Survival after cancer diagnosis among patients with higher income and education in Israel, a country with highly appreciated health service.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1598-1598
Author(s):  
Yakir Rottenberg ◽  
Aviad Zick ◽  
Tamar Peretz
Keyword(s):  
Lung Cancer ◽  
Cancer Diagnosis ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Lower Socioeconomic Status ◽  
Cancer Data ◽  
Risk Of Death ◽  
Lower Socioeconomic ◽  
Treatment Disparities ◽  
After Cancer

1598 Background: In recent years, the 5 year survival following cancer diagnosis is about two thirds. Among patients with various chronic diseases, improved survival is known to be associated with higher income and education. The aim of the current study is to assess the influence of income and education on survival following cancer diagnosis in Israel. Methods: Retrospective cohort study, using baseline measurement from the 1995 census conducted by the Central Bureau of Statistics in Israel. Cancer data were obtained from the Israel Cancer Registry. Cox proportional hazards ratios were calculated for mortality among cancer patients and adjusted for age, sex, religious, income and education years. The first model excluded cancers associated with early detection (breast, prostate, colorectal and cervix), and a second model excluded also lung cancer in order to control for smoking which is common in lower socioeconomic status. Results: A total of 3,712 cases of cancer and 1,252 deaths were reported during the study period. Higher income (HR=0.985 per 1000NIS, approximately 330$ in 1995's value, p=0.016) and education (HR=0.957 per year of education, p<0.001) were associated with decreased risk of death after cancer diagnosis. Jews had better prognosis than non-Jews following cancer diagnosis (HR=0.62, p<0.001), while males (HR=1.54, p<0.001) and age (HR=1.036 per year, p<0.001) had been associated with worse prognosis. The association between higher income and education was not changed in a model which excluded lung cancer. Conclusions: Higher income and education are associated with improved survival after cancer diagnosis. In the light of current study, further studies are needed to depict the variation in cancer incidence, stage at diagnosis and treatment disparities related to socioeconomic variables.

Outcomes among women with brain metastases from gynecologic (gyn) malignancies.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e18034-e18034
Author(s):  
Kristen Cagino ◽  
Ryan Kahn ◽  
Susie Chan ◽  
Charlene Thomas ◽  
Paul J. Christos ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Surgical Resection ◽  
Cancer Diagnosis ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Continuous Variables ◽  
Presenting Symptoms ◽  
Risk Of Death ◽  
Whole Brain Radiation

e18034 Background: Brain metastasis secondary to gyn malignancy is rare and associated with poor prognosis, with limited available data and no definitive management guidelines. We aimed to identify factors and treatments associated with improved overall survival (OS). Methods: Patients were identified retrospectively with brain metastases from gyn malignancies between 2004-2019. Descriptive statistics were used to describe the cohort of patients using N (%) and median [IQR] for categorical and continuous variables, respectively. Univariate cox proportional hazards regression was performed to evaluate the effect of different prognostic factors on OS. Results: 32 patients presented with brain metastasis from gyn primaries (ovarian/primary peritoneal n = 14, cervical n = 7, uterine n = 11). Median age of initial cancer diagnosis was 62 (54-59). At initial diagnosis 83% of patients were Stage III/IV and underwent surgical management (56%), chemotherapy (100%), or pelvic radiation (31%). The median time from cancer diagnosis to brain metastasis was 18mos. 66% presented with multiple; 34% with isolated brain metastases. The most common presenting symptoms were extremity weakness/numbness (78%), seizures (34%), and headaches (28%). Surgical resection was most often combined with stereotactic radiosurgery (SRS) and/or whole brain radiation therapy (WBRT) (Table 1). Median survival from date of brain metastases was longer in patients treated by SRS alone compared to WBRT alone (95 vs 11 mos). Treatment with SRS + Surgery compared to SRS or WBRT alone revealed a trend toward improved OS (p = .06; p = .07). Increased time from initial cancer diagnosis to brain metastasis was associated with improved OS, with one-month increase in time associated with a 7% reduction in risk of death (p = 0.01). Initial cancer treatment, Stage, histology, and number of brain lesions did not affect OS. Conclusions: Patients with brain metastasis secondary to gyn malignancies with the longest OS had the greatest lag time between initial cancer diagnosis and brain metastasis diagnosis. Treatment with multimodal therapy with radiation and surgical resection was associated with the longest OS. [Table: see text]

scholarly journals Association between prediagnosis depression and mortality among postmenopausal women with colorectal cancer

