scholarly journals Socioeconomic Environment and Survival in Patients with Digestive Cancers: A French Population-Based Study

Cancers ◽  
2021 ◽  
Vol 13 (20) ◽  
pp. 5156
Author(s):  
Laure Tron ◽  
Mathieu Fauvernier ◽  
Anne-Marie Bouvier ◽  
Michel Robaszkiewicz ◽  
Véronique Bouvier ◽  
...  
Keyword(s):  
Bile Duct ◽  
Excess Mortality ◽  
Social Inequalities ◽  
Cancer Survival ◽  
Population Based ◽  
Digestive Cancer ◽  
Net Survival ◽  
Mortality Hazard ◽  
Digestive Cancers

Social inequalities are an important prognostic factor in cancer survival, but little is known regarding digestive cancers specifically. We aimed to provide in-depth analysis of the contextual social disparities in net survival of patients with digestive cancer in France, using population-based data and relevant modeling. Digestive cancers (n = 54,507) diagnosed between 2006–2009, collected through the French network of cancer registries, were included (end of follow-up 06/30/2013). Social environment was assessed by the European Deprivation Index. Multidimensional penalized splines were used to model excess mortality hazard. We found that net survival was significantly worse for individuals living in a more deprived environment as compared to those living in a less deprived one for esophageal, liver, pancreatic, colon and rectal cancers, and for stomach and bile duct cancers among females. Excess mortality hazard was up to 57% higher among females living in the most deprived areas (vs. least deprived) at 1 year of follow-up for bile duct cancer, and up to 21% higher among males living in the most deprived areas (vs. least deprived) regarding colon cancer. To conclude, we provide a better understanding of how the (contextual) social gradient in survival is constructed, offering new perspectives for tackling social inequalities in digestive cancer survival.

scholarly journals Reference-adjusted and standardized all-cause and crude probabilities as an alternative to net survival in population-based cancer studies

2020 ◽  
Vol 49 (5) ◽  
pp. 1614-1623
Author(s):  
Paul C Lambert ◽  
Therese M-L Andersson ◽  
Mark J Rutherford ◽  
Tor Åge Myklebust ◽  
Bjørn Møller
Keyword(s):  
Excess Mortality ◽  
Cancer Survival ◽  
Age Distribution ◽  
Relative Survival ◽  
Reference Population ◽  
Mortality Rates ◽  
Population Based ◽  
Population Groups ◽  
Net Survival ◽  
Common Reference

Abstract Background In population-based cancer survival studies, the most common measure to compare population groups is age-standardized marginal relative survival, which under assumptions can be interpreted as marginal net survival; the probability of surviving if it was not possible to die of causes other than the cancer under study (if the age distribution was that of a common reference population). The hypothetical nature of this definition has led to confusion and incorrect interpretation. For any measure to be fair in terms of comparing cancer survival, then differences between population groups should depend only on differences in excess mortality rates due to the cancer and not differences in other-cause mortality rates or differences in the age distribution. Methods We propose using crude probabilities of death and all-cause survival which incorporate reference expected mortality rates. This makes it possible to obtain marginal crude probabilities and all-cause probability of death that only differ between population groups due to excess mortality rate differences. Choices have to be made regarding what reference mortality rates to use and what age distribution to standardize to. Results We illustrate the method and some potential choices using data from England for men diagnosed with melanoma. Various marginal measures are presented and compared. Conclusions The new measures help enhance understanding of cancer survival and are a complement to the more commonly used measures.

scholarly journals Does access to care play a role in liver cancer survival? The ten-year (2006–2015) experience from a population-based cancer registry in Southern Italy

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Walter Mazzucco ◽  
Francesco Vitale ◽  
Sergio Mazzola ◽  
Rosalba Amodio ◽  
Maurizio Zarcone ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Access To Care ◽  
Cancer Registry ◽  
Health Care Services ◽  
Cancer Survival ◽  
Developed Countries ◽  
Population Based ◽  
Easy Access ◽  
Net Survival ◽  
Poor Access

