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New Sights in Cancer Survival Analysis: Non-clinical Determinants of Survival for Patients with Cancer

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Survivorship and Quality of Life".

Deadline for manuscript submissions: closed (31 March 2022) | Viewed by 22797

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Special Issue Editor

Prof. Dr. Guy Launoy

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Guest Editor

1. ANTICIPE U1086 INSERM-UCN, Centre François Baclesse, 14000 Caen, France
2. Calvados Digestive Cancer Registry, University Hospital of Caen, 14000 Caen, France
3. Epidemiology Research and Evaluation Unit, Department of Research, University Hospital of Caen, Avenue de la Côte de Nacre, CEDEX, 14033 Caen, France
Interests: survival; contextual effect; socioeconomic factors; deprivation; multilevel analysis; centre effect; population-based studies; hierarchical-structured data; aggregated data

Special Issue Information

Dear Colleagues,

Almost all research on prognostic factors for cancers focuses on intrinsic factors related to the disease or the individual. However, many extrinsic factors also have a strong influence on the chances of survival of patients: their social environment, the place where they are treated, the organization of the health system. The analysis of these factors requires unbiased quality data and adapted statistical analysis models. A good understanding of these factors in general explanatory models and their integration into well-conducted interventional research protocols would allow the implementation of an evidence-based public health policy. This Special Issue of the journal illustrates the importance of non-clinical prognostic factors through several examples from population-based studies. It also brings together the general concepts and explanatory models allowing a general understanding of the mechanisms of social determination of cancer prognosis as well as several conceptual frameworks which are particularly relevant for probing a chronic, multifactorial disease such as cancer.

Prof. Dr. Guy Launoy
Guest Editor

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Keywords

survival
contextual effect
socioeconomic factors
deprivation
multilevel analysis
center effect
population-based studies
hierarchical-structured data
aggregated data

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Published Papers (7 papers)

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15 pages, 2731 KiB

Open AccessArticle

No Impact of Seasonality of Diagnoses on Baseline Tumor Immune Infiltration, Response to Treatment, and Prognosis in BC Patients Treated with NAC

by Beatriz Grandal, Ashwaq Aljehani, Elise Dumas, Eric Daoud, Floriane Jochum, Paul Gougis, Judicaël Hotton, Amélie Lemoine, Sophie Michel, Enora Laas, Marick Laé, Jean-Yves Pierga, Khaoula Alaoui Ismaili, Florence Lerebours, Fabien Reyal and Anne Sophie Hamy

Cancers 2022, 14(13), 3080; https://doi.org/10.3390/cancers14133080 - 23 Jun 2022

Viewed by 1515

Abstract

Breast cancer (BC) is the most common cancer in women worldwide. Neoadjuvant chemotherapy (NAC) makes it possible to monitor in vivo response to treatment. Several studies have investigated the impact of the seasons on the incidence and detection of BC, on tumor composition, and on the prognosis of BC. However, no evidence is available on their association with immune infiltration and the response to treatment. The objective of this study was to analyze pre- and post-NAC immune infiltration as assessed by TIL levels, the response to treatment as assessed by pathological complete response (pCR) rates, and oncological outcomes as assessed by relapse-free survival (RFS) or overall survival (OS) according to the seasonality of BC diagnoses in a clinical cohort of patients treated with neoadjuvant chemotherapy. Out of 1199 patients, the repartition of the season at BC diagnosis showed that 27.2% were diagnosed in fall, 25.4% in winter, 24% in spring, and 23.4% in summer. Baseline patient and tumor characteristics, including notable pre-NAC TIL levels, were not significantly different in terms of the season of BC diagnosis. Similarly, the pCR rates were not different. No association for oncological outcome was identified. Our data do not support the idea that the seasonality of diagnoses has a major impact on the natural history of BC treated with NAC. Full article

(This article belongs to the Special Issue New Sights in Cancer Survival Analysis: Non-clinical Determinants of Survival for Patients with Cancer)

