Significant Annual Percent Changes Research Articles

Trends in the use of neoadjuvant chemotherapy for low-grade serous ovarian cancer in the United States.

5581 Background: Following the publication of randomized trials demonstrating its noninferiority, the use of neoadjuvant chemotherapy (NACT) for the treatment of advanced stage epithelial ovarian cancer has increased substantially in the United States. However, low-grade serous ovarian cancers (LGSOC) respond poorly to chemotherapy compared with high-grade serous carcinoma. For LGSOC, clinical guidelines favor surgical resection prior to adjuvant therapy. This study seeks to describe patterns and temporal trends in the use of NACT for LGSOC. Methods: This cohort study identified women treated for stage III or IV LGSOC in a Commission on Cancer accredited cancer program between January 1, 2004, to December 31, 2020. We fit Poisson regression models to evaluate temporal trends in the use of NACT and cytoreductive outcomes, and to identify factors associated with receipt of NACT. We considered age, race/ethnicity, Charlson Comorbidity Index, year of diagnosis, insurance status, income, facility type, census region, and stage as potentially associated with NACT. Due to the high rate of missingness in data describing cytoreductive outcomes after surgery, we undertook both multiply imputed and complete case analyses. Results: A total of 3,343 patients received treatment for LGSOC during the study period. The mean age at diagnosis was 54.8 year (SD 15.5) and most patients (82%) were white. The most commonly observed upfront treatment strategies were cytoreductive surgery followed by adjuvant chemotherapy (63.7%) and surgery without chemotherapy (19.2%). Treatment with NACT followed by interval cytoreductive surgery (13.0%) or chemotherapy alone (4.1%) were less common. The proportion of patients who received NACT increased from 9.5% in 2004 to 25.9% in 2020, corresponding to a statistically significant annual percent change (APC) of 7.2% (95% CI 5.6-8.9). Increasing decade of age (risk ratio [RR] 1.15; 95% CI 1.09-1.23), increasing calendar year of diagnosis (RR 1.07; 95% CI 1.05-1.08) and stage IV disease (RR 2.66; 95% CI 2.3-3.07) were associated with a higher probability of receiving NACT. Other variables were not associated with receipt of NACT. Among patients who underwent cytoreductive surgery, the proportion who achieved no gross residual disease remained stable over the course of the study period in both complete case (APC 0.5%; 95% CI -1.8 to 0.9) and multiply imputed (APC -0.1%; 95% CI -1.6 to 1.3) analyses. Conclusions: The use of NACT for patients with LGSOC increased substantially from 2004 to 2020. Despite increased utilization of NACT, the rate of complete cytoreduction has not improved over the study period, possibly calling into question the effectiveness of NACT in reducing tumor burden in this setting.

Sentinel surveillance of substance-related self-harm in Canadian emergency departments, 2011 − 19

IntroductionSelf-harm is a public health concern that can result in serious injury or death. This study provides an overview of emergency department (ED) visits for patients presenting with substance-related self-harm.MethodsCases of self-harm in the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) database were extracted (April 2011 to September 2019; N = 15,682), using various search strategies to identify substance-related self-harm cases for patients 10 years and older. Cases involving alcohol, cannabis, illicit drugs, or medications (or any combinations of these) were included. Additional variables, including age and sex, location and the severity of injury (hospital admission) were examined. Proportionate injury ratios (PIR) were used to compare emergency department outcomes of self-harm and unintentional injuries involving substance use. Time trends were quantified using Joinpoint regression. For cases requiring hospital admission, text fields were analyzed for contextual factors.ResultsA total of 9470 substance-related self-harm cases were reported (28.1% of all intentional injury cases), representing 820.0 records per 100,000 eCHIRPP records. While age patterns for both sexes were similar, the number of cases for females was significantly higher among 15-19 year olds. Over half (55%) of cases that identified substance type involved medications, followed by multi-type substance use (19.8%). In the ED, there were proportionally more treatments, observations, and admissions presenting with substance-related self-harm compared to substance-related unintentional injury cases. Among those aged 20+ years, a statistically significant increasing trend of 15.9% per year was observed, while among those aged 10-19 years a significant annual percent change of 16.9% was noted (2011 to 2019). Text field analysis demonstrated suicide attempt or ideation was a reoccurring theme among all age groups. Poor mental health status or conflict with family or an intimate partner were reported stressors, depending on age group. Additional self-harming injuries, such as cutting, were reported among all age groups.ConclusionOur study found that hospital admission for substance-related self-harm was highest for patients aged 15-19 years, especially females, and that they were more likely to use medications. The statistically significant increasing trend of cases found between 2011 and 2019 is notable. Patients showed multiple types of adversities, demonstrating the complexity of this issue.

