Validating an algorithm to identify metastatic gastric cancer in the absence of routinely collected TNM staging data

Abstract Background Accurate TNM stage information is essential for cancer health services research, but is often impractical and expensive to collect at the population-level. We evaluated algorithms using administrative healthcare data to identify patients with metastatic gastric cancer. Methods A population-based cohort of gastric cancer patients diagnosed between 2005 and 2007 identified from the Ontario Cancer Registry were linked to routinely collected healthcare data. Reference standard data identifying metastatic disease were obtained from a province-wide chart review, according to the Collaborative Staging method. Algorithms to identify metastatic gastric cancer were created using administrative healthcare data from hospitalization, emergency department, and physician billing records. Time frames of data collection in the peri-diagnosis period, and the diagnosis codes used to identify metastatic disease were varied. Algorithm sensitivity, specificity, and accuracy were evaluated. Results Of 2366 gastric cancer patients, included within the chart review, 54.3% had metastatic disease. Algorithm sensitivity ranged from 50.0- 90%, specificity ranged from 27.6 - 92.5%, and accuracy from 61.5 - 73.4%. Sensitivity and specificity were maximized when the most conservative list of diagnosis codes from hospitalization and outpatient records in the six months prior to and the six months following diagnosis were included. Conclusion Algorithms identifying metastatic gastric cancer can be used for research purposes using administrative healthcare data, although they are imperfect measures. The properties of these algorithms may be generalizable to other high fatality cancers and other healthcare systems. This study provides further support for the collection of population-based, TNM stage data

Factors Associated with Receipt of Symptom Screening in the Year after Cancer Diagnosis in a Universal Health Care System: A Retrospective Cohort Study

Purpose: Patient-reported symptom data are collected prospectively by a provincial cancer agency to mitigate the significant symptom burden that patients with cancer experience. However, an assessment of whether such symptom screening occurs uniformly for those patients has yet to be performed. In the present study, we investigated patient, disease, and health system factors associated with receipt of symptom screening in the year after a cancer diagnosis. Methods: Patients diagnosed with cancer between 2007 and 2014 were identified. We measured whether 1 or more symptom screenings were recorded in the year after diagnosis. A multivariable modified Poisson regression with robust error variance was used to identify predictors [age, comorbidity, rurality, socioeconomic status, immigration status, cancer site, registration at a regional cancer centre (CC), and year of diagnosis] of being screened for symptoms. Results: Of 425,905 patients diagnosed with cancer, 163,610 (38%) had 1 or more symptom screening records in the year after diagnosis, and 75% survived at least 1 year. We identified variability in symptom screening by primary cancer site, regional CC, age, sex, comorbidity, material deprivation, rurality of residence, and immigration status. Patients who had been diagnosed with melanoma or endocrine cancers, who were not registered at a regional CC, who lived in the most urban areas, who were elderly, and who were immigrants were least likely to undergo symptom screening after diagnosis. Conclusions: Our evaluation of the implementation of a population-based symptom screening program in a universal health care system identified populations who are at risk for not receiving screening and who are therefore future targets for improvements in population symptom screening and better management of cancer-related symptoms at diagnosis

The effect of a severe psychiatric illness on colorectal cancer treatment and survival: A population-based retrospective cohort study.

