Time from incident primary cancer until recurrence or second primary cancer: Risk factors and impact in general practice

Rasmussen, Linda Aagaard; Jensen, Henry; Virgilsen, Line Flytkjær; Falborg, Alina Zalounina; Møller, Henrik; Vedsted, Peter

doi:10.1111/ecc.13123

Cited by 16 publications

(12 citation statements)

References 42 publications

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“…Similar to our crude estimates, the aforementioned Danish study on breast cancer recurrence reported lower risks in women living alone, also after adjustment for age, education level, comorbidity, calendar period, tumor and lymph node stage, and adjuvant therapy (chemotherapy and/or radiotherapy) [ 8 ]. However, their findings may be affected by residual confounding from other dimensions of SEP, which were not incorporated in their study (e.g., income and employment).…”

Section: Discussionsupporting

confidence: 86%

“…However, in Nordic countries, health inequality persists despite the build-up of the welfare states (also called the Nordic paradox) [ 7 ]. Studies set in Denmark, a country with tax-funded healthcare, report increased risks of breast cancer recurrence (and other cancer types) among patients with low education and in those living alone [ 8 ], and a higher 5-year mortality in women with lower education and income [ 9 , 10 ], even after adjusting for tumor characteristics, treatment, and comorbidities [ 11 , 12 ]. The same tendency has been observed in other European countries [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…Accordingly, most premenopausal women are recommended taxane-based chemotherapy, followed by up to 10 years of tamoxifen therapy for those with ER+ tumors, whereas postmenopausal women to a greater extent can forego chemotherapy [ 18 – 20 ]. Yet, studies on breast cancer prognosis according to SEP did not distinguish pre- from postmenopausal breast cancer [ 8 – 11 ], lacked treatment-specific information [ 8 , 15 , 21 , 22 ], failed to stratify by ER status [ 8 – 11 , 14 , 15 , 21 , 22 ], and included patients with metastatic breast cancer [ 11 , 13 , 14 , 22 , 23 ]. We therefore investigated the association between individual-level SEP and breast cancer recurrence and overall mortality in a contemporary cohort of Danish premenopausal women with non-metastatic breast cancer, treated with taxane-based chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

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Socioeconomic position and prognosis in premenopausal breast cancer: a population-based cohort study in Denmark

Hjorth

Damkier

Ejlertsen

et al. 2021

BMC Med

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Background To investigate how socioeconomic position (SEP) influences the effectiveness of cancer-directed treatment in premenopausal breast cancer patients in terms of breast cancer recurrence and mortality. Methods We conducted a cohort study nested in the ProBeCaRe (Predictors of Breast Cancer Recurrence) cohort (n = 5959). We identified all premenopausal women aged 18–55 years diagnosed with non-metastatic breast cancer and prescribed docetaxel-based chemotherapy in Denmark during 2007–2011. Population-based administrative registries provided data on SEP: marital status (married including registered partnership or single including divorced or widowed), cohabitation (cohabiting or living alone), education (low, intermediate, or high), income (low, medium, or high), and employment status (employed, unemployed, or health-related absenteeism). For each SEP measure, we computed incidence rates, cumulative incidence proportions (CIPs), and used Poisson regression to compute incidence rate ratios (IRRs) and 95% confidence intervals (CIs) of recurrence and death. We stratified on estrogen receptor (ER) status/tamoxifen to evaluate interaction. Results Our study cohort included 2616 women; 286 (CIP 13%) experienced recurrence and 223 (CIP 11%) died during follow-up (median 6.6 and 7.2 years, respectively). Single women had both increased 5-year risks of recurrence (IRR 1.45, 95% CI 1.11–1.89) and mortality (IRR 1.83, 95% CI 1.32–2.52). Furthermore, we observed increased 5-year mortality in women with low education (IRR 1.49, 95% CI 0.95–2.33), low income (IRR 1.37, 95% CI 0.83–2.28), unemployment (IRR 1.61, 95% CI 0.83–3.13), or health-related work absenteeism (IRR 1.80, 95% CI 1.14–2.82), but smaller or no increased risk of recurrence. These findings were especially evident among women with ER+ tumors prescribed tamoxifen. Overall analyses (follow-up max. 10 years) provided similar results. Conclusions Low SEP in premenopausal women with non-metastatic breast cancer was associated with increased mortality, but not always recurrence. This suggests underdetection of recurrences in certain groups. Poor prognosis in women with low SEP, especially single women, may partly be explained by tamoxifen adherence.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Socioeconomic position and prognosis in premenopausal breast cancer: a population-based cohort study in Denmark

