West of Scotland Cancer Surveillance Unit

Glasgow, United Kingdom

West of Scotland Cancer Surveillance Unit

Glasgow, United Kingdom

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Grose D.,Beatson Oncology Center | Grose D.,West of Scotland Cancer Surveillance Unit | Devereux G.,Royal Infirmary | Brown L.,Royal Infirmary | And 10 more authors.
Journal of Thoracic Oncology | Year: 2011

Background: Treatment and survival rates within Scotland for patients with lung cancer seem lower than in many other European countries. No study of lung cancer has attempted to specifically investigate the association between variation in investigation, comorbidity, and treatment and outcome between different centers. Methods: Patient demographics, World Health Organization/Eastern Cooperative Oncology Group performance status, and primary treatment modality were recorded. In addition to recording the comorbidities present in each patient, the severity of each comorbidity was graded on a 4-point scale (0-3) using validated severity scales. Data were collected as the patient was investigated and entered in an anonymized format into a database designed for the study. Results: Prospectively collected data from 882 patients diagnosed with lung cancer in four Scottish centers. A number of statistically significant differences were identified between centers. These included investigation, treatment between centers (i.e., surgical rates), age, tumor histology, smoking history, socioeconomic profile, ventilatory function, and performance status. Predictors of declining performance status included increasing severity of a number of comorbidities, age, lower socioeconomic status, and specific centers. Conclusions: This study has identified many significant intercenter differences within Scotland. We believe this to be the first study to identify nontumor factors independent of performance status that together limit the ability to deliver radical, possibly curative, therapy to our lung cancer population. It is only by identifying such factors that we can hope to improve on the relatively poor outlook for the majority of Scottish patients with lung cancer. Copyright © 2011 The International Association for the Study of Lung Cancer.


Mansouri D.,Royal Infirmary | McMillan D.C.,Royal Infirmary | Crearie C.,Royal Infirmary | Morrison D.S.,West of Scotland Cancer Surveillance Unit | And 2 more authors.
British Journal of Cancer | Year: 2015

Background: Population colorectal cancer screening programmes have been introduced to reduce cancer-specific mortality through the detection of early-stage disease. The present study aimed to examine the impact of screening introduction in the West of Scotland.Methods: Data on all patients with a diagnosis of colorectal cancer between January 2003 and December 2012 were extracted from a prospectively maintained regional audit database. Changes in mode, site and stage of presentation before, during and after screening introduction were examined.Results: In a population of 2.4 million, over a 10-year period, 14 487 incident cases of colorectal cancer were noted. Of these, 7827 (54%) were males and 7727 (53%) were socioeconomically deprived. In the postscreening era, 18% were diagnosed via the screening programme. There was a reduction in both emergency presentation (20% prescreening vs 13% postscreening, P≤0.001) and the proportion of rectal cancers (34% prescreening vs 31% pos-screening, P≤0.001) over the timeframe. Within non-metastatic disease, an increase in the proportion of stage I tumours at diagnosis was noted (17% prescreening vs 28% postscreening, P≤0.001).Conclusions: Within non-metastatic disease, a shift towards earlier stage at diagnosis has accompanied the introduction of a national screening programme. Such a change should lead to improved outcomes in patients with colorectal cancer. © 2015 Cancer Research UK. All rights reserved.


Morrison D.S.,West of Scotland Cancer Surveillance Unit | Boyle S.,Glasgow and Clyde Weight Management Service | Morrison C.,Greater Glasgow and Clyde NHS Board | Allardice G.,Greater Glasgow and Clyde NHS Board | And 2 more authors.
Public Health Nutrition | Year: 2012