ObjectivesTo identify inequalities in cancer survival rates for patients with a history of severe psychiatric illness (SPI) compared to those with no history of mental illness and explore differences in the provision of recommended cancer treatment as a potential explanation.DesignPopulation-based retrospective cohort study using linked cancer registry and administrative data at ICES.SettingThe universal healthcare system in Ontario, Canada.ParticipantsColorectal cancer (CRC) patients diagnosed between April 1st, 2007 and December 31st, 2012. SPI history (schizophrenia, schizoaffective disorders, other psychotic disorders, bipolar disorders or major depressive disorders) was determined using hospitalization, emergency department, and psychiatrist visit data and categorized as 'no history of mental illness, 'outpatient SPI history', and 'inpatient SPI history'.Main outcome measuresCancer-specific survival, non-receipt of surgical resection, and non-receipt of adjuvant chemotherapy or radiation.Results24,507 CRC patients were included; 482 (2.0%) had an outpatient SPI history and 258 (1.0%) had an inpatient SPI history. Individuals with an SPI history had significantly lower survival rates and were significantly less likely to receive guideline recommended treatment than CRC patients with no history of mental illness. The adjusted HR for cancer-specific death was 1.69 times higher for individuals with an inpatient SPI (95% CI 1.36-2.09) and 1.24 times higher for individuals with an outpatient SPI history (95% CI 1.04-1.48). Stage II and III CRC patients with an inpatient SPI history were 2.15 times less likely (95% CI 1.07-4.33) to receive potentially curative surgical resection and 2.07 times less likely (95% CI 1.72-2.50) to receive adjuvant radiation or chemotherapy. These findings were consistent across multiple sensitivity analyses.ConclusionsIndividuals with an SPI history experience inequalities in colorectal cancer care and survival within a universal healthcare system. Increasing advocacy and the availability of resources to support individuals with an SPI within the cancer system are warranted to reduce the potential for unnecessary harm

Étude transversale sur la santé mentale et le bien-être de jeunes de familles liées au milieu militaire

IntroductionL’objectif de l’étude était de comparer la santé mentale et les comportements à risque de jeunes Canadiens de familles liées au milieu militaire (« familles de militaires ») et de jeunes Canadiens de familles de civils au sein d’un échantillon récent. Nous avons émis l’hypothèse que les jeunes de familles de militaires auraient une moins bonne santé mentale, une moins grande satisfaction à l’égard de la vie et une plus grande propension à prendre des risques que les jeunes de familles de civils. MéthodologieDans cette étude transversale, nous avons utilisé les données de l’Enquête sur les comportements de santé des jeunes d’âge scolaire au Canada menée en 2017-2018, dont les participants constituaient un échantillon représentatif des jeunes de la 6e à la 10e années. Les questionnaires utilisés ont permis de recueillir des renseignements sur l’emploi des parents dans l’armée et sur six indicateurs de santé mentale, de satisfaction à l’égard de la vie et de comportements à risque. Nous avons utilisé des modèles multivariés de régression de Poisson avec une variance d’erreur robuste, en pondérant les données de l’enquête et en tenant compte des grappes correspondant aux écoles. RésultatsL’échantillon comprenait 16 737 élèves, dont 9,5 % ont indiqué qu’un parent ou un tuteur servait ou avait servi dans l’armée canadienne. Après ajustement pour le niveau scolaire, le sexe et le niveau d’aisance familiale, les jeunes de famille de militaires étaient 28 % plus susceptibles de faire état d’un faible sentiment de bien-être (IC à 95 % : 1,17 à 1,40), 32 % plus susceptibles de faire état de sentiments persistants de désespoir (1,22 à 1,43), 22 % plus susceptibles de faire état de problèmes émotionnels (1,13 à 1,32), 42 % plus susceptibles de faire état d’un faible degré de satisfaction à l’égard de la vie (1,27 à 1,59) et 37 % plus susceptibles de déclarer adopter fréquemment des comportements à risque (1,21 à 1,55). ConclusionLes jeunes de familles de militaires ont déclaré avoir une moins bonne santé mentale et adopter davantage de comportements à risque que les jeunes issus de familles de civils. Les résultats laissent penser qu’il faudrait prévoir un soutien supplémentaire en matière de santé mentale et de bien-être pour les jeunes Canadiens de familles de militaires et qu’il faudrait mener des travaux de recherche longitudinaux pour comprendre les déterminants sous-jacents qui contribuent à ces différences

A cross-sectional study of mental health and well-being among youth in military-connected families

