Number Of Cancer Diagnoses Research Articles

3.D. Round table: Cancer Epidemiology and Prevention: which opportunities from the EU Cancer Mission?

Abstract While Europe accounts for a tenth of the world's population, it holds a quarter of the world's cancer cases. In the current scenario that see an increase in the proportion of elderly population in the EU, lives lost to cancer in the EU are set to increase by more than 24% by 2035, making it the leading cause of death in the EU. The overall economic impact of cancer in Europe is estimated to exceed €100 billion annually. Moreover, the COVID-19 pandemic has severely impacted cancer care, disrupting prevention and treatment, delaying diagnosis and vaccination, and affecting access to medicines. Since the pandemic began, the number of cancer diagnoses has decreased, foreshadowing a future increase in cases. In response to such challenges, the Europe's Beating Cancer Plan (EBPC) published in 2021 reflects a political commitment to leave no stone unturned to take action against cancer. In the EBPC, there is a renewed commitment to invest in cancer prevention, treatment and care that recognises the growing challenges, and opportunities to overcome them, including the developments in cancer care. In order to implement the EBPC the European Commission will use all the related funding instruments of the Horizon Europe Framework Programme for Research and Innovation (2021-2027) and it will be constantly guided from the experts of the Mission Board of Cancer. By establishing specific goals together with funding, the EU ensures the involvement of the Member States in tackling risk factors that are common to most non-communicable diseases. Simultaneously, there is a clear step towards health equity by collecting data stratified by equity-relevant attributes such as education or income. On another level, the focus on cancer might trigger new effective outcome-based payment models for personalised medicine, as well as better collection of data needed for a value-based approach on the effectiveness of health care. In the round table the panellists will discuss the opportunities and challenges of the EBCP implementation with the President of the Cancer Mission Board Walter Ricciardi, by addressing the epidemiological scenario of cancer disease in Europe and the related economic burden (Joao Vasco Santos), the role of the Comprehensive Cancer Control Networks and related Joint Action (Tit Albreht), and the readiness of the health services (Johan Hansen). Key messages • The implementation of the Europe's Beating Cancer Plan requires coordinated efforts among stakeholders with a clear leadership from Public Health Professionals. • Many externalities can be achieved through the EBCP as cancer has same determinants of most of the non-communicable diseases. Speakers/Panelists Walter Ricciardi Catholic University of the Sacred Heart Rome, Rome, Italy Tit Albreht National Institute of Public Health, Ljubljana, Slovenia João Vasco Santos EUPHA-ECO Johan Hansen EUPHA-HSR

Impact of the COVID-19 pandemic on cancer diagnoses, stage and survival in Alberta.

The COVID-19 pandemic is suspected to have affected cancer care and outcomes among patients in Canada. In this study, we evaluated the impact of the state of emergency period during the COVID-19 pandemic (Mar. 17 to June 15, 2020) on cancer diagnoses, stage at diagnosis and 1-year survival in Alberta. We included new diagnoses of the 10 most prevalent cancer types from Jan. 1, 2018, to Dec. 31, 2020. We followed patients up to Dec. 31, 2021. We used interrupted time series analysis to examine the impact of the first COVID-19-related state of emergency in Alberta on the number of cancer diagnoses. We used multivariable Cox regression to compare 1-year survival of the patients who received a diagnosis during 2020 after the state of emergency with those who received a diagnosis during 2018 and 2019. We also performed stage-specific analyses. We observed significant reductions in diagnoses of breast cancer (incidence rate ratio [IRR] 0.67, 95% confidence interval [CI] 0.59-0.76), prostate cancer (IRR 0.64, 95% CI 0.56-0.73) and colorectal cancer (IRR 0.64, 95% CI 0.56- 0.74) and melanoma (IRR 0.57, 95% CI 0.47-0.69) during the state of emergency period compared with the period before it. These decreases largely occurred among early-stage rather than late-stage diagnoses. Patients who received a diagnosis of colorectal cancer, non-Hodgkin lymphoma and uterine cancer in 2020 had lower 1-year survival than those diagnosed in 2018; no other cancer sites had lower survival. The results from our analyses suggest that health care disruptions during the COVID-19 pandemic in Alberta considerably affected cancer outcomes. Given that the largest impact was observed among early-stage cancers and those with organized screening programs, additional system capacity may be needed to mitigate future impact.

Impact of SARS-CoV-2 on surgical services in a Scottish remote and rural setting.

