Cancer screening utilization in patients diagnosed with cancer types with and without recommended screening modalities.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10557-10557
Author(s):  
Ariella Cohain ◽  
Christine Hathaway ◽  
Mudit Gupta ◽  
Braxton Lagerman ◽  
Yali Li ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cancer Screening ◽  
Cancer Patients ◽  
Late Stage ◽  
Screening Methods ◽  
Stage At Diagnosis ◽  
Tumor Registry ◽  
Late Stage Diagnosis ◽  
Screening Adherence ◽  
Cancer Types

10557 Background: Several studies have shown screening methods can detect cancer at earlier stages and improve cancer prognosis; however, only four cancer types (breast, colorectal, cervical, and lung) currently have screening methods recommended by the United States Preventive Services Taskforce (USPSTF). In 2021, these four cancers are expected to make up roughly 40% of new cases and cancer deaths, meaning that the majority of cancer deaths will be associated with cancer types lacking recommended screening. We sought to characterize patients who were diagnosed with cancer types with and without recommended screening modalities to demonstrate the gaps in screening faced by the majority of cancers today. Methods: The Geisinger Health System (GHS) Phenomics Initiative Database (PIDB) provides deidentified data from electronic health, billing, and imaging records, and a tumor registry. PIDB was used to identify patients aged 50 to 76 who had cancers diagnosed between 2008 and 2020 and a record of USPSTF-recommended cancer screenings within GHS prior to diagnosis. Analysis focused on patients who received care at GHS during their screening-eligible intervals. Results: Between 2008 and 2020, 13,347 incident invasive cancers were identified in the GHS tumor registry. Of these, 40% (N = 5,331) were cancer types with a recommended screening modality. 57% of these cases (N = 3,039; 23% of all incident cancers) occurred in patients who underwent screening in the interval preceding diagnosis. Screening adherence was significantly associated with stage at diagnosis; patients who were not screened for their diagnosed cancer were more than twice as likely to have a late-stage diagnosis as compared with patients who received screening (multivariate ordinal logistic regression, OR = 2.16, p < 0.001). Patterns of screening adherence in this population are complex; however, 57% of these patients had received screening for a different cancer type. The majority of incident cancers were of those types with no recommended screening modality (N = 8,016; 60% of all incident cancers). Of these, most (N = 6,252; 78%) had been screened for at least one of breast, lung, colon, or cervical cancer and nearly half (N = 3,607; 45%) were current for all guideline-recommended screenings. Not surprisingly, stage at diagnosis was not associated with adherence to any or all screening modalities (multivariate ordinal logistic regression, p = 0.11 and p = 0.45). Conclusions: The majority (79%) of individuals diagnosed with cancer had a history of adherence to at least one screening recommendation. Out of all cancer patients, only 23% were screened specifically for the cancer with which they were subsequently diagnosed, a group that is associated with a lower odds of a late-stage diagnosis. This suggests that the majority of cancer patients who underwent any cancer screening did not benefit from earlier stage diagnosis.

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.

scholarly journals Chemotherapy for Late-Stage Cancer Patients: Meta-Analysis of Complete Response Rates

F1000Research ◽  
2015 ◽  
Vol 4 ◽  
pp. 232 ◽  
Author(s):  
Martin L. Ashdown ◽  
Andrew P. Robinson ◽  
Steven L. Yatomi-Clarke ◽  
M. Luisa Ashdown ◽  
Andrew Allison ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Late Stage ◽  
Meta Analysis ◽  
Complete Response ◽  
Drug Regimen ◽  
Cancer Type ◽  
Late Stage Cancer ◽  
Pubmed Database ◽  
Wide Range ◽  
Cancer Types

Complete response (CR) rates reported for cytotoxic chemotherapy for late-stage cancer patients are generally low, with few exceptions, regardless of the solid cancer type or drug regimen. We investigated CR rates reported in the literature for clinical trials using chemotherapy alone, across a wide range of tumour types and chemotherapeutic regimens, to determine an overall CR rate for late-stage cancers. A total of 141 reports were located using the PubMed database. A meta-analysis was performed of reported CR from 68 chemotherapy trials (total 2732 patients) using standard agents across late-stage solid cancers—a binomial model with random effects was adopted. Mean CR rates were compared for different cancer types, and for chemotherapeutic agents with different mechanisms of action, using a logistic regression. Our results showed that the CR rates for chemotherapy treatment of late-stage cancer were generally low at 7.4%, regardless of the cancer type or drug regimen used. We found no evidence that CR rates differed between different chemotherapy drug types, but amongst different cancer types small CR differences were evident, although none exceeded a mean CR rate of 11%. This remarkable concordance of CR rates regardless of cancer or therapy type remains currently unexplained, and motivates further investigation.

