Mortality among children and young people who survive cancer in Northern Ireland

ABSTRACT: Whilst survival rates for childhood cancers are excellent, it is known that these patients have an increased risk of death from disease recurrence and other causes. We investigate patterns, trends and survival of cancers in children and young adults in N. Ireland. MATERIALS AND METHODS: 21 years (1993-2013) of cancer incidence data including non-malignant brain tumours from the N. Ireland Cancer Registry for persons aged 0-24 years was analysed using Joinpoint regresssion for trend and the Kaplan Meier method for survival analysis up to end 2013 with excess mortality calculated at one and five years after first cancer diagnosis using standardised mortality ratios. RESULTS: 2633 children and young people were diagnosed with cancer, 1386 (52.6%) male and 1247 female with 1139 (43.3%) aged 0-14. While trends increased over time they did not reach statistical significance except in the 15-24 age group for males and females combined. The most common cancers for age 0-14 were brain, eye and central nervous system and leukaemia with skin (including non-melanoma skin) the most common in the 15-24 age group. 59 patients (2.2%) had a record of a second cancer. Survival was high at 90.7% after 1 year, better among females and similar for older and younger groups. Although mortality in children is low overall, there was an excess mortality 24.7% (22-27.5) p<0.001 at one year and 7.3% (5.5-9.2) p<0.001 for those who survived 5 years. Excluding the primary cancer there was an excess mortality for one year survivors, with deaths twice that of the background level (SMR= 2.2 (1.3-3.0)p=0.005 and although one and a half times background levels at 5 years, the excess mortality was not significant 1.5 (0.6-2.3 p=0.269). CONCLUSION: Whilst survival from childhood cancers is excellent, this work in common with larger studies, highlights the need for ongoing monitoring of cancer survivors. Preventable skin cancer was identified as a problem in young adults

Predictors of an early death in patients diagnosed with colon cancer : A retrospective case-control study in the UK

Acknowledgements The authors gratefully appreciate the contribution of data abstractors: Donna Floyd, Rosemary Ward, Jacqui Napier, Kate Donnelly and Bríd Morris. The authors also thank Business Services Organisation, Health and Social Care NI for facilitating the note review. Finally, the authors would like to thank all patients whose data was used in this studyPeer reviewedPublisher PD

Effect of investigation intensity and treatment differences on prostate cancer survivor's physical symptoms, psychological well-being and health-related quality of life: a two country cross-sectional study

Aim: To investigate effects on men's health and well-being of higher prostate cancer (PCa) investigation and treatment levels in similar populations.Participants PCa survivors in Ireland where the Republic of Ireland (RoI) has a 50% higher PCa incidence than Northern Ireland (NI).Method: A cross-sectional postal questionnaire was sent to PCa survivors 2–18 years post-treatment, seeking information about current physical effects of treatment, health-related quality of life (HRQoL; EORTC QLQ-C30; EQ-5D-5L) and psychological well-being (21 question version of the Depression, Anxiety and Stress Scale, DASS-21). Outcomes in RoI and NI survivors were compared, stratifying into ‘late disease’ (stage III/IV and any Gleason grade (GG) at diagnosis) and ‘early disease’ (stage I/II and GG 2–7). Responses were weighted by age, jurisdiction and time since diagnosis. Between-country differences were investigated using multivariate logistic and linear regression.Results: 3348 men responded (RoI n=2567; NI n=781; reflecting population sizes, response rate 54%). RoI responders were younger; less often had comorbidities (45% vs 38%); were more likely to present asymptomatically (66%; 41%) or with early disease (56%; 35%); and less often currently used androgen deprivation therapy (ADT; 2%; 28%). Current prevalence of incontinence (16%) and impotence (56% early disease, 67% late disease) did not differ between RoI and NI. In early disease, only current bowel problems (RoI 12%; NI 21%) differed significantly in multivariate analysis. In late disease, NI men reported significantly higher levels of gynaecomastia (23% vs 9%) and hot flashes(41% vs 19%), but when ADT users were analysed separately, differences disappeared. For HRQoL, in multivariate analysis, only pain (early disease: RoI 11.1, NI 19.4) and financial difficulties (late disease: RoI 10.4, NI 7.9) differed significantly between countries. There were no significant between-country differences in DASS-21 or index ED-5D-5L score.Conclusions: Treatment side effects were commonly reported and increased PCa detection in RoI has left more men with these side effects. We recommended that men be offered a PSA test only after informed discussion