Cystic fibrosis-related mortality trends in Brazil for the 1999-2017 period: a multiple-cause-of-death study.

ABSTRACTObjective:To describe causes of death and mortality data related to cystic fibrosis (CF) using a multiple-cause-of-death methodology. Methods:Annual mortality data for the 1999-2017 period were extracted from the Brazilian National Ministry of Health Mortality Database. All death certificates in which category E84 (CF) of the ICD-10, was listed as an underlying or associated cause of death were selected. Epidemiological and clinical data were described, and standardized mortality rates were calculated per year and for the 2000-2017 period. A joinpoint regression analysis was performed to detect changes in the mortality rates during the study period. Results:Overall, 2,854 CF-related deaths were identified during the study period, ranging from 68 in 1999 to 289 in 2017. CF was the underlying cause of death in 83.5% of the death certificates. A continuous upward trend in the death rates was observed, with a significant annual percent change of 6.84% (5.3-8.4%) among males and 7.50% (6.6-8.4%) among females. The median age at death increased from 7.5 years in 1999 to 56.5 years in 2017. Diseases of the respiratory system accounted for 77% of the associated causes in the death certificates that reported CF as the underlying cause of death. Conclusions:A significant and continuous increase in CF-related death rates was found in Brazil in the last years, as well as a concurrent increase in the median age at death.

Morbimortality Tendency by Venous Thrombophlebitis in Brazil: A Temporal Series

BACKGROUNDPhlebitis is an inflammation of a vein and occurs especially due to trauma.This study characterizes the profile and evaluates the tendency of morbimortality by phlebitis, thrombophlebitis and deep venous thrombosis in Brazil between 2011 and 2020.METHODSIt is a temporal series, with data obtained from a Brazilian platform, DATASUS. The hospitalization (HR) and the mortality (MR) rates were calculated, and temporal tendency by regression of Prais-Winstein was estimated.FINDINGS409647 hospitalizations were registered, with average HR of 20.01/100.000 habitants. The Southwest region presented 54.44% of cases, followed by South and Northwest. The South and Midwest registered a decreased tendency for HR (764.9%, CI95%756.0; p<0.05) and stationary in the other regions, without a statistically significant annual percent change. The epidemiological profile of morbidity showed predominance in females (61.2%), caucasians (42.9%) and in 50-59 years (19.1%). There were 10072 deaths, with MR of 4.93 deaths/1 million habitants, with Southwest leading (51.2%), besides, an increased tendency was observed in Northwest (574.5%; CI95% 585.1; 564; p<0.05), a decreased tendency in South (551.6%; CI95% 563.3; 538.2; p<0.05) and, for the rest, a stationary tendency. Epidemiologically, females (57.3%), caucasian (38.1%) and 80+ years old (27.9%) predominated.INTERPRETATIONThe tendency was predominantly stationary in brazilian regions, for morbidity, it decreased in South and Middle West. For mortality, it increased in the Northwest and decreased in the South.

Clinical characteristics and a rising incidence of early-onset colorectal cancer in a nationwide cohort of 521 patients aged 18-40 years

BackgroundThe incidence of early-onset colorectal cancer (eoCRC) has been reported to increase, and patients with eoCRC seem to be diagnosed at more advanced stages compared to elderly patients. The aim of this study was to describe patient and disease characteristics, symptomatology and the incidence of eoCRC in a national cohort. Materials and methods521 eoCRC patients (≤40 years old) diagnosed with histologically verified colorectal cancer (CRC) during the years 2001–2013 were identified in national databases and compared to more than 15,000 CRC patients aged 66–75 years. Age-adjusted incidence was calculated for eoCRC patients and various sub-analyses were performed. ResultsMore advanced stages were seen in eoCRC patients compared to elderly patients (stage II: p < 0.001, III: p = 0.01 and IV: p < 0.01). Differences were statistically significant in colon cancer, but not in rectal cancer. A significant difference in sex distribution was seen between right and left-sided tumors in the eoCRC group. The age-adjusted incidence rate increased during the study period (1.60–2.55 per 100.000), and significant annual percent changes (APC) were seen in young females (APC = 4.73) and left-sided tumor localization (including rectal cancer) (APC = 4.54), respectively. ConclusionIn this nationwide cohort of eoCRC patients, our results confirm that young patients are diagnosed at advanced stages, and that the incidence of eoCRC is increasing.

