Cancer Epidemiology最新文献_第6页

Modifiable and non-modifiable risk factors of early-onset colorectal cancer: National Health Interview Survey analysis 早发结直肠癌的可改变和不可改变风险因素：全国健康访谈调查分析。

IF 2.4 3区医学 Q3 ONCOLOGY

Cancer Epidemiology

Pub Date : 2024-10-08 DOI: 10.1016/j.canep.2024.102682

Yahan Zhang, Ange Lu, Hyeun Ah Kang

Background and aims

Although the incidence of colorectal cancer (CRC) diagnosed in individuals younger than 50 years, early-onset CRC (EO-CRC), is rapidly increasing, the risk factors for EO-CRC are still being identified. This study aimed to confirm the modifiable and non-modifiable characteristics identified as risk factors for EO-CRC.

Methods

This cross-sectional study used 2004–2018 National Health Interview Survey (NHIS) data, which provides comprehensive health information gathered from national annual household interview surveys. Demographic, clinical, and behavioral characteristics of EO-CRC patients were compared with those without. In addition, their non-age-related characteristics (gender, race/ethnicity, region, body mass index [BMI], alcohol consumption, and smoking status) were compared with individuals with average-onset CRC (AO-CRC). For both comparisons, multivariable logistic regression analyses were performed.

Results

We identified 156 patients with EO-CRC, 204,846 with non-CRC, and 1972 with AO-CRC. Comparison between the EO-CRC and the non-CRC groups showed that higher odds of having EO-CRC was associated with older age (Odds Ratio [OR]=1.11, 95 % CI=1.08–1.14, p<0.001), living in the Midwest (vs. South) (OR=1.64, 95 % CI=1.06–2.55, p=0.03), and history of alcohol consumption (vs. lifetime abstainer) (OR=2.09, 95 % CI=1.01–4.36, p=0.049). Lower odds of having EO-CRC were associated with being Hispanic (OR=0.43, 95 % CI=0.22–0.84, p=0.01) or Asian (OR=0.38, 95 % CI=0.16–0.92, p=0.03) (vs. non-Hispanic White) and having moderate or vigorous physical activities (vs. no activity) (OR=0.58, 95 % CI=0.34–0.999, p=0.0496 and OR=0.34; 95 % CI=0.21–0.55, p<0.0001, respectively). Compared with patients with AO-CRC, patients with EO-CRC were more likely to be Hispanic (vs. non-Hispanic White) (OR=2.21, 95 % CI=1.13–4.33, p=0.02).

Conclusion

This study verified several modifiable (i.e., alcohol consumption and physical activity) and non-modifiable (i.e., race/ethnicity) risk factors while also discovering a new factor (i.e., geographical region) associated with EO-CRC.

背景和目的：尽管在50岁以下的人群中确诊的结直肠癌（CRC），即早发性结直肠癌（EO-CRC）的发病率正在迅速上升，但EO-CRC的风险因素仍在不断确定之中。本研究旨在确认作为 EO-CRC 危险因素的可改变和不可改变特征：这项横断面研究使用了 2004-2018 年全国健康访谈调查（NHIS）数据，该数据提供了从全国年度家庭访谈调查中收集的全面健康信息。将 EO-CRC 患者的人口、临床和行为特征与非 EO-CRC 患者进行了比较。此外，还将他们与年龄无关的特征（性别、种族/民族、地区、体重指数[BMI]、饮酒量和吸烟状况）与平均发病型 CRC（AO-CRC）患者进行了比较。两种比较均进行了多变量逻辑回归分析：结果：我们发现了 156 例 EO-CRC 患者、204846 例非 CRC 患者和 1972 例 AO-CRC 患者。EO-CRC 组和非 EO-CRC 组之间的比较显示，年龄越大，患 EO-CRC 的几率越高（Odds Ratio [OR]=1.11, 95 % CI=1.08-1.14, pConclusion）：这项研究验证了几个可改变（即饮酒和体育锻炼）和不可改变（即种族/民族）的风险因素，同时还发现了一个与 EO-CRC 相关的新因素（即地理区域）。

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引用次数: 0

Beyond the urban-rural divide: Exploring spatial variations in breast cancer outcomes in Queensland, Australia 超越城乡差别：探索澳大利亚昆士兰州乳腺癌结果的空间差异。

IF 2.4 3区医学 Q3 ONCOLOGY

Cancer Epidemiology

Pub Date : 2024-10-03 DOI: 10.1016/j.canep.2024.102681

Kou Kou , Jessica Cameron , Paramita Dasgupta , Aiden Price , Hao Chen , Derrick Lopez , Kerrie Mengersen , Sandi Hayes , Peter Baade

Background

Breast cancer is the most commonly diagnosed cancer among women worldwide. While previous studies have reported urban and rural differences in breast cancer outcomes, the level of heterogeneity within these broad regions is currently unknown.

