Substantial under-estimation in cancer incidence estimates for developing countries due to under-ascertainment in elderly cancer cases

Under-ascertainment of elderly cases in cancer registry data is a well-known problem. This article provides the cancer incidence in developing countries corrected for the under-ascertainment in elderly cancer cases (aged 65+). The original incidence rate by GLOBOCAN 2002 was 11% (men 15%; women 7%) under-estimated, so there were 6,462,000 new cancer cases (3,093,000 men; 2,737,000 women) in 2002 topping the original estimate by 632,000. This paper is the first attempt to quantify the under-ascertainment bias in the cancer burden of developing countries and opens the discussion on how cancer incidence could be corrected in this increasing part of the population.     

Iran cancer incidence should be corrected for under-ascertainment in cancer cases in the elderly (aged 65+).

OBJECTIVE: This article is to calculate corrected Iran cancer incidence by a novel method to compensate under-ascertainment of cancer cases in the very elderly (aged 65+). STUDY DESIGN AND SETTING: Corrected age-specific rate for a certain cancer in age group 65+ was calculated from the age-specific rate of that cancer in age group 55-64 multiplied by the corresponding coefficient from reference cancer registry (sex- and age-specific coefficients from Finnish Cancer Registry, a nation-wide registry with high validity of data). All cancer data were obtained from GLOBOCAN 2002. RESULTS: The crude rate (and number of new cases) for "All sites excluding skin" was 13.6% (men 18.7%; women 8.1%) under-estimated. The under-enumeration was 18.9% for the age-standardized rate (men 25.4%; women 11.8%). This means there were 58,000 new cancer cases (about 7,000 more than original) in 2002. Corrected incidence for the year 2050 was 26.1% higher (men 32.8%; women 17.3%) than the original estimate (49,000 more). Depending on cancer site and sex, percentage under-estimation varied remarkably. CONCLUSION: After correction, the estimates of number of new cases and incidence rates of Iran increase substantially. Without correction, cancer occurrence measures can be remarkably under-estimated which may lead to inadequate resource allocation for control measures.     

New methods of handling cases of unknown age in cancer registry data

The essential assumption of random missing age behind the 'conventional method' of handling cancer patients of unknown age does not often hold. This article is to introduce four alternative methods based on more acceptable assumptions. Methods: More cases with unknown age are allocated to the older age-groups in all the new methods. In the 'weighting method', cases of unknown age are distributed according to distribution of cases of known age, whereas in the 'last-group method', all of them are added to the oldest age-group. In the 'progressive method', unknown-age cases are added to the age-groups above 60 progressively (weighting=1/63, 2/63, 4/63, 8/63, 16/63, and 32/63), whereas in the 'additive method', they are allocated to the age-groups above 60 additively (weighting=1/21, 2/21, 3/21, 4/21, 5/21, and 6/21). Data were from the Cancer in Five Continent database, vol. VIII. Results: Age-standardized rates for 'All sites' in Zaragoza (Spain), Cali (Colombia), Algiers (Algeria), and Gambia showed that results by all the methods differed, the magnitude ranging from 0.1 to 3.1% depending on the method, registry, sex, and the defined last age-group. Conclusion: Conventional and weighting methods are not based on acceptable assumptions. The last-group method is not stable because it depends on a defined age-group as last (65+, 75+ or 85+). Both progressive and additive methods have more acceptable assumptions. The progressive method is preferable above all others because it can produce an age-specific curve with the expected exponential increase.     

A Method to Adjust for Ascertainment Bias in the Evaluation of Cancer Registry Data

