Morbimortalidad del mieloma múltiple en España: estudio poblacional de 23 años (1994-2016)

Antecedentes El mieloma múltiple (MM) es una de las neoplasias hematológicas malignas más comunes en todo el mundo y, a pesar de los importantes avances de las dos últimas décadas, sigue siendo una enfermedad incurable. Dado que los sistemas de atención médica y la gestión de pacientes difieren entre países y regiones dentro del mismo país, se necesitan datos epidemiológicos de registros de cáncer basados en la población de alta calidad para evaluar mejor el panorama heterogéneo de la enfermedad. Hasta donde conocemos, no existe ningún estudio de base poblacional en España que estudie íntegramente la incidencia, mortalidad y supervivencia del MM. Estos estudios deberían realizarse en el marco de los registros de cáncer españoles de base poblacional (RCBP) que cuentan con una metodología estandarizada de trabajo y estándares de calidad internacionales bien definidos y avalados. Objetivos El objetivo ha sido determinar la incidencia del MM, según sexo y edad durante el período 1994-2016, analizar las tendencias temporales de la incidencia y las tasas de mortalidad (incluida la mortalidad temprana o precoz) y estimar las tasas de supervivencia neta a 5 años. Metodología La incidencia, la mortalidad, incluida la mortalidad precoz a los seis meses (M 6-m) y la supervivencia en el MM se analizaron de forma exhaustiva en dos RCBP de Granada y Girona, durante un período de veintitrés años entre 1994 y 2016; dividido en tres períodos: 1994-2001, 2002-2009 and 2010-2016. Para el cálculo de las tasas estandarizadas se utilizó la primera versión (1976) de la población europea como estándar para ambos sexos y por períodos expresadas en casos nuevos por 100.000 habitantes de la población en riesgo y año y la edad para la estandarización se estratificó en intervalos de cinco años en 15-49, 50-69 y 70-99 años. Se estimó el porcentaje de cambio anual (PCA) de la incidencia y de la mortalidad con el análisis de regresión Joinpoint y la supervivencia neta estandarizada (SNE) por edad con el método de Pohar-Perme. El seguimiento activo y pasivo de los casos se realizó desde la fecha del diagnóstico hasta el final del seguimiento al 31 de diciembre de 2018, cuando se comprobó el estado vital de cada uno de ellos. Resultados Entre 1994 y 2016, se diagnosticaron 1957 pacientes con mieloma múltiple, con una mediana de edad de 72 años, de los cuales, el 51 por ciento son hombres y el 49 por ciento son mujeres. Las tasas de incidencia y mortalidad estandarizadas por edad disminuyeron en ambos sexos, de 4.37 a 4.09 y 2.83 a 2.16, respectivamente. La mayor tasa de incidencia la presentaron los hombres en el período 2010-2016 (4.95 por 100,000 habitantes), en cambio en las mujeres la mayor tasa de incidencia se dio en el período 2002-2009 (4.09 por 100,000 habitantes). Las tendencias de la incidencia y mortalidad para ambos sexos presentaron un PCA de + 0.1% y -1.4%, respectivamente, aunque no estadísticamente significativos. La M 6-m durante los tres períodos estudiados fue del 23.72%, 24.17% y 20.18% y las TSNEE a cinco años en estos tres períodos fue de 27.4%, y 38.8% y 47.4%. En cuanto a la evolución de la supervivencia por grupos de edad se observa una notable mejoría, sobre todo en los pacientes más jóvenes con TSNEE de: 32.4% al 78.5% en el grupo de 15 a 49 años, del 27.5% al 58.5% para los de 50 a 69 años y del 24.8% al 26.3% para el grupo de mayor edad. Conclusiones La incidencia en nuestro medio es >4/100,000 personas/año y presenta una tendencia estable en general durante todo el estudio, con solo un pequeño aumento para los hombres. La mortalidad, incluida la M 6-m, muestra una disminución progresiva en ambos sexos. Tanto la incidencia como la mortalidad fue mayor en los hombres que en las mujeres. La edad juega un papel fundamental en la supervivencia, con una tendencia progresiva a la mejoría muy notable en los pacientes menores de 70 años, pero solo un beneficio menor en los mayores de 70 años (que representan más de la mitad de todos los pacientes). La atención actual del MM requiere un enfoque multidisciplinario y eficiente con integración permanente de los avances clínicos provenientes de los ensayos clínicos (pacientes seleccionados), junto con los datos epidemiológicos de alta calidad derivados de los RCBP (pacientes de la vida real). El conocimiento y seguimiento de las tendencias en incidencia, mortalidad y supervivencia es una contribución esencial de los RCBP que los médicos y toda la comunidad del MM deben conocer