The SARS-CoV-2 (COVID-19) pandemic has brought about instability in healthcare providers worldwide; this includes rural settings that had fewer cases of COVID-19 in the first year of the pandemic. This article examines the impact of COVID-19 on the surgical services offered at the Balfour Hospital, Orkney Islands, Scotland in the UK and the impact the pandemic had indirectly on the service in 2020. The authors conducted a retrospective study concentrating on surgical services including emergency hospital presentations and the number of cancer diagnoses, specifically colorectal. Colorectal malignancies were specifically investigated as in the Balfour Hospital they are primarily diagnosed by surgeons. Focus was on diagnosis and outcomes between June 2020 and October 2020, in comparison with the previous year. This time period was chosen because surgical services reconvened after a period of inactivity due to the COVID-19 pandemic. The types of emergency admission into the Balfour Hospital during this time were examined, as well as delayed surgeries and the impact of delaying surgery. The data show that, although the prevalence of cancers diagnosed was static, patients presented at a much later stage, with significant impact on prognosis and quality of life. Aside from cancer diagnosis, non-urgent work was significantly disrupted due to the pandemic in 2020. The average waiting time for non-urgent clinic consultation increased from 6 weeks to 18 weeks during this period. The number of patients awaiting endoscopic investigations increased threefold. There was also an increase in the number of emergency admissions due to complications of disease. Although the effects of COVID-19 have been felt nationwide, the impact is more exaggerated in rural communities such as Orkney due to the small population. It is likely the indirect impact on surgical morbidity and mortality in Orkney in 2020 was disproportionately higher than the impact of COVID-19 in the local community. Furthermore, due to limited island resources, a significant number of patients required transfer to tertiary centres for management of complications. This is a unique issue affecting rural communities.

Knowledge of Cancer Among Syrians: A Cross-Sectional Study

Background: The worldwide burden of cancer continues to rise, mainly due to global demographic changes and an increase in cancer-causing habits, such as smoking, epically in low-income countries. The Syrian National Cancer Registry (SNCR)estimates that 17,599 new cancer cases were diagnosed before the start of the war in 2011. According to statistics from the Al Bairouni 2020 hospital-based registry, which includes data on more than 60% of Syrian cancer patients, the number of cancer diagnoses has been rising in Syria. There is no research conducted in Syria to determine people’s knowledge about cancer and risk factors, symptoms, and signs. This research aims to determine how well-informed Syrians were on the following topics:(i) the age-related risk and prevalence of cancer; (ii) cancer signs and symptoms; and (iii) cancer risk factors. In addition, determining how well-informed different demographic categories. Method: This is a cross-sectional study which was conducted in Syria. Participants who were eligible to participate in the study who were residents of Syria irrespective their age or gender. The instrument of survey was a structured questionnaire the content of which was adapted from the validated cancer awareness measure (CAM) the cam was translated to Arabic and a scoring system was applied to the questionnaire. The questionnaire was distributed via several social media platforms. Results: A total of 1463 participants completed the questionnaire. There were 768 respondents (52.5%) said that there is no relation between age and cancer. Almost all the participants (85.6%) thought that the breast cancer is the most common cancer among women, while around half of the participants (55.1%) reported that the prostate cancer was the most common cancer among males. The most frequently reported cancer symptom was unexplained weight loss (73.2%), followed by unexplained swelling/lump (66.5%). The level of knowledge about cancer signs/symptoms among the participants were good in 623 (42.6%), fair in 594 (40.6%), and poor in 246 (16.8%). The most commonly recognized risks of cancer were smoking (83.5%). Conclusion: According to this research, taking into consideration the war and the bad economic situation that Syria is facing, Syrians’ knowledge towards cancer is acceptable. However, it is not meeting the ideal expectations. More research should be held to dig deeper into this issue.

Intérêts de l’intégration précoce de soins palliatifs aux soins oncologiques : une revue rapide des écrits

With the number of cancer diagnoses and cancer-related deaths on the rise, palliative care is becoming a more important consideration for helping to improve the quality of life of patients and families and the support they receive during their healthcare journey. Accordingly, the early integration of palliative care into standard oncology care would appear to be an underutilized and novel approach that could be used to address the specific needs of palliative oncology patients. Oncology nurses play a central role in this process, delivering care throughout the health continuum, including palliative care. The purpose of this rapid review is to outline the benefits of early palliative care interventions and describe their characteristics. A literature search on CINAHL and PubMed returned five randomized trials conducted between 2010 and 2018. An analysis of these papers showed that the majority of the selected studies concluded that the early integration of palliative care into standard oncology care, which includes such treatments as chemotherapy and radiation therapy, can lead to improvements in quality of life, symptoms of anxiety and depression, and overall survival rate. Keywords: palliative care, early palliative care, intervention, cancer, oncology

PD-1 The impact of COVID-19 on diagnosis, stage and treatment of esophageal and gastric cancer