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15 pages, 836 KiB

Open AccessArticle

Long-Term Survival, Prognostic Factors, and Quality of Life of Patients Undergoing Pelvic Exenteration for Cervical Cancer

by Mihai Stanca, Dan Mihai Căpîlna and Mihai Emil Căpîlna

Cancers 2022, 14(9), 2346; https://doi.org/10.3390/cancers14092346 - 9 May 2022

Cited by 12 | Viewed by 2601

Abstract

Background: Considerable efforts have been carried out over the past 30 years to support patients with advanced cervical cancer. Throughout this time, Eastern European countries have been left aside from the decision-making groups on this matter, hence the absence of similar studies in this geographical area. In these countries, the quality of life (QoL) of patients with cervical cancer might be considered a “caprice”, and the discomforts they encounter following pelvic exenteration for cervical cancer are often perceived as a “normal phenomenon”. Methods: This study examined forty-seven patients submitted to pelvic exenteration followed up for nine years after the surgical intervention. The first objective of this study is to identify the prognostic factors that influence the overall survival (OS) of patients undergoing pelvic exenteration for FIGO stage IVA, recurrent or persistent cervical cancer after previous conclusive treatments. The second objective is to assess the QoL of the surviving patients using the QLQ-C30 and QLQ-CX24 standardized questionnaires. Results: The mean age of the participants was 54 years (range 36–67). At the time of the study, there were 25 living patients (53.2%), the 3-year OS was 61%, and the 5-year OS was 48.7%. Cox regression analysis recognized parameter invasion, pelvic lymph node metastases, positive resection margins, early postoperative complications, and infralevatorian pelvic exenteration as negative prognostic factors influencing the OS (p < 0.05). Of the 25 survivors, 18 patients answered the QoL questionnaires. The cost of favorable survival has been translated into poor overall QoL, unsatisfactory functional, social, and symptom scores, a high prevalence of cervical cancer-specific symptoms such as lymphedema, peripheral neuropathy, severe menopausal symptoms, distorted body image, and lack of sexual desire. The lower scores are comparable to the only three studies available in the literature that assessed the QoL of patients undergoing pelvic exenteration precisely for cervical cancer. Conclusions: Despite its retrospective nature and some limitations, this paper, similar to other studies, shows a decent OS but with a marked adverse impact on QoL, suggesting the importance of adequate psycho-emotional and financial support for these patients following pelvic exenteration. This study also contributes to the current knowledge regarding advanced cervical cancer treatment, depicting survival, prognostic factors, and QoL of patients undergoing pelvic exenteration for cervical cancer in a reference center in Eastern Europe. Our study can provide a comparison for future prospective randomized trials needed to confirm these results. Full article

(This article belongs to the Special Issue New Sights in Cancer Survival Analysis: Non-clinical Determinants of Survival for Patients with Cancer)

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12 pages, 1074 KiB

Open AccessArticle

Cancer Patients’ Survival According to Socioeconomic Environment in a High-Income Country with Universal Health Coverage

by Vesna Zadnik, Tina Žagar, Sonja Tomšič, Ana Mihor and Katarina Lokar

Cancers 2022, 14(7), 1620; https://doi.org/10.3390/cancers14071620 - 23 Mar 2022

Cited by 4 | Viewed by 2933

Abstract

Despite having an established systematic approach to population survival estimation in Slovenia, the influence of socioeconomic environment on cancer patients’ survival has not yet been evaluated. Thus, the main aim of our study was to quantify the potential impact of socioeconomic environment on cancer patients’ survival in our population in the 21st century. The net survival was calculated and stratified into quintiles of Slovenian version of the European Deprivation Index for all adult cancer patients diagnosed between 2004 and 2018 using the national cancer registry data. After accounting for basic demographic variables (age and gender), differences in stage at diagnosis, as well as the impact of the cancer treatment improvements over time, we found that cancer patients in Slovenia with lower socioeconomic status experience worse survival and have higher mortality. In particular, the odds of dying from oral, stomach, colorectal, liver, pancreatic, lung, breast, ovarian, corpus uteri, prostate, and bladder cancers, as well as for melanoma, leukemia, and non-Hodgkin lymphoma, are significantly higher in the socioeconomically most deprived group of patients compared to the most affluent group. The inequalities in cancer burden we found could help decision-makers to better understand the magnitude of this problem. Full article

(This article belongs to the Special Issue New Sights in Cancer Survival Analysis: Non-clinical Determinants of Survival for Patients with Cancer)