Epidemiology of Multiple Myeloma

Multiple myeloma is a heterogeneous hematological malignancy in which epidemiology plays an increasingly important role. In recent years, an unprecedented intensive research, including both clinical and molecular epidemiology, has deepened the knowledge about its pathogenesis, risk factors, and prognostic factors, leading also to the approval of new drugs. Although the etiology remains largely unknown, among the confirmed risk factors, only obesity and the exposure to certain carcinogens are potentially preventable. Familial myeloma and occupational myeloma are topics of great interest. Most population-based cancer registries show a stable incidence or only a slight trend to increase. The diagnostic delay should be avoided as much as possible. Mortality rates, including early mortality, are progressively decreasing, although infection remains the leading cause of mortality. The outcome in terms of overall survival and health-related quality of life has remarkably improved, joining the group of potentially curable malignancies. Nowadays the clinical scenario is challenging. Clinical and epidemiological variables of interest should be standardized in clinical records. Patients should be included in a population-based registry network. The clinical coordination of a multidisciplinary team in a specialized unit is needed in order to maximize the outcome of every patient

The role of multimorbidity in short-term mortality of lung cancer patients in Spain: a population-based cohort study

M.A.L.F. received support from the Instituto de Salud Carlos III, Madrid, Spain (grant/award no. CP17/00206-EU-FEDER). This work was supported by the Instituto de Salud Carlos III, Madrid, Spain [EU-FEDER-FIS PI-18/01593], the Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiologia y Salud Publica), the Cancer Epidemiological Surveillance Subprogram (VICA) from the Instituto de Salud Carlos III, Madrid, Spain, and the Andalusian Department of Health [PI-0152/2017]. The funders had no role in the design and conduct of the study, data collection, management, analysis, and interpretation of the data, the preparation, review, or approval of the manuscript or the decision to submit the manuscript for publication.Aim: Chronic diseases often occur simultaneously and tend to be associated with adverse health outcomes, but limited research has been undertaken to understand their role in lung cancer mortality. Therefore, this study aims to describe the prevalence and patterns of having one (comorbidity) or ≥ 2 chronic diseases (multimorbidity) among lung cancer patients in Spain, and to examine the association between comorbidity or multimorbidity and short-term mortality risk at six months after cancer diagnosis. Methods: In this population-based cohort study, data were drawn from two Spanish population-based cancer registries, Girona and Granada, and electronic health records. We identified 1259 adult lung cancer patients, diagnosed from 1st January 2011 to 31st December 2012. We identified the most common patterns of individual comorbidities and their pairwise correlations. We used a flexible parametric modelling approach to assess the overall short-term mortality risk 6 months after cancer diagnosis by levels of comorbidity after adjusting for age, sex, smoking status, province of residence, surgery, cancer stage, histology, and body mass index. Results: We found high prevalence of comorbidity in lung cancer patients, especially among the elderly, men, those diagnosed with advanced-stage tumours, smokers, and obese patients. The most frequent comorbidities were chronic obstructive pulmonary disease (36.6%), diabetes (20.7%) and heart failure (16.8%). The strongest pairwise correlation was the combination of heart failure with renal disease (r = 0.20, p < 0.01), and heart failure with diabetes (r = 0.16, p < 0.01). Patients with either one or two or more comorbidities had 40% higher overall mortality risk than those without comorbidities (aHR for comorbidity: 1.4, 95%CI: 1.1–1.7; aHR for multimorbidity: 1.4, 95%CI: 1.1–1.8), when relevant confounding factors were considered. Conclusions: The presence of comorbid diseases, rather than the number of comorbidities, was associated with increasing the risk of short-term lung cancer mortality in Spain. Comorbidity was a consistent and independent predictor of mortality among lung cancer patients, six months after diagnosis. The most common comorbid conditions were age-, obesity- and tobacco-related diseases. Our findings highlight the need to develop targeted preventive interventions and more personalised clinical guidelines to address the needs of lung cancer patients with one or more comorbidities in Spain.Instituto de Salud Carlos III CP17/00206-EU-FEDER EU-FEDER-FIS PI-18/01593Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiologia y Salud Publica)Cancer Epidemiological Surveillance Subprogram (VICA) from the Instituto de Salud Carlos III, Madrid, SpainAndalusian Department of Health PI-0152/201

Socioeconomic Inequalities in Colorectal Cancer Survival in Southern Spain: A Multilevel Population-Based Cohort Study.

