Impact of a Prior Cancer Diagnosis on Quality of Care and Survival Following Acute Myocardial Infarction: Retrospective Population-Based Cohort Study in England

BACKGROUND: An increasing proportion of patients with cancer experience acute myocardial infarction (AMI). We investigated differences in quality of AMI care and survival between patients with and without previous cancer diagnoses. METHODS: A retrospective cohort study using Virtual Cardio-Oncology Research Initiative data. Patients aged 40+ years hospitalized in England with AMI between January 2010 and March 2018 were assessed, ascertaining previous cancers diagnosed within 15 years. Multivariable regression was used to assess effects of cancer diagnosis, time, stage, and site on international quality indicators and mortality. RESULTS: Of 512388 patients with AMI (mean age, 69.3 years; 33.5% women), 42187 (8.2%) had previous cancers. Patients with cancer had significantly lower use of ACE (angiotensin-converting enzyme) inhibitors/angiotensin receptor blockers (mean percentage point decrease [mppd], 2.6% [95% CI, 1.8–3.4]) and lower overall composite care (mppd, 1.2% [95% CI, 0.9–1.6]). Poorer quality indicator attainment was observed in patients with cancer diagnosed in the last year (mppd, 1.4% [95% CI, 1.8–1.0]), with later stage disease (mppd, 2.5% [95% CI, 3.3–1.4]), and with lung cancer (mppd, 2.2% [95% CI, 3.0–1.3]). Twelve-month all-cause survival was 90.5% in noncancer controls and 86.3% in adjusted counterfactual controls. Differences in post-AMI survival were driven by cancer-related deaths. Modeling improving quality indicator attainment to noncancer patient levels showed modest 12-month survival benefits (lung cancer, 0.6%; other cancers, 0.3%). CONCLUSIONS: Measures of quality of AMI care are poorer in patients with cancer, with lower use of secondary prevention medications. Findings are primarily driven by differences in age and comorbidities between cancer and noncancer populations and attenuated after adjustment. The largest impact was observed in recent cancer diagnoses (<1 year) and lung cancer. Further investigation will determine whether differences reflect appropriate management according to cancer prognosis or whether opportunities to improve AMI outcomes in patients with cancer exist

Avoiding lodging in irrigated spring wheat. I. Stem and root structural requirements

A model of the lodging process has been successfully adapted for use on spring wheat grown in North-West Mexico (NWM). The lodging model was used to estimate the lodging-associated traits required to enable spring wheat grown in NWM with a typical yield of 6 t ha−1 and plant height of 0.7 m to achieve a lodging return period of 25 years. Target traits included a root plate spread of 51 mm and stem strength of the bottom internode of 268 N mm. These target traits increased to 54.5 mm and 325 N mm, respectively, for a crop yielding 10 t ha−1. Analysis of multiple genotypes across three growing seasons enabled relationships between both stem strength and root plate spread with structural dry matter to be quantified. A NWM lodging resistant ideotype yielding 6 t ha−1 would require 3.93 t ha−1 of structural stem biomass and 1.10 t ha−1 of root biomass in the top 10 cm of soil, which would result in a harvest index (HI) of 0.46 after accounting for chaff and leaf biomass. A crop yielding 10 t ha−1 would achieve a HI of 0.54 for 0.7 m tall plants or 0.41 for more typical 1.0 m tall plants. This study indicates that for plant breeders to achieve both high yields and lodging-proofness they must either breed for greater total biomass or develop high yielding germplasm from shorter crops

Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2)

BACKGROUND: Worldwide data for cancer survival are scarce. We aimed to initiate worldwide surveillance of cancer survival by central analysis of population-based registry data, as a metric of the effectiveness of health systems, and to inform global policy on cancer control. METHODS: Individual tumour records were submitted by 279 population-based cancer registries in 67 countries for 25·7 million adults (age 15-99 years) and 75,000 children (age 0-14 years) diagnosed with cancer during 1995-2009 and followed up to Dec 31, 2009, or later. We looked at cancers of the stomach, colon, rectum, liver, lung, breast (women), cervix, ovary, and prostate in adults, and adult and childhood leukaemia. Standardised quality control procedures were applied; errors were corrected by the registry concerned. We estimated 5-year net survival, adjusted for background mortality in every country or region by age (single year), sex, and calendar year, and by race or ethnic origin in some countries. Estimates were age-standardised with the International Cancer Survival Standard weights. FINDINGS: 5-year survival from colon, rectal, and breast cancers has increased steadily in most developed countries. For patients diagnosed during 2005-09, survival for colon and rectal cancer reached 60% or more in 22 countries around the world; for breast cancer, 5-year survival rose to 85% or higher in 17 countries worldwide. Liver and lung cancer remain lethal in all nations: for both cancers, 5-year survival is below 20% everywhere in Europe, in the range 15-19% in North America, and as low as 7-9% in Mongolia and Thailand. Striking rises in 5-year survival from prostate cancer have occurred in many countries: survival rose by 10-20% between 1995-99 and 2005-09 in 22 countries in South America, Asia, and Europe, but survival still varies widely around the world, from less than 60% in Bulgaria and Thailand to 95% or more in Brazil, Puerto Rico, and the USA. For cervical cancer, national estimates of 5-year survival range from less than 50% to more than 70%; regional variations are much wider, and improvements between 1995-99 and 2005-09 have generally been slight. For women diagnosed with ovarian cancer in 2005-09, 5-year survival was 40% or higher only in Ecuador, the USA, and 17 countries in Asia and Europe. 5-year survival for stomach cancer in 2005-09 was high (54-58%) in Japan and South Korea, compared with less than 40% in other countries. By contrast, 5-year survival from adult leukaemia in Japan and South Korea (18-23%) is lower than in most other countries. 5-year survival from childhood acute lymphoblastic leukaemia is less than 60% in several countries, but as high as 90% in Canada and four European countries, which suggests major deficiencies in the management of a largely curable disease. INTERPRETATION: International comparison of survival trends reveals very wide differences that are likely to be attributable to differences in access to early diagnosis and optimum treatment. Continuous worldwide surveillance of cancer survival should become an indispensable source of information for cancer patients and researchers and a stimulus for politicians to improve health policy and health-care systems

Revealing deep structural influences on the Upper Cretaceous Chalk of East Anglia (UK) through inter-regional geophysical log correlations

New borehole geophysical log interpretations between Wiltshire and north Norfolk show detailed lateral changes in the spatial relationships of Chalk Group marker beds. They show how marker beds in the Turonian and Coniacian Chalk Group in East Anglia pass laterally into their correlatives further west, and reveal unusual lateral thickness changes affecting stratigraphical intervals in the East Anglian succession. Newly enhanced regional gravity and magnetic data indicate that these thickness changes are probably related to WNW to ESE trending structural lineaments in the Palaeozoic basement rocks of the buried Anglo-Brabant Massif. The later part of the Mid Turonian and early part of the Late Turonian succession across East Anglia is greatly thickened, and shows almost no lateral variability. These relatively soft, smooth-textured chalks equate with thinner, hard, nodular beds formed in both shallow marine and deeper basinal settings elsewhere in southern England. Since it seems unlikely that there was greater sediment accommodation space across East Anglia at this time compared to basinal areas, this thickening may reflect a localised coccoliths productivity pulse, or perhaps a sheltered palaeogeographical position that protected the area from sediment-winnowing marine currents