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244728
Author(s):  
Xiaoyun Liang ◽  
Michael Hendryx ◽  
Lihong Qi ◽  
Dorothy Lane ◽  
Juhua Luo
Keyword(s):  
Colorectal Cancer ◽  
Depressive Symptoms ◽  
Cancer Diagnosis ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Risk Of Death ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
Antidepressant Use

Background There are no epidemiologic data on the relation of depression before colorectal cancer diagnosis to colorectal cancer mortality among women with colorectal cancer, especially those who are postmenopausal. Our aim was to fill this research gap. Methods We analyzed data from a large prospective cohort in the US, the Women’s Health Initiative (WHI). The study included 2,396 women with incident colorectal cancer, assessed for depressive symptoms and antidepressant use before cancer diagnosis at baseline (screening visit in the WHI study) during 1993–1998. Participants were followed up from cancer diagnosis till 2018. We used Cox proportional hazards regression to estimate adjusted hazard ratios (HRs) between depression (depressive symptoms or antidepressant use) at baseline, and all-cause mortality and colorectal cancer-specific mortality. Results Among women with colorectal cancer, there was no association between baseline depression and all-cause mortality or colorectal cancer-specific mortality after adjusting for age or multiple covariates. Conclusion Among women with colorectal cancer, there was no statistically significant association between depression before colorectal cancer diagnosis and all-cause mortality or colorectal cancer-specific mortality. Further studies are warranted to assess depressive symptoms and antidepressant use, measured at multiple points from baseline to diagnosis, and their interactions with specific types of colorectal cancer treatment on the risk of death from colorectal cancer.

scholarly journals Incidence of non-pulmonary cancer and lung cancer by amount of emphysema and airway wall thickness: a community-based cohort

2017 ◽  
Vol 49 (5) ◽  
pp. 1601162 ◽  
Author(s):  
Ane Aamli Gagnat ◽  
Miriam Gjerdevik ◽  
Frode Gallefoss ◽  
Harvey O. Coxson ◽  
Amund Gulsvik ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Wall Thickness ◽  
Proportional Hazards ◽  
Quantitative Computed Tomography ◽  
Cox Proportional Hazards ◽  
Airway Wall ◽  
Strong Argument ◽  
Cancer Data ◽  
Airway Wall Thickness ◽  
Pulmonary Cancer

There is limited knowledge about the prognostic value of quantitative computed tomography (CT) measures of emphysema and airway wall thickness in cancer.The aim of this study was to investigate if using CT to quantitatively assess the amount of emphysema and airway wall thickness independently predicts the subsequent incidence of non-pulmonary cancer and lung cancer.In the GenKOLS study of 2003–2005, 947 ever-smokers performed spirometry and underwent CT examination. The main predictors were the amount of emphysema measured by the percentage of low attenuation areas (%LAA) on CT and standardised measures of airway wall thickness (AWT-PI10). Cancer data from 2003–2013 were obtained from the Norwegian Cancer Register. The hazard ratio associated with emphysema and airway wall thickness was assessed using Cox proportional hazards regression for cancer diagnoses.During 10 years of follow-up, non-pulmonary cancer was diagnosed in 11% of the subjects with LAA <3%, in 19% of subjects with LAA 3–10%, and in 17% of subjects with LAA ≥10%. Corresponding numbers for lung cancer were 2%, 3% and 11%, respectively. After adjustment, the baseline amount of emphysema remained a significant predictor of the incidence of non-pulmonary cancer and lung cancer. Airway wall thickness did not predict cancer independently.This study offers a strong argument that emphysema is an independent risk factor for both non-pulmonary cancer and lung cancer.

