Is Access to Care Associated With Stage at Presentation and Survival for Melanoma Patients?

2019 ◽  
Vol 23 (6) ◽  
pp. 586-594 ◽  
Author(s):  
Lacey D. Pitre ◽  
Geordie Linford ◽  
Gregory R. Pond ◽  
Elaine McWhirter ◽  
Hsien Seow
Keyword(s):  
Primary Care ◽  
Socioeconomic Status ◽  
Overall Survival ◽  
Access To Care ◽  
Population Based ◽  
Administrative Databases ◽  
Cancer Center ◽  
Physician Visits ◽  
Melanoma Prognosis ◽  
Melanoma Patients

Background Melanoma incidence increases with socioeconomic status but the effect of rurality and access to primary care or dermatology on patient outcomes is unclear. Objectives The objectives of this study were to determine whether access to care, rurality, or socioeconomic status are associated with melanoma stage at presentation and prognosis. Methods Linked administrative databases from Ontario, Canada, were retrospectively analyzed to identify a population-based cohort of patients diagnosed with melanoma between 2004 and 2012. Rurality was assessed using the rural index of Ontario (RIO) score, and the number of visits to dermatology and primary care was used to evaluate access to care. Results We identified 18 776 melanoma patients, of whom 9591 had completed pathological staging. Patients with higher RIO scores, living further from a cancer center or in a rural community, were less likely to see a dermatologist in the year prior to diagnosis ( P < .001 for all). Patients seen by a dermatologist within 365 days prior to diagnosis were less likely to present with stage III or IV disease (odds ratio 0.63, P < .001) and had improved overall survival (hazard ratio [HR] for death 0.77, P < .001). There was a nonlinear association between number of family physician visits and melanoma prognosis, with patients who had 3 to 5 visits per year having the best overall survival (HR 0.88, P = .003). Conclusion Our findings strengthen the known association between access to dermatology and melanoma outcomes by linking individual patients’ prediagnosis access to care to pathological stage at diagnosis and overall survival.

scholarly journals Nomogram predicted overall survival of patients with neuroendocrine carcinoma of the breast

2020 ◽  
Author(s):  
Wenwen Tian ◽  
Xinhua Xie ◽  
Yanan Kong ◽  
Peng Liu ◽  
Weige Tan ◽  
...  
Keyword(s):  
Overall Survival ◽  
Neuroendocrine Carcinoma ◽  
Operating Characteristic ◽  
Roc Curves ◽  
Population Based ◽  
Cancer Center ◽  
Breast Cancers ◽  
Seer Database ◽  
Carcinoma Of The Breast ◽  
N Stage

Abstract Background For primary neuroendocrine carcinoma of breast was a very rare subtype in breast cancers, its prognosis was still controversial and there was no independent standard for its treatment. The purpose of our retrospective study was to construct a nomogram to predict the overall survival (OS) of patients with neuroendocrine carcinoma of the breast. Methods 150 patients of training cohort were collected from Surveillance, Epidemiology, and End Results (SEER) database diagnosed between 2003 and 2015, and 93 patients of verification cohort were enrolled from Sun Yat-sen University Cancer Center (Guangzhou, China) diagnosed between 2004 and 2018. The nomogram was constructed uniting three significantly risk factors of overall survival identified by univariate and multivariate analysis and then validated using receiver operating characteristic (ROC) curves for discrimination, calibration plots and the decision curves analysis (DCA). Results Age, N stage and PR status were closely and significantly related to overall survival in patients with breast neuroendocrine carcinoma. The C-index of nomogram in the training and verification cohorts are 0.775 (95% CI, 0.784 to 0.615) and 0.760 (95% CI, 0.705 to 0.800) respectively. Calibration plots of practical and predicted possibility for the nomogram demonstrated that the predictive 5-year overall survival rate was in accordance with the actual overall survival probability in both sets. Moreover, the decision curves (DCA) also expressed pretty clinical benefit of the nomogram across a range of high-risk threshold. Conclusion This novel population-based nomogram may help with treatment decisions in patients with neuroendocrine carcinoma of the breast (NEBC).