The Copenhagen Oral Cavity Squamous Cell Carcinoma database: protocol and report on establishing a comprehensive oral cavity cancer database.

ObjectiveThe aim was to establish a large comprehensive database of patients with oral cavity squamous cell carcinoma (OSCC) to enable surveillance and research of the disease.MethodsAll patients diagnosed and/or treated for OSCC at Rigshospitalet, University of Copenhagen, Denmark in the period 2000–2014 were included. Rigshospitalet is a tertiary treatment center and covers the Eastern Denmark region, comprising nearly half of the approximately 5.8 million inhabitants of Denmark. Data on numerous variables regarding general information of the patients at diagnosis, their primary cancer, recurrence, treatment, prior cancers, and secondary cancers were collected from the Danish Pathology Register and by evaluation of medical charts.ResultsOne thousand three hundred and ninety-nine OSCC patients were included in the database (62% males). The median age at diagnosis was 63 years (range: 23–99 years). The most common anatomical location was the floor of mouth (38%). Among patients with known stage, 70.0% were diagnosed in T-stage 1 or 2 and 64.9% were diagnosed in N-stage 0. Most patients were treated with primary surgery (81.7% among patients with known treatment), of these 44% received adjuvant radiotherapy after surgery. The overall age-standardized incidence of OSCC per 100,000 increased from 2.15 in 2000 to 3.04 in 2014, with a significant annual percent change of 3.2%.ConclusionWe have established a consecutive, population-based database of 1,399 OSCC patients. This creates a basis for multiple studies that will elaborate our understanding of OSCC, and hopefully improve diagnosis, treatment, and rehabilitation of OSCC patients.

Pediatric papillary thyroid carcinoma: outcomes and survival predictors in 2504 surgical patients.

To evaluate outcomes and predictors of survival of pediatric thyroid carcinoma, specifically papillary thyroid carcinoma. SEER was searched for surgical pediatric cases (≤20 years old) of papillary thyroid carcinoma diagnosed between 1973 and 2011. Demographics, clinical characteristics, and survival outcomes were analyzed using standard statistical methods. All papillary types, including follicular variant, were included. A total of 2504 cases were identified. Overall incidence was 0.483/100,000 persons per year with a significant annual percent change (APC) in occurrence of 2.07% from baseline (P<0.05). Mean age at diagnosis was 16 years and highest incidence was found in white, female patients ages 15-19. Patients with tumor sizes<1cm more likely received lobectomies/isthmusectomies versus subtotal/total thyroidectomies [OR=3.03 (2.12, 4.32); P<0.001]. Patients with tumors≥1cm and lymph node-positive statuses [OR=99.0 (12.5, 783); P<0.001] more likely underwent subtotal/total thyroidectomy compared to lobectomy/isthmusectomy. Tumors≥1cm were more likely lymph node-positive [OR=39.4 (16.6, 93.7); p<0.001]. Mortality did not differ between procedures. Mean survival was 38.6years and higher in those with regional disease. Disease-specific 30-year survival ranged from 99 to 100%, regardless of tumor size or procedure. Lymph node sampling did not affect survival. The incidence of pediatric papillary thyroid cancer is increasing. Females have a higher incidence, but similar survival to males. Tumors ≥1cm were likely to be lymph node-positive. Although tumors ≥1cm were more likely to be resected by subtotal/total thyroidectomy, survival was high and did not differ based on procedure.

Childhood cancer mortality in Japan, 1980-2013.

BackgroundThis study aimed to provide an updated analysis of childhood cancer mortality rates and long-term trends to 2013 to describe the current level of deaths and identify changes in recent decades.MethodsData on number of deaths from cancer in children aged under 15 years were derived from Vital Statistics in Japan and the World Health Organization (WHO) mortality database for comparison countries. Trends in mortality were examined by fitting a joinpoint regression model.ResultsFor all cancers combined, the mortality rate during 2010–2013 was 19.9 per 1,000,000 population for boys and 17.5 for girls in Japan. Mortality from all cancers combined decreased significantly from 1980 to 2003 for boys and from 1980 to 2001 for girls. Afterwards, the rates remained stable for both sexes. Mortality from leukemia declined over the entire study period by 4.6 % per year (p <0.05) in boys and 4.3 % per year (p <0.05) in girls. For central nervous system (CNS) tumors, a slight increase in mortality was observed for both sexes, with a statistically significant annual percent change (APC) of 0.5 % (p <0.05) for boys and 0.6 % (p <0.05) for girls.ConclusionsWe provided updated information on recent trends of childhood cancer death. The establishment of a nationwide, childhood cancer registry is required in Japan. Moreover, trends in cancer mortality should be monitored continuously.

