Cancers

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14 pages, 2088 KiB

Open AccessArticle

From Real-World Data to Causally Interpretable Models: A Bayesian Network to Predict Cardiovascular Diseases in Adolescents and Young Adults with Breast Cancer

by Alice Bernasconi, Alessio Zanga, Peter J. F. Lucas, Marco Scutari, Serena Di Cosimo, Maria Carmen De Santis, Eliana La Rocca, Paolo Baili, Ilaria Cavallo, Paolo Verderio, Chiara M. Ciniselli, Sara Pizzamiglio, Adriana Blanda, Paola Perego, Paola Vallerio, Fabio Stella, Annalisa Trama and The Ada Working Group

Cancers 2024, 16(21), 3643; https://doi.org/10.3390/cancers16213643 - 29 Oct 2024

Viewed by 682

Abstract

Background: In the last decades, the increasing number of adolescent and young adult (AYA) survivors of breast cancer (BC) has highlighted the cardiotoxic role of cancer therapies, making cardiovascular diseases (CVDs) among the most frequent, although rare, long-term sequalae. Leveraging innovative artificial [...] Read more.

Background: In the last decades, the increasing number of adolescent and young adult (AYA) survivors of breast cancer (BC) has highlighted the cardiotoxic role of cancer therapies, making cardiovascular diseases (CVDs) among the most frequent, although rare, long-term sequalae. Leveraging innovative artificial intelligence (AI) tools and real-world data (RWD), we aimed to develop a causally interpretable model to identify young BC survivors at risk of developing CVDs. Methods: We designed and trained a Bayesian network (BN), an AI model, making use of expert knowledge and data from population-based (1036 patients) and clinical (339 patient) cohorts of female AYA (i.e., aged 18 to 39 years) 1-year survivors of BC, diagnosed in 2009–2019. The performance achieved by the BN model was validated against standard classification metrics, and two clinical applications were proposed. Results: The model showed a very good classification performance and a clear causal semantic. According to the predictions made by the model, focusing on the 25% of AYA BC survivors at higher risk of developing CVDs, we could identify 81% of the patients who would actually develop it. Moreover, a desktop-based app was implemented to calculate the individual patient’s risk. Conclusions: In this study, we developed the first causal model for predicting the CVD risk in AYA survivors of BC, also proposing an innovative AI approach that could be useful for all researchers dealing with RWD. The model could be pivotal for clinicians who aim to plan personalized follow-up strategies for AYA BC survivors. Full article

(This article belongs to the Special Issue Advances in Cancer Data and Statistics)

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14 pages, 884 KiB

Open AccessArticle

Use Cases Requiring Privacy-Preserving Record Linkage in Paediatric Oncology

by Dieter Hayn, Karl Kreiner, Emanuel Sandner, Martin Baumgartner, Bernhard Jammerbund, Markus Falgenhauer, Vanessa Düster, Priyanka Devi-Marulkar, Gudrun Schleiermacher, Ruth Ladenstein and Guenter Schreier

Cancers 2024, 16(15), 2696; https://doi.org/10.3390/cancers16152696 - 29 Jul 2024

Viewed by 732

Abstract

Large datasets in paediatric oncology are inherently rare. Therefore, it is paramount to fully exploit all available data, which are distributed over several resources, including biomaterials, images, clinical trials, and registries. With privacy-preserving record linkage (PPRL), personalised or pseudonymised datasets can be merged, [...] Read more.

Large datasets in paediatric oncology are inherently rare. Therefore, it is paramount to fully exploit all available data, which are distributed over several resources, including biomaterials, images, clinical trials, and registries. With privacy-preserving record linkage (PPRL), personalised or pseudonymised datasets can be merged, without disclosing the patients’ identities. Although PPRL is implemented in various settings, use case descriptions are currently fragmented and incomplete. The present paper provides a comprehensive overview of current and future use cases for PPRL in paediatric oncology. We analysed the literature, projects, and trial protocols, identified use cases along a hypothetical patient journey, and discussed use cases with paediatric oncology experts. To structure PPRL use cases, we defined six key dimensions: distributed personalised records, pseudonymisation, distributed pseudonymised records, record linkage, linked data, and data analysis. Selected use cases were described (a) per dimension and (b) on a multi-dimensional level. While focusing on paediatric oncology, most aspects are also applicable to other (particularly rare) diseases. We conclude that PPRL is a key concept in paediatric oncology. Therefore, PPRL strategies should already be considered when starting research projects, to avoid distributed data silos, to maximise the knowledge derived from collected data, and, ultimately, to improve outcomes for children with cancer. Full article

