Research LettersTrends in mortality from cancer in the European Union, 1955–94
Summary
Over the past few years, age-standardised mortality rates have levelled off or declined for most cancer sites in the European Union, with the main exception of lung cancer in women.
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Cited by (59)
Lung cancer diagnosis: Hospitalization costs
2006, Archivos de BronconeumologiaConocer los costes directos del proceso de diagnóstico del cáncer de pulmón (CP) en el año 2003. Como objetivo secundario se evaluó el coste asociado a los ingresos definidos como inadecuados.
Se ha llevado a cabo un estudio de una cohorte prospectiva de casos de CP diagnosticado durante el año 2003 mediante citohistología o por criterios clinicorradiológicos. Se determinó el coste total, según Decreto 222/2003 de Tarifas de los Servicios Sanitarios de Galicia, diferenciando entre pacientes ingresados y ambulatorios, y entre carcinoma microcítico y no microcítico. Asimismo, se analizaron los ingresos inapropiados, según criterios establecidos por nuestro grupo, y se estimó el ahorro que supondría haberlos manejado de forma ambulatoria. Para el análisis estadístico se utilizó el programa estadístico SPSS 10.0.
Se diagnosticó de CP a 160 pacientes, 76 (47,5%) de forma ambulatoria y 84 (52,5%) mediante ingreso. Éste se consideró inapropiado en 27. El diagnóstico fue de carcinoma no microcítico en 108 pacientes y microcítico en 38, y en 14 se estableció por criterios clinicorradiológicos. El coste total fue de 742.847 € (media: 4.643 €; intervalo de confianza del 95%, 4.049-5.236), de 552.614 € (media: 6.579 €) en los ingresados y de 190.233 € (media: 2.503 €) en los ambulatorios. El coste medio en los carcinomas microcíticos fue de 3.692 € y en los no microcíticos de 5.070 €. En los primeros, el coste medio en la enfermedad limitada fue significativamente menor que en la enfermedad extendida (1.894 frente a 4.098 €), y en los segundos el coste medio en los estadios iniciales también fue significativamente menor que en los avanzados (3.660 frente a 5.494 €). El ahorro estimado por ingresos inapropiados sería de 120.258 €.
El coste medio del paciente con manejo ambulatorio es un 62% inferior al que ocasiona el ingresado. El coste medio en el carcinoma no microcítico es mayor que en el microcítico, y el de los estadios avanzados, mayor que el de los iniciales. En nuestra serie, el ahorro estimado por ingresos inapropiados sería de 120.258 € por año.
To establish the direct costs of the process of diagnosing lung cancer in 2003. As a secondary objective, the cost of admissions defined as inappropriate was evaluated.
A prospective cohort study of lung cancer cases diagnosed in 2003 was performed. Diagnosis was based on cytohistology or clinical and radiological criteria. The total cost was determined according to Decree 222/2003, governing Galician health service rates. A distinction was drawn between hospitalized patients and outpatients, and between small cell and non-small cell carcinomas. Inappropriate admissions were analyzed in accordance with the criteria established by our study team, and the savings that would have been made had these patients been treated as outpatients were calculated. The statistical analyses were performed using SPSS version 10.0.
A total of 160 patients were diagnosed with lung cancer; 76 (47.5%) of these were outpatients, and the remaining 84 (52.5%) were hospitalized patients. Admissions were considered inappropriate in 27 cases. Of the total of 160 patients, 108 were diagnosed as having non-small cell carcinomas, and 38 as having small cell carcinomas; the remaining 14 patients were diagnosed on the basis of clinical-radiological criteria. Total cost was €742 847 (mean, €4643; 95% confidence interval, €4049-€5236), composed of €552 614 (mean, €6579) for admitted patients, and €190 233 (mean, €2503) for outpatients. Mean cost was €3692 for the small cell carcinomas, and €5070 for the non-small cell carcinomas. Comparing limited and extensive small cell carcinomas, the mean cost for the former was significantly lower than for the latter (€1894 compared to €4098); there was also a lower mean cost for early compared to advanced stages of non-small cell carcinomas (€3660 compared to €5494). The savings to be made from unnecessary admissions were calculated at €120 258.
