National Cancer Registry Data Research Articles

National epidemiology of digital papillary adenocarcinoma in England 2013-2020: a population-based registry study.

Digital papillary adenocarcinoma (DPA), formerly known as aggressive DPA, is a rare adnexal cancer of sweat gland differentiation with metastatic potential. DPA epidemiology and patient outcome data are a prerequisite to develop diagnostic and therapeutic guidance, which is lacking for this rare cancer. To report the incidence, patient demographics and treatment of patients with DPA in England from 1 January 2013 to 31 December 2020 using national cancer registry data. DPA diagnoses in England during 2013-2020 were identified from the National Cancer Registration Dataset using morphology and behaviour codes. These were registered from routinely collected pathology reports and cancer outcomes and services datasets. The 2013 European age-standardised incidence rates (EASRs) were calculated. In total, 36 DPA (7 in females and 29 in males) were diagnosed. The median age at diagnosis for the cohort was 54 years (interquartile range 46-64). The most frequently affected sites were upper limbs (81%). All patients in the cohort received surgical excisions. The European age-standardised incidence rate (EASRs) was 0.10 [95% confidence interval (CI) 0.07-0.14] per 1,000,000 person-years (PY)]. This study reports the incidence and variation of DPA in England between 2013 and 2020. DPA was more common in older men and predominantly affected the upper limbs. This supports the need to develop a national policy for the reporting and management of DPA as well as clinical guideline development.

Hospital Volume for Rectal Cancer Resection Plays a Pivotal Role in Improving Outcomes: A Population-based Analysis.

Assessing the association between hospital surgical volume (SV) and outcomes after rectal cancer surgery (RCS), using national population-based data. For RCS, the association of higher SV with improved short- and/or long-term outcomes remains controversial. National cancer registry data and administrative data were used to select patients diagnosed with stage I-III rectal cancer in 2009-2018 and who underwent RCS. The average annual SV of RCS was categorised as low (<15; LV), medium (15-29; MV) or high (≥30; HV). The association between SV and 90-day and 1-year excess postoperative mortality (90DPM and 1YEPM) and 5-year observed survival (5YOS) was evaluated. From the 11,519 patients , RCS was performed in LV (4,088; 36%), MV (2,795; 24%) or HV (4,636; 40%) hospitals. Observed 90DPM was significantly better in HV (2.3% 95%CI[1.9,2.8]) than in LV (3.7% 95%CI[3.2,4.4]) and MV (3.5% 95%CI[2.9,4.3]) with adjusted OR 1.4, P<0.0001. Continuous regression analysis showed significantly higher 90DPM in annual SV <35 compared to ≥35 (OR 1.6 95%CI[1.21,2.11]; P=0.0009). Observed 1YEPM was significantly better in HV (2.9% 95%CI[2.2,3.6]) compared to LV (4.7% 95%CI [3.9,5.6]) with adjusted excess HR 1.31 95%CI[1.00,1.73] and P=0.05, and to MV (5.0% 95%CI[4.0,6.1]) with adjusted excess HR 1.45 95%CI[1.09,1.94] and P=0.01. The 5YOS was significantly better in HV (75.9% 95%CI[74.6,77.2]) than in LV (70.3% 95%CI[68.8,71.8]) and MV (71.5% 95%CI[69.7,73.2]) with adjusted HR 1.4 in both LV and MV versus HV, P≤0.003. This population-based study identified robustly superior outcomes at 90-days, 1-year and 5-years after RCS in hospitals with higher volumes.

Cancer incidence and digital information seeking in Germany: a retrospective observational study

Awareness is vital for cancer prevention. US studies show a strong link between web searches and cancer incidence. In Europe, the relationship remains unclear. This study characterizes regional and temporal relationships between cancer incidence and web searches and investigates the content of searches related to breast, cervical, colorectal, lung, prostate, and testicular cancer, brain tumors, and melanoma in Germany (July 2018–December 2019). Aggregate data from Google Ads Keyword Planner and national cancer registry data were analyzed. Spearman’s correlation coefficient (rS) examined associations between cancer incidence and web search, repeated measures correlation (rrm) assessed time trends and searches were qualitatively categorized. The frequency of malignancy-related web searches correlated with cancer incidence (rS = 0.88, P = 0.007), e.g., breast cancer had more queries than the lower-incidence cervical cancer. Seasonally, incidence and searches followed similar patterns, peaking in spring and fall, except for melanoma. Correlations between entity incidence and searches (0.037 ≤ rrm ≤ 0.208) varied regionally. Keywords mainly focused on diagnosis, symptoms, and general information, with variations between entities. In Germany, web searches correlated with regional and seasonal incidence, revealing differences between North/East and South/West. These insights may help improve prevention strategies by identifying regional needs and assessing impact of awareness campaigns.