Objective To evaluate the first phase of a specialist weight management programme provided entirely within the UK National Health Service. Design Prospective cohort study using multiple logistic regression analysis to report odds of ≥5 kg weight loss in all referrals and completers, and odds of completion, with 95 % confidence intervals. Anxiety and depression 'caseness' were measured by the Hospital Anxiety and Depression Scale. Setting Glasgow and Clyde Weight Management Service (GCWMS) is a specialist multidisciplinary service, with clinical psychology support, for patients with BMI ≥35 kg/m 2 or BMI ≥30 kg/m 2 with co-morbidities. Subjects All patients referred to GCWMS between 2004 and 2006. Results Of 2976 patients referred to GCWMS, 2156 (72.4 %) opted into the service and 809 completed phase 1. Among 809 completers, 35.5 % (n 287) lost ≥5 kg. Age ≥40 years, male sex (OR = 1.39, 95 % CI 1.05, 1.82), BMI ≥ 50 kg/m 2 (OR = 1.70, 95 % CI 1.14, 2.54) and depression (OR = 1.81, 95 % CI 1.35, 2.44) increased the likelihood of losing ≥5 kg. Diabetes mellitus (OR = 0.55, 95 % CI 0.38, 0.81) and socio-economic deprivation were associated with poorer outcomes. Success in patients aged ≥40 years and with BMI ≥50 kg/m 2 was associated with higher completion rates of the programme. Patients from the most deprived areas were less likely to lose ≥5 kg because of non-completion of the programme. Conclusions Further improvements in overall effectiveness might be achieved through targeting improvements in appropriateness of referrals, retention and effective interventions at specific populations of patients. © The Authors 2011.


PubMed | Glasgow and Clyde Weight Management Service, University of Glasgow and West of Scotland Cancer Surveillance Unit
Type: Journal Article | Journal: Clinical obesity | Year: 2016

The objective of the study is to investigate the effect of baseline anxiety and depression, using different definitions for caseness, on attrition and weight outcomes following a multidisciplinary weight management programme. The study design is a prospective observational study. The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression with caseness scoring 11 and severity 14. The participants were all patients who began a weight management programme between 1 October 2008 and 30 September 2009 (n=1838). The setting was the Glasgow and Clyde Weight Management Service (GCWMS), a specialist multidisciplinary service, which aims to achieve a minimum of 5kg weight loss. The results were as follows: patients with HADS score 14 were referred to the integrated psychology service for psychological assessment or intervention. Patients with caseness (HADS 11) for anxiety (33%) and depression (27%) were significantly younger, heavier, more socio-economically deprived and a higher proportion was female. There was a significant positive correlation between HADS anxiety and depression scores and increasing body mass index (r(2) =0.094, P<0.001 and r(2) =0.175, P<0.001, respectively). Attendance and completion was lower throughout follow-up amongst patients with anxiety or depression. More patients with HADS score 11 achieved 5kg or 5% weight loss and by 12 months those with anxiety had a significantly higher mean weight loss (P=0.032). Participants who scored for severe anxiety (HADS 14) achieved similar weight loss to those without, whilst participants who scored for severe depression achieved significantly greater weight loss than non-cases at 3, 6 and 12 months of follow-up (P<0.01). Despite a less favourable case-mix of risk-factors for poor weight loss, patients who scored caseness for severe anxiety or depression and were offered additional psychological input achieved similar or better weight loss outcomes.


Shafique K.,University of Glasgow | Shafique K.,Dow University of Health Sciences | Morrison D.S.,University of Glasgow | Morrison D.S.,West of Scotland Cancer Surveillance Unit
PLoS ONE | Year: 2013

In the United Kingdom, survival of prostate cancer patients has improved since the 1990s. A deprivation gap in survival (better survival for the least deprived compared with the most deprived) has been reported but it is not known if differential distribution of earlier age or lower grade disease at diagnosis might explain such patterns. We therefore investigated the impact of age and Gleason grade at diagnosis on the deprivation gap in survival of prostate cancer patients over time. Incident cases of prostate cancer (ICD-10 C61) from the West of Scotland were extracted from the Scottish Cancer Registry from 1991 to 2007. Socio-economic circumstances were measured using the Scottish Index for Multiple Deprivation 2004 (SIMD). Age and deprivation specific mortality rates were obtained from the General Registrar Office for Scotland (GRO(S)). The survival gradient across the five deprivation categories was estimated with linear regression, weighted by the variance of the relative survival estimate. We examined the data for 15,292 adults diagnosed with prostate cancer between 1991 and 2007. Despite substantial improvements in survival of prostate cancer patients, a deprivation gap persists throughout the three periods of diagnoses. The deprivation gap in five year relative survival widened from -4.76 in 1991-1996 to -10.08 in 2003-2007. On age and grade-specific analyses, a significant deprivation gap in five year survival existed between all age groups except among patients' age ≥75 and both low and high grade disease. On multivariate analyses, deprivation was significantly associated with increased excess risk of death (RER 1.48, 95% CI 1.31-1.68, p-value<0.001) independent of age, Gleason grade and period of diagnosis. The deprivation gap in survival from prostate cancer cannot be wholly explained by socio-economic differentials in early detection of disease. Further research is needed to understand whether differences in comorbidities or treatment explain inequalities in prostate cancer outcomes. © 2013 Shafique, Morrison.