Distance-to-care: Stage at diagnosis for New Mexico (NM) residents with colorectal cancer (CRC).

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 421-421 ◽  
Author(s):  
Meredith C. Mason ◽  
Andrew Bruner ◽  
Angela W. Meisner ◽  
Katherine T. Morris ◽  
Itzhak Nir ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Logistic Regression ◽  
New Mexico ◽  
Late Stage ◽  
Early Stage ◽  
Stage At Diagnosis ◽  
Multiple Logistic Regression ◽  
Place Of Residence ◽  
Distance To Care ◽  
Incident Cases

421 Background: CRC is a leading cause of morbidity and mortality among NM’s American Indians, Hispanics, and non-Hispanic whites. Previous studies have shown that rural residents are more likely than urban dwellers to be diagnosed with late stage disease. Geographically New Mexico is the 5th largest state with a population of 2 million, many of whom reside in rural regions. This study was designed to characterize the association between distance-to-care and stage of disease at diagnosis in NM. Methods: The population-based NM Tumor Registry was used to identify records for all incident cases of CRC between 2001-2008. Latitude and longitude were determined for the place of residence for cancer cases and for the facility where each case was diagnosed. The “Great Circles” algorithm was used to estimate the distance from place of residence to the diagnosing facility. The percentage of cases diagnosed with early stage vs. other stages (i.e., regional, distant, and unknown stages-combined) was assessed by quartile of distance-to-care with the use of the chi-squared test for trend. Multiple logistic regression was used to characterize the association between stage and quartile of distance-to-care while controlling for other factors know to be associated with stage at diagnosis. Results: Analysis was based on 6,291 incident cases of CRC that were diagnosed among NM residents. Latitude and longitude for both place of residence at diagnosis and location of diagnosing facility were available for 4,385 (69.7%) of all incident cases. The percentage of cases diagnosed at early stage was inversely related to the distance between the place of residence at diagnosis and the facility where the cancer was diagnosed, as follows: 41.4% of cases in Quartile 1 (shortest distance-to-care); 39.9% in Quartile 2; 37.8% in Quartile 3; and 35.3% in Quartile 4 (p=0.002).By multiple logistic regression, distance-to-care was a significant predictor of stage at diagnosis after adjustment of sex, age and race/ethnicity. Conclusions: Rural residents of NM who must travel relatively long distances to receive medical care are at increased risk of being diagnosed at late stage colorectal cancer.

scholarly journals Community-Based Cancer Screening Program: The DESH (Detect Early Save Her, Him) Initiative of Piramal Swasthya

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 146s-146s
Author(s):  
S.K.B. Hegde ◽  
S. Sadanand ◽  
S.M. Bhagabaty ◽  
A.C. Kataki ◽  
S. Chanda ◽  
...  
Keyword(s):  
Cancer Screening ◽  
Late Stage ◽  
Diagnostic Tests ◽  
Screening Program ◽  
Community Level ◽  
Community Based ◽  
Cervical Cancers ◽  
Oral Cancers ◽  
Late Stage Diagnosis ◽  
Screening Unit

Background and context: Two-thirds of global cancer deaths are from less developed countries. Late stage presentation and inability to access care are observed to be higher in lower and middle-income countries resulting in avoidable deaths and disability. Kamrup district in Assam has the fourth highest incidence of cancers in India. Detect Early Save Her, Him (DESH) initiative by Piramal Swasthya in Kamrup district focuses on reducing late-stage diagnosis and mortality. Aim: To reduce the proportion of late-stage diagnosis and mortality from breast, cervical and oral cancers through a community based screening and referral program. Strategy: 1. Community level interventions to increase awareness, improve knowledge, alter attitudes and motivate and mobilize people to undergo screening. 2. Evidence based highly sensitive screening and referral through mobile cancer screening unit. 3. Partnering with a regional cancer care institute (Dr. B. Borooah Cancer Institute - BBCI) to ensure end to end care to the patients. Program: DESH initiative in partnership with BBCI was launched in November 2017. The Mobile Cancer Screening Unit (MCSU) is fully equipped with state-of-the-art cancer screening facilities including a mammography unit. It is staffed by trained medical doctor, two nurses, a radiographer, two community mobilization officers, a counselor, a driver and a helper. Apart from the driver and the helper, the entire staff is women. In consultation with community networks, a schedule is prepared to conduct awareness programs at the community level. Subsequently, the MCSU visits the village and the staff screen the adult population over the age of 30 years for the presence of oral, breast and cervical cancer. A vehicle ferries those who are screened positive, to BBCI for diagnostic tests. The program is also supported by a helpline, which provides tele-counseling for suspected cases of cancer. Outcomes: A total of 1750 beneficiaries have been screened for oral, breast and cervical cancers through 43 screening clinics in 18 villages of Kamrup district from November 2017 through March 2018. Of them, 57% were females. 57 beneficiaries (3.25%) were screen-positive. Majority were positive for oral cancers (n=50) followed by breast and cervical cancers. Out of the 15 beneficiaries who visited BBCI, 3 were confirmed to have oral cancer. What was learned: Rural community of Kamrup district has been very receptive of the screening program with 1750 people screened in a short duration of time. Many screen-positive patients have not yet to visited the hospital for diagnostic tests, due to their financial difficulties. With financial support from the government through a special scheme, the number of screen-positive patients reaching the hospital for diagnostic tests is expected to increase substantially. DESH initiative aims to screen 15,000 individuals in the next 12 months and the results will provide better insights about the scalability and impact of the program.

