Health Reports | Year: 2014
Background: Relative survival analyses of cancer data often incorporate outdated information about expected survival when current information is not readily available. The assumption is that any bias introduced into the estimation of expected survival, and hence, into the estimate of relative survival, will be negligible. However, empirical studies of potential bias have yet to be published. Data and methods: Data are from the Canadian Cancer Registry with mortality follow-up through record linkage to the Canadian Vital Statistics Death Database. Period method relative survival ratios (RSRs) for 2005- 2007 were derived using life tables centred on the 2006 Census of Population to estimate expected survival. The analysis was repeated using life tables from 5 and 10 years earlier. Results: Deriving expected survival from life tables 5 years out of date resulted in increases in RSRs for all cancers. These increases became greater with lengthening survival duration. For example, increases in 1-, 5- and 10-year RSRs were 0.2, 0.8 and 1.7 percentage units, respectively, for all cancers combined. Increases in 5-year survival were highest for prostate (2.0) and bladder cancer (1.6); among males (1.2); and among people aged 75 to 99 at diagnosis (1.9). Differences were approximately double when life tables 10 years out of date were used. Interpretation: The use of historical rather than current expected survival data in calculating RSRs for cancer may lead to consequential overestimation of survival. © Minister of Industry, 2014.
Health Reports | Year: 2013
Background: Despite use of the North American Association of Central Cancer Registries' indicator for assessing completeness of case ascertainment in populationbased cancer registries, little has been published about its methodology, usefulness and accuracy in Canada. Data and methods: Canadian cancer incidence, cancer mortality, and population census data were used to quantify case completeness in 2007. Two indicators (I1 and I2) that expressed the observed age-standardized incidence rate relative to the expected rate were calculated. The assumption of stable age-standardized sex- and cancer-sitespecifi c incidence-to-mortality rate ratios across regions was assessed. Associations between I1, I2 and simpler indicators of completeness were examined. Results: The assumption of stable age-standardized sexand cancer-site-specifi c incidence-to-mortality rate ratios across regions was not consistently supported-substantial regional differences emerged. I1 was strongly correlated with I2 (r=0.93, n=315, p<0.0001), and both were most strongly and consistently associated with the age-standardized incidence-to-mortality rate ratio. The frequency of undercoverage did not increase consistently with expected case-fi nding diffi culty. Interpretation: The age-standardized incidence-to-mortality rate ratio may provide a less complicated method of identifying undercoverage.
Health Reports | Year: 2013
Background This study quantifies differences in life expectancy between residents of Inuit Nunangat and people in the rest of Canada; estimates the contribution of specific causes of death to the differences; and examines these differences over time, by sex and by age group. Data and methods A geographic approach was used to decompose differences in life expectancy for residents of Inuit Nunangat, compared with people living outside this geographic area. Differences in life expectancy by cause, sex, and age group were calculated using the discrete method of decomposition and were applied to abridged life tables. Causes of death were classified according to Global Burden of Disease categories. Attributable causes of death were calculated for causes amenable to medical intervention and for smoking-related diseases. Results The largest contributor to life expectancy differences between males in Inuit Nunangat and the rest of Canada was injury, particularly selfinflicted injury at ages 15 to 24. For females, the largest contributors were malignant neoplasm and respiratory disease at ages 65 to 79. Interpretation The gap in life expectancy between residents of Inuit Nunangat and the rest of Canada can be attributed to specific groups of causes occurring within specific age ranges. © Minister of Industry, 2013.
Journal of Obstetrics and Gynaecology Canada | Year: 2012
Objective: To establish national guidelines for the assessment of women's sexual health concerns and the provision of sexual heath care for women. Evidence: Published literature was retrieved through searches of PubMed, CINAHL, and the Cochrane Library from May to October 2010, using appropriate controlled vocabulary (e.g., sexuality, "sexual dysfunction," "physiological," dyspareunia) and key words (e.g., sexual dysfunction, sex therapy, anorgasmia). Results were restricted, where possible, to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no language restrictions. Searches were updated on a regular basis and incorporated in the guideline to December 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. Each article was screened for relevance and the full text acquired if determined to be relevant. The evidence obtained was reviewed and evaluated by the members of the Expert Workgroup established by the Society of Obstetricians and Gynaecologists of Canada. Values: The quality of evidence was evaluated and recommendations made using the use of criteria described by the Canadian Task Force on Preventive Health Care (Table). © 2012 Society of Obstetricians and Gynaecologists of Canada.
Journal of Obstetrics and Gynaecology Canada | Year: 2013
Objective: To promote careful education, administration, monitoring and restricted distribution when prescribing and dispensing chemotherapeutic and potentially teratogenic medications, as well as to develop clinical recommendations for the use of cancer chemotherapy in pregnant women and women of child-bearing age. Outcomes: To ensure that women of child-bearing age receiving chemotherapy can be appropriately counselled on the risks of becoming pregnant during treatment, and to provide guidance for health care practitioners treating pregnant women with antineoplastic agents. Evidence: Published literature was retrieved through searches of PubMed or Medline, CINAHL, and The Cochrane Library in 2011, using appropriate controlled vocabulary (e g, antineoplastic agents, neoplasms, pregnancy) and key words (e g, cancer, neoplasms, pregnancy, chemotherapy, antineoplastic agents) Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies Studies were restricted to those with available English abstracts or text. Searches were updated on a regular basis and incorporated in the guideline to October 2011. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and from national and international medical specialty societies. Values: The quality of evidence is rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). Benefits, harms, and costs: This guideline highlights the need to prevent pregnancy in women who are being treated for cancer and informs health care professionals treating pregnant women with chemotherapy of the potential risks of the therapy or ameliorated treatment protocols. SUMMARY STATEMENTS AND RECOMMENDATIONS: Summary Statements1.As women are postponing child-bearing, more of them are experiencing cancer in pregnancy (II-2)2.Chemotherapeutic agents used to combat cancer cross the placenta and may adversely affect embryogenesis by affecting cell division (II-1)3.Exposure to such agents after the first trimester of pregnancy has not been associated with increased risk of malformations but is associated with increased risk of stillbirth, intrauterine growth restriction, and fetal toxicities. (II-2). Recommendations: 1.The health care provider should examine the patient's risk of pregnancy and desire to prevent pregnancy during chemotherapy. (I-A)2.Decisions about the best course of management in pregnancy, including timing of delivery, should balance maternal and fetal risks Most authorities concur that maternal health and well-being must prevail (I-A)3.Women diagnosed with cancer in pregnancy should be optimally managed by a multidisciplinary team that includes oncologists and/or hematologists (depending on the malignancy), perinatologists, family physicians, psychologists, social workers, and spiritual advisors, if sought by the family (I-A). © 2013 Society of Obstetricians and Gynaecologists of Canada.