Abstract Aims/Introduction We investigated the association between coexisting diabetes at the time of cancer diagnosis, and the overall survival and incidence of second primary cancer in patients with cancer and receiving drug therapy for diabetes. Materials and Methods We used cancer registry and administrative data of patients diagnosed with cancer at designated cancer care hospitals in Osaka Prefecture between 2010 and 2015. The presence of diabetes was identified from the prescription records of antidiabetic drugs in Diagnosis Procedure Combination System data. After adjusting for patient characteristics, we compared overall survival between patients with cancer with coexisting diabetes and those without coexisting diabetes using the Cox proportional hazards model. In addition, the impact of coexisting diabetes on the risk of developing second primary cancer was evaluated using a competing risk analysis. Results Of the 131,701 patients with cancer included in the analysis, 6,135 (4.7%) had coexisting diabetes. The 5‐year survival rates for patients with and without coexisting diabetes were 56.2% (95% confidence interval 54.8–57.6) and 72.7% (95% confidence interval 72.4–73.0), respectively. Coexisting diabetes was associated with a higher risk of developing second primary cancer (subdistribution hazard ratio 1.23; 95% confidence interval 1.08–1.41). In site‐specific analysis, coexisting diabetes was associated with an increased risk for the development of second primary cancer of multiple myeloma, and cancer of the uterus, pancreas and liver. Conclusions Coexisting diabetes was associated with a higher mortality and risk of developing second primary cancer in Japanese patients with cancer and on drug therapy for diabetes.
Abstract Background The association between cancer survivors and heart disease mortality remains unclear. This study analyzed the risk of fatal heart disease in cancer survivors. Methods Data from the Osaka Cancer Registry collected between 1985 and 2013 and data from the vital statistics in Japan were retrospectively analyzed. Causes of death were investigated. Standardized mortality ratios (SMRs) were calculated to compare the risk of fatal heart disease between patients with cancer and the general population. Poisson regression models were used to estimate the risk of fatal heart disease in patients with cancer and other cancer subgroups. Results In total, 688,473 cancer patients were included in the analysis, and 337,117 patients died during the study period. Among them, 10,781 patients died of heart disease, with 5,020 of these patients having ischemic heart disease; 3,602 patients, heart failure; 441 patients, hypertensive disease; and 1,718 patients, other heart diseases. The SMR (95% confidence interval [CI]) for heart disease was 2.85 (2.80–2.91). The SMRs (95% CIs) for ischemic heart disease, heart failure, and hypertensive disease were 3.26 (3.17–3.35); 2.69 (2.60–2.78), and 4.47 (4.07–4.90), respectively. The risk of fatal heart disease increased over time after cancer diagnosis. The multivariable Poisson regression model showed that males were more likely to die of heart disease than females (relative risk, 1.39; 95% CI, 1.34–1.45). Notably, the risk of fatal heart disease among cancer survivors has decreased in recent years. Conclusions Cancer survivors have a higher risk of fatal heart disease than the general population.
To assess the mortality trends of four major histological subtypes of cervical cancer diagnosed between 1994 and 2018.This population-based retrospective cohort study was conducted using the Osaka Cancer Registry data from 1994 to 2018. A total of 12,003 patients with cervical cancer, squamous cell carcinoma (SCC), adenocarcinoma (A), adenosquamous cell carcinoma (AS), or small cell neuroendocrine carcinoma (SCNEC) were identified. Patients were classified into groups according to the extent of disease (localized, regional, or distant), year of diagnosis (1994-2002, 2003-2010, or 2011-2018), and histological subtype (SCC, A/AS, or SCNEC). Then, their survival rates were assessed using univariate and multivariate analyses.Overall, improved survival rates were observed according to the year of diagnosis in patients with local, regional, and distant cervical cancers. When examined according to the histological subtypes, improved survival rates according to the year of diagnosis were observed in patients with local, regional, and distant SCCs and in those with local and regional A/AS. In patients with distant A/AS, the survival rates did not improve since 2003. In patients with cervical cancer with SCNEC, the survival rates did not improve since 1994 irrespective of the extent of the disease. In the multivariate analysis, non-SCC histology was found to be an independent prognostic factor for OS.In contrast to SCC histology associated with improved survival between 1994 and 2018, SCNEC histology and advanced (stage IVB) A/AS remain to be the unmet medical needs for the management of cervical cancer.