Cancer diagnosis after emergency presentations in people with mental health and substance use conditions: a national cohort study

BackgroundCancer survival and mortality outcomes for people with mental health and substance use conditions (MHSUC) are worse than for people without MHSUC, which may be partly explained by poorer access to timely and appropriate healthcare, from screening and diagnosis through to treatment and follow-up. Access and quality of healthcare can be evaluated by comparing the proportion of people who receive a cancer diagnosis following an acute or emergency hospital admission (emergency presentation) across different population groups: those diagnosed with cancer following an emergency presentation have lower survival.MethodsNational mental health service use datasets (2002–2018) were linked to national cancer registry and hospitalisation data (2006–2018), to create a study population of people aged 15 years and older with one of four cancer diagnoses: lung, prostate, breast and colorectal. The exposure group included people with a history of mental health/addiction service contact within the five years before cancer diagnosis, with a subgroup of people with a diagnosis of bipolar disorder, schizophrenia or psychotic disorders. Marginal standardised rates were used to compare emergency presentations (hospital admission within 30 days of cancer diagnosis) in the exposure and comparison groups, adjusted for age, gender (for lung and colorectal cancers), ethnicity, area deprivation and stage at diagnosis.ResultsFor all four cancers, the rates of emergency presentation in the fully adjusted models were significantly higher in people with a history of mental health/addiction service use than people without (lung cancer, RR 1.19, 95% CI 1.13, 1.24; prostate cancer RR 1.69, 95% CI 1.44, 1.93; breast cancer RR 1.42, 95% CI 1.14, 1.69; colorectal cancer 1.31, 95% CI 1.22, 1.39). Rates were substantially higher in those with a diagnosis of schizophrenia, bipolar disorder or psychotic disorders.ConclusionsImplementing pathways for earlier detection and diagnosis of cancers in people with MHSUC could reduce the rates of emergency presentation, with improved cancer survival outcomes. All health services, including cancer screening programmes, primary and secondary care, have a responsibility to ensure equitable access to healthcare for people with MHSUC.

Unveiling cancer risk in ANCA-associated vasculitis: result from the Turkish Vasculitis Study Group (TRVaS).

To investigate cancer incidence in patients with ANCA-associated vasculitis (AAV), compare it with the age/sex-specific cancer risk of the Turkish population, and explore independent risk factors associated with cancer. This multicenter, incidence case-control study was conducted using the TRVaS registry. AAV patients without cancer history before AAV diagnosis were included. Demographic and AAV-related data of patients with and without an incident cancer were compared. Standardized cancer incidence rates were calculated using age-/sex-specific 2017 Turkish National Cancer Registry data for cancers (excluding non-melanoma skin cancers). Cox regression was performed to find factors related to incident cancers in AAV patients. Of 461 AAV patients (236 [51.2%] male), 19 had incident cancers after 2022.8 patient-years follow-up. Median (IQR) disease duration was 3.4 (5.5) years, and 58 (12.6%) patients died [7 with cancer and one without cancer (log-rank, p = 0.04)]. Cancer-diagnosed patients were older, mostly male, and more likely to have anti-PR3-ANCA positivity. The cumulative cyclophosphamide dose was similar in patients with and without cancer. Overall cancer risk in AAV was 2.1 (SIR) ((1.3-3.2), p = 0.004); lung and head-neck [primary target sites for AAV] cancers were the most common. In Cox regression, male sex and ≥ 60years of age at AAV diagnosis were associated with increased cancer risk, while receiving rituximab was associated with decreased cancer risk. Cancer risk was 2.1 times higher in AAV patients than the age-/sex-specific cancer risk of the Turkish population population, despite a high rate of rituximab use and lower dose of cyclophosphamide doses. Vigilance in cancer screening for AAV patients covering lung, genitourinary, and head-neck regions, particularly in males and the elderly, is vital.