scholarly journals Impact of Socioeconomic Status on Adult Patients with Asthma: A Population-Based Cohort Study from UK Primary Care

2021 ◽  
Vol Volume 14 ◽  
pp. 1375-1388
Author(s):  
John Busby ◽  
David Price ◽  
Riyad Al-Lehebi ◽  
Sinthia Bosnic-Anticevich ◽  
Job FM van Boven ◽  
...  
Keyword(s):  
Primary Care ◽  
Socioeconomic Status ◽  
Cohort Study ◽  
Population Based ◽  
Adult Patients

Predictors of pathologic complete response (pCR) after neoadjuvant chemoradiation (Neo CRT) for rectal cancer: A multicenter population-based study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14073-e14073
Author(s):  
Dawn Elizabeth Armstrong ◽  
Haider Ali ◽  
Erin Diana Powell ◽  
Julie A. Price Hiller ◽  
Patricia Tang ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Access To Care ◽  
Clinical Stage ◽  
Pathologic Complete Response ◽  
Disease Free Survival ◽  
Population Based ◽  
Cancer Center ◽  
Significant Independent Predictor ◽  
Curative Intent ◽  
Statin Use

e14073 Background: pCR to Neo CRT for rectal cancer is associated with better outcomes and used as an early indicator of response. To assess the rate and predictors of pCR, as well as access to care, we performed a retrospective study in two Canadian provinces. Methods: Cancer registries identified consecutive patients with clinical stage I-III rectal cancer from the Tom Baker Cancer Center, Cross Cancer Institute, and Dr. H. Bliss Murphy Cancer Centre who received Neo CRT and had curative intent surgery (Sx) from 2005 to 2011. Patient, tumor and therapy characteristics were correlated with response. Results: 301 patients were included of which 59 (19.6%) had a pCR to Neo CRT. At a median follow-up of 17 months, disease free survival was 96.7% for pCR vs 82.3% for non-pCR (p=0.005). 43 (73%) patients with pCR received adjuvant chemotherapy including bolus FU 27 (63%), capecitabine 10 (23%) and oxaliplatin-based 6 (14%). Median time from diagnosis to consult was 4 weeks (wks), from consult to start of Neo CRT 3.3 wks and start of CRT to Sx 13 wks. On multivariate analysis a low pre-op CEA (p=0.0323) was a significant independent predictor of pCR while statin use at initial consult (p=0.077) and higher pre-op hemoglobin (p=0.0974) trended toward significance when adjusted for clinical stage. Conclusions: Rates of pCR in a population based setting are substantial. A lower pre-op CEA is associated with a pCR to Neo CRT. Statin use and pre-op hemoglobin require further investigation. Our access to care data provides a baseline for future comparisons. [Table: see text]

Follow-up of long-term young breast cancer survivors.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 8-8
Author(s):  
Corinne Daly ◽  
Elisabeth M. Del Giudice ◽  
Rinku Sutradhar ◽  
Lawrence Frank Paszat ◽  
Drew Wilton ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Cancer Registry ◽  
Breast Cancer Survivors ◽  
Negative Binomial ◽  
Population Based ◽  
Cancer Center ◽  
Physician Visits ◽  
Young Breast Cancer