Methods

Population-level data from Queensland Cancer Register including 58,679 women aged at least 20 years who were diagnosed with breast cancer in Queensland, Australia, 2000–2019 were linked to BreastScreen Queensland and Queensland Hospital Admitted Patients Data Collection to estimate five breast cancer outcomes: incidence, proportion of localised disease and screen-detected cases (via public-funded program), surgical rates, and 5-year survival. Bayesian spatial models were used to smooth outcomes across 512–517 small areas in Queensland.

Results

The incidence of breast cancer was not proportionally distributed, with urban regions having higher rates. Less than half (47 %) of women were diagnosed with localised disease, 91 % had surgery, with five-year relative survival of 92 %. There was no evidence of geographic variation in the proportion of localised disease, surgical rates, or survival over Queensland. Publicly-funded screening detected 38 % of cases, with lower proportion of screen-detected cases observed in Queensland’s urbanised south-east corner.

Conclusion

Although the disparities in health outcomes faced by Australians living in rural areas have received increased attention, this study found limited evidence for spatial variation in breast cancer outcomes along the continuum of care across Queensland. These results suggest the detection and management practices for breast cancer may provide an achievable benchmark for other cancer types in reducing the geographical disparity in cancer outcomes.

背景：乳腺癌是全球妇女中最常见的癌症。虽然之前的研究报告了城市和农村在乳腺癌结果上的差异，但目前还不清楚这些大区域内的异质性程度：方法：将 2000-2019 年期间澳大利亚昆士兰癌症登记册（包括 58,679 名年龄在 20 岁以上、被诊断患有乳腺癌的女性）中的人口级数据与昆士兰乳腺癌筛查（BreastScreen Queensland）和昆士兰医院住院病人数据收集（Queensland Hospital Admitted Patients Data Collection）联系起来，以估计五种乳腺癌结果：发病率、局部疾病和筛查发现病例（通过公共资助项目）的比例、手术率和 5 年生存率。贝叶斯空间模型用于平滑昆士兰州 512-517 个小区域的结果：结果：乳腺癌的发病率并不是按比例分布的，城市地区的发病率更高。不到一半（47%）的妇女被诊断为局部疾病，91%的妇女接受了手术，五年相对生存率为 92%。没有证据表明昆士兰州的局部疾病比例、手术率或存活率存在地域差异。公费筛查发现了 38% 的病例，昆士兰城市化的东南角地区筛查发现的病例比例较低：尽管生活在农村地区的澳大利亚人所面临的健康结果差异已受到越来越多的关注，但本研究发现，在昆士兰州，乳腺癌治疗结果的空间差异证据有限。这些结果表明，乳腺癌的检测和管理方法可为其他癌症类型提供一个可实现的基准，以减少癌症结果的地域差异。

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引用次数: 0

Trends in incidence, treatment modalities and prognosis of esophageal adenocarcinoma in the US population 美国人口中食管腺癌的发病率、治疗方式和预后趋势。

IF 2.4 3区医学 Q3 ONCOLOGY

Cancer Epidemiology

Pub Date : 2024-10-03 DOI: 10.1016/j.canep.2024.102683

Zhuoyang Yu , Tong Chen , Haoyu Peng , Anyuan Li , Yutong Wei , Shiyu Xiao

Background

Esophageal adenocarcinoma (EAC) was the predominant subtype of esophageal cancer in the Western population. However, an updated and comprehensive analysis of epidemiologic, clinical, and prognostic characteristics of esophageal adenocarcinoma is lacking.

Materials and methods

This was a population-based cohort study using the Surveillance Epidemiology and End-Results (SEER) Database. Patients diagnosed with EAC between 1988 and 2020 were included. Incidence trends, clinical characteristics, treatment patterns, and relative survival were systematically analyzed.

Results

The overall age-standardized incidence rate of EAC significantly increased from 1.7 per 100000 persons in 1988 to 3.6 per 100000 persons in 2020. There were no significant changes in the distribution of age group, sex, and primary site of EAC over time. However, the proportion of EAC clinically staged as I or II decreased from 35.1 % to 27.9 %. Over time, palliative chemotherapy in metastatic EAC increased from 26.7 % to 41.3 %, combination therapy was still the main treatment strategy for nonmetastatic EAC. Despite the 5-year survival rate was less than 20 %, 1-year survival has experienced a moderate increase from 46.7 % to 53.7 %. Specifically, 1-year survival rate for nonmetastatic EAC undergoing surgery only experienced a significant increase from 80.2 % in 2004–2006 to 94.7 % in 2019–2020. For metastatic EAC, obvious improvement in 1-year survival rate was observed in those treated with systematic therapy (from 26.6 % in 2004–2006 to 41.2 % in 2019–2020). In the multivariable analysis, older age, male sex, lower household income, living without a partner, advanced TNM stage, and receiving no cancer treatment were significantly associated with poor survival.

