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  • 1
    Keywords: COHORT ; POPULATION ; COLON-CANCER ; SURVIVORS ; EORTC QLQ-C30 ; GENERAL-POPULATION ; SCORES
    Abstract: PURPOSE To compare long-term quality of life (QoL) of colorectal cancer survivors with QoL in the general population and investigate changes in QoL of survivors during the 10 years after diagnosis. PATIENTS AND METHODS Health-related QoL was assessed 1, 3, 5, and 10 years after diagnosis in a population-based cohort starting with 439 patients with colorectal cancer from Saarland, Germany, using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30. QoL after 5 and 10 years and time course of QoL during the 10 years after diagnosis were compared with controls from the general population of Germany, after controlling for sex and age. Results Overall, 234 and 196 patients were still alive after 5 and 10 years, respectively. Of these survivors, 178 (76%) responded in the 5-year follow-up, 133 (68%) in the 10-year follow-up, and 117 (60%) participated in all follow-ups. Over the entire follow-up, younger survivors (age at diagnosis, less than 60 years) reported restrictions in role, social, emotional, and cognitive functioning and specific problems like constipation, diarrhea, fatigue, and insomnia. Older survivors (age at diagnosis, greater than or equal 70 years) reported comparable or even better QoL than controls within the first 3 to 5 years after diagnosis and comparable to worse QoL 5 to 10 years after diagnosis. CONCLUSION Although younger survivors continuously reported detriments in various QoL dimensions during the 10-year period after diagnosis, detriments in older survivors became apparent in the long run only.
    Type of Publication: Journal article published
    PubMed ID: 21768465
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  • 2
    Keywords: CANCER ; SURVIVAL ; DIAGNOSIS ; DISEASE ; POPULATION ; AGE ; colorectal cancer ; COLON-CANCER ; MORPHOLOGY ; SUBSITE ; EUROPE ; PATIENT SURVIVAL ; PERIOD ANALYSIS ; colonoscopy ; EMPIRICAL-EVALUATION ; colorectal ; UP-TO-DATE ; EUROCARE-4
    Abstract: BACKGROUND: Colorectal cancer is the most common cancer in Germany and the second most common cause of cancer-related deaths in both men and women. The aim of this study is to provide detailed analysis of recent developments in survival of colorectal cancer patients using newly available data on a national basis. METHODS: We included data from 11 German cancer registries covering a population of 33 million inhabitants. Period analysis and modelled period analysis were used to provide most up-to-date estimates of 5-year relative survival in 2002-2006. RESULTS: The analysis was based on records of 164 996 colorectal cancer patients. Five-year relative survival was 63.0% overall, decreased with age and was significantly higher among women than among men in patients under 75 years. Overall age-adjusted 5-year relative survival increased from 60.6 to 65.0% over the period 2002-2006. Significant increase in survival was only observed in patients with localised or regional disease. Highest subsite-specific survival was observed in patients with cancer in descending (67.7%) and ascending (66.5%) colon. CONCLUSION: Survival of patients with colorectal cancer continued to increase in the early 21st century in Germany, with 5-year relative survival reaching 65% in 2006. However, lack of progress still persisted in patients with advanced disease.
    Type of Publication: Journal article published
    PubMed ID: 22555397
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  • 3
    Keywords: POPULATION ; ACUTE LYMPHOBLASTIC-LEUKEMIA ; LONG-TERM SURVIVAL ; UNITED-STATES ; PERIOD ANALYSIS ; ACUTE MYELOID-LEUKEMIA ; ACUTE MYELOBLASTIC-LEUKEMIA ; UP-TO-DATE ; ethnicity ; CANCER REGISTRY DATA
    Abstract: 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.
    Type of Publication: Journal article published
    PubMed ID: 22929974
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  • 4
    Keywords: POPULATION ; TUMORS ; PATTERNS ; LONG-TERM SURVIVAL ; PROGNOSTIC-FACTORS ; TRENDS ; REGISTRY ; RELATIVE SURVIVAL ; EMPIRICAL-EVALUATION ; UP-TO-DATE
    Abstract: Population-based studies on ovarian cancer providing survival estimates by age, histology, laterality, and stage have been sparse. We aimed to derive the most up-to-date and detailed survival estimates for ovarian cancer patients in Germany. We used a pooled German national dataset including data from 11 cancer registries covering 33 million populations. A total of 21 651 patients diagnosed with ovarian cancer in 1997-2006 were included. Period analysis was carried out to calculate the 5-year relative survival (RS) for the years 2002-2006. Trends in survival between 2002 and 2006 were examined using model-based period analysis. Age adjustment was performed using five age groups (15-44, 45-54, 55-64, 65-74, and 75+ years). Overall, the age-adjusted 5-year RS in 2002-2006 was 41%. A strong age gradient was observed, with a decrease in the 5-year RS from 67% in the age group 15-49 years to 28% in the age group 70+ years. Furthermore, the prognosis varied markedly by histology, laterality, and stage, with the age-adjusted 5-year RS ranging from 25% (for carcinoma not otherwise specified) to 81% (for stromal cell carcinoma), reaching 46% for unilateral and 32% for bilateral carcinoma and reaching 82% for Federation of Gynecology and Obstetrics (FIGO) stages I and II, 36% for FIGO stage III, and 18% for FIGO stage IV. No improvement in survival could be observed for any of the subgroups in the period between 2002 and 2006. Our analyses suggest that an improvement in the 5-year RS for ovarian cancer may have stagnated in the early 21st century and underline the need for a more effective translation of therapeutic innovation into clinical practice.
