Central Cancer Registry Research Articles

Abstract P4-03-28: Patient Reported Symptom Burden Amongst Immigrant and Canadian Long-Term Resident Women Undergoing Breast Cancer Surgery

Abstract Background: Disparities in breast cancer outcomes are well documented, with a burgeoning body of literature shedding light on the influence of multiple factors. Much of the literature comes from the US, with the current situation in Canada less well understood. Canada’s universal health care system may mitigate some, but unlikely all differences. First generation immigrants compromise 21.9% of the Canadian population. Differences in breast cancer screening rates and stage at diagnosis have been demonstrated between immigrant and non-immigrant Canadian women. However, breast cancer outcomes in the Canadian immigrant population have not been well studied. Patient reported outcomes are one such set of outcomes and crucial in understanding the patient experience. The purpose of this study is to compare symptom burden and trajectories between immigrant and Canadian long-term resident women with breast cancer undergoing breast cancer surgery in Ontario. Methods: A population-level retrospective cohort-study using linked Ontario administrative databases was constructed. Women >18 years of age with newly diagnosed breast cancer between 2010-2016 undergoing surgery at a regional cancer center were included. Baseline variables including immigration status, age, stage, comorbidity and income quintile were collected. The proportion of patients reporting moderate/severe Edmonton Symptom Assessment System Scale (ESAS) scores for each of 9 individual symptom categories over time was collected. Multivariable logistic regression models using generalized estimating equations with exchangeable correlation structure to account for repeated measures were constructed to assess the probability of a moderate/severe score for each of the individual ESAS symptom categories. Results: The cohort included 14,056 women, of which 12,250 (87.2%) were categorized as long-term Canadian residents and 1,806 (12.8%) as immigrants. Immigrant women had a younger mean age of diagnosis (53 vs. 61 years), were more likely to reside in a lowest income quintile neighbourhood (22.2% vs 15.4%), were less likely to be on a primary care physician roster within the last 2 years (83.7% vs. 90.4%) and were less often diagnosed with Stage I/II disease (80.9% vs. 84.6%) (all p< 0.0001). The proportion of women reporting moderate/severe scores was significantly higher amongst immigrant women for 7/9 symptom categories (anxiety, depression, drowsiness, nausea, pain, shortness of breath and well-being) with the largest difference observed for depression (13.1% vs 10.8%, p< 0.0001) and pain (14.8% vs. 12.0%, p< 0.0001). Comparing symptom trajectories, differences between groups were most pronounced within the first 12 months, though for depression and pain, statistically significant differences also existed at 36 months. On multivariable regression analysis, immigration status was persistently associated with higher proportion of moderate/severe score for pain only (OR 1.12, 95% CI 1.02-1.23). Immigration status was associated with a protective effect for anxiety (OR 0.86, 95% CI 0.78-0.94), drowsiness (OR 0.81, 95% CI 0.73-0.89) and tiredness (OR 0.86, 95% CI 0.79-0.94). Conclusions: To our knowledge, this is the first study comparing symptom burden amongst immigrant and non-immigrant Canadian women with breast cancer at a population-level. Immigrant women undergoing breast cancer surgery were found to have a higher burden of symptoms across most categories, and for depression and pain this difference was found to persist even at 3-years. However, the higher burden of symptoms in many categories seemed to be explained by factors such as younger age and more advanced disease. Adjusting for other factors, immigrant women with breast cancer reported more pain, indicating a need for better symptom management in this population. Citation Format: Elena Parvez, Megan M. Chu, David Kirkwood, Aristithes Doumouras, Jessica Bogach. Patient Reported Symptom Burden Amongst Immigrant and Canadian Long-Term Resident Women Undergoing Breast Cancer Surgery. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-03-28.

Abstract OT2-01-05: The CROWN Study (CaRdiac Outcomes With Near complete estrogen deprivation): A multicenter, prospective cohort study of cardiovascular outcomes in premenopausal women treated with ovarian suppression and an aromatase inhibitor