During the COVID-19 pandemic, a profound decrease in the number of cancer diagnoses was observed. For patients with esophagogastric cancer, a diagnostic delay may have resulted in more advanced disease at the time of diagnosis. Also, downscaling of oncological care during COVID-19 may have resulted in postponed or different treatments. Therefore, we aimed to investigate the effects of the COVID-19 pandemic in 2020 on the stage at diagnosis and oncological care of esophagogastric cancer. Patients who were diagnosed in 2020 and included in the Netherlands Cancer Registry were allocated to 5 periods that correspond to the severity of the COVID-19 pandemic in the Netherlands. These were compared to patients diagnosed in the same period in the years 2017-2019. The number of diagnoses, tumor characteristics, type of treatment, time until the start of treatment and, in case of resection, the time between neoadjuvant therapy and resection were evaluated for esophageal cancer (EC) and gastric cancer (GC) separately. The 2020 cohort in the Netherlands consisted of 2388 EC patients and 1429 GC patients. The absolute number of diagnoses decreased most prominently in the months March and April of 2020 for both EC and GC. The total number of EC diagnoses in 2020 decreased significantly compared to 2017-2019 (n=2522, p=0.027), whereas the total number of GC diagnoses did not decrease (n=1442, p=0.270). In the weeks after the first COVID-19 case in the Netherlands and before the COVID-19 lockdown, the percentage of incurable diagnoses increased from 52.5% to 67.7% for GC (p=0.011) and did not increase for EC (33.0% to 40.8%, p = 0.092). The percentage of patients with potentially curable EC receiving neoadjuvant chemoradiotherapy with resection decreased from 35.0% in 2017-2019 to 27.4% in 2020 (p < 0.001), whereas the percentage of patients receiving neoadjuvant chemoradiation without resection increased from 9.5% in 2017-2019 to 13.9% in 2020 (p < 0.001). The percentage of patients receiving definitive chemoradiation did not change significantly (p=0.119). For GC patients, no significant changes in type of treatment were found. The time between neoadjuvant chemotherapy and gastric resection decreased in 2020 with four days (p=0.006), while the time between neoadjuvant therapy and esophageal resection increased with 5 days (p=0.005). For both tumor types, the time between diagnosis and start of treatment was significantly shorter for patients diagnosed during and after the COVID-19 lockdown. We found a significant decrease in the number of EC diagnoses in 2020 and a shift in the type of treatment in potentially curable EC patients, with fewer resections being performed. Yet, it is unclear whether this is the result of the COVID-19 pandemic or due to an ongoing trial which implements watchful waiting after chemoradiotherapy. The oncological care for GC patients did not change during the COVID-19 pandemic. The shorter time between diagnosis and start of treatment may have been the result of a sense of urgency, since it was unknown in what way COVID-19 might affect the continuity of care in the upcoming future.

Review of rapid access clinic referrals in breast care centre during the COVID-19 pandemic

Background: The continuation of cancer services throughout the Covid pandemic has required careful consideration of referral numbers, footfall to the hospital and provision of a secure environment. Concerns regarding delayed diagnosis and resumption of near to normal activity has seen an increase in referrals. There is scope now to modify the referral into the two-week wait system and put units in better stance if future pandemic waves occur.Aim: To introduce and measure a guidance tool for primary care in determining actual need for one-stop clinic as per the Association of Breast Surgery Guidelines (October 2020) through an electronically distributed letter.Design and setting: Retrospective data analysis using information from electronic patient notes.Method: A snapshot audit was then undertaken over a two week long period before and after the tool was distributed. Referral criteria and triple assessment outcomes were measured to see if this guidance was being followed.Results: Following guidance to Primary Care, breast pain as the only presenting symptom fell by 58%, the number of patients being discharged with 'no pathology detected' halved, and there was no drop in the number of cancer diagnoses.Conclusion: Use of explicit guidance for Primary Care with regards to low risk symptoms as per NICE guidelines can have a significant effect on the pressures of the two-week wait system and reduce footfall to the hospital. A larger study period and close tracking of patients will help to ensure safety and allow units to manage referrals in a timely manner. Background: The continuation of cancer services throughout the Covid pandemic has required careful consideration of referral numbers, footfall to the hospital and provision of a secure environment. Concerns regarding delayed diagnosis and resumption of near to normal activity has seen an increase in referrals. There is scope now to modify the referral into the two-week wait system and put units in better stance if future pandemic waves occur. Aim: To introduce and measure a guidance tool for primary care in determining actual need for one-stop clinic as per the Association of Breast Surgery Guidelines (October 2020) through an electronically distributed letter. Design and setting: Retrospective data analysis using information from electronic patient notes. Method: A snapshot audit was then undertaken over a two week long period before and after the tool was distributed. Referral criteria and triple assessment outcomes were measured to see if this guidance was being followed. Results: Following guidance to Primary Care, breast pain as the only presenting symptom fell by 58%, the number of patients being discharged with 'no pathology detected' halved, and there was no drop in the number of cancer diagnoses. Conclusion: Use of explicit guidance for Primary Care with regards to low risk symptoms as per NICE guidelines can have a significant effect on the pressures of the two-week wait system and reduce footfall to the hospital. A larger study period and close tracking of patients will help to ensure safety and allow units to manage referrals in a timely manner.

