RESUMEN
OBJECTIVES: Patients with advanced colorectal cancer (CRC) who have received oxaliplatin, 5-fluoropyrimidine, and irinotecan chemotherapy (with or without bevacizumab) and antiepidermal growth factor receptor therapy (if KRAS is wild type) have no further standard treatment options. Although repeating a prior chemotherapy [in particular, oxaliplatin and fluoropyrimidine (FOX)] is an option, there is very little evidence in the literature for this approach; thus, we reviewed our registry to assess the frequency and outcome of rechallenging with FOX. METHODS: Patients who had been rechallenged with FOX were identified from the South Australian metastatic CRC database. Patient characteristics were analyzed, and tumor response was retrospectively assessed using Response Evaluation Criteria in Solid Tumors criteria. RESULTS: Twenty patients were eligible for inclusion in this analysis. The number of prior lines of therapy received for metastatic CRC was 4 lines for 2 patients, 3 lines for 6 patients, 2 lines for 7 patients, and 1 line for 3 patients, with 3 patients having received oxaliplatin as adjuvant therapy. Four patients had received bevacizumab previously, 7 patients had undergone antiepidermal growth factor receptor treatment, and 4 patients had undergone liver resection earlier. Response rate was 18%, and 47% had stable disease. The median progression-free survival was 3.7 months, median overall survival was 7.8 months, and 1-year survival was 37%. CONCLUSIONS: In this selected population, there is evidence of modest activity of rechallenge with FOX chemotherapy, although radiologic response is uncommon.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/mortalidad , Terapia Recuperativa/métodos , Supervivencia sin Enfermedad , Fluorouracilo/administración & dosificación , Fluorouracilo/efectos adversos , Humanos , Estimación de Kaplan-Meier , Compuestos Organoplatinos/administración & dosificación , Compuestos Organoplatinos/efectos adversos , Oxaliplatino , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The South Australian (SA) myositis database has registered all patients with biopsy-proven inflammatory myositis in SA from 1980 to 2009. We determined the incidence and associations of malignancy in myositis by linking this database with the SA cancer registry. Standardized incidence ratios (SIR) for malignancy were determined using the total SA population over the same time period, stratified by age and gender. The SIR for cancer in the myositis population (n = 373) was 1.39, p = 0.047. There was a trend towards an increased SIR in dermatomyositis but no increased risk of malignancy in polymyositis or inclusion body myositis. Malignancies of the lung and prostate were the commonest and 28 % of malignancies occurred within one year of IIM diagnosis. The odds of developing cancer were significantly raised in the presence of a shawl sign, male gender, and in patients with overlap syndrome or rheumatoid arthritis whilst myalgia was a significant protective factor. HLA-A28 allele was overrepresented in patients with malignancy (11 vs 2 %, p = 0.006). Patients in SA with myositis are at modestly increased risk for malignancy. We report clinical and genetic risk factors allowing the identification of patients at greatest risk for malignancy.
Asunto(s)
Miositis/epidemiología , Neoplasias/epidemiología , Adulto , Factores de Edad , Anciano , Comorbilidad , Bases de Datos Factuales , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Miositis/genética , Neoplasias/genética , Sistema de Registros , Riesgo , Factores Sexuales , Australia del Sur/epidemiologíaRESUMEN
AIMS: Male breast cancer (MBC) is an uncommon disease with a paucity of information in the literature. The treatment of MBC has traditionally been extrapolated from experience with female breast cancer. This study reports on the treatment and outcomes of this disease in South Australia over a 30-year period. METHODS: From 1977 to 2007 63 patients with a median age of 62 years (range 33-85 years) were identified and treated for MBC. Data obtained, included initial stage, pathological features, treatment and outcomes. RESULTS: With a median follow up of 4.9 years (range 2 months to 19 years) the 5-year overall survival (OS) rate was 85% with median survival of 5.5 years. In all, 18 (29%) were diagnosed with recurrent disease, while 45 (72%) remained disease free. The median time to recurrence was 2.5 years. One patient failed locally, three (4%) had locoregional recurrence and distant recurrence was noted in 14 patients (22%). Disease stage at presentation was a significant predictor of 5-year OS and recurrence (P = 0.012 and P = 0.0001). Tumor diameter was also a significant predictor of 5-year OS and recurrence (P = 0.006 and P = 0.021). CONCLUSION: This retrospective series has a 5-year OS that compares favorably with other published series of MBC. The positive findings may help change the misperception that MBC is an inherently aggressive disease process with a poor clinical outcome. Further studies are needed to carefully and thoroughly investigate this rare but treatable disease.