Impact of a Population-Based Colorectal Cancer Screening Program on Local Health Services Demand in Italy: A 7-Year Survey in a Northern Province

In 2005, the National Health Service recommended a population-based colorectal cancer (CRC) screening program using biennial fecal occult blood testing (FOBT), followed by total colonoscopy in positive patients. So far, no studies have been performed to evaluate the impact of a mass-screening CRC campaign on the health system services at the community level in Italy. We have therefore assessed the workload generated by the first two biennial rounds of screening program on the activity of hospital services involved in CRC diagnosis in the Lecco province. Routine data from all hospital services of our province were collected on activity levels related to CRC diagnosis from January 2003 to December 2009. This time span covered the 2 years prior to, as well as the two biennial rounds of the CRC screening program. In particular, we focused on the volume of outpatient FOBTs and colonoscopies (both diagnostic and interventional) performed among subjects outside the screening program. Joinpoint models were used to test whether an apparent change in trend of examination over time was statistically significant in different age cohorts of the population (<50 years, 50-69 years, and ≥70 years). The volume of "extra-screening" per-patient/FOBTs and colonoscopies increased significantly over the evaluated periods in all ages, until year 2008, when a steady trend was beginning; the AAPCs (average of the annual percent changes) values were 5.7, 3.1, and 8.4 for FOBT and 14.6, 13.4, and 16.7 for colonoscopy in the three age cohorts, respectively. However, the increase in both FOBT and colonoscopy demand was maximal in the cohort ≥70 years, where three statistically significant annual percent changes (APCs) were identified (in 2003-2005, 2005-2006, and 2006-2007 APCs were 12.3, 14.9, and 15.9 for FOBT, and 18.7, 36.8, and 25.4 for colonoscopy, respectively). After the implementation of a FOBT-based mass-screening program for CRC, careful consideration must be given to the significant increase in the workload of hospital services involved in CRC diagnosis, outside the screening campaign. The extra-work mainly involves gastroenterologists performing colonoscopy, whose activity increased over the 5-year period by 118%, as well as laboratory services, where the demand of FOBTs rose by 40%. This phenomenon, mainly attributable to a profound change in the attitude toward CRC screening by those age cohorts outside the program, covers a time span of two full rounds of screening, whereupon a steady trend for colonoscopy is apparent.

Trend and Geographic Variations in the Incidence of Waldenstrom's Macroglobulinemia in the United States over 17 Years from 1988 to 2004.

Background: Waldenstrom's Macroglobulinemia (WM) is an uncommon subtype of B cell malignancy. The updated trend of its incidence in the United States has not been reported.Objective: To better understand the incidence and epidemiological features of WM in the United States.Methods: We conducted a population-based incidence study with 1463 patients (pts) with WM identified from the Surveillance, Epidemiology, and End Results (SEER) tumor registries over 17 years. From the SEER data, 78,558 pts of all ages diagnosed with non-Hodgkin's lymphoma (NHL) were identified between 1988 and 2004 in 9 SEER areas. Of these pts, 1463 had pathologically confirmed WM, accounting for 2% of NHL. The incidence with 95% confidence intervals were generated from SEER*Stat Software and was age-adjusted to the U.S. year 2000 standard population. Annual Percent Change (APC)for the incidence was calculated and considered to be statistically significant if p value was less than 0.05. The crude 1-year survival rate was calculated as the ratio of the number of pts who survived over 1 year and the number of pts diagnosed with WM.Results: Of the1463 pts with WM, median age at diagnosis was 73. Overall incidence rate was 0.37/100,000/year, which increased with age from 0.03 in pts aged <50 to 1.03 in pts aged 60–69 and 2.76 in pts aged 80 or older. The age-adjusted incidence did not change significantly from 0.34 in 1988 compared with 0.36 in 2004. Therefore was no significant Annual Percent Change (0.97%, p>0.05). Incidence of WM was higher in men (0.52) than in women (0.26) (P<0.001). There were substantial geographic variations (p<0.001) in the incidence of WM. The age-adjusted incidence was highest in Seattle (0.49) and lowest in Atlanta (0.19). The incidence was higher in Caucasians (0.40) than in African-Americans (0.17) and other races (0.20). Annual Percentage Change was 1.3% in Caucasians (p<0.05).Conclusion: The overall incidence of Waldenstrom's Macroglobulinemia did not change significantly from 1988 to 2004, and was significantly higher in male Caucasians. There were substantial geographical variations in the incidence of Waldenstrom's Macroglobulinemia in the United States.