    Type of Publication: Journal article published
    PubMed ID: 22694826
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  • 5
    Keywords: POPULATION ; LONG-TERM SURVIVAL ; UNITED-STATES ; PERIOD ANALYSIS ; RELATIVE SURVIVAL ; CELL TRANSPLANTATION ; cancer survival ; UP-TO-DATE ; HEALTH-INSURANCE ; RACE
    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), AfricanAmericans (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.
    Type of Publication: Journal article published
    PubMed ID: 23879201
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  • 6
    Keywords: DIAGNOSIS ; MORTALITY ; POPULATION ; COLORECTAL-CANCER ; INEQUALITIES ; PATIENT SURVIVAL ; PERIOD ANALYSIS ; ENGLAND ; UP-TO-DATE ; REGIONAL DEPRIVATION
    Abstract: Although socioeconomic inequalities in cancer survival have been demonstrated both within and between countries, evidence on the variation of the inequalities over time past diagnosis is sparse. Furthermore, no comprehensive analysis of socioeconomic differences in cancer survival in Germany has been conducted. Therefore, we analyzed variations in cancer survival for patients diagnosed with one of the 25 most common cancer sites in 1997-2006 in ten population-based cancer registries in Germany (covering 32 million inhabitants). Patients were assigned a socioeconomic status according to the district of residence at diagnosis. Period analysis was used to derive 3-month, 5-year and conditional 1-year and 5-year age-standardized relative survival for 2002-2006 for each deprivation quintile in Germany. Relative survival of patients living in the most deprived district was compared to survival of patients living in all other districts by model-based period analysis. For 21 of 25 cancer sites, 5-year relative survival was lower in the most deprived districts than in all other districts combined. The median relative excess risk of death over the 25 cancer sites decreased from 1.24 in the first 3 months to 1.16 in the following 9 months to 1.08 in the following 4 years. Inequalities persisted after adjustment for stage. These major regional socioeconomic inequalities indicate a potential for improving cancer care and survival in Germany. Studies on individual-level patient data with access to treatment information should be conducted to examine the reasons for these socioeconomic inequalities in cancer survival in more detail.
    Type of Publication: Journal article published
    PubMed ID: 24259308
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  • 7
    Keywords: DIAGNOSIS ; POPULATION ; BREAST-CANCER ; STAGE ; CARE ; DISTANCE ; RELATIVE SURVIVAL ; ACCESS ; imputation
    Abstract: Background: Cancer care services including cancer prevention activities are predominantly localised in central cities, potentially causing a heterogeneous geographic access to cancer care. The question of an association between residence in either urban or rural areas and cancer survival has been analysed in other parts of the world with inconsistent results. This study aims at a comparison of age-standardised 5-year survival of cancer patients resident in German urban and rural regions using data from 11 population-based cancer registries covering a population of 33 million people. Material and methods: Patients diagnosed with cancers of the most frequent and of some rare sites in 1997-2006 were included in the analyses. Places of residence were assigned to rural and urban areas according to administrative district types of settlement structure. Period analysis and district type specific population life tables were used to calculate overall age-standardised 5-year relative survival estimates for the period 2002-2006. Poisson regression models for excess mortality (relative survival) were used to test for statistical significance. Results: The 5-year relative survival estimates varied little among district types for most of the common sites with no consistent trend. Significant differences were found for female breast cancer patients and male malignant melanoma patients resident in city core regions with slightly better survival compared to all other district types, particularly for patients aged 65 years and older. Conclusion: With regard to residence in urban or rural areas, the results of our study indicate that there are no severe differences concerning quality and accessibility of oncological care in Germany among different district types of settlement.