Loss to follow-up of cancer patients in the poorest district of the United States.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6123-6123 ◽  
Author(s):  
Antranik Mangardich ◽  
Aleksandra Mamorska-Dyga ◽  
Doru Paul ◽  
Ghulam Khan ◽  
Svetlana Vassel ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Retention Rate ◽  
Mental Health Center ◽  
The United States ◽  
Stage At Diagnosis ◽  
South Bronx ◽  
Loss To Follow Up ◽  
Significant Difference ◽  
Cancer Types

6123 Background: Loss to follow-up (LFU) of cancer patients is a serious dilemma, and has only been narrowly studied. Lincoln Medical and Mental Health Center (LMMHC) serves South Bronx (SB), the poorest district in the nation. The purpose of this study was to assess rates of LFU and correlate it with age, sex, ethnicity, race, cancer types, and stage at diagnosis. Methods: We collected data from 1,552 patients diagnosed with invasive cancer in LMMHC between 2006-2010. The data collected were age, sex, ethnicity, race, type of cancer, stage, LFU, treatment, and vital status. Results: From the 1,552 patients, roughly 25 % were LFU, with 50% receiving some initial form of treatment. The remaining percentages are shown below (Table). A higher rate of LFU was with patients younger than 65 (OR: 1.38, 95% CI: 1.08-1.76). There was no correlation between sex and LFU. Non-Hispanics were more likely to be LFU compared to Hispanics (OR: 1.39, 95% CI: 1.07 – 1.8). Blacks were more likely to be LFU compared to non-Blacks (OR: 1.43, 95% CI: 1.12–1.82). There was no significance between LFU and stage at diagnosis. Looking at cancer specific data, colon cancer (C) and head and neck cancers (HN) had the highest percentage of LFU (30% each). There was higher LFU rate for C compared to breast cancer (B) (OR: 1.7, 95% CI: 1.03-2.8), prostate cancer (P) (OR: 1.88, 95% CI: 1.18-3.02), and lung cancer (L) (OR: 1.64 95% CI: 0.94- 2.8). HN patients were more likely LFU compared to B (OR: 2.4, 95% CI: 1.13-5.2), P (OR: 2.69, 95 % CI: 1.28-5.68), and L (OR: 2.3, 95% CI: 1.05-5.19) patients. There was no significant difference between C and HN patients in respect to LFU. Conclusions: In the SB, LFU rates are related to age, ethnicity, race, and type of cancer. Younger patients, blacks, non-Hispanics, and those with C and HN cancers were most likely to be LFU, the latter likely due to the lack of a HN surgeon at LMMHC. We hope that with focus on race, ethnicity, and cancer-specific disparities in LFU rates, we will improve the retention rate of our cancer patients in the future. [Table: see text]

scholarly journals Screening Practices among First Degree Relatives of Breast Cancer Patients in Nepal

2019 ◽  
Author(s):  
Rashmi Mulmi ◽  
Gambhir Shrestha ◽  
Surya Raj Niraula ◽  
Deepak Kumar Yadav ◽  
Paras Kumar Pokharel
Keyword(s):  
Breast Cancer ◽  
Logistic Regression ◽  
Cancer Patients ◽  
Screening Methods ◽  
Multiple Logistic Regression ◽  
Breast Cancer Patients ◽  
Screening Practices ◽  
First Degree Relatives ◽  
Regular Screening ◽  
High Level

