHRpancreas = 2.19; 95% CI 1.27, 3.78; and sdHRstomach = 2.38; 95% CI 1.17, 4.58). Additionally, for lung/bronchus cancer, patients who were never married patients were more likely to die by suicide than those married/partnered (sdHRlung/bronchus = 1.47; 95% CI 1.09, 1.98). Conclusions: Marital status is associated with suicide mortality among cancer survivors, and divorced/separated survivors may have greater suicide mortality risks, independent of cancer site. As overall probability of suicide remains low, these findings might help identify cancer survivors who may be candidates for ongoing surveillance and psychosocial support to mitigate suicide mortality risks.

scholarly journals Illness Understanding of Oncology Patients in a Community-Based Cancer Institute

2017 ◽  
Vol 13 (9) ◽  
pp. e800-e808 ◽  
Author(s):  
Shanthi Sivendran ◽  
Sarah Jenkins ◽  
Sarah Svetec ◽  
Michael Horst ◽  
Kristina Newport ◽  
...  
Keyword(s):  
Advanced Cancer ◽  
Early Stage ◽  
Stage I ◽  
Cancer Stage ◽  
Stage At Diagnosis ◽  
Community Based ◽  
Oncology Patients ◽  
Number Of Patients ◽  
Knowledge Of Cancer ◽  
Active Disease

Purpose: Several studies have demonstrated that patients have a poor understanding of prognosis, survival, and effectiveness of chemotherapy, particularly in the setting of advanced cancer. This study examines oncology patients’ understanding of their illness based on accurate reporting of stage at diagnosis and knowledge of cancer status (ie, free of cancer or in remission v active disease). Materials and Methods: Two hundred eight patients with cancer previously treated at our large community-based cancer institute participated in the Consumer-Based Cancer Care Value Index field survey. Electronic medical record documentation of stage at diagnosis and cancer status was compared with patients’ self-reported responses. Concordance of responses and variables influencing discordance were evaluated. Results: In 51.0% of patients, self-reported cancer stage matched the abstracted stage, with the highest concordance in patients with advanced cancer (72%) versus patients with stage I to III disease (36.4% to 61.5%). Unexpectedly, discordance was lower among patients with advanced cancer compared with patients with stage I to III cancer ( P = .0528). Patients who were concordant for cancer stage at diagnosis were significantly more likely to be female ( P = .001), be younger than age 65 years ( P = .01), have an income > $60,000 ( P = .03), and have more education ( P = .02). In 64.4% of patients, self-reported cancer status (ie, free of cancer or in remission v active disease) matched the abstracted status. Nearly 30% of patients were not sure about their status, even when they were free of cancer or in remission. Conclusion: Our findings confirm that more than one quarter of patients with advanced cancer have poor illness understanding and highlight that an even greater number of patients with early stage I to III cancer have poor illness understanding. These observations highlight the need to improve illness understanding for patients across the entire cancer continuum.

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