Conclusion

In summary, this population-based study of EAC patients in the US showed an increase in incidence, a shift in treatment modalities for metastatic EAC, and moderately improved 1-year survival. The search for more effective surveillance and treatment strategies should be continued in the future.

背景：食管腺癌（EAC）是西方人群中食管癌的主要亚型。然而，目前还缺乏对食管腺癌的流行病学、临床和预后特征的最新全面分析：这是一项基于人群的队列研究，使用的是监测、流行病学和最终结果（SEER）数据库。研究纳入了 1988 年至 2020 年期间确诊为 EAC 的患者。研究对发病趋势、临床特征、治疗模式和相对存活率进行了系统分析：结果：EAC的总体年龄标准化发病率从1988年的每10万人1.7例显著上升至2020年的每10万人3.6例。随着时间的推移，EAC的年龄组、性别和原发部位分布没有明显变化。不过，临床分期为 I 或 II 期的 EAC 比例从 35.1% 降至 27.9%。随着时间的推移，转移性EAC的姑息化疗比例从26.7%上升到41.3%，但联合疗法仍是非转移性EAC的主要治疗策略。尽管 5 年生存率不到 20%，但 1 年生存率却从 46.7% 增加到 53.7%。具体而言，接受手术治疗的非转移性 EAC 的 1 年生存率仅从 2004-2006 年的 80.2% 显著增加到 2019-2020 年的 94.7%。对于转移性 EAC，接受系统治疗者的 1 年生存率明显提高（从 2004-2006 年的 26.6% 提高到 2019-2020 年的 41.2%）。在多变量分析中，年龄较大、性别为男性、家庭收入较低、无伴侣生活、TNM分期较晚以及未接受癌症治疗与生存率较低显著相关：总之，这项针对美国 EAC 患者的人群研究表明，EAC 的发病率有所上升，转移性 EAC 的治疗方式有所转变，1 年生存率略有提高。未来应继续寻找更有效的监测和治疗策略。

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引用次数: 0

Incident cardiovascular disease risk among older Asian, Native Hawaiian and Pacific Islander liver cancer survivors 亚裔、夏威夷原住民和太平洋岛民老年肝癌幸存者的心血管疾病发病风险。

IF 2.4 3区医学 Q3 ONCOLOGY

Cancer Epidemiology

Pub Date : 2024-10-02 DOI: 10.1016/j.canep.2024.102680

Jing Wang , Yancen Pan , Chun-Pin Esther Chang , Anees Daud , Randa Tao , Mia Hashibe

Background

Cardiovascular disease (CVD) is a significant global health concern, particularly among Asian, Native Hawaiian, and Pacific Islander (ANHPI) communities that face unique health challenges. Liver cancer disproportionately affects ANHPI populations and has intricate associations with CVD risks due to shared pathophysiological mechanisms and metabolic disturbances. However, the specific CVD risk profile of ANHPI liver cancer patients remains poorly understood.

Methods

Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified and matched 1150 ANHPI and 2070 Non-Hispanic White (NHW) liver cancer patients diagnosed between 2000 and 2017. We used the Fine-Gray sub-distribution hazard model to estimate hazard ratios (HRs) and 95 % confidence intervals (95 % CIs) for CVD risks, including ischemic heart disease (IHD), heart failure, and stroke, among ANHPI liver cancer patients compared to NHW counterparts and among ANHPI subgroups.

Results

ANHPI liver cancer patients demonstrated a lower risk of IHD compared to NHW counterparts (HR, 0.65, 95 % CI, 0.50, 0.86), aligning with broader trends. Subgroup analysis revealed notable heterogeneity within ANHPI populations, with Southeast Asian (HR, 0.65, 95 % CI, 0.42, 1.00) and Chinese patients (HR, 0.53, 95 % CI, 0.33–0.83) exhibiting lower IHD risks compared to their NHW counterparts. However, Native Hawaiian and Pacific Islander liver cancer patients showed elevated risks of heart failure (HR, 3.16, 95 % CI, 1.35–7.39) and IHD (HR, 5.64, 95 % CI, 2.19–14.53) compared to their Chinese counterparts.

