cancer survival

癌症生存率
  • 文章类型: Journal Article
    在韩国,从2001年到2021年,癌症发病率增加了56.5%。然而,与2001年至2005年相比,2017年至2021年的5年癌症生存率增加了17.9%。癌症生存率随着社会经济地位的降低而下降,不同癌症类型之间的存活率存在差异。分析癌症患者生存的社会经济模式可以帮助识别高危人群,并确保他们从干预措施中受益。
    本研究的目的是分析被诊断为六种类型胃癌的患者的生存率差异,结直肠,肝脏,乳房,子宫颈,和肺癌-基于韩国全国数据的社会经济地位。
    这项研究使用与国家健康信息数据库链接的韩国中央癌症登记数据库,对2014年至2018年12月31日期间诊断为癌症的患者进行随访。生成了按收入状况分层的Kaplan-Meier曲线,并对每种癌症类型进行对数秩检验,以评估统计学显著性.使用Cox比例风险回归模型计算任何原因的总生存期的95%CI的风险比。
    六种不同类型癌症的存活率如下:胃癌,69.6%(96,404/138,462);结直肠癌,66.6%(83,406/125,156);肝癌,33.7%(23,860/70,712);肺癌,30.4%(33,203/109,116);乳腺癌,91.5%(90,730/99,159);和宫颈癌,78%(12,930/16,580)。在将医疗援助组与最高收入组进行比较时,胃癌的风险比为1.72(95%CI1.66-1.79),结直肠癌1.60(95%CI1.54-1.56),肝癌1.51(95%CI1.45-1.56),肺癌为1.56(95%CI1.51-1.59),2.19(95%CI2.01-2.38)用于乳腺癌,宫颈癌为1.65(95%CI1.46-1.87)。较高的剥夺指数和晚期诊断阶段与死亡风险增加相关。
    社会经济地位在几种癌症类型中显著调节癌症生存率的差异。这种效应在不太致命的癌症如乳腺癌中尤其明显。因此,考虑到癌症的类型和社会经济因素,社会和医疗干预措施,如早期癌症检测和适当的治疗对于弱势群体是必要的。
    UNASSIGNED: In South Korea, the cancer incidence rate has increased by 56.5% from 2001 to 2021. Nevertheless, the 5-year cancer survival rate from 2017 to 2021 increased by 17.9% compared with that from 2001 to 2005. Cancer survival rates tend to decline with lower socioeconomic status, and variations exist in the survival rates among different cancer types. Analyzing socioeconomic patterns in the survival of patients with cancer can help identify high-risk groups and ensure that they benefit from interventions.
    UNASSIGNED: The aim of this study was to analyze differences in survival rates among patients diagnosed with six types of cancer-stomach, colorectal, liver, breast, cervical, and lung cancers-based on socioeconomic status using Korean nationwide data.
    UNASSIGNED: This study used the Korea Central Cancer Registry database linked to the National Health Information Database to follow up with patients diagnosed with cancer between 2014 and 2018 until December 31, 2021. Kaplan-Meier curves stratified by income status were generated, and log-rank tests were conducted for each cancer type to assess statistical significance. Hazard ratios with 95% CIs for any cause of overall survival were calculated using Cox proportional hazards regression models with the time since diagnosis.
    UNASSIGNED: The survival rates for the six different types of cancer were as follows: stomach cancer, 69.6% (96,404/138,462); colorectal cancer, 66.6% (83,406/125,156); liver cancer, 33.7% (23,860/70,712); lung cancer, 30.4% (33,203/109,116); breast cancer, 91.5% (90,730/99,159); and cervical cancer, 78% (12,930/16,580). When comparing the medical aid group to the highest income group, the hazard ratios were 1.72 (95% CI 1.66-1.79) for stomach cancer, 1.60 (95% CI 1.54-1.56) for colorectal cancer, 1.51 (95% CI 1.45-1.56) for liver cancer, 1.56 (95% CI 1.51-1.59) for lung cancer, 2.19 (95% CI 2.01-2.38) for breast cancer, and 1.65 (95% CI 1.46-1.87) for cervical cancer. A higher deprivation index and advanced diagnostic stage were associated with an increased risk of mortality.