scholarly journals A retrospective, quantitative assessment of disease burden in patients with leptomeningeal metastases from non-small-cell lung cancer

2019 ◽  
Vol 22 (5) ◽  
pp. 675-683 ◽  
Author(s):  
Kathryn S Nevel ◽  
Natalie DiStefano ◽  
Xuling Lin ◽  
Anna Skakodub ◽  
Shahiba Q Ogilvie ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Molecular Characterization ◽  
Disease Burden ◽  
Proportional Hazards ◽  
Leptomeningeal Metastasis ◽  
Circulating Tumor Cell ◽  
Cox Proportional Hazards ◽  
Prognostic Indicators ◽  
Rank Test ◽  
Risk Of Death

Abstract Background Improvements in detection and molecular characterization of leptomeningeal metastasis from lung cancer (LC-LM) coupled with cerebrospinal fluid (CSF)-penetrating targeted therapies have altered disease management. A barrier to formal study of these therapies in LM is quantification of disease burden. Also, outcomes of patients with targetable mutations in LC-LM are not well defined. This study employs molecular and radiographic measures of LM disease burden and correlates these with outcome. Methods We reviewed charts of 171 patients with LC-LM treated at Memorial Sloan Kettering. A subset had MRI and CSF studies available. Radiographic involvement (n = 76) was scored by number of gadolinium-enhancing sites in 8 locations. CSF studies included cytopathology, circulating tumor cell (CTC) quantification (n = 16), and cell-free DNA (cfDNA) analysis (n = 21). Clinical outcomes were compared with Kaplan–Meier log-rank test and Cox proportional hazards methodologies. Results Median overall survival was 4.2 months (95% CI: 3.6–4.9); 84 patients (49%) harbored targetable mutations. Among bevacizumab-naïve patients with MRI and CSF cytology at time of LC-LM diagnosis, extent of radiographic involvement correlated with risk of death (hazard ratio [HR]: 1.16; 95% CI: 1.02–1.33; P = 0.03), as did CSF CTC (HR: 3.39, 95% CI: 1.01–11.37; P = 0.048) and CSF cfDNA concentration (HR: 2.58; 95% CI: 0.94–7.05; P = 0.06). Those without a targetable mutation were almost 50% more likely to die (HR: 1.49; 95% CI: 1.06–2.11; P = 0.02). Conclusions Extent of radiographic involvement and quantification of CSF CTC and cfDNA show promise as prognostic indicators. These findings support molecular characterization and staging for clinical management, prognostication, and clinical trial stratification of LC-LM.

Beyond the Traditional Prognostic Indicators: The Impact of Primary Care Utilization on Cancer Survival

2007 ◽  
Vol 25 (36) ◽  
pp. 5793-5799 ◽  
Author(s):  
Laura E. Jones ◽  
Caroline Carney Doebbeling
Keyword(s):  
Lung Cancer ◽  
Primary Care ◽  
Cancer Diagnosis ◽  
Survival Duration ◽  
Rank Test ◽  
Care Utilization ◽  
Risk Of Death ◽  
After Cancer ◽  
Primary Care Utilization ◽  
The Impact

Purpose To our knowledge to date, the effect of primary care utilization on health outcomes in cancer patients has not been described. The objective of this study was to investigate the impact of primary care utilization within 6 months of cancer diagnosis on survival in patients with lung cancer. Patients and Methods We used electronic medical record data (1997 to 2005) to identify male veterans with incident lung cancers (N = 323). Primary care utilization was assessed in the 6 months after cancer diagnosis. Patients were observed from cancer diagnosis to death or to last date of health care utilization (ie, censoring date). Univariate and multivariate Cox proportional hazards models tested whether primary care utilization was associated with improved survival. Multivariate analyses adjusted for demographic and clinical characteristics. Results During an average follow-up of 16.6 months, 259 patients died. In multivariate analysis, the risk of death was 36% (hazard ratio [HR], 0.64; 95% CI, 0.45 to 0.90), 56% (HR, 0.44; 95% CI, 0.29 to 0.65), and 57% (HR, 0.43; 05% CI, 0.29 to 0.64) lower for patients who had one, two, or at least three primary care visits, respectively, in the first 6 months after cancer diagnosis as compared with those without primary care utilization. The median survival duration (P < .0001, log-rank test) was 3.68, 7.52, 13.88, and 13.75 months for patients with no, one, two, or at least three primary care visits, respectively. Conclusion Primary care utilization in the early phase of cancer treatment has a marked effect that results in a reduced mortality risk in patients with incident lung cancer. Additional research is required to determine how and why primary care utilization is an important prognostic indicator of prolonged survival in patients with lung cancer.