(This article belongs to the Special Issue Advances in Cancer Data and Statistics)

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10 pages, 1495 KiB

Open AccessArticle

Lung Cancer and Air Quality in a Large Urban County in the United States

by Hollis Hutchings, Qiong Zhang, Sue C. Grady, Jessica Cox, Andrew Popoff, Carl P. Wilson, Shangrui Zhu and Ikenna Okereke

Cancers 2024, 16(11), 2146; https://doi.org/10.3390/cancers16112146 - 5 Jun 2024

Cited by 1 | Viewed by 1088

Abstract

Lung cancer is the leading cancer-related killer in the United States. The incidence varies geographically and may be affected by environmental pollutants. Our goal was to determine associations within time series for specific air pollutants and lung cancer cases over a 33-year period [...] Read more.

Lung cancer is the leading cancer-related killer in the United States. The incidence varies geographically and may be affected by environmental pollutants. Our goal was to determine associations within time series for specific air pollutants and lung cancer cases over a 33-year period in Wayne County, Michigan, controlling for population change. Lung cancer data for Wayne County were queried from the Michigan Cancer Registry from 1985 to 2018. Air pollutant data were obtained from the United States Environmental Protection Agency from 1980 to 2018. Autoregressive distributed lag (ARDL) models were estimated to investigate time lags in years between specific air pollution levels and lung cancer development. A total of 58,866 cases of lung cancer were identified. The mean age was 67.8 years. Females accounted for 53 percent of all cases in 2018 compared to 44 percent in 1985. Three major clusters of lung cancer incidence were detected with the most intense clusters in downtown Detroit and the heavily industrialized downriver area. Sulfur dioxide (SO₂) had the strongest statistically significant relationship with lung cancer, showing both short- and long-term effects (lag range, 1–15 years). Particulate matter (PM_2.5) (lag range, 1–3 years) and nitrogen dioxide (NO₂) (lag range, 2–4 years) had more immediate effects on lung cancer development compared to carbon monoxide (CO) (lag range, 5–6 years), hazardous air pollutants (HAPs) (lag range, 9 years) and lead (Pb) (lag range, 10–12 years), which had more long-term effects on lung cancer development. Areas with poor air quality may benefit from targeted interventions for lung cancer screening and reductions in environmental pollution. Full article

(This article belongs to the Special Issue Advances in Cancer Data and Statistics)

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17 pages, 1021 KiB

Open AccessArticle

Drug Cost Avoidance Resulting from Participation in Clinical Trials: A 10-Year Retrospective Analysis of Cancer Patients with Solid Tumors

by Maria-Josep Carreras, Berta Renedo-Miró, Carolina Valdivia, Elena Tomás-Guillén, Anna Farriols, Laura Mañós, Jana Vidal, María Alcalde, Isabel De la Paz, Inés Jiménez-Lozano, Maria-Eugenia Palacio-Lacambra, Nuria Sabaté, Enriqueta Felip, Elena Garralda, Margarita Garau, Maria-Queralt Gorgas, Josep Monterde and Josep Tabernero

Cancers 2024, 16(8), 1529; https://doi.org/10.3390/cancers16081529 - 17 Apr 2024

Viewed by 1236

Abstract

The objective of this single-center retrospective study was to describe the clinical characteristics of adult patients with solid tumors enrolled in cancer clinical trials over a 10-year period (2010–2019) and to assess drug cost avoidance (DCA) associated with sponsors’ contributions. The sponsors’ contribution [...] Read more.