    UNASSIGNED: Socioeconomic status significantly mediates disparities in cancer survival in several cancer types. This effect is particularly pronounced in less fatal cancers such as breast cancer. Therefore, considering the type of cancer and socioeconomic factors, social and medical interventions such as early cancer detection and appropriate treatment are necessary for vulnerable populations.
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  • 文章类型: Journal Article
    背景:神经内分泌肿瘤(NENs)在全球范围内的发病率正在增加。先前对英国癌症数据库(国家癌症登记和分析服务(NCRAS))的分析显示,在大多数肿瘤部位,女性的生存优势显着。本研究旨在将NCRAS与监测进行比较,流行病学,和最终结果程序(SEER),以使用相同的统计方法验证这些结果。
    方法:从NCRAS和SEER中提取了14,834和108,399例NENs患者,分别。使用限制平均生存时间(RMST)和Kaplan-Meier生存估计值计算NEN每个解剖部位的男性和女性的60个月生存率。计算60个月RMST女性生存优势(FSA)。
    结果:FSA在NCRAS和SEER中相似。FSA最高发生在肺和胃NENs。
    结论:来自SEER的数据证实了NCRAS发表的研究结果。女性生存优势仍然无法解释。
    BACKGROUND: Neuroendocrine neoplasms (NENs) are increasing in incidence globally. Previous analysis of the UK cancer database (National Cancer Registration and Analysis Service (NCRAS)) showed a notable female survival advantage in most tumour sites. This study aims to compare NCRAS to the Surveillance, Epidemiology, and End Results Program (SEER) to validate these results using the same statistical methods.
    METHODS: A total of 14,834 and 108,399 patients with NENs were extracted from NCRAS and SEER, respectively. Sixty-months survival for both males and females for each anatomical site of NENs were calculated using restricted mean survival time (RMST) and Kaplan-Meier Survival estimates. The sixty-month RMST female survival advantage (FSA) was calculated.
    RESULTS: FSA was similar in NCRAS and SEER. The highest FSA occurred in lung and stomach NENs.
    CONCLUSIONS: The data from SEER confirm the findings published by NCRAS. Female survival advantage remains unexplained.
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  • 文章类型: Journal Article
    背景:癌症患者的生活质量(QoL)显著影响治疗反应和死亡率。了解癌症患者的QoL域及其影响因素有助于创建改善QoL和缓解患者体验的干预措施。本研究测量癌症患者的OoL及其影响因素。
    方法:一项基于前瞻性横断面问卷的研究包括目前正在接受治疗的年龄>18岁的癌症患者。问卷收集了社会和经济数据,随后是经过验证的阿拉伯文版本的欧洲癌症研究和治疗组织生活质量问卷(EORTC-QLQ-C30)。所描述的数值变量的平均值和标准偏差以及所描述的分类变量的频率和百分比。方差分析,F-tests,并报告P值。
    结果:在182名癌症患者中,60%是女性。年轻患者在身体和角色功能方面表现出更高的QoL(P=.016和.03),并且经历了更显着的财务影响(P=.0144)。女性报告了更多癌症症状的不良反应,包括疲劳,恶心,呕吐,和疼痛(36.7%vs25.5%,P=0.005;20.6%对11.5%,P=.0186;34.7%对25.1%,P=.0281)。与其他患者相比,单身患者的身体功能QoL优于其他患者(P=0.0127)。长途旅行的患者更有可能面临不利的经济后果(P=.007)。哮喘患者在身体上表现出较低的QoL,角色,和认知功能(72.3vs37.8,P=.0147;76.4vs22.2,P=.0024;84.7vs44.4,P=.0038),并报告呼吸困难和食欲减退增加(16vs55.6和26.1vs66.7,均P<.05)。
    结论:影响沙特癌症患者QoL的因素包括年龄,婚姻状况,性别,医院距离,和慢性病。因此强调个性化护理策略的必要性,以提高预后并减轻癌症护理的总体负担。
    BACKGROUND: Cancer patients\' quality of life (QoL) significantly influences treatment response and mortality rates. Understanding QoL domains among patients with cancer and what affects it can help create interventions that improve QoL and ease patients\' experience. This study measures the OoL among patients with cancer and influencing factors.