scholarly journals 778Risk of 27 cancer types in relation to tobacco smoking: cohort study involving 229,028 Australians

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Marianne Weber ◽  
Peter Sarich ◽  
Pavla Vaneckova ◽  
Stephen Wade ◽  
Emily Banks ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Risk ◽  
Tobacco Control ◽  
Proportional Hazards ◽  
Lung Cancer Risk ◽  
Cox Proportional Hazards ◽  
Unknown Primary ◽  
Cancer Type ◽  
Cancer Data ◽  
Never Smokers

Abstract Background Tobacco smoke is a known carcinogen and the magnitude of smoking-related cancer risk varies according to time and population. Local, contemporary evidence can drive appropriate tobacco control. We provide comprehensive cancer risk estimates related to smoking in the population-based, New South Wales (NSW) 45 and Up Study. Methods We estimated smoking-related hazard ratios (HR) for cancer using Cox proportional hazards regression using linked questionnaire (2006-2009) and incident cancer data (n ≥ 50 cases per cancer type), from the NSW Cancer Registry (to December 2013) (via CHeReL). Results Of 18,475 cancers among 229,028 participants aged ≥45 years, current smokers had significantly increased risks of cancers of the lung, larynx, head and neck, oesophagus, liver, bladder, pancreas, stomach, colorectum, and cancers with unknown primary site, compared to never-smokers; lung cancer risk was markedly elevated, including for current-smokers of 1-5 cigarettes/day (HR = 9.25, 95%CI=5.2-16.6), increasing to 38.39 (26.2-56.2) for current-smokers of &gt; 30 cigarettes/day. Quitting substantively decreased cancer risk compared to continued smoking, with lung cancer risk decreasing with decreasing age at quitting (p(trend)&lt;0.05), however risks remained elevated for those quitting aged &gt;25 compared to never-smokers (1.73, 1.1-2.6 for age 26-30 years). An estimated 20% of current-smokers in Australia will get lung cancer during their lifetime versus 1.6% of never-smokers. Conclusions Smoking-attributable cancer risks in Australia are significant, comparable to contemporary risks from other developed nations. Key messages Smokers – including “light” smokers – are at high cancer risk, with ∼one-fifth of Australian lifetime smokers developing lung cancer. Quitting is beneficial. Continued investment in tobacco control is essential.

scholarly journals Adaptive metabolic and inflammatory responses identified using accelerated aging metrics are linked to adverse outcomes in severe SARS-CoV-2 infection

2021 ◽  
Author(s):  
Alejandro Márquez-Salinas ◽  
Carlos A Fermín-Martínez ◽  
Neftalí Eduardo Antonio-Villa ◽  
Arsenio Vargas-Vázquez ◽  
Enrique C. Guerra ◽  
...  
Keyword(s):  
Critical Illness ◽  
Proportional Hazards ◽  
Inflammatory Responses ◽  
Age Groups ◽  
Accelerated Aging ◽  
Cox Proportional Hazards ◽  
Adverse Outcomes ◽  
Adaptive Responses ◽  
Predictive Capacity ◽  
Risk Of Death

