Maria Theresa Redaniel

Recent improvement in survival of patients with multiple myeloma: variation by ethnicity

Abstract Survival for patients with multiple myeloma has increased during the first decade of the 21st century. However, it is unknown whether the improvements in survival have extended equally in all ethnic groups. Using data from the United States Surveillance, Epidemiology and End Results Program, we assessed trends in survival and disease-related mortality for patients with myeloma by ethnic group, including non-Hispanic whites (nHw), African-Americans (AA), Hispanics and people of Asian and Pacific Islander descent (API) from 1998–2001 to 2006–2009. Overall, age adjusted 5-year relative survival increased, from 35.6% in 1998–2001 to 44% in 2006–2009. The greatest improvements were observed for patients aged 15–49, for whom survival increased by + 16.8% units for nHw and + 14.4% units for AA, whereas improvement was less pronounced and not statistically significant in Hispanics and API. Excess mortality hazard ratios were 1.20 (95% confidence interval [CI]: 1.09–1.33) for AA and 1.25 (95% CI: 1.11–1.41) for Hispanics compared to nHw in 2006–2009. Although survival increased greatly for nHw with myeloma between 1998–2001 and 2006–2009, smaller increases were observed for people of other ethnic groups. Persistent excess mortality was seen for AA and Hispanic patients with myeloma. Ethnic inequalities persisted or even increased from earlier periods to 2006–2009. The results suggest that ethnic minorities may not have benefited from newer treatments to the same extent as nHw patients have.

Changes in survival by ethnicity of patients with cancer between 1992–1996 and 2002–2006: is the discrepancy decreasing?

BACKGROUND Patients of minority race/ethnicity have lower survival after diagnosis with most types of cancer. Little data are available concerning changes in disparity over time. Here, we examine changes in survival by race/ethnicity of patients with common cancers in two recent time periods. PATIENTS AND METHODS We used modeled period analysis to determine relative survival (RS) for non-Hispanic white (nHw), African-American (AA), and Hispanic patients in the Surveillance, Epidemiology, and End Results database diagnosed with common solid and hematological malignancies. RESULTS Five-year RS improved overall and for nHw for each tumor examined, ranging from+2%points (pancreatic cancer) to+16.4%points [non-Hodgkins lymphoma, (NHL)]. Greater improvement was observed for AA and Hispanics than nHw in breast and prostate cancer and NHL. Less improvement was observed for AA and Hispanics than for nHw for lung and pancreatic cancer. No statistically significant improvement was observed for AA and Hispanics with myeloma or acute leukemia. Survival disparities ranging from 0.5%points (myeloma) to 13.1%points (breast) between nHw and AA remained. CONCLUSIONS Progress has been made in decreasing disparities in survival between nHw and minorities in breast cancer, prostate cancer, and NHL. Little progress has been made in reducing disparities for the other studied cancers.BACKGROUND Patients of minority race/ethnicity have lower survival after diagnosis with most types of cancer. Little data are available concerning changes in disparity over time. Here, we examine changes in survival by race/ethnicity of patients with common cancers in two recent time periods. PATIENTS AND METHODS We used modeled period analysis to determine relative survival (RS) for non-Hispanic white (nHw), African-American (AA), and Hispanic patients in the Surveillance, Epidemiology, and End Results database diagnosed with common solid and hematological malignancies. RESULTS Five-year RS improved overall and for nHw for each tumor examined, ranging from + 2% points (pancreatic cancer) to + 16.4% points [non-Hodgkins lymphoma, (NHL)]. Greater improvement was observed for AA and Hispanics than nHw in breast and prostate cancer and NHL. Less improvement was observed for AA and Hispanics than for nHw for lung and pancreatic cancer. No statistically significant improvement was observed for AA and Hispanics with myeloma or acute leukemia. Survival disparities ranging from 0.5% points (myeloma) to 13.1% points (breast) between nHw and AA remained. CONCLUSIONS Progress has been made in decreasing disparities in survival between nHw and minorities in breast cancer, prostate cancer, and NHL. Little progress has been made in reducing disparities for the other studied cancers.