Asunto(s)
Neoplasias de la Mama Masculina/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama Masculina/epidemiología , Neoplasias de la Mama Masculina/patología , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/tratamiento farmacológico , Recurrencia Local de Neoplasia/epidemiología , Recurrencia Local de Neoplasia/patología , Estudios Retrospectivos , Australia del Sur/epidemiología , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND: Colorectal cancer is a common cause of cancer death in Australia and is primarily managed operatively. Surgical databases are valuable in monitoring performance in cancer treatment and detecting problems and trends. METHODS: Diagnostic and treatment variables and short-term outcomes were gathered prospectively for patients undergoing resection for colorectal cancer over a 9-year period. Survival data were obtained by linkage to state and interstate death indices. RESULTS: Eight hundred and five patients underwent resection for colorectal cancer during the study period. Overall 5-year survival was 61%. Five-year cancer-specific survival was 73%. Five-year cancer-specific survival for Australian Clinico-Pathological Staging (ACPS) stages A, B, C and D was 96, 80, 61 and 19%, respectively (P < 0.0001). Emergency presentations showed diminished survival (59% versus 75%, P < 0.0001) after controlling for age and stage (hazard ratio (HR) 1.78, P= 0.005), as did transfusion recipients (63% versus 74%, P= 0.0014; HR 1.78, P= 0.004). Anastomotic leak did not affect survival in multivariable analysis. Non-cancer causes accounted for 26% deaths, primarily comprising cardiovascular deaths in the elderly. DISCUSSION: High case ascertainment, data completeness and accuracy can be obtained with prospective, independently gathered data linked electronically to national death records. Survival for colorectal cancer in South Australia continues to improve. Close follow-up for disease recurrence is warranted for transfusion recipients, emergencies and advanced disease. Locally managed databases with linkage to state registries and other institutions are powerful methods to improve data quality and surgical care at a national level.
Asunto(s)
Neoplasias Colorrectales/cirugía , Bases de Datos Factuales , Sistema de Registros , Adulto , Anciano , Anciano de 80 o más Años , Transfusión Sanguínea/estadística & datos numéricos , Quimioterapia Adyuvante , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/radioterapia , Urgencias Médicas , Femenino , Estudios de Seguimiento , Adhesión a Directriz/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Complicaciones Posoperatorias/epidemiología , Guías de Práctica Clínica como Asunto , Estudios Prospectivos , Radioterapia Adyuvante , Australia del Sur , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
OBJECTIVE: To determine survival rates of patients with lymphoma in South Australia. DESIGN AND SETTING: De-identified data from the SA Cancer Registry on all patients with lymphoma were analysed, as well as the subgroup treated at the Royal Adelaide Hospital (RAH). For non-Hodgkin lymphoma (NHL), we used the International Working Formulation (IWF) grading. SA and RAH data on survival rates were compared with those for the whole of Australia and the United States. PATIENTS: All patients diagnosed with lymphoma and treated in SA in 1977-2007. OUTCOME MEASURES: 5-year survival rates for patients with lymphoma, by type of lymphoma and age. RESULTS: Of the total of 8651 patients with lymphoma, 939 were classified as having Hodgkin lymphoma (HL) and 7712 as having NHL. Of those with NHL, 1805 had low-grade, 3576 intermediate-grade, and 510 high-grade NHL. In another 1821 patients, the data were insufficient to make an IWF grading. There was a substantial increase in 5-year survival rates for patients with lymphoma between 1977 and 2007 in SA. While the increase in 5-year survival rates for HL was 7.6 percentage points, survival rates peaked at 88%. For NHL, there was an 18.7 percentage points increase in 5-year survival rates. The first significant increase of 7 percentage points was associated with the introduction of bone marrow transplantation; this was maintained with the increase in 5-year survival rates reaching 14 percentage points by 1995-1999. Since 1999, there has been a further increase of 5 percentage points in 5-year survival rates with the introduction of rituximab. CONCLUSION: Outcomes in patients with NHL have improved significantly, most likely because of the use of bone marrow transplantation and rituximab. Hospital- and state-based cancer registry data reflect the reality of population outcomes and the impact of new technologies.