Abstract Background Hepatocellular carcinoma (HCC) is the most frequent primary invasive cancer of the liver. During the last decade, the epidemiology of HCC has been continuously changing in developed countries, due to more effective primary prevention and to successful treatment of virus-related liver diseases. The study aims to examine survival by level of access to care in patients with HCC, for all patients combined and by age. Methods We included 2018 adult patients (15–99 years) diagnosed with a primary liver tumour, registered in the Palermo Province Cancer Registry during 2006–2015, and followed-up to 30 October 2019. We obtained a proxy measure of access to care by linking each record to the Hospital Discharge Records and the Ambulatory Discharge Records. We estimated net survival up to 5 years after diagnosis by access to care (“easy access to care” versus “poor access to care”), using the Pohar-Perme estimator. Estimates were age-standardised using International Cancer Survival Standard (ICSS) weights. We also examined survival by access to care and age (15–64, 65–74 and ≥ 75 years). Results Among the 2018 patients, 62.4% were morphologically verified and 37.6% clinically diagnosed. Morphologically verified tumours were more frequent in patients aged 65–74 years (41.6%), while tumours diagnosed clinically were more frequent in patients aged 75 years or over (50.2%). During 2006–2015, age-standardised net survival was higher among HCC patients with “easy access to care” than in those with “poor access to care” (68% vs. 48% at 1 year, 29% vs. 11% at 5 years; p < 0.0001). Net survival up to 5 years was higher for patients with “easy access to care” in each age group (p < 0.0001). Moreover, survival increased slightly for patients with easier access to care, while it remained relatively stable for patients with poor access to care. Conclusions During 2006–2015, 5-year survival was higher for HCC patients with easier access to care, probably reflecting progressive improvement in the effectiveness of health care services offered to these patients. Our linkage algorithm could provide valuable evidence to support healthcare decision-making in the context of the evolving epidemiology of hepatocellular carcinoma.

scholarly journals Improvement in childhood cancer survival in Lithuania over three decades

2020 ◽  
Vol 27 (1) ◽  
pp. 1-9
Author(s):  
Jelena Rascon ◽  
Giedrė Smailytė
Keyword(s):  
Childhood Cancer ◽  
Cancer Survival ◽  
Survival Rates ◽  
Population Based ◽  
Early Years ◽  
University Hospital ◽  
Entire Cohort ◽  
Background Population ◽  
Childhood Cancer Survival

Background. Population-based EUROCARE-5 studies demonstrated that childhood cancer survival rates in Lithuania were 10–20% lower than the European mean. We aimed to analyse the change in the outcome of treatment of paediatric malignancies in Lithuania over 30 years. Methods. A single-centre retrospective analysis of children below 18 years of age treated for cancer at Vilnius University Hospital Santaros Klinikos between 1982 and 2011 was carried out. The minimal requirement of 5-year follow-up after diagnosis was specified for survival estimation. The vital status was assessed using data from the population-based Lithuanian Cancer Registry. To evaluate changes over time, the entire cohort was split into three groups according to the time of diagnosis: 1982–1991, 1992–2001, and 2002–2011. Results. A total of 1268 children met the inclusion criteria. The shortest median follow-up was 8.9 (IQR 6.4–11.5) years for patients treated in the third decade. The 5-year overall survival of the entire cohort increased from 37.3% (95% CI 30.2–44.3) in 1982–1991 to 70.7% (95% CI 66.4–74.1) in 2002–2011 (p < 0.0001). The same trend was evident when calculated separately for leukaemia (p < 0.0001), lymphoma (p < 0.0005), and solid tumours (p < 0.004). The percentage of cure rose from zero in the early years of the period analysed to 80% in 2010 and 2011. The improvement in the treatment outcome was attributable to the reduction of treatment-related mortality from 45.8% in 1982–1991 to 12.4% in 2002–2011 and disease recurrence from 30.4% to 19.6% for the same periods, respectively. Conclusions. Significant progress in the cure rate of children treated for cancer at our institution was observed over 30 years. Collaborative national and international clinical and research efforts are crucial to ensure further advances in care and cure.

scholarly journals The Impact of Follow-up Type and Missed Deaths on Population-Based Cancer Survival Studies for Hispanics and Asians

2014 ◽  
Vol 2014 (49) ◽  
pp. 210-217 ◽  
Author(s):  
P. S. Pinheiro ◽  
C. R. Morris ◽  
L. Liu ◽  
T. J. Bungum ◽  
S. F. Altekruse
Keyword(s):  
Cancer Survival ◽  
Population Based ◽  
Survival Studies ◽  
The Impact

scholarly journals The impact of timely cancer diagnosis on age disparities in colon cancer survival in New Zealand

2020 ◽  
Author(s):  
Sophie Pilleron ◽  
Camille Maringe ◽  
Hadrien Charvat ◽  
June Atkinson ◽  
Eva JA Morris ◽  
...  
Keyword(s):  
Colon Cancer ◽  
New Zealand ◽  
Cancer Diagnosis ◽  
Older Patients ◽  
Excess Mortality ◽  
Cancer Survival ◽  
Population Based ◽  
Age At Diagnosis ◽  
Age Disparities ◽  
The Impact