The mean cost for outpatient lung cancer treatment was 62% lower than for hospitalization. Nonsmall cell carcinomas were more costly on average than small cell carcinomas, and advanced stages of the small cell carcinomas involved a higher average cost than the initial stages of the disease. For our series, the savings to be made from unnecessary admissions were calculated at €120 258.
Patterns of mortality in a cohort of workers followed during 28 years: The Manresa study
2004, Revista Espanola de CardiologiaDescribir los patrones de mortalidad de una cohorte de trabajadores seguida durante 28 años, estimar posibles tendencias y compararlas con las observadas en la población general.
La cohorte estudiada incluye a 1.059 trabajadores varones sanos de 30 a 59 años seguidos durante 28 años. Cada 5 años se realizaron exámenes de salud a la población estudiada. La información acerca de los fallecimientos se obtuvo a partir de los certificados de defunción. La razón de mortalidad estandarizada (RME) se calculó utilizando las tasas específicas por sexo y edad del registro de mortalidad poblacional de Cataluña para el mismo período.
El número de defunciones observadas en esta cohorte fue de 259 (24%). Las primeras causas de mortalidad fueron las enfermedades cardiovasculares (ECV) (n = 90; 35%) y las neoplasias (n = 90; 35%). No se observó ningún exceso de mortalidad en esta cohorte con respecto a la observada en la población general; la mortalidad total y las tasas por causas específicas fueron inferiores o similares a las de la población general. El número de fallecimientos esperados fue de 382. La RME fue significativamente inferior: 67,7% (intervalo de confianza [IC] del 95%, 59,7%-76,5%).
Los patrones de mortalidad de este estudio son similares a los de la población general; la mortalidad total es inferior a la esperada; se describe por tanto el «efecto del trabajador sano» que afecta a la mortalidad total, especialmente durante los primeros períodos de seguimiento.
To describe mortality patterns in a cohort of workers followed for 28 years, to estimate possible trends, and to compare the findings with those for the general population.
The cohort included 1059 healthy male workers aged 30 to 59 years and followed for 28 years. Physical examinations and structured interviews were carried out every 5 years. Deaths were recorded from death certificates. The standardized mortality ratio (SMR) was calculated using sex-and age-specific mortality rates for the Catalan population as a reference for the same time period.
The number of observed deaths in this cohort was 259 (24%). The main causes of death were cardiovascular diseases (n = 90, 35%) and cancer (n = 90, 35%). No excess mortality was observed in the cohort in comparison to the general population. All-cause mortality was lower, and cause-specific mortality was lower than or similar to rates in the general population. Overall, 382 deaths were expected, resulting in a significantly lower standardized mortality ratio of 67.7% (95% CI: 59.7%-76.5%).
The patterns of mortality in this cohort of male workers were similar to those in the general population. Total mortality was lower than expected–evidence of the «healthy worker effect» which was particularly strong during the early part of the follow-up period.
Lung Cancer Mortality in Andalucia, 1975-2000
2003, Archivos de BronconeumologiaDescribir la evolución de la mortalidad por cáncer de pulmón en Andalucía durante el período 1975–2000.
Las defunciones por cáncer de pulmón durante el período 1975–2000 se obtuvieron del Instituto Andaluz de Estadística. Se han calculado los siguientes indicadores: tasas brutas, tasas ajustadas por edad, tasas truncadas y tasas acumuladas.
En los varones las tasas descienden en todos los grupos de edad por encima de los 50 años durante el período 1994–2000. En las mujeres las tasas son muy inferiores, aunque se aprecia un incremento en los grupos de 35-39 años y de 45–49 años, lo que queda reflejado en un incremento de las tasas truncadas (35–64 años) del 6,1% en el período 1994–2000. En las mujeres de mayor edad las tasas fluctúan más en los diferentes grupos de edad, aunque en conjunto la tasa truncada (<65 años) desciende un 9,7% en el período 1995–2000.
En Andalucía las tasas de mortalidad por cáncer de pulmón en varones han comenzado a descender desde 1994. Por el contrario, se registra un incremento en las mujeres jóvenes, pero con tasas muy inferiores.
To describe trends in lung cancer mortality in Andalucia, Spain, during the period from 1975 through 2000.