Asunto(s)
Linfoma/epidemiología , Estadificación de Neoplasias , Medición de Riesgo/métodos , Adulto , Distribución por Edad , Anciano , Estudios de Seguimiento , Humanos , Incidencia , Linfoma/patología , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Australia del Sur/epidemiología , Tasa de Supervivencia/tendencias , Factores de TiempoRESUMEN
BACKGROUND: Age is a major risk factor for development of sporadic colorectal cancer but elderly patients are underrepresented in clinical trials and are potentially offered chemotherapy less often. METHODS: Data were obtained from South Australian Clinical Registry for advanced colorectal cancer between 1st February 2006 and 9th September 2010. Patients who received chemotherapy were analysed to assess the impact of single versus combination chemotherapy and to assess the outcome in two age cohorts, age < 70 years and ≥ 70 years. RESULTS: Out of a total of 1745 patients in the database during this time period, 951 (54.5%) received systemic chemotherapy. 286 (30%) received first line therapy (median age 74 years) with single agent fluoropyrimidine and 643 patients (68%) received first line combination chemotherapy (median age 64 years). The median overall survival of patients receiving first line combination chemotherapy was 23.9 months compared to 17.2 months for those who received single agent fluoropyrimidine (p<0.001). Combination chemotherapy was given to 81% of patients aged < 70 years compared to 53% of those ≥ 70 years. There was no significant difference in median overall survival of patients receiving chemotherapy by age cohort, 21.3 months for age <70 years and 21.1 months for age ≥ 70 years (p = 0.4). CONCLUSION: Treatment outcomes are comparable in both the elderly and younger patients. Patients who received initial combination chemotherapy were younger and had a longer median overall survival. In our study, age appeared to influence the treatment choices but not necessarily outcome.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/mortalidad , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sistema de Registros , Australia del Sur/epidemiología , Resultado del Tratamiento , Adulto JovenRESUMEN
AIM: Evidence supporting improved outcomes for small cell lung cancer (SCLC) in recent decades is limited. This study aimed to identify patterns of care and survival over two time periods; 1 January 1987 to 31 December 1996 (cohort A) and 1 January 1997 to 31 December 2006 9 (cohort B). METHODS: Patients' characteristics, management and outcome data were extracted from the Hospital Cancer Registry and clinical records. Survival analysis was determined using the Kaplan-Meier method and the log-rank test. Factors influencing survival outcome were assessed using Cox proportional hazards regression. RESULTS: The total number of patients was 392 (224 in cohort A, 168 in cohort B). Overall 38% patients in cohort A and 24% in cohort B had limited stage (LS) disease at diagnosis. Combined chemoradiotherapy for LS increased from 5% in cohort A to 65% in cohort B. Overall 19% of patients in cohort A and 24% in cohort B received symptomatic treatment alone (STA). Median survival for LS in cohort B was significantly higher (19.5 months), than in cohort A (11.8 months) (P = 0.03). In extensive stage (ES) disease, median survival was 6.2 months in cohort A and 4.3 months in cohort B (P = 0.7). Variables for poorer outcome were STA, male gender, poor performance status, ES and whether the diagnosis was made in the earlier time period in cohort A. CONCLUSION: Outcomes for LS SCLC have improved with combined chemoradiotherapy, in keeping with worldwide data. The trends may also reflect recent improvements in staging and standardization of treatment. The outcome for ES-SCLC remains poor.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/radioterapia , Carcinoma Pulmonar de Células Pequeñas/tratamiento farmacológico , Carcinoma Pulmonar de Células Pequeñas/radioterapia , Anciano , Australia , Estudios de Cohortes , Terapia Combinada , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Modelos de Riesgos Proporcionales , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
INTRODUCTION: The aims of the South Australian Clinical Registry for Metastatic Colorectal Cancer are to record case outcomes according to site of recurrence and mode of clinical practice and to utilize the accumulated information for quality assurance activities. METHODS: All patients who had a diagnosis of synchronous or metachronous metastatic colorectal cancer (CRC) after 1 February 2006 were eligible to be included in the registry. Data on patient details, disease characteristics, investigations, histopathology and treatment were collected. Disease-specific survival data were assessed using Kaplan-Meier product moment estimates and the log-rank test of equality was used for comparisons. RESULTS: 1544 patients have been entered as of 22 March 2010. In addition, 54.7% of primary CRCs were in the rectosigmoid area, 92.9% of them adenocarcinomas. Also, 52.6% of patients received chemotherapy and 15% had radiotherapy. Two hundred five patients underwent liver resection, nine had radiofrequency ablation and seven had selective internal radiotherapy. The overall 3-year survival from time of diagnosis of metastatic CRC was 29.5%. There was no significant survival difference between patients with synchronous and metachronous metastatic CRC. Patients with lung- or liver-only metastases have significantly improved survival if they underwent surgical resection. DISCUSSION: The treatment of patients with metastatic CRC continues to progress with modern medical and surgical developments. Important insights into the current patterns of care and clinical outcomes for metastatic CRC are provided by these data. In addition, this registry provides a feasible and useful database for the evaluation of current treatments established as best evidence in this population.