Objective: We described the role of patient-related and clinical factors on age disparities in colon cancer survival among patients aged 50-99 using New Zealand population-based cancer registry data linked to hospitalization data. Design: We included new colon cancer cases diagnosed between 1 January 2006 and 31 July 2017, followed up to 31 December 2019. We linked these cases to hospitalisation data for the five years before the cancer diagnosis. We modelled the effect of age at diagnosis, sex, deprivation, comorbidity, and route to diagnosis on colon cancer survival by stage at diagnosis (localized, regional, distant, missing). Results: Net survival decreased as the age at diagnosis increased, notably in advanced stages and missing stage. The excess mortality in older patients was minimal for localised cancers, maximal during the first six months for regional cancers, the first 18 months for distant cancers, and over the three years for missing stages. The age pattern of the excess mortality hazard varied according to sex for distant cancers, the route to diagnosis for regional and distant cancers, and comorbidity for cancer with missing stages. Conclusion: The present population-based study shows that factors reflecting timeliness of cancer diagnosis most affected the difference in survival between middle-aged and older patients, probably by impacting treatment strategy. Because of the high risk of poor outcomes related to treatment in older patients, efforts made to improve earlier diagnosis in older patients are likely to help reduce age disparities in colon cancer survival in New Zealand.

scholarly journals Correcting inaccurate background mortality in excess hazard models through breakpoints

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Robert Darlin Mba ◽  
◽  
Juste Aristide Goungounga ◽  
Nathalie Grafféo ◽  
Roch Giorgi
Keyword(s):  
Excess Mortality ◽  
Cancer Survival ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Relative Survival ◽  
Population Based ◽  
Deprivation Level ◽  
Parameter Estimates ◽  
Background Mortality ◽  
Proposed Model

Abstract Background Methods for estimating relative survival are widely used in population-based cancer survival studies. These methods are based on splitting the observed (the overall) mortality into excess mortality (due to cancer) and background mortality (due to other causes, as expected in the general population). The latter is derived from life tables usually stratified by age, sex, and calendar year but not by other covariates (such as the deprivation level or the socioeconomic status) which may lack though they would influence background mortality. The absence of these covariates leads to inaccurate background mortality, thus to biases in estimating the excess mortality. These biases may be avoided by adjusting the background mortality for these covariates whenever available. Methods In this work, we propose a regression model of excess mortality that corrects for potentially inaccurate background mortality by introducing age-dependent multiplicative parameters through breakpoints, which gives some flexibility. The performance of this model was first assessed with a single and two breakpoints in an intensive simulation study, then the method was applied to French population-based data on colorectal cancer. Results The proposed model proved to be interesting in the simulations and the applications to real data; it limited the bias in parameter estimates of the excess mortality in several scenarios and improved the results and the generalizability of Touraine’s proportional hazards model. Conclusion Finally, the proposed model is a good approach to correct reliably inaccurate background mortality by introducing multiplicative parameters that depend on age and on an additional variable through breakpoints.

scholarly journals Ethnicity, deprivation and screening: survival from breast cancer among screening-eligible women in the West Midlands diagnosed from 1989 to 2011

2015 ◽  
Vol 113 (3) ◽  
pp. 548-555 ◽  
Author(s):  
M Morris ◽  
L M Woods ◽  
N Rogers ◽  
E O'Sullivan ◽  
O Kearins ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Social Inequalities ◽  
Cancer Survival ◽  
Breast Cancer Survival ◽  
Net Survival ◽  
Black And White ◽  
Cancer Registry Data ◽  
West Midlands ◽  
Ethnicity Data ◽  
Screening History

Abstract Background: Social inequalities in breast cancer survival are smaller when the cancer is screen-detected. We examined survival from screen-detected and non screen-detected breast cancer by ethnicity and deprivation. Methods: Cancer registry data for 20 283 women aged 50–70 years, diagnosed between 1989–2011 and invited for screening, were linked with screening and ethnicity data. We examined Asian, Black and White groups, less deprived and middle/more deprived women. Net survival was estimated using ethnic- and deprivation-specific life tables. Estimates were corrected for lead-time bias and over-diagnosis. Results: Net survival varied by screening history. No significant differences in survival were found by ethnicity. Five-year net survival was 90.0% (95% CI, 89.3–90.8%) in less deprived groups and 86.7% (85.9–87.4%) among middle/more deprived women. Screening benefitted all ethnic and both deprivation groups. Whether screen-detected or not, more deprived women had significantly poorer outcomes: 5-year net survival was 78.0% (76.7–79.2%) for deprived women who were not screen-detected compared with 94.0% (93.1–95.1%) for less deprived women who were screen-detected. Conclusions: The three ethnic groups differed little in their breast cancer survival. Although screening confers a survival benefit to all, there are still wide disparities in survival by deprivation. More needs to be done to determine what underlies these differences and tackle them.