Conclusion

Our study highlights the complexity of CVD risks among ANHPI liver cancer patients. Addressing these disparities is crucial for improving cardiovascular outcomes and reducing the burden of CVD among ANHPI liver cancer patients.

背景：心血管疾病（CVD）是全球关注的重大健康问题，尤其是在面临独特健康挑战的亚裔、夏威夷原住民和太平洋岛民（ANHPI）群体中。肝癌不成比例地影响着亚裔夏威夷及太平洋岛民群体，由于共同的病理生理机制和代谢紊乱，肝癌与心血管疾病风险有着错综复杂的联系。然而，ANHPI 肝癌患者的具体心血管疾病风险概况仍鲜为人知：我们利用监测、流行病学和最终结果（SEER）-医疗保险数据，确定并匹配了 1150 名 ANHPI 和 2070 名在 2000 年至 2017 年期间确诊的非西班牙裔白人（NHW）肝癌患者。我们使用 Fine-Gray 亚分布危险模型估算了 ANHPI 肝癌患者与 NHW 患者以及 ANHPI 亚组之间的心血管疾病（包括缺血性心脏病 (IHD)、心力衰竭和中风）风险的危险比 (HRs) 和 95 % 置信区间 (95 % CIs)：ANHPI肝癌患者的IHD风险低于NHW肝癌患者（HR, 0.65, 95 % CI, 0.50, 0.86），与更广泛的趋势一致。亚组分析显示，ANHPI人群内部存在明显的异质性，东南亚（HR，0.65，95 % CI，0.42，1.00）和中国患者（HR，0.53，95 % CI，0.33-0.83）的IHD风险低于NHW人群。然而，与华裔患者相比，夏威夷原住民和太平洋岛民肝癌患者发生心力衰竭（HR，3.16，95 % CI，1.35-7.39）和IHD（HR，5.64，95 % CI，2.19-14.53）的风险较高：我们的研究强调了ANHPI肝癌患者心血管疾病风险的复杂性。结论：我们的研究凸显了非裔美国人肝癌患者心血管疾病风险的复杂性，解决这些差异对于改善非裔美国人肝癌患者的心血管疾病预后和减轻心血管疾病负担至关重要。

{"title":"Incident cardiovascular disease risk among older Asian, Native Hawaiian and Pacific Islander liver cancer survivors","authors":"Jing Wang , Yancen Pan , Chun-Pin Esther Chang , Anees Daud , Randa Tao , Mia Hashibe","doi":"10.1016/j.canep.2024.102680","DOIUrl":"10.1016/j.canep.2024.102680","url":null,"abstract":"<div><h3>Background</h3><div>Cardiovascular disease (CVD) is a significant global health concern, particularly among Asian, Native Hawaiian, and Pacific Islander (ANHPI) communities that face unique health challenges. Liver cancer disproportionately affects ANHPI populations and has intricate associations with CVD risks due to shared pathophysiological mechanisms and metabolic disturbances. However, the specific CVD risk profile of ANHPI liver cancer patients remains poorly understood.</div></div><div><h3>Methods</h3><div>Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified and matched 1150 ANHPI and 2070 Non-Hispanic White (NHW) liver cancer patients diagnosed between 2000 and 2017. We used the Fine-Gray sub-distribution hazard model to estimate hazard ratios (HRs) and 95 % confidence intervals (95 % CIs) for CVD risks, including ischemic heart disease (IHD), heart failure, and stroke, among ANHPI liver cancer patients compared to NHW counterparts and among ANHPI subgroups.</div></div><div><h3>Results</h3><div>ANHPI liver cancer patients demonstrated a lower risk of IHD compared to NHW counterparts (HR, 0.65, 95 % CI, 0.50, 0.86), aligning with broader trends. Subgroup analysis revealed notable heterogeneity within ANHPI populations, with Southeast Asian (HR, 0.65, 95 % CI, 0.42, 1.00) and Chinese patients (HR, 0.53, 95 % CI, 0.33–0.83) exhibiting lower IHD risks compared to their NHW counterparts. However, Native Hawaiian and Pacific Islander liver cancer patients showed elevated risks of heart failure (HR, 3.16, 95 % CI, 1.35–7.39) and IHD (HR, 5.64, 95 % CI, 2.19–14.53) compared to their Chinese counterparts.</div></div><div><h3>Conclusion</h3><div>Our study highlights the complexity of CVD risks among ANHPI liver cancer patients. Addressing these disparities is crucial for improving cardiovascular outcomes and reducing the burden of CVD among ANHPI liver cancer patients.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"93 ","pages":"Article 102680"},"PeriodicalIF":2.4,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Mapping the patient journey and treatment patterns in early-stage (stage I-III) non-small cell lung cancer 绘制早期（I-III 期）非小细胞肺癌患者的病程和治疗模式图。

IF 2.4 3区医学 Q3 ONCOLOGY

Cancer Epidemiology

Pub Date : 2024-10-01 DOI: 10.1016/j.canep.2024.102678

Sarah Sharman Moser , Shira Yaari , Lior Apter , Bernadette Poellinger , Milan Rheenen , Ashwini Arunachalam , Gabriel Chodick , Moshe Hoshen , Sivan Gazit , Nava Siegelmann-Danieli

Introduction

We map the patient journey from symptom onset to intervention and describe primary treatment in a retrospective population-based cohort study of patients in a large healthcare-provider.