Analysis of mesothelioma cases and National Cancer Registry data to assess asbestos exposure in India

&lt;sec&gt;&lt;title&gt;SETTING&lt;/title&gt;Asbestos exposure can cause mesothelioma, a form of cancer which should be recorded by cancer registries. However, such registries currently cover only a small fraction (16%) of the population in India. Because India still uses asbestos, it is important to understand its health impact, especially the number of mesothelioma cases.&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;OBJECTIVE&lt;/title&gt;To assess the number of mesothelioma cases in India and compare these to the number reported to the National Cancer Registry.&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;DESIGN&lt;/title&gt;We used the Right to Information Act 2005 to gather data for 83 hospitals across India from 2012 to 2022-2023.&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;RESULTS&lt;/title&gt;From a total of 83 hospitals, there were 2,213 cases of mesothelioma from 2012 onwards. During the 2012–2016 period, the number of reported cases in the Cancer Registry was 54, whereas 1,126 cases were reported by these hospitals for this period. Only 21 (25%) of the hospitals assessed in this study were part of the population-based national cancer registry programme. Overall, cases of mesothelioma occur far more frequently than are reported in cancer registries.&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;CONCLUSION&lt;/title&gt;National record-keeping is inadequate and the system needs to be expanded and improved across all of India. This will provide more effective reporting and help to highlight the risk of exposure to asbestos.&lt;/sec&gt;

Use of statins and risks of ovarian, uterine, and cervical diseases: a cohort study in the UK Biobank

PurposeTo examine the associations between use of statins and risks of various ovarian, uterine, and cervical diseases, including ovarian cancer, endometrial cancer, cervical cancer, ovarian cyst, polycystic ovarian syndrome, endometriosis, endometrial hyperplasia, endometrial polyp, and cervical polyp.MethodsWe conducted a cohort study among female participants in the UK Biobank. Information on the use of statins was collected through verbal interview. Outcome information was obtained by linking to national cancer registry data and hospital inpatient data. We used Cox proportional hazards regression to examine the associations.ResultsA total of 180,855 female participants (18,403 statin users and 162,452 non-users) were included. Use of statins was significantly associated with increased risks of cervical cancer (adjusted hazard ratio (HR), 1.55; 95% confidence interval (95% CI), 1.05–2.30) and polycystic ovarian syndrome (adjusted HR, 4.39; 95% CI, 1.68–11.49). However, we observed no significant association between use of statins and risk of ovarian cancer, endometrial cancer, ovarian cyst, endometriosis, endometrial hyperplasia, endometrial polyp, or cervical polyp.ConclusionOur findings suggest that use of statins is associated with increased risks of cervical cancer and polycystic ovarian syndrome, but is not associated with increased or decreased risk of ovarian cancer, endometrial cancer, ovarian cyst, endometriosis, endometrial polyp, or cervical polyp.

Population-Based Prognostic Models for Head and Neck Cancers Using National Cancer Registry Data from Taiwan.

This study aims to raise awareness of the disparities in survival predictions among races in head and neck cancer (HNC) patients by developing and validating population-based prognostic models specifically tailored for Taiwanese and Asian populations. A total of 49,137 patients diagnosed with HNCs were included from the Taiwan Cancer Registry (TCR). Six prognostic models, divided into three categories based on surgical status, were developed to predict both overall survival (OS) and cancer-specific survival using the registered demographic and clinicopathological characteristics in the Cox proportional hazards model. The prognostic models underwent internal evaluation through a tenfold cross-validation among the TCR Taiwanese datasets and external validation across three primary racial populations using the Surveillance, Epidemiology, and End Results database. Predictive performance was assessed using discrimination analysis employing Harrell's c-index and calibration analysis with proportion tests. The TCR training and testing datasets demonstrated stable and favorable predictive performance, with all Harrell's c-index values ≥ 0.7 and almost all differences in proportion between the predicted and observed mortality being < 5%. In external validation, Asians exhibited the best performance compared with white and black populations, particularly in predicting OS, with all Harrell's c-index values > 0.7. Survival predictive disparities exist among different racial groups in HNCs. We have developed population-based prognostic models for Asians that can enhance clinical practice and treatment plans.