Asunto(s)
Neoplasias Colorrectales/epidemiología , Garantía de la Calidad de Atención de Salud/estadística & datos numéricos , Sistema de Registros/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/uso terapéutico , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Australia del Sur/epidemiología , Análisis de SupervivenciaRESUMEN
BACKGROUND: Kidney cancer has a high incidence in Australia by world standards but has attracted little public health attention because of its low ranking among other cancers as a cause of death. Incidence, mortality and survival trends were investigated in this study for an Australian population and cancer control opportunities considered. DESIGN: Age-standardized incidence and mortality rates were analyzed by broad age category using data from an Australian cancer registry. Disease-specific survivals were analyzed using the Kaplan-Meier product limit estimate and multivariable Cox proportional hazards regression. RESULTS: Incidence rates approximately doubled during 1980-2008, with large increases affecting both sexes. Increases were more evident for renal cell and other histology types occurring predominantly in adulthood than childhood nephroblastomas. The male to female incidence ratio approximated 2:1 but decreased over time and was lower in younger than older age groups. The increase in mortality rate was smaller (at 25%) and higher in males (at 36%) than females (at 7%). Mortality increases were restricted to the age range of 70 years and over. Five-year survivals increased from 47% for 1980-84 to 66% for 2000-08 and multivariate predictors of high case fatality were older age at diagnosis and less recent diagnostic period. Country cases had lower survivals than metropolitan cases, although the difference was small. CONCLUSIONS: Increases in mortality were smaller than incidence increases, evidently due to offsetting increases in case survival, and did not affect the younger age groups. Further reductions in tobacco smoking and reducing the prevalence of obesity will be important to prevent renal cell carcinomas. Molecular research is advocated to develop targeted therapies and potentially, an effective screening technology. Cancer registries need to routinely publish their data by histology type to enable more detailed global trend analyses. Population registries also need to record stage of cancer at diagnosis to facilitate interpretation of changes in survival.
Asunto(s)
Neoplasias Renales/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Femenino , Humanos , Estimación de Kaplan-Meier , Neoplasias Renales/mortalidad , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Salud Pública , Sistema de Registros , Factores de Riesgo , Adulto JovenRESUMEN
OBJECTIVE: The aim was to explore incidence, mortality and case survivals for invasive neuroendocrine cancers in an Australian population and consider cancer control implications. METHODS: Directly age-standardised incidence and mortality rates were investigated from 1980 to 2006, plus disease-specific survivals. RESULTS: Annual incidence per 100,000 increased from 1.7 in 1980-1989 to 3.3 in 2000-2006. A corresponding mortality increase was not observed, although numbers of deaths were low, reducing statistical power. Increases in incidence affected both sexes and were more evident for female lung, large bowel (excluding appendix), and unknown primary site. Common sites were lung (25.9%), large bowel (23.3%) (40.9% were appendix), small intestine (20.6%), unknown primary (15.0%), pancreas (6.5%), and stomach (3.7%). Site distribution did not vary by sex (p = 0.260). Younger ages at diagnosis applied for lung (p = 0.002) and appendix (p < 0.001) and older ages for small intestine (p < 0.001) and unknown primary site (p < 0.001). Five-year survival was 68.5% for all sites combined, with secular increases (p < 0.001). After adjusting for age and diagnostic period, survivals were higher for appendix and lower for unknown primary site, pancreas, and colon (excluding appendix). CONCLUSIONS: Incidence rates are increasing. Research is needed into possible aetiological factors for lung and large-bowel sites, including tobacco smoking, and excess body weight and lack of exercise, respectively; and Crohn's disease as a possible precursor condition.