Abstract Background: Treatment for premenopausal women with high or intermediate risk hormone receptor (HR)+ breast cancer (BC) now includes the concurrent use of ovarian function suppression (OFS) and an aromatase inhibitor (AI) therapy to induce near complete estrogen deprivation (NCED). The long-term cardiovascular (CV) sequela for women treated with NCED is unknown. Premature menopause in the non-cancer population is associated with CV disease, including atherosclerosis and coronary artery disease, which can be detected pre-clinically by myocardial perfusion imaging and coronary artery plaques. This, together with the CV morbidity associated with other aspects of BC treatment and future life-years of these women, warrants further investigation with the goal of identifying pre-clinical markers of myocardial compromise. We seek to do this with the following specific aims: 1. Characterize and quantify the extent of coronary microvascular injury and perfusion changes experienced during early NCED therapy. 2. Characterize and quantify the extent of structural and functional alterations to the aorta and left ventricle while on NCED therapy. 3. Identify potential biomarkers and additional risk factors for CV morbidity in patients receiving NCEDTrial Design: This is a federally funded (NHLBI) prospective cohort study conducted at 3 regional NCI-supported Cancer Centers (Atrium Health Wake Forest Baptist, Virginia Commonwealth and Duke) that will include premenopausal women, age ≤ 55, with Stage I-III BC following completion of planned chemotherapy, surgery and radiation with an ECOG 0-1. HR+ BC patients will receive an AI and OFS. Women with HR- BC are included as comparators. CV imaging and biomarkers will be obtained at baseline, 1 year and 2 years (Table 1). These assessments will include serial cardiac magnetic resonance (CMR) and coronary computed tomography angiography (CCTA) imaging as well as laboratory measurements, including exploratory biomarkers. The primary outcome is myocardial perfusion reserve (MPR) as measured by CMR imaging stress studies. We will correlate CMR imaging with CCTA to provide complementary detail of coronary plaque changes. The study will also assess the relevance of pre-existing risk factors, including an emphasis on racial disparities, on study outcomes, and dynamic change in modifiable and treatment related risk factors. Statistical Methods: We plan to enroll 90 women, 67 in the NCED group and 23 in the HR-group, allowing for a 10% drop out rate. There are two primary types of statistical analyses. The first includes testing hypotheses between group (NCED vs HR-) and within group (longitudinal changes within the NCED group) for Aims 1 and 2. Comparisons will be made using longitudinal mixed models to examine effects on outcomes measured. The second analyses, for Aim 3, involve developing predictive equations utilizing a stepwise linear regression approach to determine if patient demographics, clinical parameters and serum biomarkers are associated with MPR. The sample size allows 80% power to address specific aims for between and within group comparisons, including a between group difference of 2.8% in our primary outcome, MPR. Present Accrual: 0 Target Accrual: 90 Contact information: Emily Douglas, MD; edouglas@wakehealth.edu Table 1: Study Procedures Citation Format: Emily Douglas, Nathaniel O’Connell, Mary Hackney, Wendy Bottinor, John Grizzard, Igor Klem, Carolyn Park, Sujethra Vasu, Karl Richardson, Susan Dent, Ralph D’Agostino, Gregory Hundley, Jennifer Jordan, Alexandra Thomas. The CROWN Study (CaRdiac Outcomes With Near complete estrogen deprivation): A multicenter, prospective cohort study of cardiovascular outcomes in premenopausal women treated with ovarian suppression and an aromatase inhibitor [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT2-01-05.

Post-Acute Care Outcomes of Cancer Patients

Background: Post-acute care outcomes for patients with cancer <65 with multiple payers are largely unknown. Objective: Describe the population and outcomes of younger adults discharged to skilled nursing facility (SNF) and those discharged home or with home health care six months following hospitalization. Design: Descriptive cohort analysis. Setting/Subjects: Using a linkage between the Colorado All Payers Claims Database and the Colorado Central Cancer Registry, we studied patients <65 with stage III or IV advanced cancer between 2012 and 2017. Measurements: Receipt of cancer treatment, 30-day readmission, death, and hospice use. Groups of interest were compared by patient demographics and disease characteristics using chi-square tests. Logistic regression was used to describe unadjusted and adjusted outcome rates among discharge setting. Kaplan-Meier method was used to estimate survival by discharge destination. Results: Three percent of patients were discharged to SNF, 79.0% to home, and 18.0% to home health care. SNF discharges were less likely to receive cancer treatment. Among decedents, 39.0%, 51.0%, and 58.0% of SNF, home, and home health care discharges received hospice, respectively. Patients with Medicaid were more likely to be discharged to an SNF. Black/Hispanic patients were more likely to have Medicaid and received less radiation and hospice care, irrespective of discharge location. Those who were discharged to SNF were more likely to receive radiation compared to White patients. Conclusions: Younger patients with cancer discharged to SNF were unlikely to receive cancer treatment and hospice care before death. Racial disparities exist in cancer treatment receipt and hospice use warranting further investigation.

Optimizing Cancer Survivorship Care: Examination of Factors Associated with Transition to Primary Care.