Using the trend of age-standardized incidence rate of cancers (ASR) is inaccurate for registration withincomplete reporting, especially in developing registries. The relative age-standardized ratio (RASR) is a newmeasure that takes ascertainment bias of registration into account. RASR is calculated from the ASR for eachcancer divided by the ASR for leukemia. Leukemia was chosen as the reference because its ASR is rather constantover time in valid registries. The adjusted relative age-standardized rate (ARASR with same unit as ASR) iscalculated by multiplying the RASR for a specific cancer in a particular year by the sum of ASRs of that cancerover the years for which a trend is being determined and then dividing result by the sum of RASRs of the cancerfor those years. Two likely assumptions are behind use of ARASR, first, constant ASR of leukemia over time,second, if under/over-registration occurs, it happens for all cancers to the same extent (random under/overreporting).Using the ARASR with empirical data of valid Finnish and SEER cancer registries proved that trendof ASRs for each cancer is almost equal to its ARASR. Using trends of ARASRs instead of ASRs in a registry withincomplete data collection in first years of registration demonstrated more realistic results. In conclusion, theARASR is more accurate than the ASR for studying cancer incidence trends in registries with incomplete reporting.ARASRs in different countries or different times are comparable since they are age-standardized. Moreover,comparison between trends of ASRs and ARASRs can be used as a test for validity of registration.     

Concurrent chemoradiotherapy for limited-disease small cell lung cancer in elderly patients aged 75 years or older

Background: The optimal treatment for limited-disease small cell lung cancer(LD-SCLC) in patients aged 75 years or older remains unknown. Methods: Elderly patients with LD-SCLC who were treated with chemoradiotherapywere retrospectively reviewed to evaluate their demographiccharacteristics and the treatment delivery, drug toxicitiesand antitumor efficacy. Results: Of the 94 LD-SCLC patients treated with chemotherapy and thoracicradiotherapy at the National Cancer Center Hospital between1998 and 2003, seven (7.4%) were 75 years of age or older. Allof the seven patients were in good general condition, with aperformance status of 0 or 1. Five and two patients were treatedwith early and late concurrent chemoradiotherapy, respectively.While the four cycles of chemotherapy could be completed inonly four patients, the full dose of radiotherapy was completedin all of the patients. Grade 4 neutropenia and thrombocytopeniawere noted in seven and three patients, respectively. Granulocyte-colonystimulating factor support was used in five patients, red bloodcell transfusion was administered in two patients and platelettransfusion was administered in one patient. Grade 3 or moresevere esophagitis, pneumonitis and neutropenic fever developedin one, two and three patients, respectively, and one patientdied of radiation pneumonitis. Complete response was achievedin six patients and partial response in one patient. The mediansurvival time was 24.7 months, with three disease-free survivorsfor more than 5 years. Conclusion: Concurrent chemoradiotherapy promises to provide long-term benefitwith acceptable toxicity for selected patients of LD-SCLC aged75 years or older.     

Implications for determining the optimal treatment for locally advanced rectal cancer in elderly patients aged 75 years and older

Patients were excluded if they were older than 75 years of age in most clinical trials. Thus, the optimal treatment strategies in elderly patients with locally advanced rectal cancer (LARC) are still controversial. We designed our study to specifically evaluate the cancer specific survival of four subgroups of patients according to four different treatment modalities: surgery only, radiation (RT) only, neoadjuvant RT and adjuvant RT by analyzing the Surveillance, Epidemiology, and End Results (SEER)-registered database. The results showed that the 5-year cancer specific survival (CSS) was 52.1% in surgery only, 27.7% in RT only, 70.4% in neoadjuvant RT and 60.4% in adjuvant RT, which had significant difference in univariate log-rank test (P < 0.001) and multivariate Cox regression (P < 0.001). Thus, the neoadjuvant RT and surgery may be the optimal treatment pattern in elderly patients, especially for patients who are medically fit for the operation.     

高龄vater壶腹癌行局部切除的价值探讨

目的:探讨对高龄vater壶腹癌患者进行局部切除术的价值。方法:回顾性总结24例高龄vater壶腹癌患者行局部切除术后临床情况及生存状况。结果:24例高龄vater壶腹癌患者行局部切除术后均无并发症及围手术期死亡,恢复快。1、2、3年生存率为分别为91.6%、75.0%和70.8%,与胰十二指肠切除术相比无明显差异。结论:对高龄vater壶腹癌患者行局部切除是一种较为合理的选择。     