Background The coronavirus disease 2019 (COVID-19) affected cancer care in Japan, but the detailed impact on cancer diagnosis and treatment is not well-understood. We aimed to assess the impact of COVID-19 on digestive cancer care in Osaka Prefecture, which has a population of 8.8 million. Methods We conducted a multi-center cohort study, using hospital-based cancer registry (HBCR) data linked to administrative data from 66 designated cancer care hospitals in Osaka. Records of patients diagnosed with cancer of the stomach, colorectum, esophagus, liver, gallbladder or pancreas were extracted from the HBCR data. Baseline characteristics, such as the number of diagnoses, routes to diagnosis and clinical stage, were compared between patients diagnosed in 2019 and those in 2020. We also compared treatment patterns such as the number of treatments (operations, endoscopic surgeries, chemotherapies, radiotherapies), pathological stage and time to treatment for each digestive cancer. Results In total, 62,609 eligible records were identified. The number of diagnoses decreased in 2020, ranging from -1.9% for pancreatic cancer to -12.7% for stomach cancer. Screen-detected cases decreased in stomach and colorectal cancer. The percentage of clinical stage III slightly increased across different cancers, although it was only significant for colorectal cancer. Among 52,741 records analyzed for treatment patterns, the relative decrease in radiotherapy was larger than for other treatments. The median time from diagnosis to operation was shortened by 2–5 days, which coincided with the decrease in operations. Conclusion The impact of COVID-19 on cancer care in 2020 was relatively mild compared with other countries but was apparent in Osaka. Further investigation is needed to determine the most affected populations.
Abstract Background Few previous studies have examined the relationship between hospital volume and hazard of death for head and neck cancer patients. The purpose of this study was to examine the association between hospital volume and 5-year survival from diagnosis among head and neck cancer patients. Methods Using data from the population-based Osaka Cancer Registry, hospital volume was divided into three volume groups according to the number of head and neck cancer treatments identified between 2009 and 2011. We analysed the association between hospital volume and 5-year survival among 3069 patients aged 0–79 using Cox proportional hazard models, adjusting for characteristics of patients. Results Compared with head and neck cancer patients in high-hospital volume, patients treated in middle- and low-hospital volume were found to have a higher risk of death (middle-hospital volume: hazard ratio = 1.26; 95% confidence interval, 1.09–1.46, low-hospital volume: hazard ratio = 1.24; 95% confidence interval, 1.06–1.46). Conclusions We found a significantly higher risk of hazard of death in middle- and low-hospital volume than in high-hospital volume for head and neck cancer.
Abstract Although the survival rate of patients with childhood cancer has greatly improved, long‐term survivors face specific problems such as the late effects of cancer treatment. In this study, we estimated the number of people who had experienced childhood cancer to predict their needs for medical care and social resources. Using data from the population‐based Osaka Cancer Registry, we identified children aged 0–14 years who were diagnosed with cancer between 1975 and 2019. We estimated the prevalence on December 31, 2019, and the 5‐ and 10‐year prevalence (i.e., the number of survivors living up to 5 or 10 years after the diagnosis of cancer) over time. The prevalence proportion was age‐standardized using a direct standardization method. The prevalence estimates for Osaka were applied to the national population to determine the national prevalence in Japan. Among 8186 patients diagnosed with childhood cancer in Osaka, 5252 (987 per million) survived until December 31, 2019. The 5‐year prevalence per million increased from 194 in 1979 to 417 in 2019 (+116%), while the 10‐year prevalence increased from 391 in 1984 to 715 in 2019 (+83%). Based on the long‐term registry data, an estimated 73,182 childhood cancer survivors were living in Japan by the end of 2019. The increasing 5‐year and 10‐year prevalence proportions indicate the continued need for cancer survivorship support for children, adolescents, and young adults. These estimates of the prevalence of childhood cancer survivors, including long‐term survivors, may be useful for policymakers and clinicians to plan and evaluate survivorship care.