Healthcare systems in Canada and elsewhere have identified the need to develop methods to effectively and safely transition appropriate cancer survivors to primary care. It is generally accepted that survivors with a low risk of adverse events, including recurrence and toxicity, should be more systematically identified and offered transition. There remains a lack of clarity about what constitutes an appropriate profile that would assist greater application in practice. To address this gap, we examined the clinical profiles of patients that were transitioned from a large regional cancer centre to the community. The factors examined included disease site, clinical stage, time since diagnosis/first consult, cancer treatments, and Edmonton Symptom Assessment System (ESAS) scores. In total, 2604 patients were identified as transitioned between 2013 and 2020. These patients tended to have common cancers (e.g., breast, endometrium, colorectal) that were generally of lower stage. Half of the patients had received chemotherapy and/or radiation treatment. Nearly one-third of survivors were transitioned within a year of first consult and a third after five years. Most patients reported minimal symptoms based on ESAS scores prior to being transitioned. This study represents one of the first to analyze the types of cancer patients that are being selected for transition to primary care.

Soybean product consumption decreases risk of gastric cancer: results from the Health Examinees Study.

Epidemiological findings on the association between soybean product consumption and gastric cancer risk remain inconsistent. We evaluated the relationship between soybean product consumption and the risk of gastric cancer in a prospective cohort study in Korea. This prospective cohort study included a total of 139,267 participants aged 40-69years from the Health Examinees-Gem (HEXA-G) study between 2004 and 2013. Information on cancer diagnosis was retrieved from the Korea Central Cancer Registry until 31 December 2018. Multivariate hazard ratios (HRs) and 95% of confidence intervals (CIs) for the risk of gastric cancer according to the consumption of soybean products were estimated using Cox proportional hazards models. A total of 767 incident cases of gastric cancer occurred over an average follow-up period of 9.21years. We found that men who consumed two servings per week had 37% lower risk of gastric cancer compared with who consume those who almost never consumed (HR for tofu consumption of more than two servings/week vs. almost never consumed was 0.63 (95% CI 0.45, 0.89); p for trend = 0.04). Among men with a BMI of less than 25kg/m2, increased consumption of soybean paste (p for trend = 0.02) and tofu (HR 0.51 (95% CI 0.32, 0.82 for more than two servings/week vs. almost never consumed); p for trend = 0.01) was associated with decreased risk of gastric cancer. Our results suggest that a high consumption of soybean products has a protective effect against gastric cancer.

Replantation of solitary kidney in a patient with giant primary retroperitoneal sarcoma

Background. Surgery for non-organ malignant retroperitoneal tumors poses a serious challenge. Long-term asymptomatic course of the disease leads to a delayed diagnosis, when tumors can reach massive size with potential involvement of adjacent organs and critical structures. In most cases, nephrectomy is often required during resection of retroperitoneal sarcomas. Recently, there has been growing interest in nephronsaving surgery for large retroperitoneal tumors.Description of the clinical case. A 70-year-old patient was admitted to Irkutsk Regional Cancer Center with right-sided giant primary retroperitoneal tumor and grade 1 hydronephrosis of solitary right kidney. The patient underwent extended resection of primary retroperitoneal tumor with right-sided hemicolectomy and nephradrenalectomy. Extracorporeal resection of the solitary kidney was then performed. After obtaining negative kidney smears (imprints), the kidney was replanted in the pool of right iliac vessels. No complications were observed in the postoperative period. Histopathology examination revealed was welldifferentiated liposarcoma. On follow-up examination 38 months after surgery, there were no signs of local tumor recurrence, and renal function was satisfactory.Conclusion. Extracorporeal resection of the kidney with heterotopic replantation is an effective nephron-saving method in surgery for primary retroperitoneal sarcomas. The patient’s solitary kidney with primary retroperitoneal sarcoma is an absolute indication for kidney’s saving, including the use of transplant technologies.

Real-World Impact of SABR on Stage I Non-Small-Cell Lung Cancer Outcomes at a Scottish Cancer Centre.