Asunto(s)
Neoplasias/epidemiología , Australia/epidemiología , Femenino , Humanos , Incidencia , Masculino , Neoplasias/diagnóstico , Neoplasias/mortalidad , Sistemas Neurosecretores , Grupos de Población , Investigación , Proyectos de Investigación , Fumar/epidemiología , Fumar/mortalidadRESUMEN
BACKGROUND: Metastatic carcinoid tumors (MCTs), an important subgroup of neuroendocrine tumors, occur infrequently and often have an indolent course, limiting data on long-term treatment outcomes. We aimed to assess treatment trends at a single center over time and the impact on the outcome. STUDY: Patients diagnosed with carcinoid tumors in the North West Adelaide Health Service between January 1, 1985 and March 1, 2007 were identified from the South Australian Cancer Registry. RESULTS: We identified 92 patients with carcinoid tumors; 49 had MCT. Although treatment options increased over time, the most significant change was to access octreotide therapy, with 24 receiving long-acting somatostatin analogs. Survival improved over time and the median overall survival for patients receiving long-acting somatostatin analogs was 112 months compared with 53 months for those who did not (P=0.021, hazard ratio: 2.46). Ten year survival was 40% and 22%, respectively. About 75% of evaluable patients had a biochemical response to initial therapy and a measurable response occurred in 3 of 24 (13%) patients. CONCLUSIONS: This single center experience has provided insight into current treatment options for MCT, and suggests the use of long-acting somatostatin analogs may impact on disease control and survival. However, the uptake of other treatment options seems limited and there is a need for agents that target tumor progression.
Asunto(s)
Antineoplásicos Hormonales/uso terapéutico , Tumor Carcinoide/terapia , Octreótido/uso terapéutico , Anciano , Tumor Carcinoide/mortalidad , Tumor Carcinoide/patología , Bases de Datos Factuales , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Metástasis de la Neoplasia , Sistema de Registros , Estudios Retrospectivos , Somatostatina/análogos & derivados , Somatostatina/uso terapéutico , Australia del Sur , Tasa de Supervivencia , Factores de Tiempo , Resultado del TratamientoRESUMEN
The incidence of liver and intrahepatic bile duct cancer in Australia is low at about one third the world average but increases are evident. South Australian registry data have been used to describe: age-standardized incidence and mortality trends; and disease-specific survivals, using Kaplan-Meier estimates and Cox proportional hazards regression. The study included 1,220 incident cancers (901 hepatocellular carcinomas; 201 cholangiocarcinomas; 118 other types) and 983 deaths. Incidence and mortality rates increased by 2-3 fold during 1977-2007. Incidence increases affected males, females and all ages. There was a strong: male predominance (3 to 1); and age gradient (70+ year old incidence >30 times under 50 year old incidence). Compared with hepatocellular carcinomas, cholangiocarcinomas and other histology types more often affected females and older ages and less often the Asian born. All histology types showed similar incidence increases. Apart from recognized risk factors (e.g., hepatitis B/C infection and aflatoxins for hepatocellular carcinoma; liver-fluke infection for cholangiocarcinomas, etc.), common risk factors may include excess alcohol consumption and possibly obesity and diabetes mellitus. Five-year disease-specific survival in 1998-2007 was 16%, with higher fatalities applying for earlier periods, older patients, males, lower socio-economic groups, and cholangiocarcinomas. Aboriginal patients tended to have higher case fatalities (p=0.054). Survival increases may be due to earlier diagnosis from alpha feta protein testing and diagnostic imaging, plus more aggressive treatment of localized disease. Mortality increases require a preventive response, including hepatitis B vaccination, prevention of viral infection though contaminated blood and other body fluids, early detection initiatives for high-risk patients, aggressive surgery for localized disease, and experimentation with new systemic therapies.
Asunto(s)
Adenocarcinoma/epidemiología , Neoplasias de los Conductos Biliares/epidemiología , Carcinoma Hepatocelular/epidemiología , Colangiocarcinoma/epidemiología , Neoplasias Hepáticas/epidemiología , Adenocarcinoma/mortalidad , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Neoplasias de los Conductos Biliares/mortalidad , Conductos Biliares Intrahepáticos , Carcinoma Hepatocelular/mortalidad , Colangiocarcinoma/mortalidad , Femenino , Humanos , Neoplasias Hepáticas/mortalidad , Masculino , Persona de Mediana Edad , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
South Australian registry data were used to explore age-standardised incidence and mortality rates and case survivals for pancreatic cancer during 1977 to 2006. Disease-specific survivals were investigated using Kaplan-Meier estimates and Cox proportional hazards regression. While annual incidence and mortality rates were relatively stable among males during 1983-2006, they were 14% and 17% lower respectively than for the 1977-82 baseline. A converse non-significant secular trend was suggested in females, in that incidence in 1989-2006 was 10% higher than in 1977-88, with a corresponding 9% increase in mortality. As a result, male to female incidence rate ratios decreased from 1.73:1 in 1977-82 to about 1.34:1 in 2001-06. One-year survival was 18.0% but this figure decreased to 3.6% at five years. Higher survivals were evident for more recent diagnostic periods, with one-year survival increasing from 14.3% in 1977-88 to 23.9% in 2001-06. Multivariable proportional hazards regression indicated that case fatality was higher in the older age groups and lower for neuroendocrine than other histology types, patients from high and mid-high than lower socio-economic areas, and for more recent diagnostic periods. The differences by diagnostic period, socio-economic status and histology type applied both to the age range less than 60 years and between 60 and 79 years, but were not evident in older patients. The divergent secular trends in incidence and mortality in males and females and associated decreases in male to female rate ratio are consistent with trends in the USA and likely reflect differences in historic tobacco smoking trends by sex. While survival at five years from diagnosis is still only about 5%, patients are living longer with more surviving one year or more, probably due to gains in treatment and potentially in diagnostic technology.