Methods

Newly diagnosed adult patients diagnosed with stages I-III non-small cell lung cancer (NSCLC) between 2016 and 2019 were identified from the Israel National Cancer Registry and chart review was performed to extract de-identified data. The following timelines were constructed: from symptom onset to imaging, imaging to biopsy, and biopsy to primary treatment initiation. Cutoff: 31st December 2021. The initial symptom was captured up to one year prior to biopsy.

Results

Among 302 patients (41 % female, 70 % >=65 years, 79 % former or current smoking, 62 % adenocarcinoma), 34.1 % stage I, 10.3 % stage II, 42.1 % stage III and 13.6 % unknown (AJCC ver. 8). In the baseline year, 80.5 % of patients reported at least one symptom to their physician, and 12.3 % reported four or more symptoms. The most common symptoms reported were cough (29.8 %), pneumonia (24.2 %), chest pain (18.5 %), bronchitis (17.5 %) and wheezing (17.2 %). For patients with an initial symptom (n=243) median time from symptom onset to imaging was 5.5 months (95% CI:4.8–6.3), and time from imaging to primary treatment initiation was 2.6 (2.3–2.9) months in all patients. Total duration from symptom to intervention was 8.5 months (7.6–9.3). Over 93 % of stage I patients underwent surgery and 4.9 % received definitive radiation. Over 83 % of stage II patients underwent surgery; of these, 54.8 % received adjuvant/neoadjuvant chemotherapy. Of stage III patients, 68.5 % received definitive chemoradiation (half received durvalumab), and the remaining underwent surgery with adjuvant/neoadjuvant treatment.

Conclusion

A total of 80.5 % of patients were symptomatic and the median duration from symptom onset to treatment initiation was 8.5 month long. Improving patient and physician awareness to lung cancer symptoms, and the introduction of screening programs are essential for reducing those delays.

简介：我们绘制了大型医疗机构患者从症状出现到接受干预的过程，并描述了主要治疗方法：我们在一项基于人群的回顾性队列研究中绘制了患者从症状出现到接受干预的过程，并描述了一家大型医疗机构对患者的主要治疗方法：从以色列国家癌症登记处确定了2016年至2019年期间新诊断出的I-III期非小细胞肺癌（NSCLC）成人患者，并进行了病历审查以提取去身份化数据。构建了以下时间线：从症状发作到成像，从成像到活检，从活检到开始主要治疗。截止日期：2021 年 12 月 31 日。活组织检查前一年内采集初始症状：在 302 名患者中（41% 为女性，70% 年龄大于等于 65 岁，79% 曾经或正在吸烟，62% 为腺癌），34.1% 为 I 期，10.3% 为 II 期，42.1% 为 III 期，13.6% 为未知期（AJCC 第 8 版）。在基线年，80.5% 的患者向医生报告了至少一种症状，12.3% 的患者报告了四种或更多症状。最常见的症状是咳嗽（29.8%）、肺炎（24.2%）、胸痛（18.5%）、支气管炎（17.5%）和喘息（17.2%）。有初始症状的患者（243 人）从症状出现到成像的中位时间为 5.5 个月（95% CI：4.8-6.3），所有患者从成像到开始初级治疗的时间为 2.6（2.3-2.9）个月。从出现症状到采取干预措施的总时间为 8.5 个月（7.6-9.3 个月）。超过 93% 的 I 期患者接受了手术，4.9% 接受了明确的放射治疗。超过 83% 的 II 期患者接受了手术，其中 54.8% 接受了辅助/新辅助化疗。在III期患者中，68.5%接受了明确的化学放疗（一半接受了杜伐单抗），其余患者接受了手术和辅助/新辅助治疗：结论：80.5%的患者无症状，从出现症状到开始治疗的中位时间为8.5个月。提高患者和医生对肺癌症状的认识以及引入筛查计划对减少这些延误至关重要。