Stereotactic ablative body radiotherapy (SABR) offers patients with stage I non-small-cell lung cancer (NSCLC) a safe, effective radical therapy option. The impact of introducing SABR at a Scottish regional cancer centre was studied. The Edinburgh Cancer Centre Lung Cancer Database was assessed. Treatment patterns and outcomes were compared across treatment groups (no radical therapy (NRT), conventional radical radiotherapy (CRRT), SABR and surgery) and across three time periods reflecting the availability of SABR (A, January 2012/2013 (pre-SABR); B, 2014/2016 (introduction of SABR); C, 2017/2019, (SABR established)). 1143 patients with stage I NSCLC were identified. Treatment was NRT in 361 (32%), CRRT in 182 (16%), SABR in 132 (12%) and surgery in 468 (41%) patients. Age, performance status, and comorbidities correlated with treatment choice. The median survival increased from 32.5 months in time period A to 38.8 months in period B to 48.8 months in time period C. The greatest improvement in survival was seen in patients treated with surgery between time periods A and C (HR 0.69 (95% CI 0.56-0.86), p < 0.001). The proportion of patients receiving a radical therapy rose between time periods A and C in younger (age ≤ 65, 65-74 and 75-84 years), fitter (PS 0 and 1), and less comorbid patients (CCI 0 and 1-2), but fell in other patient groups. The introduction and establishment of SABR for stage I NSCLC has improved survival outcomes in Southeast Scotland. Increasing SABR utilisation appears to have enhanced the selection of surgical patients and increased the proportion of patients receiving a radical therapy.

Impact of chemotherapy on anxiety, depression, and suicidality amongst testicular cancer survivors.

418 Background: Chemotherapy for testicular cancer (TC) is highly effective yet associated with significant consequences on long-term health-related quality of life. We evaluate the impact of chemotherapy on anxiety, depression, and suicidality amongst TC survivors. Methods: We conducted a retrospective cohort study of US veterans diagnosed with TC in the Veterans Health Affairs database from 1990-2016. Patients with non-primary germ cell tumor histologies were excluded. Baseline disease characteristics and treatment received were ascertained from the VA Central Cancer Registry. Anxiety or depression was a composite endpoint comprised of diagnosis codes for anxiety, depression, or administration of medications used to treat these diagnoses. Incident suicidality was defined as a diagnosis code for suicidal ideation. Time to event was defined as time from diagnosis to event or censor at the time of last follow-up. Rates of outcomes were reported through cumulative incidences. Associations with outcomes and receipt of chemotherapy were assessed through multivariable Cox regression models. Results: In total, 1684 patients (1174 seminoma, 510 nonseminoma) were included in the cohort. Median age at diagnosis in the cohort was 40 years old. Median follow up time was 7.67 years for surviving patients. 1506 (89.4%) patients were white, 114 (6.8%) were African American, and 64 (3.8%) were another or unknown race. There were 1066 (63.3%) stage I patients, 191 (11.3%) stage II, 198 (11.8%) stage III, and 229 (13.6%) unknown stage patients. 579 (34.4%) patients received chemotherapy. At the time of diagnosis, 104 (6.2%) patients already experienced anxiety or depression. At 10 years, cumulative incidence of the diagnosis of anxiety or depression as 44.1% in the entire cohort. At 10 years, cumulative incidence of the diagnosis of suicidality was 5.5%. On multivariable Cox regression, factors associated with a higher risk of anxiety or depression were older age at diagnosis (Hazard Ratio (HR): 1.11 per standard deviation increase, p=0.01), being unemployed (HR: 1.25, p=0.01), and receipt of chemotherapy (HR: 1.43, p&lt;0.001). Race, stage, alcohol or tobacco use and seminoma type were nonsignificant. Factors associated with increased risks of suicidality were being unemployed (HR: 2.00, p=0.01) and not being married (HR: 2.50, p=0.001). Stage, age, race, alcohol and tobacco use, seminoma type, and receipt of chemotherapy were not significantly associated with suicidality. Conclusions: Psychosocial morbidity is high among TC survivors. Despite being effective and necessary for maintaining excellent oncologic outcomes, chemotherapy appears to increase the rates of psychosocial morbidity. Socioeconomic risk factors, including employment and marriage, may also impact psychosocial health. Clinicians should be proactive in identifying support systems for TC survivors.

Changes in the treatment rate of patients newly diagnosed with stage IV cancer near the end of life from 2012 to 2017 in Korea.