8 Background: Evidence suggests breast cancer patients can be offered follow-up by family physician without concern of important recurrence–related serious clinical events occurring more frequently or quality of life being negatively affected. This study describes population-based patterns of follow-up care in 5-year recurrence-free young breast cancer survivors to determine factors influencing continued oncology follow-up in Ontario, Canada. Methods: We conducted a retrospective population-based cohort study using cancer registry and administrative data. Women diagnosed with an incident breast cancer aged 20-44 between 1992 and 1999, survived for at least 5 years and recurrence-free for 5 years past diagnosis were identified in the Ontario Cancer Registry. Each survivor was matched to 5 control women with the same calendar year of birth and place of residence in Ontario. We determined outpatient physician visits with primary care, medical, radiation and surgical oncology physicians to investigate trends associated with increasing survivorship and compared visit rates to controls. We used negative binomial regression to investigate factors predicting high utilization of oncology services among survivors after 5-year recurrence survival. Results: We identified 4,581 survivors and 22,898 controls. By year 10, 51% breast cancer survivors were still being followed by an oncologist. In the survivors, fewer physician visits were observed among recurrence-free breast cancer survivors as time increased from diagnosis (Visit Rate Ratio [VRR] =0.95, 95% CI: 0.94, 0.96). Breast cancer survivors diagnosed from 1992-1995 had a higher rate of physician visits than those diagnosed from 1996-1999 (VRR = 1.16, 95% CI: 1.07, 1.25). More oncologist visits were associated with patients visiting a female oncologist (VRR = 1.20, 95% CI: 1.09, 1.33) and fewer visits were associated with patients visiting an oncologist who practiced outside of a regional cancer center (VRR = 0.67, 95% CI: 0.58, 0.77). Conclusions: Oncology visits of young breast cancer survivors after 5-year survival were associated with oncologist factors indicating that prolonged oncology follow-up in breast cancer survivors may be driven by practice patterns rather than patients’ needs.

Retrospective cohort study of real-world treatment patterns and overall survival in patients with chronic lymphocytic leukemia (CLL) diagnosed between 2010 to 2017 in Ontario, Canada.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e20003-e20003
Author(s):  
Shazia Hassan ◽  
Manjusha Hurry ◽  
Soo Jin Seung ◽  
Ryan Walton ◽  
Ashlie Elnoursi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Real World ◽  
Population Based ◽  
Treatment Patterns ◽  
Lymphocytic Leukemia ◽  
Administrative Databases ◽  
Probability Of Survival ◽  
Ontario Cancer Registry ◽  
Time To Initiation ◽  
Line Of Therapy

e20003 Background: With recent advances in treatment of CLL, it is important to understand emerging treatment patterns and associated outcomes. A population-based study was undertaken to describe the management and survival of CLL patients in Ontario, Canada. Methods: Patients diagnosed with CLL between January 1, 2010 and December 31, 2017 were identified in the Ontario Cancer Registry and linked to provincial administrative databases. Treatment patterns by line of therapy were characterized, including analyses of time to initiation and between therapies. Overall survival was calculated. Results: 2,887 CLL patients were identified (median age 68yr; 67% male). The mean time from diagnosis to first line (1L) treatment was 651 days with 35% of patients receiving fludarabine-cyclophosphamide-rituximab (FCR) based treatment. During the study period, 71% of patients did not yet receive second line (2L) therapy and did not have subsequent follow up, while 19% received 2L ibrutinib. Median time to 2L initiation from 1L treatment discontinuation was 636 days. The table summarizes 1L and 2L therapies. Of the 827 patients on 2L therapy, 65% received ibrutinib. After the introduction of publicly funded novel agents in 2015, a shift in treatment patterns away from FCR and chlorambucil based regimens was observed. Overall mean survival for the cohort from diagnosis was 6.8yrs, and mean 5 year probability of survival was 72.4%. Conclusions: A shift in treatment patterns for CLL can be seen with the introduction of newer therapies, such as ibrutinib. The results can support healthcare decision-makers by characterizing the size of this patient population, real world treatment patterns and survival outcomes for patients with CLL. [Table: see text]

scholarly journals A population-based study of pulmonary monitoring and toxicity for patients with testicular cancer treated with bleomycin

2020 ◽  
Vol 27 (6) ◽  
Author(s):  
M.J. Raphael ◽  
M.D. Lougheed ◽  
X. Wei ◽  
S. Karim ◽  
A.G. Robinson ◽  
...  
Keyword(s):  
Testicular Cancer ◽  
Pulmonary Toxicity ◽  
Pulmonary Function Tests ◽  
Population Based ◽  
Primary Objective ◽  
Administrative Databases ◽  
Chest Imaging ◽  
Physician Visits ◽  
Ontario Cancer Registry ◽  
Incident Cases