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引用次数: 0

Corrigendum to “Machine learning computational model to predict lung cancer using electronic medical records”. Journal: Cancer Epidemiology, volume 92 (2024) 利用电子病历预测肺癌的机器学习计算模型 "的更正。期刊：癌症流行病学》，第 92 卷（2024 年）。

IF 2.4 3区医学 Q3 ONCOLOGY

Cancer Epidemiology

Pub Date : 2024-09-30 DOI: 10.1016/j.canep.2024.102649

Matanel Levi , Teddy Lazebnik , Shiri Kushnir , Noga Yosef , Dekel Shlomi

引用次数: 0

Three-year hospital service use trajectories of people diagnosed with cancer: A retrospective cohort study 确诊癌症患者的三年医院服务使用轨迹：回顾性队列研究

IF 2.4 3区医学 Q3 ONCOLOGY

Cancer Epidemiology

Pub Date : 2024-09-19 DOI: 10.1016/j.canep.2024.102676

Rebecca J. Mitchell , Geoffrey P. Delaney , Gaston Arnolda , Winston Liauw , Reidar P. Lystad , Jeffrey Braithwaite

Background

Information regarding hospital service use by people newly diagnosed with cancer can inform patterns of healthcare utilisation and resource demands. This study aims to identify characteristics of group-based trajectories of hospital service use three years after an individual was diagnosed with cancer; and determine factors predictive of trajectory group membership.

Method

A group-based trajectory analysis of hospital service use of people aged ≥30 years who had a new diagnosis of cancer during 2018 in New South Wales, Australia was conducted. Linked cancer registry, hospital and mortality data were examined for a three-year period after diagnosis. Group-based trajectory models were derived based on number of hospital admissions. Multinominal logistic regression examined predictors of trajectory group membership.

Results

Of the 44,577 new cancer diagnosis patients, 29,085 (65.2 %) were hospitalised at least once since their cancer diagnosis. Four distinct trajectory groups of hospital users were identified: Low (68.4 %), Very-Low (25.1 %), Moderate-Chronic (2.2 %), and Early-High (4.2 %). Key predictors of trajectory group membership were age group, cancer type, degree of cancer spread, prior history of cancer, receiving chemotherapy, and presence of comorbidities, including renal disease, moderate/serious liver disease, or anxiety.

Conclusions

Comorbidities should be considered in cancer treatment and management decision making. Caring for people diagnosed with cancer with multimorbidity requires multidisciplinary shared care.

背景有关新诊断出癌症的患者使用医院服务的信息可以为医疗保健的使用模式和资源需求提供参考。本研究旨在确定个人被诊断出癌症三年后基于群体的医院服务使用轨迹的特征；并确定预测轨迹群体成员的因素。方法对澳大利亚新南威尔士州2018年期间新诊断出癌症的≥30岁人群的医院服务使用情况进行了基于群体的轨迹分析。对诊断后三年内的关联癌症登记、医院和死亡率数据进行了检查。根据入院人数得出了基于组别的轨迹模型。结果在 44,577 名新确诊癌症患者中，29,085 人（65.2%）在确诊癌症后至少住院一次。结果发现了四个不同的住院患者轨迹组别：低度组（68.4%）、极低度组（25.1%）、中度慢性组（2.2%）和早期高度组（4.2%）。癌症治疗和管理决策中应考虑合并症。照顾确诊患有多病的癌症患者需要多学科共同护理。

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引用次数: 0

Examining concordance with the guidelines of the national comprehensive cancer network for the treatment of endometrial cancer in Puerto Rico 检查波多黎各子宫内膜癌治疗是否符合国家综合癌症网络的指导方针

IF 2.4 3区医学 Q3 ONCOLOGY

Cancer Epidemiology

Pub Date : 2024-09-19 DOI: 10.1016/j.canep.2024.102664

Yisel Pagán-Santana , Maira Castañeda-Avila , Ruth Ríos-Motta , Luis Santos-Reyes , Karen J. Ortiz-Ortiz

Background

Endometrial cancer poses a significant health concern in Puerto Rico, where it ranks as the primary gynecological malignancy among women. This study evaluates concordance with the National Comprehensive Cancer Network (NCCN) guidelines for endometrial cancer first treatment in Puerto Rican women and its association with 5-year overall survival.

Methods

Data on patients with endometrial cancer diagnosed between 2009 and 2015 was obtained from the Puerto Rico Central Cancer Registry, which is linked to the Puerto Rico Health Insurance Linkage database (n = 2114). The association between receiving guideline-concordant first treatment and clinical, socioeconomic, and health system factors was evaluated using logistic regression. The 5-year overall survival was calculated using the Kaplan-Meier method. Cox proportional hazard regression models were used to estimate hazard ratios and 95 % confidence intervals (CIs) for associations between guideline-concordant first treatment and overall survival.