放疗同时多因子介入治疗60例晚期癌症的随机研究

目的探索晚期癌症的治疗方法。方法１９９６年１月～１９９７年３月,将６０例预期生存仅３～６个月的晚期癌症患者随机分成两组：（１）综合治疗组：放疗的同时用化疗药物、免疫反应修饰剂和中药制剂等多因子介入治疗;（２）对照组：单用放疗。两组放疗方法相同,腹腔肿块照射ＤＴ５０Ｇｙ,２５次／３５天,其他肿块照射ＤＴ６０Ｇｙ,３０次／４２天。结果综合治疗组有效率、平均缓解期、中位生存期和１年生存率分别为９３．３％、７．４个月、１１个月和４６．７％,对照组分别为６３．３％、４．７个月、６．５个月和６．７％,两组差异均有显著性（Ｐ＜０．０１）。结论综合治疗可有效延长晚期癌症患者生存期,并明显改善其生存质量。     

Sociological Transition and Breast Cancer in the Arab World: the Experience of Lebanon

Background: Breast cancer is the leading cause of cancer death among females in Lebanon. This study aimed at analyzing its epidemiology in the country over time. Methods: Data were extracted from the Lebanese National Cancer Registry (NCR) for the years 2004 through 2010. Age-standardized and age-specific incidence rates for cancers per 100,000 population were calculated. Results: Breast cancer ranked first, accounting for an average of 37.6% of all new female cancer cases in Lebanon during the period of 2004-2010. Breast cancer was found to have been increasing faster than other hormone-related women’s cancers (i.e. of the ovaries and corpus uteri). The breast cancer age-standardized incidence rates (world population) (ASRw) increased steadily from 2004 (71.0) to 2010 (105.9), making the burden comparable to that in developed countries, reflecting the influence of sociological and reproductive patterns transitioning from regional norms to global trends. The age-specific incidence rates for breast cancer rose steeply from around age 35-39 years, to reach a first peak in the age group 45-49 years, and then dropped slightly between 50 and 64 years to rise again thereafter and reach a second peak in the 75+ age group. Five-year age-specific rates among Lebanese women between 35 and 49 years were among the highest observed worldwide in 2008. Conclusion: Breast cancer is continuously on the rise in Lebanon. The findings of this study support the national screening recommendation of starting breast cancer screening at the age of 40 years. It is mandatory to conduct an in-depth analysis of contributing factors and develop consequently a comprehensive National Breast Cancer Control strategy.     

Real-world clinical practice for advanced non-small-cell lung cancer in the very elderly: A retrospective multicenter analysis

BackgroundThe optimal treatment for advanced non-small cell lung cancer (NSCLC) in very elderly patients is unclear. We aimed to evaluate their treatment in real-world clinical practice and identify suitable therapy that can improve their prognosis.Materials and methodsThe medical records of 132 Japanese patients aged 80 years and older with advanced NSCLCs who were enrolled at a university hospital and its 9 affiliates were retrospectively analyzed. Clinical characteristics and overall survival (OS) were compared based on the Eastern Cooperative Oncology Group Performance Status (ECOG PS) and biomarker statuses. Patients were defined as biomarker-positive if programmed death-ligand 1 tumor proportion score (PD-L1 TPS) was ≥ 50% or activating mutations were present in epidermal growth factor receptor, anaplastic lymphoma kinase, or c-ros oncogene 1. Finally, the factors contributing to better prognosis were explored in both PS 0 - 2 and PS 3 - 4 patient groups.ResultsThe PS 0 - 2 patients showed a longer median OS than the PS 3 - 4 patients (5.5 vs. 1.6 months). PS 0 - 2 patients with positive biomarkers who received chemotherapy showed a significantly longer median OS than those without (18.1 vs. 3.7 months). Among the biomarker-negative/unknown PS 0 - 2 patients, the median OS showed no significant difference between those who received chemotherapy and those who did not (4.5 vs. 3.1 months). The multivariate analysis showed that treatment with tyrosine kinase inhibitors or immune checkpoint inhibitors was related to better prognoses in the PS 0 - 2 group.ConclusionBiomarker-matched therapy is effective even in very elderly patients. Meanwhile, the effectiveness of chemotherapy for biomarker-negative/unknown PS 0 - 2 patients is questionable.     

