Long-Term Survival in Patients with Cancers: A SEER-based analysis

Objectives: Long-term survival is an important endpoint in management of different malignancies which is rarely assessed due to unfeasibility of follow-up for long duration of time. In this study, we explored real-world data on cancer’s long-term survival using historical records from the Surveillance, Epidemiology, and End Results (SEER) Program. Besides reporting the 5-year relative survival, we analyzed the 10- and 20- year survival rates for different types of cancers. Additionally, survival trends as a function of time, age, and tumor type were reviewed and reported. Methods: We used SEER*Stat (version 8.3.6.1) for data acquisition from the SEER 9 Regs (Nov 2019 Submission) database. Data of patients diagnosed with cancer between 1975 and 2014 were retrieved and included in the analysis. Results: For patients diagnosed with any malignant disease (n = 4,412,024), there was a significant increase in median overall survival over time (p<0.001). The 20-, 10-, and 5-year survival rates were higher in solid tumors compared to hematological malignancies (50.8% vs. 38%, 57% vs. 47.4%, and 62.2% vs. 57.4%, respectively). The highest 20-year relative survival rates were observed in thyroid cancer (95.2%), germ cell and trophoblastic neoplasms (90.3%), melanoma (86.8%), Wilms’ tumor (86.2%), and prostate cancer (83.5%). Conclusions: Long-term follow-up data were suggestive of high 20-year relative survival rates for most tumor types. Relative survival showed an improving trend over time especially in solid tumors. Keywords: Survival; Neoplasms; SEER Program; Prognosis; United States

Addressing Climate Change Impacts on Health

Climate change is a global health emergency, with impacts felt most acutely by vulnerable populations and communities. This paper explores health risks from climate change in a global context, setting out key risks and actions towards addressing these. In the context of COP27, it draws in a focus on Egypt as a case study throughout to exemplify the risks faced by countries which are particularly vulnerable to the health impacts of climate change. This policy working paper has been produced by the Academy of Scientific Research and Technology in Egypt, with contributions from the UK Universities Climate Network, through an academic collaboration ahead of COP27 in Egypt in 2022

NuCLS: A scalable crowdsourcing, deep learning approach and dataset for nucleus classification, localization and segmentation

High-resolution mapping of cells and tissue structures provides a foundation for developing interpretable machine-learning models for computational pathology. Deep learning algorithms can provide accurate mappings given large numbers of labeled instances for training and validation. Generating adequate volume of quality labels has emerged as a critical barrier in computational pathology given the time and effort required from pathologists. In this paper we describe an approach for engaging crowds of medical students and pathologists that was used to produce a dataset of over 220,000 annotations of cell nuclei in breast cancers. We show how suggested annotations generated by a weak algorithm can improve the accuracy of annotations generated by non-experts and can yield useful data for training segmentation algorithms without laborious manual tracing. We systematically examine interrater agreement and describe modifications to the MaskRCNN model to improve cell mapping. We also describe a technique we call Decision Tree Approximation of Learned Embeddings (DTALE) that leverages nucleus segmentations and morphologic features to improve the transparency of nucleus classification models. The annotation data produced in this study are freely available for algorithm development and benchmarking at: https://sites.google.com/view/nucls

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially