Interpretation of Best Medical Coding Practices by Case-Based Reasoning - A User Assistance Prototype for Data Collection for Cancer Registries

International audienceIn the fight against cancer, cancer registries are an important tool. At the heart of these registries is the data collection and coding process. This process is ruled by complex international standards and numerous best practices, which can easily overwhelm (coding) operators. In this paper, a system assisting operators in the interpretation of best medical coding practices and a short evaluation are presented. By leveraging the arguments used by the coding experts to determine the best coding option, the proposed system answers coding questions from operators and provides a partial explanation for the proposed solution

A 50% higher prevalence of life-shortening chronic conditions among cancer patients with low socioeconomic status

Background: Comorbidity and socioeconomic status (SES) may be related among cancer patients. Method : Population-based cancer registry study among 72 153 patients diagnosed during 1997-2006. Results : Low SES patients had 50% higher risk of serious comorbidity than those with high SES. Prevalence was increased for each cancer site. Low SES cancer patients had significantly higher risk of also having cardiovascular disease, chronic obstructive pulmonary diseases, diabetes mellitus, cerebrovascular disease, tuberculosis, dementia, and gastrointestinal disease. One-year survival was significantly worse in lowest vs highest SES, partly explained by comorbidity. Conclusion : This illustrates the enormous heterogeneity of cancer patients and stresses the need for optimal treatment of cancer patients with a variety of concomitant chronic conditions

Long-term all-sites cancer mortality time trends in Ohio, USA, 1970–2001: differences by race, gender and age

BACKGROUND: There were significant changes in cancer mortality in the USA over the last several decades, in the whole country and in particular states. However, no in depth analysis has been published so far, dealing with changes in mortality time trends in the state of Ohio. Since the state of Ohio belongs to the states of relatively high level of all-sites mortality in both males and females, it is of interest to analyze recent changes in mortality rates, as well as to compare them with the situation in the rest of the USA. The main aim of this study was to analyze, describe and interpret all-sites cancer mortality time trends in the population of the State of Ohio. METHODS: Cancer mortality data by age, sex, race and year for the period 1970–2001 were obtained from the Surveillance Research Program of the National Cancer Institute SEER*Stat software. A joinpoint regression methodology was used to provide estimated annual percentage changes (EAPCs) and to detect points in time where significant changes in the trends occurred. RESULTS: In both, males and females mortality rates were higher in blacks compared with whites. The difference was bigger in males (39.9%) than in women (23.3%). Mortality rates in Ohio are generally higher than average USA rates – an overall difference was 7.5% in men in 1997–2001, and 6.1% in women. All-sites mortality trends in Ohio and in the whole USA are similar. However, in general, mortality rates in Ohio remained elevated compared with the USA rates throughout the entire analyzed period. The exceptions are the rates in young and middle-aged African Americans. CONCLUSION: Although direction of time trends in Ohio are similar in Ohio and the whole US, Ohio still have cancer mortality rates higher than the US average. In addition, there is a significant discrepancy between white and black population of Ohio in all-sites mortality level, with disadvantage for Blacks. To diminish disparities in cancer mortality between African Americans and white inhabitants of Ohio efforts should be focused on increasing knowledge of black people regarding healthy lifestyle and behavioral risk factors, but also on diminishing socioeconomic differences, and last but not least, on better access to medical care

Going up or coming down? The changing phases of the lung cancer epidemic from 1967 to 1999 in the 15 European Union countries.