Abstract Background Chronological age (CA) is a predictor of adverse COVID-19 outcomes; however, CA alone does not capture individual responses to SARS-CoV-2 infection. Here, we evaluated the influence of aging metrics PhenoAge and PhenoAgeAccel to predict adverse COVID-19 outcomes. Furthermore, we sought to model adaptive metabolic and inflammatory responses to severe SARS-CoV-2 infection using individual PhenoAge components. Methods In this retrospective cohort study, we assessed cases admitted to a COVID-19 reference center in Mexico City. PhenoAge and PhenoAgeAccel were estimated using laboratory values at admission. Cox proportional hazards models were fitted to estimate risk for COVID-19 lethality and adverse outcomes (ICU admission, intubation, or death). To explore reproducible patterns which model adaptive responses to SARS-CoV-2 infection, we used k-means clustering using PhenoAge components. Results We included 1068 subjects of whom 222 presented critical illness and 218 died. PhenoAge was a better predictor of adverse outcomes and lethality compared to CA and SpO2 and its predictive capacity was sustained for all age groups. Patients with responses associated to PhenoAgeAccel&gt;0 had higher risk of death and critical illness compared to those with lower values (log-rank p&lt;0.001). Using unsupervised clustering we identified four adaptive responses to SARS-CoV-2 infection: 1) Inflammaging associated with CA, 2) metabolic dysfunction associated with cardio-metabolic comorbidities, 3) unfavorable hematological response, and 4) response associated with favorable outcomes. Conclusions Adaptive responses related to accelerated aging metrics are linked to adverse COVID-19 outcomes and have unique and distinguishable features. PhenoAge is a better predictor of adverse outcomes compared to CA.

scholarly journals Pre-diagnosis neutrophil-to-lymphocyte ratio and mortality in individuals who develop lung cancer

2021 ◽  
Author(s):  
Laurie Grieshober ◽  
Stefan Graw ◽  
Matt J. Barnett ◽  
Gary E. Goodman ◽  
Chu Chen ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Proportional Hazards ◽  
Smoking Status ◽  
Cox Proportional Hazards ◽  
Neutrophil To Lymphocyte Ratio ◽  
Blood Draw ◽  
Lymphocyte Ratio ◽  
Cox Proportional Hazards Models ◽  
Inflammatory Profile ◽  
Heavy Smokers

Abstract Purpose The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation that has been reported to be associated with survival after chronic disease diagnoses, including lung cancer. We hypothesized that the inflammatory profile reflected by pre-diagnosis NLR, rather than the well-studied pre-treatment NLR at diagnosis, may be associated with increased mortality after lung cancer is diagnosed in high-risk heavy smokers. Methods We examined associations between pre-diagnosis methylation-derived NLR (mdNLR) and lung cancer-specific and all-cause mortality in 279 non-small lung cancer (NSCLC) and 81 small cell lung cancer (SCLC) cases from the β-Carotene and Retinol Efficacy Trial (CARET). Cox proportional hazards models were adjusted for age, sex, smoking status, pack years, and time between blood draw and diagnosis, and stratified by stage of disease. Models were run separately by histotype. Results Among SCLC cases, those with pre-diagnosis mdNLR in the highest quartile had 2.5-fold increased mortality compared to those in the lowest quartile. For each unit increase in pre-diagnosis mdNLR, we observed 22–23% increased mortality (SCLC-specific hazard ratio [HR] = 1.23, 95% confidence interval [CI]: 1.02, 1.48; all-cause HR = 1.22, 95% CI 1.01, 1.46). SCLC associations were strongest for current smokers at blood draw (Interaction Ps = 0.03). Increasing mdNLR was not associated with mortality among NSCLC overall, nor within adenocarcinoma (N = 148) or squamous cell carcinoma (N = 115) case groups. Conclusion Our findings suggest that increased mdNLR, representing a systemic inflammatory profile on average 4.5 years before a SCLC diagnosis, may be associated with mortality in heavy smokers who go on to develop SCLC but not NSCLC.

scholarly journals Dementia Adjudication Triggers Associated With Increased Mortality for Older Australians: Evidence From ASPREE