Logue J.,University of Glasgow | Allardice G.,West of Scotland Cancer Surveillance Unit | Gillies M.,University of Glasgow | Forde L.,NHS Greater Glasgow and Clyde | And 2 more authors.
BMJ Open | Year: 2014

Objectives: There is limited evidence on the effectiveness of weight management programmes provided within routine healthcare and inconsistent use of outcome measures. Our aim was to evaluate a large National Health Service (NHS) weight management service and report absolute and proportional weight losses over 12 months. Design: Prospective observational study. Setting: Glasgow and Clyde Weight Management Service (GCWMS), which provides care for residents of NHS Greater Glasgow and Clyde area (population 1.2 million). Participants: All patients who began GCWMS between 1 October 2008 and 30 September 2009. Interventions: Structured educational lifestyle programme employing cognitive behavioural therapy, 600 kcal deficit diet, physical activity advice, lower calorie diet and pharmacotherapy. Primary and secondary outcomes measures: Baseline observation carried forward (BOCF), last observation carried forward (LOCF) and changes in programme completers reported using outcomes of absolute 5 kg and 5% weight losses and mean weight changes at a variety of time points. Results: 6505 referrals were made to GCWMS, 5637 were eligible, 3460 opted in and 1916 (34%) attended a first session. 78 patients were excluded from our analysis on 1838 patients. 72.9% of patients were women, mean age of all patients at baseline was 49.1 years, 43.3% lived in highly socioeconomically deprived areas and mean weights and body mass indices at baseline were 118.1 kg and 43.3 kg/m2, respectively. 26% lost ≥5 kg by the end of phase 1, 30% by the end of phase 2 and 28% by the end of phase 3 (all LOCF). Weight loss was more successful among men, particularly those ≤29 years old. Conclusions: Routine NHS weight management services may achieve moderate weight losses through a comprehensive evidence-based dietary, activity and behavioural approach including psychological care. Weight losses should be reported using a range of outcome measures so that the effectiveness of different services can be compared.


Shafique K.,University of Glasgow | McLoone P.,West of Scotland Cancer Surveillance Unit | Qureshi K.,Gartnavel General Hospital | Leung H.,Beatson Institute for Cancer Research | And 2 more authors.
Nutrition and Cancer | Year: 2012

Tea may be a potentially modifiable and highly prevalent risk factor for the most common cancer in men, prostate cancer. However, associations between black tea consumption and prostate cancer in epidemiological studies have been inconsistent, limited to a small number of studies with small numbers of cases and short follow-up periods and without grade-specific information. We conducted a prospective cohort study of 6,016 men who were enrolled in the Collaborative Cohort Study between 1970 and 1973 and followed up to December 31, 2007. We used Cox proportional hazards models to investigate the association between tea consumption and overall as well as grade-specific risk of prostate cancer incidence. Three hundred and eighteen men developed prostate cancer in up to 37years of follow-up. We found a positive association between consumption of tea and overall risk of prostate cancer incidence (P = 0.02). The association was greatest among men who drank ≥7 cups of tea per day (HR: 1.50, 95% CI: 1.06 to 2.12), compared with the baseline of 0-3 cups/day. However, we did not find any significant association between tea intake and low-(Gleason <7) or high-grade (Gleason 8-10) prostate cancer incidence. Men with higher intake of tea are at greater risk of developing prostate cancer, but there is no association with more aggressive disease. Further research is needed to determine the underlying biological mechanisms for the association. © 2012 Taylor and Francis Group, LLC.