Asunto(s)
Carcinoma Neuroendocrino/epidemiología , Carcinoma Neuroendocrino/mortalidad , Neoplasias Pancreáticas/epidemiología , Neoplasias Pancreáticas/mortalidad , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Vigilancia de la Población , Pronóstico , Sistema de Registros , Tasa de SupervivenciaRESUMEN
OBJECTIVE: To investigate factors that most influenced survival from bladder cancer in New South Wales, Australia (NSW) and to consider the impact of changes in coding practices on the reporting the of bladder cancer outcomes. PATIENTS AND METHODS: All NSW cases of bladder cancer diagnosed between 1980 and 2003 were followed to the end of 2004 (17 923 cases). Survival analysis was undertaken using Kaplan-Meier unadjusted disease-specific survival and adjusted disease-specific survival using Cox proportional hazards regression modelling. This analysis was unique in that it modelled the effect of sex, age, country of birth, socio-economic status (SES), histological type, extent of disease and period of diagnosis on survival from bladder cancer in NSW. RESULTS: After adjusting for sex, age, extent of disease, SES, period of diagnosis and histological type, the likelihood of death was 11% (95% confidence interval, CI 5-18%) higher in females than in males, with case fatality most influenced by age at diagnosis, extent of disease, and histological type. When the analysis was repeated for cases with a method 6 (i.e. coding undertaken in the registry after examination of the pathology report, which would enhance accuracy), the likelihood of death was 13% (95% CI 5-21%) higher in females than in males. CONCLUSIONS: The NSW analysis controls for variability in coding, extent of disease at diagnosis and histological type of cancer. The analysis shows significantly lower survival from bladder cancer in NSW women compared with men, with no improvement in survival from 1980 to 2003. Possible reasons for the lower survivals in women, the lack of improvement in survival and coding differences in jurisdictions are discussed.
Asunto(s)
Sistema de Registros , Neoplasias de la Vejiga Urinaria/mortalidad , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Métodos Epidemiológicos , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Nueva Gales del Sur/epidemiología , Factores Sexuales , Factores Socioeconómicos , Adulto JovenRESUMEN
South Australian registry data were used to investigate trends in laryngeal cancer age-standardised incidence, mortality and disease-specific survival from 1977 to 2005. Incidence rates decreased by 32% from 1980-84 to 2000-05, affecting both sexes and ages under 70 years. There were concurrent reductions in mortality, although statistical significance was not achieved with the numbers of deaths examined (p>0.05). More than other cancers, laryngeal cancers presented in: the 50-79 year age range; males, particularly those born in Southern Europe; UK/Irish migrants; and residents of lower socio-economic areas. Compared with other cancers, laryngeal cancers were less common in more recent diagnostic periods. The ratio of glottis to other laryngeal cancers was higher in males, older patients, and those born in Southern Europe, UK/Ireland and Western Europe. A secular increase in this ratio was evident. The five-year survival from laryngeal cancer was 68%, with poorer outcomes applying for older patients, non-metropolitan residents, patients with cancers of laryngeal sub-sites other than glottis, and potentially patients born in Southern Europe. Secular changes in survival were not observed. Reductions in incidence are attributed to decreases in tobacco smoking in males and reductions in per capital alcohol consumption since the 1970s. The higher ratio of glottis to other laryngeal cancer sub-sites in males may indicate a greater contribution made by tobacco, as opposed to alcohol, in males. The lower survival observed in non-metropolitan patients may reflect poorer access to radiation oncology and other specialist services, although delays in diagnosis for other reasons may have contributed.