Records of lung cancer deaths for the period from 1975 through 2000 were obtained from the Statistical Institute of Andalucia. The following indicators were calculated: crude rates, age-adjusted rates, truncated rates, and cumulative rates.
Mortality rates for men dropped in all subject groups aged over 50 years during the period from 1994 through 2000. In women mortality rates were much lower, although we observed an increase in the 35–39 and 45-49 age groups, which is reflected in the 6.1% rise in the truncated rates (35–64 years) during the period from 1994 through 2000. In older women mortality rates fluctuated more within the different age groups, although on the whole the truncated rate for all those over 65 years old fell by 9.7% in the period between 1995 and 2000.
Lung cancer mortality rates among men in Andalusia began to decrease after 1994. In contrast, mortality increased among young women, although their rates are still very low.
Cancer in women
2003, International Journal of Gynecology and ObstetricsIncidence, mortality and survival trends for the most frequent cancers affecting women are presented on a worldwide basis. Data sources are represented by several different cancer databases, as no single world cancer database covers these epidemiological measures. Monitoring cancer incidence, mortality and survival are fundamental indicators which allow estimates and predictions of geographical and temporal changes of these diseases, enabling the design and set-up of adequate cancer control activities and national health programs. The observed differences in cancer incidence, mortality and survival in more developed countries compared with less developed countries (as defined by WHO) are mainly due to different individual and social risk factors between the two geo-political areas. For some cancers, advancements in screening, diagnosis and treatment in the more developed areas were the most effective factors in reducing incidence and mortality as well as prolonging survival. These effects were not detected in the less developed areas because of the limited access to primary and specialist care.
A randomized phase II study of alternating and sequential regimens of docetaxel and doxorubicin as first-line chemotherapy for metastatic breast cancer
2003, Annals of OncologyCitation Excerpt :Breast cancer is a leading contributor to cancer deaths worldwide [1, 2].
This phase II study evaluated the feasibility and efficacy of alternating and sequential regimens of docetaxel and doxorubicin as first-line chemotherapy for metastatic breast cancer (MBC).
Women with MBC requiring first-line chemotherapy for progressive disease (n = 106) were randomized and received 3-weekly monotherapy with docetaxel (T, 100 mg/m2, 1-h i.v. infusion) and doxorubicin (A, 75 mg/m2, 20–30-min i.v. infusion) either on a cycle-by-cycle alternating basis (ATATATAT, n = 51) or sequentially each for four cycles (TTTTAAAA, n = 55).
For both regimens, the median number of cycles administered was the maximum of eight. The alternating and sequential groups achieved similar objective tumor response rates (60% and 67%, respectively) and similar median duration of response (47 and 44 weeks, respectively). With a median follow-up of31 months, median survival times were estimated at 20 and 26 months in the alternating and sequential groups, respectively. No unexpected toxicities were reported. Compared with alternating therapy, patients receiving sequential therapy were more likely to complete the planned eight chemotherapy cycles (69% versus 63%), and had a lower incidence of febrile neutropenia (2% versus 14%).
Alternating and sequential docetaxel–doxorubicin regimens are viable alternatives to simultaneous combination therapy in MBC, with sequential therapy achieving slightly higher response rates and improved tolerability compared with alternating therapy.
Mortality from major cancer sites in the European Union, 1955-1998
2003, Annals of OncologyAfter long-term rises, over the last decade age-standardised mortality from most common cancer sites has fallen in the European Union (EU). For males, the fall was 11% for lung and intestines, 12% for bladder, 6% for oral cavity and pharynx, and 5% for oesophagus. For females, the fall was 7% for breast and 21% for intestines. There were also persisting declines in stomach cancer (30% in both sexes), uterus (mainly cervix,–26%) and leukaemias (–10%). Mortality rates for other common neoplasms, including pancreas for both sexes, prostate and ovary, tended to stabilise. The only unfavourable trends were observed for female lung cancer (+15%). Lung cancer rates in women from the EU are approximately one-third of thosein the USA, and 50% lower than breast cancer rates in the EU. Lung cancer rates in European women have also tended to stabilise below the age of 75 years. Thus, effective interventions on tobacco control could, in principle, avoid a major lung cancer epidemic in European women.