BACKGROUND: Colorectal cancer (CRC) is the most frequently diagnosed cancer in Spain. Socioeconomic inequalities in cancer survival are not documented in Spain. We aim to study the association of socioeconomic inequalities with overall mortality and survival among CRC patients in southern Spain. METHODS: We conducted a multilevel population-based cohort study, including CRC cases for the period 2011-2013. The study time-to-event outcome was death, and the primary exposure was CRC patients' socioeconomic status assessed by the Spanish deprivation index at the census tract level. We used a mixed-effects flexible hazard model, including census tract as a random intercept, to derive overall survival estimates by deprivation. RESULTS: Among 3589 CRC patients and 12,148 person-years at risk (pyr), 964 patients died before the end of the follow-up. Mortality by deprivation showed the highest mortality rate for the most deprived group (96.2 per 1000 pyr, 95% CI: 84.0-110.2). After adjusting for sex, age, cancer stage, and the area of residence, the most deprived had a 60% higher excess mortality risk than the less deprived group (excess mortality risk ratio: 1.6, 95% CI: 1.1-2.3). CONCLUSIONS: We found a consistent association between deprivation and CRC excess mortality and survival. The reasons behind these inequalities need further investigation in order to improve equality cancer outcomes in all social groups

Is hospital discharge administrative data an appropriate source of information for cancer registries purposes? Some insights from four Spanish registries

<p>Abstract</p> <p>Background</p> <p>The use of hospital discharge administrative data (HDAD) has been recommended for automating, improving, even substituting, population-based cancer registries. The frequency of false positive and false negative cases recommends local validation.</p> <p>Methods</p> <p>The aim of this study was to detect newly diagnosed, false positive and false negative cases of cancer from hospital discharge claims, using four Spanish population-based cancer registries as the gold standard. Prostate cancer was used as a case study.</p> <p>Results</p> <p>A total of 2286 incident cases of prostate cancer registered in 2000 were used for validation. In the most sensitive algorithm (that using five diagnostic codes), estimates for Sensitivity ranged from 14.5% (CI95% 10.3-19.6) to 45.7% (CI95% 41.4-50.1). In the most predictive algorithm (that using five diagnostic and five surgical codes) Positive Predictive Value estimates ranged from 55.9% (CI95% 42.4-68.8) to 74.3% (CI95% 67.0-80.6). The most frequent reason for false positive cases was the number of prevalent cases inadequately considered as newly diagnosed cancers, ranging from 61.1% to 82.3% of false positive cases. The most frequent reason for false negative cases was related to the number of cases not attended in hospital settings. In this case, figures ranged from 34.4% to 69.7% of false negative cases, in the most predictive algorithm.</p> <p>Conclusions</p> <p>HDAD might be a helpful tool for cancer registries to reach their goals. The findings suggest that, for automating cancer registries, algorithms combining diagnoses and procedures are the best option. However, for cancer surveillance purposes, in those cancers like prostate cancer in which care is not only hospital-based, combining inpatient and outpatient information will be required.</p

Early mortality in multiple myeloma: the time-dependent impact of comorbidity: A population-based study in 621 real-life patients.

Multiple myeloma is a heterogeneous disease with variable survival; this variability cannot be fully explained by the current systems of risk stratification. Early mortality remains a serious obstacle to further improve the trend toward increased survival demonstrated in recent years. However, the definition of early mortality is not standardized yet. Importantly, no study has focused on the impact of comorbidity on early mortality in multiple myeloma to date. Therefore, we analyzed the role of baseline comorbidity in a large population-based cohort of 621 real-life myeloma patients over a 31-year period. To evaluate early mortality, a sequential multivariate regression model at 2, 6, and 12 months from diagnosis was performed. It was demonstrated that comorbidity had an independent impact on early mortality, which is differential and time-dependent. Besides renal failure, respiratory disease at 2 months, liver disease at 6 months, and hepatitis virus C infection at 12 months, were, respectively, associated with early mortality, adjusting for other well-established prognostic factors. On the other hand, the long-term monitoring in our study points out a modest downward trend in early mortality over time. This is the first single institution population-based study aiming to assess the impact of comorbidity on early mortality in multiple myeloma. It is suggested that early mortality should be analyzed at three key time points (2, 6, and 12 months), in order to allow comparisons between studies. Comorbidity plays a critical role in the outcome of myeloma patients in terms of early mortality. Am. J. Hematol. 91:700-704, 2016. © 2016 Wiley Periodicals, Inc