Asunto(s)
Causas de Muerte , Neoplasias Laríngeas/epidemiología , Neoplasias Laríngeas/terapia , Invasividad Neoplásica/patología , Distribución por Edad , Análisis de Varianza , Terapia Combinada , Femenino , Humanos , Incidencia , Neoplasias Laríngeas/patología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estadificación de Neoplasias , Oportunidad Relativa , Probabilidad , Modelos de Riesgos Proporcionales , Sistema de Registros , Investigación/normas , Estudios Retrospectivos , Medición de Riesgo , Distribución por Sexo , Factores Socioeconómicos , Australia del Sur/epidemiología , Análisis de SupervivenciaRESUMEN
OBJECTIVES: To investigate incidence, mortality and case survival trends for cancer of unknown primary site (CUP) and consider clinical implications. METHOD: South Australian Cancer Registry data were used to calculate age-standardised incidence and mortality rates from 1977 to 2004. Disease-specific survivals, socio-demographic, histological and secular predictors of CUP, compared with cancers of known primary site, and of CUP histological types, using multivariable logistic regression were investigated. RESULTS: Incidence and mortality rates increased approximately 60% between 1977--80 and 1981--84. Rates peaked in 1993--96. Male to female incidence and mortality rate ratios approximated 1.3:1. Incidence and mortality rates increased with age. The odds of unspecified histological type, compared with the more common adenocarcinomas, were higher for males than females, non-metropolitan residents, low socio-economic areas, and for 1977--88 than subsequent diagnostic periods. CUP represented a higher proportion of cancers in Indigenous patients. Case survival was 7% at 10 years from diagnosis. Factors predictive of lower case survival included older age, male sex, Indigenous status, lower socio-economic status, and unspecified histology type. CONCLUSION: Results point to poor CUP outcomes, but with a modest improvement in survival. The study identifies socio-demographic groups at elevated risk of CUP and of worse treatment outcomes where increased research and clinical attention are required.
Asunto(s)
Métodos Epidemiológicos , Neoplasias Primarias Desconocidas/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Estudios Epidemiológicos , Femenino , Humanos , Incidencia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Neoplasias Primarias Desconocidas/clasificación , Neoplasias Primarias Desconocidas/mortalidad , Neoplasias Primarias Desconocidas/patología , Proyectos Piloto , Pautas de la Práctica en Medicina/estadística & datos numéricos , Salud Pública , Práctica de Salud Pública , Sistema de Registros , Factores de Riesgo , Factores Socioeconómicos , Australia del Sur/epidemiologíaRESUMEN
OBJECTIVES: To investigate trends in cervical cancer incidence, mortality and survival by histology for benchmarking purposes ahead of practice change and the introduction of Human Papilloma Virus (HPV) vaccine. METHODS: Using data from the South Australian Cancer Registry, age-standardised rates are presented for four-year periods from 1977 to 2004. Socio-demographic and secular predictors of glandular as opposed to squamous cancers are investigated, using multivariable logistic regression. Disease-specific survivals are analysed using Kaplan-Meier product-limit estimates and Cox proportional hazards regression. RESULTS: Incidence and mortality rates reduced by 55.1% and 59.3% respectively between 1977-80 and 2001-04, with larger reductions for squamous than glandular cancers. The ratio of squamous to glandular cancer incidence reduced from 5.4:1 in 1977-88 to 2.8:1 in 1993-2004, with a corresponding reduction from 5.2:1 to 3.0:1 for mortality. Compared with squamous cancers, glandular lesions were more common in patients from higher socio-economic areas, but less common in those over 70 years of age, Aboriginal patients, and those born in Southern Europe. CONCLUSION: The proportion of cancers comprising glandular lesions has increased, possibly reflecting prevention of squamous cancers through treatment of screen-detected preinvasive lesions. Additional mortality reductions from screening may be limited where the proportion of glandular lesions is high, with vaccination offering the best prospects for gains in the long term. Priority should be given to Aboriginal and Torres Strait Islander women in vaccination programs in view of their high death rate from cervical cancer.