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12 pages, 964 KiB

Open AccessArticle

The Overall Quality of Life and Oncological Outcomes Following Radical Hysterectomy in Cervical Cancer Survivors Results from a Large Long-Term Single-Institution Study

by Mihai Stanca, Dan Mihai Căpîlna, Cristian Trâmbițaș and Mihai Emil Căpîlna

Cancers 2022, 14(2), 317; https://doi.org/10.3390/cancers14020317 - 9 Jan 2022

Cited by 7 | Viewed by 2990

Abstract

(1) Background: Cervical cancer patients have been found to have worse quality of life (QoL) scores due to cancer treatment, not only when compared to the general population, but also when compared to other gynecological cancer survivors. In Eastern European developing countries, the health care system often cannot afford the uppermost standardized treatment for these patients. In the absence of a comparable study in our country, the authors’ aim for this retrospective cross-sectional observational study was to evaluate the overall survival (OS) and the QoL o cervical cancer survivors; (2) Methods: 430 patients were analyzed. The first objective is to evaluate the OS rates of patients with cervical cancer stages IA2 to IIB undergoing radical hysterectomy (RH) +/− neoadjuvant or adjuvant radiotherapy +/− chemoradiotherapy treatment combinations. The second objective is to assess their QoL, using two standardized questionnaires issued by the European Organisation for Research and Treatment of Cancer (EORTC), namely QLQ-C30 and QLQ-CX24. (3) Results: The mean age of the participants was 51 years (22–76) and the average follow-up time was 65 months (2–128). At the time of the analysis, 308 out of 430 patients were alive, with a mean five-year OS of 72.4%. The multivariate Cox regression analysis identified stage IIB, parametrial invasion, and the lymph node metastases as independent prognostic risk factors negatively impacting the OS. Of the 308 patients still alive at the time of the analysis, 208 (68%) answered the QoL questionnaires. The QLQ-C30 shows a good long-term Global QoL of 64.6 (median), good functioning scores, and a decent symptom scale value. However, the EORTC QLQ-CX24 showed high values of cervical cancer-specific symptoms, namely: lymphedema, peripheral neuropathy, severe menopausal symptoms, and distorted body-image perception. The results also indicate a significant decline in the quality of sexual life with a low sexual enjoyment and decreased level of sexual activities. (4) Conclusion: Despite a good OS, in this setting of patients, cervical cancer survivors have a modest QoL and sexual function. Our study may provide a comparison for future randomized, controlled trials in Eastern European countries needing to confirm these results. Full article

(This article belongs to the Special Issue New Sights in Cancer Survival Analysis: Non-clinical Determinants of Survival for Patients with Cancer)

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19 pages, 6113 KiB

Open AccessArticle

Excess Mortality by Multimorbidity, Socioeconomic, and Healthcare Factors, amongst Patients Diagnosed with Diffuse Large B-Cell or Follicular Lymphoma in England

by Matthew James Smith, Aurélien Belot, Matteo Quartagno, Miguel Angel Luque Fernandez, Audrey Bonaventure, Susan Gachau, Sara Benitez Majano, Bernard Rachet and Edmund Njeru Njagi

Cancers 2021, 13(22), 5805; https://doi.org/10.3390/cancers13225805 - 19 Nov 2021

Cited by 5 | Viewed by 2914

Abstract

(1) Background: Socioeconomic inequalities of survival in patients with lymphoma persist, which may be explained by patients’ comorbidities. We aimed to assess the association between comorbidities and the survival of patients diagnosed with diffuse large B-cell (DLBCL) or follicular lymphoma (FL) in England accounting for other socio-demographic characteristics. (2) Methods: Population-based cancer registry data were linked to Hospital Episode Statistics. We used a flexible multilevel excess hazard model to estimate excess mortality and net survival by patient’s comorbidity status, adjusted for sociodemographic, economic, and healthcare factors, and accounting for the patient’s area of residence. We used the latent normal joint modelling multiple imputation approach for missing data. (3) Results: Overall, 15,516 and 29,898 patients were diagnosed with FL and DLBCL in England between 2005 and 2013, respectively. Amongst DLBCL and FL patients, respectively, those in the most deprived areas showed 1.22 (95% confidence interval (CI): 1.18–1.27) and 1.45 (95% CI: 1.30–1.62) times higher excess mortality hazard compared to those in the least deprived areas, adjusted for comorbidity status, age at diagnosis, sex, ethnicity, and route to diagnosis. (4) Conclusions: Deprivation is consistently associated with poorer survival among patients diagnosed with DLBCL or FL, after adjusting for co/multimorbidities. Comorbidities and multimorbidities need to be considered when planning public health interventions targeting haematological malignancies in England. Full article