Surgical wound infection and cancer among the elderly: a case control study

Surgical wound infection occurs in fewer than 5% of operations. Nevertheless, it represents the second most common type of hospital-acquired infection and results in increased morbidity and mortality. As with all nosocomial infections, the rate of surgical wound infection increases with age. Patients over 65 years of age run an approximately 15% risk of surgical wound infection. Two-thirds of patients with invasive cancer other than non-melanotic skin cancer are aged 65 years and over. Over half of them are treated surgically for their cancer. Cancer and other chronic diseases have been cited as possible causes of the increased risk of nosocomial infection among the elderly. Using the Foothills Hospital Wound Study Data Base as the sampling frame, we conducted a case-control study of surgical wound infection and cancer among the elderly. Cancer was found not to be a risk factor for surgical wound infection. The results are discussed in relation to the role of immunity in both disorders.     

Validation of HPV triage in cytology-based cervical cancer screening for ASC-US cases using Japanese data

ObjectiveIn Japan, cervical cancer screening consists of a cytology examination performed once every 2 years. We verified whether the risk of cervical intraepithelial neoplasia (CIN) 3 disease or higher (CIN3+) was equivalent to that of cytology negative cases (negative for intraepithelial lesion or malignancy [NILM]) for patients with a cytological diagnosis of “atypical squamous cells of undetermined significance (ASC-US)” who tested negative for human papillomavirus (HPV).MethodsData from a total of 22,925 cases who had undergone cervical cancer screening at least twice or who had completed follow-up examinations after cervical screening at a single facility between April 2013 and April 2018 were analyzed. The cumulative incidence of CIN3+ was calculated for each category of initial cytology finding and HPV result (NILM, > ASC-US, ASC-US/HPV (unknown), ASC-US/HPV⁺, and ASC-US/HPV⁻). The statistical analysis was conducted using the Cox proportional hazards model.ResultsThe hazard ratio for the cumulative incidence of CIN3+ in 2 years relative to that for NILM cases was 2.7 (95% confidence interval=1.0–7.8) for > ASC-US cases, 0.5 (0.1–1.7) for ASC-US/HPV (unknown), 0.8 (0.3–2.4) for ASC-US/HPV⁺ cases, and 0.3 (0.1–1.0) for ASC-US/HPV⁻ cases.ConclusionBecause the cumulative incidence of CIN3+ at 2 years for the ASC-US/HPV⁻ cases was sufficiently low, compared with that of the NILM cases, we considered it reasonable and safe to perform HPV triage for ASC-US cases and to allow HPV-negative cases to return for their next screening in 2 years, which is the same follow-up schedule as that for NILM cases.     

奥瑞姆自理模式对老年非小细胞肺癌化疗患者癌因性疲乏和睡眠质量的影响

目的探讨奥瑞姆(Orem)自理模式对老年非小细胞肺癌(NSCLC)化疗患者癌因性疲乏(CFS)和睡眠质量的影响。方法选取2019年1月至2020年12月间上海中医药大学附属曙光医院收治的接受化疗的90例老年NSCLC患者,采用随机数表法分为对照组和Orem组,每组45例。对照组患者给予与病情和化疗相关的常规护理,Orem组患者在常规护理基础上开展Orem自理模式干预。采用自我护理能力测定量表(ESCA)、Piper疲乏调查量表(PFS)和匹兹堡睡眠量表(PSQI)评估自理能力、CFS程度和睡眠质量,对两组患者得分情况进行比较。结果与干预前比较,两组患者干预后ESCA评分提高,PFS、PSQI评分均下降,差异均有统计学意义(均P <0.05)。与对照组比较,Orem组干预后ESCA评分较高,PFS、PSQI评分和睡眠障碍发生率均更低,差异均有统计学意义(均P <0.05)。结论 Orem自理模式能提高老年NSCLC患者自理能力,有助于减轻CFS程度和改善睡眠质量。     

Heimlich翼瓣引流管气胸引流术在肿瘤介入诊疗中的应用(附13例报告)