Background Bleomycin is commonly used to treat advanced testicular cancer and can be associated with severe pulmonary toxicity. The primary objective of the present study was to describe the use of pulmonary function tests (pfts) and chest imaging before, during, and after treatment with bleomycin. Methods To identify all incident cases of testicular cancer treated with bleomycin-based chemotherapy in the Canadian province of Ontario during 2005–2010, the Ontario Cancer Registry was linked with chemotherapy treat­ment records. Health administrative databases were used to describe use of pfts, chest imaging, and physician visits for respiratory complaints. Results Of 394 patients treated with orchiectomy and chemotherapy who received at least 1 dose of bleomycin, 93% had complete chemotherapy records available. In the 4 weeks before, during, and within 2 years after finishing bleomycin-based chemotherapy, pfts were performed in 17%, 17%, and 29% of patients respectively. Chest imaging was performed in 68%, 62%, and 98% of patients in the same time periods. In the 2 years after bleomycin-based chemotherapy, 23% of treated patients had a physician visit for respiratory symptoms. That rate was substantially higher for men with greater exposure to bleomycin: 40% (24 of 60) for 10–12 doses bleomycin compared with 21% (53 of 250) for 7–9 doses and with 14% (8 of 58) for 1–6 doses (p = 0.002). Conclusions Quality improvement initiatives are needed to increase baseline rates of chest imaging within 4 weeks of starting chemotherapy for testicular cancer; to understand why such a high proportion of men have chest imaging during bleomycin-based chemotherapy; and to mitigate the excess pulmonary toxicity seen with increasing expos­ure to bleomycin.

A population-based validation of a clinical age-based prognostic tool to predict survival in melanoma patients (Preprint)

2021 ◽  
Author(s):  
Yu-Jen Wang ◽  
Mingchih Chen ◽  
Yen Chun Huang ◽  
Tian-Shyug Lee
Keyword(s):  
Machine Learning ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Outcome Prediction ◽  
Prediction Models ◽  
Population Based ◽  
Survival Prediction ◽  
Prediction Tool ◽  
Old Patients ◽  
Melanoma Patients

BACKGROUND Melanoma is the most serious form of skin cancer, and the treatment can be challenging if the disease progresses to the metastatic stage. Depth of invasion is a good prognostic factor for predicting outcome. However, no good outcome prediction system that combines the staging system with other chronic systemic diseases is available to date. We investigated melanoma-related data from a population-based database and developed an outcome prediction tool for melanoma patients via machine learning. OBJECTIVE Build up a prediction tool for melanoma patients METHODS The clinical data of patients with melanoma were extracted from Taiwan’s National Health Insurance Research Database between 2008 and 2015 and were analysed in this study. Clinical data including demographic, pathologic, staging, and treatment data from melanoma patients over 18 years old were abstracted and collected. Prognostic factors were analyzed. Logistic regression (LR), random forest (RF) modelling, and multivariate adaptive regression splines (MARS) were applied to calculate predicted overall survival (OS). A 5-fold cross-validation method was applied. Two age groups (≥64 years old as the older age group and <64 years old as the general population group) with different prognostic factors were identified, and prognostic models for survival outcomes were built. RESULTS A total of 3481 patients were enrolled in our study. The 1-, 3-, and 5-year overall survival rates were 92.2%, 80.1%, and 70.3%, respectively. The Cox proportional hazard model showed that older age, male sex, higher grade, higher clinical stage, larger tumour size, positive surgical margins, no surgical intervention, and a higher Charlson comorbidity index (CCI) were associated with higher hazard ratios. LR, RF, and MARS techniques were used to validate the overall survival without tracking time, the accuracy of the MARS model for the <64-year-old patients and ≥64-year-old patients was 90.4% and 80.7%, respectively, with 3-, and 5-year the accuracy of prediction models are 94% and 89.6%. CONCLUSIONS Machine learning techniques offer excellent survival prediction in melanoma patients. Age-based survival prediction models may be applied for better clinical decision making. CLINICALTRIAL N/A

scholarly journals Functional Gastrointestinal Disorders in a Primary Care Pediatric Clinic

