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Borg N.,Addenbrookes Hospital | Guilfoyle M.R.,Addenbrookes Hospital | Greenberg D.C.,Eastern Cancer Registration and Information Center | Watts C.,Addenbrookes Hospital | Thomson S.,Leeds General Infirmary
Journal of Neuro-Oncology | Year: 2011

Serum albumin is an established predictor of survival in numerous cancers but its prognostic value in central nervous system tumours has not been established. Here we have examined prognostic factors in 685 patients with histologically proven glioblastoma multiforme (GBM), the majority of which (n = 549) had pre-operative serum albumin assayed. Mean serum albumin was 34.7 g/l (SD 5.2). Post-operative survival was significantly less for patients with hypoalbuminaemia (<30 g/l, n = 82) than for patients with normal albumin level (median 2.3 vs. 5.6 months, P<0.001 Log-rank test). Furthermore, patients with lower normal albumin (30-40 g/l, n = 371) had significantly shorter survival compared against patients with albumin in the upper normal range (40-50 g/l, n = 96; median 5.1 vs. 8.8 months, P<0.001). Multivariate Cox regression showed the independent predictors of survival were age, debulking surgery, chemoradiotherapy, and serum albumin (Hazard Ratio 0.97 per g/l, P<0.005). This study suggests pre-operative serum albumin level is a significant predictor of survival in patients with GBM. Further studies are needed to examine the relationship between albumin and other known prognostic factors, and to determine if pre-operative serum albumin is a clinically useful predictor of survival. © Springer Science+Business Media, LLC. 2011. Source


Ali A.M.G.,University of Cambridge | Greenberg D.,Eastern Cancer Registration and Information Center | Wishart G.C.,University of Cambridge | Pharoah P.,University of Cambridge
British Journal of Cancer | Year: 2011

Background:Breast cancer relative survival (BCRS), which compares the observed survival of women with breast cancer with the expected survival of women for the whole population of the same age, time period, and geographical region, tends to be poorer in older women, but the reasons for this are not clear. We examined the influence of patient and tumour characteristics, and treatment on BCRS to see whether these could explain the age-specific effect.Methods:Data for 14 048 female breast cancer patients diagnosed from 1999 to 2007, aged 50 years or over were obtained from the Eastern Cancer Registration and Information Centre. We estimated relative 5-and 10-year survival for patients in four age groups (50-69, 70-74, 75-79, and 80 years). We also modelled relative excess mortality (REM) rate using Poisson regression adjusting for patient characteristics and treatment. The REMs derived from these models quantify the extent to which the hazard of death differs from the hazard in the reference category, after taking into account the background risk of death in the general population. We compared the results with those obtained for breast cancer-specific mortality, analysed using multivariate Cox regression.Results:Median follow-up time was 4.7 years. Relative 5-year survival was 89, 81, 76, and 70% for patients aged 50-69, 70-74, 75-79, and 80 years, respectively. Corresponding relative 10-year survival was 84, 77, 67, and 66%. Unadjusted REM was 1.93, 2.74, and 3.88 for patients aged 70-74, 75-79, and 80 years, respectively, (50-69 years as reference). The equivalent hazard ratios from the Cox model were 1.88, 2.45, and 3.81. These were attenuated after adjusting for confounders (REM-1.49, 1.36, and 1.23; Cox-1.47, 1.50, and 1.76).Conclusion:We confirmed poorer BCRS in older women in our region. This was partially explained by known prognostic factors. Further research is needed to determine whether biological differences or suboptimal management can explain the residual excess mortality. © 2011 Cancer Research UK. All rights reserved. Source


Lejeune C.,French Institute of Health and Medical Research | Lejeune C.,University of Burgundy | Sassi F.,The London School of Economics and Political Science | Ellis L.,London School of Hygiene and Tropical Medicine | And 4 more authors.
International Journal of Epidemiology | Year: 2010

