Which indicators of early cancer diagnosis from population-based data sources are associated with short-term mortality and survival?

Abstract

HighlightsEach difference in tumour stage (I–IV) predicts lower five-year survival, so prognostic information is lost in binary indicators.Emergency presentation is associated with lower survival, independently of stage.A high proportion of patients whose stage is not recorded die immediately after diagnosis.Interval from first symptoms to diagnosis is not consistently associated with survival.

Temporal and geographic changes in stage at diagnosis in England during 2008–2013: A population-based study of colorectal, lung and ovarian cancers

“…Imputation models including auxiliary patient information were fitted with the R package jomo [29], which accounts for the multi-level structure of the data (patients clustered within CCGs). It was assumed that stage was missing randomly conditional on variables strongly associated with either stage (I to IV) [16,[30][31][32], or with recording of stage [17]: quarter year of diagnosis, cancer registry area, CCG, age, sex, patient's Indices of Multiple deprivation (IMD) income quintile, Charlson comorbidity score, tumour topography, tumour morphology, route to diagnosis, receipt of major surgical treatment (yes/no), treatment admission method (elective/non-elective), time from diagnosis to censoring, and vital status at censoring. Cancer registry area of diagnosis was included as well as CCG, as historically the regional registries recorded stage at different levels of completeness for different tumours.…”

“…The patients missing stage data had poorer outcomes [16,17], were older, had more comorbidities, were more commonly diagnosed as an emergency, and less likely to receive major treatment. We estimate that excluding them leads to overstatement of early-stage diagnosis by 1-5 percentage points.…”

“…Epidemiological analyses of stage trends are needed in addition to these in order to evaluate progress. Patient records missing stage should be included in surveillance through an imputation approach as done here, or prognostic measures based on estimated stage or survival could be used [16]. This recommendation is based on analysis of patients in England, but is likely to be equally relevant to the Detect Cancer Early programme in Scotland [40], and other stage surveillance programmes internationally.…”

“…Nationally, stage recording increased dramatically from 2008 but still only covered 71% of patients in 2013 [15]. The patients without recorded stage have poorer outcomes than patients with stage recorded, suggesting a less favourable underlying stage distribution [16,17].…”

The Magnetic Nanomaterial Biofunctions in Cancer Diagnosis and Therapy

“…Most diagnosed cancer patients are already in advanced and late stages; this hinders requisite curative effect. Besides, the primary cancer treatment includes surgery, chemotherapy, and radiotherapy [2]. However, the complete removal of the tumor tissue through surgical treatment is intractable.…”