Anne-Elie Carsin

Associations between cancer‐related financial stress and strain and psychological well‐being among individuals living with cancer

Cancer places a financial and economic burden on individuals, but relatively little is known about the consequences. We investigated associations between cancer‐related financial stress and strain and psychological well‐being.

Inequity in colorectal cancer treatment and outcomes: a population-based study

Several uncertainties surround optimal management of colorectal cancer. We investigated treatment patterns and factors influencing treatment receipt and mortality in routine clinical practice. We included 15 249 individuals, recorded by the National Cancer Registry (Ireland), with primary invasive colon or rectal tumours, diagnosed during 1994–2002. Logistic regression and Cox proportional hazards were used to determine factors associated with treatment receipt within 1 year of diagnosis and with mortality, respectively. A total of 78% had colorectal resection, 31% chemotherapy, and 13% radiotherapy (4% colon; 28% rectum). Half of stage IV patients underwent resection. Chemotherapy and radiotherapy use increased by at least 10% per annum. There was a notable increase in pre-operative radiotherapy from 2000 onwards. Patient-related factors were significantly associated with treatment receipt. Patients who were male, older, not married, or smokers had significantly higher risks of death. Chemotherapy was significantly associated with lower mortality for stage III, but not stage II, colon cancer. For rectal cancer, pre-operative radiotherapy was associated with reduced mortality. Surgery and chemotherapy were associated with longer survival for stage IV patients. The observed inequities in treatment and outcomes suggest that there is potential for further dissemination of therapies in routine practice. Improving treatment availability overall, and equity, has the potential to reduce mortality.

Factors associated with psychological distress following colposcopy among women with low-grade abnormal cervical cytology: a prospective study within the Trial Of Management of Borderline and Other Low-grade Abnormal smears (TOMBOLA)

Little is known about psychological after‐effects of colposcopy and associated investigations and treatment in women with low‐grade abnormal cervical cytology. We investigated psychological distress following colposcopy and related procedures.

Smoking at diagnosis is an independent prognostic factor for cancer-specific survival in head and neck cancer: findings from a large, population-based, study

Background: Some studies suggest smoking may result in poorer clinical outcomes in head and neck cancer, but the evidence is heterogeneous and some of it is poor quality. In a large, population-based, study we investigated: (i) whether smoking at diagnosis is an independent prognostic factor for cancer-specific survival in head and neck cancer; and (ii) whether the association varies by site and treatment. Methods: Head and neck cancers (ICD10 C01-C14, and C30–32) diagnosed from 1994 to 2009 were abstracted from the National Cancer Registry Ireland, and classified by smoking status at diagnosis. Follow-up was for 5 years or until December 31, 2010. Multivariate Cox proportional hazards models were used to compare cancer-specific death rates in current, ex-, and never smokers. Subgroup analyses by site and treatment were conducted. Results: In total, 5,652 head and neck cancers were included. At diagnosis, 24% were never smokers, 20% ex-smokers, and 56% current smokers. Compared with never smokers, current smokers had a significantly raised death rate from cancer [multivariate HR, 1.36; 95% confidence interval (CI), 1.21–1.53]. The association was similar after restriction to squamous cell tumors. A significantly increased cancer-related death rate was seen for current smokers with oral cavity, pharyngeal, and laryngeal cancers. The association was stronger in surgically treated patients [HR, 1.49; 95% CI, 1.25–1.79; P(interaction) = 0.01]. Neither radiotherapy nor chemotherapy modified the effect of smoking. Conclusions: Patients with head and neck cancer who smoke at diagnosis have a significantly increased cancer death rate. Impact: Greater efforts are needed to encourage and support smoking cessation in those at risk of, and diagnosed with, head and neck cancer. Cancer Epidemiol Biomarkers Prev; 23(11); 2579–90. ©2014 AACR.

Intakes of Dietary Folate and Other B Vitamins Are Associated with Risks of Esophageal Adenocarcinoma, Barrett's Esophagus, and Reflux Esophagitis

Folate is implicated in carcinogenesis via effects on DNA synthesis, repair, and methylation. Efficient folate metabolism requires other B vitamins and is adversely affected by smoking and alcohol. Esophageal adenocarcinoma (EAC) may develop through a process involving inflammation [reflux esophagitis (RE)] leading to metaplasia [Barretts esophagus (BE)] and carcinoma. Within a population-based, case-control study, we investigated associations between dietary folate and related factors and risks of EAC, BE, and RE. EAC and BE cases had histologically confirmed disease; RE cases had endoscopically visible inflammation. Controls, age-sex frequency matched to EAC cases, were selected through population and general practice registers. Participants underwent structured interviews and completed food-frequency questionnaires. Multivariate ORs and 95% CIs were computed using logistic regression. A total of 256 controls and 223 EAC, 220 BE, and 219 RE cases participated. EAC risk decreased with increasing folate intake (OR highest vs. lowest = 0.56; 95% CI: 0.31, 1.00; P-trend < 0.01). Similar trends were found for BE (P-trend < 0.01) and RE (P-trend = 0.01). Vitamin B-6 intake was significantly inversely related to risks of all 3 lesions. Riboflavin intake was inversely associated with RE. Vitamin B-12 intake was positively associated with EAC. For EAC, there was a borderline significant interaction between folate intake and smoking (P-interaction = 0.053); compared with nonsmokers with high (≥ median) folate intake, current smokers with low intakes (<median) had an 8-fold increased risk (OR: 8.15; 95% CI: 3.61, 18.40). The same group had increased BE risk (OR: 2.93; 95% CI: 1.24, 6.92; P-interaction = 0.12). Folate and other dietary methyl-group factors are implicated in the etiology of EAC and its precursors.