PubMed | University of Glasgow, Royal Alexandra Hospital and West of Scotland Cancer Surveillance Unit
Type: | Journal: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland | Year: 2016

Several modifiable and non-modifiable health related behaviours are associated with the incidence of Colorectal Cancer (CRC), but there is little research on their association with survival. The project aimed to investigate possible relationships between modifiable behavioural factors and outcomes on a study cohort of CRC patients undergoing potentially curative surgery.A retrospective cohort study was carried out of patients diagnosed with non-metastatic CRC undergoing elective curative surgery (January 2011 - December 2012), residing in the NHS Greater Glasgow & Clyde (NHSGGC) area, UK. Data were obtained from the Scottish Cancer Registry, National Scottish Death Records. Pre-operative assessment of smoking, alcohol consumption, nurse-measured body mass index (BMI) and exercise levels were recorded and patients were followed until death or censorship. Survival analysis was carried out and proportional hazards assumptions were assessed graphically using plots and were then formally tested using the PHTEST procedure in STATA.Of the initial 527 patients, 181 (34%) satisfied the inclusion criteria. The total duration of follow up was 480 person-years. At the pre-operative assessment, 75% were overweight or obese, 10.6% were current smokers, 13.1% recorded excess alcohol consumption and 8.5% had physical difficulty climbing stairs. Age, BMI, histopathological stage and physical capacity all independently affected survival (P<0.05). Overweight patients (HR 2.81) and those who had difficulty climbing stairs (HR 3.31) had a significantly poorer survival.The study found evidence that pre-operative exercise capacity and BMI are important independent prognostic factors of survival in patients undergoing curative surgery for CRC. This article is protected by copyright. All rights reserved.


Shafique K.,University of Glasgow | Oliphant R.,West of Scotland Cancer Surveillance Unit | Morrison D.S.,University of Glasgow | Morrison D.S.,West of Scotland Cancer Surveillance Unit
British Journal of Cancer | Year: 2012

Background: If the observed increasing incidence of prostate cancer and higher incidence in more affluent men are due to differences in diagnostic sensitivity, an excess of asymptomatic low-grade tumours might be expected.Methods:We conducted a descriptive population-based study of incident cases of prostate cancer (International Classification of Diseases version 10 codes for prostate cancer) in the West of Scotland, using the Scottish Cancer Registry data from 1991 to 2007. Socio-economic circumstances were measured using the Carstairs score, and disease grade measured using the Gleason score. Deprivation-specific European age-standardised incidence rates were calculated, and joinpoint regression analysis were used to identify significant changes in trends over time.Results:A total of 15 519 incident cases of prostate cancer were diagnosed. Incidence increased by 70% from 44 to 75 per 100 000 cases between 1991 and 2007, an average annual growth of 3.6%. Men aged ≥ 65 years experienced the largest increase in incidence. A widening socio-economic deprivation gap in incidence appeared from 1998 onwards in low-grade disease only. From 2003 to 2007, the deprivation gap (affluent to deprived) was 40.3 per 100 000 cases (P<0.001; trend), with rates 37% lower among the most deprived compared with the most affluent. This deprivation gap represents an estimated 1764 cases of prostate cancer over a 5-year period.Conclusion:Prostate cancer incidence continues to increase; an increase in low-grade disease in affluent men may suggest that prostate-specific antigen testing is responsible, but it does not explain the overall increases in all grades of disease. © 2012 Cancer Research UK All rights reserved.


PubMed | West of Scotland Cancer Surveillance Unit
Type: Evaluation Studies | Journal: Public health nutrition | Year: 2013

To evaluate the first phase of a specialist weight management programme provided entirely within the UK National Health Service.Prospective cohort study using multiple logistic regression analysis to report odds of 5 kg weight loss in all referrals and completers, and odds of completion, with 95 % confidence intervals. Anxiety and depression caseness were measured by the Hospital Anxiety and Depression Scale.Glasgow and Clyde Weight Management Service (GCWMS) is a specialist multidisciplinary service, with clinical psychology support, for patients with BMI 35 kg/m2 or BMI 30 kg/m2 with co-morbidities.All patients referred to GCWMS between 2004 and 2006.Of 2976 patients referred to GCWMS, 2156 (724 %) opted into the service and 809 completed phase 1. Among 809 completers, 355 % (n 287) lost 5 kg. Age 40 years, male sex (OR = 139, 95 % CI 105, 182), BMI 50 kg/m2 (OR = 170, 95 % CI 114, 254) and depression (OR = 181, 95 % CI 135, 244) increased the likelihood of losing 5 kg. Diabetes mellitus (OR = 055, 95 % CI 038, 081) and socio-economic deprivation were associated with poorer outcomes. Success in patients aged 40 years and with BMI 50 kg/m2 was associated with higher completion rates of the programme. Patients from the most deprived areas were less likely to lose 5 kg because of non-completion of the programme.Further improvements in overall effectiveness might be achieved through targeting improvements in appropriateness of referrals, retention and effective interventions at specific populations of patients.

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