    METHODS: A prospective cross-sectional questionnaire-based study included cancer patients aged >18 currently receiving treatment. The questionnaire collected social and economic data, followed by the validated Arabic version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30). Means and standard deviations for described numeric variables and frequencies and percentages described categorical variables. Analysis of variance, F-tests, and P-values were reported.
    RESULTS: Among 182 cancer patients, 60% were female. Younger patients exhibited higher QoL in physical and role functioning (P = .016 and .03) and experienced more significant financial impact (P = .0144). Females reported more adverse effects from cancer symptoms, including fatigue, nausea, vomiting, and pain (36.7% vs 25.5%, P = .005; 20.6% vs 11.5%, P = .0186; 34.7% vs 25.1%, P = .0281). Single patients had superior QoL in physical functioning compared to others (P = .0127). Patients traveling long distances were more likely to face adverse financial consequences (P = .007). Asthmatic patients exhibited lower QoL in physical, role, and cognitive functioning (72.3 vs 37.8, P = .0147; 76.4 vs 22.2, P = .0024; 84.7 vs 44.4, P = .0038) and reported increased dyspnea and appetite loss (16 vs 55.6 and 26.1 vs 66.7, both P < .05).
    CONCLUSIONS: Factors influencing QoL in Saudi cancer patients include age, marital status, gender, hospital distance, and chronic conditions. Thus emphasizing the necessity for personalized care strategies to enhance outcomes and alleviate the overall burden of cancer care.
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  • 文章类型: Journal Article
    目的:目前尚缺乏关于阿片类药物使用相关疾病患者癌症发病率和死亡率的研究。我们的目标是测量癌症的发病率,2010-18年期间,挪威被诊断患有阿片类药物使用相关疾病的患者的死亡率和生存率。
    方法:这是2010-18年在挪威进行的一项队列研究。
    方法:诊断为阿片类药物使用相关疾病的个体(n=20.710)。
    方法:我们利用国家卫生和人口登记的数据链接进行了一项队列研究。阿片类药物使用相关疾病的信息是从专业医疗保健中提取的,挪威癌症登记处的恶性肿瘤和死因登记处的死亡。通过计算特定性别的年龄标准化发病率(SIR)和死亡率(SMR)比率,将癌症发病率和死亡率与普通人群进行比较。计算一年生存率。
    结果:与普通人群相比,患有阿片类药物使用相关疾病的患者发生癌症的总体风险增加[SIR=1.2,95%置信区间(CI)=1.1~1.3],癌症死亡率高于2倍(SMR=2.3,95%CI=2.0~2.7).观察到肝脏的风险过高(12.6,95%CI=9.1-17.0),喉(4.7,95%CI=1.7-10.2),肺癌(3.5,95%CI=2.8-4.3)和胰腺癌(2.6,95%CI=1.6-4.0),而黑色素瘤的风险降低(0.5,95%CI=0.3-0.9),乳腺癌(0.6,95%CI=0.4-0.9)和前列腺癌(0.3,95%CI=0.1-0.4)。肝脏的位点特异性SMR显著升高(12.3,95%CI=8.5-17.2),肺(3.9,95%CI=3.0-5.0),胰腺癌(3.0,95%CI=1.7-4.8)和结肠癌(1.9,95%CI=1.1-3.1)。肝癌诊断后的平均1年生存率很低,胰腺癌和结肠癌,比一般人口少10%到15%。
    结论:在挪威,在阿片类药物使用相关疾病患者中,癌症发病率和癌症相关死亡率似乎升高.
    OBJECTIVE: Studies on cancer incidence and mortality among people with opioid use-related disorders are lacking. We aimed to measure cancer-specific incidence, mortality and survival among people diagnosed with opioid use-related disorders in Norway during 2010-18.
    METHODS: This was a cohort study conducted in Norway during 2010-18.
    METHODS: Individuals (n = 20 710) diagnosed with opioid use-related disorders.
    METHODS: We conducted a cohort study utilizing a data-linkage of national health and population registers. Information on opioid use-related disorders was extracted from specialized healthcare, malignancies from the Cancer Registry of Norway and deaths from Cause of Death Registry. Cancer incidence and mortality were compared with the general population by calculating sex-specific age-standardized incidence (SIR) and mortality (SMR) ratios. One-year survival rates were computed.
