Roberto Lillini

Age and case mix-standardised survival for all cancer patients in Europe 1999–2007: Results of EUROCARE-5, a population-based study

BACKGROUND Overall survival after cancer is frequently used when assessing a health care services performance as a whole. It is mainly used by the public, politicians and the media, and is often dismissed by clinicians because of the heterogeneous mix of different cancers, risk factors and treatment modalities. Here we give survival details for all cancers combined in Europe, correlating it with economic variables to suggest reasons for differences. METHODS We computed age and cancer site case-mix standardised relative survival for all cancers combined (ACRS) for 29 countries participating in the EUROCARE-5 project with data on more than 7.5million cancer cases from 87 population-based cancer registries, using complete and period approach. RESULTS Denmark, United Kingdom (UK) and Eastern European countries had lower survival than neighbouring countries. Five-year ACRS has been increasing throughout Europe, and substantial increases, between 1999-2001 and 2005-2007, have been achieved in countries where survival was lower in the past. Five-year ACRS for men and women are positively correlated with macro-economic variables like the Gross Domestic Product (GDP) and Total National Expenditure on Health (TNEH) (R2 about 70%). Countries with recent larger increases in GDP and TNEH had greater increases in cancer survival. CONCLUSIONS ACRS serves to compare all cancer survival in Europe taking account of the geographical variability in case-mixes. The EUROCARE-5 data on ACRS confirm previous EUROCARE findings. Survival appears to correlate with macro-economic determinants, particularly with investments in the health care system.

Development of a cross-cultural deprivation index in five European countries

Background Despite a concerted policy effort in Europe, social inequalities in health are a persistent problem. Developing a standardised measure of socioeconomic level across Europe will improve the understanding of the underlying mechanisms and causes of inequalities. This will facilitate developing, implementing and assessing new and more effective policies, and will improve the comparability and reproducibility of health inequality studies among countries. This paper presents the extension of the European Deprivation Index (EDI), a standardised measure first developed in France, to four other European countries—Italy, Portugal, Spain and England, using available 2001 and 1999 national census data. Methods and results The method previously tested and validated to construct the French EDI was used: first, an individual indicator for relative deprivation was constructed, defined by the minimal number of unmet fundamental needs associated with both objective (income) poverty and subjective poverty. Second, variables available at both individual (European survey) and aggregate (census) levels were identified. Third, an ecological deprivation index was constructed by selecting the set of weighted variables from the second step that best correlated with the individual deprivation indicator. Conclusions For each country, the EDI is a weighted combination of aggregated variables from the national census that are most highly correlated with a country-specific individual deprivation indicator. This tool will improve both the historical and international comparability of studies, our understanding of the mechanisms underlying social inequalities in health and implementation of intervention to tackle social inequalities in health.

Electrochemotherapy for the management of cutaneous and subcutaneous metastasis: A series of 39 patients treated with palliative intent

Electrochemotherapy (ECT) is technique for local control of skin metastasis. This study is primarily aimed at assessing the clinical activity of ECT in a prospective cohort of patients, and evaluating the association between primary tumor histology, number of metastatic lesions and size of tumor deposits and objective response rate.

Incidence and mortality trends for four major cancers in the elderly and middle-aged adults: An international comparison

BACKGROUND Time trends comparisons by age are important to understand the specific needs of elderly cancer patients and to improve clinical procedures. The aim is to compare 1998-2005 cancer incidence and mortality trends in Italy and the US for both sexes and for two age groups, namely 50-69 year old and 70+ year old. METHODS Cancer incidence and mortality data came from 22 Cancer Registries (CRs) of the Italian association of cancer registries (AIRTUM), while the US incidence records were provided by 13 SEER CRs and the mortality statistics provided by the WHO Database. Trends were analysed by the Joinpoint Regression Program in order to obtain Annual Percent Changes and Joinpoints. RESULTS Colorectal cancer incidence trends were favourable in the US for both sexes and in both age groups, whilst the rates increased in Italian elderly individuals and mortality rates fell markedly only in the US. For lung cancer, incidence and mortality decreased in men but increased in women in the two geographical areas. Breast cancer incidence and mortality declined both in Italy and the US for younger women, but the trends were less favourable in the Italian elderly individuals. The increase of prostate incidence slowed down and mortality diminished for every age group in the US, whilst in Italy only in the younger group. CONCLUSIONS For major cancers, the Italian elderly experienced less favourable trends than the middle-aged patients whereas, in the US, the trends were similar for both age groups and favourable also for the elderly.