Asunto(s)
Benchmarking/métodos , Vacunas contra Papillomavirus , Vigilancia de la Población/métodos , Neoplasias del Cuello Uterino/epidemiología , Adulto , Distribución por Edad , Anciano , Australia/epidemiología , Femenino , Humanos , Incidencia , Modelos Logísticos , Persona de Mediana Edad , Sistema de Registros , Clase Social , Neoplasias del Cuello Uterino/mortalidad , Neoplasias del Cuello Uterino/patologíaRESUMEN
RATIONALE: Treatment guidelines recommend a more conservative surgical approach than mastectomy for early stage breast cancer and a stronger emphasis on adjuvant therapy. Registry data at South Australian teaching hospitals have been used to monitor survivals and treatment in relation to these guidelines. AIMS AND OBJECTIVES: To use registry data to: (1) investigate trends in survival and treatment; and (2) compare treatment with guidelines. METHODS: Registry data from three teaching hospitals were used to analyse trends in primary courses of treatment of breast cancers during 1977-2003 (n=4671), using univariate analyses and multiple logistic regression. Disease-specific survivals were analysed using Kaplan-Meier product limit estimates and multivariable Cox proportional hazards regression. RESULTS: The 5-year survival was 79.9%, but with a secular increase, reaching 83.6% in 1997-2003. The relative risk of death (95% confidence limits) was 0.74 (0.62, 0.88) for 1997-2003, compared with previous diagnoses, after adjusting for tumour node metastasis stage, grade, age and place of residence. Treatment changes included an increase in conservative surgery (as opposed to mastectomy) from 51.7% in 1977-1990 to 76.8% in 1997-2003 for stage I (P<0.001) and from 31.1% to 52.2% across these periods for stage II (P<0.001). Adjuvant radiotherapy also became more common (P<0.001), with 20.6% of patients receiving this treatment in 1977-1990 compared with 60.7% in 1997-2003. Radiotherapy generally was more prevalent when conservative surgery was provided, although also relatively common in mastectomy patients when tumour diameters exceeded 50 mm or when there were four or more involved nodes. The proportion of patients receiving chemotherapy increased (P<0.001), from 19.6% in 1977-1990 to 36.9% in 1997-2003, and the proportion having hormone therapy also increased (P<0.001), from 34.3% to 59.4% between these periods. CONCLUSIONS: Survivals appear to be increasing and treatment trends are broadly consistent with guideline directions, and the earlier research on which these recommendations were based.
Asunto(s)
Neoplasias de la Mama/terapia , Hospitales de Enseñanza , Pacientes , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Sistema de Registros , Australia del Sur , Análisis de SupervivenciaRESUMEN
This is a retrospective study of patients with oral and oropharyngeal tongue cancers who presented to the Royal Adelaide Hospital (RAH) from 1987 to 2004. The aims of this study were to determine sociodemographic and tumour characteristics, treatment patterns and five-year disease-specific survival of the disease. All cases of tongue cancers, including untreated and palliative cases, were identified through the Royal Adelaide Hospital Cancer Registry and were included in statistical analysis. A total of 212 cases of tongue cancer were identified. Patients less than 45 years of age accounted for 15% of cases and had a tendency to present with advanced stage disease. Squamous cell carcinoma was the most common histological type. Almost 30% of recorded cases were oropharyngeal or base of tongue cancers. Nearly half of the patients had advanced stage (III and IV) disease at presentation, which was significantly associated with rural area of residence, base of tongue sub-site and early diagnostic period. Treatment involved a multidisciplinary approach and majority of patients were treated with a curative intent. Palliative treatment was more likely to be given to patient with oropharyngeal tongue cancers or advance stage disease. There was no significant improvement of five-year disease-specific survival over the 18-year period. Poorer survival was significantly associated with age 45 years or older, oropharyngeal tongue cancers and advanced stage disease. Tongue cancer is an important health issue associated with poor survival. Early detection and diagnosis is important in order to improve survival rate for this malignancy.
Asunto(s)
Carcinoma de Células Escamosas/terapia , Neoplasias Orofaríngeas/terapia , Neoplasias de la Lengua/terapia , Adulto , Anciano , Carcinoma de Células Escamosas/patología , Terapia Combinada , Métodos Epidemiológicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Orofaríngeas/patología , Cuidados Paliativos/estadística & datos numéricos , Pronóstico , Neoplasias de la Lengua/patología , Resultado del TratamientoRESUMEN
In a population survey, 2652 respondents aged 15+ years reported their preferred place of death, if dying of 'a terminal illness such as cancer or emphysema', to be home (70%), a hospital (19%), hospice (10%), or nursing home (<1%). The majority of respondents in all socio-demographic categories reported a preference for dying at home, with the greatest majorities occurring in younger age groups. After weighting to the age-sex distribution of all South Australian cancer deaths, 58% in our survey declared a preference to die at home, which is much higher than the 14% of cancer deaths that actually occurred at home in South Australia in 2000-2002. Multivariable analyses indicate that predictors of preferred home death include younger age, male, born in the UK/Ireland or Italy/Greece, better physical health, poorer mental health, and fewer concerns about dying at home. Predictors of preference for death in a hospice rather than hospital include older age, female, single, metropolitan residence, having higher educational and income levels, paid employment, awareness of advanced directives, and interpreting 'dying with dignity' as death without pain or suffering. Investigating the differences between preferred and actual places of death may assist service providers to meet end-of-life wishes.