International differences in lung cancer survival by sex, histological type and stage at diagnosis

Araghi, M.et al | 2021| International differences in lung cancer survival by sex, histological type and stage at diagnosis: an ICBP SURVMARK-2 Study| Thorax | Published Online First: 19 July 2021| doi: 10.1136/thoraxjnl-2020-216555

The authors of this study set out to answer the following research question: Are there international disparities in lung cancer survival by clinically relevant subgroups in the most recent population-level data?

In this paper, they present their in-depth results of the most up-to-date differences of lung cancer stage distribution and survival by histological types, age group and sex for each included country, as well as within countries, followed by a discussion of potential causes of the disparities including clinical and data factors.

Abstract

Introduction

 Lung cancer has a poor prognosis that varies internationally when assessed by the two major histological subgroups (non-small cell (NSCLC) and small cell (SCLC)).

Method

 236 114 NSCLC and 43 167 SCLC cases diagnosed during 2010–2014 in Australia, Canada, Denmark, Ireland, New Zealand, Norway and the UK were included in the analyses. One-year and 3-year age-standardised net survival (NS) was estimated by sex, histological type, stage and country.

Results

 One-year and 3-year NS was consistently higher for Canada and Norway, and lower for the UK, New Zealand and Ireland, irrespective of stage at diagnosis. Three-year NS for NSCLC ranged from 19.7 per cent for the UK to 27.1 per cent for Canada for men and was consistently higher for women (25.3% in the UK; 35.0% in Canada) partly because men were diagnosed at more advanced stages. International differences in survival for NSCLC were largest for regional stage and smallest at the advanced stage. For SCLC, 3-year NS also showed a clear female advantage with the highest being for Canada (13.8 per cent for women; 9.1 per cent for men) and Norway (12.8 per cent for women; 9.7 per cent for men).

Conclusion

 Distribution of stage at diagnosis among lung cancer cases differed by sex, histological subtype and country, which may partly explain observed survival differences. Yet, survival differences were also observed within stages, suggesting that quality of treatment, healthcare system factors and prevalence of comorbid conditions may also influence survival. Other possible explanations include differences in data collection practice, as well as differences in histological verification, staging and coding across jurisdictions.

Full paper is available from Thorax

Failings in imaging services have put cancer patients at risk, watchdog says

Parliamentary and Health Service Ombudsman | July 2021 | Unlocking Solutions in Imaging: working together to learn from failings in the NHS

This report highlights recurrent failings in the way X-rays and scans are reported on and followed up across NHS services.

This report shares findings from complaints made to the Parliamentary and Health Service Ombudsman (PHSO) about failings in imaging in the NHS. The majority of these complaints involve people who had cancer at the time they used imaging services.

In highlighting the learning from these complaints, PHSO’s objective is to support NHS services to improve. Doing this will require significant collaboration between NHS leaders in radiology services and those who work in other clinical specialties that request and act on the findings of X-ray, CT and MRI scans. This includes GPs, physicians, surgeons, physiotherapists, paediatricians and clinicians working in emergency departments.

It recommends a system-wide programme of improvements for more effective and timely management of X-rays and scan (Source: Ombudsman).

Image source: ombudsman.org.uk

Unlocking Solutions in Imaging: working together to learn from failings in the NHS

Where next for primary care?

NHS Confederation | July 2021 | Where next for primary care?

This blog post underlines how healthcare staff working in primary care should embrace the strengths of primary care while finding new synergies with the wider healthcare system. 

NHS Confederation Where next for primary care?

Be Clear on Cancer: first national ‘Cervical Screening Saves Lives’ campaign

Public Health England | July 2021 | Be Clear on Cancer: first national ‘Cervical Screening Saves Lives’ campaign

This online publication evaluates the first national ‘Cervical Screening Saves Lives’ campaign which ran in 2019 from 5 March 2019 to 30 April 2019 in England, as part of the wider Be Clear on Cancer initiative.

Full details from Public Health England

[NICE Technology Appraisal Guidance] Nivolumab for advanced non-squamous non-small-cell lung cancer after chemotherapy

NICE | July 2021 | Nivolumab for advanced non-squamous non-small-cell lung cancer after chemotherapy

NICE has published technology appraisal guidance for Evidence-based recommendations on nivolumab (Opdivo) for advanced non-squamous non-small-cell lung cancer in adults after chemotherapy.

See NICE for full details

Nivolumab for advanced non-squamous non-small-cell lung cancer after chemotherapy

Sleep and physical activity in relation to all-cause, cardiovascular disease and cancer mortality risk

Huang, B., et al | 2021| Sleep and physical activity in relation to all-cause, cardiovascular disease and cancer mortality risk| British Journal of Sports Medicine|  Published Online First: 29 June 2021. doi: 10.1136/bjsports-2021-104046

The authors of this study investigated the joint association of physical activity (PA) and a novel comprehensive sleep score with all-cause and subtype-specific CVD and cancer mortality risks. They report that among middle-aged UK adults without obstructive sleep apnoea history or class III obesity, PA at levels at or above the WHO guideline (600 metabolic equivalent task mins/week) threshold eliminated most of the deleterious associations of poor sleep with mortality.

Abstract

Objectives Although both physical inactivity and poor sleep are deleteriously associated with mortality, the joint effects of these two behaviours remain unknown. This study aimed to investigate the joint association of physical activity (PA) and sleep with all-cause and cause-specific mortality risks.

Methods 380 055 participants aged 55.9 (8.1) years (55 per cent women) from the UK Biobank were included. Baseline PA levels were categorised as high, medium, low and no moderate-to-vigorous PA (MVPA) based on current public health guidelines. We categorised sleep into healthy, intermediate and poor with an established composited sleep score of chronotype, sleep duration, insomnia, snoring and daytime sleepiness. We derived 12 PA–sleep combinations, accordingly. Mortality risks were ascertained to May 2020 for all-cause, total cardiovascular disease (CVD), CVD subtypes (coronary heart disease, haemorrhagic stroke, ischaemic stroke), as well as total cancer and lung cancer.

Results After an average follow-up of 11.1 years, sleep scores showed dose-response associations with all-cause, total CVD and ischaemic stroke mortality. Compared with high PA-healthy sleep group (reference), the no MVPA-poor sleep group had the highest mortality risks for all-cause (HR (95 per cent CIs), (1.57 (1.35 to 1.82)), total CVD (1.67 (1.27 to 2.19)), total cancer (1.45 (1.18 to 1.77)) and lung cancer (1.91 (1.30 to 2.81))). The deleterious associations of poor sleep with all outcomes, except for stroke, was amplified with lower PA.

Conclusion The detrimental associations of poor sleep with all-cause and cause-specific mortality risks are exacerbated by low PA, suggesting likely synergistic effects. Our study supports the need to target both behaviours in research and clinical practice.

Full paper Sleep and physical activity in relation to all-cause, cardiovascular disease and cancer mortality risk