(This article belongs to the Special Issue New Sights in Cancer Survival Analysis: Non-clinical Determinants of Survival for Patients with Cancer)

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20 pages, 3269 KiB

Open AccessArticle

Socioeconomic Environment and Survival in Patients with Digestive Cancers: A French Population-Based Study

by Laure Tron, Mathieu Fauvernier, Anne-Marie Bouvier, Michel Robaszkiewicz, Véronique Bouvier, Mélanie Cariou, Valérie Jooste, Olivier Dejardin, Laurent Remontet, Arnaud Alves, FRANCIM Group, Florence Molinié and Guy Launoy

Cancers 2021, 13(20), 5156; https://doi.org/10.3390/cancers13205156 - 14 Oct 2021

Cited by 12 | Viewed by 2113

Abstract

Social inequalities are an important prognostic factor in cancer survival, but little is known regarding digestive cancers specifically. We aimed to provide in-depth analysis of the contextual social disparities in net survival of patients with digestive cancer in France, using population-based data and relevant modeling. Digestive cancers (n = 54,507) diagnosed between 2006–2009, collected through the French network of cancer registries, were included (end of follow-up 30 June 2013). Social environment was assessed by the European Deprivation Index. Multidimensional penalized splines were used to model excess mortality hazard. We found that net survival was significantly worse for individuals living in a more deprived environment as compared to those living in a less deprived one for esophageal, liver, pancreatic, colon and rectal cancers, and for stomach and bile duct cancers among females. Excess mortality hazard was up to 57% higher among females living in the most deprived areas (vs. least deprived) at 1 year of follow-up for bile duct cancer, and up to 21% higher among males living in the most deprived areas (vs. least deprived) regarding colon cancer. To conclude, we provide a better understanding of how the (contextual) social gradient in survival is constructed, offering new perspectives for tackling social inequalities in digestive cancer survival. Full article

(This article belongs to the Special Issue New Sights in Cancer Survival Analysis: Non-clinical Determinants of Survival for Patients with Cancer)

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17 pages, 2780 KiB

Open AccessSystematic Review

Socio-Economic Inequalities in Lung Cancer Outcomes: An Overview of Systematic Reviews

by Daniel Redondo-Sánchez, Dafina Petrova, Miguel Rodríguez-Barranco, Pablo Fernández-Navarro, José Juan Jiménez-Moleón and Maria-José Sánchez

Cancers 2022, 14(2), 398; https://doi.org/10.3390/cancers14020398 - 13 Jan 2022

Cited by 38 | Viewed by 6607

Abstract

In the past decade, evidence has accumulated about socio-economic inequalities in very diverse lung cancer outcomes. To better understand the global effects of socio-economic factors in lung cancer, we conducted an overview of systematic reviews. Four databases were searched for systematic reviews reporting on the relationship between measures of socio-economic status (SES) (individual or area-based) and diverse lung cancer outcomes, including epidemiological indicators and diagnosis- and treatment-related variables. AMSTAR-2 was used to assess the quality of the selected systematic reviews. Eight systematic reviews based on 220 original studies and 8 different indicators were identified. Compared to people with a high SES, people with a lower SES appear to be more likely to develop and die from lung cancer. People with lower SES also have lower cancer survival, most likely due to the lower likelihood of receiving both traditional and next-generation treatments, higher rates of comorbidities, and the higher likelihood of being admitted as emergency. People with a lower SES are generally not diagnosed at later stages, but this may change after broader implementation of lung cancer screening, as early evidence suggests that there may be socio-economic inequalities in its use. Full article

(This article belongs to the Special Issue New Sights in Cancer Survival Analysis: Non-clinical Determinants of Survival for Patients with Cancer)

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