Results

In our cohort, 53.9 % of patients received guideline-concordant first treatment. Receiving care at a Commission on Cancer-accredited center, being evaluated by a gynecologist-oncologist, and possessing private insurance enhanced the likelihood of receiving guideline-concordant first treatment. In the Cox regression models, receiving guideline-concordant first treatment was associated with a lower mortality risk (HR: 0.72, 95 % CI: 0.59–0.89).

Conclusion

Guideline-concordant first treatment is a strong predictor of improved survival rates in endometrial cancer. Given that guidelines based on scientific evidence have been demonstrated to enhance patient outcomes, we must understand and promote the factors contributing to their adoption.

背景在波多黎各，子宫内膜癌是女性最主要的妇科恶性肿瘤，对健康构成了严重威胁。本研究评估了波多黎各妇女接受国家综合癌症网络（NCCN）指南规定的子宫内膜癌首次治疗的一致性及其与 5 年总生存率的关系。方法 2009 年至 2015 年期间确诊的子宫内膜癌患者数据来自波多黎各中央癌症登记处，该登记处与波多黎各健康保险链接数据库（n = 2114）相连。采用逻辑回归法评估了接受指南一致的首次治疗与临床、社会经济和医疗系统因素之间的关系。采用 Kaplan-Meier 法计算 5 年总生存率。我们使用 Cox 比例危险回归模型估算了指南一致的首次治疗与总生存率之间的危险比和 95% 的置信区间 (CI)。在癌症委员会认可的中心接受治疗、由妇科肿瘤专家进行评估以及拥有私人保险，这些因素都增加了患者接受与指南一致的首次治疗的可能性。在 Cox 回归模型中，接受与指南一致的首次治疗与较低的死亡风险相关（HR：0.72，95 % CI：0.59-0.89）。鉴于以科学证据为基础的指南已被证明能提高患者的治疗效果，我们必须了解并促进采用这些指南的因素。

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引用次数: 0

Colorectal cancer in older adults after the USPSTF’s 2008 updated screening recommendation USPSTF 2008 年更新筛查建议后的老年人结直肠癌情况

IF 2.4 3区医学 Q3 ONCOLOGY

Cancer Epidemiology

Pub Date : 2024-09-18 DOI: 10.1016/j.canep.2024.102677

Jason Semprini

Background

Colorectal cancer (CRC) screenings can improve detection and prevent precancerous polyps from becoming malignant tumors. In 2008, the United States Preventive Services Task Force (USPSTF) updated their policy and no longer recommended that adults over age 75 screen for CRC. We evaluated how this policy update impacted screening behaviors and CRC outcomes in older adults.

Methods

We obtained data from the Behavioral Risk Factor Surveillance System to analyze blood stool and colonoscopy screening, the Surveillance, Epidemiological, End Results program to analyze CRC staging and survival, the National Association of Centralized Cancer Registries to analyze CRC incidence, and the National Center for Health Statistics to analyze mortality. With a difference-in-differences design, we compared the changes in outcome trends of the exposed group (age 75+), before and after 2008, with the changes in trends of a similar unexposed group (age 65–74).

Results

There was no association between the 2008 update and blood stool tests in older adults. We did, however, find that the update was associated with a 3.0 %-point decline in the probability of older adults completing a colonoscopy within the past two years (C.I. = −4.0, −2.0). Among older adults diagnosed with CRC, the update was associated with a 1.5 %-point increase in the probability of presenting at an advanced stage (C.I. = 1.1, 1.9). Finally, the update was also associated with lower CRC incidence (Est. = −13.9 cases/100,000 population; C.I. = −22.6, −5.1) and mortality rates (Est. = −5.6 deaths/100,000 population; C.I. = −10.1, −1.1). We observed the largest associations between the policy and CRC outcomes in adults age 85+.

Discussion

The USPSTF’s 2008 recommendation was associated with reduced colonoscopies, especially in adults over age 85. Whether this recommendation, or the 2021 updated guidance, optimizes population health by reducing the burden of CRC screening in older adults remains unknown.