Lung cancer, the most common cause of cancer death in the European Union (EU), continues to have an enormous impact on the health experience of the men and women living in the constituent countries. Information on the course of the lung cancer epidemic is essential in order to formulate an effective cancer control policy. This paper examines recent trends in lung cancer mortality rates in men and women in each of the 15 countries, comparing cross-sectional rates of death in younger (aged 30-64 years) and older populations (aged 65 years or over), and the age, period of death, and birth cohort influences in the younger age group. The latter analysis establishes the importance of year of birth, related to modifications in the tobacco habit among recently born generations. The stage of evolution of the lung cancer epidemic varies markedly by sex and country in terms of the direction, magnitude, and phase of development of national trends. In males, there is some consistency in the direction of the trends between EU countries, declines are apparent in most countries, at least in younger men, with rates in older men either reaching a plateau, or also falling. In younger persons, a decreasing risk of lung cancer death reflects changes in successive birth cohorts, due to modifications in the smoking habit from generation to generation, although these developments are in very different phases across countries. Portugal is the exception to the male trends; there are increases in mortality in both age groups, with little sign of a slowing down by birth cohort. In women, there are unambiguous upsurges in rates seen in younger and older women in almost all EU countries in recent decades, and little sign that the epidemic has or will soon reach a peak. The exceptions are the United Kingdom (UK) and Ireland, where lung cancer death rates are now declining in younger women and stabilising in older women, reflecting a declining risk in women born since about 1950. It is too early to say whether the observed plateau or decline in rates in women born very recently in several countries is real or random. To ascertain whether recent trends in lung cancer mortality will continue, trends in cigarette consumption should also be evaluated. Where data are available by country, the proportion of adult male smokers has, by and large, fallen steadily in the last five decades. In women, recent smoking trends are downwards in Belgium, Denmark, Sweden and the Netherlands, although in Austria and Spain, large increases in smoking prevalence amongst adults are emerging. Unambiguous public health messages must be effectively conveyed to the inhabitants of the EU if the lung cancer epidemic is to be controlled. It is imperative that anti-tobacco strategies urgently target women living in the EU, in order to halt their rapidly increasing risk of lung cancer, and prevent unnecessary, premature deaths among future generations of women

Abstract POSTER-CTRL-1216: Profile of BRCA testing in ovarian cancer patients in the US and EU

Abstract Purpose: Around 13% of patients with ovarian cancer harbor mutations in the BRCA genes. Their disease has distinct characteristics which may impact treatment pathways. However, currently only a selected subset of ovarian cancer patients are offered testing for BRCA mutation, based largely upon family history of BRCA-related tumors. Frequencies of, and barriers to testing are not well characterized; therefore, our objective was to describe the current BRCA testing practices among women diagnosed with ovarian cancer. Methods: A survey of 465 oncologists, 513 pathologists and 97 laboratory directors, including detailed questionnaires for 435 ovarian cancer patients, across the US, UK, France, Germany, Italy and Spain was conducted during 2013 by Ipsos Healthcare syndicated MDx Monitor. Results: Physician awareness of BRCA testing in ovarian cancer patients varies: 61–86% in EU and over 90% in US. 50–67% of oncologists in EU, compared with over 80% in US, claim to have used BRCA testing within 6 months from diagnosis. On average, between 24% (US) to 7% (UK) of ovarian cancer patients were tested for BRCA post-diagnosis with large variations between physicians. Guidelines and patient requests were drivers for testing; barriers included perceived lack of clinical utility/targeted therapies (~35%), lack of BRCA risk factors (~5–70% depending on country), patient refusal (~5%), and reimbursement/cost (~15%). In all markets, both germline and somatic BRCA testing were common. Testing was generally performed in remote laboratories for efficiency. In US, most testing was conducted by Myriad; in EU several different tests, including 5% that were developed locally (by individual laboratories), were used. Conclusions: While there is broad knowledge and use of BRCA testing, the survey has highlighted significant barriers which may prevent ovarian cancer patients from being offered the test. Ongoing research aims to demonstrate the value of testing a broader cohort of patients, to identify individuals who may benefit from more personalized treatment approaches. Citation Format: Tyczynski JE, Moss S, De Richter P. Profile of BRCA testing in ovarian cancer patients in the US and EU [abstract]. In: Proceedings of the 10th Biennial Ovarian Cancer Research Symposium; Sep 8-9, 2014; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2015;21(16 Suppl):Abstract nr POSTER-CTRL-1216.</jats:p

The changing global patterns of female breast cancer incidence and mortality.

One in ten of all new cancers diagnosed worldwide each year is a cancer of the female breast, and it is the most common cancer in women in both developing and developed areas. It is also the principal cause of death from cancer among women globally. We review the descriptive epidemiology of the disease, focusing on some of the key elements of the geographical and temporal variations in incidence and mortality in each world region. The observations are discussed in the context of the numerous aetiological factors, as well as the impact of screening and advances in treatment and disease management in high-resource settings