Abstract Background Little is known about dementia’s impact on patterns of diagnosis, treatment, and outcomes in cancer patients. This study aimed to elucidate the differences in cancer staging, treatment, and mortality in older cancer patients with and without preexisting dementia. Methods Using cancer registry data and administrative data from 30 hospitals in Japan, this multicentre retrospective cohort study examined patients aged 65–99 years who were newly diagnosed with gastric, colorectal, or lung cancer in 2014–2015. Dementia status (none, mild, and moderate-to-severe) at the time of cancer diagnosis was extracted from clinical summaries in administrative data, and set as the exposure of interest. We constructed multivariable logistic regression models to analyse cancer staging and treatment, and multivariable Cox regression models to analyse three-year survival. Results Among gastric ( n = 6016), colorectal ( n = 7257), and lung ( n = 4502) cancer patients, 5.1%, 5.8%, and 6.4% had dementia, respectively. Patients with dementia were more likely to receive unstaged and advanced-stage cancer diagnoses; less likely to undergo tumour resection for stage I, II, and III gastric cancer and for stage I and II lung cancer; less likely to receive pharmacotherapy for stage III and IV lung cancer; more likely to undergo tumour resection for all-stage colorectal cancer; and more likely to die within three years of cancer diagnosis. The effects of moderate-to-severe dementia were greater than those of mild dementia, with the exception of tumour resection for colorectal cancer. Conclusion Older cancer patients with preexisting dementia are less likely to receive standard cancer treatment and more likely to experience poorer outcomes. Clinicians should be aware of these risks, and would benefit from standardised guidelines to aid their decision-making in diagnosing and treating these patients.
Abstract Background The effectiveness of chemotherapy in older adult patients with biliary tract cancer (BTC) remains to be established, despite the fact that the majority of patients diagnosed with BTC tend to be aged ≥ 70 years. In this study, we used three databases to examine the effectiveness of chemotherapy in a large patient population aged ≥ 70 years with metastatic BTC. Methods Using a large Japanese database that combined three data sources (Osaka Cancer Registry, Japan’s Diagnosis Procedure Combination, the hospital-based cancer registry database), we extracted the data from patients pathologically diagnosed with metastatic BTC, between January 1, 2013, and December 31, 2015, in 30 designated cancer care hospitals (DCCHs). A cohort of patients with comparable backgrounds was identified using propensity score matching. The log-rank test was used to examine how chemotherapy affected overall survival (OS). Results Among 2,622 registered patients with BTC in 30 DCCHs, 207 older adult patients aged > 70 years with metastatic BTC were selected. Chemotherapy significantly improved the prognosis of older adult patients, according to propensity score matching (chemotherapy, 6.4 months vs. best supportive care, 1.8 months, P value < 0.001). The number of patients receiving chemotherapy tends to decrease with age. Gemcitabine plus cisplatin (GC) and gemcitabine plus S-1 (oral fluoropyrimidine) (GS) combination therapy were frequently performed in the chemotherapy group for patients under 80 years of age (70–74 years, 61.7%; 75–79 years, 62.8%). In contrast, monotherapy including GEM and S-1 was more frequently performed in age groups over 80 years (80–84 years, 56.2%; 85–89 years, 77.7%; ≥90 years, 100%). In the chemotherapy group among older adult patients aged < 85 years, the median OS was significantly longer according to age-group analysis of the 5-year age range following propensity score matching. Conclusions In older adult patients with metastatic BTC who received chemotherapy, prolonged survival was observed. Chemotherapy may be a viable option for patients with metastatic BTC who are aged < 85 years.