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 161-161
Author(s):  
Jane Banaszak-Holl ◽  
Xiaoping Lin ◽  
Jing Xie ◽  
Stephanie Ward ◽  
Henry Brodaty ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
The Elderly ◽  
Cox Proportional Hazards ◽  
Service Planning ◽  
Cox Proportional Hazards Model ◽  
Cognitive Test ◽  
Risk Of Death ◽  
Hazards Model ◽  
Using Data

Abstract Research Aims: This study seeks to understand whether those with dementia experience higher risk of death, using data from the ASPREE (ASPirin in Reducing Events in the Elderly) clinical trial study. Methods: ASPREE was a primary intervention trial of low-dose aspirin among healthy older people. The Australian cohort included 16,703 dementia-free participants aged 70 years and over at enrolment. Participants were triggered for dementia adjudication if cognitive test results were poorer than expected, self-reporting dementia diagnosis or memory problems, or dementia medications were detected. Incidental dementia was adjudicated by an international adjudication committee using the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) criteria and results of a neuropsychological battery and functional measures with medical record substantiation. Statistical analyses used a cox proportional hazards model. Results: As previously reported, 1052 participants (5.5%) died during a median of 4.7 years of follow-up and 964 participants had a dementia trigger, of whom, 575 (60%) were adjucated as having dementia. Preliminary analyses has shown that the mortality rate was higher among participants with a dementia trigger, regardless of dementia adjudication outcome, than those without (15% vs 5%, Χ2 = 205, p &lt;.001). Conclusion: This study will provide important analyses of differences in the hazard ratio for mortality and causes of death among people with and without cognitive impairment and has important implications on service planning.

Absolute Prostate-Specific Antigen Value After Androgen Deprivation Is a Strong Independent Predictor of Survival in New Metastatic Prostate Cancer: Data From Southwest Oncology Group Trial 9346 (INT-0162)

2006 ◽  
Vol 24 (24) ◽  
pp. 3984-3990 ◽  
Author(s):  
Maha Hussain ◽  
Catherine M. Tangen ◽  
Celestia Higano ◽  
Paul F. Schelhammer ◽  
James Faulkner ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Specific Antigen ◽  
Proportional Hazards ◽  
Strong Predictor ◽  
Specific Antigen ◽  
Androgen Deprivation ◽  
Time To Death ◽  
Cancer Data ◽  
Risk Of Death ◽  
Group Trial

Purpose To establish whether absolute prostate-specific antigen (PSA) value after androgen deprivation (AD) is prognostic in metastatic (D2) prostate cancer (PCa). Patients and Methods D2 PCa patients with baseline PSA of at least 5 ng/mL received 7 months induction AD. Patients achieving PSA of 4.0 ng/mL or less on months 6 and 7 are randomly assigned to continuous versus intermittent AD on month 8. Eligibility for this analysis required a prestudy PSA with at least two subsequent PSAs and that patients be registered at least 1 year before analysis date. Survival was defined as time to death after 7 months of AD. Associations were evaluated by proportional hazards regression models. Results One thousand one hundred thirty four of 1,345 eligible patients achieved a PSA of 4 ng/mL or less. At end of induction, 965 patients maintained PSA of 4 or less and 604 had a PSA of 0.2 ng/mL or less. After controlling for prognostic factors, patients with a PSA of 4 or less to more than 0.2 ng/mL had less than one third the risk of death (ROD) as those with a PSA of more than 4 ng/mL (P < .001). Patients with PSA of 0.2 ng/mL or less had less than one fifth the ROD as patients with a PSA of more than 4 ng/mL (P < .001) and had significantly better survival than those with PSA of more than 0.2 to 4 ng/mL or less (P < .001). Median survival was 13 months for patients with a PSA of more than 4 ng/mL, 44 months for patients with PSA of more than 0.2 to 4 ng/mL or less, and 75 months for patients with PSA of 0.2 ng/mL or less. Conclusion A PSA of 4 ng/mL or less after 7 months of AD is a strong predictor of survival. This data should be used to tailor future trial design for D2 prostate cancer.

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