    RESULTS: Compared with the general population, people with opioid use-related disorders were at an increased risk of developing cancer overall [SIR = 1.2, 95% confidence interval (CI) = 1.1-1.3] with a higher than twofold cancer mortality rate (SMR = 2.3, 95% CI = 2.0-2.7). Excess risk was observed for liver (12.6, 95% CI = 9.1-17.0), larynx (4.7, 95% CI = 1.7-10.2), lung (3.5, 95% CI = 2.8-4.3) and pancreas cancer (2.6, 95% CI = 1.6-4.0), whereas reduced risk was found for melanoma (0.5, 95% CI = 0.3-0.9), breast (0.6, 95% CI = 0.4-0.9) and prostate cancers (0.3, 95% CI = 0.1-0.4). Site-specific SMRs were significantly elevated for liver (12.3, 95% CI = 8.5-17.2), lung (3.9, 95% CI = 3.0-5.0), pancreas (3.0, 95% CI = 1.7-4.8) and colon cancers (1.9, 95% CI = 1.1-3.1). The average 1-year survival rate after a cancer diagnosis was low in liver, pancreas and colon cancer, ranging from 10 to 15% less than that of the general population.
    CONCLUSIONS: In Norway, cancer incidence and cancer-related mortality appear to be elevated among individuals with opioid use-related disorders.
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  • 文章类型: Journal Article
    目的:癌症患者是灾难期间和之后最脆弱的人群。我们评估了在飓风Irma和María之后,治疗中断对波多黎各妇科癌症妇女生存率的影响。
    方法:在2016年1月至2017年9月期间诊断的基于临床的女性样本中进行回顾性队列研究(n=112)。从诊断到2019年12月对妇女进行随访,以评估生命状况。进行Kaplan-Meier存活曲线和Cox比例风险模型。
    结果:平均年龄为56(±12.3)岁;子宫体(58.9%)是最常见的妇科癌症。主要治疗方法为手术(91.1%)和化疗(44.6%)。总的来说,75.9%的人在飓风之前接受治疗,16.1%的人在随访期间经历了治疗中断,8.9%的人在随访期间死亡。双变量分析中与治疗中断相关的因素包括年龄较小(≤55岁),患有区域性/远处疾病,并接受>1次癌症治疗(p<0.05)。粗略分析显示,中断治疗的女性死亡风险增加(HR:3.88,95%CI=1.09-13.77),调整年龄和癌症分期后持续存在(HR:2.49,95%CI=0.69-9.01)。
    结论:研究结果强调了飓风过后治疗中断对癌症生存率的不利影响,强调需要为这一弱势群体制定应急计划。
    OBJECTIVE: Cancer patients are among the most vulnerable populations during and after a disaster. We evaluated the impact of treatment interruption on the survival of women with gynecologic cancer in Puerto Rico following Hurricanes Irma and María.
    METHODS: A retrospective cohort study among a clinic-based sample of women with gynecological cancer diagnosed between January 2016 and September 2017 (n = 112) was done. Women were followed from their diagnosis until December 2019, to assess vital status. Kaplan-Meier survival curves and Cox proportional hazards models were performed.
    RESULTS: Mean age was 56 (± 12.3) years; corpus uteri (58.9%) was the most common gynecologic cancer. Predominant treatments were surgery (91.1%) and chemotherapy (44.6%). Overall, 75.9% were receiving treatment before the hurricanes, 16.1% experienced treatment interruptions, and 8.9% died during the follow-up period. Factors associated with treatment interruption in bivariate analysis included younger age (≤55 years), having regional/distant disease, and receiving > 1 cancer treatment (P < 0.05). Crude analysis revealed an increased risk of death among women with treatment interruption (HR: 3.88, 95% CI: 1.09-13.77), persisting after adjusting for age and cancer stage (HR: 2.49, 95% CI: 0.69-9.01).
    CONCLUSIONS: Findings underscore the detrimental impact of treatment interruption on cancer survival in the aftermath of hurricanes, emphasizing the need for emergency response plans for this vulnerable population.