Background: Significant socio-economic disparities have been reported in survival from colorectal cancer in a number of countries, which remain largely unexplained. We assessed whether possible differences in access to treatment among socio-economic groups may contribute to those disparities, using a population-based approach. Methods: We retrospectively studied 71 917 records of colorectal cancer patients, diagnosed between 1997 and 2000, linked to area-level socio-economic information (Townsend index), from three cancer registries in UK. Access to treatment was measured as a function of delay in receipt of treatment. We assessed socio-economic differences in access through logistic regression models. Based on relative survival ≤3 years after diagnosis, we estimated excess hazard ratios (EHRs) of death for different socio-economic groups. Results: Compared with more affluent patients, deprived patients had poorer survival [EHR=1.20; 95% confidence interval (CI) 1.16-1.25], were less likely to receive any treatment within 6 months [odds ratio (OR)=0.87, 95% CI 0.82-0.92] and, if treated, were more likely to receive late treatment. No disparities in survival were detected among patients receiving treatment within 1 month from diagnosis. Disparities existed among patients receiving later or no treatment (EHR=1.30; 95% CI 1.22-1.39), and persisted after adjustment for age and stage at diagnosis (EHR=1.15; 95% CI 1.08-1.24). Conclusions: Tumour stage helped explain socio-economic disparities in colorectal cancer survival. Disparities were also greatly attenuated among patients receiving early treatment. Aspects other than those captured by our measure of access, such as quality of care and patient preferences in relation to treatment, might contribute to a fuller explanation. © The Author 2010. Published by Oxford University Press on behalf of the International Epidemiological Association. All rights reserved. Source


Skellett A.M.,Norwich University | Hafiji J.,University of Cambridge | Greenberg D.C.,Eastern Cancer Registration and Information Center | Wright K.A.,Eastern Cancer Registration and Information Center | Levell N.J.,Norwich University
Clinical and Experimental Dermatology | Year: 2012

Background. Basal cell carcinoma (BCC) is the commonest cancer in many countries, but the current incidence in young people from the UK is unknown. Aim. To ascertain a recent incidence of BCC in the under-30 population in the UK. Methods. Cancer registry data from part of the Eastern Region of the UK was analysed for two periods: 1981-1989 and 1998-2006. Case notes were examined for a cohort of the patients from 1998 to 2006. Results. The incidence of BCC increased from 0.73 to 1.79 per 100 000 in those aged < 30 years over the study period. More than half (55%) of BCCs were on the head and neck, and the most common histological subtype was superficial BCC (38%). Conclusions. The reported incidence of BCC in those aged < 30 years has increased by 145% during this period, corresponding to an average annual increase of 8.53%. This may be partially due to earlier presentation and to increased use of surgical treatments. © 2011 British Association of Dermatologists. Source


Crawford R.,University of Cambridge | Greenberg D.,Eastern Cancer Registration and Information Center
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2012

Objective Our hypothesis is that the adoption of Department of Health (DH) guidance has led to an improvement in outcome in gynaecological cancer survival. Setting In 1999 the DH in England introduced the Improving Outcomes in Gynaecological Cancer guidance, advising case management by multidisciplinary teams with surgical concentration in specialist hospitals. This guidance was rapidly adopted in the East of England, with a population of 2.5 million. Population The population of the Anglia Cancer Network was approximately 2.3 million. Methods From 1996 to 2003, details of 3406 cases of gynaecological cancer were identified in the Anglia region of England. Survival analysis was performed by Cox proportional hazards regression, relative to cases diagnosed in 1996. Main outcome measure Primary endpoint was survival. Results The survival rates for cases diagnosed between 1996 and 1999 were broadly the same across the time period, with a marked improvement taking place in 2000, and continuing to 2003 (HR 0.71, 95% CI 0.64-0.79, comparing 2000-03 with 1996-99 diagnoses), for all gynaecological sites combined. Adjustment for treatments or method of case follow-up did not attenuate these improvements. There was a concurrent change towards major surgery being performed in specialist centres from 2000. Conclusions The adoption of the 1999 guidance on gynaecological cancer, which included multidisciplinary case management and centralisation of surgery, resulted in a marked step-change improvement in survival of gynaecological cancer in an area of eastern England in 2000. © 2011 RCOG. Source

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