Time Trends in Male Breast Cancer Incidence, Mortality, and Survival in Austria (1983-2017).

Male breast cancer (MBC) comprises less than 1% of all breast cancer cases globally and remains understudied with persisting sex-specific survival disadvantages. We aim to contribute to better understanding of MBC with a comprehensive analysis of time-trends over several decades in Austria. We used Austrian National Cancer Registry data on 1648 cases of MBC cases diagnosed between 1983 and 2017 in Austria. Overall incidence, mortality, and survival rates, as well as age-, stage-, and period-specific incidence and survival rates were calculated. Joinpoint regression was performed to assess trends. MBC incidence rates increased throughout the whole observation period (1983-2017) with an annual percent change (APC) of 1.44% (95% confidence interval, CI: 0.77 to 2.11). During the same period, morality rates were stable (APC: -0.25, 95% CI: -0.53 to 0.60). Ten-year survival rates showed three phases of decreasing increases with an average APC of 2.45%, 1983-2009 (95% CI: 2.1 to 2.74). Five-year survival rates improved until 2000 (APC: 2.31, 95% CI: 1.34 to 3.30) and remained stable thereafter (APC: 0.10, 95% CI: -0.61 to 0.80). Stage-specific analyses showed a single trend of stable incidence rates of distant disease MBC (APC: -0.03, 95% CI: -1.67 to 1.65). Further, we observed increases in localised, regional, and unknown stage cancer incidence and increases in incidence rates across all age groups over the whole observation period. However, the estimates on these subgroup-specific trends (according to age- and stage) show wider 95% CIs and lower bounds closer to zero or negative in comparison to our findings on overall incidence, mortality, and survival. Despite improvements in survival rates, MBC mortality rates remained largely stable between 1983 and 2017 in Austria, possibly resulting from a balance between increasing overall incidence and stable incidence rates of distant disease MBC.

Potential role of Fibrosis-4 score in hepatocellular carcinoma screening: The Kangbuk Samsung Health Study.

Hepatocellular carcinoma (HCC) is a major cause of cancer-related death, with low survival rates worldwide. Fatty liver disease (FLD) significantly contributes to HCC. We studied the screening performance of different methods for identifying HCC in patients with FLD or with metabolic risk factors for FLD. Korean adults (n=340825) without a prior HCC diagnosis were categorized into four groups: normal (G1), ≥2 metabolic risk factors (G2), FLD (G3), and viral liver disease or liver cirrhosis (G4). The National Cancer Registry data were used to identify HCC cases within 12months. We assessed the area under the receiver operating characteristic curve, sensitivity, specificity, and positive and negative predictive values of individual or combined screening methods. In 93 HCC cases, 71 were identified in G4, whereas 20 cases (21.5%) in G2 and G3 combined where ultrasound and Fibrosis-4 performed similarly to alpha-fetoprotein and ultrasound. In G2, Fibrosis-4 and ultrasound had the highest area under the receiver operating characteristic curve (0.93 [0.87-0.99]), whereas in G3, the combined screening methods had the highest area under the receiver operating characteristic curve (0.98 [0.95-1.00]). The positive predictive value was lower in G2 and G3 than in G4, but was >5% when restricted to a high Fibrosis-4 score. More than 21% of HCC cases were observed in patients with diagnosed FLD or at risk of FLD with metabolic risk factors. Nevertheless, screening for HCC in individuals without cirrhosis or viral hepatitis yielded very low results, despite the potential value of the Fibrosis-4 score in identifying individuals at high risk of HCC.