IntroductionThe study objective was to compare the mental health and risk-taking behaviour of Canadian youth in military-connected families to those not in military-connected families in a contemporary sample. We hypothesized that youth in military-connected families have worse mental health, lower life satisfaction and greater engagement in risk-taking behaviours than those not in military-connected families. MethodsThis cross-sectional study used 2017/18 Health Behaviour in School-aged Children in Canada survey data, a representative sample of youth attending Grades 6 to 10. Questionnaires collected information on parental service and six indicators of mental health, life satisfaction and risk-taking behaviour. Multivariable Poisson regression models with robust error variance were implemented, applying survey weights and accounting for clustering by school. ResultsThis sample included 16 737 students; 9.5% reported that a parent and/or guardian served in the Canadian military. After adjusting for grade, sex and family affluence, youth with a family connection to the military were 28% more likely to report low well-being (95% CI: 1.17–1.40), 32% more likely to report persistent feelings of hopelessness (1.22–1.43), 22% more likely to report emotional problems (1.13–1.32), 42% more likely to report low life satisfaction (1.27–1.59) and 37% more likely to report frequent engagement in overt risk-taking (1.21–1.55). ConclusionYouth in military-connected families reported worse mental health and more risk-taking behaviours than youth not in military-connected families. The results suggest a need for additional mental health and well-being supports for youth in Canadian military-connected families and longitudinal research to understand underlying determinants that contribute to these differences

Paternal alcohol misuse in UK military families:A cross-sectional study of child emotional and behavioural problems

Introduction: This study explores the association between paternal alcohol misuse and child emotional and behavioural problems in a representative sample of UK military families. Methods: Cohort study data on paternal alcohol consumption were linked to survey data from UK military families on child outcomes. Paternal alcohol use was measured using the Alcohol Use Disorders Identification Test. Parents reported on child behavioural outcomes using the Strengths and Difficulties Questionnaire, measuring hyperactivity and inattention, emotional symptoms, conduct problems, peer relationship problems, prosocial behaviour, and total difficulties. Multivariable logistic regression accounted for survey weights and clustering. Effect modification by child age and gender and paternal mental health was explored. Results: A total of 595 fathers and 1,002 children were included in the study; 364 fathers were classed as misusing alcohol (weighted 62.3%). Paternal alcohol misuse was associated with higher odds of conduct disorders (OR 1.39; 95% CI, 0.98-1.98), although this association was not statistically significant (p = 0.07). A significant association between paternal alcohol misuse and conduct disorders was apparent for girls and in the restricted analysis of the children of fathers who did not report symptoms of depression or posttraumatic stress disorder. Discussion: This study suggests that paternal alcohol misuse may have an effect on the well-being of children in military families. Further studies replicating this association are warranted

Suicide in Canadian veterans living in Ontario:A retrospective cohort study linking routinely collected data

ObjectivesTo compare the risk of death by suicide in male veterans with age-matched civilians.DesignRetrospective cohort study linking provincial administrative databases between 1990 and 2013 with follow-up complete until death or December 31, 2015.SettingPopulation-based study in Ontario, Canada.ParticipantsEx-serving Canadian Armed Forces and Royal Canadian Mounted Police veterans living in Ontario who registered for provincial health insurance were included. A civilian comparator group was matched 4:1 on age and sex.Main outcomeDeath by suicide was classified using standard cause of death diagnosis codes from a provincial registry of mandatory data collected from death certificates. Fine and Gray sub-distribution hazards regression compared the risk of death by suicide between veterans and civilians. Analyses were adjusted for age, residential region, income, rurality and major physical comorbidities.Results20 397 male veterans released to Ontario between 1990 and 2013 and 81 559 age–sex matched civilians were included. 4.2% of veterans died during the study time frame, compared with 6.5% of the civilian cohort. Death by suicide was rare in both cohorts, accounting for 4.6% and 3.6% of veteran and civilian deaths, respectively. After adjustment for confounders, veterans had an 18% lower risk of dying from causes other than suicide (HR 0.82, 95% CI 0.76 to 0.89) and a similar risk of dying by suicide (HR 1.01, 95% CI 0.71 to 1.43), compared with civilians.ConclusionsDeaths by suicide were rare in male veterans residing in Ontario. Our findings demonstrate that veterans had a similar risk of suicide-related mortality as an age-matched civilian population. A better understanding of effective suicide prevention as well as clarifying pathways to seeking and receiving mental health supports and services are important areas for future consideration