Recent trends in survival of adult patients with acute leukemia: overall improvements, but persistent and partly increasing disparity in survival of patients from minority groups

The survival of younger patients with acute leukemia has improved in the early 21st century, but it is unknown whether people of all ethnic and racial backgrounds have benefited equally. Using cancer registry data from the Surveillance, Epidemiology and End Results Program, we assessed trends in 5-year relative survival for patients aged 15 years or more with acute lymphoblastic leukemia and acute myeloblastic leukemia divided by racial and ethnic group, including non-Hispanic whites, African-Americans, Hispanics, and Asian-Pacific Islanders in the 1990s and the early 21st century. Modeled period analysis was used to obtain the most up-to-date estimates of survival. Overall, the 5-year survival increased from 31.6% in 1997-2002 to 39.0% in 2003-2008 for patients with acute lymphoblastic leukemia and from 15.5% in 1991-1996 to 22.5% in 2003-2008 for those with acute myeloblastic leukemia. Nevertheless, among patients with acute lymphoblastic leukemia, age-adjusted 5-year relative survival rates remained lower for African-Americans and Hispanics than for non-Hispanic whites. Among patients with acute myeloblastic leukemia, the increase in survival was greatest (from 32.6% in 1991-1996 to 47.1% in 2003-2008) for younger patients (15-54 years), and was more pronounced for non-Hispanic whites (+16.4% units) than for other patients (+10.8% units). Increases in survival are observed in all ethnic or racial groups. Nevertheless, among patients with acute leukemias, disparities in survival persist between non-Hispanic white people and people of other ethnic or racial groups. Disparities are increasing in younger patients with acute myeloblastic leukemia. Improvements in access to treatment, especially for minority patients, may improve outcomes.

Features of cancer in teenagers and young adults in primary care: a population-based nested case–control study

Background:Teenagers and young adults (TYA, 15–24 years) diagnosed with cancer report repeated visits to primary care before referral. We investigated associations of symptoms and consultation frequency in primary care with TYA cancers.Methods:Population-based, case–control study was carried out using data from the Clinical Practice Research Datalink (CPRD). A total of 1064 TYA diagnosed with cancer were matched to 13 206 controls. Symptoms independently associated with specific cancers were identified. Likelihood ratios (LRs) and positive predictive values (PPVs) were calculated.Results:In the 3 months before diagnosis, 397 (42.9%) cases consulted ⩾4 times vs 593(11.5%) controls (odds ratio (OR): 12.1; 95% CI: 9.7, 15.1), yielding a PPV for any cancer of 0.018%. The LR of lymphoma with a head/neck mass was 434 (95% CI: 60, 3158), with a PPV of 0.5%. Corresponding figures in other cancers included – LR of leukaemia with lymphadenopathy (any site): 29 (95% CI: 8, 112), PPV 0.015%; LR of CNS tumour with seizure: 56 (95% CI: 19, 163), PPV 0.024%; and LR of sarcoma with lump/mass/swelling: 79 (95% CI: 24, 264), PPV 0.042%.Conclusion:Teenagers and young adults with cancer consulted more frequently than controls in the 3 months before diagnosis. Primary care features of cancer match secondary care reports, but were of very low risk; nonetheless, some features increased the likelihood of cancer substantially and should be taken seriously when assessing TYA.

Survival of Patients with Chronic Myelocytic Leukemia: Comparisons of Estimates from Clinical Trial Settings and Population-Based Cancer Registries