Abstract Background Family history is a significant risk factor for development of breast cancer, particularly for women of first-degree relatives. For women at high risk for breast cancer, regular screening is the mainstay of risk management. This study aims to find out the breast cancer screening practices among first degree relatives of breast cancer patient and determine factors associated with their screening practices.Methods A cross-sectional study was carried out among 150 purposively selected first-degree female relatives of breast cancer patients undergoing treatment at B.P Koirala Memorial Cancer Hospital, aged between 20 and 60 years. A semi-structured questionnaire was used to collect data by face to face interview. Screening practices were characterized as regular screening practices performed by the respondents, which include any of these screening methods: monthly breast self-examination or clinical examination yearly at least once in 3 years or regular mammogram 1 or 2 yearly. Level of awareness was categorized into two categories ‘high level’ and ‘low level’ taking median score as the cut-off value. Chi-square tests and multiple logistic regression were used to test the association between screening practices and related factors.Results The mean age of the participants was 37.6 years (SD 10.9). A total of 38.7% had practiced regular breast screening methods. Only two-fifth of them had a high level of awareness on risk factors and warning signs of breast cancer. In multiple logistic regression, literate (OR 7.13, 95% CI 2.32-21.10), economic status above poverty line (OR 2.62, 95% CI 1.01-6.80), presence of benign breast disease (OR 5.10, 95% CI 1.31-19.84) and high perceived risk of breast cancer (OR 14.17, 95% CI 5.10-39.41) were found to be significant positive predictors of regular screening practices.Conclusions This study showed a low rate of regular screening practices among the first degree relatives of breast cancer patients. There is a need to provide comprehensive, updated, and inclusive information and support and interventions aimed at increasing awareness of the importance of healthy behaviors in cancer prevention among these high-risk groups.

THE EFFECTIVENESS OF SCREENING FOR CANCER

2017 ◽  
Vol 63 (4) ◽  
pp. 557-567
Author(s):  
Anton Barchuk ◽  
K. Gagua ◽  
S. Tarkov ◽  
A. Nefedova ◽  
Andrey Nefedov ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Colorectal Cancer ◽  
Cancer Screening ◽  
Lung Cancer Screening ◽  
Population Based ◽  
The Other ◽  
Qualitative Assessment ◽  
Screening Methods ◽  
Cancer Breast ◽  
Cancer Types

Cancer screening literature was discussed in this review publication. Broad spectrum of studies was used to make conclusion about effectiveness of screening methods in reaching its major objectives, perspective of screening methods for several cancer types were also discussed. Qualitative assessment of studies was done. Cervical cancer, breast cancer and colorectal cancer screening was proved to be effective. Effectiveness of prostate and lung cancer screening as well as population-based stomach cancer prevention is also discussed. Negative and inconclusive results of screening studies of the other cancer types were also mentioned and perspectives for future diagnostics option for cancer screening were given.

scholarly journals Association between use of urgent suspected cancer referral and mortality and stage at diagnosis: a 5-year national cohort study

2020 ◽  
Vol 70 (695) ◽  
pp. e389-e398 ◽  
Author(s):  
Thomas Round ◽  
Carolynn Gildea ◽  
Mark Ashworth ◽  
Henrik Møller
Keyword(s):  
Colorectal Cancer ◽  
Cohort Study ◽  
Cancer Patients ◽  
Late Stage ◽  
Significant Proportion ◽  
Cancer Type ◽  
Stage At Diagnosis ◽  
Risk Of Death ◽  
Urgent Referral ◽  
National Cohort

BackgroundThere is considerable variation between GP practices in England in their use of urgent referral pathways for suspected cancer.AimTo determine the association between practice use of urgent referral and cancer stage at diagnosis and cancer patient mortality, for all cancers and the most common types of cancer (colorectal, lung, breast, and prostate).Design and settingNational cohort study of 1.4 million patients diagnosed with cancer in England between 2011 and 2015.MethodThe cohort was stratified according to quintiles of urgent referral metrics. Cox proportional hazards regression was used to quantify risk of death, and logistic regression to calculate odds of late-stage (III/IV) versus early-stage (I/II) cancers in relation to referral quintiles and cancer type.ResultsCancer patients from the highest referring practices had a lower hazard of death (hazard ratio [HR] = 0.96; 95% confidence interval [CI] = 0.95 to 0.97), with similar patterns for individual cancers: colorectal (HR = 0.95; CI = 0.93 to 0.97); lung (HR = 0.95; CI = 0.94 to 0.97); breast (HR = 0.96; CI = 0.93 to 0.99); and prostate (HR = 0.88; CI = 0.85 to 0.91). Similarly, for cancer patients from these practices, there were lower odds of late-stage diagnosis for individual cancer types, except for colorectal cancer.ConclusionHigher practice use of referrals for suspected cancer is associated with lower mortality for the four most common types of cancer. A significant proportion of the observed mortality reduction is likely due to earlier stage at diagnosis, except for colorectal cancer. This adds to evidence supporting the lowering of referral thresholds and consequent increased use of urgent referral for suspected cancer.

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