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  • 文章类型: Journal Article
    背景骨肉瘤(OSC)是最常见的原发性骨肿瘤,通常通过手术治疗。很少有先前的研究在国家注册水平上通过特定的手术技术评估OSC生存率的差异。我们试图在监测中比较OSC患者基于手术亚型的生存率,流行病学,和结束结果(SEER)数据库。方法我们在SEER数据库中搜索了2000年至2019年之间诊断的恶性OSC,这些OSC是通过手术管理的。对于广泛切除(局部肿瘤破坏或切除与部分切除)和根治性切除(保留肢体的根治性切除与有或没有带切除的截肢),分别进行了一年和五年的生存比较。结果共纳入4303例患者,其中3587人接受了手术治疗。局部破坏和部分切除之间没有生存差异(风险比=0.826,p=0.303)。然而,年龄较小,较低分期,无辐射管理与生存率改善相关。根治性切除比较显示,与保留肢体手术相比,肢体截肢与更差的生存率相关(风险比=1.531,p<0.001)。年龄更小,女性性别,较低的阶段,接受化疗,新辅助加辅助化疗与生存率提高相关,而Black和美洲印第安人或阿拉斯加原住民与生存率较差相关.结论我们的发现表明,与截肢相比,保留肢体的根治性切除术的患者存活明显。广泛切除手术的生存率没有差异。新辅助和辅助化疗的组合使用也产生改善的存活率。OSC生存率可以通过新辅助和辅助化疗的组合的保留肢体手术来优化。
    Background Osteosarcoma (OSC) is the most common primary bone tumor and is often managed surgically. Few prior investigations have assessed differences in OSC survival by specific surgical techniques at a national registry level. We sought to compare survival based on surgical subtypes for OSC patients in the Surveillance, Epidemiology, and End Results (SEER) database. Methodology We searched the SEER database for malignant OSCs diagnosed between 2000 and 2019 which were surgically managed. Separate survival comparisons were made for one and five years for wide excision (local tumor destruction or resection versus partial resection) and radical excision (radical resection with limb-sparing versus limb amputation with or without girdle resection). Results A total of 4,303 patients were included, of whom 3,587 were surgically managed. There were no survival differences between local destruction and partial resection (hazard ratio = 0.826, p = 0.303). However, younger age, lower staging, and management without radiation were associated with improved survival. The radical excision comparison showed limb amputation was associated with worse survival than limb-sparing surgery (hazard ratio = 1.531, p < 0.001). Younger age, female sex, lower stage, receipt of chemotherapy, and neoadjuvant plus adjuvant chemotherapy were associated with improved survival while Black and American Indian or Alaska Native were associated with worse survival. Conclusions Our findings show that patients managed with limb-sparing radical resection survived significantly compared to limb amputation. There were no differences in survival for wide excision surgeries. The use of a combination of neoadjuvant and adjuvant chemotherapy also yields improved survival. OSC survival may be optimized with limb-sparing surgery with a combination of neoadjuvant and adjuvant chemotherapy.