The objective of this single-center retrospective study was to describe the clinical characteristics of adult patients with solid tumors enrolled in cancer clinical trials over a 10-year period (2010–2019) and to assess drug cost avoidance (DCA) associated with sponsors’ contributions. The sponsors’ contribution to pharmaceutical expenditure was calculated according to the actual price (for each year) of pharmaceutical specialties that the Vall d’Hebron University Hospital (HUVH) would have had to bear in the absence of sponsorship. A total of 2930 clinical trials were conducted with 10,488 participants. There were 140 trials in 2010 and 459 in 2019 (228% increase). Clinical trials of high complexity phase I and basket trials accounted for 34.3% of all trials. There has been a large variation in the pattern of clinical research over the study period, whereas, in 2010, targeted therapy accounted for 79.4% of expenditure and cytotoxic drugs for 20.6%; in 2019, immunotherapy accounted for 68.4%, targeted therapy for 24.4%, and cytotoxic drugs for only 7.1%. A total of four hundred twenty-one different antineoplastic agents were used, the variability of which increased from forty-seven agents in 2010, with only seven of them accounting for 92.8% of the overall pharmaceutical expenditure) to three hundred seventeen different antineoplastic agents in 2019, with thirty-three of them accounting for 90.6% of the overall expenditure. The overall expenditure on antineoplastic drugs in clinical care patients not included in clinical trials was EUR 120,396,096. The total cost of antineoplastic drugs supplied by sponsors in a clinical trial setting was EUR 107,306,084, with a potential DCA of EUR 92,662,609. Overall, clinical trials provide not only the best context for the progress of clinical research and healthcare but also create opportunities for reducing cancer care costs. Full article

(This article belongs to the Special Issue Advances in Cancer Data and Statistics)

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10 pages, 734 KiB

Open AccessArticle

Impact of Indoor Radon Exposure on Lung Cancer Incidence in Slovenia

by Mojca Birk, Tina Žagar, Sonja Tomšič, Katarina Lokar, Ana Mihor, Nika Bric, Miran Mlakar and Vesna Zadnik

Cancers 2024, 16(8), 1445; https://doi.org/10.3390/cancers16081445 - 9 Apr 2024

Viewed by 1207

Abstract

Indoor radon is an important risk factor for lung cancer, as 3–14% of lung cancer cases can be attributed to radon. The aim of our study was to estimate the impact of indoor radon exposure on lung cancer incidence over the last 40 [...] Read more.

Indoor radon is an important risk factor for lung cancer, as 3–14% of lung cancer cases can be attributed to radon. The aim of our study was to estimate the impact of indoor radon exposure on lung cancer incidence over the last 40 years in Slovenia. We analyzed the distribution of lung cancer incidence across 212 municipalities and 6032 settlements in Slovenia. The standardized incidence ratios were smoothed with the Besag–York–Mollie model and fitted with the integrated nested Laplace approximation. A categorical explanatory variable, the risk of indoor radon exposure with low, moderate and high risk values, was added to the models. We also calculated the population attributable fraction. Between 2.8% and 6.5% of the lung cancer cases in Slovenia were attributable to indoor radon exposure, with values varying by time period. The relative risk of developing lung cancer was significantly higher among the residents of areas with a moderate and high risk of radon exposure. Indoor radon exposure is an important risk factor for lung cancer in Slovenia in areas with high natural radon radiation (especially in the southern and south-eastern parts of the country). Full article

(This article belongs to the Special Issue Advances in Cancer Data and Statistics)

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12 pages, 2149 KiB

Open AccessArticle

Association between Cholecystectomy and the Incidence of Pancreaticobiliary Cancer after Endoscopic Choledocholithiasis Management

by Chi-Chih Wang, Jing-Yang Huang, Li-Han Weng, Yao-Chun Hsu, Wen-Wei Sung, Chao-Yen Huang, Chun-Che Lin, James Cheng-Chung Wei and Ming-Chang Tsai

Cancers 2024, 16(5), 977; https://doi.org/10.3390/cancers16050977 - 28 Feb 2024

Viewed by 1353

Abstract

(1) Background: Previous studies have raised concerns about a potential increase in pancreaticobiliary cancer risk after cholecystectomy, but few studies have focused on patients who undergo cholecystectomy after receiving endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis. This study aims to clarify cancer risks in [...] Read more.