The early integration of palliative care into oncology care: A rapid review.

With the number of cancer diagnoses and cancer-related deaths on the rise, palliative care is becoming a more important consideration for helping to improve the quality of life of patients and families and the support they receive during their healthcare journey. Accordingly, the early integration of palliative care into standard oncology care would appear to be an underutilized and novel approach that could be used to address the specific needs of palliative oncology patients. Oncology nurses play a central role in this process, delivering care throughout the health continuum, including palliative care. The purpose of this rapid review is to outline the benefits of early palliative care interventions and describe their characteristics. A literature search on CINAHL and PubMed returned five randomized trials conducted between 2010 and 2018. An analysis of these papers showed that the majority of the selected studies concluded that the early integration of palliative care into standard oncology care, which includes such treatments as chemotherapy and radiation therapy, can lead to improvements in quality of life, symptoms of anxiety and depression, and overall survival rate.

The impact of the covid 19 pandemic on cancer diagnosis in a pathology service in southern Brazil

The Covid-19 pandemic has had a significant impact on people's lives. One of these impacts can be verified in the diagnosis of other diseases, especially cancer. Problem: What was the impact on the diagnosis of new cases of cancer in the region covered by a pathology service in southern Brazil during the pandemic? General objective: To evaluate whether there was a decrease in the number of cancer diagnoses in a pathology service in southern Brazil during the pandemic. Methodology: We analyzed the case reports carried out in the Laboratories of the Infolaudo Group, during the initial months of the pandemic (April and May 2020) and compared with the same months of 2019, in order to measure the impact of the pandemic on the diagnosis of cancer in a Pathology Service in southern Brazil. Results: Comparing the periods of April and May 2019 with the same period in 2020, a 34.2% decrease in pathological procedures was noticed. Some types of cancer, such as colon, esophagus, breast and prostate, had a significant decrease in diagnoses, being 19.7%, 45%, 18.2% and 37.7%, respectively. Conclusion: With the closure of many clinics and clinics in the early stages of the pandemic, there was a decrease in cancer diagnoses in the laboratories surveyed.

Demographic and Epidemiological Contributions to Recent Trends in Cancer Incidence in Hong Kong.

Simple SummaryHong Kong has an ageing Chinese population with high life expectancy and a rising number of new cancer cases (156.5% increase for women and a 96% increase for men during the period 1983–2017). While both population growth and population ageing could contribute to this trend, it is unknown whether change in disease risk contributes to or inhibits this trend. In this study, we quantify the demographic and epidemiological contributions to this trend by disentangling the effect of these factors, finding that this increasing trend is mostly due to population growth (66.1% for women, 25.4% for men) and population ageing (95% for women, 119.4% for men), with changes in disease risk inhibiting this increasing trend (−4.5% for women, −48.8% for men).Background: Hong Kong has an ageing Chinese population with high life expectancy and a rising number of cancer cases. While population ageing could lead to higher incidence, we aim to quantify the demographic and epidemiological contributions to this trend by disentangling the effect of these factors. Methods: We analysed secular trends of cancer incidences of all cancer sites combined, including the five top cancers in men and women in Hong Kong in 1983–2017, by disentangling effects of demographics (ageing population and population growth) and cancer risk/rate change using the RiskDiff methodology. Results: Overall, age-standardised incidences of all cancers combined in women and in men declined over the study period (−5.3% for women, −30.2% for men), but total incident cancer case counts increased dramatically (156.5% for women, 96% for men). This increase was primarily due to ageing and increasing population (95% age, 66.1% growth for women, and 119.4% age, 25.4% growth for men), while disease risk for all cancers combined has a decreasing trend (−4.5% for women and −48.8% for men). For the site-specific risk changes among the most five common cancer types, there were increases in risks of prostate and colorectal cancers in men, and breast, endometrial, and thyroid cancers in women. Conclusion: Demographic changes and ageing in our Chinese population resulted in a marked increase in the number of cancer diagnoses in Hong Kong in past decades. The surge in incident case counts overall is expected to stress the healthcare system in terms of the increased demand of healthcare professionals. Cancer surveillance should be enhanced in view of the growing demand from older patients and the cancer types with fast-increasing incidence rates in our population.