    Type of Publication: Journal article published
    PubMed ID: 24680643
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  • 8
    Keywords: CANCER ; Germany ; POPULATION ; BREAST-CANCER ; HEALTH ; colorectal cancer ; chemotherapy ; COLON-CANCER ; COMORBIDITY ; STATES ; exercise ; ASSOCIATIONS ; quality of life ; SURVIVORS ; RANDOMIZED CONTROLLED-TRIAL ; Long term effects ; LOW RECTAL-CANCER ; OLDER-ADULT ; Systematic review
    Abstract: Background Due to the growing number of long term (〉= 5 years) colorectal cancer survivors investigation of their quality of life (QoL) is important for an evaluation of chronic or late effects of the disease and treatment and to adjust treatment strategies to patients needs Method To summarise current research results multiple databases including PubMed, EMBASE and CINAHL were used to identify articles about long term QoL of colorectal cancer survivors The content of 10 included studies was independently extracted by two reviewers Results Colorectal cancer survivors indicated a good overall QoL but may have slightly lower physical QoL than the general population Furthermore survivors had worse depression scores and reported to suffer from long term symptoms such as bowel problems and distress regarding cancer Apart from stoma and recurrence of the disease mainly general and health related factors such as age social network size income education BMI and number of comorbidities were associated with QoL Studies were mainly conducted in the United States (US) (n = 7) and were heterogeneous with respect to the QoL instrument used and the adjustment to covariates QoL assessment was cross sectional in all studies Conclusion Despite an overall good QoL colorectal cancer survivors have specific physical and psychological problems The reported determinants of QoL may serve to identify survivors with special needs But further studies are needed that focus on problems like distress depression and bowel problems of long term colorectal cancer survivors
    Type of Publication: Journal article published
    PubMed ID: 20605090
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  • 9
    Keywords: POPULATION ; AGE ; COLORECTAL-CANCER ; UNITED-STATES ; PATIENT SURVIVAL ; PERIOD ANALYSIS ; UP-TO-DATE ; THYROID-CANCER ; EARLY 21ST-CENTURY ; DEATH CERTIFICATE
    Abstract: Monitoring cancer survival by population-based cancer registries is a prerequisite to evaluate current quality of cancer care. The present study provides 1-, 5- and 10-year relative survival as well as 5-year relative survival conditional on 1-year survival estimates and recent survival trends for Germany using data from 11 population-based cancer registries, covering around one third of the German population. Period analysis was employed to estimate relative survival for 24 common and 11 less common cancer sites for the period 2007-2010. German and United States survival estimates were compared utilizing the Surveillance, Epidemiology and End Results 13 database. Trends in cancer survival in Germany between 2002-2004 and 2008-2010 are described. Five-year relative survival increased in Germany from 2002-2004 to 2008-2010 for most cancer sites. Among the 24 most common cancers, largest improvements were seen for multiple myeloma (+8% units), non-Hodgkin lymphoma (+6.2% units), prostate cancer (+5.2% units) and colorectal cancer (+4.6% units). In 2007-2010, the survival disadvantage in Germany compared to the US was largest for cancers of the mouth/pharynx (-11.0% units), thyroid (-6.8% units), and prostate (-7.5 % units). While survival estimates were much lower for elderly patients in both countries, differences in age patterns were observed for some cancer sites. The reported improvements in cancer survival might reflect advances in quality of cancer care on the population level as well as increased use of screening in Germany. The survival differences across countries and the survival disadvantage in the elderly require further investigation. (c) 2014 Wiley Periodicals, Inc.
    Type of Publication: Journal article published
    PubMed ID: 25380088
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  • 10
    Keywords: CANCER ; SURVIVAL ; POPULATION ; ACCURACY ; epidemiologic methods ; REGISTRIES ; RATIOS
    Abstract: Background:Relative survival estimates cancer survival in the absence of other causes of death. Previous work has shown that standard errors of non-standardised relative survival may be substantially overestimated by the conventionally used method. However, evidence was restricted to non-standardised relative survival estimates using Hakulinen's method. Here, we provide a more comprehensive evaluation of the accuracy of standard errors including age-standardised survival and estimation by the Ederer II method.Methods:Five- and ten-year non-standardised and age-standardised relative survival was estimated for patients diagnosed with 25 common forms of cancer in Finland in 1989-1993, using data from the nationwide Finnish Cancer Registry. Standard errors of mutually comparable non-standardised and age-standardised relative survival were computed by the conventionally used method and compared with bootstrap standard errors.Results:When using Hakulinen's method, standard errors of non-standardised relative survival were overestimated by up to 28%. In contrast, standard errors of age-standardised relative survival were accurately estimated. When using the Ederer II method, deviations of the standard errors of non-standardised and age-standardised relative survival were generally small to negligible.Conclusion:In most cases, overestimations of standard errors are effectively overcome by age standardisation and by using Ederer II rather than Hakulinen's method.
    Type of Publication: Journal article published
    PubMed ID: 22173672
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