(1) Background: Previous studies have raised concerns about a potential increase in pancreaticobiliary cancer risk after cholecystectomy, but few studies have focused on patients who undergo cholecystectomy after receiving endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis. This study aims to clarify cancer risks in these patients, who usually require cholecystectomy, to reduce recurrent biliary events. (2) Methods: We conducted a nationwide cohort study linked to the National Health Insurance Research Database, the Cancer Registry Database, and the Death Registry Records to evaluate the risk of pancreaticobiliary cancers. All patients who underwent first-time therapeutic ERCP for choledocholithiasis from 2011 to 2017 in Taiwan were included. We collected the data of 13,413 patients who received cholecystectomy after endoscopic retrograde cholangiopancreatography and used propensity score matching to obtain the data of 13,330 patients in both the cholecystectomy and non-cholecystectomy groups with similar age, gender, and known pancreaticobiliary cancer risk factors. Pancreaticobiliary cancer incidences were further compared. (3) Results: In the cholecystectomy group, 60 patients had cholangiocarcinoma, 61 patients had pancreatic cancer, and 15 patients had ampullary cancer. In the non-cholecystectomy group, 168 cases had cholangiocarcinoma, 101 patients had pancreatic cancer, and 49 patients had ampullary cancer. The incidence rates of cholangiocarcinoma, pancreatic cancer, and ampullary cancer were 1.19, 1.21, and 0.3 per 1000 person-years in the cholecystectomy group, all significantly lower than 3.52 (p < 0.0001), 2.11 (p = 0.0007), and 1.02 (p < 0.0001) per 1000 person-years, respectively, in the non-cholecystectomy group. (4) Conclusions: In patients receiving ERCP for choledocholithiasis, cholecystectomy is associated with a significantly lower risk of developing pancreaticobiliary cancer Full article

(This article belongs to the Special Issue Advances in Cancer Data and Statistics)

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11 pages, 2709 KiB

Open AccessArticle

Impact of the COVID-19 Pandemic on Incidence and Observed Survival of Malignant Brain Tumors in Belgium

by Tim Tambuyzer, Dimitri Vanhauwaert, Tom Boterberg, Steven De Vleeschouwer, Hanna M. Peacock, Joanna Bouchat, Geert Silversmit, Freija Verdoodt, Cindy De Gendt and Liesbet Van Eycken

Cancers 2024, 16(1), 63; https://doi.org/10.3390/cancers16010063 - 21 Dec 2023

Viewed by 1841

Abstract

(1) Background: This study evaluates the impact of the COVID-19 pandemic on the incidence, treatment, and survival of adults diagnosed with malignant brain tumors in Belgium in 2020. (2) Methods: We examined patients aged 20 and older with malignant brain tumors (2004–2020) from [...] Read more.

(1) Background: This study evaluates the impact of the COVID-19 pandemic on the incidence, treatment, and survival of adults diagnosed with malignant brain tumors in Belgium in 2020. (2) Methods: We examined patients aged 20 and older with malignant brain tumors (2004–2020) from the Belgian Cancer Registry database, assessing incidence, WHO performance status, vital status, and treatment data. We compared 2020 incidence rates with projected rates and age-standardized rates to 2015–2019. The Kaplan–Meier method was used to assess observed survival (OS). (3) Results: In 2020, there was an 8% drop in age-specific incidence rates, particularly for those over 50. Incidence rates plunged by 37% in April 2020 during the first COVID-19 peak but partially recovered by July. For all malignant brain tumors together, the two-year OS decreased by four percentage points (p.p.) in 2020 and three p.p. in 2019, compared to that in 2015–2018. Fewer patients (−9 p.p.) with glioblastoma underwent surgery, and the proportion of patients not receiving surgery, radiotherapy, or systemic therapy increased by six percentage points in 2020. (4) Conclusions: The COVID-19 pandemic profoundly impacted the diagnosis, treatment strategies, and survival of brain tumor patients in Belgium during 2020. These findings should guide policymakers in future outbreak responses, emphasizing the need to maintain or adapt (neuro)-oncological care pathways and promote informed decision making when care capacity is limited. Full article

(This article belongs to the Special Issue Advances in Cancer Data and Statistics)

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19 pages, 1560 KiB

Open AccessArticle

Comparative Analysis of Three Predictive Models of Performance Indicators with Results-Based Management: Cancer Data Statistics in a National Institute of Health

by Joel Martínez-Salazar and Filiberto Toledano-Toledano

Cancers 2023, 15(18), 4649; https://doi.org/10.3390/cancers15184649 - 20 Sep 2023

Cited by 3 | Viewed by 1685

Abstract

Predictive models play a crucial role in RBMs to analyze performance indicator results to manage unexpected events and make timely decisions to resolve them. Their use in Mexico is deficient, and monitoring and evaluation are among the weakest pillars of the model. In [...] Read more.