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  • 文章类型: Journal Article
    背景:结直肠癌患者的预后在很大程度上取决于他们的外科护理质量。然而,仅仅依靠单一的质量指标并不能充分反映现代围手术期护理的多面性.已建议使用一种新工具“教科书结果”(TO)来提供对手术质量的全面评估。这项研究旨在研究TO如何影响计划手术的结直肠癌患者的长期预后。方法:将2014年至2018年在立陶宛维尔纽斯大学SantarosKlinikos医院和国家癌症研究所的两个主要癌症治疗中心接受选择性结直肠癌切除术和原发性吻合术的所有患者的数据输入前瞻性维护的数据库。该研究将TO定义为包含七个参数的复合质量指标:R0切除,取回≥12个淋巴结,在医院内期间没有术后并发症,住院时间少于14天,手术后90天内没有再入院,手术后30天内没有再干预,没有30天的死亡率。比较达到TO的患者和未达到TO的患者之间的长期结果。确定了与未能达到TO相关的因素。结果:纳入研究的1524例患者中,达到795(52.2%)。ASA评分(III-IV)较高的患者被确定为未能达到TO的几率较高(OR1.497,95%CI1.203-1.863),而接受微创手术的患者发生类似失败的几率较低(OR0.570,95%CI0.460-0.706).TO导致5年总体改善-(80.2%与65.5%,p=0.001)和无病生存率(76.6%vs.62.6%;p=0.001)比率。结论:选择性结直肠切除术对52.5%的患者产生成功的TO。ASA评分高的患者未能达到TO的可能性增加,而微创手术与更高的TO率相关。未能获得成功手术结果的患者经历降低的长期结果。
    Background: The outcomes of patients with colorectal cancer greatly depend on the quality of their surgical care. However, relying solely on a single quality indicator does not adequately capture the multifaceted nature of modern perioperative care. A new tool-\"Textbook Outcome\" (TO)-has been suggested to provide a comprehensive evaluation of surgical quality. This study aims to examine how TO affects the long-term outcomes of colorectal cancer patients who are scheduled for surgery. Methods: The data of all patients undergoing elective colorectal cancer resection with primary anastomosis at two major cancer treatment centers in Lithuania-Vilnius University Hospital Santaros Klinikos and National Cancer Institute-between 2014 and 2018 were entered into the prospectively maintained database. The study defined TO as a composite quality indicator that incorporated seven parameters: R0 resection, retrieval of ≥12 lymph nodes, absence of postoperative complications during the intrahospital period, hospital stay duration of fewer than 14 days, no readmission within 90 days after surgery, no reinterventions within 30 days after surgery, and no 30-day mortality. Long-term outcomes between patients who achieved TO and those who did not were compared. Factors associated with failure to achieve TO were identified. Results: Of the 1524 patients included in the study, TO was achieved by 795 (52.2%). Patients with a higher ASA score (III-IV) were identified to have higher odds of failure to achieve TO (OR 1.497, 95% CI 1.203-1.863), while those who underwent minimally invasive surgery had lower odds for similar failure (OR 0.570, 95% CI 0.460-0.706). TO resulted in improved 5-year overall-(80.2% vs. 65.5%, p = 0.001) and disease-free survival (76.6% vs. 62.6%; p = 0.001) rates. Conclusions: Elective colorectal resections result in successful TO for 52.5% of patients. The likelihood of failure to achieve TO is increased in patients with a high ASA score, while minimally invasive surgery is associated with higher TO rates. Patients who fail to achieve successful surgical outcomes experience reduced long-term outcomes.
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  • 文章类型: Journal Article
    背景:癌症诊断影响患者对当前和未来劳动力市场活动的选择。这些选择对政府的影响基于所支付的税收和获得的福利的变化。在这项分析中,我们探讨了人类生长受体2(HER2)阳性残留浸润性乳腺癌和不同的治疗方法如何影响不包括医疗费用的政府账户。
    方法:使用已发表的疾病模型中的HER2阳性早期乳腺癌(eBC)健康状况来确定疾病不同阶段工作和工资影响的可能性。通过应用既定的政府观点建模框架,49岁女性的间接生产率损失已转化为对政府的财政后果。财政预测(贴现)包括按疾病阶段划分的总税收收入,与下班时间和提前退休有关的政府转移费用,和净财政余额(例如,加拿大三个国家的总税收转移),葡萄牙,和巴西。
    结果:加拿大健康女性的净财政余额为109,551加元,而HER2阳性eBC女性接受曲妥珠单抗(69,767加元)或曲妥珠单抗(62,971加元)治疗。在这三个国家观察到类似的模式,但反映了每个国家的总体税收负担,劳动力活动,和可获得的公共福利。诊断年龄是可能的净财政平衡的重要决定因素,因为这会影响剩余的工作年限。
    结论:与健康女性相比,被诊断为HER2阳性eBC的女性估计支付的终生总税更少,获得的疾病福利更多。改善结果的治疗方法可能会从改善的劳动力参与中为政府带来财政收益。
    BACKGROUND: Cancer diagnosis influences the choices that patients make regarding current and future labor market activity. These choices have implications for governments based on resulting changes in taxes paid and benefits received. In this analysis we explore how human growth receptor 2 (HER2)-positive residual invasive breast cancer and different treatments influence government accounts excluding health costs.