背景直肠癌（CRC）筛查可以提高发现率，防止癌前息肉变成恶性肿瘤。2008 年，美国预防服务工作组（USPSTF）更新了他们的政策，不再建议 75 岁以上的成年人进行 CRC 筛查。我们从行为风险因素监测系统（Behavioral Risk Factor Surveillance System）获取数据，分析血便和结肠镜筛查情况；从监测、流行病学和最终结果项目（Surveillance, Epidemiological, End Results program）获取数据，分析 CRC 分期和存活情况；从全国癌症集中登记协会（National Association of Centralized Cancer Registries）获取数据，分析 CRC 发病率；从全国卫生统计中心（National Center for Health Statistics）获取数据，分析死亡率。通过差分设计，我们比较了 2008 年前后暴露组（75 岁以上）与类似的未暴露组（65-74 岁）的结果趋势变化。但我们发现，2008 年的更新与老年人在过去两年内完成结肠镜检查的概率下降 3.0% 个百分点有关（C.I. = -4.0, -2.0）。在确诊为 CRC 的老年人中，更新后出现晚期的概率增加了 1.5 个百分点（C.I. = 1.1, 1.9）。最后，政策更新还与较低的 CRC 发病率（估计值 = -13.9 例/100,000 人口；C.I. = -22.6, -5.1）和死亡率（估计值 = -5.6 例死亡/100,000 人口；C.I. = -10.1, -1.1）相关。讨论USPSTF 2008 年的建议与结肠镜检查次数减少有关，尤其是在 85 岁以上的成年人中。该建议或 2021 年更新的指南是否能通过减轻老年人的 CRC 筛查负担来优化人口健康仍是未知数。

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引用次数: 0

Trajectories in mammographic breast screening participation in middle-age overweight and obese women: A retrospective cohort study using linked data 中年超重和肥胖妇女参与乳腺 X 线照相筛查的轨迹：使用关联数据的回顾性队列研究

IF 2.4 3区医学 Q3 ONCOLOGY

Cancer Epidemiology

Pub Date : 2024-09-17 DOI: 10.1016/j.canep.2024.102675

K.A. McBride , S. Munasinghe , S. Sperandei , A.N. Page

Objectives

Despite the established benefits and availability of mammographic breast screening, participation rates remain suboptimal. Women with higher BMIs may not screen regularly, despite being at increased risk of postmenopausal breast cancer and worse outcomes. This study investigated the association between prospective changes in BMI and longitudinal adherence to mammographic screening among women with overweight or obesity.

Methods

Retrospective cohort study of women (N = 2822) participating in the Australian Longitudinal Study on Women's Health with an average follow-up of 20 years, with screening participation enumerated via BreastScreen NSW, Australia clinical records over the period 1996–2016. Association between BMI and subsequent adherence to screening was investigated in a series of marginal structural models, incorporating a time variant/invariant socio-demographic, clinical, and health behaviour confounders. Models were also stratified by a proxy measure of socio-economic status (education).

Results

Participants with overweight/obesity were less adherent to mammography screening, compared to healthy/underweight participants (OR=1.29, 95 % CI=1.07, 1.55). The association between overweight/obesity and non-adherence was higher among those who ever had private health insurance (OR=1.30, 95 % CI=1.05, 1.61) compared to those who never had private health insurance and among those with lower educational background (OR=1.38, 95 % CI=1.08, 1.75) compared to those with higher educational background.

Conclusions

Long-term impacts on screening participation exist among women with higher BMI, who are less likely to participate in routinely organised breast screening. Women with a higher BMI should be a focus of efforts to improve breast screening participation, particularly given their increased risk of breast cancer and association of higher BMI with worse breast cancer outcomes among older women.

目标尽管乳腺 X 线照相术乳腺筛查具有公认的益处，而且也很普及，但参与率仍然不理想。体重指数（BMI）较高的女性可能不会定期进行筛查，尽管她们绝经后罹患乳腺癌的风险会增加，而且结果也会恶化。本研究调查了超重或肥胖妇女的体重指数前瞻性变化与纵向坚持乳腺X线摄影筛查之间的关系。方法对参加澳大利亚妇女健康纵向研究的妇女（N = 2822）进行回顾性队列研究，平均随访 20 年，通过 1996-2016 年期间澳大利亚新南威尔士州乳腺筛查临床记录统计筛查参与情况。通过一系列边际结构模型研究了体重指数与后续筛查依从性之间的关系，并纳入了时间变量/不变的社会人口学、临床和健康行为混杂因素。结果与健康/体重不足的参与者相比，超重/肥胖的参与者较少坚持乳腺X光筛查（OR=1.29，95 % CI=1.07，1.55）。与从未购买过私人医疗保险的人相比，曾经购买过私人医疗保险的人（OR=1.30，95 % CI=1.05，1.61）和教育背景较低的人（OR=1.38，95 % CI=1.08，1.75）与教育背景较高的人相比，超重/肥胖与不坚持筛查之间的关联度更高。体重指数较高的妇女应成为提高乳腺筛查参与率的重点人群，特别是考虑到她们罹患乳腺癌的风险增加，以及体重指数较高与老年妇女乳腺癌预后较差之间的关联。

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引用次数: 0