2015 ◽  
Vol 2 ◽  
pp. 2333794X1456845 ◽  
Author(s):  
Ronen Stein ◽  
Thomas Chelimsky ◽  
Hong Li ◽  
Gisela Chelimsky
Keyword(s):  
Primary Care ◽  
Socioeconomic Status ◽  
Functional Gastrointestinal Disorders ◽  
Population Based ◽  
Care Practice ◽  
Gastrointestinal Disorders ◽  
Pediatric Clinic ◽  
Validated Questionnaire ◽  
Rome Iii

Functional gastrointestinal disorders (FGIDs) are a common problem in pediatric patients and can affect quality of life. However, the extent of these disorders may vary in different subpopulations of children. This study investigated the prevalence of FGIDs in an inner-city primary care practice. Healthy patients between the ages of 9 and 17 were administered a validated questionnaire that assessed for FGIDs and other somatic complaints. Eleven of 145 patients (7.5%) met criteria for FGIDs based on Rome III Diagnostic Criteria. Raynaud-like symptoms tended to occur more often in patients meeting criteria for FGIDs, although this association was not statistically significant ( P = .07). The lower prevalence of FGIDs in this population compared with earlier studies may suggest a link between socioeconomic status and the prevalence of FGIDs. Larger population-based studies consisting of a heterogeneous cohort from a variety of socioeconomic backgrounds are necessary to further elucidate the true connection between FGIDs and socioeconomic status.

Genetic variation in immunomodulatory genes as markers of melanoma recurrence-free and overall survival.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9021-9021
Author(s):  
Justin Rendleman ◽  
Shulian Shang ◽  
Jerry Shields ◽  
Christina Adaniel ◽  
Nathaniel H. Fleming ◽  
...  
Keyword(s):  
Overall Survival ◽  
Target Genes ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Anatomic Site ◽  
Cox Models ◽  
Melanoma Prognosis ◽  
Sequenom Iplex ◽  
Melanoma Patients ◽  
Immune Related Genes

9021 Background: Small reported studies have provided some evidence implicating immune related genes in melanoma susceptibility and prognosis; however candidate selection of these prior efforts has been limited. In this study, we performed an analysis of germline variants in immuno-modulatory genes for their association with melanoma survival in a well characterized cohort of prospectively accrued melanoma patients. Methods: Germline DNA isolated from blood samples of 817 melanoma patients was genotyped for 94 SNPs tagging 55 immuno-modulatory genes using Sequenom iPLEX. Cox models were used to test associations between each SNP and recurrence-free and overall survival (RFS and OS), with adjustments for age, gender, subtype, thickness, ulceration, and anatomic site. ROC curves were constructed from different SNP/clinical covariate combinations and the area under the curve (AUC) was used to assess their utility in the classification of 3-year recurrence. Results: The SNP rs2796817 in TGFB2 had strong associations with both RFS (HR=3.8, CI 95%: 1.3-11, p=0.02) and OS (HR=5.5, CI 95%: 1.6-19, p=0.029). Other interesting associations with OS came from IRF8 (rs4843861, HR=0.62, CI 95%: 0.39-0.99, p=0.017), CCL5 (rs4796120, HR=7.6, CI 95%: 2.3-25, p=0.035), and CD8A (rs3810831, HR=2.4, CI 95%: 0.91-6.2, p=0.048). A multivariate model including stage, subtype, and one of the SNPs (rs3810831 from CD8A), was shown to improve the AUC when compared to a model including only stage and subtype (0.77 vs. 0.79). Conclusions: We identified several immune-related loci associated with melanoma RFS and OS. The strongest association, rs2796817, maps in TGFB2, which among other functions suppresses IL-2 dependent T-cell growth. In addition to other associations found in the study these findings provide evidence for the involvement of immuno-modulatory genes in melanoma prognosis and suggest further investigations of immune related genes in disease progression. This is currently underway in the second stage validation analysis, which includes an expanded set of immune target genes as well as an additional independent cohort of melanoma patients.

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