    METHODS: HER2-positive early breast cancer (eBC) health states from a published disease model were used to establish likelihood of working and wage impact at different stages of disease. The indirect productivity losses for an average woman aged 49 years were translated into fiscal consequences to government by applying an established government perspective-modeling framework. The fiscal projections (discounted) include gross tax revenue by disease stage, government transfer costs related to time off work and early retirement ,and net fiscal balance (e.g., gross taxes-transfers) in three countries Canada, Portugal, and Brazil.
    RESULTS: The net fiscal balance in Canada for a healthy woman was C$109,551 compared with a HER2-positive eBC woman treated with trastuzumab emtansine (C$69,767) or trastuzumab (C$62,971). A similar pattern was observed in the three countries but reflecting the overall tax burden in each country, labor force activity, and available public benefits. Age at diagnosis was an important determinant of the likely net fiscal balance, as this influences the remaining working years.
    CONCLUSIONS: Women diagnosed with HER2-positive eBC were estimated to pay less lifetime gross taxes and receive more in sickness benefits compared with healthy women. Treatments that improve outcomes are likely to offer fiscal gains for government from improved work force participation.
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  • 文章类型: Journal Article
    OBJECTIVE: Cancer is a leading cause of death among people living with intellectual or developmental disabilities (IDD). There is little empirical evidence documenting survival or comparing outcomes to those without IDD. This study investigated the association between IDD and cancer survival among adults with breast (female), colorectal, or lung cancer.
    METHODS: A population-based retrospective cohort study was conducted in Ontario, Canada, with routinely collected data. Patients with breast, colorectal, or lung cancer were included (2007‒2019). IDD status before cancer was determined using an established administrative data algorithm. The outcomes of interest included death from any cause and death from cancer. Cox proportional hazards models and competing events analyses using multivariable cause-specific hazards regression were completed. Analyses were stratified by cancer type. Interactions with age, sex, and stage at diagnosis, as well as sensitivity analyses, were completed.
    RESULTS: The final cohorts included 123,695 breast, 98,809 colorectal, and 116,232 lung cancer patients. Individuals with IDD experienced significantly worse survival than those without IDD. The adjusted hazard ratios of all-cause death were 2.74 (95% CI 2.41‒3.12), 2.42 (95% CI 2.18‒2.68), and 1.49 (95% CI 1.34‒1.66) times higher for breast, colorectal, and lung cancer patients with IDD relative to those without. These findings were consistent for cancer-specific deaths. With few exceptions, worse survival for people with IDD persisted regardless of stage at diagnosis.
    CONCLUSIONS: People with IDD experienced worse cancer survival than those without IDD. Identifying and intervening on the factors and structures responsible for survival disparities is imperative.
    RéSUMé: OBJECTIFS: Le cancer est l’une des principales causes de mortalité chez les personnes vivant avec des déficiences intellectuelles ou des troubles du développement (DI/TD). Il y a peu de preuves empiriques décrivant la survie de ces personnes lorsqu’elles sont atteintes d’un cancer ou comparant leurs résultats à ceux des personnes sans DI/TD. Notre étude porte sur l’association entre les DI/TD et la survie au cancer chez les adultes atteints de cancer du sein (femmes), du colorectum ou du poumon. MéTHODE: Une étude de cohorte rétrospective populationnelle a été menée en Ontario, au Canada, à l’aide de données recueillies systématiquement. Nous avons inclus les patientes et les patients atteints de cancer du sein, du colorectum ou du poumon (2007‒2019). Nous avons identifié la présence des DI/TD avant le cancer à l’aide d’un algorithme de traitement de données administratives reconnu. Les résultats d’intérêt étaient les décès de toutes causes et les décès dus au cancer. Nous avons appliqué des modèles des risques proportionnels de Cox et des analyses des événements concurrents en utilisant la régression multivariée des risques par cause. Nos analyses ont été stratifiées selon le type de cancer. Nous avons tenu compte des interactions avec l’âge, le sexe et le stade au diagnostic et effectué des analyses de sensibilité. RéSULTATS: Les cohortes finales ont inclus 123 695 personnes atteintes de cancer du sein, 98 809 atteintes de cancer colorectal et 116 232 atteintes de cancer du poumon. La survie des sujets ayant des DI/TD a été significativement moins bonne que celle des sujets sans DI/TD. Les rapports de risques instantanés ajustés pour les décès de toutes causes étaient 2,74 fois (IC de 95 % 2,41‒3,12), 2,42 fois (IC de 95 % 2,18‒2,68) et 1,49 fois (IC de 95 % 1,34‒1,66) plus élevés chez les personnes atteintes de cancer du sein, du colorectum et du poumon et ayant des DI/TD que chez les personnes sans DI/TD. Ces constatations ressortent pour tous les décès attribuables à des cancers particuliers. Avec peu d’exceptions, la survie moins bonne pour les personnes ayant des DI/TD persistait quel que soit le stade au moment du diagnostic. CONCLUSION: La survie au cancer était moins bonne chez les personnes ayant des DI/TD que chez celles n’ayant pas de DI/TD. Il est impératif d’identifier les facteurs et les structures responsables de ces disparités dans la survie et d’intervenir en conséquence.