PI-D CONTROLLER BASED ON AN IMPROVED CROW SEARCH ALGORITHM FOR CANCER GROWTH TREATMENT

The number of cancer diagnoses and deaths worldwide is rising every year despite technological advancements in diagnosing and treating multiple forms of cancer. An oncolytic virus is a type of tumor-killing virus that can infect and analyze cancer cells while mostly preserving normal cells. The oncolytic Vesicular-Stomatitis Virus therapeutic's cell cycle-specific action mathematically investigated. An optimal Proportion Integral-Derivative (PI-D) controller is introduced in this paper based on a suggested Improved Crow Search Algorithm (ICSA) to enhance the outcome of oncolytic virotherapy. The control technique was tested in a computer using MATLAB simulation. The suggested ICSA is used to tune the parameters of the PI-D controller. The ICSA used the inertia factor and boundary handle mechanism in the position update equation to balance exploration and exploitation. The simulation results show that decrease in total dose, tumor cells to 30%, the tumor remain in the treatment area from day 30 onwards. Furthermore, the ICSA algorithm outperforms the CSA and PSO algorithms by 34.5497×10-6 and 15.2573 ×10-6, respectively, indicating the robustness of treatment methods that can accomplish tumor reduction through biological parameters ambiguity.

Differential Impact of COVID-19 on Cancer Diagnostic Services Based on Body Regions: A Public Facility-Based Study in Hong Kong.

PurposeA reduction in cancer services during the coronavirus disease of 2019 pandemic has affected cancer diagnoses. The purpose of this study is to quantitatively determine the impact on cancer diagnostic service in public facilities across Hong Kong. Quantifying the temporal changes in the number of cancer diagnoses before, during, and after the outbreak is useful to establish the scale of the problem and assess if there has been an adequate level of response.Methods and MaterialsThis is a retrospective cohort study using a territory-wide database in Hong Kong from 2017 to 2020, and consecutive specimens received for pathologic diagnosis in public laboratories in 41 hospitals were retrieved.ResultsIn 2020, a total of 455,453 pathologic specimens were received, which amounted to a 15.5% reduction compared with the prior 3-year average (P < .001). An analysis of confirmed malignant pathologic diagnoses revealed a statistically significant reduction in colorectal (–10.0%; P < .001) and prostate (–19.7%; P < .001), nonsignificant reduction in lung (–3.0%; P = .0526), and a marginal but nonsignificant increase for breast (0.7%; P = .7592) regions. Based on time series projection data, the estimated missed cancers for the 3 regions with reduced investigations were colorectal (10.0%), lung (3.0%), and prostate (19.7%).ConclusionsVariable impact on actual malignant pathologic diagnoses based on 4 body regions was observed, with a statistically significant reduction in colorectal, lung, and prostate regions, and marginal but insignificant increase in breast regions. The findings could help public health policy with future planning and intervention.

Cancer diagnoses and survival rise as 65‐year‐olds become Medicare‐eligible

A Medicare effect has been described to account for increased health care utilization occurring at the age of 65 years. The existence of such an effect in cancer care, where it would be most likely to reduce mortality, has been unclear. Patients aged 61 to 69 years who were diagnosed with lung, breast, colon, or prostate cancer from 2004 to 2016 were identified with the Surveillance, Epidemiology, and End Results database and were dichotomized on the basis of eligibility for Medicare (61-64 vs 65-69 years). With age-over-age (AoA) percent change calculations, trends in cancer diagnoses and staging were characterized. After matching, uninsured patients who were 61 to 64 years old (pre-Medicare group) were compared with insured patients who were 65 to 69 years old (post-Medicare group) with respect to cancer-specific mortality. In all, 134,991 patients were identified with lung cancer, 175,558 were identified with breast cancer, 62,721 were identified with colon cancer, and 238,823 were identified with prostate cancer. The AoA growth in the number of cancer diagnoses was highest at the age of 65 years in comparison with all other ages within the decade for all 4 cancers (P < .01, P < .001, P < .01, and P < .001, respectively). In a comparison of diagnoses at the age of 65 years with those in the 61- to 64-year-old cohort, the greatest difference for all 4 cancers was seen in stage I. In matched analyses, the 5-year cancer-specific mortality was worse for lung (86.3% vs 78.5%; P < .001), breast (32.7% vs 11.0%; P < .001), colon (57.1% vs 35.6%; P < .001), and prostate cancer (16.9% vs 4.8%; P < .001) in the uninsured pre-Medicare group than the insured post-Medicare group. The age threshold of 65 years for Medicare eligibility is associated with more cancer diagnoses (particularly stage I), and this results in lower long-term cancer-specific mortality for all cancers studied. Contributing to the current debate regarding Medicare for all, this study shows that the expansion of Medicare would improve cancer outcomes for the near elderly.