This study aimed to evaluate changes in the cancer treatment rate among patients newly diagnosed with stage IV cancer using socio-demographic and clinical subgroups in a nationwide cohort of Korean patients. This retrospective, national-level study used the Korea Central Cancer Registry (KCCR), which is linked to the National Health Insurance Service (NHIS) database, from January 1, 2012 to December 31, 2017. The records of patients newly diagnosed with stage IV of the 5 cancers with the highest cancer-related mortality rate were identified to analyze changes in the treatment rate. The main outcome examined in this study was the change in the cancer treatment rate between 2012 and 2017, as measured using the annual percent change (APC). A total of 106,082 patients with newly diagnosed gastric, colorectal, liver, pancreatic, and lung cancers at the end of life (EoL) were identified from the KCCR-NHIS database. Of these patients, 76,533 (72.1%) received cancer treatment. Over the study period (2012-2017), the proportion of patients who received cancer treatment at EoL decreased by 8.3%, with an APC of -2.1% (95% confidence interval, -2.6 to -1.6). This declining trend of cancer treatment among patients with advanced cancer stage at EoL was consistent among socio-demographic and clinical subgroups. The proportion of untreated patients with stage IV cancer is increasing in the Korea. For patients who are not undergoing standard cancer treatment near EoL, an alternative care plan, such as early palliative care, should be considered.

The association of Medicaid expansion and pediatric cancer overall survival.

Medicaid eligibility expansion, though not directly applicable to children, has been associated with improved access to care in children with cancer, but associations with overall survival are unknown. Data for children ages 0 to 14 years diagnosed with cancer from 2011 to 2018 were queried from central cancer registries data covering cancer diagnoses from 40 states as part of the Centers for Disease Control and Prevention's National Program of Cancer Registries. Difference-in-differences analyses were used to compare changes in 2-year survival from 2011-2013 to 2015-2018 in Medicaid expansion relative to nonexpansion states. In adjusted analyses, there was a 1.50 percentage point (95% confidence interval = 0.37 to 2.64) increase in 2-year overall survival after 2014 in expansion relative to nonexpansion states, particularly for those living in the lowest county income quartile (difference-in-differences = 5.12 percentage point, 95% confidence interval = 2.59 to 7.65). Medicaid expansion may improve cancer outcomes for children with cancer.

Single-Stage Free Flap Reconstruction Following Extremity Sarcoma Resection: a Regional Cancer Center Experience.

Surgery remains mainstay modality of treatment of STS of extremity. In majority of patients, primary closure is possible following surgical resection of the tumor. Primary closure of wound may not be feasible in tumors with large area of skin involvement and sometimes following a whoopsprocedure. We analyzed postoperative complications and oncological outcomes in patients who underwent free flap reconstruction. Thirty-seven patients who required a free flap for reconstruction of the defect following resection of the STS were included in the study. There were 26 men and 11 women with a mean age of 40years. Seventy-three percent tumors were in lower limb; 62% patients had undergone a whoops procedure elsewhere. Flaps were fasciocutaneous in 19, myocutaneous in 15, and free muscle transfers in 3 patients. Seventeen patients had early surgical site complications. Nine patients had early flap failures. Of the 9, 6 patients had total loss of flap and in 3 the flaps were salvaged. Two patients had partial loss (< 50% of total area) of flap. Four patients had edge necrosis and two had suture diastasis. Nine patients had late surgical site complications. Four had post-radiotherapy wound dehiscence. Late SSI was noted in two. Late joint contracture and chronic lymphedema was seen in one patient each. One died due to sepsis. Statistically significant association was not found between patient, tumor or treatment-related factors and complications or flap failures. Mean duration of surgery was 7.73h. Twenty-three patients required multiple surgeries due to complications. Mean time to initiate adjuvant therapy from the date of surgery was 47days. Mean OS of the group was 67 ± 7.3months. Mean RFS was 58 ± 7.8months. Single-stage free flap reconstruction following surgical resection of extremity sarcoma is a viable option of reconstruction while salvaging the limb. Though associated with high rate of early surgical site complications, they are manageable.

Cohort Study Protocol: A Cohort of Korean Atomic Bomb Survivors and Their Offspring.

In 1945, atomic bombs were dropped on Hiroshima and Nagasaki. Approximately 70 000 Koreans are estimated to have been exposed to radiation from atomic bombs at that time. After Korea's Liberation Day, approximately 23 000 of these people returned to Korea. To investigate the long-term health and hereditary effects of atomic bomb exposure on the offspring, cohort studies have been conducted on atomic bomb survivors in Japan. This study is an ongoing cohort study to determine the health status of Korean atomic bomb survivors and investigate whether any health effects were inherited by their offspring. Atomic bomb survivors are defined by the Special Act On the Support for Korean Atomic Bomb Victims, and their offspring are identified by participating atomic bomb survivors. As of 2024, we plan to recruit 1500 atomic bomb survivors and their offspring, including 200 trios with more than 300 people. Questionnaires regarding socio-demographic factors, health behaviors, past medical history, laboratory tests, and pedigree information comprise the data collected to minimize survival bias. For the 200 trios, whole-genome analysis is planned to identify de novo mutations in atomic bomb survivors and to compare the prevalence of de novo mutations with trios in the general population. Active follow-up based on telephone surveys and passive follow-up with linkage to the Korean Red Cross, National Health Insurance Service, death registry, and Korea Central Cancer Registry data are ongoing. By combining pedigree information with the findings of trio-based whole-genome analysis, the results will elucidate the hereditary health effects of atomic bomb exposure.