The combined effect of age and socio-economic status on breast cancer survival

The study aims to investigate the effect of age and socio-economic status (SES) on breast cancer relative survival at 5 years from diagnosis (RS-5%). The Liguria Region Cancer Registry collected clinico-pathological information for 1081 patients resident in Genoa city diagnosed in 1996 and 2000. Patients were divided into three age groups (0-49, 50-69 and ≥70 years) and into quintiles of SES, measured according to a synthetic regional deprivation index built by Census tract variables and validated by comparison with the national deprivation index. The association of prognostic factors and RS-5% was evaluated by bivariate and multivariate analyses. RS-5% was very high for the first two age groups (91%) and decreased in patients aged 70 or older (82%) (unadjusted HR=2.7, P=0.001). The first four SES quintiles had homogeneous RS-5% (89-92%) and only the last very deprived group had lower rates (77%) (unadjusted HR=2.3, P=0.011). Very deprived elderly patients showed a much lower RS-5% (58%). Elderly and very deprived women were more likely to have large tumours, positive lymph nodes and less likely to receive conserving surgery, axillary dissection and adjuvant therapies. After adjusting for tumour characteristics and treatment modalities the increased risk of dying in the elderly disappeared completely, while the higher risk of very deprived women was eliminated only after correction for all the covariates simultaneously. The survival observed for breast cancer patients resident in Genoa was very high, however elderly and very low SES women have to be monitored. These variations are probably due to inequity in healthcare access and to a difficult taken in charge.

Hematological Malignancies in the Elderly: The Epidemiological Perspective

In the more developed countries the total number of new cases with a hematological tumour was 415,433 for all ages, whilst 188,654 occurred in people aged 70 or more years, representing the 45 % of total cases, equally divided into two sexes. The most these malignancies is closely linked to age and incidence rates increased exponentially after 50 years of age.

Estimates of cancer burden in Liguria.

AIMS AND BACKGROUND The regional health care system of Liguria caters for a resident population which is among the oldest in Europe. One population-based cancer registry is present in the region, providing incidence and survival data for the Genoa province (covering 55% of the regional population). This paper will estimate the incidence, prevalence and mortality in the Liguria region for cancers of the lung, breast, prostate, colon-rectum, stomach and uterine cervix and melanoma of the skin in 1970-2015. METHODS The estimated figures were obtained by applying the MIAMOD method. Starting from mortality and survival data, incidence and prevalence were derived using a statistical back-calculation approach. Survival was modeled on the basis of published data from the Italian cancer registries. The MIAMOD method was applied also to estimate the colorectal cancer incidence, mortality and prevalence rates in the Ligurian provinces in the period 1988-2015. RESULTS In 2012 about 1,500 new cases of breast cancer were expected in Ligurian women. The estimates for the other cancer sites were considerably lower, ranging from 839 (colon-rectum) to 54 (cervix). In men about 1,400 new cases were estimated for prostate cancer, while the incidence for the other sites ranged from 1,118 (colon-rectum) to 208 (skin melanoma). The breast cancer prevalence rate was more than 10 times the incidence rate in women, and the lung cancer prevalence rate was more than double the incidence rate in both sexes. Mortality rates were highest for lung cancer in men and breast cancer in women; the lowest rates were estimated for melanoma and cancer of the uterine cervix. CONCLUSION In Liguria a large portion of the health expenditure has been devoted to diagnostic and therapeutic resources. This may have contributed to the reduction of mortality rates and to the improvement of cancer survival. This phenomenon, added to population aging, will inflate the cancer prevalence. One of the major challenges for the Liguria region is to face the increasing demand for oncology services.