背景与目的:肿瘤患者在接受介入诊疗操作中(如穿刺活检、经皮穿刺肺癌射频消融治疗等),可能会并发气胸,且这类气胸多为单纯性气胸。传统的处理方法是采用胸腔引流管与水封瓶相连接的胸腔闭式引流术,此术创伤大,患者需要住院接受治疗。Heimlich翼瓣引流管(简称Heimlich管)用于胸腔引流在国外已有多年,但在国内罕有报道。本文通过总结13例肿瘤患者在介入诊疗中并发气胸后应用Heimlich管的经验,探讨这一微创技术的临床价值。方法:1999年3月～2003年2月对13例介入诊疗中并发气胸的肿瘤患者应用Heimlich管微创插管技术方法行气胸引流。患者中6例住院治疗,7例门诊观察。结果:所有气胸患者经Heimlich管引流2～3天后,气胸消失,塌陷的肺组织完全复张,无任何并发症发生。结论:Heimlich管连接置入胸腔的多侧孔猪尾形导管行气胸引流术具有操作简单快捷、安全可靠、疗效好、患者可在门诊接受观察等优点,尤其值得在胸腔肿瘤介入诊疗操作中并发单纯气胸的患者中推广应用。     

Chronic pain following treatment for cancer: the role of opioids

Opioids are the most effective analgesics for severe pain and the mainstay of acute and terminal cancer pain treatments. In those settings, opioids are used over a limited time period so that opioid tolerance, if it develops, is relatively easy to overcome, and other problems of opioid use, including substance abuse, are unlikely to be problematic. As cancer treatments improve and increasing numbers of cancer patients experience long remissions, chronic pain due to cancer, or to cancer treatment, becomes a clinical problem that oncologists will encounter. Chronic pain differs from acute and terminal pain in several fundamental respects. In the case of chronic pain, functional restoration is a predominant goal of treatment. Because it is often due to neuronal damage, the pain may be particularly sensitive to nonopioid medications, and opioids can be reserved for refractory pain. If opioids are chosen, tolerance, dependence, and addiction can interfere, and safeguards designed to minimize these must be built into the treatment plan. This article reviews the principles of chronic opioid therapy for non-cancer pain and how these principles may be adapted for patients with chronic pain due to cancer.     

电视胸腔镜手术治疗老年肺癌151例临床分析

目的 探讨胸腔镜手术治疗老年肺癌患者的可行性及应用价值.方法 回顾分析151例70岁以上老年肺癌施行胸腔镜肺癌根治手术的临床资料.结果 全组无手术死亡,并发症发生率18.5%(28/151).其中心律失常12例,肺部感染9例,肺不张3例,切口感染2例.结论 对于老年肺癌患者在严格掌握手术适应证及充分围手术期处理的前提下,采用胸腔镜手术行肺叶切除及淋巴结清扫,是安全可行的,可以降低并发症发生率,提高老年肺癌的治疗效果.     

Gastric cancer in the young,with special reference to 14 pregnancy-associated cases: Analysis based on 2,325 consecutive cases of gastric cancer

Clinicopathologic features of gastric cancer in young women were analyzed with special reference to pregnancy (P). Among 2,325 consecutive patients, there were 152 young patients under 40 years of age (57 males and 95 females), and 14 P-associated cases were identified. The male-to-female ratio was 1.7:1.0 on the whole, but 1.0:1.7 in the young group with more females predominating as the age of patients decreased. Among characteristics of gastric cancer in the young females, we noted a significantly higher frequency of both Borrmann type 4 cancer and poorly differentiated adenocarcinoma with the scirrhus type of growth and peritoneal metastasis. These characteristics were more pronounced in the P-associated cases. Although we were unable to determine the mechanism for these tendencies, our findings suggest that the development and growth of gastric cancer in young women may be influenced by their natural, biological and hormonal circumstances. The prognosis of the young women with or without associated pregnancy was good afer curative surgery. Both early detection of gastric cancer and subsequent potentially curative surgery are the best ways to obtain good survival for young women, as is the case for members of other age and sex groups. © 1995 Wiley-Liss, Inc.