scholarly journals The Proportion Cured of Patients with Resected Stage II–III Cutaneous Melanoma in Sweden

Cancers ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 2456
Author(s):  
Hanna Eriksson ◽  
Deborah Utjés ◽  
Roger Bagge Olofsson ◽  
Peter Gillgren ◽  
Karolin Isaksson ◽  
...  
Keyword(s):  
Cutaneous Melanoma ◽  
Excess Mortality ◽  
Relative Survival ◽  
Population Based ◽  
Stage Ii ◽  
Survival Times ◽  
Stage Iiia ◽  
Stage Iiic ◽  
Resected Stage

Background: Cure proportion represents the proportion of patients who experience the same mortality rate as the general population and can be estimated together with the survival of the proportion experiencing excess mortality (the uncured). The aim was to estimate the cure proportions and survival among uncured stage II–III cutaneous melanoma (CM) patients. Methods: 1- and 5-year relative survival ratios, cure proportions and the median survival times of uncured stage II–III CM patients in Sweden (n = 6466) were calculated based on data from the nationwide population-based Swedish Melanoma Register 2005–2013 with a follow-up through 2018. Results: Stages IIB and IIC showed significant differences in standardized cure proportions vs. stage IIA CM (0.80 (95% CI 0.77–0.83) stage IIA; 0.62 (95% CI 0.59–0.66) stage IIB; 0.42 (95% CI 0.37–0.46) for stage IIC). Significant differences in standardized cure proportions were found for stages IIIB and IIIC-D CM vs. stage IIIA (0.76 (95% CI 0.68–0.84) stage IIIA; 0.52 (95% CI 0.45–0.59) stage IIIB; 0.35 (95% CI 0.30–0.39) for stage IIIC–D). Conclusions: The results are emphasizing the poor prognosis with low proportions cured by surgery only for sub-groups of stage II–III CM, specifically within stages IIB–C CM.

scholarly journals Excess Mortality by Multimorbidity, Socioeconomic, and Healthcare Factors, amongst Patients Diagnosed with Diffuse Large B-Cell or Follicular Lymphoma in England

Cancers ◽  
2021 ◽  
Vol 13 (22) ◽  
pp. 5805
Author(s):  
Matthew James Smith ◽  
Aurélien Belot ◽  
Matteo Quartagno ◽  
Miguel Angel Luque Fernandez ◽  
Audrey Bonaventure ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
B Cell ◽  
Excess Mortality ◽  
Population Based ◽  
Cancer Registry Data ◽  
Mortality Hazard ◽  
Comorbidity Status ◽  
Imputation Approach ◽  
Large B Cell ◽  
Deprived Areas

(1) Background: Socioeconomic inequalities of survival in patients with lymphoma persist, which may be explained by patients’ comorbidities. We aimed to assess the association between comorbidities and the survival of patients diagnosed with diffuse large B-cell (DLBCL) or follicular lymphoma (FL) in England accounting for other socio-demographic characteristics. (2) Methods: Population-based cancer registry data were linked to Hospital Episode Statistics. We used a flexible multilevel excess hazard model to estimate excess mortality and net survival by patient’s comorbidity status, adjusted for sociodemographic, economic, and healthcare factors, and accounting for the patient’s area of residence. We used the latent normal joint modelling multiple imputation approach for missing data. (3) Results: Overall, 15,516 and 29,898 patients were diagnosed with FL and DLBCL in England between 2005 and 2013, respectively. Amongst DLBCL and FL patients, respectively, those in the most deprived areas showed 1.22 (95% confidence interval (CI): 1.18–1.27) and 1.45 (95% CI: 1.30–1.62) times higher excess mortality hazard compared to those in the least deprived areas, adjusted for comorbidity status, age at diagnosis, sex, ethnicity, and route to diagnosis. (4) Conclusions: Deprivation is consistently associated with poorer survival among patients diagnosed with DLBCL or FL, after adjusting for co/multimorbidities. Comorbidities and multimorbidities need to be considered when planning public health interventions targeting haematological malignancies in England.

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