THE RADIOTHERAPY USE BY OLDER CANCER PATIENTS IN PORTUGAL—2018 NATIONAL CANCER REGISTRY DATA

Abstract In Portugal, cancer is the second leading cause of death, accounting for 28544 in 2018, around 25% of all deaths. Radiotherapy (RT) will be required by around half of the cancer patients. Older patients should be treated with ultrahipofractionation and highly precise/accurate technology to reduce the treatment sessions and to avoid side effects which are important for their quality of life. Nowadays, there is a global lack of RT infrastructure/investment that compromises cancer outcomes. The aim of this study was to evaluate the RT coverage by older patients in Portugal. The authors examined the 2018 national cancer registry data regarding the RT use stratified by cancer site and age groups. A total of 14448 cancer registries regarding patients aged 70 y/o or over were included. We calculated the optimal use through the application of the optimal utilisation percentage of RT for each cancer site, published by European SocieTy for Radiotherapy and Oncology - Health Economics in Radiation Oncology (ESTRO-HERO) project. The ratio between optimal use and real RT use was 56%, 51%, 41%, and 36% for the patients aged 70-74, 75-79, 80-84, and 85+, respectively. We should interpret these results considering the complex older patients’ setting of multi-morbidity and geriatric syndromes. Furthermore, radiation oncologists face a lack of evidence that supports optimal treatment decisions for older patients. There is an urgent need for older adults’ inclusive clinical trials, measures to reduce ageism, improve access, and provide the cornerstone of quality cancer care for older adults - the geriatric assessment.

1- and 5-Year Survival for Adults with Acute Myeloid Leukaemia and 30-Day Mortality after Initial Systemic Anti-Cancer Therapy, with an Exploration of Factors Associated with Poorer Outcomes: Data from a National Registry in England, 2013-2020

Introduction Randomised trials are recognised as the gold standard to test interventions to improve outcomes of patients with acute myeloid leukaemia (AML). However, there is a pressing need to understand outcomes in non-selected patient cohorts from real-world datasets. We report outcomes of 1- and 5- year overall survival (OS) following AML diagnosis and 30-day mortality after systemic anti-cancer therapy (SACT) using national cancer registry data in England of the United Kingdom. Methods The National Cancer Registration Dataset (NCRD) and the Systemic Anti-Cancer Therapy Dataset (SACT dataset) were used. The NCRD holds the population-based national cancer registry for England (Henson el. Al. Int J Epidemiol. 2020;49:16-16h). The SACT dataset is a population-based resource of treatments delivered in secondary and tertiary settings (Bright el. al. Int J Epidemiol. 2020;49:15-15l). Patients aged 18-99 years and diagnosed with AML between 01.01.2013 and 31.12.2020 were included and identified in NCRD using ICD-O3 coding (Fritz et. al. WHO 2013). Patients recorded as receiving SACT ≤90 days after diagnosis with a regimen typically used for AML were extracted using the SACT dataset up to 31.12.2021. Survival was followed up to 31.12.2022. OS with 95% confidence interval (95% CI) following AML diagnosis were calculated using Kaplan-Meier methodology. Hazard ratios (HRs) with 95% CI were generated using Cox proportional hazards regression to assess how covariates (intensity of SACT, age at diagnosis, gender, ethnicity, Index of Multiple Derivation (IMD), comorbidity, and year of diagnosis) were associated with 1- and 5-year survival. 30-day mortality after the initial SACT was calculated for the treated patients. Odds ratios (ORs) with 95% CI were generated using logistic regression to examine how covariates listed above, plus ECOG score of performance status (PS) and body mass index (BMI) were associated with the likelihood of dying ≤30 days. Results 17,107 patients were identified, of whom 7,906 (46%) had documented SACT. The median age at diagnosis was 72 years, (66 years and 77 years with and without documented SACT). Median survival following AML diagnosis was 0.6 years (95%CI: 0.5-0.6). 1- and 5-year OS were 39.8% (95% CI, 39.1-40.5) and 18.8% (95% CI, 18.1-19.4), respectively. Survival varied by intensity of SACT, patients received intensive SACT (IT) had a significantly better chance of surviving at 1- and 5-year than patients received non-intensive SACT (NIT) or without documented SACT (Table 1). Survival decreased with increasing age. Patients of Asian and Black ethnicity had a better survival outcome than White. Patients from the least deprived areas had improved 1- and 5-year survival versus those from the most deprived areas. People with no comorbidity had a better survival than those with comorbidities. There was no significant difference in survival by gender. Patients diagnosed in 2013 and 2020 had a significant (p&amp;lt;0.05) 1-year adjusted HR when compared to patients diagnosed in 2017, but their 5-year adjusted HRs were non-significant. This is very likely due to data issues as 2013 was the year cases in the NCRD began to be coded into ICD-O3 codes and 2020 was the year when a national lockdown due to COVID-19 took place. Unadjusted 30-day mortality for IT and NIT was 7.8% and 13.3%, respectively (Figure 1). After adjusting for covariates, patients who received NIT were less likely to die ≤30 days than IT patients (adjusted OR, 0.7, 95% CI, 0.6-0.9 p&amp;lt;0.01). Older patients, those from most deprived areas and those with worse PS all had higher 30-day mortality. Gender, known ethnicity, comorbidity, year of diagnosis, and known BMI were not significantly associated with 30-day death after SACT. Conclusions This study illustrates the value of large real-world data sets. Our data confirmed known negative associations of older age, comorbidity, and poor PS on outcomes. We demonstrate that, in England, white ethnicity is associated with reduced survival after accounting for covariates. Socioeconomic deprivation was negatively associated with both OS and 30-day mortality. Further work is needed to understand whether disease biology or other factors are responsible for this disparity. Our study underlines the importance of careful selection of treatment intensity given the increased adjusted 30-day mortality from intensive treatment.