Predictive models play a crucial role in RBMs to analyze performance indicator results to manage unexpected events and make timely decisions to resolve them. Their use in Mexico is deficient, and monitoring and evaluation are among the weakest pillars of the model. In response to these needs, the aim of this study was to perform a comparative analysis of three predictive models to analyze 10 medical performance indicators and cancer data related to children with cancer. To accomplish these purposes, a comparative and retrospective study with nonprobabilistic convenience sampling was conducted. The predictive models were exponential smoothing, autoregressive integrated moving average, and linear regression. The lowest mean absolute error was used to identify the best model. Linear regression performed best regarding nine of the ten indicators, with seven showing p < 0.05. Three of their assumptions were checked using the Shapiro–Wilk, Cook’s distance, and Breusch–Pagan tests. Predictive models with RBM are a valid and relevant instrument for monitoring and evaluating performance indicator results to support forecasting and decision-making based on evidence and must be promoted for use with cancer data statistics. The place numbers obtained by cancer disease inside the main causes of death, morbidity and hospital outpatients in a National Institute of Health were presented as evidence of the importance of implementing performance indicators associated with children with cancer. Full article

(This article belongs to the Special Issue Advances in Cancer Data and Statistics)

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15 pages, 2587 KiB

Open AccessArticle

Colorectal Cancer Survival in German–Danish Border Regions—A Registry-Based Cohort Study

by Christiane Rudolph, Gerda Engholm, Ron Pritzkuleit, Hans H. Storm and Alexander Katalinic

Cancers 2023, 15(18), 4474; https://doi.org/10.3390/cancers15184474 - 8 Sep 2023

Cited by 1 | Viewed by 1135

Abstract

The aim of this study was (i) to update the reporting of colorectal cancer survival differences over time in the German–Danish border region (Schleswig-Holstein, Southern Denmark, and Zealand) and (ii) to assess the extent to which it can be explained by stage and [...] Read more.

The aim of this study was (i) to update the reporting of colorectal cancer survival differences over time in the German–Danish border region (Schleswig-Holstein, Southern Denmark, and Zealand) and (ii) to assess the extent to which it can be explained by stage and primary treatment. Incident invasive colorectal cancer cases diagnosed from 2004 to 2016 with a follow-up of vital status through 31 December 2017 were extracted from cancer registries. Analyses were conducted by anatomical subsite and for four consecutive periods. Kaplan–Meier curves and log-rank tests were computed. Cox regression models using data from Schleswig-Holstein from 2004 to 2007 as the reference category were run while controlling for age, sex, stage, and treatment. The cox regression models showed decreasing hazard ratios of death for all three regions over time for both anatomical subsites. The improvement was stronger in the Danish regions, and adjustment for age, sex, stage, and treatment attenuated the results only slightly. In 2014–2016, colon cancer survival was similar across regions, while rectal cancer survival was significantly superior in the Danish regions. Regional survival differences can only partially be explained by differing stage distribution and treatment and may be linked additionally to healthcare system reforms and screening efforts. Full article

(This article belongs to the Special Issue Advances in Cancer Data and Statistics)

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13 pages, 2111 KiB

Open AccessEditor’s ChoiceArticle

Population-Based Clinical Cancer Registration in Germany

by Alexander Katalinic, Marco Halber, Martin Meyer, Maren Pflüger, Andrea Eberle, Alice Nennecke, Soo-Zin Kim-Wanner, Tobias Hartz, Kerstin Weitmann, Andreas Stang, Christina Justenhoven, Bernd Holleczek, Daniela Piontek, Ian Wittenberg, Annika Heßmer, Klaus Kraywinkel, Claudia Spix and Ron Pritzkuleit

Cancers 2023, 15(15), 3934; https://doi.org/10.3390/cancers15153934 - 2 Aug 2023

Cited by 21 | Viewed by 3408

Abstract

Introduction: In 2013, a new federal law obligated all German federal states to collect additional clinical data in population-based cancer registries as an active tool for monitoring and improving the quality of cancer care, increasing transparency and promoting health research. Now, 10 years [...] Read more.