INTRODUCTION The survival of patients with chronic myelocytic leukemia (CML) has improved during the past decades. However, there have been discrepancies between results reported from clinical trials and population-based studies. We aimed to elucidate the extent of these discrepancies. METHODS We examined the 5-year survival rate of patients in clinical trials of CML treatment and compared these results with the survival of patients in the general population using the Surveillance, Epidemiology, and End Results (SEER) database, correcting for differences in the age structure of the patient populations. RESULTS Twenty-nine trials were identified for data extraction. The survival rate calculated from SEER data was lower than the survival rate in clinical trials in the corresponding period, with differences of 2.1%-50.7%. Age-adapted survival was similar for four trials, but differences up to 35.8% were seen in most. Limitations of the study include the lack of information on chemotherapy in the SEER database and possible heterogeneity of cases. DISCUSSION The survival rate in clinical trials of CML treatment is higher than the survival rate of all patients with CML. We speculate that the difference may be a result of access to better medications, selection of healthier patients for trials, and the time necessary for adoption of new treatments. This finding underscores the need for population-based studies to give a more realistic idea of survival for patients with a given malignancy in the general population.

Suicide in the Philippines: time trend analysis (1974-2005) and literature review

BackgroundSuicide prevention is given a low priority in many Western Pacific countries due to competing health problems, stigma and poor understanding of its incidence and aetiology. Little is known about the epidemiology of suicide and suicidal behaviour in the Philippines and although its incidence is reported to be low, there is likely to be under-reporting because of its non-acceptance by the Catholic Church and the associated stigma to the family. This study aims to investigate trends in the incidence of suicide in the Philippines, assess possible underreporting and provide information on the methods used and the reasons for suicide.MethodsData for suicide deaths occurring between 1974 and 2005 were obtained from Philippine Health Statistics. Age- and sex-specific trends were examined graphically. Underreporting was investigated by comparing trends in suicides, accidents and deaths of undetermined intent. To provide a fuller picture of suicide in the Philippines, a comprehensive search for published papers, theses and reports on the epidemiology of suicide in the Philippines was undertaken.ResultsThe incidence of suicide in males increased from 0.23 to 3.59 per 100,000 between 1984 and 2005. Similarly, rates rose from 0.12 to 1.09 per 100,000 in females. Amongst females, suicide rates were highest in 15-24 year olds, whilst in males rates were similar in all age groups throughout the study period. The most commonly used methods of suicide were hanging, shooting and organophosphate ingestion. In non-fatal attempts, the most common methods used were ingestion of drugs, specifically isoniazid and paracetamol, or organophosphate ingestion. Family and relationship problems were the most common precipitants. While rates were lower compared to other countries, there is suggestive evidence of underreporting and misclassification to undetermined injury. Recent increases may reflect either true increase or better reporting of suicides.ConclusionsWhile suicide rates are low in the Philippines, increases in incidence and relatively high rates in adolescents and young adults point to the importance of focused suicide prevention programs. Improving data quality and better reporting of suicide deaths is likewise imperative to inform and evaluate prevention strategies.

Diagnostic Intervals and Its Association with Breast, Prostate, Lung and Colorectal Cancer Survival in England: Historical Cohort Study Using the Clinical Practice Research Datalink

Rapid diagnostic pathways for cancer have been implemented, but evidence whether shorter diagnostic intervals (time from primary care presentation to diagnosis) improves survival is lacking. Using the Clinical Practice Research Datalink, we identified patients diagnosed with female breast (8,639), colorectal (5,912), lung (5,737) and prostate (1,763) cancers between 1998 and 2009, and aged >15 years. Presenting symptoms were classified as alert or non-alert, according to National Institute for Health and Care Excellence guidance. We used relative survival and excess risk modeling to determine associations between diagnostic intervals and five-year survival. The survival of patients with colorectal, lung and prostate cancer was greater in those with alert, compared with non-alert, symptoms, but findings were opposite for breast cancer. Longer diagnostic intervals were associated with lower mortality for colorectal and lung cancer patients with non-alert symptoms, (colorectal cancer: Excess Hazards Ratio, EHR >6 months vs <1 month: 0.85; 95% CI: 0.72-1.00; Lung cancer: EHR 3-6 months vs <1 month: 0.87; 95% CI: 0.80-0.95; EHR >6 months vs <1 month: 0.81; 95% CI: 0.74-0.89). Prostate cancer mortality was lower in patients with longer diagnostic intervals, regardless of type of presenting symptom. The association between diagnostic intervals and cancer survival is complex, and should take into account cancer site, tumour biology and clinical practice. Nevertheless, unnecessary delay causes patient anxiety and general practitioners should continue to refer patients with alert symptoms via the cancer pathways, and actively follow-up patients with non-alert symptoms in the community.