Projection of cancer incidence and death to 2040 in the US: Impact of cancer screening and a changing demographic.

1566 Background: Coping with the current and future burden of cancer requires an in-depth understanding of cancer incidence and death trends. As of 2020, breast, lung, prostate, and colorectal cancer are the most incident cancers, while lung, colorectal, pancreas, and breast cancer result in the most deaths. Here we integrate observed cancer statistics and trends with observed and estimated US demographic data to project cancer incidences and deaths to the year 2040. Methods: Demographic cancer-specific delay-adjusted incidence and death rates from the Surveillance, Epidemiology, and End Results Program (2014-2016) were combined with US Census Bureau population growth projections (2016) and average annual percentage changes in incidence (2011-2015) and death (2012-2016) rates to project cancer incidences and deaths through the year 2040. We examined the 10 most incident and deadly cancers as of 2020. We utilized Joinpoint analysis to examine changes in incidence and death rates over time relative to changes in screening guidelines. Results: We predict the most incident cancers in 2040 in the US will be breast (322,000 diagnoses in 2040) and lung (182,000 diagnoses in 2040) cancer. Continuing decades long observed incident rate trends we predict that melanoma (173,000 diagnoses in 2040) will become the 3rd most common cancer while prostate cancer (63,000 diagnoses in 2040) will become the 5th most common cancer after colorectal cancer (139,000 diagnoses in 2040). Lung cancer (61,000 deaths in 2040) is predicted to continue to be the leading cause of cancer related death, with pancreas (45,000 deaths in 2040) and liver &amp; intrahepatic bile duct (38,000 deaths in 2040) cancer surpassing colorectal cancer (34,000 deaths in 2040) to become the second and third most common causes of cancer related death, respectively. Breast cancer deaths (29,000 in 2040) are predicted to continue to decrease and become the fifth most common cause of cancer death. Joinpoint analysis of incidence and death rates supports a significant past, present, and future impact of cancer screening programs on the number of cancer diagnoses and deaths, particularly for prostate, thyroid, melanoma incidences, and lung cancer deaths. Conclusions: We demonstrate marked changes in the predicted landscape of cancer incidence and deaths by 2040. Our analysis reveals an influence of cancer screening programs on the number of cancer diagnoses and deaths in future years. These projections are important to guide future research funding allocations, healthcare planning, and health policy efforts.

Cancer diagnoses and survival rise as 65-year-olds become Medicare eligible.

2015 Background: A “Medicare effect” has been described to account for increased health care utilization occurring at the age of 65, when individuals become eligible for government-sponsored health care. The existence of such an effect in cancer care, where it would be most likely to reduce mortality, has been unclear. Methods: Patients aged 61-69 diagnosed with lung, breast, colon, or prostate cancer from 2004-2016 were identified using the Surveillance, Epidemiology, and End Results database and dichotomized based on eligibility for Medicare (age 61-64 vs 65-69). Using age-over-age percent change calculations, trends in cancer diagnosis, AJCC staging, and survival were characterized. Results: 134,991 patients were identified with lung cancer; 175,558 with breast; 62,721 with colon; and 238,823 with prostate. The age-over-age growth in the number of cancer diagnoses was highest at age 65 when compared to all other ages within the decade, for all four cancers (Table: p&lt;0.01, p&lt;0.001, p&lt;0.01, p&lt;0.001 respectively). Comparing age 65 diagnoses to the 61-64 year old cohort, the greatest difference for all four cancers was seen in stage I (lung p&lt;0.001; breast p&lt;0.002; colon p&lt;0.001; prostate p&lt;0.02). The older (65-69), Medicare-eligible cohort had higher cancer specific 5-year survival than the 61-64 aged cohort for lung (22.0% vs 21.0%, p&lt;0.01) and colon cancer (66.2% vs 63.2%, p&lt;0.01). Conclusions: The 65 age threshold for Medicare eligibility is associated with more cancer diagnoses, particularly in stage I, resulting in improved cancer-specific survival for some cancers. Near-elderly individuals may be delaying care until the age of 65. A Medicare-for-all system would thus be likely to reduce cancer mortality. [Table: see text]

Association of Pedicle Sign Type with Clinical and Radiological Features in Patients with Symptomatic Spinal Metastases.