Hjorth

Damkier

Ejlertsen

et al. 2021

BMC Med

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“…We need a better understanding of the symptom presentation in CR and SPC, and how patients and healthcare professionals react to new symptoms. Furthermore, considerations should be made on the best use of the limited resources in the healthcare system, and risk stratified follow-up pathways should be considered [48]. Studies have reported a false positive rate of 71% in tests, which all raised suspicion of CR [23], and a probability of 87% for at least one false positive test within five years of follow-up [49].…”

Section: Discussionmentioning

confidence: 99%

Healthcare utilisation in general practice and hospitals in the year preceding a diagnosis of cancer recurrence or second primary cancer: a population-based register study

Rasmussen

Jensen

Virgilsen

et al. 2019

BMC Health Serv Res

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BackgroundThe organisation of cancer follow-up is under scrutiny in many countries, and general practice is suggested to become more involved. A central focus is timely detection of recurring previous cancer and new second primary cancer. More knowledge on the patient pathway before cancer recurrence and second primary cancer is warranted to ensure the best possible organisation of follow-up. We aimed to describe the healthcare utilisation in the year preceding a diagnosis of cancer recurrence or second primary cancer.MethodsThis nationwide register study comprises patients diagnosed with bladder, breast, colorectal, endometrial, lung, malignant melanoma and ovarian cancer in Denmark in 2008–2016. The frequency of healthcare contacts during the 12 months preceding a cancer recurrence or second primary cancer was estimated and compared to the frequency of cancer survivors in cancer remission. The main analyses were stratified on sex and healthcare setting. Furthermore, two sub-analyses were stratified on 1) sex, healthcare setting and age group and on 2) sex, healthcare setting and comorbidity status.ResultsThe study population consisted of 7832 patients with recurrence and 2703 patients with second primary cancer. On average, the patients were in contact with general practice one time per month in the 12th month preceding a new cancer diagnosis (recurrence or second primary cancer). Increasing contact rates were seen from 7 months before diagnosis in general practice and from 12 months before diagnosis in hospitals. This pattern was more pronounced in patients with cancer recurrence, younger patients and patients with no comorbidity. For instance, the contact rate ratios for hospital contacts in non-comorbid women with recurrence demonstrated 30% more contacts in the 12th month before recurrence and 127% more contacts in the 2nd month before recurrence.ConclusionsThe results show that cancer survivors are already seen in general practice on a regular basis. The increasing contact rates before a diagnosis of cancer recurrence or second primary cancer indicate that a window of opportunity exists for more timely diagnosis; this is seen in both general practice and in hospitals. Thus, cancer survivors may benefit from improvements in the organisation of cancer follow-up.

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“…A further paper by Rasmussen et al () looks beyond diagnostic and treatment intervals—to “time to recurrence”, for malignant melanoma, bladder, lung, ovarian, endometrial, colorectal and breast cancer in patients in Denmark. They found that lower educational level, living alone and comorbidity were associated with shorter time to recurrence.…”

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confidence: 99%

Compassion: An essential component of cancer care

Weller

2019

Eur J Cancer Care

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Time from incident primary cancer until recurrence or second primary cancer: Risk factors and impact in general practice

Cited by 16 publications

References 42 publications

Socioeconomic position and prognosis in premenopausal breast cancer: a population-based cohort study in Denmark

Socioeconomic position and prognosis in premenopausal breast cancer: a population-based cohort study in Denmark

Healthcare utilisation in general practice and hospitals in the year preceding a diagnosis of cancer recurrence or second primary cancer: a population-based register study

Compassion: An essential component of cancer care

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