Survival for patients with chronic leukemias in the US and Britain: Age-related disparities and changes in the early 21st century

Chronic lymphocytic leukemia (CLL) and chronic myeloid leukemia (CML) are highly treatable conditions occurring primarily in older patients. Lower survival among older people has been reported in both conditions, but newer treatments may change both the overall survival rate and the relative risk associated with aging. Here, we examine survival for patients with CLL and CML in the United States (US) and England.

The association of waiting times from diagnosis to surgery with survival in women with localised breast cancer in England.

Background:Survival from breast cancer in the United Kingdom is lower than in other developed countries. It is unclear to what extent waiting times for curative surgery affect survival.Methods:Using national databases for England (cancer registries, Hospital Episode Statistics and Office of National Statistics), we identified 53 689 women with localised breast cancer, aged ⩾15 years, diagnosed between 1996 and 2009, who had surgical resection with curative intent within 62 days of diagnosis. We used relative survival and excess risk modelling to determine associations between waiting times and 5-year survival.Results:The median diagnosis to curative surgery waiting time among breast cancer patients was 22 days (interquartile range (IQR): 15–30). Relative survival was similar among women waiting between 25 and 38 days (RS: 93.5%; 95% CI: 92.8–94.2%), <25 days (RS: 93.0%; 95% CI: 92.5–93.4%) and between 39 and 62 days (RS: 92.1%; 95% CI: 90.8–93.4%). There was little evidence of an increase in excess mortality with longer waiting times (excess hazard ratio (EHR): 1.06; 95% CI: 0.88–1.27 comparing waiting times 39-62 with 25–38 days). Excess mortality was associated with age (EHR 65–74 vs 15–44 year olds: 1.23; 95% CI: 1.07–1.41) and deprivation (EHR most vs least deprived: 1.28; 95% CI: 1.09–1.49), but waiting times did not explain these differences.Conclusion:Within 62 days of diagnosis, decreasing waiting times from diagnosis to surgery had little impact on survival from localised breast cancer.

Recent trends in survival of adult patients with acute leukemia: overall improvements, but persistent and partly increasing disparity in survival of minority patients

The survival of younger patients with acute leukemia has improved in the early 21st century, but it is unknown whether people of all ethnic and racial backgrounds have benefited equally. Using cancer registry data from the Surveillance, Epidemiology and End Results Program, we assessed trends in 5-year relative survival for patients aged 15 years or more with acute lymphoblastic leukemia and acute myeloblastic leukemia divided by racial and ethnic group, including non-Hispanic whites, African-Americans, Hispanics, and Asian-Pacific Islanders in the 1990s and the early 21st century. Modeled period analysis was used to obtain the most up-to-date estimates of survival. Overall, the 5-year survival increased from 31.6% in 1997-2002 to 39.0% in 2003-2008 for patients with acute lymphoblastic leukemia and from 15.5% in 1991-1996 to 22.5% in 2003-2008 for those with acute myeloblastic leukemia. Nevertheless, among patients with acute lymphoblastic leukemia, age-adjusted 5-year relative survival rates remained lower for African-Americans and Hispanics than for non-Hispanic whites. Among patients with acute myeloblastic leukemia, the increase in survival was greatest (from 32.6% in 1991-1996 to 47.1% in 2003-2008) for younger patients (15-54 years), and was more pronounced for non-Hispanic whites (+16.4% units) than for other patients (+10.8% units). Increases in survival are observed in all ethnic or racial groups. Nevertheless, among patients with acute leukemias, disparities in survival persist between non-Hispanic white people and people of other ethnic or racial groups. Disparities are increasing in younger patients with acute myeloblastic leukemia. Improvements in access to treatment, especially for minority patients, may improve outcomes.