Experience in the Treatment of Breast Cancer Using Tunnel Type Linear Accelerator

Purpose: Describes the features of dosimetric planning for breast cancer and conducts statistics analysis of the radiation treatment planning results, while taking into account 2.5 years of work experience on the Halcyon linear accelerator at the Irkutsk Regional Cancer Center.&#x0D; Materials and methods: Varian Halcyon tunnel type linear accelerator and Varian TrueBeam C-arm linear accelerator were used for breast irradiation. Treatment planning was performed in the Eclipse planning system, Acuros dose calculation algorithm. The experience of using the specified equipment and developments in the field of radiation treatment planning using the Halcyon system are presented.&#x0D; Results: Developed an approach to planning breast radiation at the Halcyon linear accelerator. A retrospective analysis of 84 radiation treatment plans on linear accelerators of various types was carried out. Breast treatment plans for Halcyon linear accelerator have equal dosimetric parameters in comparison to the TrueBeam treatment plans.&#x0D; Conclusion: Linear accelerator Halcyon can be used for treating breast cancer if staff understands specifics of treatment planning and treatment delivery.

Patterns and trends in esophageal cancer incidence and mortality in China: An analysis based on cancer registry data

BackgroundEsophageal cancer poses a significant global burden, while its patterns and trends remain to be clarified. The aim of this study is to provide an update on the incidence and mortality rates of esophageal cancer and their trends in China based on data from the National Cancer Registry. MethodsWe extracted data from the National Central Cancer Registry (NCCR) of China from 2000 to 2016 and performed comprehensive quality control. We calculated age-standardized rates of China (ASR China) and world (ASR world) using the Chinese population in 2000 and the Segi's world standard population, and performed a joinpoint regression analysis to examine the trend in incidence and mortality of esophageal cancer. The annual percent change (APC) and weighted average APC (AAPC) over the entire study period were estimated to measure the changing trend. Subgroup analyses were conducted by sex, region and pathological type. ResultsA total of 487 eligible cancer registries were included in the data analysis and 22 registries with uninterrupted registration data were used for trend analysis. In 2016, there were an estimated of 184,500 incident cases of esophageal cancer and 142,300 deaths in China. The crude incidence, ASR China and ASR world were 25.25/100,000, 11.00/100,000 and 11.13/100,000, respectively. And the crude mortality, ASR China and ASR world were 19.38/100,000, 8.25/100,000 and 8.28/100,000, respectively. Esophageal squamous cell carcinoma (ESCC) was the most common histological type, accounting for 85.79% of all cases, followed by esophageal adenocarcinoma (EAC) (11.00%) and others (3.21%). There was a decreasing trend of ASR world in incidence and mortality during 2000–2016 with the AAPC of -4.6% (95% CI: -5.7%, -3.4%) and -4.6% (95% CI: -5.2%, -3.9%). The pattern and trend of esophageal cancer differ in sex, region and pathological type. ConclusionsThe burden of esophageal cancer in China remains high with sex, regional and subtype differences. The incidence and mortality of esophageal cancer have continued to decline over the past decade, which was due in part to the reductions in risk factor exposure and the implementation of screening.

Choice of Survival Metric and Its Impacts on Cancer Survival Estimates for American Indian and Alaska Native People.

Different survival metrics have different applicability to clinical practice and research. We evaluated how choice of survival metric influences assessment of cancer survival among American Indian and Alaska Native (AIAN) people relative to non-Hispanic Whites (NHW). A secondary objective was to present variations in survival among AIAN people by age, sex, stage, and Indian Health Service (IHS) region. Five-year survival was calculated using the North American Association of Central Cancer Registries Cancer in North America dataset. We calculated survival among AIAN people, compared with NHW using four approaches: (i) observed (crude) survival, (ii) cause-specific survival, (iii) relative survival using age- and sex-adjusted lifetables, and (iv) relative survival using lifetables additionally adjusted for race, geography, and socioeconomic status. For AIAN people, we evaluated how survival varied by age, stage at diagnosis, and IHS region. Observed survival methods produced the lowest estimates, and-excepting prostate cancer-cause-specific methods produced the highest survival estimates. Survival was lower among AIAN people than NHW for all methods. Among AIAN people, survival was higher among those 20-64 years, females, and tumors diagnosed at local stage. Survival varied by IHS region and cancer sites. These results support the assertion that using the same methodology to compare survival estimates between racial and ethnic groups is of paramount importance, but that the choice of metric requires careful consideration of study objectives. These findings have the potential to impact choice of survival metric to explore disparities among AIAN people.