Because of population aging in Japan, the number of cancer diagnoses is increasing rapidly. The pedicle sign is a valuable radiographic indicator of metastases, as the pedicle is the most commonly affected vertebral structure in radiographic assessment. However, few studies have carefully examined the morphological features of pedicle signs. To improve the capacity of medical professionals to diagnose symptomatic spinal metastases, we retrospectively examined the morphological characteristics of pedicle signs and their associations with clinical and radiological features. 186 patients with symptomatic spinal metastases who visited our department during the period from January 1, 2011 through December 31, 2017 were enrolled. The pedicle sign was defined as a missing or obscured pedicle on an anteroposterior radiograph. Radiographs were evaluated for pedicles and other vertebrae structures. Clinical and other radiological features were compared in relation to the type of pedicle sign identified. Pedicle signs were classified as completely disappeared (complete, 26 patients), partially disappeared (partial, 40 patients), or obscured by the osteoblastic background (blastic, 28 patients). Disappearance of both the bone cortex and pedicle was observed in almost half of the patients with complete or partial pedicle signs. The complete pedicle sign was associated with significantly longer survival. Diagnosis of bone metastases requires understanding of pedicle sign types.

Financial hardship associated health care utilization among cancer survivors in the United States.

133 Background: A cancer diagnosis is associated with medical financial hardship in the U.S. However, little is known about health consequences associated with financial hardship. This study examines associations between medical and non-medical financial hardship on healthcare utilization among cancer survivors. Methods: We used the National Health Interview Survey (2013-2017) to identify cancer survivors (18-64 years: n = 5200; 65+ years: n = 7326). Medical financial hardship included material (e.g., problems paying medical bills), psychological (e.g., worry about medical bills), and behavioral (e.g., forgoing care due to cost) domains, and non-medical financial hardship included food hardship and worry for other financial needs (e.g. retirement, monthly bills, standard of living, and housing costs). We compared cancer survivors by intensities of medical and non-medical financial hardships in: 1) emergency department (ED) visits; 2) preventive services use (receipt of influenza vaccine, and blood pressure/cholesterol screenings); and 3) cervical/breast/colorectal cancer screenings among eligible cancer survivors. We used generalized ordinal logistic regressions, controlling for demographic characteristics, time since diagnosis, number of cancer diagnoses, insurance, income, and comorbidities. Results: Across age groups, both higher medical and non-medical hardship intensities were associated with higher ED visits and lower use of preventive services. Compared to cancer survivors with lowest intensity, higher percentages of ED visits were observed among those with highest medical hardship intensity (ages 18-64: 42% vs 26.2%; ages 65+: 37.2% vs 27.9%, all p &lt; .01) and highest non-medical hardship intensity (ages 18-64: 37.6% vs 24.3%, p = .01). Moreover, compared to lowest intensity, highest medical hardship intensity was associated with lower influenza vaccination (ages 18-64: 45.6% vs 52.5%; ages 65+: 64.6% vs 75.6%, p &lt; .05) and breast cancer screening (54.4% vs 65.9%, p &lt; .05). Conclusions: Cancer survivors with higher medical and non-medical financial hardships have more ED visits and medical financial hardship was also associated with less use of preventive services and some cancer screening.

Employer provided health benefits among cancer survivors in the United States.

155 Background: Nearly 40% of cancer survivors are of working age in the U.S. Access to high quality diagnosis, treatment, and survivorship care requires both health insurance coverage and sick leave, key components of employer health benefits. This study examines work limitations, paid sick leave, and employer offered health insurance among cancer survivors. Methods: We used the National Health Interview Survey (2001-2017) to identify cancer survivors aged 18-64 years. Work limitations were asked among all cancer survivors regardless of work status (n = 15,247), and categorized into unable to work, limited in type/amount of work, and not limited at all. Paid sick leave and employer offered health insurance offered were asked of cancer survivors who were working in the last week (n = 8741). We used generalized ordinal logistic regressions to examine work limitation and employer health benefits among cancer survivors, controlling for demographic characteristics, time since cancer diagnosis, number of cancer diagnoses, income, and comorbidities. Stratified analyses by type of workplace (private sector, federal/state/local government, and self-employed), and hours worked per week (full time with 35+ hours per week vs part time &lt; 35 hours per week) was conducted. Results: Among cancer survivors aged 18-64 years, 10.7% and 5.3% reported unable to work at all and limited in types/amounts of work, respectively; 57.7% and 67.6% of those working in the last week received paid sick leave and employer offered health insurance, respectively. In stratified analyses, government jobs were associated with the highest paid sick leave and employer insurance (85.7% and 85.6%, respectively), followed by private sector (58.3% and 70.7%, respectively), and self-employed (8.3% and 15.7%), respectively. Moreover, full time jobs had higher paid sick leave (65.2% and 21.9%, respectively) and employer insurance (75.7% and 29.1%, respectively) then part time jobs. Conclusions: Cancer survivors experience work limitations and many working cancer survivors do not receive paid sick leave or health insurance from their employers. Evaluation of the effects of employer-based health benefits on survivorship care and outcomes will be important for future research.