Introduction: In 2013, a new federal law obligated all German federal states to collect additional clinical data in population-based cancer registries as an active tool for monitoring and improving the quality of cancer care, increasing transparency and promoting health research. Now, 10 years later, the current status of the expanded cancer registration is presented, including current figures on cancer in Germany. Methods: Reporting of cancer is mandatory for physicians, and about 5 to 10 reports from different healthcare providers are expected for each case. A uniform national dataset of about 130 items is used, and reports are usually sent electronically to the registry. We used the most recent data available from cancer registries up to the year of diagnosis in 2019. We calculated incidence rates and 5-year relative survival (5YRS) for common cancers. Data on clinical outcomes and benchmarking based on quality indicators (QIs) from guidelines were provided by the Cancer Registry Schleswig-Holstein (CR SH). Results: All federal state cancer registries met most of the previously defined national eligibility criteria. Approximately 505,000 cancer cases were registered in 2019, with breast, prostate, colorectal and lung cancer being the most common cancers. The age-standardised cancer incidence has slightly decreased during the last decade. and spatial heterogeneity can be observed within Germany. 5YRS for all cancers was 67% and 63% for women and men, respectively. Therapy data for rectal cancer in 2019–2021 from the CR SH are shown as an example: 69% of the registered patients underwent surgery, mostly with curative intent (84%) and tumour-free resection (91%). Radiotherapy was given to 33% of the patients, and chemotherapy was given to 40%. Three selected QIs showed differences between involved healthcare providers. Discussion: The implementation of population-based clinical cancer registration can be considered a success. Comprehensive recording of diagnosis, treatment and disease progression and the use of registry data for quality assurance, benchmarking and feedback have been implemented. Full article

(This article belongs to the Special Issue Advances in Cancer Data and Statistics)

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22 pages, 1499 KiB

Open AccessArticle

Long-Term Projections of Cancer Incidence and Mortality in Japan and Decomposition Analysis of Changes in Cancer Burden, 2020–2054: An Empirical Validation Approach

by Phuong The Nguyen, Eiko Saito and Kota Katanoda

Cancers 2022, 14(24), 6076; https://doi.org/10.3390/cancers14246076 - 9 Dec 2022

Cited by 7 | Viewed by 2890

Abstract

Purpose: The aim of this study was to project new cancer cases/deaths forward to 2054, and decompose changes in cancer cases/deaths to assess the impact of demographic transitions on cancer burden. Methods: We collected data on cancer cases/deaths up to 2019, empirically validated [...] Read more.

Purpose: The aim of this study was to project new cancer cases/deaths forward to 2054, and decompose changes in cancer cases/deaths to assess the impact of demographic transitions on cancer burden. Methods: We collected data on cancer cases/deaths up to 2019, empirically validated the projection performance of multiple statistical models, and selected optimal models by applying time series cross-validation. Results: We showed an increasing number of new cancer cases but decreasing number of cancer deaths in both genders, with a large burden attributed to population aging. We observed the increasing incidence rates in most cancer sites but reducing rates in some infection-associated cancers, including stomach and liver cancers. Colorectal and lung cancers were projected to remain as leading cancer burdens of both incidence and mortality in Japan over 2020–2054, while prostate and female breast cancers would be the leading incidence burdens among men and women, respectively. Conclusions: Findings from decomposition analysis require more supportive interventions for reducing mortality and improving the quality of life of Japanese elders. We emphasize the important role of governments and policymakers in reforming policies for controlling cancer risk factors, including oncogenic infections. The rapid increase and continued presence of those cancer burdens associated with modifiable risk factors warrant greater efforts in cancer control programs, specifically in enhancing cancer screening and controlling cancer risk factors in Japan. Full article

(This article belongs to the Special Issue Advances in Cancer Data and Statistics)

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