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  • 文章类型: Journal Article
    目的:评估心理健康状况,新南威尔士州(NSW)诊断为癌症的青少年和年轻人的精神卫生服务联系(AYAs)以及与癌症死亡率的关联表明。方法:在2005-2017年被诊断为癌症的3998NSWAYAs中,从医院住院记录和指定的医疗和药品保险索赔中获得精神卫生服务联系人。癌前心理接触的可能性是通过对社会人口统计学和癌症特征进行逻辑回归调整后的癌前心理接触评估的。使用竞争风险回归估计与癌症后心理健康接触相关的癌症特异性死亡风险。结果:癌症诊断后5年心理健康服务接触者的患病率为27.0%,高于相应的癌前病变患病率21.4%。最常见的心理健康状况是抑郁和焦虑。与癌前心理卫生服务机构接触的患者,癌症后诊断为心理卫生接触的几率更高(调整后的比值比5.69,置信区间[95%CI]:4.90-6.75)。5年癌症特异性生存率为87.9%(95%CI:85.8-89.8)与精神卫生服务接触癌症后的患者,低于没有这种接触的患者的93.9%(95%CI:93.0-94.7)。癌症诊断后有精神卫生服务接触的患者癌症死亡率的亚风险比(SHR)为1.67(95%CI:1.29-2.15),根据社会人口统计学特征进行调整,癌症阶段,和癌前心理健康状况。结论:癌症诊断后,精神卫生服务接触的患病率增加。心理健康护理应该是AYA癌症患者的优先事项,特别是高危人群。
    Purpose: To assess the mental health conditions, as indicated by mental health service contact in adolescents and young adults (AYAs) diagnosed with cancer in New South Wales (NSW) and associations with cancer mortality. Methods: In 3998 NSW AYAs diagnosed with cancer in 2005-2017, mental health service contacts were obtained from hospital inpatient records and specified medical and pharmaceutical insurance claims. Odds of postcancer mental health contact were assessed by precancer mental contacts using logistic regression adjusted for sociodemographic and cancer characteristics. The risk of cancer-specific mortality related to postcancer mental health contacts was estimated using competing risk regression. Results: The prevalence of mental health service contacts in the 5 years postcancer diagnosis was 27.0%, higher than the corresponding precancer prevalence of 21.4%. The most common mental health conditions were depression and anxiety. The odds of having a mental health contact postcancer diagnosis were higher in patients with a precancer mental health service contact (adjusted odds ratio 5.69, confidence intervals [95% CIs]: 4.90-6.75). The 5-year cancer-specific survival was 87.9% (95% CI: 85.8-89.8) for patients with a mental health service contact postcancer, which was lower than the 93.9% (95% CI: 93.0-94.7) for patients without this contact. The subhazard ratio (SHR) for cancer mortality in patients having mental health service contact postcancer diagnosis was 1.67 (95% CI: 1.29-2.15), adjusted for sociodemographic characteristics, cancer stage, and precancer mental health status. Conclusion: The prevalence of mental health service contact increased after a cancer diagnosis. Mental health care should be a continued priority for AYA cancer patients, particularly for high-risk groups.
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