Social determinants of physicians’ treatment recommendation in early glottic cancer.

65 Background: Glottic cancer is often diagnosed early due to its deleterious effects on the voice. National cancer treatment guidelines recommend larynx preserving treatment, either surgery or radiation, since both modalities have similar rates of local control and recurrence. Without any survival advantage for either treatment modality, physicians may make treatment recommendations based on other clinical or nonclinical factors. Methods: Using the National Cancer Database, a national hospital-based cancer registry data, this retrospective cohort analysis included adult patients, aged 18 years and older, with clinically confirmed diagnosis of early-stage (T1 and T2) glottic cancer between 2004 and 2017 (n = 27,632). The outcome of interest was physicians’ treatment recommendation of surgery or radiation therapy. Main measures included social determinants of health variables, including race/ethnicity, urban/rural status, health insurance status, and income. We further adjusted for covariates, including age and gender. Logistic regression analysis estimated odds of physicians’ recommendation of radiation versus Surgery, based on social determinants of health factors and adjusting for all covariates in the model. Results: More patients received recommendation for radiation treatment vs surgery (78% vs 22%). Female patients were less likely to receive a recommendation of radiation (aOR = 0.90; 95% CI 0.82, 0.98), while Black patients had increased odds of being recommended radiation compared to White patients (aOR = 1.16, 95% CI 1.04, 1.29). Both facility type and location, and patients’ urban vs. rural status were all associated with treatment recommendation, and individuals residing in rural areas had 32% increased odds of being recommendation radiation treatment vs surgery (aOR = 1.32; 95% CI 1.06, 1.64). Conclusions: Radiation treatment is prevalent in early-glottic cancer care, and we found an association between social determinants of health and physician recommendation of treatment. Further research should examine concordance of patient treatment preference vs physician recommendation.

Delivered relative dose intensity in adolescent and young adult germ cell tumours in England: Assessment of data quality and consistency from clinical trials compared to national cancer registration data.

Adolescent and young adults (AYA) with germ cell tumours (GCT) have poorer survival rates than children and many older adults with the same cancers. There are several likely contributing factors to this, including the treatment received. The prognostic benefit of intended dose intensity is well documented in GCT from trials comparing regimens. However, evidence specific to AYA is limited by poor recruitment of AYA to trials and dose delivery outside trials not being well examined. We examined the utility of cancer registration data and a clinical trials dataset to investigate the delivery of relative dose intensity (RDI) in routine National Health Service practice in England, compared to within international clinical trials. Linked data from the Cancer Outcomes and Services Dataset (COSD) and the Systemic Anti-Cancer Therapy (SACT) dataset, and data from four international clinical trials were analysed. Survival over time was described using Kaplan-Meier estimation; overall, by age category, International Germ-Cell Cancer Collaborative Group (IGCCCG) classification, stage, tumour subtype, primary site, ethnicity and deprivation. Cox regression models were used to determine the fully adjusted effect of RDI on mortality risk. The quality of both datasets was critically evaluated and clinically enhanced. RDI was found to be well maintained in all datasets with higher RDIs associated with improved survival outcomes. Real-world data demonstrated several strengths, including population coverage and inclusion of sociodemographic variables and comorbidity. It is limited in GCT however, by the poor completion of data items enabling risk classification of patients and a higher proportion of missing data.