Differential trends in rising endometrial cancer incidence by age, race, and ethnicity.

Endometrial cancer (EC) incidence is on the rise. Although early-onset endometrial cancer (EOEC; age at diagnosis <50 years) is relatively uncommon, the incidence of EOEC has been reportedly increasing in recent decades. However, the rising EOEC has not been thoroughly described with regard to the racial and ethnic disparities and compared with late-onset EC (age at diagnosis ≥50 years). We used the Cancer in North America (CiNA) Analytic File, 1995-2018, from the North American Association of Central Cancer Registries, which allowed us to examine trends in invasive EC incidence by racial and ethnic groups and by age at diagnosis. We found striking differences for demographic and tumor characteristics as well as racial and ethnic patterns and time trends in EC incidence between EOEC and late-onset EC. The faster increases in EOEC incidence rates, especially among non-White women, mirror similar observations in other cancers, pointing to a possible link with rising obesity epidemic in younger generations.

Cancer statistics, 2023

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population-based cancer occurrence and outcomes using incidence data collected by central cancer registries and mortality data collected by the National Center for Health Statistics. In 2023, 1,958,310 new cancer cases and 609,820 cancer deaths are projected to occur in the United States. Cancer incidence increased for prostate cancer by 3% annually from 2014 through 2019 after two decades of decline, translating to an additional 99,000 new cases; otherwise, however, incidence trends were more favorable in men compared to women. For example, lung cancer in women decreased at one half the pace of men (1.1% vs. 2.6% annually) from 2015 through 2019, and breast and uterine corpus cancers continued to increase, as did liver cancer and melanoma, both of which stabilized in men aged 50years and older and declined in younger men. However, a 65% drop in cervical cancer incidence during 2012 through 2019 among women in their early 20s, the first cohort to receive the human papillomavirus vaccine, foreshadows steep reductions in the burden of human papillomavirus-associated cancers, the majority of which occur in women. Despite the pandemic, and in contrast with other leading causes of death, the cancer death rate continued to decline from 2019 to 2020 (by 1.5%), contributing to a 33% overall reduction since 1991 and an estimated 3.8 million deaths averted. This progress increasingly reflects advances in treatment, which are particularly evident in the rapid declines in mortality (approximately 2% annually during 2016 through 2020) for leukemia, melanoma, and kidney cancer, despite stable/increasing incidence, and accelerated declines for lung cancer. In summary, although cancer mortality rates continue to decline, future progress may be attenuated by rising incidence for breast, prostate, and uterine corpus cancers, which also happen to have the largest racial disparities in mortality.

Quality Assessment of Hand Hygiene and Effectiveness of WHO 6 Step Training among Healthcare Personnel in a Tertiary Care Cancer Hospital in Trivandrum, India: A Cross-sectional Study

Introduction: World Health Organization (WHO) 6 steps for effective Hand Hygiene (HH) practice to prevent cross infections emphasises on coverage of all aspects of the hand with the Alcohol Based Hand Rub (ABHR). The quality of hand rubbing usually remains un-monitored among healthcare workers. Hence, interventions to ensure both compliance and quality combined with periodic training would fill the deficiency in these practices in the healthcare setting. Aim: To analyse the quality of HH using an Ultraviolet (UV) sensitive ABHR among healthcare workers in the Operation Theatre (OT) and post-surgical Intensive Care Unit (ICU). Materials and Methods: This cross-sectional study was conducted in Regional Cancer Centre, Trivandrum, Kerala, India. Study population included 104 healthcare providers in the OT and post-surgical ICU, over a period of two months, from June 2017 to July 2017. Participants were asked to disinfect their hands according to WHO 6 steps using an ABHR to which an UV light sensitive pigment was added, and then place them in an UV light sensitive cabinet. Digital images of both sides of their hands were recorded. Every area of the hand not covered by the hand rub appeared as a dark spot and was considered an error. Pass criteria allowed a maximum of two small uncovered areas (dark spots &lt;0.6 cm2 ) on the dorsal side of the hand and no uncovered areas on the palmar aspect. Each hand was observed specifically at four areas and the most missed areas were identified. Statistical analysis was done by Fisher’sexact test using Statistical Package for Social Sciences (SPSS) version 28.0. Results: Out of the total 104 participants, 28 were doctors, 46 were nurses, 22 were nursing students and 8 were OT technicians. A total of 65 participants were males (62%) and 85 participants (82%) were in the 35-40 years age group. The HH was found to be better on the right hand in all the sub-groups studied. The difference in the hand rub coverage on all the four observed areas of the right hand was not significant. On the left-side, hygiene in between the fingers (p-value 0.012) and at the finger tips (p-value 0.007) was poorest. Among the groups studied, doctors performed better with a higher group score of 60.7% compared to 22.7% of that of nursing students (p-value 0.030). Conclusion: Quality of HH practice using ABHR among personnel involved in peri-operative care is poor and requires improvement with regular monitoring and training.