Questionnaire order significantly increased response to a postal survey sent to primary care physicians

OBJECTIVE Primary care physicians are increasingly being asked to participate in postal surveys. Difficulties in achieving adequate response rates among physicians have been reported. We investigated the effect of two low-cost interventions on response to a primary care physician postal questionnaire. STUDY DESIGN AND SETTING A 2x2 factorial trial was developed within the context of a national survey assessing views and practices of physicians regarding prostate-specific antigen testing. We evaluated questionnaire order (version 1: demographics first, version 2: topic-specific questions first) and written precontact. A national database of primary care physicians was compiled. One thousand five hundred ninety-nine physicians were randomly selected, stratified by health board, and randomized. RESULTS 47.9% of eligible physicians completed a questionnaire. There was a statistically significant 5.1% higher response rate among physicians receiving version 1 of the questionnaire than those receiving version 2 (50.6% vs. 45.4%, P=0.05); the adjusted odds of response were significantly raised (odds ratio=1.24; 95% confidence interval=1.01-1.54). Precontact resulted in a nonsignificant 3.6% increase in response (49.8% vs. 46.2%; P=0.16). The interventions did not interact. CONCLUSION Ordering questionnaires with general questions first can significantly increase response rates, whereas precontact can achieve a modest increase. These strategies may enhance response while adding little to the cost of a physician survey.

Geographical analysis of cancer incidence in Ireland: A comparison of two Bayesian spatial models

AIMS Our objective was to describe the geographical variation in cancer incidence using gastro-intestinal and non-melanoma skin cancer incidence data in Ireland using two different Bayesian spatial models and to compare the performance of these models. METHODS Cases diagnosed between 1994 and 2003 were extracted from the National Cancer Registry of Ireland. Population data were estimated from census data. For each of 3401 electoral divisions (EDs), relative risk (RR) estimates were calculated and smoothed using a conditional autoregressive model (CAR) and a spatial partition model introduced by Hegarty and Barry using a product partition model (PPM). The results were compared by mapping the ratio of the two RR estimates and other mainly descriptive statistics. RESULTS The two methods gave broadly similar results. For gastro-intestinal cancers the RRs were lower in a northwest/southeast band across the country with greater RRs around Dublin, Cork and in Donegal. Greater RR of non-melanoma skin cancer was observed in coastal areas. Median differences between the RR estimates were small (=0.01). The range of RRs was wider when estimated by the CAR model illustrating that the PPM smoothed the data to a greater extent than the CAR model. CONCLUSIONS The two approaches gave similar results providing stronger evidence for the resulting geographical patterns. PPMs give a more global picture of the risk distribution whereas CAR models provide more local estimates. The observed patterns may reflect socio-demographic or geographic variations in risk factors or access to cancer services. By helping to identify those risks, these maps may help in the optimal allocation of scarce health resources.

Association between smoking at diagnosis and cause‐specific survival in patients with rectal cancer: Results from a population‐based analysis of 10,794 cases

Currently, the 5‐year survival rate for rectal cancer remains at <60%. The identification of potentially modifiable prognostic factors would be of considerable public health importance. A few studies have suggested associations between smoking and survival in rectal cancer; however, the evidence is inconsistent, and most of these studies were relatively small. In a large population‐based cohort study, we investigated whether smoking at diagnosis is an independent prognostic factor for cancer‐specific survival in rectal cancer and whether the association varies by sex, age, or treatment.

The Impact of Adjustment for Socioeconomic Status on Comparisons of Cancer Incidence between Two European Countries

Background. Cancer incidence rates vary considerably between countries and by socioeconomic status (SES). We investigate the impact of SES upon the relative cancer risk in two neighbouring countries. Methods. Data on 229,824 cases for 16 cancers diagnosed in 1995–2007 were extracted from the cancer registries in Northern Ireland (NI) and Republic of Ireland (RoI). Cancers in the two countries were compared using incidence rate ratios (IRRs) adjusted for age and age plus area-based SES. Results. Adjusting for SES in addition to age had a considerable impact on NI/RoI comparisons for cancers strongly related to SES. Before SES adjustment, lung cancer incidence rates were 11% higher for males and 7% higher for females in NI, while after adjustment, the IRR was not statistically significant. Cervical cancer rates were lower in NI than in RoI after adjustment for age (IRR: 0.90 (0.84–0.97)), with this difference increasing after adjustment for SES (IRR: 0.85 (0.79–0.92)). For cancers with a weak or nonexistent relationship to SES, adjustment for SES made little difference to the IRR. Conclusion. Socioeconomic factors explain some international variations but also obscure other crucial differences; thus, adjustment for these factors should not become part of international comparisons.