Faster Diagnosis and Treatment for Cancer: Assessing Patient Pathways Using a Panel Regression Analysis of the English National Cancer Registration Data

ObjectivesTimely treatment is crucial for patients with cancer, affecting both their experience and outcomes. This study examined events that shorten or extend cancer pathways. MethodsA cohort of breast, lower gastrointestinal, lung, and prostate cancers diagnosed between 2015 and 2016 in England were identified using cancer registration data. This was linked to Hospital Episode Statistic data, Cancer Waiting Times data, and specialized treatment data sets to highlight key events and dates in the pathways of 236 205 patients.Our fixed-effects panel regression included straight-to-test first appointments, multiple tests on the same day, number of multidisciplinary team meetings, appointment cancellations, trust fixed effects, and patient factors, including sex, ethnicity, index of multiple deprivations, age, comorbidities, stage, and route to diagnosis. ResultsPatients with straight-to-test, multiple tests on the same day, and who were discussed in a single multidisciplinary team meeting waited a shorter time for treatment (-5, -4, and -7 days, respectively). Cancelled appointments and attending multiple providers were associated with longer pathways (+11 and +9 days). ConclusionsOur findings highlight specific areas in which redesigning cancer pathways and transfers between hospitals could potentially lead to less waiting time for treatment, and suggest that policies aimed at reducing cancellations, by patients or hospitals, have the potential to improve waiting times.

Geographical Variation in Underlying Social Deprivation, Cardiovascular and Other Comorbidities in Patients with Potentially Curable Cancers in England: Results from a National Registry Dataset Analysis

AimsTo describe the prevalence of cardiovascular disease (CVD), multiple comorbidities and social deprivation in patients with a potentially curable cancer in 20 English Cancer Alliances. Materials and methodsThis National Registry Dataset Analysis used national cancer registry data and CVD databases to describe rates of CVD, comorbidities and social deprivation in patients diagnosed with a potentially curable malignancy (stage I–III breast cancer, stage I–III colon cancer, stage I–III rectal cancer, stage I–III prostate cancer, stage I–IIIA non-small cell lung cancer, stage I–IV diffuse large B-cell lymphoma, stage I–IV Hodgkin lymphoma) between 2013 and 2018. Outcome measures included observation of CVD prevalence, other comorbidities (evaluated by the Charlson Comorbidity Index) and deprivation (using the Index of Multiple Deprivation) according to tumour site and allocation to Cancer Alliance. Patients were allocated to CVD prevalence tertiles (minimum: <33.3rd percentile; middle: 33.3rd to 66.6th percentile; maximum: >66.6th percentile). ResultsIn total, 634 240 patients with a potentially curable malignancy were eligible. The total CVD prevalence for all cancer sites varied between 13.4% (CVD n = 2058; 95% confidence interval 12.8, 13.9) and 19.6% (CVD n = 7818; 95% confidence interval 19.2, 20.0) between Cancer Alliances. CVD prevalence showed regional variation both for male (16–26%) and female patients (8–16%) towards higher CVD prevalence in northern Cancer Alliances. Similar variation was observed for social deprivation, with the proportion of cancer patients being identified as most deprived varying between 3.3% and 32.2%, depending on Cancer Alliance. The variation between Cancer Alliance for total comorbidities was much smaller. ConclusionSocial deprivation, CVD and other comorbidities in patients with a potentially curable malignancy in England show significant regional variations, which may partly contribute to differences observed in treatments and outcomes.

Suicide after a Diagnosis of Cancer: Follow-Up of 1.4 Million Individuals, 2009-2019.