Abstract IS-2: The challenge of definition and adoption; perspective from the Middle East

Abstract Cancer has become one of the leading causes of morbidity and mortality worldwide. The World Health Organization has warned the number of cancer diagnoses in the Middle East (ME) in the next two decades will nearly double unless authorities take action. This means the ME will have the highest relative increase of all regions in the world. Breast cancer is the most common cancer in ME (15%) and the second most common in terms of cancer related mortality (9%). Across the world, the cost of healthcare is rising faster than economies are growing, creating the case for value based healthcare (VBHC), with value based medicine taking center stage. VBHC helps healthcare providers manage cost increases, make the best use of finite resources and deliver improved care to patients. The challenge for effective control of cancer is multifaceted. It mandates integration of effective cancer prevention, encouraging early detection, and utilization of resource adapted therapeutic and supportive interventions. Overly expensive drugs may consume resources; not just drugs for other conditions but paying for these may reduce the ability to invest in other cancer services like surgery, radiotherapy or early detection services. Access to cancer drugs is imperative but their price tag is creating a significant barrier to access. Countries in the ME are heterogeneous in terms of income. However, they all have different aspects of challenge when it comes to implementing value based models. Many have other priorities such as improving quality and increasing access to basic health services. Others struggle with the challenges of fragmented systems, and the limits of existing healthcare infrastructure and operations. A particular challenge among others is the deficiency in the core components focusing on objective measures of outcomes and costs; including policies and institutions for value in healthcare. These obstacles are, indeed, shared by many other countries. As technology advances and new value-based approaches take hold in wealthy economies, those countries that are still investing in developing their health systems have an opportunity to learn from their experience, saving precious resources and delivering better long-term care for their societies. Citation Format: Al Sukhun S. The challenge of definition and adoption; perspective from the Middle East [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr IS-2.

Abstract B73: Trends in racial disparities in cancer incidence among white and black older adults in the United States

Abstract Background: As cancer occurs more commonly in older adults (≥65 years), the aging of the U.S. population is expected to markedly increase the number of cancer diagnoses. Despite this increase, older adults are an understudied cancer patient population. Few studies have reported trends in cancer incidence rates among older adults in the U.S., however, none have examined trends in racial disparities in cancer incidence in this population. Purpose of the study: To examine potential racial disparities in cancer incidence over time among older adults using data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. Methods: Cases of female breast, prostate, colorectal, and lung and bronchus cancer were reported to one of 18 SEER registries. Differences in cancer incidence rates by race and changes in these differences over time were examined for cases aged ≥65 years diagnosed 1973-2013. Results: From 1973-2013, lung and bronchus and female breast cancer incidence rates increased while colorectal cancer incidence rates decreased among older adults. Prostate cancer incidence rates increased between 1973 and the mid-nineties and then decreased until 2013 among older adults. Among older women diagnosed with breast cancer, white women had higher incidence rates than black women; however, the percent difference in rates decreased from 23.4% in 1973-1977 to 6.3% in 2008-2013. For prostate cancer, black older men had higher prostate cancer incidence rates than white men from 1973-2013. The percent difference in prostate cancer incidence rates between white and black older men remained relatively large over time, from 45.9% in 1973-1977 to 50.1% in 2008-2013. From 1973-1992, white older adults had higher colorectal incidence rates than black older adults. Notably, beginning in 1993, the colorectal cancer incidence rates among black older adults surpassed those of white older adults. The percent difference in the colorectal cancer incidence rates between white and black older men increased from 4.3% in 1993-1997 to 18.1% in 2008-2013. Lastly, from 1973-2013, black older adults had higher lung and bronchus cancer incidence rates than white older adults. The percentage difference for the rates between white and black older adults decreased from 11.9% in 1973-1977 to 8.5% in 2008-2013. Conclusion: There are considerable racial disparities in cancer incidence rates in the U.S. among older adults. Continued efforts involving cancer prevention are needed to reduce these disparities. Citation Format: Jessica L. Krok-Schoen, James L. Fisher, Ryan D. Baltic, Electra D. Paskett. Trends in racial disparities in cancer incidence among white and black older adults in the United States. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B73.