Effect of investigation intensity and treatment differences on prostate cancer survivor's physical symptoms, psychological well-being and health-related quality of life: a two country cross-sectional study

Aim: To investigate effects on men's health and well-being of higher prostate cancer (PCa) investigation and treatment levels in similar populations. Participants: PCa survivors in Ireland where the Republic of Ireland (RoI) has a 50% higher PCa incidence than Northern Ireland (NI). Method: A cross-sectional postal questionnaire was sent to PCa survivors 2–18 years post-treatment, seeking information about current physical effects of treatment, health-related quality of life (HRQoL; EORTC QLQ-C30; EQ-5D-5L) and psychological well-being (21 question version of the Depression, Anxiety and Stress Scale, DASS-21). Outcomes in RoI and NI survivors were compared, stratifying into ‘late disease’ (stage III/IV and any Gleason grade (GG) at diagnosis) and ‘early disease’ (stage I/II and GG 2–7). Responses were weighted by age, jurisdiction and time since diagnosis. Between-country differences were investigated using multivariate logistic and linear regression. Results: 3348 men responded (RoI n=2567; NI n=781; reflecting population sizes, response rate 54%). RoI responders were younger; less often had comorbidities (45% vs 38%); were more likely to present asymptomatically (66%; 41%) or with early disease (56%; 35%); and less often currently used androgen deprivation therapy (ADT; 2%; 28%). Current prevalence of incontinence (16%) and impotence (56% early disease, 67% late disease) did not differ between RoI and NI. In early disease, only current bowel problems (RoI 12%; NI 21%) differed significantly in multivariate analysis. In late disease, NI men reported significantly higher levels of gynaecomastia (23% vs 9%) and hot flashes(41% vs 19%), but when ADT users were analysed separately, differences disappeared. For HRQoL, in multivariate analysis, only pain (early disease: RoI 11.1, NI 19.4) and financial difficulties (late disease: RoI 10.4, NI 7.9) differed significantly between countries. There were no significant between-country differences in DASS-21 or index ED-5D-5L score. Conclusions: Treatment side effects were commonly reported and increased PCa detection in RoI has left more men with these side effects. We recommended that men be offered a PSA test only after informed discussion

Cancer incidence projections in Northern Ireland to 2040

Funding: The Northern Ireland Cancer Registry is funded by the Public Health Agency. The funders had no role in the study design, data collection, analysis and interpretation of results, or writing of the manuscript. Acknowledgements: NICR uses data provided by patients and collected by the health service as part of their care and support.Peer reviewedPostprin

A new composite measure of colonoscopy: the Performance Indicator of Colonic Intubation (PICI)

Abstract Background and study aim Cecal intubation rate (CIR) is an established performance indicator of colonoscopy. In some patients, cecal intubation with acceptable tolerance is only achieved with additional sedation. This study proposes a composite Performance Indicator of Colonic Intubation (PICI), which combines CIR, comfort, and sedation. Methods Data from 20 085 colonoscopies reported in the 2011 UK national audit were analyzed. PICI was defined as the percentage of procedures achieving cecal intubation with median dose (2 mg) of midazolam or less, and nurse-assessed comfort score of 1 – 3/5. Multivariate logistic regression analysis evaluated possible associations between PICI and patient, unit, colonoscopist, and diagnostic factors. Results PICI was achieved in 54.1 % of procedures. PICI identified factors affecting performance more frequently than single measures such as CIR and polyp detection, or CIR + comfort alone. Older age, male sex, adequate bowel preparation, and a positive fecal occult blood test as indication were associated with a higher PICI. Unit accreditation, the presence of magnetic imagers in the unit, greater annual volume, fewer years’ experience, and higher training/trainer status were associated with higher PICI rates. Procedures in which PICI was achieved were associated with significantly higher polyp detection rates than when PICI was not achieved. Conclusions PICI provides a simpler picture of performance of colonoscopic intubation than separate measures of CIR, comfort, and sedation. It is associated with more factors that are amenable to change that might improve performance and with higher likelihood of polyp detection. It is proposed that PICI becomes the key performance indicator for intubation of the colon in colonoscopy quality improvement initiatives.</jats:p