BREAST CANCER SURVIVAL: A HOSPITAL-BASED STUDY IN REGIONAL CANCER CENTRE, BENGALURU

Introduction: Breast cancer is one of the most common cancer among Indian Women. The age adjusted rate (AAR) of Breast cancer is 42.1/100000 women in Bengaluru and it is the leading site of cancer in Bengalurian females. The hospital based cancer registry was established in 1983 and is registering around 800 Breast cancer cases per year. Most of them were diagnosed with late stage. The objective of this study is to evaluate Pattern of Care and estimate the Survival rate with respect to different stages, Treatment modalities, ER, PR, HER-2 Status of breast cancer treated only at Kidwai Cancer Institute. A retrospective cohort study was Methodology carried out with 191 Carcinoma Breast cases at a Regional Cancer Centre (Kidwai Memorial Institute of Oncology), Bengaluru. The study started from 2006-2007 and was followed-up until the end of 2020. Five-year survival (60 Months) probabilities were estimated using the Kaplan-Meier and loss adjusted survival analysis method for less than 80% follow-up group for ten years. The log rank test was used to compare the survival between the factors. The overall observed survival rates at 5years Results (60 months) was 72.7%. When analysis was conducted for specic stages, Stage II, Stage III and Stage IV survival rates are 95%, 67% and 17% respectively and is statistically signicant (p&lt;0.001), 39 Patients were dead and 13 Patients were lost for follow-up. The overall survival rate at 10 years was 62.4% and lost for follow-up was 26.5% and death was 27.7%, the Kaplan Meier analysis was unable to be carried out as more than 20% censored cases were seen, hence loss adjusted survival analysis was carried out for 10 years. 89 Patients were alive, 52 patients were dead and 50 patients were lost for follow-up at 10 years. Conclusion: In surgical histopathological nding Estrogen receptor, Progesterone receptor and HER-2 status did not have signicant impact on survival of patients. The post-operative Radiotherapy and combination of modalities of treatment had signicant effect on the long term survival of the patients after adjusting for disease stage.

Psychiatric comorbidities and breast cancer: A study from Jammu region of UT of J&K, India.

Breast cancer is the most common cancer among females of all age groups. The diagnosis of cancer itself has a menacing impact on the psychosocial health of an individual leading to various psychiatric comorbidities. This can impact the overall prognosis of cancer patients. To study the prevalence of psychiatric comorbidities among female breast cancer patients and to assess its association with sociodemographic and clinical factors among these. A cross-sectional hospital-based study was conducted for a period of 1 year in the Regional Cancer Centre. All females in the age group of 18 years and above, who were confirmed to have breast cancer were included in the study. A self-designed proforma was administered to elicit information about sociodemographic and clinical details of the study subjects. Hospital Anxiety and Depression Scale (HADS) and Perceived Stress Scale (PSS) were used to assess the prevalence of psychiatric comorbidities like depression, anxiety, and stress among these subjects. Data thus obtained were analyzed using the Statistical Package for the Social Sciences (SPSS) Software. A total of 205 subjects were included in the study. The mean age was reported as 49.25 ± 11.44 years, most of these were married homemakers residing in nuclear families in rural areas. Prevalence of depression, anxiety, and stress was found to be 60%, 73.17%, and 83.41%, and these were significantly associated (P < 0.05) with residence, number of living children, visits per month to hospitals, time since diagnosis, and type of treatment received. There is a high risk of psychiatric comorbidities among breast cancer female patients and an urgent need for effective strategies to prevent these.