Background: The study explores whether Polish cancer patients face elevated suicide risk, emphasizing the vital need to comprehend and mitigate their unique mental health struggles. Methods: We conducted a cohort study based on Polish National Cancer Registry data (diagnosis in 2009-2019). Age-, sex-, and year-standardized mortality ratios (SMR) are presented with 95% confidence intervals (CIs) overall and by sex. Results: The study included 1.43 million individuals diagnosed with cancer. There were 830 suicide cases in this group. The overall SMR for suicide was 1.34 (95% CI 1.25-1.43). The highest risk of suicide death was observed in the first six months after diagnosis (SMR = 1.94, 1.69-2.21): cancers of the heart and pleura (19.15, 2.32-69.18), an unspecified site (3.99, 1.09-10.22), and the esophagus (3.34, 1.08-7.79). The highest overall risk of suicide after cancer diagnosis was observed in esophageal (2.94, 1.47-5.26), gastric (2.70, 2.00-3.57), cervical (2.20, 1.06-4.05), and head and neck cancers (2.06, 1.52-2.72). Conclusions: Patients with cancer face significantly higher suicide risk, peaking within six months post-diagnosis. Urgent integration of suicide risk screening and prevention into cancer care is crucial, supporting mental well-being and guiding proactive healthcare strategies.

Diagnostic performance of screening mammography according to menstrual cycle among Asian women.

To investigate the performance metrics of screening mammography according to menstrual cycle week in premenopausal Asian women. This retrospective study included 69,556 premenopausal Asian women who underwent their first screening mammography between 2011 and 2019. The presence or absence of a breast cancer diagnosis within 12 months after the index screening mammography served as the reference standard, determined by linking the study data to the national cancer registry data. Menstrual cycles were calculated, and participants were assigned to groups according to weeks 1-4. The performance metrics included cancer detection rate (CDR), sensitivity, specificity, and positive predictive value (PPV), with comparisons across menstrual cycles. Among menstrual cycles, the lowest CDR at 4.7 per 1000 women (95% confidence interval [CI], 3.8-5.8 per 1000 women) was observed in week 4 (all P < 0.05). The highest sensitivity of 72.7% (95% CI, 61.4-82.3) was observed in week 1, although the results failed to reach statistical significance. The highest specificity of 80.4% (95% CI, 79.5-81.3%) was observed in week 1 (P = 0.01). The lowest PPV of 2.2% (95% CI, 1.8-2.7) was observed in week 4 (all P < 0.05). Screening mammography tended to show a higher performance during week 1 and a lower performance during week 4 of the menstrual cycle among Asian women. These results emphasize the importance of timing recommendations that consider menstrual cycles to optimize the effectiveness of screening mammography for breast cancer detection.

Outcomes of dostarlimab versus chemotherapy in post-platinum patients with recurrent/advanced endometrial cancer: data from the GARNET trial and the National Cancer Registration Service in England

ObjectivesImmune checkpoint inhibitors have emerged as novel treatment options in patients with endometrial cancer. In this study we aimed to compare the survival outcomes of patients with recurrent or advanced...

Prostate cancer outcomes following whole-gland and focal high-intensity focused ultrasound.

To report the 5-year failure-free survival (FFS) following high-intensity focused ultrasound (HIFU). This observational cohort study used linked National Cancer Registry data, radiotherapy data, administrative hospital data and mortality records of 1381 men treated with HIFU for clinically localised prostate cancer in England. The primary outcome, FFS, was defined as freedom from local salvage treatment and cancer-specific mortality. Secondary outcomes were freedom from repeat HIFU, prostate cancer-specific survival (CSS) and overall survival (OS). Cox regression was used to determine whether baseline characteristics, including age, treatment year, T stage and International Society of Urological Pathology (ISUP) Grade Group were associated with FFS. The median (interquartile range [IQR]) follow-up was 37 (20-62) months. The median (IQR) age was 65 (59-70) years and 81% had an ISUP Grade Group of 1-2. The FFS was 96.5% (95% confidence interval [CI] 95.4%-97.4%) at 1 year, 86.0% (95% CI 83.7%-87.9%) at 3 years and 77.5% (95% CI 74.4%-80.3%) at 5 years. The 5-year FFS for ISUP Grade Groups 1-5 was 82.9%, 76.6%, 72.2%, 52.3% and 30.8%, respectively (P < 0.001). Freedom from repeat HIFU was 79.1% (95% CI 75.7%-82.1%), CSS was 98.8% (95% CI 97.7%-99.4%) and OS was 95.9% (95% CI 94.2%-97.1%) at 5 years. Four in five men were free from local salvage treatment at 5 years but treatment failure varied significantly according to ISUP Grade Group. Patients should be appropriately informed with respect to salvage radical treatment following HIFU.